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RC-10-1729Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 161072 Permit Number: RC -9 -10 -1729 Inspection Date: June 16, 2011 Inspector: Bruhn, Norman Owner: WOOLIN, RACHEL Job Address: 489 NE 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060140640 Building Department Comments REPLACE KITCHEN CABINETS AND DRYWALL REPAIR IN 2 BEDROOMS CEILINGS WORK EXCEEDS PERMIT NB 3 -2 -11 Pass eVf . Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until June 17, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 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 y Permit No. 1 �1 O-°- ic4 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING _R 6u� CO0(91-T c `78 6-g773-07 O�WNE� -i� NamE �"cc S l� "order_ � City: or State: ` r zip: 3 3 ! cT Tenant/Lessee Name: Phone #: Email: IT�R AiI^ i1BFSS: r 7 e / 3 B City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: TR`rnri}� a, V n G Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Type of Work: OAddress fir„ i on-Pf--W /Q� oO< l 0 Square/Linear Footage of Work: 9 Phone #: Alteration ONew DRepair/Replace ❑Demolition C 7Jiut 1,0 CAie ILf Cte-Y 6.4--- it COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ItY.7-Or Le.h ' IP 62- r—er i--( )-■ cef - ` `.ry'1 *********************** **.**** *+ x******. Fees.****.e****** *+ x+ x** ****e**.****, ****** ***a * ** Submittal Fee $Sa Permit Fee $ SO0c9a CCF $ CO /CC $ Scanning Fee $ ng Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ 519 • -) 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 be approved and a reinspection fee will be charged. Signature (Owner r di"A;„`err The foregoing instrument was acknowledged before me this day of ice!CL�20 lQby P1QkJit - WOOLI t ) ' who ipersonally known o me or who has produced t _ I D W —ISOAstlii ®tion and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: �u uit //i SIlye i //s /, es 1 I� O1k ? Ut Commission # . ' s' DD165901:'�p�� e OF ************ �x** * ********* *x� *>sx��x**U4+oopm** ** * ********* * ********** * ****** ** x* a: ******** * *******>H+x******** * ** APPROVED BY Plans Examiner Zoning Signature Contractor The foregoing instrument was acknowledged before me this day of ,20 ,by 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: Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF RRST INSPECTION PERMIT NO. TAX FOLIO NO. 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: Description of improvement: 1111111111111111111111111 I 1 111111111111111111 CFN 2010R0699106 OR P,k 27455 Ps 00361 (1as) RECORDED 10/15/2010 09:35:54 HARVEY RUV.IN? CLERK OF COURT I`IIAt1I -DARE CDUNTYr FLORIDA LAST PAGE Owner(s) name and q¢ dress: ' r4 CC 4t •e Interest in property: L} W " Q. L•' Name and address of fee simple titleholder. Contra o name, adds = .-, = d • o e number: • , ,o 1. 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 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)(47., Florida Statutes, Name. address and phone number: AIRIAMMTAK 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 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) 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 I, 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 WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Si.nature(s) • �. ..r(s) or • ed Officer/Director/Partner/Manager i 4 k€ i y . d'_ _ -r►.� ifw ,, Prepared By Print Name :r ' , L( e. t. w' bd L / x IF Print Name Title/Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The for ins instrume was acknowied • ed . =fore me this 14 day of J . Individually, or ❑ as for ersonally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92525.. FLORIDA STATUTES 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. Signature(s) of Owner(s) or .Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By ITATE3pF FLORIDA, COUIITY OF DADE' • HEREBY CERTIFY that this is a tv ,r,gmA1 fIle n s thee on 1 V it1t1. . / 129.01.52 PAGE 9 81O , A 0 20 NITNE Aitt y hand and Official Seat. IARVE UVI CLERK, of Circu t a ' County Courts Sy J � D.C. 1301E1M2 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT / NAME: 7{,::1_6)--C4(01 UUOO t, I 1 DATE: /®/6/ / 0 ADDRESS: ` er N..16 q S` Do hereby petition the Village of Miami Shores to act as my own contractor 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 that 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 - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). 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 understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, a act as my own contractor with certain restrictions even though I do not have a license. Initia 2. I understand that building permits are not required to be signed by a property owner unless he or she is r ponsible for the construction and is not hiring a licensed contractor to assume responsibility. Initia 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name i tead of my own name. I.also understand that the contractor is required by law to be licensed in Florida and to list his or MI se numbers on permits and contracts. Initi 4. I understand that I may, build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or subs ntially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I b or substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working o residence. It is my responsibility to ensure that the persons whom I employ have the license required by law municipal ordinance. ding or unty or Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am will ly acing as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initia 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide worke pensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvforidalicense.com /dbpr /pro /cilb /indi.html Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the info have provided on this disclosure. Initi Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who goes not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of 1,13 , 20 1 C') By ` WOOL) "who was personally known to me or who has Y N� Y 'r. . . re License or -"k DA-607W LtCgs identification. OWNER \\\0\11111111111 '\veer Permit No: 10 -/ 702 Job Name , 2010. Miami Shores Viiiage Building Department Building Critique Sheet C jA:(10-c it .rze, ��Gf-,�/ 74) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7 5.2204 Fax: (305) 7 6.8972 Page 1 of 1 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 sheet's and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Return to: CHRISTOPHER P. KELLEY, P.A. 11098 Biscayne Boulevard, Suite 205 Miami, FL 33161 Instrument Prepared By: CHRISTOPHER P. KELLEY, Esquire 11098 Biscayne Boulevard, Suite 205 Miami, FL 33161 Folio No. 11- 3206 - 014 -0640 1 11111111111 11111 11111111111111111111 110 1111 CFN 201 ORO'77030 OR Bk 27344 Fss 16 1 - 1682; (lass) RECORDED 08/25/2010 13 =55:26 DEED DOC TAX 1,350.130 HARVEY RUVTH, CLERK OF COURT MIAMI -DAt E COUNTY', FLORIDA WARRANTY DEED THIS INDENTURE, Made this a day of August, 2010, Between, KENNETH C. SCASSERRA, a single man, and MARTIN SCASSERRA and MELISSA SCASSERRA, h sb nd and wife, as GRANTORS, and RAQUEL WOOLIN, whose post office address is 3Street, Miami - . FL 33138, GRANTEES, WITNESSETH, That said GRANTORS, for and in consideration of the sum of Ten and 00/100 Dollars, and other good and valuable considerations to said GRANTORS in hand paid by said GRANTEES, the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEES, and GRANTEES' heirs and assigns forever, the following described land, situate, Tying and being in Miami -Dade County, Florida to -wit: Lots 23 and 24, Block 53, of MIAMI SHORES SECTION 2, according to the Plat thereof, as recorded in Plat Book 10, Page 37, of the Public Records of Miami -Dade County, Florida. SUBJECT TO: Applicable zoning and /or restrictions and prohibitions imposed by governmental authority; Conditions, Restrictions limitations, reservations, easements, and other matters appearing on records, if any; Utility easements of record, taxes for the year 2010 and subsequent years. and said GRANTORS do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. IN WITNESS WHEREOF, GRANTORS have hereunto set their hands and seals the day and year first above written. Signed, sealed, and delivered in our presence: nes Print Signature °" ss Signature CIIIRISTOPHER Print Name PO Al KENNET C. SCASSERRA Grantor 442 NE 103 Street Miami Shores, FL 33138 Book27399/Page1681 CFN #20100577030 Page 1 of 2 Miami -Dade County Clerk - County Recorder's Official Record Search Results 0 Item(s) in Basket Page 1 of 1 Home Online Services About us Contact us BACK TO SEARCH PAGE County Recorder's Official Record Search Results printer friendly Party Name: WOOLIN, RAQUEL Doc Tvge: ANY PROPERTY TRANSFER - -PT BEGIN A NEW SEARCH Img Clerk's File No Doc Type Rec Date Plat Book/Page Rec Book/Page Blk Legal Misc Ref First Party (Code) Second Party (Code) 2002 R 304146 QCD 05/16/02 39/300 20399/4836 LOTS 3 & 4 WOOLIN, RAQUEL (R) , WOOLIN, MARTIN &W gi 2002 R 304146 QCD 05/16/02 39/300 20399/4836 LOTS 3 & 4 WOOLIN, RAQUEL (D) WOOLIN, RAQUEL fii 2008 R 513089 DEE 06/23/08 46/940 26443/2451 5 LOT 7 WOOLIN, RAQUEL (B)) BERNAY, BETTI Ili 2008 R 513113 DEE 06/23/08 46/940 26443/2487 5 LOT 6 WOOLIN, RAQUEL (B) BERNAY, BETTI 2008 R 513209 DEE 06/23/08 46/940 26443/2714 5 LOT 8 WOOLIN, RAQUEL (D) BERNAY, BETTI 2009 R 819517 DEE 11/13/09 39/300 27082/3766 LOTS 3 & 4 WOOLIN, RAQUEL (D) DEAN, WILLIAM H ig 2009 R 922079 QCD 12/24/09 39/120 27128/4979 5 LOT 12 &1E32 OF LOT WOOLIN, RAQUEL (R) LA FORTUNATA LLC 4 2010 R 577030 DEE 08/25/10 10/370 27399/1681 53 LOTS 23 & 24 WOOLIN, RAQUEL (•R) SCASSERRA, KENNETH C 10 records per page. 9 BACK TO SEARCH PAGE S0141755 Displaying Page 1 of 1 8 record(s) retrieved 1< PREV PAGE NEXT PAGE >1 printer co friendly BEGIN A NEW SEARCH Official Records Search Home 1 official Record Information ( aft land I Laain Home 1 privacy Statement !Disclaimer 1 Contact Us 1 About Us 2008 Clerk of the Court. All Rights reserved. http: / /www2.miami- dadeclerk.com/public - records /Search.aspx 10/14/2010 11/08/2010 10:26 MORGAN INSURANCE 3 41/441:cITIZENS NO.941 13-() Roof Condit* Cart!!! F The feria is • may t 1 ���� yy��(.b��t You in r yrini y ova, Citizoi* A Rod* Immo • i.:. a {' t 1 A ;, • rn ette: 1 b ildh9l { 'r g A • Ah ensth,leer the onicridee; or A .\ti}4 to verify i!il} , } ,, duty Of ul car al trektiolpeflos ) MotE Thu fcmt dose not verity ion rriffsetior usa arm ; r, „ t fQn Faln ttiR, _ `.ut..ii +' AP at !Mir Mtn* What jam/. up t 11 PoPfaximait Att re azw *tie of or Moven deck Om)? Y Ooleldei Wiithe+t f1 60rol ReOnernat Ale tea any a lifialeks/ 0 Ye .} ,f yes leo , *pronging the ._ . ; ry mof's woe are required to be 'with =& ogle Or On Y Peden who lermintlYend+ the On , f .:i myths. trim or deco** eny,i , der a c nal doom: nosieeding ieforeesion le may of 8 *bey al'the (Printed) eleDhane 47 5-4.3 Ai 41 Cs Gd edobons- 11/0B/2010 10026 MORGAN INSURANCE 305943219573 toi INS # �.T ONS, SIV 11 ST NO.941 D002 Mit&a- "5 vezale-e. I ,care DA,Lk„- Y �J Ik(a, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156660 Scheduled Inspection Date: June 15, 2011 Inspector: Hernandez, Rafael Owner: WOOLIN, RACHEL Permit Number: PL -9 -10 -1717 Job Address: 489 NE 95 Street Project: Miami Shores, FL 33138- <NONE> Contractor: DELLA ROSSA PLUMBING & SOLAR LLC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140640 Phone: (954)479 -4270 Building Department Comments INSTALL NEW ISLAND SINK AND WATER HEATER FOR ICE MAKER Passed 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- 156532. CREATED AS REINSPECTION FOR INSP- 151730. WORK EXCEEDS PERMIT MASTER ON HOLD NB June 14,2011 For Inspections please call: (305)762 -4949 Page 4 of 23 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 o-n Inspection Number: INSP- 151730 Permit Number: PL -9 -10 -1717 Scheduled Inspection Date: March 02, 2011 Inspector: Hernandez, Rafael Owner: WOOLIN, RACHEL Job Address: 489 NE 95 Street Miami Shores, FL 33138- NEV (-54- Project: <NONE> Contractor: DELLA ROSSA PLUMBING & SOLAR LLC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140640 Phone: (954)479 -4270 Building Department Comments INSTALL NEW ISLAND SINK AND WATER HEATER FOR ICE MAKER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Co ents CANCELL BY RACHEL March 01, 2011 For Inspections please call: (305)762 -4949 Page 9 of 44 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 to e° Owner's Name (Fee Sim le Titleholder) /� ��JJ'' cf _J t UBO A i Phone # Owner's Address yr9 it"( F,- 1/5- A City 11)11'481:' - 1 48 ' c)/1 U ,-e State [ Zip Permit No 5EP 2 S n10 BY: Master Permit No. Tenant!Lessee Name Email 7-g'l Ski ^ so 7y 3 s'sg' Phone # Job Address (where the work is being done) 14 5C1 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Contrac r dres City 7 bi Qualifier ame ig0:5, +n.L hone # 9crt 979- 9Z7 State FL Zip X33/7 Phone # State Certificate or Registration No. ( /y2 7-7,0, Certificate of Competency No. Contact Phone / 1/7 9-- /Z 7) E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Additio 111! teration ❑Ne D cribe Work: rs-7 �, !� n G!r{ is CA-is umbi r ❑ ' epair/R lace ❑ Demolition ********** ** * * * * * * * * * ********* * *x *** * * ** Fees** * * * **r * * ** * * * * * ** * * *** * * *** * * * * *** *** * ** Permit Fee $ ro CCF $ Submittal Fee $ �.�A Notary $ Scanning $ Strual Review. $ Training/Education Fee $ Radon $ DPBR $ Violation date: CO /CC $ Technology Fee $ Bond $ 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 ubject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins' - tion which occurs seven (7) days after the buildin g permit is issued. In the absence of such posted notice, the inspection will be ap • • d a reinspection fee will be charged. �, r O wner or Agent The foregoin instrume t was acknowledged before me this `: % The forego i instrument was acknowledged before me thi day of 20 Qby day of , 200by who is personally known to me or who has produced who is personally known to me or who has produced 6) As identification and who did take an oath. NOTARY PUBLIC: `v`���I111t0U�Ni /,! ` \ \very / %,,, Sign: L- �► -�\ , Sign: Print: 4 'cam,\ %%\1% Ap��� . S. Print: 0 c�Q ‘���.7`. S.� •. �1 My Commission Expires: ************** * * * * *** *** * * ** * * * **** * * * ****;A' s r* � ie* * * * * * * ** ** * * * * * * ** * ** * * ** * * * * ** v* * ** * * * ** * ** * * * * *** APPROVED BY . (; / q.7.27 -,. Plans Examiner Zoning as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked 10/15/2010 10:55 9545849454 ALLINONEINSURANCE PAGE 01/02 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 09/28/10 • — ALL IN ONE INSURANCE PRODUCER • ALI, CE - DAVIE 6795 STIRLING ROAD DAVIE, FL 33314 • Phone: (954)594-3000 Fax: (954)584 -9454 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THIS CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE pQLICIES BELOW. INSURERS AFFORDING COVERAGE "WEED ROSSA PLUMBING & SOLAR LLC 57,40 SW 20TH ST PLANTATION, FL 33317 INSURER At American Vehicle Insurance Company INSURER : INSURER C: INSURER EN INSURER E: COVERAGE THE POL CIES e F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEE POLICY PERIOD INDICATED. NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI4ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES: AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRe. LTR TYPE OF 1NEU - CE POLICY NUMBER POLICY EFFECTIVE DA'L'E (MM/DDIYY) POLICY EXPIRATION • DATE M/DO/YY) - LIMPf$ A rX GENERAL LIABILITY M COMMERCIAL GENERAL LIARILPry DOCLAWI8 MADE D OCCUR D GEM. AGGREGATE UMIT AMISS PER: pOLICY❑ PROJECT ❑LOC GL0511069530 -1 , 07/10/2010 07/10/2011 EACH OCCURENCE 8 1, 000, 000 FIRE DAMAGE(Any one tire) E 100,000 MED (P(A^y we p ) $ 5, 0 00 PERSONAL AAPAPVWO" $ 1,000,000 GENERAL AGGREGATE s 2, 000, 000 PRODUCTS • COMP/OP AGG $ 2,000,000 AUTOMOIALE L1AB UTY _ ANY AUTO ALL OWNED AUTOS _ SCHEDULED AUTOS HIRED NON-OWNED AUTOS — ' COMBINED SINGLE UMR es axiom) $ BODILY S6)uRY person) $ RESIT INJURY SPerac da ij PROPERTY OAMAGU (Per askant $ GARAGE LIABILITY R_ANYAUTO 0 ONL - EAACCIDENT 8 OTHER T1 AN EA ACC $ moo ONLY: AGO $ EXCESS LABILITY ]OCCUR ❑CiAJM$ MADE EOUOTIBLE EACH OCCURANCE ...-) AGGREGATE i 5 -- $ i WORKERS EMPLY AND UABILITY • • ]wIC STATl1TORY min QOTHER EL EACHACCIOENT S E.LbISEABE -EA EMPLOYEE 8 E.LOISE/ SE . POLF5Y LIMIT S OTHER DESORIPUON OP OPRAATIONSILOCATIONSIVEH ICLESiEXCUJS!OW$ ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PLUMING & SOLAR---JOSEPH DELLA ROSSA IS THE QUALIFIER • • • • • • CERTIFICATE HOLDER 1 1 ADDmONAI.INSURED:INSUREDLFrTER: I CANCELLATION • • ' MIAMI SHORES VILLAGE 10050 NF 2AVE MIAMI SHORES, FL 33138 Faxed to: 305- 756 -8972 • SHOULD ANY OF THE VE DESCRIBED POUGFB RE CANCELLED BEFORE THE EXPIRATION DATE THE iEDF, THE L9SUIN3INSURER Vgiu. ENDEAVOR TO MAIL JR DAYS WETTER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO Dow SHALL WORE NO OBLIGATION OR LLAg1L17Y OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AuT .DazEDREPRE:IENTAr1VE ‘:94'142 ACORD 264 (7197) ACORD CORPORATION 1986 10/15/2010 10:55 9545849454 ALLINONEINSURANCE PAGE 02/02 '�_°!z °� CERTIFICATE OF LIABILITY INSURANCE 9/28/2010 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 IIE1WEEN THE ISSUING INSURER[$), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. . IMPORTANT2 If the CeYtifieete holder is an ADDITIONAL INSURED, the pollcy(1es) MINA be endorsed. If SUBROGATION I3 WANED, subJes.t to the terms and Conditions of the policy, certain policies may require an endorsement A statement on this corttflcaee does not confer rights to the certificate holder In lieu of such endorsemenEs). PRODUCER ALL IN ONE INSURANCE 6795 Stirling Rd Davie, FL 33314 CONTACT gH ex* (954)584 -3000 (954)584 -9454 MAIRLtsalosehotka@bellsouth.net ADD salosehOtka@bellzouth.net PRODUtER CUSTOMERrDe: itesusenie) AFF6ROW6 RUMS INSURED DELLA ROSSA PLUMBING & SOLAR LLC 514071 20 STREET PLANTATION, FL 33317 er7VFMAt*PC INSURER A: INSURER B: PROGRESSIVE EXPRESS INSURER C : INSURER D : INSURER E :WEST PORT IN$ /APPALACHIAN INSURER F • REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDmON 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 CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MI uw __ TYPE QFrNBURANCE AWL R BUR - NWR GENERAL LIABILITY COMMERCIAL GENERAL, LIABILITY CLAIMS -MADE El OCCUR POLICY NUMBER GENt AGGREGATE min- APPLIES PER 7 POLICY n °, n 100 AUTOMOBILE LIABILITY ANYAUTO . . ALL OWNED AUTOS B X SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAR EXCESS LIAR ,(MM/DD/YYYY) LIMITS EACH ocCU1 RENcE S w.MAIS _ iTE PREMISES (Eve off) $ MED EXP (Any one Person) 5 PERSOwv.B ADV INJURY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ 04475507 -0 12/17/09 12/17/10 COMBINED SINGLE LIMIT (Ea =dent) $ ODDLY INJURY (Per person) BODILY INJURY (Per ecoIdetht) $ 100,000 s 300,000 PROPERTY OAMAGE (Por aoddQnt 50.4000 $ OCCUR CLAIMSS MA E 1i DEDUCTIBLE RETENTION $ WQRItERB COMPENSATION AND EMPLOYERS' UABIiJTY ANY PROPMETORiPARTHEIVEMOLMVE OFFICERAIEMBER ExCLUDEtn Eandetoay io MO DESCRIPTION OF OPERATIONS below .rrN n N/A TWC3251364 09/16/10 09/16/11 $ EACH OCCURRENCE AGGREGATE 5 $ X 1 TORY L 3 rs ER EL, EACH ACCIDENT E.L DISEASE - €A EMPLOYEE DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (harsh ACORD 109, Addit o tel Remarks senedulc, If more space is required) 2005 Chevrolet Express G2500 1GCGG25v251221211 2005 Chevrolet Express G2500 1GCGG29V451231649 2008 Mercedes -Benz Clk 350 WDETJ56H08F237809 CEMTIFICATE HOLDER k.L DISEASE - POLICY LIMIT $ 1,000,000 $ 1,000,000 $ 1,000,00 — CANCELLATION MIAMI SHORES 'VILLAGE BUILDING DEPARTMENT 10050 N.E. 2N0 AVE. MIAMI SHORES, FL 33138 FAX :305- 756 --8972 . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD 01988 -2009 ACORD CORPORATION. M lights reserved. 10/15/2010 11:03 9545849454 ALLINONEINSURANCE PAGE 01/02 ACORAM CERTIFICATE OF LIABILITY INSURANCE PRODUCER ALL IN ONE INSURANCE - DAVIE 6795 STIRLING ROAD DAVIE, FL 33314 Phone: (954) 584 -3000 Fax: (954) 584 -9454 INSURED DELLA ROSSA PLUMBING & SOLAR I4LC 5140 SW 20TH sT PLANATION, FL 33317 COVERAGE DATE #MWbmyn 09/28/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 140 RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: American Vehicle Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: THE POLIGIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY $E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES: AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POUCY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE [MM IDD/YY) DATE (MIMIDW YY) lams GENERAI"LIAISLJTY EACHOCCIIrRENCE S 1,000,000 21 COMMERCIAL GENERAL LIABILITY MCLAINS MADE El OCCUR A GEML AGGREGATE LOST APPLIES PER: 21 POLICY QPROJECT °Loa 1&T0M iLe LW9W7Y ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE)<LAIMLI7Y ANY AUTO Ecc sS LIABILITY :OCCUR QCLAIMS MIAD& Wm. NTION • WORKERS COM PENSA'RON AND EMPLOYERS LIABILITY THER GL0511069530 -1 07/10/2010 07/10/2011 FARE DAMAGE(Aiiy mm f) $ MED EXPCAny m:e parson) $ PERSONAL AND ADV INJURY $ GENERAL AGGREGATE $ 100, 000 5,000 1,000,000 2,000,000 PROBUCTS.COMP/OPAGG $ 2,000,000 COMBINED SINGLE LIMIT (ea amides) BODILY INJURY (per perse ) S BODILY INJURY Per accident) $ PROPERTY DAMAGE (Poracddant) AUTO ONLY EA AaCIDENT $ OTHER THAN !wA ACC S AUTO ONLY: AGO $ EACH GCCURANCE $ S AGGREGATE $ $ STATUTORY LIMITS ❑OTHER $ Si: EACH ACOIDENT $ E.L,DIBAASSACSA PLOYEE $ ELOISEASE- POLICYUMrr S DESCRIPTION OF OPERADONSLticATioNSNEIficLESIEXCLUSIONs ADDED BY enDORSEMENTISPEcW.. PROVISION$ PLUMBING & SOLAR - -- JOSEPH DELLA ROSSA IS THE QUALIFIER CERTIFICATE HOLDER I I ADDITIONAL IN D:INSURED LET ERs CANCELLATION MIAMI SHORES viLLAGE 10050 NE 2AVE MIAMI SHORES, F7 33138 Faxed to: 305 -7SE -,8972 SHOULD ANY OFF 1HI ABOVE DESCRIBED PoucIES BE CANCELLED BEFFIE ExPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRP[TEN NOTICE TO THE CER1 FICATE HOLDER NAMED TO THC LEFT. BUT manta TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER, LTS AGENT,'$ OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 264 (7/97) ACORD CORPORATION 1888 10/15/2010 11:03 9545849454 A __,- CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A C REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If tiro certificate holder Is an ADDITIONAL INSURED, the policy(le the terms and Conditions LOU* poky, Certain polio)ee may require an endorsom Certificate bower In Hsu of Such endorsement(s). PRODUCER ALL IN ONE INSURANCE 6795 Stirling Rd Davie, FL 33314 INSURED DELLA ROSSA•PLUMBING & SOLAR LLC 5140 SW 20 STREET PLANTATION, FL 33317 COVERAGES ALLINONEINSURANCE PAGE 02/02 BILITY INSURANCE 9 /28/2010 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS D OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ONTRACT BETWEEN THE ISSUING INSURER{$), AUTHORIZED ) must be endorsed. If SUBROGATION IS WAIVED, subject to rd. A statement On this certificate doe% not confer rights to the r,, .f NAME ac k (954) 584 -3000 a ,No •(959) 584 -9454 A RSSs:bsabotka @bellsouth.net PRODUCER CUSTOMER ID t lNaU,O;I{t5) AFFORDING comma! NAICf INSURER A : INSURER B : PROGRESSIVE EXPRESS INSURER C : INSURER D : INSURER E .WEST PORT INS /APPALACHIAN INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL 8 B ����Cp mR TYPE OF INSURANCE INSR Hyp POLICY NUMBER % ttwpr Y, SMM/DR/YYYY) GENERAL LIABILITY comatERCIAL GENERAL LIABILITY CL41MS -MADE OCCUR GEN'L AGGREGATE Low APPLIES PER n POLICY 7 JEc : LOC AUTOMOBILE Lu►BLfTY ANYAUTO ALL OWNED AUTOS scHEWLED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAR EXCESS IIAB E LIMrTS EACH OCCURRENCE $ DAMAGE E ILL) PREMISES (s o cc ca $ RED EXP (My One permn) S PERSONAL& AIN PLILIRY $ GENERAL AGGREGATE i PRODUCTS - comP/OP AGO E 3 04475507 -0 12/17/09 12/17/10 COMBINED SINGLE UMrT (Ea am3den0 sb BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per =Nerd) a 100, oo 300,000 3 .50;000 S OCCUR CLAIRg -MADE DEDUCTIBLE RETENTION S . WORKERS COMPENSATION AND EMPLOYERS'LWBOJTY edeurestenf NADER eo:LUDE cxlrn/E NKI DEOprnbe under ON OF OPERATIONS below EACH OCCURRENCE a $ AGGREGATE 3 YIt� n NIA DESCRIPTION OF OPERATIONS / LOOATI0Ns / VEHICLES (Attach 2005 Chevrolet Express. G2500 2005 Chevrolet Express G2500 2008 Merceda's -Benz Clk 350 CER71FICATE HOLDER TWC3251364 09/16/10 09/16/11 X irony • r EAR E.L. EACH ACCIDENT $ 1,000,000 1,060,000 $ 1,000,000 E.1 DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT ACORD 101, Adanonai Remarks Schedule, If more space le requires 1GCGG25V251221211 1GCGG29V451231649 RDSTJ561108F237809 MTMX SHORES VILLAGE BUILDING DEPARTMENT 10050 N.B. 2ND AVER MIAMI SHORES, FL 33138 FAX:305- 756 -8972 ACORD26 (200A/oe) CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DE 'RED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 7988 -2099 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL 8 B ����Cp mR TYPE OF INSURANCE INSR Hyp POLICY NUMBER % ttwpr Y, SMM/DR/YYYY) GENERAL LIABILITY comatERCIAL GENERAL LIABILITY CL41MS -MADE OCCUR GEN'L AGGREGATE Low APPLIES PER n POLICY 7 JEc : LOC AUTOMOBILE Lu►BLfTY ANYAUTO ALL OWNED AUTOS scHEWLED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAR EXCESS IIAB E LIMrTS EACH OCCURRENCE $ DAMAGE E ILL) PREMISES (s o cc ca $ RED EXP (My One permn) S PERSONAL& AIN PLILIRY $ GENERAL AGGREGATE i PRODUCTS - comP/OP AGO E 3 04475507 -0 12/17/09 12/17/10 COMBINED SINGLE UMrT (Ea am3den0 sb BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per =Nerd) a 100, oo 300,000 3 .50;000 S OCCUR CLAIRg -MADE DEDUCTIBLE RETENTION S . WORKERS COMPENSATION AND EMPLOYERS'LWBOJTY edeurestenf NADER eo:LUDE cxlrn/E NKI DEOprnbe under ON OF OPERATIONS below EACH OCCURRENCE a $ AGGREGATE 3 YIt� n NIA DESCRIPTION OF OPERATIONS / LOOATI0Ns / VEHICLES (Attach 2005 Chevrolet Express. G2500 2005 Chevrolet Express G2500 2008 Merceda's -Benz Clk 350 CER71FICATE HOLDER TWC3251364 09/16/10 09/16/11 X irony • r EAR E.L. EACH ACCIDENT $ 1,000,000 1,060,000 $ 1,000,000 E.1 DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT ACORD 101, Adanonai Remarks Schedule, If more space le requires 1GCGG25V251221211 1GCGG29V451231649 RDSTJ561108F237809 MTMX SHORES VILLAGE BUILDING DEPARTMENT 10050 N.B. 2ND AVER MIAMI SHORES, FL 33138 FAX:305- 756 -8972 ACORD26 (200A/oe) CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DE 'RED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 7988 -2099 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 153969 Scheduled Inspection Date: December 07, 2010 Inspector: Devaney, Michael Owner: WOOLIN, RACHEL Job Address: 489 NE 95 Street Miami Shores, FL 33138- Permit Number: EL -9 -10 -1664 Project: <NONE> Contractor: MICHAUD ELECTRICAL SERVICES INC Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140640 Phone: (786)273 -1270 Building Department Comments SERVICE UPGRADE AND PANEL CHANGE. NEW KITCHEN REMODEL AND WILL ADD SMOKE DETECTORS stop order until owner applies for int. remodel 9/23/2010 Passed 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- 151412. Add smoke/carbon monoxide detectors & kitchen receptacles to code. December 06, 2010 For Inspections please call: (305)762 -4949 Page 12 of 22 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. E4 10 (0011— PERMIT APPLICATION Master Permit No. R c, - (0-rag FBC 20 118 NO \I 5, 2015 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): gk q FL_ (& d 7 ®1— l "/ Phon#: rvi st) 7(& Address: et-e ? % / ?\ City: t�.a �g � 1,44,4 l VI ®f � State:' --- Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: e CONTRACTOR: Company Name: At\e. r A v \� c_, &P--`1- J Phone #:1 / ^ 2 7 3 1 Z 7o Address: 3T12 V `W 07 5 RA City: AN\\∎cs...w�.■ CI o -r C( State: 42 L Zip: 305'g r Qualifier Name: �-b _1 A c),..a.s Phone #: State Certification or Registration #: "0/3O/ 7 3 Certificate of Competency #: Contact Phone #: 1Bp6.' 2 7 3 " / 17 0 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ I' Square/Linear Footage of Work: Type of Work: ❑Address OAlteration bNew ORepair/Replace Description of Work: 14° ‘..! 1 Q UDemolition �x+x� .x�xm+x�x �u********* * * *�x****�x+x+xx�x * **Fees�x�u�x� **A: :4h7e poo*Iwrxigix** Submittal Fee $ Permit Fee $ 7 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Oz21 r .%}9. 1 ,r6,A ,/ ���'�� l i'_'4_ � 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this q day of % '0 IIP/ l �l '220 ID , by /7429/id 4,10 kit who is personally known to me or who has produced ,.'-D.-Q -A4a e) -7 'a-0 a J As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission 101.141:11 11011111t 4., b, SIOr s,, 3671 * * * * * * * * * * * * * * * * * * * ** APPROVED BY Contractor ' / The foregoing instrument was acknowledged before me this `/ day of/VOV Jfl /P[ , 20 /12_, by f /4311 /7IC /Zep who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: Print: My Commis MEAN O. Ask ;:MY COMMISSION I D®651t7t •; ,,va �= EXPIRES; A�d17, Mt1 c • Bonded Thru Notary 9§II& Untie e3 Zoning Clerk ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMMD/YYYY) 11/2/2010 TYPE OF INSURANCE PRODUCER Phone# 305- 655 -1006 Cloverleaf Insurance Brokers 18314 NW 7th Avenue Miami, Florida 33169 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 NAIC # INSURED MICHAUD ELECTRICAL SERVICES INC. 3882 NW 207 STREET ROAD OPA LOCKA, FL 33055 INSURER A: GRANADA INSURANCE COMPANY 500,000. INSURER B: INSURER C: LIABILITY COMMERCIAL GENERALLIABWTY INSURER D: INSURER E: $ 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 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. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM/DDIYYI 04/21/10 POLICY EXPIRATION DATE (MM/DD/YY) 04/21/11 LIMITS EACH OCCURRENCE $ 500,000. A GENERAL LIABILITY COMMERCIAL GENERALLIABWTY 0185FL0008734 MAGE TO RENTED PREMISES Eaoccurence) $ 50,000• CLAIMS MADE X OCCUR MEDEXP(Anyoneperson) $ 1,000. PERSONAL &ADVINJURY $ 500,000. GENERAL AGGREGATE $ 1,000,000. GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS - COMP/OP AGG $ 1,000,000. POLICY JET LOC 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 UABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below I TORY LIMITS I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL WORK IN BUILDINGS. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BUILDING DEPARTMENT DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 10050 NE 2nd AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL MIAMI SHORES, FL 33168 IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRES - /0, AUTHO . S • l ATIVE • ACORD 25 (2001/08) 0 ACORD CORPORATION 1988 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 04 /05/2009 EXPIRATION DATE: 04/05/2011 PERSON: FITZROY H MICHAUD FEIN: 043766397 BUSINESS NAME AND ADDRESS: MICHAUD ELECTRICAL SERVICES INC 3882 NW 207 STREET RD OPA LOCKA, FL 33055 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 61i 151r6--/ 8'- °L.. D .i rot try I 1151 l ?VIiami 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 No.`s 110- 1(Q(o4 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type; ELECTRICAL Owner's Name (Fee Simple Titleholder) fiv% I f1 ©l cf;e/ Phone # 1:‘ 7777 ,I SEP 1 ;,7 BY Owner's Address lc City/111,4/1v' 34,14ef State F4— Zip 3.31 ?q Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 469 City Miami Shores Village County Miam. -Dade FOLIO / PARCEL # Zip Is Building Historically Designated YES Contractor's Company Name L Dy 6-r4i «►. _ _ Contractor's Address $ ! k tie City (h4 Qualifier Name State Certificate or Registration No. NO Flood Zone Phone # 36$ - 7Sj —/, // zip 33 (3,g Phone # 13coo 37 /.3 Certificate of Competency No. Contact Phone E -mail 1 42or►//4., PJCc.7962. el, icz € Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 7 OD m, co Type of Work: ❑Addition Alteration Describe Work: £4e- 1/ i ate/@. Square / Linear Footage Of Work: [New ❑ Repair/Replace ❑ Demolition 2,5 *************************************** F************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ J « Notary $ CCF $ CO /CC $ Training/Education Fee $ S $ Radon $ DPBR $ c� ouble Fee $ / 1 Violation date: Structural Review. $ Total Fee Now Due $ 17"' Technology Fee $ Bond $ 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 FIFCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BO1T FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AF'IIDAVIT: 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 s Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1 �1 The foregoing instrument was acknowledged before me this ) % day of E rL 20 fell, by day of ..fe. , 20 1.G, by who is personally known to me or who has produced Ohl/t1,' 1'. As identification and who did take an oath. NOTARY PUB C: 41' 9F® 7 -14 Sign: Print: My Commission Ex Tres: 1-1 l 0r zo( who is personally known tom ) or who has produced as identification and who did take an oath. APPROVED BY r° '44, Notary Public State of Florida Michelle Perez A My omm.:.a ?o oe Expires 04 /0812013 NOTARAF t 1,/4 t My Commission Expires: 7& S 67, Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06 /10/2009) Clerk checked (1 hs b—l1'I LONGMAN ELECTRIC INC EC 13003713 Malggv,g)) BY: . LONGMAN ELECTRIC INC. Date of submission: November 8, 2010 844 NE 98 Street Miami Shores, FL 33138 Dear Miami Shores Village: I am writing to let you know that I wish to withdrawl my permit application for Raquel Woolin at 489 NE 95th Street Miami Shores, FL 33138 and any and all electric work was /is not performed by Longman Electric Inc. Thank you for your assistance in this matter. Michael Longman 305 - 758 -1211 Office 305- 757 -9806 Fax www.longmanelectric.com Longman Electric Inc. Signed By: Date: I /./ //© 1 • , p p 12051- L'11 A/4 IF cleft ,/e7 ihaks IA 33 3pg SEP 20111 14-Q-Ate, Cai/LA-2-A-tc. qk aykA4) ki foL-- CLi IL3(01-1 Miami Shores Village APPROVED ZONING DEPT BLDG DEPT v 4 DATE -uatECT--To-ONFMICE WITH Ali FEDERAL STATE AND COUNTY RULES AND REGULATIONS fI4 4t 1*-24.-ta- • fbe design It . is 61""1.1L7-°"11 • Note. TiTtlroving On artistic "terpretation Of • bIi qf • rendition. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• •• •• • • • • ••••• • • Rao P esig 8/23/201 Printed; Sna/2010 Drowi•Ei 1}; •• ••• • • • • • • • •• • • •.• ••• • • • • • • • • • • •• ••• •• • • • •• • • • •• • ••• • • • • • • • • • • • • •• • • • ••• • 0 • • • • • • • • • • • • • • • • • • •• • • • • •• • • ••• • • • • ••• • • • • • --• • • • • • • -"'" • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • Note: Tbie drawing is an arfistio interpretation of the general appeoraLtoe, of the design. It is not W elnt to be an exact xefditiett. rF�clptOa�i IL D eeihi•••: 6/29120. P rixaa:d: 8/23/2010 Drawing A: •• ••• • • • • • • • • • •• ••• • • • • • • • • • • • • • • • • • • • • • • •• • ••• • ••• •• • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • ••• • • • • 111_10_114,L4, • • O. • • ••• • • • • • • • • • • • • • • •• •• • • • •• 00 8041 • • • 000 • • Note: 't'bie dinw`aK ism° artlsti° interpretation of the general appearance the dosien. it 03 not meant, to be iinexnn2 rendition. vea1Bne1 8/Z3/Z01 Printed: 8!23/2010 489 NE 95th Street Miami Shores, FL 33138 METER Main 200 AMP 3#2/OTHHN 2" Sch. 80 PVC 200 AMP Nema 3R PANEL 1 Phase 120 / 240 F— #4 Ground �— FPL 2" Sch. 80 PVC ROD 10' X 5/, ROD 10' X 5/, Cold Water SNO11V'Ino3d ONV S31nt AMMO (INV 3LV.S °WM30333 TIV HIM 33NVIldWO0 O! iO3POnS 3.WD A8 03AOHddb e6e11111 sa.00NS IweIW 489 NE 95th Street Street Miami Shores, FL 33138 Raqul Woolin Panel Schedule 1.) A/C Handler 3.) A/C Handler 5.) A/C Compressor 7.) A/C Compressor 9.) Washer 11. )Dish Washer 13.) Kitchen App. 15.) Kitchen App. 17.) lighting 19.) Lighting 60 Amp 60 Amp 50 Amp 50 Amp 20 Amp 20 Amp 20 Amp 20 Amp 15 Amp 20 Amp 2.) Range 50 Amp 4.) Range 50 Amp 6.) Dryer 30 Amp 8.) Dryer 30 Amp 10.) Lighting 15 Amp 12.) Lighting 15 Amp 14.) Lighting 15 Amp 16.) Lighting 15 Amp 18.) Lighting 20 Amp 20.) Refrig 20 Amp 489 NE 95th Street Miami Shores, FL 33138 Raqul Woolin LOAD CALCULATION 2375 sgft x 3VA 7125 Small Appliance 3000 Laundry 1500 Dishwasher 1200 Water heater 4500 Disposal 1000 Dryer 5000 Range 10000 Pump 1200 34525 -10000 24525 10000 x 40% 9810.00 9810.00 19810 10000 air conditioning 29810 full VA 29810 / 240 0 volts= 124.2083 amperage )0-,Lv)()-Ls'iY /1 • crmea-D )72,rr CY-)00 • . y , yp2cr v`, s'er 1 r\J d 571\Q/ J 3_N „ikatoy--A211)9 C''01u -r)-ec?) cYlv()/(17 -P7216b. 54-9 (777()1 LEEDEg 0 no 19-4912)?-73u\l± -eV-013V) 400,) -?-pAticri '1A/1 )29 Irvfnkfir otrON C D -,A }. 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