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CC-10-467BUILDING PERMIT APPLICATION FBC 20 Permit Typ BUILDIN Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 ROOFING Tr 'mm1711,17 BY: ...e4,„ SAISMO Owner's Name (Fee Simple Titleholder) L-1sj y9 Q}$ Phone # Owner's Address 1 1 4 o 4.c: C c 4.4 C2 s E . L City 24`- thr e -- ..sl414.. State # L Zip 33 /.S if- Tenant/Lessee Name 01 Z Z E( i A S, 1-1. -Cpj •P,4 PA 1 ® 0$. ) Phone # Email sif 49 �isC p t) fL A, Permit No. Master Permit No. CC. I 0 --1 4(.0 - 4" Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # t MJ er To ,3 5c/e P t, 4 k_ i / L® T Is Building Historically Designated YES NO Flood Zone Contractor's Company Name c» , ST 12 o C. t ai O.e v e_ C ® PP a Phone # 305 5'36 - Tel oz Contractor's Address J el /U L 044 A ✓.Q ir.i 4 / y Cit IN, a& A a 2.P■ State r(, Zip 'B 8 l 0 o Qualifier Name Cey U SS A v 3 A , �'+'q Phone # 30 — Z. I S- 148? State Certificate or Registration No. C. GC . /5 0 4 e 4.s Certificate of Competency No. / Contact Phone - 186 3 L t7 * 3 f 0 i E -mail 0 (I o a1- 2 iti J ``�' ?),,z it Soo14 .o A/et %Apse. to Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 7 g CO . ® O Square / Linear Footage Of Work: 2, V O Type of Work: ['Addition Alteration ['New 0 Repair/Replace D Demolition — Describe Work: -- 1"; LE L ck 0 cep u 5:11 C 4 L � . � 1 Ai ( J g �') i e t F} / e / r (P 1/0-16 ► J Cr- / a Lz c' c4 L / PF t .`➢ 1 c , ******** * * * * * * * * * * ** * * * * * * * * * * * * * * * * *** F * * ** *** * * ** * * * * * * * * * * * * * * ** * * ** * * * * * * * **** Submittal Fee d? _c)c Technology Fee $ Notary $ . .r1 1�� Trainin ducation Fee $ 1 _ 71 Scanning $ 2400 Radon $ 10 00 DPBR $ V ` Bond $ Double Fee $ 2 ) ,244 • V 0 Violation date: AA f Structural Review. $ Total Fee Now Due $`1' `W Permit Fee $ CCF $ 4 "00 See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City Signature Sign: Print: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S Abk WAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is sue'. the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner The foregoing instrument was acknowledged before me this day o , 2010 , by em Pff A 0 , who is personally known to me or who has produced > I 0 As identification and who did take an oath. NOTARY PUBLIC: 0 111 1 111 1 11 i2► Zip Signatur NOTARY PUBLIC: Sign: Print: My Commission Expires ,S * * * ** * * * * * * * * *, * * * * ** *V ** * 4i * **** * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** Plans Examiner Engineer Contractor The foregoing instrument was acknowledged before me thisj2. day of , 20 ID, by (ot..� TAv/() m Wr..1 who is personally known to me or who has produced cA i� as identification and who did take an oath. My Commission = Pntm co dCC, :LL- : Expii¢s'm ' a c ° °:' O s cs Zoning Clerk checked Certificate of Occupancy Miami Shores Village 10050 NE 2 Ave, Miami Shores FI, 33138 Tel: 305-795-2204 Fax: 305-756-8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: V,41-tk4 Not Transferable POST IN A CONSPICUOUS PLACE PAPA JHONS PIZZA PLACE Passe �� (/'/�� Inspector Comments CREATED AS REINSPECTION FOR INSP- 147502. TEMP CO Need landscaping at rear Need roof permit complete. 0 ©- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 147800 Permit Number: CC- 3- 10-467 Inspection Date: September 23, 2010 Inspector: Bruhn, Norman Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project <NONE> Miami Shores, FL Contractor: CONSTRUCTION DEVELOPER GROUP CORP Building Department Comments September 23, 2010 For Inspections please call: (305)762 -4949 Permit Type: Commercial Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number (305)868 -8203 PARC2003 -23 Phone: (305)215 -1988 Page 1 of 1 Permit Type Owner Subdivision /Project Construction Type it Certificate of Occupancy Miami Shores Village 10050 NE 2 Ave, Miami Shores FI, 33138 Tel: 305- 795 -2204 Fax: 305- 756 -8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Commercial Construction IGHAL GOLOFARB <NONE> INTERIOR REMODEL 2,000 SQ FT Change of use 8849 BISCAYNE Boulevard Temporary 90 d a s Miami Shores FL Location Not Transferable POST IN A CONSPICUOUS PLACE Bldg. Permit No. CC- 3- 10-467 Contractor CONSTRUCTION DEVELOPER GROUP CORP Date Issued 07/02/2010 PAPA JOHN'S PIZZA PLACE Occupancy Load 15 PERSONS Building dfficials Approval Norman Bruhn, CBO Inspection Number: INSP- 147502 Permit Number: CC- 3- 10-467 Scheduled Inspection Date: July 02, 2010 Inspector: Bruhn, Norman Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: CONSTRUCTION DEVELOPER GROUP CORP Building Department Comments PAPA JHONS PIZZA PLACE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 01, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments Q f ,e 0 W t,,,as.cate a 4 0# For Inspections please call: (305)762 -4949 Permit Type: Commercial Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number (305)868 -8203 PARC2003 -23 Phone: (305)215 -1988 Page 12 of 14 t-KON tT UE)MAR 30 2010 14: 21/ST . 14: 20/No. 7500000330 P 1 March 29, 2010 Miami Dade County Building and Zoning Miami, Florida Re: Letter of Authorization Honorable Board; This letter is to certify that Pizzerias, LLC dba Papa John's is hereby authorizing Construction Consultants, Inc. thru his representative Mario A. Bolivar to represent our company in any and all required procedures as a Municipality, County, or Governmental Agency, may deem necessary to complete the approval of the plans for the future Papa John's Store # 428, to be located at 8849 Biscayne Blvd. Sincerel y Overton Vice President Pizzerias, LLC dba Papa John's STATE OF FLORIDA COUNTY OF MIAMI -DADS The foregoing instrument was sworn to and subscribed before me this aff day of March, 2010 by Manny Overton, who is personally known by me. A r s Yngrid Salazar _ x .. 'Cominission e ' , y os „:-Expires: MA 27.2010 •h rw*• vo w.A umattNotmiroom. Better Ingredients. Better Pizza. PIZZERIAS, LLC. AN INDEPENDENTLY OWNED AND OPERATED FAANCNI$E AM S. nI X F HWV. MIAMI FI X14%• M1151 rsz.17511• FAX 1n% A M.AAi LC Printed Name: YA/Ge. de'c'd .4 limy 25, Tv: nonsing &>ad Mimi Sheave Misr 1005014E ri Ave tliessiSbeack1138136 pep 7564972 (fies) Warms, CEO Pizonios, LLC cJb/a Paps John's 3619 S. Dixie! /Iv/ Via, FL 33143 AadelLiffaansualussita Dear Board M This kitter is OW confuniboth the pectoisba by the btasts, Plow* LLC 614 Pala MID I° and *• of the �`� Teti, LLC r A ood Shores Wine to impact the se lear& armee at . 5t Baseersti .MA as t MO dot epplicelton •for otarmits to WA and a piestimegymare sndIeenveey badness out of the shopping =Sac A�to the l Dade � (was ), legal efy he FARMINGTON SUB PE 48-17 LOT SIZE 16250 SQUARE FEET COC 221204744A4740 0304 6(6) OR 221104747 41304 03 me to the Sots that to property omelets of exec then one bundle& the temeed Outlaw ate /Ahmed 00849 B i s c a y = Blvd, o at2, 050 Squire F 11oeshod ion the North utteil i y ortte buPding. let! R3ANV a p�lD14=pg4 Nem Tim Biscayne 8T 1140 Use COWMAN OS FL. Bay moral mod, Fi. 33154 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. CC- 3° /tl_ 4C' TAX FOLIO NO. /1- 3 2 ©,t_ 0//r®/ 7, STATE OF FLORIDA. COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: k7E - - " g8it9 bits v1, - 1-11 -mi fiLf12o�� 2. Description of improvement: Ga4 T6 e; K. f 1-4 0 1C:vE 1-7 J 4," 3. Owner(s) name and address: Z- qt' i:b AAA / 1/ ® i.e.-44e ccN t$ : 011EcLo et._ -6/ )-Q1 aR = 33J5 Interest in property: 6(..NA ' Name and address of fee simple titleholder: NJa- 4. Contractor's name and address: d -c'o-S 1 1 1) CT; tl P X4. 5 (,e). b DC/ _ 5. Surety: (Payment bond required by owner from contractor, if any) k Name and address: 7. Persons within the state of Florida designated by Ownpr-Ton whom notices or other documents may be se Amount of bond $ 6. Lender's name and address: NI/A ca provided by Section 713 Florida Statutes, Name and address: 022,0 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as $srbvi4ed in Section 713.13(1)(b), Florida Statutes. Name and address: 1st/A ,, ea •\ 9. Expiratio ' date of this Notice of Commencement: (the expiration date is 1 year from the date of recording different d to i'spe ( ified Sign - of n- Print Owner's Name Sworn to and subscribed before me this n if day of Coil 2tcoq Notary Public Print Notary's Name My commission expires: C)1 /) 212-01 _ 123.01 -52 PAGE 4 8/02 I 1 a - yb PcA A 2IC,A +azO 44 ,0 �� s, ��u,� , ROSA RICARDO `is: Notary Public - State of Florida 1 My Comm. Expires Jan 12, 2014 Commission # DD 930272 I - . . m ��' Bonded Through National Notary Assn. 111111111 11111111 11111 CIFN 2C)1ORC)295800 OR Bk 27271 Ps 1072; tips } RECORDED 05/04/2010 11401 :06 HARVEY RUVIMr CLERK OF COURT MIAMI -DADE COUidTYr FLORIDA LAST PAGE C -L1Co�' erg_o - Prepared by Mf ti 6 0 4 ,20L. • Address: ( -C.Cof S`tc r c 143.1E 1-N I M i -c-. 33 g �7 ) 3 ifq. vg ACORQ CERTIFICATE OF LIABILITY INSURANCE PRODUCER Fir;lCIass Insurance Market 392 Minorca Ave. Coral Gables, FL 33134 NSURED CONSTRUCTION DEVELOPER GROUP, CORP. /20454 WEST DIXIE HIGHWAY AVENTURA. FL 33180 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOmON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ENCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR AWL TYPE OF INSURANCE POLICY WUAABER SOMELG t tl _ SAtE f IMOCe s LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY — 1 - 7 CLAIMS MADE GEM AGGREGATE LIMIT APPLIES PER I� POLICY CI OTHER AUTOMOBILE LIABILITY ■ EJ n ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS ^ I GARAGE LIABILITY NON OWNED AUTOS ANY AUTO DEDUCTIBLE RETENTION $ OCCUR WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR9'ARTNERIEXECUTIYE OFFICER/MEMBER EXCLUDED 11 y,, describe alder SPECIAL PROVISIONS below CERTIFICATE HOLDER ACORD 25 (2001/08) LOC I_ EXCESS/UMBRELLA LIAAUTY Lj OCCUR ❑ CLAIMS MADE APP132561101 Miami Shores Village 10050 Northeast 2nd Avenue Miami Shores, Florida 33138 DATE IMINDIYYTYYI 08/152009 (305 )441 - 2997 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 0 DESCRIPTION OP OPERATIONS J LOCATIONS $ VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 8J8URERA: SUA INSURANCE COMPANY B48LIRER B INSURER C INSURER D. INSURER E - -._ - EACHOOCURRENCE f$1 AIL Q 06/11/2049 06/11/2014 PREMISES O(RENTED temxd $100,000 MED EXP (Any neek mew/ $5,000 PERSONAL & ACM INJURY p`$1.000, j4ENE,RAL AGt GA I f $1.000,000 • PRODUCTS - COMP/OP AGO Si .000.000 CANCELLATION COMBlNEO SINGLE LIMIT (Eaac M.D BODILY !NAM IPe+eemenl BODILY INJURY (Per incident) PROPERTY DAMAGE (P8 Medan() 'AUTO ONLY -EA ACCIDENT $ $ IS $ OTHER THAN EA ACC $ AUTO ONLY AGO $ EACH OCCURRENCE $ AGGREGATE L � WC STATU- U OM TORY WITS __ ER E EACH ACCIDENT 'EL :DISEASE - EMPLOYEE EL. DISEASE - POUCY UNIT SHOULD ANY OF THE ABOVE DESCRIBED POUCIESBE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, THE WALL ENDE,AYDR To MAIL. _30 DAYS WRITTEN NOTICE TO r CERTIFICATE NO ,:a • TO THE LEFT. BUT FAILURE TO DO SO SHALL IMF GAD UPON THE INSURER ITS AGENTS OR ACORD CORPORATION 1088 8849 BISCAYNE BLVD MIAMI, FL 33138 Division of Hotels and Restaurants callcenter @dbpr.state.fl.us 850.487.1395 RECEIPT FOR LICENSE LICENSE NUMBER: 2332809 FILE NUMBER: 239621 This verifies that PIZZERIAS LLC Doing business as PAPA JOHN'S #428 has met the requirements for Permanent Food Service -Non- Seating licensure to operate This is authorization to operate for 30 days. An annual license will be mailed to the address on record within that period. LICENSE TYPE: 2010 / Permanent Food Service-Non- Seating Florida Departments! Busines Professi ral Regulation INSPECTOR SIGNATURE (Report HR4G ?A-DET - replaces DBPR Form HR 5021 -024 Receipt for License] Item 03: Food Temperatures Item 53a: Cert. Food Managers Item 20: Warewashing Sanftization Item 45: fire Extinguishers and Fire Suppression Systems Dates ND FOOD YET Manager Name: FABIOLA V GUIU EN Certification Date: 9/19/09 Certified by: Thompson Prometrks In *03a Cold food at proper temperatures during storage, display, service, transport, and cold holding 1� ''•)I (J' " 1 '1 Jet ' ♦1 In *01a Approved source In *03a Cold food at proper temperatures during storage, display, service, transport, and cold holding N/O *Olb Wholesome, sound condition N/0 *02 Original container; properly labeled, date marking N/O *03b Hot food at proper temperature N/A *02 -11 Consumer advisory on raw /undercooked oysters N/O *03c Foods properly cooked /reheated N/A *02 -13 Consumer advisory on raw /undercooked animal products N/0 *03d Foods properly cooled *04 Facilities to maintain product temperature *05 Thermometers provided and conspicuously placed *06 Potentially hazardous foods property thawed PIZZERIAS LLC Business Name 0 1 06/17/10 10:31 AM Inspection Date and Time Owner Name PAPA JOHN'S 1428 FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result In suspension or revocation of your license and fines. Number of Units 8849 BISCAYNE BLVD Address /City /State /Zip /etc. NOTE: Items marked above wlb an asterisk ( *) indicate a violation Inspector's Comments I acknowledge receipt of this inspection fore and comments. 06 -17 -10 Date DBPR Form HR 5022 -016 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF MOTELS AND RESTAURANTS www.MyFlorida.com /dbpr /hr Recipient The Phone: Leg Inspection Reason ANY VIOLATIONS noted herein must be corrected by the NEXT UNANNOUNCED INSPECTION, unless otherwise stated. Inspection Result Callback Date/Time Signature of Recipient FABIOLA GWLLEN OPERATOR 305- 754 -2666 MIAMI, 33138 MET INSPECTION STANDARDS during this visit 2332809 License Number 786- 344-3908 Area Code/Telephone Number 10/1/2010 License Expkatlon Page 1 of 3 NOST Vo Boiler On Site. Inspector Signature For further information please contact: Oscar Torres 8240 NW 52 Terrace 5101 Miami, Florida 33166 850 - 487 -1395 Violations marked web an asterak are critical vio{abons. Items marked IN are in compliance. Items Marked OUT are vlolaborns Specific details of violation are Ilsted on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/0 are Not Observed, and were not being conducted at the time of inspection. STATUS PHF TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL In *07 Unwrapped or potentially hazardous food not re- served 33 Contahrers covered, adequate number, Insect and rodent proof, emptied at proper intervals, dean In *08a Food protection during storage, preparation, display, service, transportation 34 Outside storage area clean, enclosure property constructed In *08b Crms contambnation, equipment, personnel, storage *08c Potential for etas - contamination; storage practices; STATUS INSECT AND RODENT CONTROL damaged food segregated *35a Presence of insects /rodents. Animals prohioited N/0 *09 Foods handled with minimum contact *35b Outer openings protected from insects, rodent proof 10 In use food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS STATUS PERSONNEL Out 36 Floors properly constructed, clean, drained, coved In *11 Personnel with infections restricted 37 Walls, ceilings, and attached equipment, constructed, clean N/0 *12a Hands washed and clean, good hygienic practices (observed), alternative operating ► 38 Lighting provided as required. Fixtures shielded N/0 *12b Proper hygienic per, egg /dtinldmg /smoking (evidence) 39 Rooms and equipment - vented as required STATUS OTHER AREAS 13 Clean clothes, hair restraints 40 Employee lockers provided and used, clean STATUS FOOD EQUIPMENT AND UTENSILS In *41a Toxic items properly stored 14 Food contact surfaces designed, constructed, mabrtahred, installed, located 15 Non-food contact surfaces designed. constructed. In *41b Toxic Items labeled and used properly 42 Premises maintained, free of litter, unnecessary articles. Cleaning and maintenance equipment properly stored. Kitchen restricted to authorized personnel Out maintained, installed, located *16 Dishwashing facilities designed, constructed, operated 1. Wash 2. Rinse 3. Sanitize 43 Complete separation from living /sleeping area, laundry 44 Clean and soiled linen segregated and property stored *17 Thermometers, gauges, test kits provided STATUS SAFETY 18 Pre - flushed, scraped, soaked *45 F9re extinguishers - proper and sufficient 19 Wash, rinse water dean, proper temperature * 46 Sing sYstem - adequate, good repair *20a Sanitizing concentration *47 Electrical wiring - adequate, good repair *20b $anftizing temperature *48 Gas appliances - properly installed, maintained 21 Wiping dohs dean, used property, stored *49 Flammable/combustible materials - properly stored In *22 Food contact surfaces of equipment and utensils clean STATUS GENERAL 23 Non-food contact surfaces dean *50 Current license properly displayed 24 Storage/handling of dean equipment, utensils 51 Other conditions sanitary and safe operation STATUS SINGLE SERVICE ARTICLES *52 False /misleading statements published or advertised relating to food/beverage 25 Service items properly stored, handled, dispensed 26 Sbngle service articles not re-used In *53a Food management certification valid STATUS WATER AND SE■AGE /PLUMBING Out *53b Employee training validation *27 Water source safe, hot and cold under pressure 54 Florida Clean Indoor Air Act *28 Sewage and waste water disposed properly 55 Automatic Gratuity Notice 29 Plumbing installed and maintained *30 Cross - connection, back siphonage, baddlow STATUS TOILET AND HANDWASHING FACILITIES Total Number of COS Violations: Total Number of Repeat Violations: *31 Toilet and handwashhlg facilities, number, convenient, designed, installed In *32 Restrooms with self -dosing doors, fixtures operate properly, facility dean, supplied with handsoap, disposable towels or hand drying devices, tissue, covered waste receptacles 1 License Number STATE OF FLORIDA NOST 2332809 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Business Name DIVISION OF HOTELS AND RESTAURANTS PAPA JOHN'S #428 wwwanyibrida.com /dbpr Inspection Date FOOD SERVICE INSPECTION REPORT 06/17/10 10:31 AM LEGAL NOTICE Initiate Failure to comply with this Notice may ate an administrative complaint that may result in suspension or revocation of your license and fines. Violations marked with an asterisk are aitical violations. Items marled IN are in compliance. Items Marked OUT are violations Speci d etaTs of v i o l a tio n a subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/0 are Not Observed, and were not being conducted at the time of inspection. OBPR Form HR 5022 -015 gote4 E. 31.444.44., Aia4tel April 15, 2010 Casey Kuffner Papa John's International 2002 Papa John's Blvd. Louisville, KY 40299 Re: Papa John's — Tenant Build - out, 8849 Biscayne Blvd., Miami Shores, FL 33138 Mr. Kuffner; We have received a copy of the local review comments concerning the above project. After review, we have provided the following responses to the pertinent comments. Fire Review Disapproval Comments 1. Provide a response sheet indicating on which sheet the comments are addressed. Acknowledged. This response letter will serve to indicate where comments have been addressed. 2. Common path of travel for an unsprinklered mercantile occupancy is limited to 75 feet (your plans show 87 feet). A rear door has been added; see revised sheets A -1, A -2 & A -5. 3. Clarify on the plans if indicate that the Kitchen Hood System meets the requirements of NFPA 96 and the Fire Suppression System meets NFPA 17A. Note #8, sheet A -2 has been added, noting that the existing Hood system, which would include the suppression, is UL 710 listed. 4. Indicate on the plans if a fare sprinkler and /or fire alarm system protect the space. If so, provide a conceptual plan indicating the existing layout and any necessary modifications to the system due to alterations. Note: if there are no changes to the system, you must still provide the existing layout. Acknowledged. There is no existing fire sprinkler or fire alarm system protecting this space; a note to this effect has been added to sheet A -1. 5105 Mac)ison Avenue : Inaianapolis, IN 46227 0 (3 7 Fax: (3 7 8 4 - 5 100 wwwbeamanassociates.com • Rix E. &et,1.4,., Aitel4toi 5. The level of floor elevation on both sides of a door shall not vary by more than '/z " and shall be maintained for at least the width of the door. Section 7.2.1.3. Acknowledged. 6. For the cooler shown, provide headroom dimensions (minimum 90 inches), projections from ceiling (80 inches AFF), door size (minimum 32 inches clear width when fully open), and floor elevation on both sides of the door (see #5 above). Requested information has been added to sheet A -1. 7. Indicate the occupancy type of any / all neighboring tenant spaces and show compliance with fire resistive separation requirements set forth in NFPA 101 (2003 ed.), Table 6.1.14.4.1. Occupancy type of neighboring space, which appears to be a cellular phone sales space, would be Group M Mercantile. By Table 6.1.14.4.1, business to mercantile is a 2 hr separation. An existing 8" concrete block wall separates the space, and is believed to be a 2 hr wall. See detail 9/A -3. 8. Provide minimum flame spread classification for interior finish per A10.2.2. See the revised Finish & Paint Schedules on sheet A -5. 9. Additional comments may follow information submitted. Acknowledged. 10. Fastrrak for rework. Acknowledged. Building Critique Sheet — Norman Bruhn. CBO 1. Plans must be reviewed and approved by Miami Dade County Fire Department. Acknowledged. Review process with Fire Department currently underway. 2. Plans must be reviewed and approved by Miami Dade County DERM. Acknowledged. 5105 Madison Avenue • Inc)ianapotis IN 46227 (3 783 -2343 * Fax: (3 7 8 4 - 5 100 www.heamanassociates.com U44 E. Eiev0.444, A/tetatel 3. Provide a receipt from Miami Dade Water and Sewer for Impact Fees. Acknowledged. Receipt will be provided under separate cover. 4. Provide approval from Florida Hotels and Restaurants. Acknowledged. Approval from DBPR will be provided under separate cover. S. Corrections for plumbing, electrical and zoning must be completed. Acknowledged. Acknowledged. Separate permits will be applied for. Separate permits for the signs and roof are required. This review does not include the signage. A completed separate sign permit must be submitted. 7. Provide the type of construction for the existing structure. We believe the existing building t 8. Indicate the use classification for the adjoining tenant. We believe the adjoining tenant to be 9. Indicate the hourly fire resistant rating for all tenant separation walls. We believe the hourly fire resistant rating of the separation walls to be 2 hour. 10. Completely dimension the toilet rooms including all fixtures, clear floor spaces for fixtures, all accessory location and heights, and profiles of all accessories. See Restroom Plan 8/A -3. Also, see the Restroom Elevation, 4/A -3. 11. Show that all floor transitions comply with the FL Accessible Code (Entry and cooler). As noted on sheet A -1 of the drawings, the floor level is even / level on both sides of the cooler door. The transition at the Entry is existing, with the existing storefront entry to remain, and is believed to be in compliance. 12. Plans show that the exterior wall is to be "infill opening match existing construction." Provide detail of the exterior wall construction include design criteria and foundation. If this is to be interior of existing glazing please note that. 5105 Madison Avenue ® Indianapolis, IN 46217 (3 7 Fax: (317) 784 -5100 www.beamanassociates.com " , . , Oil4)1A44',,, q The note and infill have been eliminated on the plans, sheets A-1, A-2 & A-5. Hopefully, this should provide some resolution for these comments. Sincerely, siros .N11:30i,stni Avoule 0 2 1 1 1 1 . 0 i 0 Hap() 1 . P " ` , 1 4.6227 (317).783-2343 Fax: tf 7b4 . . TP1111)...0alifitilla,SSOCIate&CONI April 15, 2010 Miami -Dade County Building Department 140 W. Flagler St. Suite 1603 Miami, FL 33128 RE: Papa John's Pizza Miami Shores, FL PO No.: 1782662 Mechanical Item No. 4: Electrical KERR GREULICH E N G I N E E R S I N C The following are responses to the Miami -Dade Building Department review comments dated 4/8/2010 received by Kerr - Greulich Engineers, Inc. on the above referenced project. Item No. 3: Clarify on the plans if indicate that the Kitchen Hood System meets the requirements of NFPA 96 and the fire suppression system meets NFPA 17A. Response: Please refer to revised sheets M -1, M -2, P -1, E -1 and E -2. A Type I Hood is now indicated with associated notes. Indicate on the plans if a fire sprinkler and or fire alarm system protects the space, if so, provide a conceptual plan indicating the existing layout and any necessary modifications to the system due to alterations. NOTE: if there are no changers to the system, you must still provide the existing layout. Response: The existing building does not have an existing sprinkler and fire alarm system. Per the Florida Building Code, a Group M Fire area must exceed 12,000 in order to be required to have a sprinkler and fire alarm system. The existing building is less than 6,000 square feet, therefore no sprinkler and fire alarm is not required. Item No. 2: Is the electrical service single or a three phase service? Response: please refer to revised E -1 and E -2 for single phase service. REGISTERED PROFESSIONAL ENGINEERS 1534 ORMSBY STATION COURT • PO BOX 24312 • LOUISVILLE, KY 40224 • P: 502.426.9457 • F: 502.426.2945 • W: KERR - GREULICH.COM 1 Please review and advise if you should have any questions. Very truly yours, KERR GREULICH ENGINEERS INCORPORATED Jamie Kilner JK File: 1782662 Cc: Casey Kuffner fo. Water and Sewer MIAMI, FL 33185 - REFERENCE DESCRIPTION QNTYIGPD DESCRIPTION 610 EConn eng - WASD Water Miami-Dade Water and Sewer Department New Business Office P.O. Box 330316 Miami, Florida 33233-0316 PeopleSe Acct ID# 3575 South LeJeune Road, Room 114 Miscellaneous Charges IN ACCOUNT WITH CONSTRUCTION CONSULTANTS INC 15566 SW 19 LN & S FOR 1,919 SF TAKE OUT RESTAURANT (PER PLANS) REPLACING TAKE OUT (PER LTR FROM MIAMI SHORES) @ 8849 IBISCAYNE BLVD FOLIO #11-3206-011-0190 DERM #2010-00817 PAID ICK #1165 Invoice 122238 Printed On 4/13/2010 2:51:31 PM 13y : Lizette Gonzalez Distribution: White-Customer, Yellow-General Office, Pink-Local Office, Gold-New Business iNvoicE# ir 122238J DATE: ADM 13, 2010 CUSTID: 142884 1 ER WATER: ! 1--- N/A ER SEWER: 1---- 1 N/A 1 1 ... _. -- AGMTID: 5471535401 1 DIST CODE ; UNIT PRICE ; AMOUNT 1.39 $847.90 610 Conn Ch9 - WASD Sewer 5.6 $3,416.00 1 , Verif Form- non-res exist'g (Water) 75 $75.00 1 Verif Form- non-res existg (Sewer) 75 $75.00 TOTAL: $4,413.90 WATER DEPOSITS: SEWER DEPOSITS: INVOICE NO. 122238 TOTAL: 344) 61 cic6 !.::: .?... , . .': ' 7 ::.) , : : . r" ,-, C.:I ,..-` ri • 1 r,,•.1 r+ f•-'• r'i sapp I... 1,.... ;74...? 4 , . 4137 rm ■ r„, ,.... itl ---1 r : : 13.1 - rri r.: vs.i ,-I.• riy .s. ro ■='; co ...,,, .-... o: ib , .r. , C.7 ...1;:u -1'74 ..ra f , 13. ,.... ..--, ■_-1.. f-- .....1 ::, 1 c. r.s..{ ;_,.: " ,.... f „.1. ,C 23 C '-': :3 1 . r - ,:9 c;.--, t...----4••••••••• tts".1 edit 410 fodito...T li . • pl I ypfrpt bijDli uu rCo.( 0.111070 .1I107%.7.1K711■••• .7.7; . tr.is:Mtproirniaridado4ovipspiciprodjEMPLOYEEICSIOCUICLCUROta7FoldsrPathoPORTAIXOLOB ove.rotrr: . v IR Service Paid Nli-RES WATER & WW, MR34, NORTH, In Service, C P4BL B2 05(09/1399 $p 1015414032200 - IN S,P eIRWT-C I NON-RE3 WATER & WW *Status In Servia litstag 0 173 1 0911999 Surce art s 1 -onimumu *Operatic' Areal 31 , GPO MTrrZE 38,15/2005 1, 41fROVED — tvt WOX1908 idey, Jan 04, 20 0:34 AM riiibuTER Ett SP MO elnur .• • • , t,0 POW 849 BISCAYNE BLVD MIAMI FL 33138-3365, Store • 2 SP Created By SP ID 541403261811 *Location Curb ?.7 wagon Detiosip NBL 02 44„ !i7.•.7.r.. f 2*.•)•<• 17, c, ,js" 'PON Pik+ •• urghsertkesize ye r • • 1••■•••011011.* olo RTE 04G FROM 2312 TO 1312 • • FROM 0131 I , " • •• ' • • - ' ) 44,, 1'110 I 111-0 11111141 NAME OF OWNER: PROPERTY ADDRESS: PROPOSED USAGE / NO. OF UNITS: REPLACES PREVIOUS USAGE / NO. OF UNITS: PROPERTY LEGAL: 049 BISCAYNE BLVD PREVIOUS FLOW: 350 PROPOSED FLOW: [. 960 VERIFICATION FORM EXPIRES ONE YEAR FROM DATE ON FORM PAPA JOHN'S STORE # 428/2010040110271580 ■ ITA4-OUT 1,919 SF (PER PLANS) FOLIO NUMBER: 11-3206-011-0190 TAKE-OUT (PER LETTER FROM MIAMI SHORES) [LOT 19 ASBURY PARK PS 4-110 Water & Sewer P.O. Box 330316 • 3071 SW 38th Avenue Miami, Flor da 33233-0316 305-665-7471 Carlos Alvarez, Mayor ATLAS PAGE: E-8 INV#: / 2 aP-3 ?; ORM #: 201026256 DATE: 4/1212010 GALLONS PER DAY INCREASE: 610 PREVIOUS SQUARE FOOTAGE: 1,9191 0 NEW CONSTRUCTION PROPOSED SQUARE FOOTAGE: f 1,9191 El INTERIOR RENOVATIO THIS IS TO CERTIFY THAT THE MIAMI-DADE WATER AND SEWER DEPARTMENT DOES HAVE A(N) 6 INCH WATER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE SUBJECT PROPERTY, (OR, IF WILL HAVE", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF WATER FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # N/A) SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERNMENTAL AGENCIES HAVING JURISDICTION OVER MATTERS OF WATER SUPPLY OR WITHDRAWAL. (A/ SIGNATURE OF REP SENTATIVE AUTHORIZED BY NEW BUSINESS COMMENTS: . 'WCC'S $ 847.90 SCC'S $ 3,418.00 AND VF FEES $ 150.000 TOTAL $ 4,413.90 PS # 641656717 DOES NOT EXCEED MORE THAN 50% OF TOTAL BLDG (9,537 SF) PLANS REVIEW COMMENTS: CRITERIA: THIS IS TO CERTIFY THAT THE MIAMI-DADE WATER AND SEWER DEPARTMENT DOES HAVE A(N) 8 INCH GRAVITY SEWER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE SUBJECT PROPERTY, (OR, IF 'WILL HAVE", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF SEWEF: SEWER FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # N/A ). SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERNMENTAL AGENCIES HAVING JURISDICTION OVER MATTERS OF SEWAGE DISPOSAL. FURTHERMORE, APPROVAL OF ALL SEWAGE FLOWS INTO DEPARTMENTS SYSTEM MUST BE OBTAINED FROM D.E.R.M. THE ANTICIPATED DAILY WATERAND/OR SEWAGE FLOW FOR THIS PROJECT WILL BE: SIX HUNDRED TEN [610] GALLONS PER DAY INCREASE. BY: PLANS REVIEW COMMENTS: CONTACT NAME: IvIARIO A BOLIVAR CONTACT PHONE: (7861 347-4390 Priritad Orr 4/18/2019 :1914 AM t - /tn . Frank Wilson Jr. - New Busbies Rep te. 11 Art ••••• • • • J Frank Wilson Jr. - New Bushes Rep SIGNATURE OF REPRESENTATIVE AUTHORIZED BY NEW BUSINESS COMMENTS: rb.E.R.Ii:SEIAER ALLOCATION LETTER DATED: 04-02-10 # 2016-ALLOCATION-.00817 miamidade.gov MIAMI H�)� E CAVINTY � Carlos Alvarez, Mayor B 4/12/2010 Issued Date: 4/2/2010 BISCAYNE 88 TERR LLC 1140 KANE CONCOURSE #5 FL BAY HARBOR ISLAND, FL 33154 MARIO A BOLIVAR PIZZERIAS LLC 8619 S DIXIE HWY MIAMi, FL 33143 RE: Sewer System Treatment and Transmission Capacity Certification The Miami -Dade County Department of Environmental Resources Management (DERM) has received your application for approval of a sewer service connection to serve the following protect which is more specifically described in the attached project summary. Project Name: PAPA JOHN'S STORE # 4 28/2010040110271580 Project Location: 8849, BISCAYNE BLVD, FL 331383363 Previous Lase: 1,919 SF STORE .Proposed Use: 1,919 SF TAKE OUT PIZZERIA Previous Flow: 96 GPD Total Calculated Flow: 960 GPD Allocated Flow: 864 GPD Sewer Utility: UNINCORPORATED DADE COUNTY Receiving Pump Station: 30 - 0049 DERM has evaluated your request in accordance with the terms and conditions set forth in Paragraph 16 C of the First Partial Consent Decree (CASE NO. 93-1109 CIV- MORENO) between the United States of America and Miami -Dade County. DERM hereby certifies that adequate treatment and transmission capacity, as herein defined, is available for the above described protect. Furthermore, be advised that this approval does not constitute Departmental approval for the proposed protect. Additionat reviews and approval may be required from sections having jurisdiction over specific aspects of this protect. Also, be advised that the gallons per day (GPD) flow determination indicated herein are for sewer allocation purposes only (in compliance with Consent Decree requirements) and may not be representative of GPD flows used In calculating connection fees by the utility providing the service. Please be aware that this certification is subject to'the terms and conditions set forth in the Sewer Service Connection Affidavit filed by the applicant, a copy of which is hereby attached. Should you have any questions regarding this matter, please contact the Mlami -Dade Permitting and Inspecting Center (MDPIC) (786) 315 -2800 0 DERM Office of Plan Review Services, Downtown Office (305) 372 -6899. Sir cerely, Carlos Espi ios,. '.E. Director D - gent of a . Hemandez, P.E. Chief, C >,'ce of Plan Review S= rvices MEM esources Management Ergi Plan Review Services Division 701 NW 1st Court ® 2nd Floor Miami, Florida 33136 -3902 T 305 - 372 -6899 F 305 - 372 -6631 rniarnidade.gov Page 1 of 2 111 Owner's Name: BISCAYNE 88 TERR LLC Owner's Address: 1140 KANE CONCOURSE #5 FL BAY HARBOR ISLAND, FL 33154 EEOS Allocation Number: 2010 - ALLOCATION -00817 Project: PAPA JOHN'S STORE it 428/2010040110271580 Proposed Use: 1,919 SF TAKE OUT PIZZERIA Pump Station: 30 -0049 Projected NAPOT: 4.38 2010 - ALLOCATION -00817 AMf`e +P �yy3 e ; tt ' l' '3� 3 '. Folio Lot/Block Address Flow ... Sewer Sewer Bldg Proc # (GPD) Status Cert Date Page 2 of 2 ►EmaAUaa P4X0A PROJECT LOLOglOPI Ilf tI If 3 i4 L u Is EXIST INE ., g00.WNG" !sqe3Jaa U/ //i . i'COSReIeal!- hence 1-r -ride Roatiy_/N .it ..., D Tel. pggrP r 4L c f t0 r ata` . / f4 ay Eaa/ of / Alley. gastoratioa es oPprnved by Wr7 /age o1" M/eam/ Shore - - E X I S T e—• EXIST 6AS 1. I ALL6 815CAYNi BLVD LOCATION MAP SCALE, Meow Sec- 4 Tip -g' % Pony rib 6 : 3/' 6'0/P 9,9.`OD' B' D/P 9 7 / / OR2 AON6 .P/at. t'L6.E9 88' Ilp :pp' A/P HN NN fffaoz MN. 4 _ 9.17 .. lKll•- _Ot -r -4� 5 ' _-_ 24.7:.CPVC 414' ,VConerete from_.Hr3 fawN.4 EXIST t -STY 9N IL O. rs/drasr EAST 1.511 Slaw. IRe Pre lee " NO WYE CONNECTIONS WAS. INSTALLED ON THIS SYSTEM OTHER THAN • 'COIN LAUNDRY' KN _ : 11.2a4. lT /—? e / _Alm_.. EL. 8.2s LN4_Et._.5. 89_ Lb 20' E 1P x1ST, 19 AILEy ld� Wa ciao' c ..serwoem.epd Ex/s / /hg•- 2 ". Wa ter. /Yai/' Cae esgd Ptaged by H /a/n/c_Dade Wofer_aid . 4 S' G .A Y N E a? oad.. restorrr/ion_as- _cppravcd 6y the_- 4Wilage_of_LI'<irmL. sbore � / 0 �r/ - .'_Paveer/t..resfrd oAz*, _aver4tay- frm._.. o erLsWag_HOnha/P.. see .4't1r/y_trl. _sLdr —cr assee N 'es r ta_ -fhG end_ oY_/.voy. _ ® io' Paver/ser/t re SAX /11 0/) NE 8B 7E21.2. MN .¢ s (l tcom..NN 5 to "mar_oo sea/e_.sidr'_ ee Ceofecaar Gr �f9 � g ® Ihe_awner of C aTSeTO//f 4,T'weea, AS7/ 4_4 o•.3d rte 19 • tt /k oP_H ®..BB.JB.roa�el�da.��ys arstea�/8� - �-6 1, �•tn 0 a d_. from: Ex/ efii/ g_s /E�oir/iw�s�a�oscmev/r° p e PVe : - 0.3 81: 266. ""9s* SANITAli' SEWER PROFILE . ¢CPL6 1.30' NORIZ0l913L • (',3' VERTICA . ` 4, 10 -21 -99 A6 8899056 ( 2-6"SEWER LATERALS) sw_ding 2' wa fer Hein sax /tided 4 t asg-z_' B'Prc k sew- er_/Yo /a 3.352 4; ,veLr , 2 Service . _ Reroaalied by. ... N /amt node water. /tad. Sewer Dept.__ B. O'U L.E V A R D ER- 46256 age! 2 O ."6"C•.9s _ 0 0 e e 2' 6° f'r: 0.34i 2K1:73/73:.;v7/14- 6 erseaaer "oie o f 3S1f , too ExISf. NN .EX 104 9L 2.7/ Ne✓ INV. s 2.74 S•3' ✓ .4.x /sbii9_Sealer Hai:* - 1 PxrS 74;75 2 wofee• Hans - Cut and f+•'ugad /o/nr 000'r. wwr'er s ,'sewer. cep . 6 • REVISIONS raaaal•Y SURVEY CERTIFICATION V:hereb fbe.e /eve> / /oa land d/s/aace• $43w0 74ils '4S- Bu /tr ::w ,2 or-e p are 1 aweeer ,wy direa//39 o,1d /s /hree ood correca 710 , e_beet me ray � ao wte / Grr7, 1 e /ie,F ?Mal' _ tt�9_S!/ /Vey_. /71 Ce /s . m%n/yJUq Steaatdors_..s.v t f /. by_ ,!//e. FLor do Board. 07 ' .$',- 1vr73 .' Pa.Jdar/f }o Chopler •! 6/7- 1 Florida i/t .r/r r4; • . Code. ER- 46256 NO FB E -8 GARY 8. CASTEL _ t. ss 4 47/7d. Surveyor J/ ..4 / 2 9 St'.•.`e of Florida ;nr7fes AS -BUILT PLAN ES- 7368 MIAMI SHORES COIN LAUNDRY SEWER•.MAIN EXTENSION 5TH GARY B. CASTF z/- 97 P vRO4/2 SII Osl 87x0 D S URu'EY /20/2 $W /32 CLN /aW/ F1. /86 aces• 3C OF I _ . Florida Departmentof Busines Professig - al Regulation APRIL 26, 2010 PIZZERIAS LLC Attention: Judi Witkin 307 S 21 AVE HOLLYWOOD, FL 33020 Re: Division of Hotels and Restaurants Plan Review License Type: 2010 PERMANENT FOOD SERVICE Application No. 529752 File No. 239621 Log No. HQ -10 -3869 Dear Plan Review Applicant: Charlie Crist, Govemor Charlie Liem, Interim Secretary Congratulations on your decision to operate a restaurant in Florida! I have approved the public food service establishment plans for PAPA JOHN'S #428, 8849 BISCAYNE BLVD, MIAMI, FL 33138, as of April 26, 2010, with the following condition(s): 1. IF ANY HAND WASH VIOLATIONS ARE OBSERVED AT FUTURE INSPECTIONS IN THE FOOD PREPARATION AREA, AN ADDITIONAL HAND WASH SINK "MAY" BE REQUIRED. Please have the above information or proof of compliance with the conditions ready for the inspector at your opening inspection. The conditions listed above are required to pass your opening inspection. Please include the file number and log number listed above on any documents submitted. Your plans are only approved as submitted to us and with the above conditions. Changes in proposed operational procedures may require additional equipment and certain changes may require a new plan review. If you decide to change the menu, equipment or operation, please notify us immediately. If you have not yet applied for your food service license, you should submit your Application for Food Service License and the correct fees to Tallahassee now. Please make sure to submit the completed application and fees early enough to receive your license by your planned opening date. You can find licensing information and forms online at www.myfloridalicense.com. A license fee calculator is located on our website at www. myforidalicense. com/ dbpr /hr/licensing/foodfees.html, which can help you determine the cost of your food service license. For help with the license application process, to have an application mailed to you, or if you have any questions, please call our Customer Contact Center at 850.487.1395 between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday. For faster processing, please attach a copy of this letter to the top of your completed license application along with a check or money order for the appropriate license fee. Submit the packet to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, 1940 N. Monroe Street, Tallahassee, FL 32399 -0783. Before mailing, please make sure you have completed the license application, paid the correct license fee and attached a copy of this letter to the top of your licensing packet. An incomplete or incorrect licensing packet will delay the licensing process. Your plan approval is valid for one year from the date of this letter, so you must license the proposed establishment before then. If your plan approval expires after a year, you may have to complete the plan review process including fee payment again. If you are no longer in charge of this project, please forward this letter to the correct person or company. Phone: 850.487.1395 Fax: 850.414.2949 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. Florida Department Busines Professi a Regulation Charlie Grist, Govemor Charlie Liem, Interim Secretary When the construction is complete, please call our Customer Contact at 850.487.1395 to request contact from an inspector to schedule an opening inspection. Be ready to provide the file number located at the top of this letter. Please allow 7 -10 days for the inspector to contact you to schedule the inspection. Good luck with your enterprise! Sin rely, Richard Bull Plan Reviewer ENCLOSURE(S) Phone: 850.487.1395 Fax: 850.414.2949 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. 3 Construction Finishes and S Floor Wall Cove Base Ceiling Food Preparation Tile FRP Tile Vinyl Food Storage Tile FRP Tile Vinyl Dishwash Area Tile FRP Tile Vinyl Bathrooms Tile FRP Tile Vinyl Dry Storage Tile FRP Tile Vinyl Bar NA NA N NA Sinks 4 and S Warewashing Manual washing, rinsing and sanitizing facilities provided: a 3- compartment sink ❑ 4- compartment sink Location(s): ❑ Kitchen ❑ Bar Dishwash area ❑ Other 5 NA Mechanical washing, rinsing and sanitizing facilities provided: ❑ Dishmachine ❑ Glasswasher Dishmachine /glasswasher sanitizing method: ❑ Chemical ❑ Hot Final Rinse 6 5 Drainboards or shelving /table equivalent provided at each end of dishwashing facilities 7 C Hand sink(s) provided /accessible in food prep and food dispensing area(s) 8 5 Hand sink provided /accessible in dishwashing area(s) 9 Total number of hand wash sinks shown 2 10 Food prep sink(s): 11 1- compartment ❑ 2- compartment ❑ 3- compartment Number shown: 1 Florida Depar u nento! Busines ()) Professi b nal Regulation Division of Hotels and Restaurants www.MyFloridaLicense.com/dbpr/hr LOG NUMBER HQ 10 3869 FILE NUMBER 239621 PLAN REVIEW SPECIFICATION WORKSHEET Establishment must meet all standards of Chapter 509, Part I, Florida Statutes, and Chapter 61C-4, Florida Administrative Code IIII Establishment Name: Papa John's #428 © Review Type New /Conversion ❑ Remodel ❑ Closed at least one year Current License Number: 2332809 Previous License Number and /or Name (if applicable): Previous Licensing Agency: ❑ Department of Agriculture and Consumer Services ❑ Department of Health El Division of Hotels & Restaurants WORKSHEET CODE KEY: S = Satisfactory NA = Not applicable U = Unsatisfactory — a plan cannot be approved with an item marked in this manner C = Caution — item is operationally based or cannot be determined by review and will be verified during onsite inspection Finishes in areas of moisture must be smooth, nonabsorbent and easily cleanable. Studs, joists or rafters may not be exposed in areas of moisture. iA Curved and sealed cove bases are required at floor /wall junctures. Comments: 1. If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. DBPR Form HR 5021 -011 Page 1 of 3 Revised 2009 October 27 Fire 11 Safety S Hood automatic fire suppression shown over cooking equipment (grease laden vapors) 12 C Portable extinguisher(s) shown 13 Public exit access does not go through kitchen / storage rooms / bathrooms / other high hazard areas ❑ Yes ❑ No 14 Number of exits: I Public: 1 I Employee: 1 I Total: 2 15 Square footage of establishment: 1919 16 Building fire sprinkler system installed ❑ Yes 01 No Equipment and Storage 17 NA Ice machine installed in enclosed area with outer openings protected 18 C Displayed / exposed food effectively protected 19 NA Running water dipper well installed for bulk ice cream service or equivalent handling 20 5 Equipment installed for cold holding potentially hazardous food 21 C Equipment installed for hot holding potentially hazardous food 22 C Dry storage area designated 23 C Maintenance and cleaning equipment storage area designated 24 Plumbing 25 C C Employee personal article storage designated and Bathrooms Plumbing system installed 26 5 Mop /service sink; can wash - shown Location(s): Dishwashing area 27 5 Water heating device Location: Dishwashing area 28 Establishment park/entertainment type: r Stand alone ❑ Mall (strip /enclosed) ❑ Incidental ❑ Lodging associated ❑ Theme complex 29 S Public bathroom installed Type /Location Shown: ❑ Bathroom for each sex bathroom(s) on same level ❑ Public bathrooms Unisex only ❑ Public within 300 feet on same level 30 S Public bathroom(s) accessible to customers without going through food preparation, food storage or warewashing areas 31 Water 32 S Employee bathroom(s) provided Same as customer bathroom(s) ❑ Separate Supply S Type of supply: il Municipal ❑ Onsite Well ❑ Other from customer bathroom(s) Public well permit number: 33 Provider name: Miami -Dade Water & Sewer Department 34 Written ❑ Electronic approval/verification via: ❑ Copy of bill ❑ Approval form 4 Provider letter ❑ Permit account document ❑ Verbal ❑ Other Waste Water Disposal 35 5 Type of system: © Municipal ❑ Septic Tank ❑ Package Plant ❑ Other 36 Provider name: Miami -Dade Water & Sewer Department 37 Written ❑ Electronic approval/verification via: ❑ Copy of bill ❑ Approval form 1Il Provider letter ❑ Permit account document ❑ Verbal ❑ Other 38 Septic tank system I Permit number: I ❑ Restrictions (see provisos) Tank size: gallons I Drainfield: square feet I Grease trap: gallons 39 Seating capacity per plan: ❑ Inside seating ❑ Outside seating Projected number of seats contingent upon approval from local Authority . Total: Having Jurisdiction Comments: DBPR Form HR 5021 -011 Page2of3 Revised 2009 October 27 Water 43 The following general provisos apply to all public food service establishments. ALL ITEMS WILL BE VERIFIED BY AN INSPECTOR AT THE TIME OF INSPECTION. / Backflow Prevention Hot and cold water supplied to all sinks where required (e.g., three - compartment, handwash, mop /service sinks) I4 5 4 If allowed by the local Authority Having Jurisdiction, warewashing sinks and machines may have a direct connection ting Light fixtures shielded / coated / covered where food is stored / prepared / displayed or where single- service items are open / exposed 46 Equipment 47 Illumination — 50 foot - candles in food preparation areas; 20 foot - candles in self - service areas, inside reach -in or under - counter refrigerators, handwashing and warewashing areas, equipment and utensil storage, toilet rooms; 10 foot - candles in walk -in refrigerators and freezers, dry food storage areas Installation and Operation Waste container (dumpster), grease receptacle, compactor, recycle bins on nonabsorbent surfaces (pad) 48 Local exhaust ventilation installed over cooking units releasing steam / grease laden vapors / smoke 49 Bathrooms ventilated / provided with windows; doors self - closing; doors / stalls constructed to insure privacy 50 Equipment, mop /service sink/can wash /compactor area properly drained to sanitary sewer; refrigeration waste piping discharges indirectly into floor drain or other approved receptor; Laundry facilities protected 51 Dish machines have visual sanitizer delivery system or incorporate visual / audible alarm to signal if detergents and sanitizers are not delivered to the proper cycles 52 All hose fittings protected by backflow device; back siphonage / backflow protection if no air gap /break 53 Fire 54 Doors to exterior self - closing unless emergency exit Safety Notification (Enforced by Local Authority Having Jurisdiction) No mesh filters in hood with automatic fire suppression systems installed 55 All gas appliances have a nationally recognized testing laboratory seal such as AGA or UL 56 Class K and other portable fire extinguisher installed as required by NFPA 10 and /or local fire authority 57 Automatic sprinkler and fire alarm systems required for occupancies greater than 300 58 Exit doors open outward for occupancy greater than 49 . 59 Provide 16 -inch separation / vertical splashguard of 8 -inch steel / tempered glass between fryer(s) /open flames Plan Reviewer: Richard Bull Results ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) Date: 04/26/2010 Plans returned to submitter on (date): ❑ Mailed ❑ Shipped ❑ Scanned to agent/contact person ❑ Plans picked up by: Signature: ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plan Review Packet scanned to District Date: Plan 40 Results ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) 41 1a Plans approved with provisos (see provisos below) Provisos: 1. If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plans approved with noted provisos (see provisos above) DBPR Form HR 5021 -011 Page 3 of 3 Revised 2009 October 27 • Florida Departments+ Busines?� Professional Regulation APRIL 26, 2010 PIZZERIAS LLC Attention: Judi Witkin 307 S 21 AVE HOLLYWOOD, FL 33020 Dear Plan Review Applicant: Phone: 850.487.1395 Fax: 850.414.2949 Re: Division of Hotels and Restaurants Plan Review License Type: 2010 PERMANENT FOOD SERVICE Application No. 529752 File No. 239621 Log No. HQ-10 -3869 Charlie Crist, Govemor Charlie Liem, Interim Secretary 1. IF ANY HAND WASH VIOLATIONS ARE OBSERVED AT FUTURE INSPECTIONS IN THE FOOD PREPARATION AREA, AN ADDITIONAL HAND WASH SINK "MAY" BE REQUIRED. 2 t MO jJ B Y: ®..- o -o -em o -e Congratulations on your decision to operate a restaurant in Florida! I have approved the public food service establishment plans for PAPA JOHN'S #428, 8849 BISCAYNE BLVD, MIAMI, FL 33138, as of April 26, 2010, with the following condition(s): Please have the above information or proof of compliance with the conditions ready for the inspector at your opening inspection. The conditions listed above are required to pass your opening inspection. Please indude the file number and log number listed above on any documents submitted. Your plans are only approved as submitted to us and with the above conditions. Changes in proposed operational procedures may require additional equipment and certain changes may require a new plan review. If you decide to change the menu, equipment or operation, please notify us immediately. If you have not yet applied for your food service license, you should submit your Application for Food Service License and the correct fees to Tallahassee now. Please make sure to submit the completed application and fees early enough to receive your license by your planned opening date. You can find licensing information and forms online at www.myfloridalicense.com. A license fee calculator is located on our website at www. myfloridalicense. com/ dbpr /hr/licensing/foodfees.html, which can help you determine the cost of your food service license. For help with the license application process, to have an application mailed to you, or if you have any questions, please call our Customer Contact Center at 850.487.1395 between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday. For faster processing, please attach a copy of this letter to the top of your completed license application along with a check or money order for the appropriate license fee. Submit the packet to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, 1940 N. Monroe Street, Tallahassee, FL 32399 -0783. Before mailing, please make sure you have completed the license application, paid the correct license fee and attached a copy of this letter to the top of your licensing packet. An incomplete or incorrect licensing packet will delay the licensing process. Your plan approval is valid for one year from the date of this letter, so you must license the proposed establishment before then. If your plan approval expires after a year, you may have to complete the plan review process including fee payment again. If you are no longer in charge of this project, please forward this letter to the correct person or company. 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. e Florida Department c Busi nes (`?1 Professibrial Regulation When the construction is complete, please call our Customer Contact at 850.487.1395 to request contact from an inspector to schedule an opening inspection. Be ready to provide the file number located at the top of this letter. Please allow 7 -10 days for the inspector to contact you to schedule the inspection. Good luck with your enterprise! Richard Bull Plan Reviewer ENCLOSURE(S) Phone: 850.487.1395 Fax: 850.414.2949 Charlie Crist, Govemor Charlie Liem, Interim Secretary 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. 3 Construction Finishes and S Floor Wall Cove Base Ceiling Food Preparation Tile FRP Tile Vinyl Food Storage Tile FRP Tile Vinyl Dishwash Area Tile FRP Tile Vinyl Bathrooms Tile FRP Tile Vinyl Dry Storage Tile FRP Tile Vinyl Bar NA NA NA NA Sinks 4 and S Warewashing Manual washing, rinsing and sanitizing facilities provided: ►.1 3- compartment sink ❑ 4- compartment sink Location(s): ❑ Kitchen ❑ Bar .. Dishwash area ❑ Other 5 NA Mechanical washing, rinsing and sanitizing facilities provided: ❑ Dishmachine ❑ Glasswasher Dishmachine /glasswasher sanitizing method: ❑ Chemical ❑ Hot Final Rinse 6 S Drainboards or shelving /table equivalent provided at each end of dishwashing facilities 7 C Hand sink(s) provided /accessible in food prep and food dispensing area(s) 8 5 Hand sink provided /accessible in dishwashing area(s) 9 Total number of hand wash sinks shown 2 10 Food prep sink(s): ■ 1- compartment ❑ 2- compartment ❑ 3- compartment Number shown: 1 Fi ;; iba [ e p3!-.rien Busines Profess' 'nal Regulation Division of Hotels and Restaurants www.MyFloridaLicense.com/dbpr/hr LOG NUMBER HQ 10 3869 FILE NUMBER 239621 PLAN REVIEW SPECIFICATION WORKSHEET Establishment must meet all standards of Chapter 509, Part I, Florida Statutes, and Chapter 61C-4, Florida Administrative Code III Establishment Name: Papa John's #428 © Review Type 9 New /Conversion ❑ Remodel El Closed at least one year Current License Number: 2332809 Previous License Number and /or Name (if applicable): Previous Licensing Agency: El Department of Agriculture and Consumer Services ❑ Department of Health El Division of Hotels & Restaurants WORKSHEET CODE KEY: S = Satisfactory NA = Not applicable U = Unsatisfactory — a plan cannot be approved with an item marked in this manner C = Caution — item is operationally based or cannot be determined by review and will be verified during onsite inspection Finishes in areas of moisture must be smooth, nonabsorbent and easily deanable. // Studs, joists or rafters may not be exposed in areas of moisture. 1 Curved and sealed cove bases are required at floor /wall junctures. Comments: 1. If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. DBPR Form HR 5021 -011 Page 1 of 3 Revised 2009 October 27 Fire 11 Safety S Hood automatic fire suppression shown over cooking equipment (grease laden vapors) 12 C Portable extinguisher(s) shown 13 Public exit access does not go through kitchen / storage rooms / bathrooms / other high hazard areas ❑ Yes ❑ No 14 Number of exits: I Public: 1 I Employee: 1 I Total: 2 15 Square footage of establishment: 1919 16 Building fire sprinkler system installed ❑ Yes ■ No Equipment and Storage 17 NA Ice machine installed in enclosed area with outer openings protected 18 C Displayed / exposed food effectively protected 19 NA Running water dipper well installed for bulk ice cream service or equivalent handling 20 5 Equipment installed for cold holding potentially hazardous food 21 C Equipment installed for hot holding potentially hazardous food 22 C Dry storage area designated 23 C Maintenance and cleaning equipment storage area designated 24 Plumbing 25 C C Employee personal article storage designated and Bathrooms Plumbing system installed 26 5 Mop /service sink; can wash - shown Location(s): Dishwashing area 27 S Water heating device Location: Dishwashing area 28 Establishment park/entertainment type: 1 Stand alone ❑ Mall (strip /enclosed) ❑ Incidental ❑ Lodging associated ❑ Theme complex 29 S Public bathroom installed Type /Location Shown: ❑ Bathroom for each sex bathroom(s) on same level ❑ Public bathrooms 1 Unisex only ❑ Public within 300 feet on same level 30 S Public bathroom(s) accessible to customers without going through food preparation, food storage or warewashing areas 31 Water 32 S Employee bathroom(s) provided r Same as customer bathroom(s) ❑ Separate Supply S Type of supply: Municipal ❑ Onsite Well ❑ Other from customer bathroom(s) Public well permit number: 33 Provider name: Miami -Dade Water & Sewer Department 34 Written ❑ Electronic approval/verification via: ❑ Copy of bill ❑ Approval form , Provider letter ❑ Permit account document ❑ Verbal ❑ Other Waste Water Disposal 35 S Type of system: Municipal ❑ Septic Tank ❑ Package Plant ❑ Other 36 Provider name: Miami -Dade Water & Sewer Department 37 Written ❑ Electronic approval/verification via: ❑ Copy of bill ❑ Approval form 1i4 Provider letter ❑ Permit account document ❑ Verbal ❑ Other 38 Septic tank system I Permit number: 1 ❑ Restrictions (see provisos) Tank size: gallons I Drainfield: square feet I Grease trap: gallons 39 Seating capacity per plan: ❑ Inside seating ❑ Outside seating Projected number of seats contingent upon approval from local Authority 1Ii Total: 0 Having Jurisdiction Comments: DBPR Form HR 5021 -011 Page 2 of 3 Revised 2009 October 27 The following general provisos apply to all public food service establishments. ALL ITEMS WILL BE VERIFIED BY AN INSPECTOR AT THE TIME OF INSPECTION. Water / Backflow Prevention 43 Hot and cold water supplied to all sinks where required (e.g., three-compartment, handwash, mop /service sinks) 44 If allowed by the local Authority Having Jurisdiction, warewashing sinks and machines may have a direct connection Lighting Date: Light fixtures shielded / coated / covered where food is stored / prepared / displayed or where single- service items are open / exposed 46 Illumination — 50 foot - candles in food preparation areas; 20 foot - candles in self - service areas, inside reach -in or under - counter refrigerators, handwashing and warewashing areas, equipment and utensil storage, toilet rooms; 10 foot - candles in walk -in refrigerators and freezers, dry food storage areas Equipment Installation and Operation 47 Waste container (dumpster), grease receptacle, compactor, recycle bins on nonabsorbent surfaces (pad) 48 Local exhaust ventilation installed over cooking units releasing steam / grease laden vapors / smoke 4.9 Bathrooms ventilated / provided with windows; doors self - closing; doors / stalls constructed to insure privacy 50 Equipment, mop /service sink/can wash /compactor area properly drained to sanitary sewer; refrigeration waste piping discharges indirectly into floor drain or other approved receptor; Laundry facilities protected 51 Dish machines have visual sanitizer delivery system or incorporate visual / audible alarm to signal if detergents and sanitizers are not delivered to the proper cycles 52 All hose fittings protected by backflow device; back siphonage /backflow protection if no air gap /break 53 Doors to exterior self - closing unless emergency exit Fire Safety Notification (Enforced by Local Authority Having Jurisdiction) 54 No mesh filters in hood with automatic fire suppression systems installed 55 All gas appliances have a nationally recognized testing laboratory seal such as AGA or UL 56 Class K and other portable fire extinguisher installed as required by NFPA 10 and /or local fire authority 57 Automatic sprinkler and fire alarm systems required for occupancies greater than 300 58 Exit doors open outward for occupancy greater than 49 59 Provide 16 -inch separation / vertical splashguard of 8 -inch steel / tempered glass between fryer(s) /open flames Plan Reviewer: Richard Bull Results ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) Date: 04/26/2010 Plans returned to submitter on (date): ❑ Mailed ❑ Shipped ❑ Scanned to agent/contact person ❑ Plans picked up by: I Signature: ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plan Review Packet scanned to District Date: Plan 40 Results ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) 41 . Plans approved with provisos (see provisos below) Provisos: t If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plans approved with noted provisos (see provisos above) DBPR Form HR 5021 -011 Page 3 of 3 Revised 2009 October 27 Florida Departmental Busines Professib`ra Regulation APRIL 26, 2010 ) PIZZERIAS LLC Attention: Judi Witkin 307 S 21 AVE HOLLYWOOD, FL 33020 Re: Division of Hotels and Restaurants Plan Review License Type: 2010 PERMANENT FOOD SERVICE Application No. 529752 File No. 239621 Log No. HQ -10 -3869 Dear Plan Review Applicant: Phone: 850.487.1395 Fax: 850.414.2949 Charlie Crist, Govemor Charlie Liem, Interim Secretary Congratulations on your decision to operate a restaurant in Florida! I have approved the public food service establishment plans for PAPA JOHN'S #428, 8849 BISCAYNE BLVD, MIAMI, FL 33138, as of April 26, 2010, with the following condition(s): 1. IF ANY HAND WASH VIOLATIONS ARE OBSERVED AT FUTURE INSPECTIONS IN THE FOOD PREPARATION AREA, AN ADDITIONAL HAND WASH SINK "MAY" BE REQUIRED. Please have the above information or proof of compliance with the conditions ready for the inspector at your opening inspection. The conditions listed above are required to pass your opening inspection. Please include the file number and log number listed above on any documents submitted. Your plans are only approved as submitted to us and with the above conditions. Changes in proposed operational procedures may require additional equipment and certain changes may require a new plan review. If you decide to change the menu, equipment or operation, please notify us immediately. If you have not yet applied for your food service license, you should submit your Application for Food Service License and the correct fees to Tallahassee now. Please make sure to submit the completed application and fees early enough to receive your license by your planned opening date. You can find licensing information and forms online at www.myfloridalicense.com. A license fee calculator is located on our website at www. myfloridalicense. com/ dbpr /hrllicensing/foodfees.html, which can help you determine the cost of your food service license. For help with the license application process, to have an application mailed to you, or if you have any questions, please call our Customer Contact Center at 850.487.1395 between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday. For faster processing, please attach a copy of this letter to the top of your completed license application along with a check or money order for the appropriate license fee. Submit the packet to: Department of Business and Professional Regulation, Division of Hotels and Restaurants, 1940 N. Monroe Street, Tallahassee, FL 32399 -0783. Before mailing, please make sure you have completed the license application, paid the correct license fee and attached a copy of this letter to the top of your licensing packet. An incomplete or incorrect licensing packet will delay the licensing process. Your plan approval is valid for one year from the date of this letter, so you must license the proposed establishment before then. If your plan approval expires after a year, you may have to complete the plan review process including fee payment again. If you are no longer in charge of this project, please forward this letter to the correct person or company. 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. Florida Departmentof Busines,i Professt&nal Regulation When the construction is complete, please call our Customer Contact at 850.487.1395 to request contact from an inspector to schedule an opening inspection. Be ready to provide the file number located at the top of this letter. Please allow 7 -10 days for the inspector to contact you to schedule the inspection. Good luck with your enterprise! Sin rely, ;itid Richard Bull Plan Reviewer ENCLOSURE(S) Phone: 850.487.1395 Fax: 850.414.2949 Charlie Crist, Govemor Charlie Liem, Interim Secretary 1940 NORTH MONROE STREET www.MyFloridaLicense.com TALLAHASSEE, FLORIDA 32399 -1011 License Efficiently. Regulate Fairly. 3 Construction Finishes and S Floor Wall Cove Base Ceiling Food Preparation Tile FRP Tile Vinyl Food Storage Tile FRP Tile Vinyl Dishwash Area Tile FRP Tile Vinyl Bathrooms Tile FRP Tile Vinyl Dry Storage Tile FRP Tile Vinyl Bar NA NA NA NA Sinks 4 and S Warewashing Manual washing, rinsing and sanitizing facilities provided: 3- compartment sink ❑ 4- compartment sink Location(s): ❑ Kitchen ❑ Bar Dishwash area ❑ Other 5 NA Mechanical washing, rinsing and sanitizing facilities provided: ❑ Dishmachine ❑ Glasswasher Dishmachine/glasswasher sanitizing method: ❑ Chemical ❑ Hot Final Rinse 6 S Drainboards or shelving /table equivalent provided at each end of dishwashing facilities 7 C Hand sink(s) provided /accessible in food prep and food dispensing area(s) 8 S Hand sink provided /accessible in dishwashing area(s) 9 Total number of hand wash sinks shown 2 10 Food prep sink(s): ■ 1- compartment ❑ 2- compartment ❑ 3- compartment I Number shown: 1 Florida Department¢ Busi nes ( 1 Professibna) Regulation Division of Hotels and Restaurants www.MyFloridaLicense.com/dbpr/hr LOG NUMBER HQ 10 3869 FILE NUMBER 239621 PLAN REVIEW SPECIFICATION WORKSHEET Establishment must meet all standards of Chapter 509, Part I, Florida Statutes, and Chapter 61C-4, Florida Administrative Code Establishment Name: Papa John's #428 © Review Type Z New /Conversion ❑ Remodel ❑ Closed at least one year Current License Number: 2332809 Previous License Number and /or Name (if applicable): Previous Licensing Agency: ❑ Department of Agriculture and Consumer Services ❑ Department of Health ❑ Division of Hotels & Restaurants WORKSHEET CODE KEY: S = Satisfactory NA = Not applicable U = Unsatisfactory — a plan cannot be approved with an item marked in this manner C = Caution — item is operationally based or cannot be determined by review and will be verified during onsite inspection ® Finishes in areas of moisture must be smooth, nonabsorbent and easily cleanable. Studs, joists or rafters may not be exposed in areas of moisture. ■ Curved and sealed cove bases are required at floor /wall junctures. Comments: 1. If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. DBPR Form HR 5021 -011 Page 1 of 3 Revised 2009 October 27 Fire Safety, 11 S Hood automatic fire suppression shown over cooking equipment (grease laden vapors) 12 C Portable extinguisher(s) shown 13 Public exit access does not go through kitchen / storage rooms / bathrooms / other high hazard areas ❑ Yes ❑ No 14 Number of exits: Public: 1 Employee: 1 Total: 2 15 Square footage of establishment: 1919 16 Building fire sprinkler system installed ❑ Yes No Equipment and Storage _ ._. 17 NA Ice machine installed in enclosed area with outer openings protected 18 C Displayed / exposed food effectively protected 19 NA Running water dipper well installed for bulk ice cream service or equivalent handling 20 S Equipment installed for cold holding potentially hazardous food 21 C Equipment installed for hot holding potentially hazardous food 22 C Dry storage area designated 23 C Maintenance and cleaning equipment storage area designated 24 C Employee personal article storage designated Plumbing and Bathrooms ., .. 25 C Plumbing system installed 26 S Mop /service sink; can wash - shown Location(s): Dishwashing area 27 S Water heating device Location: Dishwashing area 28 Establishment type: Stand alone ❑ Mall (strip /enclosed) ❑ Incidental ❑ Lodging associated ❑ Theme park/entertainment complex 29 S Public bathroom installed Type /Location Shown: ❑ Bathroom for each sex ■ Unisex only ❑ Public bathroom(s) on same level ❑ Public bathrooms within 300 feet on same level 30 S Public bathroom(s) accessible to customers without going through food preparation, food storage or warewashing areas 31 S Employee bathroom(s) provided ►Z1 Same as customer bathroom(s) ❑ Separate from customer bathroom(s) r . r ;E � Water Supply ; . � z " = . � 5 -,�, �, . 32 S Type of supply: ►t Municipal ❑ Onsite Well ❑ Other Public well permit number: 33 Provider name: Miami -Dade Water & Sewer Department 34 Written approval/verification via: ❑ Copy of bill ❑ Approval form Provider letter ❑ Permit ❑ Electronic account document ❑ Verbal ❑ Other Waste Water Disposal ,, 35 S Type of system: Municipal ❑ Septic Tank ❑ Package Plant ❑ Other 36 Provider name: Miami -Dade Water & Sewer Department 37 Written approval/verification via: ❑ Copy of bill ❑ Approval form Provider letter ❑ Permit ❑ Electronic account document ❑ Verbal ❑ Other 38 Septic tank system Permit number: ❑ Restrictions (see provisos) Tank size: gallons Drainfield: square feet Grease trap: gallons 39 Seating capacity per plan: ❑ Inside seating ❑ Outside seating ■ Total: 0 Projected number of seats contingent upon approval from local Authority Having Jurisdiction Comments: DBPR Form HR 5021 -011 Page 2 of 3 Revised 2009 October 27 Water 43 The following general provisos apply to all public food service establishments. ALL ITEMS WILL BE VERIFIED BY AN INSPECTOR AT THE TIME OF INSPECTION. / Backflow Prevention ,, ,... + Hot and cold water supplied to all sinks where required (e.g., three - compartment, handwash, mop /service sinks) 3 -J If allowed by the local Authority Having Jurisdiction, warewashing sinks and machines may have a direct connection tang ._ _ _ _,_._ ._ _ Light fixtures shielded / coated / covered where food is stored / prepared / displayed or where single - service items are open / exposed 46 Equipment 47 Illumination — 50 foot - candles in food preparation areas; 20 foot - candles in self- service areas, inside reach -in or under - counter refrigerators, handwashing and warewashing areas, equipment and utensil storage, toilet rooms; 10 foot - candles in walk -in refrigerators and freezers, dry food storage areas Installation and Operation ...,, {.,... _._,:_ M...... Waste container (dumpster), grease receptacle, compactor, recycle bins on nonabsorbent surfaces (pad) 48 Local exhaust ventilation installed over cooking units releasing steam / grease laden vapors / smoke 49 Bathrooms ventilated / provided with windows; doors self - closing; doors / stalls constructed to insure privacy 50 Equipment, mop /service sink/can wash /compactor area properly drained to sanitary sewer; refrigeration waste piping discharges indirectly into floor drain or other approved receptor; Laundry facilities protected 51 Dish machines have visual sanitizer delivery system or incorporate visual / audible alarm to signal if detergents and sanitizers are not delivered to the proper cycles 52 All hose fittings protected by backflow device; back siphonage /backflow protection if no air gap /break 53 Fire 54 Doors to exterior self- closing unless emergency exit Safety Notification (Enforced by Local Authority Having Jurisdiction) No mesh filters in hood with automatic fire suppression systems installed 55 All gas appliances have a nationally recognized testing laboratory seal such as AGA or UL 56 Class K and other portable fire extinguisher installed as required by NFPA 10 and /or local fire authority 57 Automatic sprinkler and fire alarm systems required for occupancies greater than 300 58 Exit doors open outward for occupancy greater than 49 . 59 Provide 16 -inch separation /vertical splashguard of 8 -inch steel / tempered glass between fryer(s) /open flames Plan Reviewer: Richard Bull Results ``?. ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) Date: 04/26/2010 Plans returned to submitter on (date): I ❑ Mailed ❑ Shipped ❑ Scanned to agent/contact person ❑ Plans picked up by: I Signature: ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plan Review Packet scanned to District I Date: Plan 40 Results ``?. ❑ Plans approved without provisos 42 ❑ Plans denied (see provisos) 41 Plans approved with provisos (see provisos below) Provisos: 1. If any hand wash violations are observed at future inspections in the food preparation area, an additional hand wash sink "may" be required. ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plans approved with noted provisos (see provisos above) DBPR Form HR 5021 -011 Page3of3 Revised 2009 October 27 Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 , Project <NONE> Owner: IGHAL GOLOFARB Phone: (305)868 -8203 Job Address: 8849 BISCAYNE Boulevard Parcel: PARC2003 -23 Miami Shores, FL Block: Lot: Scheduled Insp # 06/07/2010 INSP - 143446 Final Telephone & data O. K.. Friday, September 24, 2010 Inspection Type Inspection Status APPROVED Inspector Date Completed Michael Devaney 6/7/2010 Page 1 of 1 5.2o.I0 b rJAuD BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical 0 0 Value of Work For this Permit $ 1 ✓ COD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30$)795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Titleholder) ( G 01J P4. Phone # Permit No. £ZC10 agel Master Permit No. CC - 6 Owner's Address City State Zip Tenant/Lessee Name G r D 0 1 111 S 1 Z.L Phone # E -MAIL: p• A 7N R Job Address (where the work is being done) o 53 Li C9 131 Sc C 13 L V 1� 3 53 City Miami Shores Village County Miami -Dade Zip 3 1 3 FOLIO / PARCEL # Is Building Historically Designated YES NO 4. ai 44, : ,■ug (L Lt.s 'YS 3 05— 7 38 Contractor's Company Name Phone # Contractor's Address 2S 3 N L ('o to S T C i t y ri S t a t e FL Z i p 3 3 I ( g 2- Qualifier Name 17ON/A VRP/ b LA /N^l Phone# 305 —1-23 tB State Certificate or Registration No. E l 000 0 S `10 Certificate of Competency No. 0 1 L` 0 G 0 S 15 E - MAIL: oNA• t ) R VDL@. `(A1-100 C, °M Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: 11) COO a =Type of Work: DAddition ❑Alteration r ❑ Repair/Replace ❑ Demolition _ Describe Work: -14NIZ E( 13 Drh7ft CAaLLS /(� . h s + ****, , , *, , * *a, *,u**** **********a *ta, *** Fees***** * *****, *** *,u***** *** *****,u** ***,xaa r*** Submittal Fee $ �© 52-9- Permit Fee $ /owe " CCF $ 0 ' ( e CO /CC Notary $ Training/Education Fee $ 0 :7-- Technology Fee $ 6 • S - Scanning $ .3 • l Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ I Structural Review. $ Total Fee Now Due $ Sy le 0 See Reverse side --+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip (Revised 02/08ro6) Signature — Owner or Agent The foregoing instrument was acknowledged before me this day of 20 / 0 , by 7vnald. ✓am d a Lag, n who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: (/ l Print: My Commission Expires: ** * ** *** * * ***a *aa*** ****a* APPLICATION APPROVED BY: o - e Lender's Name applicable) L' City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition t the issuance of a building permit with an estimated va[ue exce promise in good faith that a copy oft notice of commencement and construction lien law brochure will whose property is subject to attachmen . Also, a certified copy of the recorded notice of commencement m for the first inspection which occurs en (7) days after the building permit is issued. In the absence inspection avllt *I be approved and a einspectioj ee will be charged. Signature Contractor The foregoing instrument was acknowledged before me this day of 20 . DO Om/d Vc det who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expir aa / , ' - a x Y re) $2500, the applicant must e delivered to the person t be posted at the job site of such posted notice, the Plans Examiner Engineer Zoning AC R PRODUCER (888)568 -2299 FAX: (888)868 -29 Royal Palm Agency Inc. 777 East Atlantis Avenue Suite C2, 8371 Delray Beach FL 33483 INSURED Telesystems of Florida, Inc. 253 NE 166 Street Miami 'COVERAGES OTHER AUTOMOBILE LIA8ILI•IY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS FL 33162 THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITK RESPECT T0'vuHICH THIS CERTIFICATE MAY BE ISSUED O. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS.OIBUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. W811'14p IYL • •- . J..TR WORD TYPE OF INSUwnNop POLICY NUMBER MATF nP I .I� GESERAL LAWN X CO MM6RCWL GENERAL LIAINU TY I CLAIMS MADE t 1[• I OCCUR GEM. AGGREGATE vurr APPLIES PER: x 1 POLICY I « I 'IiF r fl LOC NON-OV,NED AUTOS GARAGE LIABILITY R ANY AUTO W$$$1 UMBRELLA LABILITY J OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMP$N$A'nON AND EMPLOYERS' LWB1LrrY ANY PROPRIETORIPARTNERtEkECUTIVE C RM1 EXCLUDED? (Mandatory nee, ye s CINEw CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 : ACORD 25 (2009107) ' 1NS025 wool) Fax : CERTIFICATE =01249060000D2 NCP760043800 41 OF LIABILITY INSURANCE DAT fhthifEar YY) •• . 3/-11/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORi11ATTOt ONLY AND CONFERS NO 'RIGHTS ,UPCN: CERTIFICATE HOLDER. THIS CERTIFICATE, DOES N0 .' AMEND, £;7 OF ALTER THE COVERAGE AFFORDED BY THEPDE:TCIES•BELOW INSURERS AFFORDING COVERAGE . ' .. w'su ERA Wax Specialty Insurance• INSURER s CastlePoint Florida 1.AsUrance . INSURER 0: INSURER D: INSURER E: 9/9/2009 2/12/2010 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIALPROVISOre May 24 '10 12:43 P.01 CANCELLATION REPRESENTATIVES. 9/9/2010 2/ SNOIA.DANYOFTHEABOYEDESCROBED "' .g ; • �e: •.,,. POU'c l DATE THEREOF, THE =UM W EURER WILL ENDEAVOR T D MAL PAY NOTICE TD THE CFRTWPICATE HOLDER Lamm SP S '>per�EL:E3'T �P`t�OSO;IlAf1 IMPOSE NO OBLIGATION OR 1.1ANEITY OPANY`'" ' ` 'S'" aro tiPOr'triiES iSs �i mvls a AUTHOR>ZFD REPRESENTATIVE A TeStrake /ALISON rwag eTp ;n.. • o., NI •• NAIL iE' ri • Igts 798s -2009 ACORD CORPORATION. An lights j e( The ACORD name and logo are registered marks of ACORD EACH OCC1JRiENCE . $ O E}d O{ MED:PCP ufnf•one person) $ s .' ai. 5., 0( ] iO t PERSONAL &RDV GENEaA1 EC AT.E . S. $ • . • '• 2,...(171_,_0• 'O( j ' 2 , • GiOflidl PRODUCTS: CONIPIOPAGG co61BITEDISINGLE LIMIT (So ecadenp .. • BODILY • ' (PegpeHaanY. $' ' . . .0. UODILY INJL RY • • (Per meeklept) . • $ . . r: FROPERRY DAMAGE .: (Per eaidonp' . $ AUTO ONLY.- RA Adams' $. OTI•cR TI SN 'EAACC $• } AUTO EACH oceBRRENc$ . •• . '$ • • ., AGGRL •g • • ITr `• j l I . •.• . Fg $.L EACH:ACCICENT'. • '$' '• •• • 00' ;•00 E.L DISEASE - eMPL'oVE$ $ .$ • 1b0400 seo E.L 015EASE - POLICY Lear .0Q AC R PRODUCER (888)568 -2299 FAX: (888)868 -29 Royal Palm Agency Inc. 777 East Atlantis Avenue Suite C2, 8371 Delray Beach FL 33483 INSURED Telesystems of Florida, Inc. 253 NE 166 Street Miami 'COVERAGES OTHER AUTOMOBILE LIA8ILI•IY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS FL 33162 THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITK RESPECT T0'vuHICH THIS CERTIFICATE MAY BE ISSUED O. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS.OIBUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. W811'14p IYL • •- . J..TR WORD TYPE OF INSUwnNop POLICY NUMBER MATF nP I .I� GESERAL LAWN X CO MM6RCWL GENERAL LIAINU TY I CLAIMS MADE t 1[• I OCCUR GEM. AGGREGATE vurr APPLIES PER: x 1 POLICY I « I 'IiF r fl LOC NON-OV,NED AUTOS GARAGE LIABILITY R ANY AUTO W$$$1 UMBRELLA LABILITY J OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMP$N$A'nON AND EMPLOYERS' LWB1LrrY ANY PROPRIETORIPARTNERtEkECUTIVE C RM1 EXCLUDED? (Mandatory nee, ye s CINEw CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 : ACORD 25 (2009107) ' 1NS025 wool) Fax : CERTIFICATE =01249060000D2 NCP760043800 41 OF LIABILITY INSURANCE DAT fhthifEar YY) •• . 3/-11/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORi11ATTOt ONLY AND CONFERS NO 'RIGHTS ,UPCN: CERTIFICATE HOLDER. THIS CERTIFICATE, DOES N0 .' AMEND, £;7 OF ALTER THE COVERAGE AFFORDED BY THEPDE:TCIES•BELOW INSURERS AFFORDING COVERAGE . ' .. w'su ERA Wax Specialty Insurance• INSURER s CastlePoint Florida 1.AsUrance . INSURER 0: INSURER D: INSURER E: 9/9/2009 2/12/2010 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIALPROVISOre May 24 '10 12:43 P.01 CANCELLATION REPRESENTATIVES. 9/9/2010 2/ SNOIA.DANYOFTHEABOYEDESCROBED "' .g ; • �e: •.,,. POU'c l DATE THEREOF, THE =UM W EURER WILL ENDEAVOR T D MAL PAY NOTICE TD THE CFRTWPICATE HOLDER Lamm SP S '>per�EL:E3'T �P`t�OSO;IlAf1 IMPOSE NO OBLIGATION OR 1.1ANEITY OPANY`'" ' ` 'S'" aro tiPOr'triiES iSs �i mvls a AUTHOR>ZFD REPRESENTATIVE A TeStrake /ALISON rwag eTp ;n.. • o., NI •• NAIL iE' ri • Igts 798s -2009 ACORD CORPORATION. An lights j e( The ACORD name and logo are registered marks of ACORD Inspection Number: INSP - 145749 Scheduled Inspection Date: June 17, 2010 Inspector: Perez, JanPierre Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project: <NONE> June 16, 2010 Miami Shores, FL Contractor: TECHNO A/C INC. Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CHANGE OUT OF 2 CONDENSING UNITS 4 TONS TOTAL to LI iv Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments For Inspections please call: (305)762 -4949 Permit Number: MC -6 -10 -1052 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number (305)868 -8203 PARC2003 -23 Phone: 305 -412 -7666 Page 15 of 20 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simp e Titleholder) P�' 7A ZY7 Phone # V ,6/8 City State Zip Tenant/Lessee Name Phone # Email Owner's Address Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO k„--- Contractor's Company Name 7e-0 ©G ---...0 Contractor's Address e 3 7 � c4J /0 3 —7- City /er State Qualifier Name / ie , d ;ion No.C.--/5 , 74 Certificate of Competency No. State Certificate or Registr Contact Phone Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: Submittal Fee $ Notary $ Scanning $ Double Fee $ Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 290 -7a 6 E -mail oft Permit Fee $ Training/Education Fee $ Radon $ DPBR $ g t > PO Square / Linear Footage Of Work: ['Alteration ❑New D air/Replace * * * * * *** ************************* t CCF$ Permit No. Master Permit No, Phone # C 5 o X 7 6 6� Zip 3 2 (STC Phone# (7S) Phone # I zainwq JUN 0 5 A WC.) i0-ice cl®- 16 Flood Zone "4 ❑ Demolition CO /CC $ Technology Fee $4' Bond $ Violation date: (� Total Fee Now Due $ ` t(J1 <GO See Reverse side C f:::2 I Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Engineer Con The f instrument was ackno \ g before this) day o��/ 1 l h• is per onally own to e or who has producedf) Qt 10 -S , /..J , 20 10 b t V , NO AR PUBLIC: Sign: rc,\ "?".3 P. 4D� `1�° `F` V y'.l e e Print: ,'i • X1. -iSa ' ,aaM a ) .: ��' o tm • . ��.. a • ,k �, , * ** * * *** * * * * * * * * * * * * * * * * * * *3e****3 *** *dt�de ,� k *oYsY�Y9t3: k9e** .�O a ns Examiner Zoning My Commission Expires: cation and who did take an oath. Clerk checked Scheduled Inspection Date: June 17, 2010 Inspector: Perez, JanPierre Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project: <NONE> June 16, 2010 Miami Shores, FL Contractor: TECHNO A/C INC. Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Inspection Number: INSP- 146122 Permit Number: MC- 3- 10-474 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)868 -8203 Parcel Number PARC2003 -23 Phone: 305 -412 -7666 INSTALL 4.0 TON A/C PACKAGE UNIT, DUCTWORK, BATH FAN KITCHEN HOOD RELOCATION. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 17 of 20 BUILDING PERMIT APPLICATION FBC 20 Permit Ty : MECHANICAL Owner's Name (Fee Simple Titleholder) ; �O . t 1 Phone # Owner's Address 1/ of ® A/17,9-e d f2 /2‘G !.� City iY■9 J Zip 3I.5 Tenant/Les ee Name r,1 JD,Z/N ,/ 77.4 Phone # (77 -') 3 `F 5 0 1 Email 6 L 4 tQ-M.j ELL A e u-n -i .N `T Job Address (where the work is being done) 2g fged%e. City Miami Shores Village FOLIO / PARCEL # F4 i.i-)4-- o A � g 11-8 - 17 Le Is Building Historically Designated YES NO Contractor's Company Name 7 - CHP/V ftl C , 7v - Phone # 7r6 21t9 -n644" 43 L/S � `) , /0 S S 7 City / )9 /F i/ State ® �L Zip 33/ 57 Qualifier Name so in /goe V Phone # 74 % 2- 7o 6( State Certificate or Registration No. age. ® 5-6 70f Certificate of Competency No. Contractor's Address Contact Phone Submittal Fee $ "7g1,9 290-7‘066 gado/ MAO D 2e-I 0 city-rya,/ ..................................... Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Fee $ County Miami -Dade Zip E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ /i2 6 Square / Linear Footage Of Work: Type of Work: LAddition DAlteration New % %tii)' Repair/Replace ❑ Demolition Describe Work: 09/ S 1/ 0 ' /9' 4, dJ Cr t,191u' 1 3 •'97 -? /54 Notary $ Trainin du on Fee $ P."0 Scanning $ 3 00 Radon $ t ' DPBR $ Double Fee $ 3oto»co Structural Review. $ Violation date: a Total Fee Now Due $ triNIU\VT.TrA MAR 2 211K BY:..., Flood Zone See Reverse side Permit No. C, I - - r 1 9 Master Permit No. CC `'°4141 **** * ********************************* u 0 CCF $ (0•00 CO /CC $ Technology Fee $ K OE) Bond $ Bonding Company's Name (if applicable) Bonding Company's Address i - City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the-foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 1\J 24c The foregoing instrument was acknowledged before me this g2 day of m 20 I U, by Mak, CCU) 1) , who is personally known to me or who has produced CL— J As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY •A 1 J U_1 • �O y Cr. • 't )4 4Z 7 � •. LL, *********** * * * * * * * * * * * * * * * ** * * * * * *, * * * * * : ************ *:** * ** * * * * * * * * * * * * * * * ***** * * *** ** **** ** xaminer Engineer (Revised 07 /10 /07XRevised 06/10/2009) Signature CU1N AforeAri The foregoing instrument was acknowledged before me this day of , 20 L,� , by hik A-2.t (]iLIvi44, who is personally known to me or who has produced ) as identifi M l Uw,ho did take an oath. i .• Sign: Print: NOTARY My Commission Ex eWI " 1I / n 1 111 0‘ s � ``` Zoning Clerk checked THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. + mart LTR UU L NSRC TYPE OF INSURANCE POLICY NUMBER — POLICY - EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL- 0000018482 -00 04/26/09 04/26/1 EACH OCCURRENCE $ 30 0 , 0 0 0 X PRE ISES(Eaoccuence) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 30 0, 0 0 0 GENERAL AGGREGATE $ 300 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JEQ n LOC PRODUCTS - COMP /OP AGG , $ 300,000 X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS AND EMPLOYERS' ANY OFFICER/MEMBEREXCLUDED (Mandatory If yes, describe SPECIAL PROVISIONS COMPENSATION LIABILITY Y/ N WC STAN- O - I TORY LIMITS I fH ER ECUTIVE I E.L. EACH ACCIDENT $ In NH) under below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS From: Odalys Gonzalez At NCF Insurance FaxID: NCF Insurance To: Arlenis ARC CERTIFICATE OF LIABILITY INSURANCE 91222 T 2 2 PRODUCER + • • • NCF Insurance Associates 8700 West Flagler Street #320 Miami FL 33174 Phone:305- 446 -5474 Fax:305- 444 -8796 INSURED Techno -AC Inc. SW 33156 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: U S Security Ins Co INSURER B INSURER C: INSURER D: INSURER E: DATE (MM/DD/YYYY) 03/22/10 NAIC # COVERAGES CERTIFICATE HOLDER City of Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 ACORD 25 (2009/01) CITYMSH CANCELLATION Date: 3/2212010 08:58 AM Page: 2 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO A • REPRESS THE O' 988 -2009 PJ RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Scheduled Inspection Date: June 10, 2010 Inspector: Devaney, Michael Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project: <NONE> Miami Shores, FL Contractor: AGUILA ELECTRICAL CONTRACTORS Building Department Comments June 09, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ,t).L° \v Inspection Number: INSP - 138682 Permit Number: ELC- 3- 10-473 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number (305)868 -8203 PARC2003 -23 Phone: (305)397 -7604 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments AI' T AW 49 Page 3 of 17 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. E4L c - 413 PERMIT APPLICATION Master Permit No rcl 0— L 1101- FBC 20 Permit Typ • ELECTRICAL Owner's Name (Fee Simple Titleholder) � Gz / L. OV L P - i Phone # Owner's Address l 14o I<A •Cox; co i112 /'5 'L City eli17 UR-- s �Lr}$ State ` FL Zip 3 3) 6 Tenant/Lessee Name l"i `ZsgLJ 43 1- &A -910/1. 3 ' &Pi 5 Phone # (7 3 44 - 3 g O' Email 1501.. ; vi}2rt ?(? Eu& $ L 1f , 4 Z Job Address (where the work is being done) $ $ It/ 6 I $ e; & L i City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL #°1A9 k1 + . ) 4E-1 Lo j 4- Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 6 J/ - /4 f Ze e p* # 3 05 3 77 7 6 0 �f Contractor's Address s2 / 3 3 / 5 eu 2 1 4 6 5 City Al /11 7 A. State F‘.._ Zip 3 5 c7 3 t Qualifier Name , (� 5C2 0 0/ G..4 Phone # 3 O 5 3/ 9 7 7 c' O 4f State Certificate or Registration No. eA / 30 Ca 15 Certificate of Competency No. G4' e 00 6 0 e Contact Phone 965 577 76; o -( E -mail /9‘016,4- ez ec?e,uc . 1(D7</74/ ( . GG `k Architect/Engineer's Name (if applicable) Phone # VAR 2 2D10 BY: ea Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: ******** * * * *** * * * * * * * * * * * * * * *** * * * * * * ** F * * **** * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 2/6.4 0.0° CCF $ ` CO /CC $ Notary $ Training/Education Fee $ (V1 J Technology Fee $ 1Q Scanning $ 3'00 Radon $ 1O - 00 DPBR $10 Bond $ Double Fee $ 4Sa•CX) Violation date: Structural Review. $ Total Fee Now Due $ ' Fi • 00 See Reverse side --+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signature Lf fc Signature Owner o ` The foregoing instrument was acknowledged before me this 3v day of IdiSAM, 20 lJ by T P 0 , who is personally known to me or who has produced t 1, As identification and who did take an oath. NOTARY PUBLIC: `001n11VOO " il�s,, ua Print: ; = m �v � d �o My Commission Expires c d' >' � o . ' • 1 !111 I N 111 APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Contractor The foregoing instrument was acknowledged before me this day of Wiira.e44 , 20 tO, by _ 55( (I , who is personally known to me or who has produced ►uu►u,�, 9 as identification and who did take an oath. 4` ,v�l,�� NOTARY PUBLIC: Sign: Print: S ¥Q.... , • • , AI % :, %si Qc ' % di • ∎•• ■ � My Commission Expires: 1!111 9r**** 9r3r9r9t9e3r**3t**********de3e9i**** k*3c**** k3: 4e** *3e3c3e3e*1Y3e3e4e***** 9e4e* **3c9r******de3e**Ar** ** *4r3e*3r3c*3c****kiraY OPlans Examiner Zoning Clerk checked Permit No: 09• 66 A° Job Name: ��/r',�- J' - 7 /COLA- /49 , 2009 ELECTRIC Critique Sheet / IA- ,e pj 3 %� 2 5 a 1 Pa #( y -- 1/ / 6 a- /4.4_ • 17A bp- 7 e' - , ?e 3 1/441y se. /Z /s °QI f /`/2 e �`/ v40 y/A14 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Mike Devaney 305 - 795 -2204 M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER. C1 CMarance 1921 NIV 15O AVESURE 1O1 Pembroke Pkles FL 33926 INSURED Oct. 27. 2009 1: 09PM COVERAGES OTHER AGUILA &MIRO!. CONTRACTOR RC 21313 SW 129 PALO MLAM FL 331/7 MSS Mal LTA low Irvin= tled(I mNer ALNEML LIA1► A X woman CAI. I CONS c j tAGO L . 0MT APPLIES DER 1 PauCY LOC m nIIT AuTo ALL MINED AUMM SCHEDMEDANTOS tlD auros NONAUTOS Atwell LIABILITY ANY AUTO excessulEBRELLA UNMET OCCUR ❑ CLAIMS MAIN: R OEpuGTMLE RETEHTN WflCNAND EMPLOTERB LMA8 U PROPMETMPARTNERIMIEOUBVE OFFICERME OCCLUDED? 1P CELL ONS bN mpTIONOF OPERATIONS ILOCATIOIat VENOMS / EXCLUTAMES Elmo BY BEIOASIMMNT/SPECIAL P CERTIFICATE HOLDER ACORD 25 (20011) CITY OF IMAM SHORESVRAAGE 10950NE 2 AVENUE NAM SHORES, F1.33136 01 poucENDNEHT INSURERS AFFORDING COVERAGE INEURERA MAT15NALGROIIP INSURANCE era IMAMERE wanwriumwar CANCaUITNNE 10R7r1010 EOOILY INJURY BODILY DIARY (Pereoe6Q OMER MAN A ONLY: No. 2422 P. 13/29 THIS CRT KATE 15 ISSUED AS A MAYOR OF MFOINAAT1011 ONLY AND CONFERS NO RIGH1S UPON THE CERTIFICATE HOLDERI. THIS AGATE ROES NOT Ammo EXTEND OR ALTER THE COVERAGE AFFORIRD BY THE POL BELOW. THE POLDIES OF INSURANCE LISTED BELOW RAVE BEEN NEATER TO THE DISUSED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTINITHSTANOINO ANT REQUIREMENT. TERM OR COIDITE* OF AIRY CONTRACT OR OTINIR DOCUMENT METH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY P TAIIR. THE INSiIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREN IS SUBJECT TO ALL TIE TERMS. EXCLUSIONS AND CONOITIONS OF SUCH PINES. AGGREGATE LIMTI$ SHOWN MAY HAVE SEEN MIXED BY PAID CUJMS. EACH NAMED ;Pm n'ainiMM MEOup (Any ano> PERSONAL WMINJURY CAI. AG GATE s saes s 1,000;50 e 2,000,05 -MMAREge..ge s 11 ". CORSETED SINGLE UMW NEEENN PicPERrY mum par aseNderi) ANNINOIss AUTOmY• EAACCIQEf EAACC AGG EACH OCCURRENCE AGGREGATE DATE (B►YYIY 1 1,000,000 s 100,900 E1, EACH A88i r $ EL. DISEASE •$AELDYEE $ EL, DISEASE • POLICYLeAI S HNC SIMOULDPAYMFTIMADOVEDEsasseoPOLBM3BECNcELLEDSEFODETHEIBMELATION CATE TNETTEDF. TEE iSMENI3 MOM WEL MENEM ToDAAIL DAYS WRITTEM NoncE TTOTHECam!! MIE MISER Mao TO THE LEFT.TEITFWLERE INFGGE ND ORIMM ni OR LMMU1Y OF MY 1IETT UPOII TEE MUSES 01 AERI1TM DA PSPRESENTATITED. ACORD CORPORATION 111111 Scheduled Inspection Date: June 11, 2010 Inspector: Hernandez, Rafael Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Project: <NONE> June 10, 2010 Miami Shores, FL Contractor: AB&K PLUMBING INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Phone Number Parcel Number Inspection Number: INSP- 145853 Permit Number: PLC -3- 10-472 For Inspections please call: (305)762 -4949 \ ''\O Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration (305)868 -8203 PARC2003 -23 Phone: 305 -553 -3508 PLUMBING FOR 1 NEW RESTROOM AND KITCHEN AREA Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 5of6 BUILDING PERMIT APPLICATION FBC 2004 City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Ail mac. K @ice c r. \ r19 ) C MVP Contractor's Address 4 LI) 33 1 ptc City VA T State 9L Zip `;3c dt) Value of Work For this Permit $ Type of Work: ['Addition Miami Shores Village Building Department f0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 'Fax: (305) 756.8972 D0© County Miami -Dade Zip fp) rem-envx ) ion Permit No. P 1 0 4i a Master Permit NoCC../ 10 ° 40 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) ; S C Ay r e. $ s - TOM 1_i_[ . Phone # Owner's Address 1 I LAO e C onc'guiZse City — R A y \ -4 INV ROi:k State FL_ Zip 33 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) Phone # &305) crib d 54045 Qualifier Name - 1:2,0 \ e -k- L1 erg rN to R cl eZ Phone # 305 ) cult) - 50 , 45 State Certificate or Registration No. (? , Z C O'. 0 3 09 Certificate of Competency No. E -MAIL: a uMin'tor t lc VSOt) $1 Architect!Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: a` Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: , _ �n -4t c- "L new re res4rnorn n\(3 k i-r a - n RIFLeCA * * *.,.a,.,.,.,.a,.a,. *,......x, , , , , ........... Fees, , , *a, ........., ..... a Submittal Fee $ Permit Fee $ 00 - '1 CCF $ 5tl�l J CO /CC Notary $ Training/Education Fee $ 1 .ao Technology Fee $ 440 Scanning $ Radon $ 10 , 00 DPBR $ 10 Zo $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature a , Owner o6gent) The foregoing instrument was acknowledged before me this ,, day of f t'1 A , 2 0 10, by mc42 O t.4\ . who is personally known to me or who has produced t ip As identification and who eum/MP. �,� • t � c a NOTARY PUBLIC: Sign: Print: My Commission Expires: ** ****** # ******* ** **** * * **** APPLICATION APPROVED BY: (Revised 02/08/06) soo =a 11 The foregoing instrument was acknowledg - ' ore me this 92. day of V , 20 ‘O , by who is personally known to me or who has produced as identification and who did take an oath. ��•�m �0 :rye `a�4e#t? w bOF'.ROTO ubl r State of Florida ,r .n Expires Dec 22, 2010 My Commi Bon;: Notary Assn. PUB }Fa ,N 2 0 t J�* � Liitt . t %fe atr ** - � , u irhII� R8 999 6 ) P O � '��° Bo nded By Na ..: .s = 1,11111=, Engineer Zoning Miami Shores Village Building Department - Permit -No. - Job Name PLUMBING CRITIQUE SHEET Arme)//1:16 P-eggi Hee;l / 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Jun 1410 01:19p Jun 14 1C 06:33tA AB &K Plumbing, Corp. INTERNAI IONAL Building Address A B & K Plumbing 13427 SW 284 St Miami, F133186 Lie. 4# CFC 030209 305-216-7280 Fax # 305 -246 -3028 Affidavit of Certification of Gas line Manometer Test I, J4su s 1'46 sue}- . certify the following manometer test having been done on 6 " /ZZ /v conforms to the 2004 Florida Building Fuel Gas Code. The installation on the property described below has withstood the specified test pressure as described in NFPA 54 Z223.1 test procedure. WC1 // • TIME /0 '.uTC Building Permit # ?LC 3 -id - 4172 305 - 246 -3028 p.2 . tJ -o4 -OWW 1 N. 1 9949 22-,5'CAYN . 4A1 SAO Ras, PL• Signature MIAMI-DADE WATER 8 SEWER DEPARTMENT METER OPERTATIONS & MAINTENANCE MIAMI -DADE CROSS-CONNECTION CONTROL UNIT CCUhlrf 1001 N.W.11%STREET, MIAMI, F 33136 -2208 Phone (305)547-3046 7 Fax (305) 545 -9555 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM 1 ACCRESSDF wc- � j � .'5 ` q•YNg- 7?Ld� . A' 4.Eb- , eg OYQEROFDEVTCE: fAIDA To / VS y Z/A ` _ -_ l e 7 A6 )af ./- - gi�lf OB C'WNER D I // C 1 i5A/Q c2LI '5 'ra j H .I b ay FL. q1.1 ZP COLE: 2 �� 1CCA NAME OF TE CSYiiL.AS L. All— ,3 7 � CEF11 O E �/ �y 3d5 -80 , 7 -293 3. BU6lNESSNAME: iwre -A vaiAwra-e. A. Lei. A. BUSN °_SSACORESE. pay S&L/ 16 r'i n# ,1 iia�o mo ZI-ODDE: . 7!*�3 3 TEST KIT VAIN: I ICaEI�: i SERIAL P: �`I /13a1l� S T �,3 d { 050S0 A�,TEt.1R CAL 1 —f 0 S T TUBE: YES f NO • R.P. ✓" D. C. • P.V.B. MAKEcfASSEMBLY: W/1 i JS /zvi+ NCOELPJO SERALP: / 3 .3r L I 3 2-A4 b Z SIM: / ii LOCATION CF ASSEURLY: II HAZARLYSERVP.E: RE 4.4. o,c ®L,r) 4 CA/ w!i Cc I 1 6-4 yr! LIETEER. 7/0 5 8 ?) IN TIAL TEST NO' ANNLAL TEST: 1 CAM CF TEST: METER IN 419# o e $I Z OFFVALVF ill: SHLTOFFYALVE a LINE PRESSURE: PRESSURE STABLE: YES - NO CLGS=GTIGHT: ` CLOSED TIGHT V LEAKM: LEAKED: . . D V.A. R.P.Z.A. P.Y.S. I CHECK VALVENO.1 CHECKVALVENO.2 DIFFERENTIALRELIEFVALIIE AIR exer CHECK VALVE Closed Tight: ■ I, Closed Tight ✓r I FAILED T0 OPEN: FAJL'T0 LEAKED Leaked: _ Leaked: V OPENED AT: / PSI OPENED AT PSI HELD AT: PSI PPES { SUREDIIFFFERENITAL ACROSS CK:CK r • / PSI PRESSURE CIFFERErmALACROSSCrECK .G U PSG IF THE ASSEMBLY FAILS FOR ANY REASON, COMPLETE THIS SECTION AND NOTE REPAIRS REMARKS, REASON FOR FAILURE (1F APPARENT): (,)/9 s .r6 I?) CHECK 1 CHECK V.\RE Rai DI: FEREKr.ALRELIEF VALVE P V.B. saIdd2a CLEANED* CLEANED _ CLEANED: CLEANED: RE 'LACED: REPLACED: REPLACED: REPLACED: • D.C.V.A. . - R.P2A. P.Y.B. LLI I- Et CHECK VALVE NO. 1 CHECK VALVE NO. 2 INFERENTIAL RRIEF VALVE AR INLET CAECK VALVE Closed Tight Closed Tight FAILED - 0 OPEN: fALEcrC : LEAKED•_, Leaked: Leaked: OPENECAT* P al OPENED AT: PEI I- ELD PSI PRESSURE CIR ERENTIAL AMON CHECK PSI PRESSURE 3IFFERENRALA.:ROSSQ1Ea( pgl I CERTIFY FHA" I HAVE TESTED THE ABOVE ASSENIELY ACCURATE TO THE BEST OF IVY ABILITIES. IN ACCORDANCE W TH THE AN / A_CROSS CONNECTRON CONTROL MANUAL AND THATALL THE INFCR91ATION 15 SIGNATURE OF CERTIFIED TESTER j► DATE: 6 — ! Z. /c7 =OR OF =ICE USE ONLY: DATE Jun 1410 01:191?, AB &K Plumbing, Corp. Jun 14 1Q, 06:331 INTERNATIONAL .m laml d ade.gov /wasdfbacktlow.asp 305 - 246 -3028 JUhj - VL• r 4.J t, P p .3 c kt*-6-61901-5s 013,v. Scheduled Inspection Date: September 08, 2010 Inspector: Bruhn, Norman Owner: GOLOFARB, IGHAL Job Address: 8849 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: W&R CONSTRUCTION GROUP INC Building Department Comments September 07, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 147787 Permit Number: RF -7 -10 -1215 For Inspections please call: (305)762 -4949 Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number (305)868 -8203 Parcel Number PARC2003 -23 Phone: (786)499 -5203 FLAT ROOF REPAIR Passed , f Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments (C- Page 6 of 20 Submittal Owner's Name (Fee Simple Titleholder) 1 �C Owner' Address I t � C ,/ C cJC City a irt..L ®1' State Pi- Zip Tenant/Lease Name Phone # 'Frail 'Job Address (where the work is d City Nt ami.Shores / Villa ge FOLIO / PARCEL # ( ! .5R(9 Is Building Historically Designated. YES Architeet/Engineer's Name _ (if applicable) ,Contractor's Company Name . W/C�� © lV Contractor' Address f ,36 : . .sgR ' �G�cJ: :. City ...:. �3 FrI€5;� :. � . '....• `..:... S.tate„„�r _ Qualifier Name c (H e z T / State Certificate. or Registration No ace (3° /t / . Contact Phone. 7g'6 �.... : ; 2 C / NO Value of Work For this Permit $ Type of Work: DAddition , Alteration DNew � [[ scribe fork: r . �"�` / r.: '.Q7 done) Re94 9 : - 8 f l E County Miami -Dade Zip Zip. 0. A Phone # 78 Certificate of Competency No. E -mail / C 6U r eild it1 144 / r CO Phone ## Square / Linear Footage Of Work; • 9' . n issreir kr F9rac�Y3t fit �k3tiF3ex$ dtdt9i.�t &***4e **k�r3**F s �icyk4e9F ** Fee Permit Fee ?2 Tr Tee .$ Permit No. R F, 10 t C Master Permit No. Phone # w>6.- 0 6'" Ae Flood Zone : Phone # 7? 6 - 455- - 6 Repair/Replace BY: ❑ Demolition *4 *`* *********** ******x'**' ;P* *** * ** ** CCF $ CO /CC' $ Technology Fee $ Bond $ BUILDING PEST APPLICATION FBC 20 Permit Type: BUILDING ROOFING Notary $ Scanning Radon Double Fee $ Structura1 Review. Miami Shores Village Bui lding Department 1.0050 N.E2nd Avenue, Miami Shores;. Florida 33138 Tel: (305):795:2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 DPBR $ Violation date; Total Fee Now Due $ See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City State . Zip Lender's Name (if applicable) Mortgage. Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated, I certify that no work or installation bas commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGN'S, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ;WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU : INTEND TO DETAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an stirnuted vat. promise in good faith that a copy of the notice of commencement and construction whose property is subject to attachment. Also, a certified copy of the recorded not for the first inspection .ecurs seven (7) days after the building permit inspection will no -e approved a . a reinspection fee will be charged. Signature • wrier or Agent The fore oing instru rent was ac s pwledg d b day of u - , 20 /0, by who is persona ly known 'o - or who has produced NOTARY PUBL APPROVED BY (Revised 07110 /07XRevised 06110/2009) • t identifica and w o did take an oath. Sign. Print: 4if r4i'�#.i i�t /! X MY COMifUS +N # pp46 My Co `':scion t , of :pcl x 14.2014 vis Signature Contractor The fore ° o g instrument. was ackno ed be re �O�v , by �' day of 4 `„ ' -'� w o is'personally known to o has produced as id tiiication and who did take an oath: NOTARY P ;. L1Cs Sign: Print: My' thin - f • & Febroaey 14, 2014 Co. eoos e OT Nosy Discsant Alm * .:: ***** * * * *. * * * * * * ** * *** * ** * *** * * ** ** tit********k ** ****.* k**** A: *4 **** * * ***********x**. ******** ********ir* *,k** * * �i7�1 Plans Examiner Zoning Engineer Clerk checked '.a exceeding $2500, the applicant must lien - brochure will be delivered to the person of commencement must be posted at the job site issued In the absence of such posted notice, the NOTICE OF COMMENCEMENT A RECORDED COPY MET BE POSTED ON THE JOB SITE AT TIME OF FIRST Ni- i.ICN PBRN I N O . . TAX FOLIO NO. ! 13 Z p6 41l of Q d STATE. OF FLORIDA, COUNTY OF DACE IHEccEBYCERPFYVIRY,_As80 '" hy oi LJe uroma? fidsrl in this o ae c ' 4. -- L¢ THE UNDERSIGNED hereby gives notice that improvements will be made to n 'sea' A f`i'` r) ✓ C i i_�f r property, and in accordance with Chapter 713, Florida Siababes, the foil '` 1 7:e:R� s a r��. - 1.1i ea is provided in this Notice of Commencement STATE CF FLORIDA CCUAVTY OF MIAMhDADE 1. Legal dessccription� rope and street/add • O a�/G.L +�o 11111111111111111111111111111111111111111111 C FM 2r)10R05699 )4 OR Bk 2739E Ps 00022; (113s) RECORDED 08/23/20100 13:10=02 HARVEY RUVIHr CLERK OF COURT MIAMI -DADE COUNTYr FLORIDA LAST PAGE ourty C 9 J UG. c4 oat 650 ,u e- td to 2. Description of improvement: e -WADI` # boas 3. Owner(s) name and address: c.,,,sE Interest in property: Name and address of fee simple titleholder. ntractor's name and address: fit/ R s1"?udr(OA) / /cm.? %Pio • z5,1 O0 a. 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: /v 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7„ Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a differe Sign �'Rli Print Owner's Name Sworn to and subscribed Notary Public Print Notary's N My commissio 113 13148 8104 PA Prepared by 6 "E Y- Pt"; Cs4tfiet to 20 l . Address: 0 31 Al w y "� Ft 331 6 At4C COVERAGES CERTIFICATE OF LIABILITY INSURANCE PRODUCER Insurance Professional Consult 11240 SW 88th St Suite 202 Miami, FL 33176 Phone (305)273-4530 INSURED W&R CONSTRUCTION GROUP, Inc 11369 SW 238 HOMESTEAD,FL 33032 THE POLICIES OF INSURANCE USTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE M? BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'PIER ADITL POLICY EFFECTIVE POLICY EXPIRATION LT8 INS8I) ! TYPE OF INSURANCE POLICY NUMBER DATE(mivymyy) DATE mmirmiyy LIMITS I GENERAL UABIUTY i — I VI COMMERCIAL GENERAL LIABILJTY A CLAIMS MADE 91 OCCUR GENT. AGGREGATE LIMIT APPLIES PER 1 POLICY PROJECT j LOC AUTOMOBILE LIABILITY Li ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS1UMBRELLA LIABILITY OCCUR L CLAIMS MADE II DEDUCTIBLE 1 Li RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER CERTIFICATE HOLDER Miami Shores Village. Building Departmanet 10050 N.E. 2 Ave. Miami Shores, Florida 33138. ACORD 25 (2001/08) QF Fax (305)273-4409 CCP566081 DATE (NINUDDNY) 08/25/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEICI, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAM # INSURER A: CENTURY SURETY INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: 08/26/09 EACH OCCURRENCE DAMAGE ta 08/26/10 PREMISES (Ea assurance) MED EXP (Any one person) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS AUTHORIZED REPRESENTATIVE PERSONAL & ADV INJURY 1,000,000 [ AGGREGATE 1,000,000 PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: EACH OCCURRENCE AGGREGATE AGG 2,000,000 100,000 5,000 1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POUCY LIM WC STATU- °m- TO ITS ER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD CORPORATION 19 I certify that information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition or renovation and evidence that the required training has been.accomplished by this person will be available for inspection during normal business hours. (Print Name of Owner /Operator (Signature of Owner /Operator) r s (Date) (Contact phone #) DERM USE ONLY Postmark/Date Received ID # ❑ ,Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball I ' Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: Miami -Dade DERM Air Quality Management Division 701 N.W. 1st Court, 8th Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33135 TYPE OF NOTICE (CHECK ONE ONLY): '13 ORIGINAL ❑ REVISED ❑ CANCELLATION TYPE OF PROJECT (CHECK ONE ONLY): 1❑ DEMOLITION ❑ RENOVATION `ROOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES El NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑ YES IS ITA PLANNED RENOVATION OPERATI N? ❑ YES 1. Facility Name k "9_- Address /19 . � City i Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: ❑ School /College/University ❑ Residence ❑ Small Business Other Present Use: ❑ School/College/University, ❑ Residence ❑ Small Business Other 11. Facility Owner k. ' Phone 1, ( ) r . Address -^ e ).= -, ,- d c . i, d' 3 , State Zip City /P.-- ._ 111. Contractor's Name L Address , 161_01-158 10/08 Florida Department of Environmental Protection Division of Air Resource Management a 6 tt, State City Is the contractor exempt from licensure under section 469.002(4), F.S.? State'° Zip ''Rate ' Zi fi Zip r". County ❑ YES I NO 0 NO Phone 0 N COUNTY ❑ COURTESY MIAMi•I File # Process # IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) StartL'i' !' Finish: X F - '<' - s Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): t _,- , VI. Procedures for Unexpected RACM: V1I. Asbestos Waste Transporter: Name Phone (. ` - ) A' Address , R' . I ,'',4 ■ City ` VIII. Waste Disposal Site: Name i4k Address A5YYM�iY "JYY ° ®ti#V -�� I'J�nl- �abllclll'Ylln City State - Zip R a) 'AM QUALITY MANAG MENT DIVISION IX. RACM or - ACM: Procedure, including analytical methods, emplgyed to detect the presence of RACM aiRliganegrdrAtyltitgOtriciahlvAeld. Notifications) Regarding asbestos have been Amount of RACM or ACM* submitted in Compliance with square feet surfacing material square feet cementitious matertPlicable regulations. linear feet pipe square feet resilient floors g 1 cubic feet of RACM off facility component / , , square feet asphaM�� Date *Identify and describe suing material and other materials as .applicable:.: 13 DISTRIBUTION: White —DERM Yellow — Applicant Pink — Reserve Gold— Reserve DERM PLAN REVIEW FINAL APPROVAL DEPAIMENTC* RESOURCES MAN 1 certify th site during during .for ` the above in or tt n c tr 'aid th t an indi idual trained in the provisions of this regu4a a demolition o tion an evidenc that th required training has. been accomplitlie aI- btdsiness h rs " 7 0 (40 CFR Part 61" S `a t M) will be on- th s person will be .mail ble or inspection , 1 ( / c, - (Print Nam of Own Wrecking Ball Wet Method (Si,gnat trfO vner /Optratorj ,_ ---,: (Date) ' (Contact phone #) DERM U ¢(S�LY' Po t. k/D 9� '. to Received ID # ❑ Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: TYPE OF NOTICE (CHECK ONE ONLY): ' ORIGINAL TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? IS IT A PLANNED RENOVATION OPERATION? 1. Facility Name Address I City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: ❑ School/College/University ❑ Residence ❑ Small Business Other Present Use: ❑ SchooVCollege/University ❑ Residence ❑ Small Business Other 11. Facility Owner Phone ( Address City 111. Contractor's Name Phone ( Address City State Zip Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal ( mm/dd/yy) Start: Finish:. Demo/Renovation (mm/dd/yy) Start•. Finish: V. . Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter. Name Phone ( ) Address �". City State Zip VIII. Waste Disposal Site: Name Address 6`,dIAk6i if) 6 9 „I- LILT∎ h City State _Zip AIR QUALITY MANAGEMENT DIVISION IX. RACM or ACM: Procedure, including analytical methods, a toyeditg.detecttf%e. presence of RACM anUlriati4gWyclAttidilillIgiAlIVACtytOkl i `, '” . , Notification s) He �reiin be t os have h ra Amount of RACM op; squ fe lin .' a 9t ubi fis 161_01 -158 10/08 Florida Department of Environmental Protection Division of Air Resource Management NOTICE OF DEMOLITION OR ASBESTOS RENOVATION ❑ REVISED ❑ RENOVATION ❑ YES State YES ❑ YES Zip ❑ CANCELLATION ROOFING ❑ NO 11 NO File # DISTRIBUTION: White—DERM Yellow— Applicant Pink—Reserve Gold— Reserve Air Miami -Dade DERM Quality Management Division 701 N.W. 1st Court, 8th Floor Miami, Florida 33136 ❑ COURTESY ❑ NO Process # submitted in Compliance with square feet cementitious'materia ` tPpllcable regulations, square feet resilient flooring qua feet asphal l RAW Date ` t ° USW REVIEWER GNATtn,E DERM PLAN REVIEW FINAL APPRO L DEPARTMENTOF VI RESOURCES DATE AL I certify th the bove inform Lion ii corre +t and that an ind site during e d :molition or enov tion an. evidence that t during or a .. mess ours / (` / \ I, idual trained in the provisions of tiffs regulation (40 CFR Parr6T, S b a t,M) will be on- ',required training has been accomplishedgby this person wi i,be a ailable for inspection „. fl -(Print Name of Owner /Operator) P Glove Bag ❑ Bulldozer ❑ Wrecking Ball Sin�Y ek, ndr /O .razor ” ° t �3 � `� �I Wet Method (Date) ✓' ❑ (Contact phone #) DERM USE ONLY Postmark/Date Received Burn Down _ ID # ❑ Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball ❑ Wet Method ❑ Dry Method ❑ Explode. ❑ Burn Down OTHER: TYPE OF NOTICE (CHECK ONE ONLY): ORIGINAL TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? IS IT A PLANNED RENOVATION OPERATION? I. Facility Name Address IV. City Site Miami -Dade DERM Air Quality Management Division 701 N.W. 1st Court, 8th Floor NOTICE OF DEMOL TION OR ASBESTOS RENOVATION Miami, Florida 33136 ■ Building Size (Square Feet) Prior Use: ❑ School/College/University ❑ R Present Use: ❑ School/College/University ❑ R 11. Facility Owner Address City 111. Contractor's Nam Address City 161_01-158 10/08 Florida Department of Environmental Protection Division Air Resource Management V. Description of planned demolition or renovation work to b be used and description of affected facility components. Procedures to be Used (Chec All That Apply): VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name Address City VIII. Waste Disposal Site: Name Address City IX. RACM or ACM: Procedure, including analytical methods, en? Amount of RACM or *Identify an squ‘f linen Meet terra! Ofdt (M,o� off-facility components urfaci ig aterial and other materia 11 71STRIBUTION: White -DERM State Zip County Consultant Inspecting Site # of Floors Building Age in Years sidence ❑ Small Business Other sidence ❑ Small Business Other Phone ( ) State ❑ REVISED ❑ RENOVATION 0 YES Yellow - Applican Zip 0 ❑ NO CANCELLATION El COURTESY ROOFING ❑ YES ❑ NO File # ❑'YES ❑ NO Process # Name Phone ( State Zip Is the contractor exempt from licensure under section 469.d02(4), F.S.? ❑ YES ❑ NO Scheduled Dates: (Notice must be postmarked 10 workin days before the project start date) Asbestos Removal (mm/dd/yyj Start: Finish: Demo /Renovation (mm/dd/yy) Start: performed and methods to be employed, including demolition or renovation techniques to State Zip Pink- Reserve Gold - Reserve Phone ( State Fi Zip � G? ), 9,1fl m. N.A. d ;MiEI.)IT • loyed detect the presencu of RACM ar)+ l C*eggryJAnd 11 nopfriable 4C)4. o. 0 ka:�iGited in Compliance w'tf - i square feet cen'ientitious material nka oble i ?oulat.ons . , square feet :resilient flooring square feet asphalts oofji g__ s as applicable:.. . . ,,;. D MIAMI COUNTY Finish: E DEPARTMENT OF ENV ONMENTAL RESOURCES N EME t I( VUire-°Q20. CORE REvIEWER MOND. SIGNATURE 2 1.4-114444-- PLAN REVIEW FINAL APPROVAL DATE Roof System Required Sections of the Permit Application Form 1. Fire Directory Listing Page A "ED J BY 1,2,3,4,5,6,7 4,5,6,7 Prescriptive BUR -RAS 150 A,B,C Asphaltic Shingles A,B,D 2. From Product Approval: Front Page Specific System Description Specific System Limitations General Limitations Applicable Detail Drawings ZONING DEPT - Metal Roofs A,B,D r,!_D ,DEPT A,B,D Other SUBJECT 10 CC_MPIJANCE WITH ALL F STATE AND CC UN Y HOLES AND REGI 1,2,3.4,5,6,7 3. Design Calculations per Chapter 16, or If Applicable, RAS 127 or RAS 128 • • • • • s • A. . • •• Other Component of P roduct Approval 7 • .. . .' • Munk pal Permit Appli cation 6. Owners Notification for Roofing Considerations (Reroofing Only) .. • - • ^ • • . • • Anti Required Roof Testing /Calculation Documentation Roof System Required Sections of the Permit Application Form Attachments Required See List Below Low Slope Application A,B,C 1,2,3,4,5,6,7 4,5,6,7 Prescriptive BUR -RAS 150 A,B,C Asphaltic Shingles A,B,D 1.2,4.5.6,7 1,2.3,4,5,6,7 1,2,3,4,5.6.7 1,2,4,5,6.7 Concrete or Clay Tile A,B,D,E Metal Roofs A,B,D Wood Shingles and Shakes A,B,D Other As Applicable 1,2,3.4,5,6,7 • ••• • • • • • __ •• • SECTION 4402.14 HIGH - VELOCITY HURRICANE ZONES UNIFORM PERMIT APPLICATION Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING PERMIT APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED BELOW: ROOF ASSEMBLIES AND ROOFTOP STRUCTURES ATTACHMENTS REQUIRED • • • ••• • OCOD - • BUILDING• +— • • •• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • 7 S2S7 ores Wege -- DATE 1. SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Addi 'o, • , the following items should be addressed as part of the agreement between the owner ant the con he owner's initial in the designated space indicates that the item has been explained. Aesthetics - Workmanship: the workmanship provisions of Section R4402 are for the purpose of (ding that the roof system meets the wind resistance and water instruction performance standards. A- hetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues s color or architectural appearance, that are not part of a zoning code, should be addressed as part of ement between the owner and the contractor. 2. Si: ` Renailing wood decks: When replacing roofing, the existing wood roof deck may have to be ed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior oving the existing roof system). Common roofs: Common roofs are those which have no visible delineation between neighboring i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and /or should notify the occupants of adjacent units of roofing to be performed. 1/ Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can � vf ewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail - lion of the underside of the decking may not be acceptable. This provides the option of maintaining the • rance. 5. Ponding water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Pounding can be an indication of structural dis - s and may require the review of a professional structural engineer. Pounding may shorten the life ancy and performance of the new roofing system. Pounding conditions may not be evident until the I roofing system is removed. Pounding conditions should be corrected. 6. _ ! _ Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not ded from a buildup of water. Perimeter /edge wall or other roof extension may block this discharge if wscuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in ance with the requirements of Sections R4402, R4403 and R4413. 7. Ventilation: Most roof structures should have some i ity to vent natural airflow through the inte or of the structure assembly (the building itself). The existi amount of attic ventilation shall not be redu - be begeficial to consider - itional venting which can res ilt in exten • ing service life of the en's Signature Revised on 7/9/2009 LD 01—/0 - Contractor Signa re Date ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High- Velocity Hurricane Zone Uniform Permit Application Form. Section A (General Information) Master Permit No. Process No. ice. F i - ` Contractor's Name Job Address 53 S •' i FLORIDA BUILDING CODE — BUILDING Vs; 4 k CON P s�vvc.. � ° ® A." Cavo.3c 6 1 8 ac • • I. Low Slope ❑ Asphaltic Shingles • ❑ Mechanically Fastened Tile ❑ Metal Panel /Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ New Roof ❑ Reroofing ❑ Recovering ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) Section R (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly Identify dimensions of elevated pressure zones and location of parapets. 7 ❑ Mortar /Adhesive Set Tile ❑ Wood Shingles /Shakes ❑ Repair ❑ Maintenance 5116 G.N" Section C (Low Slope Applicationj Fill in specific roof assembly components and identify manufacturer (If a component is not used, identify as "NA ") System Manufacturer: Product Approval No.: l_. . IY m %frZ (97-420.09. Design Wind Pressures, From RAS 128 or Calculations: Pmax1: 1 Sa Pmax2: — 7 3 Pmax3: —13/• y. Max. Design Pressure, from the specific Product Approval system: Deck: �� Type: Gauge/Thickness: hickness: 67, C�� 44640 • o asPol • Slope: Anchor/Base Sheet & No. of PIy(s): 47(1 • Anchor/Base Sheet Fastener/Bonding Material: 11 7/ Insulation Base Layer: /" Base Insulation Size and Thickness: Pr/4 • Base Insulation Fastener/Bonding Material: w/n Top Insulation Layer: Top Insulation Size and Thickness: /V /4 Top Insulation Fastener/Bonding Material: N/A . Base Sheet(s) & No. of Ply(s): 40 7 5 '" ("/ Base 4 et FAstnVolnIMatetk / 1,! • Ply Shryet(sJ • & Np• Gf PIY(s); � Ply a. l - �) • • •••••••• • • T " Prptiareargittncan8 T•- • 14e99 • r Top ply: •�� 1116.A . • • • • • • • • • To Ply FastemeW onaing Material : A/g • • • •• • . • . • • • • • • • ••• • FLORIMI BIDLDING 4OkE 8ULDINd • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. � �% � Surfacing: bat/Pk/00 a �' Fastener Spacing for Anchor /Base Sheet Attachment: Field: 4 " oc @ Lap, # Rows 4 @ G "" oc Perimeter. Y" oc @ Lap, # Rows Lo @7� " oc Comer: ' oc @ Lap, # Rows A @ " oc Number of Fasteners Per Insulation Board: Field Al /¢ Perimeter W/* Come :0 • Illustrate Components Noted and Details as Applicable: Woodblocking, Gutter, Edge Termination, Stripping, Flashing, Continuous Cleat, Cant Strip, Base Flashing, Counter - Flashing, Coping, Etc. Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material Thickness, Fastener Type, Fastener Spacing or Submit GAP 'r- Parapet 2 0Ek OW 1- Hei9hL ikr koype . i� • Zrtn l e4 7 758. p. Wooh DEc4( . re ' P.T wo4,g 4x 4 246 604w/ha 2.0 942i) Opess.v. Mean Roof Height -"CV Roof System Manufacturer: Notice of Accepta ce Number: Minimum Design Win Pressures, If Applicable (From RAS 127 or Calculations): P1: P2: P3: Maximum Design Press e (From the Product Appro I Specific System): A . ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Roof Slope: 121 Ridge Ventilation? Mean Roof Height: .Steep Slop . . • • • • • . . • . . • • • • • .. ... .. • • • .. • .• . .. . • • • • • • • .•. • • • • • • • • • • • • • • • • . • • • • • • . • • • • • • • • • • • ... • FLORIDA BLQ.bliG Cabs— :BI7IC. I • • • • • • • • • • • • •• •• • • • • •• •• ••• • • • ••• • • Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. ,SPCtion in (Steep Slnpprf Rnnf System) r -- De ck Type: L Type Underlayment: sulation: L _ Fire Barrier: • Roof System i4ription Fastener Type & Spa ing: Adhesive Type: Type Cap Shee Roof Coverin Type & Size Drip Edge: I :L i •• i • • •• • •• • • • • • • • • • • • •• • • Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Sectinn F (Tile calculations) For Moment based tile systems. choose either Method t or 2. Compare the values for M with the values from Mr. if the Mr values are greater than or equal to the M values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P1: x A = ) - Mg: = Mrl Product Approval M (P2: x A = ) - Mg: = Product Approval Mr 3: x X ) - Mg: = M Product Approval Mf Mean Roof Heigh — Roof Slope 2:12 3:12 M, re wired Moment Resistance" 20' 25' 36.6 15' 30' 40' 34.4 2.2 34_4 4:12 P12 6.12 7:12 (PI: x L = x w: (P2: x L (P : x 3. 4 26.4 32.2 101 28.0 24.4 25_9 .6 27 39.7 37.4 35.1 32 30.5 28.2 42 2 39.8 37.3 74.9 32-4 30.0 'Must be used in conjunction with a list of moment ba • tile systems endorsed by the Browurd County Bourd of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the vat s for F' with the values for Fr. If the F' values are greater than or equal to the Fr values, for each area of the roof. then the tile a hment method is ac ptable. Method 3 "Moment Ba , d Tile Calculations Per RAS 127" x co % = F51 Product Approval F' x cos 0 = F Product Approval F' Method 2 "Simplified Tile Calculations Per Table Below" Required Moment of Resi nee (Mr) From Table Below Product Approval MI FLORIQA 1:1111LDIOG;CQDe BQILDIP$a • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • X - W: =F ROOF ASSEMBLIES AND ROOFTOP STRUCTURES —N- Symbo ___ rs ...._�... Where to Obtain in rmation Where to find Description Design Pressure PI or P2 or P3 RAS 127 Table 1 or by an engin a analysis prepared by PE based on ASCE 7 Mean Roof Height H lob Site Roof Slope 8 kb Site Aerodynamic Multiplier d Product Approval Restoring Moment due to Gravity M Product Approval Attachment Resistance Mr Product Approval Required Moment Resistance M Calculated • • • Minimum Atytchlinent • • • • • Rgsispmeg • • F Product Approval • • • . Req, lied Ve1Rt }tritium: }tritium: • • Fr Calculated Average Tile Weight W Product Approval • • • • • .ISIeDimensiprtg J.. = length : = width Product Approval • • • • • • • • All cat'cultt'tioesintst be 4 mypet ts die building official at the time of permit application. •• i • • •• • •• • • • • • • • • • • • •• • • Florida Building Code Edition 2007 High - Velocity Hurricane Zone Uniform Permit Application Form. Sectinn F (Tile calculations) For Moment based tile systems. choose either Method t or 2. Compare the values for M with the values from Mr. if the Mr values are greater than or equal to the M values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P1: x A = ) - Mg: = Mrl Product Approval M (P2: x A = ) - Mg: = Product Approval Mr 3: x X ) - Mg: = M Product Approval Mf Mean Roof Heigh — Roof Slope 2:12 3:12 M, re wired Moment Resistance" 20' 25' 36.6 15' 30' 40' 34.4 2.2 34_4 4:12 P12 6.12 7:12 (PI: x L = x w: (P2: x L (P : x 3. 4 26.4 32.2 101 28.0 24.4 25_9 .6 27 39.7 37.4 35.1 32 30.5 28.2 42 2 39.8 37.3 74.9 32-4 30.0 'Must be used in conjunction with a list of moment ba • tile systems endorsed by the Browurd County Bourd of Rules and Appeals. For Uplift based tile systems use Method 3. Compared the vat s for F' with the values for Fr. If the F' values are greater than or equal to the Fr values, for each area of the roof. then the tile a hment method is ac ptable. Method 3 "Moment Ba , d Tile Calculations Per RAS 127" x co % = F51 Product Approval F' x cos 0 = F Product Approval F' Method 2 "Simplified Tile Calculations Per Table Below" Required Moment of Resi nee (Mr) From Table Below Product Approval MI FLORIQA 1:1111LDIOG;CQDe BQILDIP$a • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • X - W: =F ROOF ASSEMBLIES AND ROOFTOP STRUCTURES MIA M IDADE BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) GAF Material Corporation 1361 Alps Road Wayne, NJ 07470 MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code and the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: GAF Conventional Built -Up Roof System for Wood Decks. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distrillutors a4d 1tb{ available for inspection at the job site at the request of the Building Official. • ......... • • This 46A renews and redis&s NOA No. 03- 0501.05 and consists of pages 1 thropgh 19. The submitted documentation was reviewed by Jorge L. Acebo. • ... ... • • • • • • .. • • • • • • • • .. • • • • • • • ... • .... • • • •••. • • • • • • • • • • • • • • • • • • • • . . .. • • • .. . . . . . • • • . • • NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 1 of 19 ROOFING SYSTEM APPROVAL Category: Sub - Category: Deck Type: Maximum Design Pressure TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT: TABLE 1 Product Leak BusterTM MatrixTM 307 Premium Asphalt Primer GAF Mineral ShieldTM Granules Leak BusterTM MatrixTM 305 Fibered Asphalt Emulsion Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating LeakBusterTM MatrixTM 322 Elastomeric Roof Coating LeakBusterTM MatrixTM Select Asphalt Emulsion Fibered 306 Leak BusterTM MatrixTM 204 Wet/Dry Roof Cement RUBEROID Modified Bitumen Flashing Cement LeakBusterTM MatrixTM 201 Premium SBS FlashintCement• • GAFGLA S 075: • :: : •• ••• •• • • .•• • • • • • • • • • • APPROVED • • • •• ••.• • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • •• •• • • • •• • ••• • • • • • • • • Roofing BUR Wood -75 psf Dimensions 3, 5, 55 gallons 60 & 100 lb. bags 5 gallons 1, 5 gallons 55 gallons 55 gallons 1, 5 gallons 5 gallons 5 gallons 39:37'41 meter) • • • wide • •• • • • ••• • • • • • • • • • • • • • • • ▪ • • • • Test Specification Product Description ASTM D 41 Asphalt concrete primer used to promote adhesion of asphalt in built -up roofing. ASTM D 1863 Granules for surfacing of exposed asphalt, cold process cement or emulsion. GAF Mineral ShieldTM Granules shall be used for flashing applications only. ASTM 1227 Surface coating for smooth surfaced roofs. ASTM D 2824 Fibered aluminum coating. Elastomeric roof coating. Asphalt emulsion fibered. ASTM D -4586 Refined asphalt blended with a mineral ASTM D -3409 stabilizer and fibers. Permits adhesion to wet and dry surfaces. ASTM D 4586 Fiber reinforced, polymer modified Flashing cement ASTM D 4586 Asphalt flashing Cement ASTM D 4601 Asphalt impregnated and coated glass mat base sheet. NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 2 of 19 Product GAFGLAS #80 ULTIMATM Base Sheet GAFGLAS' Flex PIyTM 6 GAFGLAS Ply 4 GAFGLAS Mineral Surfaced Cap Sheet GAFGLAS EnergyCapTM Mineral Surfaced Cap Sheet GAFGLAS STRATAVENT EliminatorTM Perforated GAFGLAS® Flashing GAFGLAS STRATAVENT EliminatorTM Nailable RUBEROID SBS Heat - WeIdTM Smooth RUBEROID SBS Heat - WeIdTM Granule RUBEROID SBS Heat - WeIdTM 170 FR RUBEROID SBS Heat - WeIdTM PLUS RUBEROID' SBS Heat - WeIdTM PLUS FR RUBEROID' SBS Heat - WeIdTM 25 •. ••• • • • RUBEROID® lagli Base 640.. • • • • • .. • . . 04141 • • .•. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• • • • • • • • •.• • APPROVED MIAMI•DADECO NTY ••• • • • • ••• • • • • • • • • • • • • • ••. • • • • • • • • • • • • • • •. •• • • • •• •• 000 • • • 000 • • Dimensions 39.37" (1 meter) wide 39.37" (1 meter) wide 39.37" (I meter) wide 39.37" (I meter) wide 39.37" (1 meter) wide 39.37" (1 meter) wide Various 39.37" (1 meter) wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide 1 meter (39.37 ") wide • • • • ••• :J957 (1 meter) :.. wide Test Specification ASTM D4601 ASTM D 2178 ASTM D 2178 ASTM D 3909 ASTM D 3909 ASTM D 4897 D 3672 ASTM D 4897 D 3672 • ASTM D -6164 ASTM D -6164 ASTM D -6164 ASTM D-6164 ASTM D -6164 ASTM D -6164 ASTM D4601, Type II, UL Type G2 BUR Product • Description Asphalt impregnated and coated, fiberglass base sheet Type VI asphalt impregnated glass felt with asphalt coating. Type IV asphalt impregnated glass felt with asphalt coating. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules. Asphalt coated, glass fiber mat cap sheet surfaced with mineral granules with factory applied layer of TOPCOAT EnergyCoteTM. Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating with factory perforations. Asphalt coated glass fiber mat flashing sheet available in three sizes. Fiberglass base sheet impregnated and coated on both sides with asphalt. Surfaced on the bottom side with mineral granules embedded in asphaltic coating. Non -Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced. Non -Woven Polyester mat coated with polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with . polymer modified asphalt and surfaced with mineral granules. Non -Woven Polyester mat coated with fire retardant polymer modified asphalt and surfaced with mineral granules. Non - Woven Polyester mat coated with polymer - modified asphalt and smooth surfaced. Premium glass fiber reinforced SBS modified base sheet NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 3 of 19 Deck Type 1: Deck Description: System Type E: Base sheet mechanically fastened. All General and System Limitations shall apply. Fire Barrier: FireOutTM Fire Barrier Coating, VersaShield ® Non- Asphaltic Fiberglass -Based (optional) Underlayment or SecurockTM. Base sheet: GAFGLAS #80 ULTIMATM Base Sheet, STRATAVENT® EliminatorTM Nailable, RUBEROID Modified Base Sheet, RUBEROID 20, RUBEROID Heat- We1dTM Smooth or RUBEROID Heat- We1dTM 25 base sheet mechanically fastened to deck as described below; Fastening Options: GAFGLAS Ply 4, GAFGLAS Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two rows 12" o.c. in the field. (Maximum Design Pressure —45 psf, See General Limitation #7) GAFGLAS® Ply 4, GAFGLAS®Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill -TecTM #12 standard, #14 or 11 15 Screws and 3" Drill -TecTM steel plate or Drill- Teem AccuTrac Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 12" o.c. in the field of the sheet. (Mi . • : eneral Limitation #7) GAFGLAS Flex PIyTM 6, GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with approved annular ring shank nails and tin caps at a fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the field. (Maximum Design Pressure —52.5 psf, See General Limitation #7) GAFGLAS #80ULTIMATM, RUBEROID 20, RUBEROID ® Mop Smooth, base sheet attached to deck with approved 11/4" annular ring shank nails and inverted 3" steel plate at a fastener spacing of 9" o.c. at the 4" lap and in two rows staggered with a fastener spacing of 9" o.c. in the center of the membrane. (Maximum Design Pressure —60 psf, See General Limitation #7) GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill -TecTM #12 standard, #14 or # 15 Screws and 3" Drill-TecTM steel plate or Drill-TecTM AccuTrac Plates, 12" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —60 psf, See General Limitation #7) ' • ••• • • • • Anyof above Base sheets attached to deck approved annular ring shank nails • • • • • • • • And inverted Drill - TecTM insulation plates at a fastener spacing of 9" o.c. at • • • ••• • • • • 4:%4" lap staggered in two rows 9" in the field. (Maximum Design Pressure —60 psf, See General Limitation #7) • ••• • • • • • • • • • • • • • • • •• • ••• • • • • • • . APPROVED MIAMI•DADE COUNTY ••• • • • • • • • • • • • • ••• • • • • • • • •. •• • • ••• • • • • • •.• • • • • • • • • • • ••• • ••• • • • • • • • • • • • • • •• •• ••• • • Wood, Non - insulated 19 / 32 " or greater plywood or wood plank decks NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 17 of 19 Ply Sheet: Cap Sheet: Surfacing: Maximum Design Pressure: See Fastening Above •• ••• • • • • • •• • • • • • • • • •• • ••• •• • • • •• APPROVED ••• • • • •, ••. • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with Drill -TecTM #12 standard, #14 or # 15 Screws and 3" Drill -TecTM steel plate or Drill -TecTM AccuTrac Plates, 8" o.c. in 4 rows. One row is in the 2" side lap. The other rows are equally spaced approximately 9" o.c. in the field of the sheet. (Maximum Design Pressure —75 psf, See General Limitation #7) One or more plies of GAFGLAS PLY 4, #80 ULTIMA, RUBEROID MOP Smooth or RUBEROID 20 adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20- 40lbs. /sq. (Optional) One ply of GAFGLAS Mineral Surfaced Cap Sheet or GAFGLAS ® EnergyCapTM Mineral Surfaced Cap Sheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20- 40lbs. /sq. (Optional, required if RUBEROID MOP Smooth or RUBEROID 20 is top membrane) Install one of the following: 1. Gravel or slag applied at 400 lbs. /sq. and 300 lbs. /sq. respectively in a flood coat of approved asphalt at 60 lbs. /sq. or applied in a flood coat of Leak BusterTM MatrixTM 103 Cold Process Adhesive applied at a rate of 3 gal. /sq. 2. GAFGLAS Mineral Surfaced Cap Sheet, GAFGLAS Energy Cap Mineral Surfaced Capsheet adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20 -40 Ibs. /sq. 3. Leak BusterTM MatrixTM 303 Premium Fibered Aluminum Roof Coating, at 1.5 gal. /sq. 4. Leak BusterTM MatrixTM 715 , Leak BusterTM MatrixTM 322, TOPCOAT MB +, TOPCOAT Fireshield Elastomeric Roofing Membrane, applied at 1 to 1•.5 gal. /sq. 5. Leak BusterTM MatrixTM 602 MB Xtra Elastomeric Roofing Membrane, EnergyCote® roof coating applied at 1 to 1.5 gal. /sq. 6. TOPCOAT Surface Seal, TOPCOAT Fireshield SB Solvent based Elastomeric Roofing Membrane applied at lto 1.5 gal. /sq 7. Advance Green Technologies Photovoltaic Laminate solar energy collector auxiliary roof equipment installed in compliance with manufacturer's specifications and applicable Building Codes. • • • • • • • • • • • • • • ••• • NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 18 of 19 WOOD DECK SYSTEM LIMITATIONS: 1 A slip sheet is required with Ply 4 and Flex PIyTM 6 when used as a mechanically fastened base or anchor sheet. 2. Minimum '/ <" Dens DeckTM or '' /z" Type X gypsum board is acceptable to be installed directly over the wood deck. GENERAL LIMITATIONS: 1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials Directory for fire ratings of this product. 2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with Product Control Approval guidelines. All other layers shall be adhered in a full mopping of approved asphalt applied within the EVT range and at a rate of 20 -40 lbsisq., or mechanically attached using the fastening pattern of the top layer 3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved asphalt, panel size shall be 4' x 4' maximum. 4. An overlay and/or recovery board insulation panel is required on all applications over closed cell foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall be at a minimum rate of 12lbs. /sq. Note: Spot attached systems shall be limited to a maximum design pressure of -45 psf. 5. Fastener spacing for insulation attachment is based on a Minimum Characteristic Force (F') value of 275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value, as field - tested, are below 275 lbf. insulation attachment shall not be acceptable. 6. Fastener spacing for mechanical attachment of anchor/base sheet or membrane attachment is based on a minimum fastener resistance value in conjunction with the maximum design value listed within a specific system. Should the fastener resistance be less than that required, as determined by the Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and calculations in compliance with Roofing Application Standard RAS 117. 7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these areas. Fastener densities shall be increased for both insulation and base sheet as calculated in compliance with Roofing Application Standard RAS 117. Calculations prepared, signed and sealed by a Florida registered Professional Engineer, Registered Architect, or Registered Roof Consultant (When this limitation is specifically referred within this NOA, General Limitation #9 will not be applicable.) 8. All attachment and sizing of perimeter nailers, metal profile, and /or flashing termination designs shall conform with Roofing Application Standard RAS 111 and applicable wind load requirements. 9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e. field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners). (When this ;limitation 4 s eciAcllill1Yeferred within this NOA, General Limitation #7 will not be applicable.) 10. All pt'dtcctt 1gsttd ein •shalI have a quality assurance audit in accordance with the Florida Building • tode and RUle9B '72'of the Florida Administrative Code. END OF THIS ACCEPTANCE ••• ••• ••• • • • • ••• • ••• • • • • •• • • • • •• •• • • • • • • • • • •• • . • . APPROVED M: 4 ECOU TY •• - • • • • • • • • • • • • •• •• ••• • • •••••• • ••• • • • • • • • • • •• • •• • ••• • • NOA No.: 07- 1219.09 Expiration Date: 11/04/13 Approval Date: 03/20/08 Page 19 of 19 Note: This form is only good for the same date of the Design Professional Appointment. (Monday & Thursday Only) Date: Or/P// Process #: / ig - 07a 00`7 1 g Tracking #: 6910 - 1 Project Name: Contact Name: Contact Phone #: * *Note to Permit Records Section: Please return plans to Fire for review immediately. Clerk: Thank you. Ext: RG 01/08 MIAMI DADE COUNTY FIRE RESCUE PLANS EXPEDITING FORM or- (TA,, MIAMI•QADE COUNTY COUNTY Comments: TO BE C ❑ ALL ❑ BLDG ❑ HCAP ❑ LANDSCAPING ❑ ROOF ❑ SIGN LI PERMIT BY AFFIDAVIT CHECK LI Dear Applicant: Please complete the following information for notification on the status of your plans. Applicant's First Name: (PRINT CLEARLY) M A a Last Name: (PRINT CLEARLY) 0 1- i VA a_ Cellular Number: ( 7 k C.) / 3 44 - Office/Home NumberL t 6 C- EMAIL Address: 'v L vA # —M or� P E t-t- ,50 v Tr4 NOTE: if AN EMAIL ADDRESS WAS PROVIDED YOU WILL BE NOTIFIED VIA EMAIL AND /OR AUTOMATIC TELEPHONE CALL CONCERNING THE STATUS Of YOUR PLANS DERM CAA CID ON ELEC OA CID UN ENRG CIA CID ON REQUESTED REVIEWS ❑ DERM ❑ ELEC ❑ MECH ❑ PLUM ❑ STRU ❑ ZNPR SHORT TERM EVENT AFFIDAVIT CHECK -FOR OFFICE USE ONLY Building Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street Miami, Florida 33175 -2474 786 - 315- 2100 ❑ ENRG ❑ PWKS ❑ OPTIONAL PLAN REVIEW LETED BY BUILDING AND OCCUPANCY REPRESENTATIVE OR PLANS PROCESSING TECHNICIAN: alk -Th � D -• R Re- s ue Residentia ❑ Commercial ❑ Plan Revision Shop Drawing TO BE COMPLETED BY PLANS PROCESSING TECHNICIANS: BLDG CIA CID ON HCAP OA COON ROOF CIA CID ON LAND QA CID QN MECH CIA CID CIN PLUM OA CID CIN miamidade.gov ❑ FIRE ❑ PWCC 0 BLDG 0 ELEC OMECH 0 PLUM 0 STRU SIGN OA CID UN STRU QA CID CIN ZNPR CIA OD UN Customer Notified By: Date: J / - . Time: 12301.117 6106 The following pages were originally attached to plans with the followin r.r/O- 467 (05' permit # PROVIDE MUNICIPAL PROCESS NUMBER HERE LOCATION OF IMPROVEMENTS Job Address g g yl 61 s C4 g c N L V'a° CONTRACTOR INFORMATION Contractor No743 a cJ Last four (4) digits of Qualifier No. Folio / /- 3.7 6 / 1 - 61 1 0 Contractor Name Lot Block Qualifier Name Subdivision PBpg Address Metes and bounds City State _ZIp TYPE OF IMPROVEMENTS [ ] New Construction on Vacant Land [` Alteration Interior [ ] Alteration Exterior [ ] Relocation of Structure [ ] Enclosure [ ] Repair [ ] Repair Due to Fire [ ] Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only Current use of property C o1"r- Farfte I I1 a- Description of Work ''.1...11 PAtIletri•e, ® S Sq. Ft. Z Units Floors CI V ®D" Value of Work 7 7 PERMIT TYPE Pc. MBLD* Category 0 / REVIEW STATUS [ ] Chg. Contractor [ ] Re -Issue [ ] Re -Stamp [ ] Revision [ ] Not Applicable for Fire OWNER'S NAME Owner PA la ms' Address City State Zip [ ] MELE Phone [ ] MLPG Last four (4) digits of Owner's Social Security No. [ ] MMEC [ ] FIRE PERSON TO PICK UP PLANS Name MAl2 o o A • (0 L `�' - ARCHITECT / ENGINEER nn Owner �e>e1 & c` Address Address 1 5SC) c' S• uo i 9 LA-46 City State City 1 i A M t State l-- Zip 3 I f ( _ Zip Phone Phone 7 g6 / 3 - 3 C°' l FIRE SPECIAL REQUEST PLAN REVIEW (SRI) 1 am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per e h additional hour in ddition to the review fees. Minimum charge a one -hour. 1 s' Request: (, ®�-J Date: 4 f "J) 0 2nd Request: Date: 3n' Request: Date: 1DERM OPTIONAL PLAN REVIEW (OPR) I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discip line. Additional review fees may apply. 1nt Request: Date: 2"d Request: Date: 3b Request: Date: • NOTE: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT 123_01 -192 3/08 M 2D I D OD tim S BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE BUILDING 01 GENERAL BUILDING - COMMERCIAL MBLD 02 SUB - GENERAL BUILDING- RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING & STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS (SURFACE PAVING) MBLD 86, TRAILER TIE DOWN MBLD 88 WALK -IN COOLER MBLD 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH MODIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROPANE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT /EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELE LPGX 01 LIQUEFIED PETROLEUM GAS MLPG 02 MISCELLANEOUS MLPG 04 LIQUEFIED PETROL. GAS /STATE MLPG MECHANICAL 09 ABOVE/BELOW GROUND TANKS/PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE