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RC-09-382Inspe,tion Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 108461 Permit Number: RC -3 -09 -382 Scheduled Inspection Date: July 30, 2009 Inspector: Bruhn, Norman Owner: WILLIAMS, MARIE Job Address: 297 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: OCHA CONTRACTOR INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060134290 Phone: (305)592 -9771 Building Department Comments DEMO WALL OF EXISTING BATH TO EXTEND AND REMODEL BATHROOM Passed Oti,014, Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 29, 2009 For Inspections plane call: (305)762 -4949 Page 5 of 33 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 12C- 3 -09 - 38Z Inspection Number: INSP - 108471 Permit Number: EL -3 -09 -383 Scheduled Inspection Date: July 08, 2009 Inspector: Devaney, Michael Owner: WILLIAMS, MARIE Job Address: 297 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ELECTRICAL MASTERS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060134290 Phone: 305 - 265 -7996 Building Department Comments INSTALL TWO GFI FOR BATHROOM Lec" Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 1..1.. fl7 9flflfl For Inspections please call: (305)762 -4949 Dn.•e 4 ..F 4 R 1. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 RC- 3 - 0°1- 3 K2_ Inspection Number: INSP - 108481 Scheduled Inspection Date: July 09, 2009 Inspector: Levrock, James Owner: WILLIAMS, MARIE Job Address: 297 NE 97 Street Miami Shores, FL 33138- Permit Number: PL -3-09 -384 Project: <NONE> Contractor: MASTER PLUMBING GROUP INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134290 Building Department Comments PLUMBING WORK FOR BATH REMODELING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 08, 2009 For Inspections please call: (305)762 -4949 Page 5 of 28 ts-rthi 0640 %17." my,* Vi BUILDING PERMIT APPLICATI FBC 200,7 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Permit Type (circl : Building Owner's Name (Fee Simple Titleholder) 2477 Owner's dress Tel: 3 f' 05) 756.8972 ft City //)mac -i, 1(1/7 -N-pd oofmg // , /��'G`<l/2iY1 7 5-07-4r State Permit No. Ri) 9. Z46 2 Master Permit No. Phone ,P- - 1 Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO 217 /i/e 17 County Miami -Dade Zip f • Contractor's Company Name Contractor's Ad ss 8 41 ° City / State Qualifier Name ��'�' / L.4) State Certificate or Registration No. 6:G�c a 2 1i' Phone # r c'7Z - ` 7 7 / Zip Phone # V /C: - (1// Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: [Addition 0Alteration [New = ; Describe Work: 1444/4/ 9- 61//1 /. 1/ ,zj»E 9/17(-46 z047-4 ,40,/,/ AJ/ "4 Repair/Replace ❑ Demolition �g, 4/A4/ /,.s '4 ***************************************Fees****************** x * *** * * *** * ** ** ** *** * * *** *** *�x�: *�x***** Submittal Fee $ �V .o�O Permit Fee $ /0d 'd CCF $ (CO GOB Notary $ ++wryry' Training/Education Fee $ lJ' 9.t.„0 Technology Fee $ "Zkr) Scanning $ ' W Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ VL-[' N Zoning $ 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 a job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab :`( _, uc sste�tj otice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this Q��� day of leoIWO* 20 , by � /Jfq m who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 44,-A--/- m. „�; 120013 .m.vmm0vvmvm00emm.mmmvmm.19m0 RITA M. PEREZ �c ®� Ytro /B /�� Comm DDN8 �3 q ,�_E? )riles 7/25/2012 Florida NotaryAsen., Qrc naaa IX Pr,F10,10a41,Mnaanm- .:= _.. - 0013.10 ©1319190131200 signature��'� tractor The foregoing instrument was acknowledged before e this �S day of �,/10,c9 , 20 Z, , by 4?�/�� /%/ dL02. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Xi 4-/ rvao000mm. m00019m0m0 .m0011mmmmmII19m.m19190m19.m00000a RITA M. PEREZ Utter 0 Ate Florida No1aryAsn¢., Inc My Commission ExpireS� IDmm ®13131313 ©m�mA�o��® . ..^mmmmmmama®mmmmm Expires Alt Zp01, *********************************** * * * * * * * * * * * * * * * * * * * * * * * **** * ***** :**>k*>i * *=x****** **: > x****>k *******>k***** 1- APPLICATION APPROVED BY: (Revised 07 /10/07) Plans Examiner Engineer Zoning Permit No: 09- .;2 Job Name: 2009 Ilea? Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 d� %curl /)/e.G 40.0t 'l< 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. Norman Bruhn CBO 305 - 795 -2204 • • ... • • • ... • .. • • • • .. • • • • • • • • • • • .. • • • • • • • ... • • • • ... • • • • .. .. • • •. • • •f144\- (.)/ it MA W-g- SUBJECT TO COMPLIANCE WITH ALL FEDERAL. STATE ! - OUNTY RULES AND REGULATIONS • • ... • • • ... .. .. • • • .. .. • • • • • • • • • • • • • ... • • • • ... • • • • • • • • • • • • • • • • . • • • t . • . . * . • • • „„,.•• i.. • .... • .. ... .. 1410;50 PA4-1'PP&1 4AYPI 1 Top t��-® ru 642424/ Uo t (11)64 1100 217 This instrument Prepared 8 : I I I 111111111111111111111111111111111111111111 Name tx ` `2 1C CFN 200980321070 Address ., ► �ilr to OR Bk 26851 P8 0681f Ups/ trn t z� ✓vu Sho,.o;;, {—t RECORDE© 05/04/2009 10:40:17 Permit No. NOTICE OF COMMENCEMENT HARVEY RUVIFlr CLERK OF COURT MIAMI -DAD£ COUNTY, FLORIDA LAST PAGE STATE OF COUNTY OF TftE UNDERSIGNED hereby gives notice that improvement will be made to certain real properly, and in accordance with Chapter 713. Florida Statutes, the following information's provided in this Notkm of Commencement. 1. Description of operty: (legal description of properly, and street address if available) $irnVe- hawme tocaiett 20.4 a9 NE. Q-T'nS't tak,rne Shoves $ z1=1 ov IC U& .N % . General description of imptoveme t 3. Owner 'F)etztt hCirt,fWo Q ,-up sn �-, toi I e E wt (raj-h tirtrnryl a. Name and address: trrltlif e U 1 tl s rv1I 197 iL) .9 `{'h1 Sh e ( 33t 6 b. interest In property: Ot, 3'yt .. .Vl'it '�1/ta c c. Name and address of fee simple titleholder (8 other than owner): r-» G IAN ttlams 4. Contractor: a. Name and address: Lazar° Pi tuzii 0ch flfz t 0. COY} , ` I b. Phone number. 802 $ NI-A3 (pl■Wt 5h142.12-+‘ M 1 5. Surely a. Name and address: b. Amount of bond 5 c. Phone number: 6. Lender a. Name and address: b. Phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be salved as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address: b. Phone number: a. In addition to himself, Owner designates the follow Section person(s) to receive a copy of the Llatora Notice as provided in 1.13.13(9(b), Florida Statutes: a. Name and address: b. Phone number. 9. Expiration data of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WO TICE OF OOMMENCEMENT. Mete SUASION Nig • N CIMfIr- • OD MIN sardinieraida Signature of Owner or OwnePa Authorized Off cer /Director Partner/Manager (" 1('1 a¢,(r l e t<-. C.0 ( I l k a_vvN5 Signatory's Title/Office The foregoing tpatruma�t• was acknowledged before me this —1 day of ,1 'l `( �/ 00%G. '�V ∎ANND►lths(name of person) as C)�+)Y& r, ` (yea►) by p�Q authority, ...e.g. officer, trustee, attorney in fact) for (type 01 behalf of whom instrument was executed). (name of party on of Notary Public — tate of Florida rint, Type, or Stamp Commissioned Name of Notary Public Commission N�umberr•• Personally Know or Produced Identification Verification Pursuant to Section 92.526. Florida 4tatutes Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. STATE OP FLORIDA, COUNTY OF DADS D HEREBY CEFM Y that Nils la tru copy of the original f r� this office on Signature of Natural Person Signing Above MIAMI-DADE COUNTY CLERK OF COURT RECORDS DEPARTMENT - NORTH DADE 1555T PISCAYNE BOULEVARD N. Mimi. FL 33160 /04/2009 TIME:10:40:17 AM RECE0T:2075345 MARIE wILLIAMS • TIEN <1 NCO 10:40:17 AM L E:20090321070 BK/PG:026851/0661 REC.ORDING FEE 10.00 t:OPJES - 1.00 FICATI0N - 2.0u P) AGE FEE 0.42 Su:). Total 13.42 AMOUNT DUE: $13.42 PAM CASH; $13.50 CASH RETURNED: $.08 TOTAL PAID: $13.42 REC BY:INDIRAS DEPUTY CLERK MAR -25 -2008 12:16 From:OCNA CONTRATORS 3055929773 To:0000000000 P.1'2 A Miami Shores Village Building Department t0050 N.E.2nd Avenue. Miami Shores. Florida 33138 Tel; (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. Rcoci -G (Z PERMIT APPLICATI f' � �� Master Permit Na. RC.UR33°- FBC ' Permlt Type: Mechanical Owner's Name (Fee Simple Titleholder) nn } (AD mar i I \ 1' 1.1(SPhoric # Owner's Address Rq I / V E ci' 1 S+y'ee city YYl IGiyU Shares state F. Zip X31 Tcnant/1.csscc Name 'Phone # E- MAIL: Job Address (where the work is being done) (9,q rl e V t n\ -yee€ City Miami Simms Village County Miami -Dade Zip :.3313 B aOt.l ° /I'Ak(I1.# Is Building Historically Designated YES NO 1 � Contractor's Company Name fie c--� ie c t, D 11.1 %�40) 5Phono If Contractor's Address 6 V( f Lt) (3? PL City "14 1(4 /, State C Qualifier Name (e .1- t) Phone ft J ` } � / I (-�__- Gip 33/ si State Certificate or Registration F- MAII,010. to 2 a4� (� 1 extifieatc of Competency No. A-PAC) , C [.v ) Architect/Engineer's Name (if pplicablc) _. Phone 1/ Value of Work For this Permit $ )1/2"-: ware / Linear Footage Of Work: �� V Type of Work: ❑Addi ion DAlteration ❑New . ❑ Rcpair/Roplacc ❑ Demolition Describe Work: A CC 4�0 .. ** **,...r.* •** ** **** rp.*... *.* * * * *p::Feco Submittal! Pee $ j Permit Fee 5 Notary $ .._ Training /Education Fee 5 Scanning $ 1j -60 Radon S Bond 5 Code Enforcement 5 Structural Review. 5 L iF O.l'BR $ CCP Technology Fee 5 Zoning $ Double: Ft $ Total Fee Now Due $ See Reverse side —► MAR -25 -2009 12:16 From:OCHA CONTRATORS 3055929773 v • • , Bonding Company's Name (if applicable) Bonding Company's Address City To : 0000000000 P.2/2 Mortgage Lender's Name (if applicable) Mortgage Lender'; Address City State Gip Application is hereby madc to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the is,.uance of a permit and that all work will be performed to meet the smndards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for L.FCTRICAL WORK, PI.IIMBiNG, SiGNS. WELLS, POOLS, FURNACES. BOILERS. HEATERS, TANKS and AIR CONI')L UONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is at:curdte 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 11) UIt1AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING VOI1R NU I10E OF COMMENCEMENT." Notice to Applicant: As a r'i,ntlirir n bi the issuance c f a building permit with an estimated value exceeding $`Ship. the applicant must .promise in goad faith that a copy of the notice of c:onunencom'nt and construction lir:n law brochure. will he delivered to the ammo whose property is subject to attachment. Also. a cer7 led copy of the recorded notice of c:wnmcnumcnrt must be potted al the job site for the first inspection which occurs seven (7) days after the building permit is issurtL In th absence of stir maul notice. the inspection will not be approved and a rcinspt tion fee will be charged. Signatu Owner or Agent The foregoing instrument was acknowledged before me this day of Q5" .20 ®R . by Maze t e.. V°, t loll who is personally known to ,`°K' te` 4Poi id NOTARY PLJRI .ontractor The foresguiug inst mcnt was t owlcdge befor me this day of /J4 , 20( , by 1' o is personally known to me or Fed-s r U 'ds identiticatio Print: My Com ission Expires: * * *W * ** NOTARY'PI11H.IC:• Sign: Print: o uN tary Public State of Florida Aidfitaltfklareinth. • My Commission DD700719 OF Expires 07/31/2011 My Commission Expires: ********* N************** W*********** M * * * * * * * * * * * * * * * * * * * * * *T* *** *** Art* ** ** * * ** **************t*** APPLTCATION APPROVED BY: tk0V irctil 1)2/0810 i) Plans Examiner Engineer Zoning Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Scheduled Inspection Date: June 02, 2009 Inspector: Perez, JanPierre Owner: WILLIAMS, MARIE Job Address: 297 NE 97 Street UUNo4 Miami Shores, FL 33138- Project: <NONE> Contractor: ACV2 AIR CONDITIONING CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134290 Phone: (305)557 -9041 Building Department Comments Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305 756.8972 BUILDING PERMIT APPLICATIO FBC 2001 Permit Type: Electrical 0/ib:01 Owner's Name (Fee Simple Titleholder) /�%' Phone # � Kr- W6 Permit No. EL 01 3 Master Permit No. X oq Owner's Address 27 4/ City State Zip Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # nrr^ r Is Building Historically Designated YES NO Contractor's Company Name 47/ c / ,%, , c Phone # Contractor's Address 6.. City AT-1/ State N/7 Qualifier Name Os ;,�� /4: State Certificate or Registration No. 10 ® e:43 3 il5 -2 E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Zip 2 _3 r1� Phone# -� Certificate of Competency No. /�� C�'®ewe 3 Phone # Square / Linear Footage Of Work: !,_Type of Work: ❑Addition ❑Alteration ❑New Describe Work: r Oaf /301,0141106/ /�¢i`OG'ire. 2 4 4 4g l ❑ Repair /Replace ❑ Demolition !%j /J- 44,i -' ***************************************Fees*********** ' xxxxxxxx*x* **x x****x** *********** Submittal Fee $ Permit Fee $ /e.' e' 'Notary $ Training /Education Fee $ O.&0 ,Sunning $ 3100 Radon S DPBR $ ;fond $ Code Enforcement $ Double Fee $ CCF $ O - (eQ CO /CC Technology Fee $ 4 -00 Zoning $ Structural Review. $ Total Fee Now Due $ 19 See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip 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: 1 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 Owner or Agent The foregoing instrument was acknowledged before me this day of g,3 , of i, 20 69, by p- / /19in__S who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: q weaama s+ Iuuosaaaaaaeea esseneasaauuaLnuaO Wig RITA M. PE My Commission Expires: Florida Notary A .. Inc I4aseaaaaeaesesesaa eosaaaEaeaaaeeasaaaaasa0 ******** Y************ra:* xxx** *****.,txxxxxxxxx**xxx**** Yr.9:***wxxxx *xx Signature Contractor The foregoing instrument was acknowledged before me this?5 day of/ /3/W ,2069,by 0,d4 i . &Ta,. - ', who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign ;-+ •dill .en ssamms o® oa0aa ,ososelaSSlaapUI.Gasaaaa,Sas RITA M. PEREZ Comm# DD0802683 Prin My Commission Expires: APPLICATION APPROVED BY: (Revised 02 /08/06) Expires 7/25/2012 A ■ ae es se sesame sasSSSepSSasaasaSUaaapasaeas. *xxrxx * *xxxxxxrxxx * *x* *x** * ** Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) 2q7 /V 1714" City a1424 5 State '� Z Owner's Address ECEIVED M 1 2 2005 Permit No. 1 0 _1. J 114 aster Permit No. RC U el - (A J 1 �� ✓ Phone # J ' V/7:- 3 7 p Zip Tenant/Lessee Name Phone # E-MAIL: Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name /4 7` * It24LM /ifJ' one # Cr j 33, 05-72. Contractor's Address P®.. 6 City AH/1/ State Zip 3 2/ f Qualifier Name �AUt- Phone # State Certificate or Registration No. 'Fe o3 7/13 Certificate of Competency No. ' 7 E -MAIL: Architect /Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ❑Alteration ONew Q Repair /Replace ❑ Demolition Describe Work: 00. wwxwY ** * ***** *** *x , * * **** * * ** **** *xrx* Fees. **wwx* wxxxwxrww *xrxwxxx*xrxxwxx�:ww•rxxx*wxrx GO tatft Submittal Fee Permit Fee $ 1/ CCF $ 0 (Q CO /CC Notary $ . Training /Education Fee $ 0 2.0 Technology Fee $ 4' Scanning $ • ( Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ I.5 '50 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 Owner or Agent The fore oing instrument was acknowledged bbeforre me this W day of �� , 20 el, by i�i , 4(1I kha» ' who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: //74 //,f /r/• ,v My Commission Expires: ********,****** ** * * * * * * * * * * * ** *,r * * ** * *** ** * */****************************** PA, Signature j 7 Contractor The foregoing instrument was acknowledged before me this '2 day of ,200!), by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Natty), Public State of Florida • Nlurca Martinez My Gam Print: i ► E ''res 01 My Commission Expires: APPLICATION APPROVED BY (Revised 02/08/06) * * * ** * * * * * ** * * * * * * * * * * * * * * * ** G y Plans Examiner Engineer Zoning