RC-10-688Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 151391 Permit Number: RC -4 -10 -688
Scheduled Inspection Date: June 07, 2011
Inspector: Bruhn, Norman
Owner: SUCCES, PIERRE & ANETTE
Job Address: 75 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Contractor: JDP CONSTRUCTION
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030580
Phone: (954)915 -0088
Building Department Comments
KITCHEN AND BATHROOMS REMODEL
Passed a j(y
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 141225. ON THE FIRST
BATHROOM
No final until all work is complete. NB
June 06, 2011
For Inspections please call: (305)762 -4949
Page 1 of 11
JOSEPH POTTS P.E. 22656
4440 N.E. 13th Ave.
Ft Lauderdale, FL 33334
954 -772 -1731- FAX 954-938-9964
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. C 1 O
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle)'B ilding Roofmg
Owner's Name (Fee Simple Titleholder) Al--e-4-4e, / a Y'CL Phone #
Owner's Address 15 r I
g
APR .1.0L
BY: .. , . ..
City pi l & r A. S h0 {,e estate
Zip 33/t id`
Tenant/Lessee Name Phone # 1 ° a%ci `° ?71-3
Job Address (where the work is being done) 75— /-4 CA.)
City Miami Shores Village County Miami -Dade Zip 3 3 / L
FOLIO /PARCEL# 4/ 4x)(0 '6106 '6. oS
Is Building Historically Designated YES NO
Contractor's Company Name 3�e C er, S)i 7A' i v s• -®
Contractor's Address i S 31 a a e- P-1
City ID _A tJl-ma— State —4-- t Zip 33331
Qualifier Name J rr y
a h ell X114, PI -e1-7--c, Phone # °c614 L4,23—
State Certificate or Registration No. C- R. C- 0 Pp cir?
Phone# g -- .:3 - 0?
Co cy
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ / C) Square / Linear Footage Of Work:
Type of Work: DAddition
Describe Work:
eiv
❑Alteration
❑New ❑ Repair/Replace ['Demolition
C �. �-� C cif-
********* *** *** ** * *** *** * *�x **** *** * * * ** Fees * * * * * *** * * * * ***�x�x�x�x****** ** x **** * * ** * * * * * **
Submittal Fee $ �' Permit Fee $
Notary $ Training/Education Fee $ gy $
Scanning $MO tadon $ 0 • SJ DPBR $ (0 '
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 4"34.1 4
See Reverse side -
( !Pd CCF $ l '� 0
�' Technology Fee
CO /CC
Zoning $
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 AI!'FIDAVIT: 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
Wag
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ' ,2f _, by 1-c-4* ea-erre,
who is personally known to me or whd has produced
As identification and who did take an oath.
%3
Signature
x.)10(
Contractor
The foregoing instrument was acknowledged pefore me this2 0
day of , 20 i 73, by
who is personally known to me or who has produced
as identification and who did take an oath.
cQMM s 6lE 1 Ofl uB e 5 004 A2m 0 14 1 OTARY
PUBLIC: OTARY PUBLIC:
Sign: Sign: t ,l
��.l A 8,, k?07 . .
T
Print: O C1 h Fses Print: SIOr n1
My Commission Expires:
,, 1 -Z U1 My Commission Expires: 2,/ Z V i 9
* * * * * * * * * * * * * *** * *a * ** *** ***** ***** ********** **: x ****** *** * * ****** * ******* ** ****** ** *******:x**** * * * * * ******
APPLICATION APPROVED BY:iJE(°r0 Plans Examiner
Engineer
Zoning
(Revised 07/10/07)
...nid,vnHr Irv�UKANCh:
81001
CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIDDIYYYY) —I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lithe _— ______ _- .._- ._-__— ___- _.----- - - -_ --
certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
- - - --- -- _- ____
PRODUCER — --
T CONTACT
NAME: Jose H Romero
086
_J
Fax (786 )206 -7066 rcuSTOMER il t i
Galloway Insurance
12884 SW 87th Avenue
Miami, FL 33176
I Phone (305)255 -1661
INSURED
I J.D.P. Construction, Inc.
15031 Saxon Circle North
Davie, Florida 33331
it
AE-MAIL statew ldeins123
,nhrr =o @yahoo.COm
i
INSUREDS) AFFORDING COVERAGE
' INSURER A: American Vehicle Insurance Company
INSURER B :
INSURER c :
INSURER p :
INSURER E :
-- - — — -- INSURERF:
COVERAGES THAT _ CERTIFICATE NUMBER:
REVISION THIS IS TO CERTIFY THTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE NOR THE POLICY PERIOD UMBER:
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LIMITS SHOWN MAY
I_ •._ NAIC tr _ J
1tiS-R HAVE BEEN REDUCED BY PAID CLAIMS
LTR TYPE OF INSURANCE LI
I GENERAL LIABILITY __ POUCY NUMBER (MMIDD/YYYY) (MM/OD/YYYYY
I Q COMMERCIAL GENERAL LIABILITY
I n L-j CLAIMS -MADE E I OCCUR
A
141j BI: Ded: $250 i N
i [J P_D:_Ded: $250 —
, GENT. AGGREGATE LIMIT APPLIES PER
- r] POLICY -r j - _n LOC
AUTOMOBILE LIABILITY -
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON - OWNED AUTOS
L I UMBRELLA LIAB 1J OCCUR
n EXCESS UAB n CLAIMS -MADE
f DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE --
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes describe under
DESCRIPTION OF OPERATIONS below
N/A
GI. - 0521015501 -00
EFF ''L1 EXP
01/22/2010
LIMITS
EACH OCCURRENCE $ 1,000,000
100,000!
01/22/2011 MED EXP Any one person) $ 5,000
PERSONAL E ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS • COMP/OP AGG $ 2,000,000
P
SE
Ea
« yq «c
COMBINED SINGLE LIMIT i $
(Ea accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
J-- - --- -L
DESCRIPTION OF OPERATIONS / LOCATIONS r VEHICLES (Attach ACORD 101- , Additional Remarks Schedule, N more space is required)
Installation of Hurricane Shutters and Patio Screens...
'Please note that any changes to this policy must be submitted to the Insurance Company for approval...
CERTIFICATE HOLDER
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, Florida 33138
Attn: Building Department
Fax # 305 -756 -8972
ACORD 25 (2009/09) QF
CANCELLATION
EACH OCCURRENCE
AGGREGATE
i WC STATU-
■ OTH-
E.L EACH ACCIDENT I y
E.L. DISEASE - EA EMPLOYE $
EL DISEASE - POLICY LIMIT ? $
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE D IVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Jose H Romero, Licensed Agent- A225234
®1988 -2009 ACORD C
The ACORD name and 1
RATION. All rights reserved.
re registered marks of ACORD
— v
ACORD., CERTIFICATE OF LIABILITY INSURAN E A $B11 1 04/14/2010
DATEIMMIDDIYVYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF —
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INFORMATION
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED DYTHE POLICIES BELOW,
PRODUCER
Rick TYA:defer ProgrAmt, LLC
219 East Livingston Stress ::
Orlando, n 37001
$88 .4171 -4353
INSURED
Recourse Management, Inc.; i X Newsmen r., LLC;
RMI Management II, LLC
201 Main Street
Suite 5
Fitchburg, MA 01220
INSURERS AFFORDING COVERAGE
INSURER A: Towns Insurance Company of New York 44300
INSURER B;State National Insurance Comp171Y 17 121
INSURER C: Tower National toourance Company 43702
INSURER D:
INSURER E:
NAIC it
COVERAGES
THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOPJV t'HSTANDING
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.
CICY EFFECTIVE POLICY ExPrralin
IN _ TYPE OF INSURAN,ge _ POLICY NUMBER I DATE tNAUDD1YYI - -WC1E oved bbMV1
tTENERALUA flJ1Y
7 COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1=1 OCCUR
GENT• AGGREGATE LIMIT APPLIES PER
POLICY PRO LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
_
HIRED AUTOS
NON -OWNED AUTOS
LIMITS
EACH OCCURRENCE
iMMAGETU RIN 1 hu
PREMISES (Ea seaMnce)
MED EXP (Any Drs parson)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPIQP AGG
0
$
S
COMBINED SINGLE LIMIT
(Es eecitlent
BODILY INJURY
(Per person)
BODILY INJURY
(Pcr=detesst)
PROPERTY bAMAGE
(Per eccklant)
A
GARAGE LIABILITY
_ I
ANY AUTO
AUTO ONLY -EA ACCIDENT
OTHER THAN
EA
ACC
AUTO ONLY; AGG
EXCESSIUMBRELLA LIABILITY
OCCUR E1 CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY CFR/MEM0ER EXCLUDED?
1} g, dtte/iUO uhdiu
SPECIAL PROVISIONS b1110w
EACH OCCURRENCE
AGGREGATE
WSLTHPE 000231 01
W$LTHPE 000232 01
W$LTHPE 000233 07.
OTHER
01/01/2010
01/01/2011
VUC STATU- C'rH-
E.L. EACH ACCIDENT $ 1, 000, 000
1,000,000
I;,L, DISEASE -POLICY LIMIT : 1,000,000
S
3
5
A
E
E.L. DISEASE • EA EMPLOYEE
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHIGI.ES I EXCLUSIONS ADDED UY ENDORSEMENT I SPECIAL PROVISION: Illinois , Michigan,
(Coverage is extended to the loosed employees oi: alternate employer (Alabama, Florida, Georgia,
Pennsylvania & Texas) ?.D -P. Cont7truct:lon, Inc. t#401025 (Effective 1/01/09) DIscLATMER: The certificate of Insurance
does not constitute a contract between the issuing inguxer(s), authorized. oend Or
certificate holder, nor does it affirmatively or negatively amend,
policies listed thereen-
CERTIFICATE HOLDER
Ni,ani , shoran V.i7,1:]ge
Building 'Department
10050 NR 2nd Avcn,C
Miami Shores, FL 33138
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ISE CANCELLED BEFORE THE EXPIRATION
DATETHEREOF,TNE ISSUING INSURER WILL ENDEAV4kT0 MAIL 30 DAYS WRITTEN NOTICE TO
iNE o>3L OAT1ONCOR UABIUTY OF NAMED KIND UPON THE INSURER, ITS AGENTS OR SHALL IMPOSE NO
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Page 1 of 1
ACORD 25 (2001!09)
Xj ACORD CORPORATION 1988
Permit No: 10 -i
Job Name
Cf,1 , 2010
Miami Shores Village
Building Department
Building Critique Sheet
o.?
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
57-11-/0
PA-o%_1(.4-g- 4.-�I w�.L�y 4 ilt ,r�rF
2S3 5S9 5
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
05/05/2010 10:21 FAX 1 800 885 7530 DATA SCAN FIELD SERVICES Q01 /001
Permit No: 10 -55
Job Name
2010
IVI iami Shores Village
Building Department
Building Critique Sheet
of
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
rax
1 2 ' 5.59 5 c
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
APR $ 1.2g10
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APPROVED
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ZONING DEPT
BLDG DEPT
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SUBJECT (0 CCMPI.iANCE
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WITH ALL FEDERAL
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NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.J )~ a NL JC2..OSO
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, Fonda Statutes, the following Information
is provided in this Notice of Commencement.
111111111111111111111111111111111111111111111
CFN 10R0303838
DR -8k 27275 Ps 0041: (10s)
RECORDED 05 /06/2010 11:38::09
HARVEY RUVIN, CLERK OF COURT
MIAMI —DADE COUNTY, FLORIDA
LAST PAGE
1. Legal description of property and street/address: All ( ) khCre S 4"X4 + DC k' "
.9ao t� 1) shy
33 )4
2. Description of improvement: 'tGf cruac(ki )- i - / .C.1,(111(-0111,--ca
3. Owner(s) name and address:
3316Y
Interest in property:
Name and address of fee simple titleholder.
4. Contractor's name and address: .a i e C v),,r - v
31
(4-.' c
5. Surety: (Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $ ST
HEREBY CERTIFY that this is • f�° °y� —fjr' = Y t�1 e
6. Lender's name and address: r
ed in this 1 fce Qn--bl aY cf
s 117, sus.
333
!n!
F mADE
7. Persons within the state of Florida designated by
provided by Section 713.13(1)(a)7., Florida Statutes, By
Name and address:
THE
4,; nts
0
ed as
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
different date is specified)
Signature of Owner
Print Owner's Name /I f1 e +k. i -e iY"'c,
Sworn to and subscribed before me this /3 day of
Notary Publi
Print Notary's Nam
My commission expires:
123.01 -52 PAGE 4 3/02
Prepared. by F - 84)41-4--
E
r'7io pi l'woL a 0)e �
Address: 30{2 c
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 153018
Scheduled Inspection Date: November 08, 2010
Inspector: Devaney, Michael
Permit Number: EL -4 -10 -689
Owner: SUCCES, PIERRE & ANETTE
Job Address: 75 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Contractor: JOHN MANCINI ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030580
Phone: (954)588 -9395
Building Department Comments
ELECTRIC WORK IN KITCHEN, ADD OUTLETS AND
BRING UP TO CODE
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 05, 2010
For Inspections please call: (305)762 -4949
Page 12 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 APP 'CATION
FBC 20
Permit Type: ELECTRICAL
Permit No. El t O {o)
Master Permit No. 10---CQ C Y
Owner's Name (Fee Simple Titleholder) .3fl c-4'4 -c -- e.r'Ce.- Phone #
Owner's Address®% 9l W / / ® 5 i
City 01) /Gin'11 Skc -''c> State 1 Zip
Tenant/Lessee Name
Email
1St,- a Co °► ?7 e3
331
Job Address (where the work
is being done) 7 5" LA./ l
Phone #
City Miami Shores Village County Miami -Dade Zip 3 3 1 6
FOLIO /PARCEL# / /—c2 r3 (v. 0 0 3 05"
Is Building Historically Desiihated YES NO '' Flood Zone
Contractor's Company Name J All In /IOV C I n 1 e /-e G4 r, CPhone #
Contractor's Address ®C ‘10-0 (_� / 0 1. t/(3)—
City PfmcS T State 1— I Zip 33d C'�-
Qualifier Name U Vie, 1 n. I Phone # $1.1 S' - q r
State Certificate or Registration No. C. 13 45-t) a3 1'°j
Contact Phone E -mail
"kV- 578- if
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Perirt $ /(' 00 —
Type of Work: �❑lAdditioii EKteration
Describe Work: U I ' u t Lo A c
es t c�
Square / Linear Footage Of Work:
:New ❑ Repair/Replace
Sc.)
❑ Demolition
* * * * * * * * * ** *r * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * *,* * * * ** * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ .22.0 / d CCF $ 1' a'O CO /CC $
Notary $
Scanning $ 3.00
Double Fee $
Structural Review. $
Training/Education Fee $ O - Technology Fee $ 1 -(QO
Radon $ /' Yl DPBR $ �'fl Bond $
Violation date:
Total Fee Now Due$ ►xa•(14-
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a re- inspection fee will be charged.
Signature }n, %� /iI J2
Owner or Agent
The foregoing instrument was acknowledged before me this 13
day o , 20 60 , by g= ive,+A Pe (Y`-t
who is personally known to me or who has produced
NOTARY PUBL
Sign:
Print:
A ^ : zI *'n^, i,o and xho ke an oath.
``"" ;: M al.' el� `" ORT
'1 MY CONIF " 5' ,;,j? )0947991
ta• EXPIRE _ ! 04, 2014
(407: 98-0 .. • Flogdahc m 5 wm
My Commission Expires:
* * * * * * * * * * * * * * * * **
APPROVED BY
Signa
Contractor
The foregoing ms ment was acknowledged before me this c%0
day of , 20 1(;) , by Iran I c,t' t ,
who is personally known to me or who has produced �irww
as identification and who did take an oath.
2-1"Pe Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
NOTARY P
Sign:
Print:
C: MARJORIE A SHORT
AI' MY COMMISSION # 00947991
EXPlR anuary 04, 2014
�,rit S hrA
My Commission Expires: ,G►— teLl 2_0 /''
Zoning
Clerk checked
04120/2010 21:36 9549722129
A D
PFINS
CERTIFICATE OF LIABILITY INSURANCE
PF INSURANCE & FINANCIAL bI_KVI
ISO N POWERLINE ROAD
POMPANO BEACH, FL
JOHN MANCINI ELECTRIC INC.
860 NE 23rd Terrace
.POMPANO BEACH, FL 3308E
3306$
Phone
954 - 973 -3038
954-972-2129
PAGE 01
I DATE poratehrn,
4P21f20i0
TH CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND aoHreato NO RIOTITd orON 11 IC elINTIPmAns
HOLDER, THIS CERTIFICATE DOES NOT AND, MEND OR
ALTOR TNC COVERA0 Ono BY THE POLICIES BELOW,
INSURERS AFFORDING COVERAGE
INhZl7R6R -AIWA CASUAL Y INC.
INSURR'
INSURER C:
INSURER D:
INSURER_
NAIC #
COVERAGES
• Y RECI IIREMBNT$Ui IdC4�_CS _D_ OF HAVE BEEN I UM U 1i ntrace UMeNT�wr H r Ear OTHTO WI Dot PERIOD T 10M' NOTWITHSTANDING . Y D 1 6 s
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, OCCLUSION$ AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS !MOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1.R TYPE OR INSURANCE
X GOMMI.1 LAAL TY
GENERAL �LuS®T STY
CLAIM L__
MAOS I OCCUR
Gam, AGGREGATE LSAT APPLIES PER
P • cY a:a LOC
AUTOMOBILE UARRRY
ANY AL MO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NI INA:WNEDAUTOS
OSAL71141
112512010
1/2612011
EACH
'MC
CE S 1T
.r1,=,r 50,000
M D MP (Any Etna Paraa) sr, 5000
AMMONIA!, *MN INJURY S 1,0000,00
GENERALA06RSZATE S 2,000,000
r -rte S
CONT$INED SINGLE LIMIT
we aaldas*
60DILY RIMY
Per Paw*
%ORLY INJURY
PROPERTY - DAMAGE
(PerexlQast)
GARAGE-UABILITY
ANY AUTO
Ell UMTITIELLA UABIUrY
OCCUR E1 CLANS MADE
OEDUCTIDLE
RETENTION $
WORMS COMPENSATION
AND EMPLOYSIWI MLBY Y1a
my PROP OFRaR$. EE PQ1UDEMEED'? 11rE ❑
to
rsth6.L P OOWI0N$ Wu*
DESCRIPTION OF °pewit es /Lemon iliONEWEIONAINONS =EDGY ENconsalektrt 9 I
C 11FICATE HOLD
Miami Shores VIIIage
Building Departmeti't
10050 NE 2nd Avapue
Miami Shores, FL 33i38' 4.
Fax #954237 -6096
ACORD 25 (2009101)
CANCELLATION
SIVULTIANYCIP MEADOW DESCRIBEIDPOLISESSNEDANCeLLEDBEFOREITHS EXPIRATION
DATE THEREO1, THE ISSUING MUM WR•L ENDEAVOR TO MAR. 1 o DAYS WRnTEN
NOME TO-ma CERYrRICATGH0LDER NAME TO Wm LEFT. BUT PMLURT3 TO *Deo *HAU.
IMPOSE NO 09LrodIION OR UAlif.ITY OP ANY KIND UPON INSURER, ITS ASEPO$ OR
asZEMENrATraas
AUTO ONLY. €A AC{tDENT
OTHER THAN
AUTO ONLY:
• EAAOO
BACH ODCURR9NCe
AGGREGATE
$
6
S
$
8
i4sTitrA 1 l
EL EACH A9CIPENT
EL DISEASE • EA EMPLOYEE
E L. 4ISPASE • PIO4IIQY UNIT
E
AUTHORIZED REPRESENTATIVII
•
1588-2009 ACORD CORPORATIOPL riahie mowed,
The ACORD name and Ingo era reglsl* red marks of ACORD
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S, an officer of a corporation who
® elects exemption from this chapter by filing a certificate on of wlecton
L under
L section may not recover benefits or compensati
0 chapter.
Pursuant to Chapter 440.05412!, F.S., Certificates of election to be
H exempt.. apply only within the scope of the business ar trade listed on
E the notice of election to be exempt
E R Pursuant 440:05413i, F.S.. Notices of election to be exempt
and. certificates of election to be exempt shaft be subject to revocation
if, at any time aft the filing . of the notice or the issuance the
certificate, the person named on the notice or certificate no Longer meets The
the requirements of this section for issuance time for tlfure� f the
person nat shah revoke a certificate to certificate at the requirements of this
person named on the cacti
section QUESTIONS? 4850) 413-1509
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE
WORKERS' OF ELEC LAW ION EXEMPT FROM FLORIDA
EFFECTIVE: 07 /23/2009
PERSON: JOHN MANCINI
FEIN 200995089
BUSINESS NAME AND ADDRESS:
JOHN MANCINI. ELECTRIC INC
2400 NE 10Th ST APT 402
POMPANO BEACH, FL 33082-4147
EXPIRATION' DATE: 07/23/2011
SCOPE OF BUSINESS OR TRADE
1- ELECTRICAL CONTRACTOR
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -08
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
16 lcw
Inspection Number: INSP - 143880 Permit Number: PL -5 -10 -889
Scheduled Inspection Date: September 10, 2010
Inspector: Hernandez, Rafael
Owner: SUCCES, PIERRE & ANETTE
Job Address: 75 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Contractor: MG PLUMBING & SPRINKLER SERVICE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030580
Phone: (305)525 -9236
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
ON THE FIRST BATHROOM
September 09, 2010
For Inspections please call: (305)762 -4949
Page 3 of 14
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 143880
Scheduled Inspection Date: September 22, 2010
Inspector: Hernandez, Rafael
Owner: SUCCES, PIERRE & ANETTE
Job Address: 75 NW 110 Street
Miami Shores, FL 33168-
Permit Number: PL -5 -10 -889
Project: <NONE>
Contractor: MG PLUMBING & SPRINKLER SERVICE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030580
Phone: (305)525 -9236
Building Department Comments
Passed
Failed
Correction
Needed
Inspector Comments
ON THE FIRST BATHROOM
9/21/2010 - FINAL ON SECOND BAT
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 21, 2010
For Inspections please call: (305)762 -4949
Page 2 of 20
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 APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)
Owner's Address "7S .P(( .)
CityP -Y S
State
Tenant/Lessee Name
Email
21Ye
t
�,' ��
((
Permit No.
MAY 19 2010
Master Permit No. G -L( -/ U - F. V
"
Phone # iS■4o - 6- 1--• d ? ? 3
Zip
331(
Phone #
Job Address (where the work is being done) T'5 /Nt / (0
S+
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # 11 o2 13(, 00-1 S-a-t)
Is Building Historically Designated YES NO
33 1 (a
Flood Zone
Contractor's Company Name /f4 Ri...444r 67.J Pgati L l tJ ne # „9D-r- s4
Contractor's Address / 6 S`- Al: S;-- °
City ,)1 L74-4-fir: ��=�-f �✓te.r ,
Qualifier NamebJ�A-,
State .-C
Zip . 7.7/45
Phone #,3(11-=-S-2-..5.--2
State Certificate or Registration No. Certificate of Competency No.
Contact Phone JOS- ,:? -�- 2 �, E -mail
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $ ' ° ® 6
Type of Work: ❑Addition ❑Alteration [New
Describe Work:
Tv_ \.Z c /y.. ( c
Square / Linear Footage Of Work: C-
Repair/Replace
❑ Demolition
********* * + * * * * * * * * * * * * * * * * * * * *** * *•* * ** Fees * * * * * * * * * * * * * * *** ** * ** * * * * * * * * **** * * * *** * *•
Submittal Fee $ Permit Fee $
Notary $
Scanning $
Double Fee $
/5-:I---
Training/Education Fee $ ®•
Radon $ D 4 DPBR $ 0
Structural Review. $
Violation date:
CCF $
CO /CC $
Technology Fee $ 0-?:0
Bond $
Total Fee Now Due $ !Q.I n
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 pennit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Qs P
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 20/0 , by ,1-t-ne c 1'l {f(`t ,
who is person y known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
i-
My Commission Expires:
Signature -- 474,
�f-
Contractor
The foregoing instrument was acknowledged before me this ilk.'
day of , 20 )' by,�� (�►�,., ,
who is person y known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *fir* * * * * * * * * * * * * * **
p = vl ie A
EXPIRES January
itHiarn
�
407 398 4163 FloddeNote ,' orvke.com
-- ---
Engineer
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
J
14 NO CQMMIOSIQN ° QD947991
P nTR S January 04, 2914
FlprldafJchrysP�!�•
Zoning
Clerk checked