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WS-07-673Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 05/15/2007 Inspector: Grande, Claudio Owner: CO, SHAPAR REALTY Job Address: 215 98 Street NE Miami Shores Village, FL Project: <NONE> Contractor: TRIGRAM LLC Permit Type: Windows /Shutters Inspection Type: Final Work Classification: Door Replacement Block: Phone Number () Parcel Number 1132060134380 Lot: Building Department Comments Monday, May 14, 2007 Page 1 of 2 MAY 1 5 20U? Passed Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Monday, May 14, 2007 Page 1 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILD G 051CDJOIA:-:. QQr rJes� PERMIT APPLICATION FBC 2004 Permit No. Master Permit No. J' Z ® 7� Permit Type (circle) Building Electrical Plumbing Mechanical Roofing (4 ek F>Q 2 (4C-' Phone # 9 -c Owner's Name (Fee Simple Owner's Address I (M-pt J rAp City t-°( State FC. Zip I Tenant/Lessee Name Phone # Job Address (where the work is being done) T,R S / N e, '2.14 A V E, City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name 1'%C %-,f1/41 Contractor's Address A) Phone # � 0.0 kt, o City t1(cM ( State (e c Zip 3 ( Name V c 0-:.c /4 e 11(C '(-gip Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ f' Q 9 Square / Linear Footage Of Work: Type of Work: ['Addition DAlteration ['New epair/Replace ❑ Demolition Describe Work: R ` & PmA Fees_ Submittal Fee $ Permit Fee $ / l Notary $ 500 Training/Education Fee $ V 'IC Scanning $ C'00 Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ CCF $ / 4Q aaCO/CC Technology Fee $ Zoning $ Double Fee $ Total Fee Now Due $ See Reverse 1� 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) S7Plans Examiner Engineer Zoning Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or i commenced prior to the issuance of a permit and that all work will be performed to meet the standards of an I construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORE, PLUMB! 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 coma 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 $2S0D, the applica 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 not $f commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit i d In the abs a of suclj posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing strument was acknowledged before meth' day of / 20 al, by who is personally known to me or who has produced The foregoing instrument was a day of f. l , 20(13, by who is personally known to me or who has As identification and who did take an oath. as identification and NOTAR Sign: Print: My Commission E * * * * * * * * * * * * * ** NOTARY P Sign: Print: My Commie * * * * * * * * * * * * * * * * * * * * * *** to of Competency Holder) 47 MY COMMISSION # UD 341409 of EXPIRES: Julyik '2008 * 1 *-0003- NOTARY * * **FL *Ncmy Di�cwnl Aiwc.' * State Certificate or Registration Nc.CC. 04 O.0 1 APPLICATION APPROVED BY: Chc 10/14/03 Certificate of Corn • •• • • • .. • • • • • • • • S • • • • • . ••• • ••• • • • ••• • • • • • • •• • • • • • 41' • • • • • • • • • •• • • • • • • • • • • • • • • • ••• • • • • ••• •• • • • •• • d MM IA DADE BUILDING CODE COMPL PERMIT #: PRODUCT CONTROL D , ION °CS WITH ALL FEDERAL STATENry RULES AND REGULATIONS NOTICE OF ACCEPTANCE- 14'0 • • •• •• • • • • • • • • • ••• • • • • • • • • ••• • • • ••• • • • • ••• •• •• • • It • • • • • • • • • • ••• MIAMI -DADE COUNTY, FLORIDA • IE'CItO -DADt FLIGLER BIYIt.D�IN�i VI• E SIT FAGR T LI EE T• S • • '60 3 • • • IIAI LOR DA 334333563 (305) 375 -2901 FAX (305) 375 -2908 •• • • • •• ••• •• Jeld -Wen, Inc. 31725 Highway 97 N. Chiloquin, OR 97624 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of constructomat a. The documentation submitted has been reviewed by Miami -Dade County Product Control Division an actecep by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority • •• • • • • • • • • • RVM APR 0 4 290? This NOA I • 1 . o . e id after the expiration date stated below. The Miami -Dade County Product Control Division (In d ' ounty) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product o to testedor quality assurance purposes. If this product or material fails to perform in the accepted er, r s u rer will incur the expense of such testing and the AHJ may immediately revoke, modi , o s peril us of such product or material within their jurisdiction. BORA reserves the right to revoke this c , it is dOtermined by Miami -Dade County Product Control Division that this p oduct 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 IiaYb Velocity 1zricane • Zone of the Florida Building Code. • • DESCRIPTION: Series "DoorCraft® Steel" Single Outswing Opaque W/E Insulated S .el Does: Hnpact APPROVAL DOCUMENT: Drawing No. DC9920, dated 09/25/00, titled "Outswing Opaque.Insulatedteel Single Door in Wood Frame ", sheets 1 through 5, prepared by R. W. Building Consultant•, dne. bearing•t&e Miami -Dade County Product Control Renewal stamp with the Notice of Acceptance nuntjl expiration date by the Miami -Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact Resistant 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 distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA # 00- 1006.05 and consists of this page 1 as well as approval document mentioned above. The submitted documentation was reviewed by Manuel Perez, P.E. • • •••• • • • •••• • • • •• • ••• • • • • •• NOA No 02- 0712.06 Expiration Date: August 05, 2007 Approval Date: August 08, 2002 Page 1 DoorCraft® Steel OUTSWING OPAQUE SINGLE DOOR WOOD EDGE INSULATED STEEL DOOR WITH WOOD FRAMES J GENERAL NOTES 1. THIS PRODUCT IS DESIGNED TO MEET THE SOUTH FLORIDA BUILDING CODE 1994 EDITION FOR MIAMI —DADE COUNTY. 2. WOOD BUCKS BY OTHERS, MUST BE ANCHORED PROPERLY TO TRANSFER LOADS TO THE STRUCTURE. 3. PRODUCT ANCHORS SHALL BE AS LISTED AND SPACED AS SHOWN ON DETAILS. ANCHOR EMBEDMENT TO BASE MATERIAL SHALL BE BEYOND WALL DRESSING OR STUCCO. 4. IMPACT RESISTANT SHUTTERS NOT REQUIRED 5. DESIGN PRESSURE RATING SHALL BE AS FOLLOWS: — FOR 6'8" WOOD FRAMES; SEE TABLE ON SHEET 2 — FOR 8'0' WOOD FRAMES; SEE TABLE ON SHEET 3 OUTSWING INSULATED STEEL DOOR (Common to all frame conditions) Door Leaf Construction: Face sheets. 24 ga. (0.020") minimum thickness, Galvanized steel A -525 commercial quality — AKDQ per ASTM 620 with min. yield strength Fy =23,300 psi. Core design: Expanded polstyrene with 1.0 to 1.25 lbs. density. Construction: steel face sheets glued to expanded polystyrene (EPS), with woad rails and Laminated Veneered Lumber stiles a wood lock block reinforcement. TABLE OF CONTENTS SHEET # DESCRIPTION 1 COMMON (GENERAL NOTES. TYPICAL ELEVATION) 2 ANCHORS AND ELEVATIONS 3 ANCHORS. ELEVATIONS AND BILL OF MATERIALS 4 VERTICAL AND HORIZONTAL CROSS SECTIONS 5 COMMON (DOOR MODELS, LOCK DETAILS) O 0 1 .* 37 -3/4" OA MAX. FRAME WIDTH 36" Ir OA MAX. PANEL WIDTH m J U e 6' -8" Height (OPTION) 37 -3/4" O.A. MAX. FRAME WIDTH 36" OA MAX. PANEL WIDTH 8' -O" Height 6 PANEL EMBOSSED DOORS VIEWED FROM EXTERIOR (SHOWN FOR CLARITY OF VIEW) •• ••• • • • • • •• • • • • • •• ••• •• • • • • • •• DESIGN PRESSURE RATING LOA MAX. PANEL HEIGHT 96" II O.A. MAX. FRAME HEIGHT 6'0" = 97 -5/16" WHERE WATER Dk7LTRATI•i REaUP LIT IS 11r RE IraNI L4 1aT•,HEEDED 0 • V10.1 4 • Ito Sa.e n'7. I NEC/WIVI — 83.01 p,• — 63.0Ir pal O 0 1 8' -O" Height 6 PANEL EMBOSSED DOORS VIEWED FROM EXTERIOR (SHOWN FOR CLARITY OF VIEW) •• ••• • • • • • •• • • • • • •• ••• •• • • • • • •• DESIGN PRESSURE RATING \\xi ERE WATER INFILTRATOR WHERE WATER Dk7LTRATI•i REaUP LIT IS 11r RE IraNI L4 1aT•,HEEDED ,•,, •�SJiVE • V10.1 4 • Ito Sa.e n'7. I NEC/WIVI — 83.01 p,• — 63.0Ir pal • • • • • • • • • •••• • • •••• P. W LLIo O 0 0 5 ••• • • • • • • • • • • • • ••• • • • • • • • •• •• • • ••• • • • ••• • • • • • • • • • • • • • •• •• APPROVED AS CZ:PUICUTH THE 50(iTH3oRIDR•sti 5 Store BY PROD CONTROL DIVI But CODE SOMPLIAN•EOFFICE ACCEPTANCE NCP r e'VOet•O,(E • • • • • • •• oz In z 0 Alitra IIU3ING COMISLONIITS. INC. 4813.684.3631 •••• DATE: S -JWO acW41 :1V.T.S. OVAL ew TJH alC. e , RW ,! • •I03920 Seri •I os�S • • •• •• • • • • • • • •• • • • • • ANCHOR LOCATIONS •• ••• • • • • • •• • • • . • • • • • • •• ••• •• • • • •• • • • • • • • • • • • • ••• • • • • • • ••• • • L 1 6'8" 6 PANEL DOOR VIEWED FROM EXTERIOR • • • • • ••• • • • • • • • • • • • • (SHOWN FOR CLARITY OF VIEW) •.. • • • ••• • • • •• • •. • •••• • •••• • • •••• • • ••• ••• • • .�a 0 • •4 i 0 I • • •' • JLq// 1 T NC 41813.664.3831 ••• PRODUCT RENEWED aseompl}ing nth the Florida Baidtag Acceptance No .r -O r Expiration Data — By APPROVfip AS C®MPLYINGIMTH TYE SOtf1#LOt1A BUILDING C •• DA . ,a. ,4 / 7 OO/ • BY �i�L7ffT1!I'� PRO.T T .. • OL DMSBONy41 EL _ v COE. COMPLIANCE OrFIEL• ACCEPT! NOO" /004:1 0.41 a4M 9/25}(10•• smug N.T.S.• OW. BY: TJH Dix. en RW > NBj .... • DC99a0 • • • • • • • •H *au 2 o •• ••• • • • • ••• • • • • • • • • • • • • • ••• • • • • . • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • ITEM DESCRIPTION 1 Latch lamb (1-1/4 x 4-9/16 Wood Jamb w 1/2 rabbet 2 Hinge Jamb (1 -1/4" x 4 -9/16" Wood Jamb) w 1/2" rabbet 3 Head jamb ( 1 -1f4" x 4 -9116" Wood Jamb) w 1/2" rabbet 4 4" x 4 butt hinges 12ga.(.0851 6 9 X 3 4 PFH wood screw (hinge to frame) #10 / x 3 PFH wood screw with 1.33" minimum embedment into sub —buck 8 #10 x 2" PEN wood screw 9 3/16" tgqpcon (1 -1/4" into masonry) 10 Saddle (barrier free) threshold 1/2 x 4 x 1/8" extruded alum. 13 Compression weatherstrip Schlegel 0 —Lon 005 650 14 # 12 X 3" PEN wood screw 15 # 9 x 1" PFH wood screw 16 Face sheet 24ga 70 thk. min) galv.steel A -525 minimum FY = 23.300 psi. 17 f1 8 x 2' PFH wood screw 18 Top Rail (wood 1.67" x 1.0421 19 Bottom Raij (wood 1.067" x 1.0651 20 Side Stile (wood 1.067" x 1.042" laminated vene r lumber) 21 Wood lock reinforcement (1.B7" x 2.75` x 4.75 24 Door sweep (not req'd with bump face threshold 25 #8 x 1/2 la. type AB` PH. SMS. 26 112 x 3" PFH wood screw 27 Kwikset titan series lock 0200) 2g t titan del (#660) Lat Latch screws #8 x 1 -1/2 P.E.H. W.S. #8 x /b2 30 Masonry wall 31 2x wood buck 32 Expanded Polystyrene (1.0 to 1.25 lb. Density) BY JELD —WEN 33 1/4" mox. shim space 34 Wood lock reinforcement (1.87" x 2.75' x 11.875') 5 "_ "fyp " I-I 26' "A' —"A" 6. 6" "B "_ "B" "B" ANCHOR LOCATIONS •• ••• • • • • • • • • • •• ••• •• • • • •• • • • • • • • • •• •• • • • • • • • • • • • • • • ••• • • • • • • ••• • • • • • •• ••• • • • • • • • w • • • • • • • 8'0" 6 PANEL DOOR" VIEWED FROM EX1I OIR (SHOWN FOR CLARITY OF VIEYY)• • • • • •••• PRODUCT RENEWED as comFiStagwtA the Rndda Raiding Code acceptance vat 7 ••• • • • • • • • • • • • • • •• •• ••• • • • • • • ••• • • • • • ••• • • • • • • • • • • • • • •• •• ••• • • a. o 0 w 0 •... • • •••• •••• • •••• • ••• • •.• • ••• 0 cON•vu, �� •813.884.3831 • i ••leers 9/25/46 ••• ARPROWN) AS DOMPLY1NG W7H WM sofrPF1(1 SA BUILDING Coot • • scALE2 N.;4.• • • • DA, / /• aws.ew T •• DY • , ''%i1'Ji!� cHx. sn RW • MOW •NiROL DNI5IOtyj trees N04 Btn i colt coltepumeE come • DC9980 • Aci . Np• B -too• r sou . . •• .4j • /-,,Frr% WOOD OR MASONRY SUBSTRATE (TYPICAL) FOR WOOD SUBSTRATE FOR MASONRY SUBSTRATE ()VERTICAL CROSS SECTION 1 L} HORIZONTAL CROSS SECTION (IYP. INSTALLATION INTO 2X WOOD BUCK) •• ••• • • • • • •• • GENERAL 41E: ANC14414 ft too: •S IB —BLGK TO MASONRY TO BE SPEtIFIEO t ff ARC4FIRECT•OF RLCORD! • • • • • • • • • • • • • • • • • • • ••• • • •t• • • • • S.* • • • • • e 41166 • • 6 • • •1• • • • • ••• • • • • • • • • It • • • • •t• • • • • • • • • • • • • • • 00 •• • • • IS •• ••• • • • ••• • • ??Rout= RetEVIED as complytag lift the Florida Batdtag Cady Acceptance No it of • - Date ,w Product Centro' 72g t! to SE •••• • • • 4000 • • • •• • ••�• • • S D 4 •••• • • • 4•••• • •••• •i4WTA 5lWautWauel • • • •••• •1 -* •.} ••• APPROYEI9A!u s Rs1, mE 411.406814(341:1245.73001.4*** • SOUWNRAMAAB"NIMU��NGCODE •• N.T.S. •4•••• a ll3pa! er TJH • • eY i!%/.!�1T':'i_ • c as m RW • PROOD CONTROL Dtr$ ON ll_ • • • • Net I=. r- 'DECOMiUANCE OFFICE ••• 9920 s s ACCEPTANI!Ea1$„Lta/006. 0(,, AL •, r ari •••: • • • ••• • •• C3 Ea v v 0 0 DOI nui El 13 CI Ell OPTIONAL FLUSH AND EMBOSSED DOOR MODELS NOTE: DOOR PANELS NOT TO EXCEED 3'O X 8'0 •• ••• • • • • • •• • • •, • • •• • • • • ••• • • • • • • • • • • •• ••• •• • • • •• • • • • • • • • • • • • • • • • • • ••• • • ••• • • • • • • • • • • • • ••• • • • • • t=i it=1L 01 El PRODUCT RENEWED as complying with We Florida Raiding Cate Acceptance No l • 2.• _ Bon Date e, • • • • • •• • • •••• • • •••• a Zz o. o o to q a z 0 • • • • • • • • • • • • • • • • • • 0 z BUILDING NTS. B4C .3831 • • • • • • • • • • aT�/ZS /00 ••••• APPROVED As1t�vR CODE THE SOUTH FLORIEem CODE N.T.S. 0 BY 0 ao/ taro. 7P TJH • • • V•r• RW PRO• -OLDISION EOFFRCE BUILDBlG CO COMA Et�ING • • te9920 ACCEPTANCE N• f7� �(}�6'0� 5��. 5 • •• ••• • • • • ••• • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • • • Miami Shores Village Building Department 10050 N E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name Date BUILDING CRITIQUE SHEET ®? -673 iunlT 02A Atli 07- 1S ed2 m ,� h/4%rci f„C i r. frnJ S r 6e C 5 e,1°4C G© a4- Reviewer: Claudio Grande C.B.O 305 - 795 -2204 Ext 1430 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: S l-k' ft • DATE: 'I- (``t ADDRESS: (`.c' �"��`'� ' � • _ ®P� S K ( N, PAY'S, Do hereby petition the Village of Miami Shores to act as my own contradtor pursuant to the laws of the State of Florida,. F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand:thhat I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one$amily or two - family residence. You may also build or improve a commiercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It May not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and • provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial .ill 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at.the time of permit application Initial 3. :I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code —. only if the structure meets the minimum•code. Initial 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed cempany-or person. Initial 7. ' I• understand that if any person gets injured on my construction project —they are entitled to workmen'ss compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost • which could include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I• can not do any Electrical, Plumbing, Heating, Air & Roof work on my-property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this A day of By who was personally known to me or who has as identification. Produced there License or ommission# gaS C DD23198•. r nd1200" ....' s B d Thrra "'it' Adffi+ac Bonding Co., Inc. Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 RECEIPT PERMIT #; /.US - 6 n DATE: 41)70 %i✓ V I, *I 54 nd l�� ❑ Contractor Owner ❑ Architect Picked up 2 sets of plans and (other) S Address: mit& R "W4' From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: K PERMIT CLEARK INITIAL: ✓��� RESUBMITTED DATE: PERMIT CLEARK INITIAL: