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RC-10-2082r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162467 Permit Number: RC -11 -10 -2082 Scheduled Inspection Date: July 26, 2011 Inspector: Bruhn, Norman Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)915 -4899 Parcel Number 1132060480010 Building Department Comments STRUCTURAL REPAIR OF POOL OVERHANG INTERIOR REMODELING PassettJ � , � Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 25, 2011 For Inspections please call: (305)762 -4949 Page 23 of 24 k\\\ Lki\ 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 i)MCCM117MB, ig .IAN 2 6 201 ZUJ Permit No. \0-� Master Permit No. Permit Type: BUILDING I `� OWNER: Name (Fee Simple Titleholder): 1039 `� ��/L ��= Phone #: �` -' +`✓� ` `� S` Address: l>�� I ICS` -^ '4 City: k f -M 541.4,e; s State: Zip: 5-c C Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1,11s VC- City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: 3313 IT Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Flood Zone: Value of Work for this Permit: $ 110 0 OW 10 Vrn. Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Description of Work: tNks 13r-i I `7 ❑New Vri ❑Repair/Replace ❑Demolition L./A- Lk-- 16 Fes_ PCP11.10 6.0 14; 1� COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ******** * * *: * * *** * * * * * * * * * * * * * *** * * * * ** Fees * * ** ** * * ** * * * * * * * *** * * * * * * * * * ** * * * ** * * * * ** Submittal Fee $— v Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 ent 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 • / / .aSignature 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: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number 2/20 t Expiration: 06 /20/2011 Applicant 210 NE 102 Street Miami Shores, FL 33138 -2427 1132060480010 Block: Lot: TODD HENDRIX Owner Information Address Phone CeII TODD HENDRIX 210 102 Street MIAMI SHORES FL 33138- (305)915 -4899 Contractor(s) HOME OWNER Phone CeII Phone Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stones: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : REMODEL & POOL OVE Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $16.80 $12.60 $12.60 $5.60 $5.00 $840.00 $27.00 $22.40 $942.00 Pay Date Pay Type Invoice # RC -11 -10 -39494 12/23/2010 Check #: 750 11/24/2010 Credit Card Amt Paid Amt Due $ 892.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use , In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 23, 2010 1 t%i Y7_-row ( ,, 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: BUILDING Permit No. Master Permit No. NOV 2 3 2010 QcIU -Zas2 OWNER: Name (Fee Simple Titleholder): IOW E%!� (' Phone #: 505' ' �� Address: Zit, I JC l oz_ City: B''l� l- PJ� 1 c(' S State: l_ Zip: > (-5( Tenant/Lessee Name: Phone #: Email: "����a1�/ +'r 0 efitd-rviv‘ezr; - cnr`r JOB ADDRESS: 7,t 0 pit I.6 City: Folio/Parcel #: Miami Shores County: I I - 5" Zv(v ( 0 Miami Dade Zip: i 3 P z Is the Building Historically Designated: Yes NO Flood Zone: Ze CONTRACTOR: Company Name: 000 t U 1-!7 l'-- Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 6'6° Square/Linear Footage of Work: 0156 Type of Work: DAddress ❑Alteration ❑New Repair/Replace Description of Work: ❑Demolition re.,„ 6-rC Ac. Pty COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $S 0. lip Permit Fee $ /0"--......- CCF $ CO /CC $ Scanning Fee $ C r Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 FT.F.CTRICAL 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 proved and a reinspection fee will be charged. Signature /'' / _ Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this Z4f The foregoing instrument was acknowledged before me this day of /' " , 20 /v, by ��C aS D ( —I x , day of , 20 , by who is personally known to me or who has produced f" L 10 i 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: /fro Sign: i• . �0,. Sign: 0310612012 Print: _� = Print: NOTARY PUBLIC ; - My Commission Expires: Commission 0 • u'�9.•. DD165901. ,4• fkt ‘''�����, �, ��� ,��,�,��,�,�,� *� *��,��,�***,4 ,� lv 4‘. , ,-*I ** **** ** *************** *** *****************************+,rte 4, /1ntrnnon‘,0 APPROVED BY 21,0 iP "/45 f g® 3IM 44t Plans Examiner Zoning 4 Structural Review Clerk My Commission Expires: (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) 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: I ©PP f,N DATE: NNu Z" I' ZA t v ADDRESS: Zt `' Nk 1111— 4 141/-'41 gI- 'p'ES, 3313£3 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. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -b ilder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may a s my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsi a for the construction and is not hiring a licensed contractor to assume responsibility. Initial 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 instead my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licen .umbers on permits and contracts. Initial 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 substantially proved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or , bstantially 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 on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by r -` my or municipal ordinance. 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 willfully act�'ng as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 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 workers compen tion for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 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 govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 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 ,''act the Florida Construction Industry Licensing Board at 850.487.1395 or htip: / /www.myfloridalicense.com /dbpr /pro /cilb /index p ml 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 information have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does 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 contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned 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 /L , 20 / By who was personally known to me or who has Produced ;'e Licens- or as identif akili! "rr'" /a,,� �L ........ Nt'r 7 �: „�' , = � y '11.1 ///Irnii100```,` ~\ OWNER NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. k! . " "7 X41- 1'TAX FOLIO NO. 0 - -5-21)6 ' r'f .11r -c'[ 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: G t o tic 1111111111111 1111111111111111111 1111111111111 f :F N 2010R0843tea -40 OR B1; 27524 P9 3679; OW RECORDED 12/16/2010 15 :36 :3' HARVEY RUVIMr CLERK OF COURT h1I III -DADE COUNTY r FLORIDA LAST PAGE Space above reserved for use of recording office r.-1 stb7�j , %- 33135 2. Description of improvement: fG ti1�DV�cIuris -i f ... oyCx4IJG tai/ 1/-- 3. Owner(s) name and address: o� F- ^� '7 to Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number: Oti ' - p•�t�.n.t 94j1 � 3138 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 r, :1. r iVicipfi�d9Niftft grnents ma '�&'7i provided by Section 713.13(1)(a)7., Florida Statutes, 1 FI FOY CERTIFY that rale Is �a I/r a ca a. Ii Me 7 s zg . '�,, Name, address and phone number: , ►�r ; i 1 7: I:; OR CO on ,___.. 1 / ti day of fJ Vii% ill 8. In addition to himself, Owners designates the folloINKTI slin i � ` ° 1 of e I le i' gr• .d 'in Section 713.13(1)(b), Florida Statutes. HARVEY r � CLERK, of 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. Signature(s) of Owner r O ner s)' Authorized Officer/Director /Partner /Manager Prepared By Prepared By Print Name Print Name Title /Office — STATE OF FLORIDA COUNTY OF MIAMI -DADE .yj? The foreNoin instrument was acknowledged before me this 1 day of 1 1(Jili�i�� By /Ci[ ,/( ,) / 1�� 1/l \L .c/G /6Z. 57 NL /- / L{, Individually, or ❑ as for Personally known, or la produced the following type of identifi on Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. 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. I !i�lhfiL�r/ Priermitirmrtrfint AS MY COMMISSION # DOOM EXPIRES January02,2811 Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director /Partner/Manager who signed above: By By 123.01 -52 PAGE 3 3/10 5372 4 I NGELMO ASSOCIATES • PA COMR BY: CHK BY: DATE. /c) ?cm, SHEET NO 1/7/ JOB NO ; • .. 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Copyright 2010 www.mecaenterprises.com Date Company Name : Address City State File Location: 11/15 /2010 Ingelmo Associates 250 Catalonia Avenue Coral Gables Florida C: \Program Basic Wind Speed(V) Structural Category Natural Frequency Importance Factor Alpha At Am Cc Epsilon Slope of Roof Ht: Mean Roof Ht RHt: Ridge Ht OH: Roof Overhang Project No. Designed By 301 Description Customer Name Proj Location Files \MECAWind \Default.wnd at Eave= 2 Bldg Length Along Ridge = User 146.00 II N/A 1.00 9.50 0.11 0.15 0.20 0.20 3.49 : 12.00 16.00 2.50 : IA : wind pressure - remodeling : Todd Hendrix : 210 NE 102nd. Street, Miami Sh Input Data: mph Structure Type Exposure Category Flexible Structure Kd Directional Factor Zg Bt Bm 1 Zmin 12 Slope of Roof(Theta) ft Type of Roof ft Eht: Eave Height ft Roof Area 50.00 ft Bldg Width Across Ridge= 2/ Building C No 1.00 900.00 ft 1.00 0.65 500.00 ft 15.00 ft 16.22 Deg Gabled 8.00 ft 2864.00 ftA Main Wind Force Resisting System (MWFRS) Figure 6 -5 Internal Pressure Coefficients for Buildings, GCpi Enclosed Bldg +GCpi = 0.18 Enclosed Bldg -GCpi = -0.18 Figure 6 -6 External Pressure Coefficients Cp - Loads on Main Wind -Force Resisting Systems(Method 2) MWFRS -Wall Pressures Perpendicular to Ridge Wall Cp + GCpi(psf) - GCpi(psf) Leeward Walls -0.50 Side Walls -0.70 Top Elev Bot Elev Kz ft ft -28.03 -11.35 -35.90 -19.22 Kzt qz - Windward Wall- Total Shear Moment psf +GCpi -GCpi + / -GCpi Kip K -ft 16.00 6.00 0.86 1.00 46.96 23.59 40.27 51.62 10.00 .00 0.85 1.00 46.32 23.16 39.84 51.19 15.5 46.5 41.1 329.3 50.00 ft Note: 1) Total = Leeward GCPi + Windward GCPi 2) Shear and Moment are sum of forces (Leeward +Windard) acting at 'Bot Elev' Roof Location Windward - Min Cp Windward - Max Cp Leeward Perp to Ridge Overhang Top (Windward) Overhang Top (Leeward) Overhang (Windward only) Cp - 0.45 0.05 - 0.52 -0.45 -0.52 0.80 MWFRS -Wall Pressures Parallel to Wall Cp +GCpi(ps£) - 26.06 -6.37 -28.81 - 17.72 -20.47 31.50 Ridge + GCpi(psf) -GCpi (psf) -9.38 10.31 - 12.14 - 17.72 - 20.47 31.50 - GCpi(psf) 3/ Leeward Walls -0.50 Side Walls -0.70 - 28.03 -11.35 - 35.90 -19.22 Top Elev Sot Elev Kz Kzt qz - Windward Wall- Total Shear Moment ft ft psf +GCpi -GCpi + / -GCpi Kip K -ft 16.00 6.00 0.86 1.00 46.96 23.59 40.27 51.62 15.5 46.5 10.00 .00 0.85 1.00 46.32 23.16 39.84 51.19 41.1 329.3 Note: 1) Total = Leeward GCPi + Windward GCPi 2) Shear and Moment are sum of forces (Leeward+Windard) acting at 'Bot Elev' Roof - Dist from Windward Edge Cp + GCpi(psf) - GCpi(psf) 0.0 ft to 6.0 ft 6.0 ft to 12.0 ft 12.0 ft to 24.0 ft 24.0 ft to 50.0 ft -0.90 -43.77 - 0.90 -43.77 - 0.50 -28.03 - 0.30 -20.15 -27.10 -27.10 -11.35 -3.47 Low Rise Bldg Provisions per Fig. 6 -10: MWFRS Transverse Direction Building GCpf +GCpi -GCpi qh Min P Max P Surface psf psf psf 1 0.5 0.18 -0.18 46.32 14.82 31.50 2 -0.69 0.18 -0.18 46.32 -40.30 -23.62 3 -0.45 0.18 -0.18 46.32 -29.18 -12.51 4 -0.39 0.18 -0.18 46.32 -26.40 -9.73 5 -0.45 0.18 -0.18 46.32 -29.18 -12.51 6 -0.45 0.18 -0.18 46.32 -29.18 -12.51 1E 0.75 0.18 -0.18 46.32 26.40 43.08 2E -1.07 0.18 -0.18 46..32 -57.90 -41.22 3E -0.65 0.18 -0.18 46.32 -38.45 -21.77 4E -0.59 0.18 -0.18 46.32 -35.67 -18.99 1T * * * * 3.71 7.87 2T * * * * -10.07 -5.91 3T * * * * -7.30 -3.13 4T * * * * -6.60 -2.43 Low Rise Bldg Provisions per Fig. 6 -10: MWFRS Longitudinal Direction Building GCpf +GCpi -GCpi qh Min P Max P Surface psf psf psf 1 0.4 0.18 -0.18 46.32 10.19 26.87 2 -0.69 0.18 -0.18 46.32 -40.30 -23.62 3 -0.37 0.18 -0.18 46.32 -25.48 -8.80 4 -0.29 0.18 -0.18 46.32 -21.77 -5.10 5 -0.45 0.18 -0.18 46.32 -29.18 -12.51 6 -0.45 0.18 -0.18 46.32 -29.18 -12.51 1E 0.61 0.18 -0.18 46.32 19.92 36.59 2E -1.07 0.18 -0.18 46.32 -57.90 -41.22 3E -0.53 0.18 -0.18 46.32 -32.89 -16.21 4E -0.43 0.18 -0.18 46.32 -28.26 -11.58 1T * * * * 2.55 6.72 2T * * * * -10.07 -5.91 3T * * * * -6.37 -2.20 4T * * * * -5.44 -1.27 Wind Pressure on Components and Cladding Width of Pressure Coefficient Zone "a" = 4.8 ft Description Width Span Area Zone Max Min Max P Min P ft ft ftA2 GCp GCp psf psf window window doors doors roof membrane roof membrane roof membrane overhang /open overhang /open 2.00 5.00 10.00 4 1.000 -1.100 2.00 5.00 10.00 5 1.000 -1.400 3.00 7.00 21.00 4 0.943 -1.043 3.00 7.00 21.00 5 0.943 -1.286 2.00 5.00 10.00 1 0.500 -0.900 2.00 5.00 10.00 2 0.500 -1.700 2.00 5.00 10.00 3 0.500 -2.600 area 2.00 5.00 10.00 2H 0.500 -2.200 area 2.00 5.00 10.00 3H 0.500 -3.700 54.661 - 59.293 54.661 - 73.190 52.025 - 56.657 52.025 - 67.918 31.499 - 50.029 31.499 - 87.087 31.499 - 128.777 23.161 - 101.910 23.161 - 171.394 1oa &"odri ?/ : ,72a /(7r (2" a, 7 (-2eg - 5,2 As,: • i/r t /f'7' PSF I NGELMO ASSOCIATES • PA COMP. BY: a-V6cp -c <e1) . CHK BY: DATE. WV . /2 ?a iD SHEET NO.: 1/ JOB NO NGELMO ASSOCIATES • PA COMP. BY. 6sima CHK BY: DATE. x!21 f1. l4 9010 SHEET NO.: JOB NO • 3x 3 • PROVIDE SIMPSON BRAND "LS -50" SKEWABLE PLATES AT HIP TRUSS PROVIDE SIMPSON BRAND "L5 -30" SKEAN:3LE PLATES (TYPICAL AT ALL JACK TRUSSES) PROVIDE SIMPSON "MT550" TWIST STRAP (SEE SECTION E/5 I) --�\ AlbxI5 12 4�- SEE TYPICAL NEJN TRUSS DETAIL THIS SHEET FOR TRUSS TIES PROVIDE 2x6 SCAB AT TOP AND BOTTOM PLATES, CONNECT WITH %" CARRIAGE BOLTS @ 12" O.G. NEW %" GDX PLYWOOD SHEATHING, PROVIDE 8d RS NAILS SPACED ® 4" O.G. (TYPICAL) 3.5" STD. PIPE COLUMN (BEYOND) SEE SECTION C/5-I FOR TRUSS REINFORCING IN THIS AREA DECORATIVE PRECAST CONCRETE COLUMN TO BE SELECTED BY OWNER (BEYOND) Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: [2c I ATE: (2, 1 `) I I, l C7 D D ` A ❑ Contractor • •wner ❑ Architect Picked up 2 sets of plans and (other) :l Address: 2-j 0 NIL_ 10-2,- S-7 From the building department on thi date in order to have corrections done to plans And /or get County stamps. I unde and that the plans need to be brought back to Miami Shores Village Building Depart ; nt to o,' inue permitting process. �_ Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: I o� 13 10 PERMIT CLERK INITIAL: v�- Permit No: 10 -2082 Job Name: December 2, 2010 Miami Shores Viiiage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Corrections for electrical must be completed. 2) Provide level of alteration /repair per FBC EX. 3) Identify R -Value for new insulation in ceiling. 4) Identify foundation for the new wood posts at interior bearing wall removal. 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 3] Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Oa 2 !i Z Job Name fJ f-kr1X Date f-41741 STRUCTURAL CRITIQUE SHEET (41e/417)-f4 ' 1 jRr' $ ve,j v .1 A -A $e Q.a ✓ @ ap Sec- A1/4-J, W Frit 443a 101/17.- lea*, tiff �eNipte `l ytoo d hekel $-te 1r efc,/ /c/h-' � Two/ t c/ all • 0 $406.0 (l e v- at 1 l tee Y-e 15- e- ot, of c9 c,14 ex/f . fooPln 9 treezde, / 'shelf 44/Ali w1,i t11 IA/ t 13 76Ver,Q y t ) i?e firdlyi 9 t how (jo u w ill f re wt' }f �� a ' P ht)l Cdo A tt-e4 i, e .$ q: col- j4 c k December 10, 2010 Norman Bruhn, CBO Village of Miami Shores Building Department 10050 NE 2nd Street Miami Shores, FL 33138 RE: Response to Building Critique Sheet Permit No. 10 -2082 Dear Mr. Bruhn: Thank you for your review of the above referenced permit. I am pleased to provide the following responses and corrected plans. Please note that responses are shown in bold italics. Comment No. 1 Corrections for electrical must be completed. A separate response to the electrical comments is attached hereto. Comment No. 2. Provide level of alteration/repair per FBC Existing Buildings Plans have been prepared per 2007 FBC Existing Buildings Alteration Level 1. This note has been added to the Sheet C -1. Comment No. 3 Identify R -Value for new insulation in ceiling Insulation is to be replaced with R -Value equivalent to 18. This note has been added to Sheet A -1. Comment No. 4 Identify foundation for the new wood posts at interior bearing wall removal. Existing continuous footing has been shown on sheetA -1. Please feel to contact me if you have any additional questions. Sincerel December 10, 2010 Norman Bruhn, CBO Village of Miami Shores Building Department 10050 NE 2nd Street Miami Shores, FL 33138 RE: Response to Electrical Critique Sheet Permit No. 10 -2082 Dear Mr. Bruhn: Thank you for your review of the above referenced permit. I am pleased to provide the following responses and corrected plans. Please note that responses are shown in bold italics. Comment No. 1. No point along kitchen counter to be more than 2 -feet from a receptacle that is GFI protected. GFI receptacles have been added along the countertop on Sheet E -1. Comment No. 2. Put dedicated receptacle under sink A dedicated under sink receptacle has added on Sheet E -1 Comment No. 3 Show receptacles with circuit numbers all areas Receptacles have been added with circuits shown all areas on Sheet E -1. Comment No. 4. Add smoke /carbon monoxide detectors to code. Smoke/Carbon monoxide detectors have been added on Sheet E -1. Note that detectors will be networked and connected to dedicated circuit Comment No. 5. Need circuit breaker panel schedule and load calculation Circuit breaker panel schedule and load calculation has been added on Sheet E -1. Comment No. 6. Any and all cloth and rubber insulated conductors to be replaced. Please feel free to contact me if you have any other questions. `'t'tttiitett>> ND HF4/0 /1i, ..,...., 0, � • .. . / 0j Sd 667 r � r r S TE OF ' tt • P. l' %. FL OR��.•• 2 ,�• e6`�66eItitl. ‘: NGELMO ASSOCIATES • PA Miami Shores Village: Building Department: Permit # 10 -2082 Job Name: Todd Hendrix 210 NE 102 "d. Street, Miami Shores Civil/ Structural Engineering Design Consulting C.A. No. 26864 pinaeimo(Minaelmo. biz www.ingelmo.biz The following are our responses to the structural comments- 1. We have added a note in the Section and the Detail to clarify the condition. 2. Plywood is noted on the section, see arrow from note on left of detail. 3. We have added elevation as requested. 4. See Architectural Responses for this comment. 5. See Detail A/S -2. Ingelmo Associates/ A Paul Ingelmo, PE. C, PE No. 29310 250 Catalonia Avenue, Suite 301 o Coral Gables, FL 33134 o Tel: 305 - 461 -6009 Fax: 305 -461 -6010 LTS /MTS /HTS Twist Straps Twist straps provide a tension connection between two wood members. They resist uplift at the heel of a truss economically. The 3" bend section eliminates interference at the transition points between wood members. MATERIAL: LTS -18 gauge; MTS -16 gauge; HTS -14 gauge FINISH: Galvanized. Some products available in stainless steel and ZMAX6 finish; see Corrosion Information, page 10 -11. INSTALLATION: • Use at specified fasteners. See General Notes. CODES: See page 12 for Code Reference Key Chart. R MTS Installation as a Truss -to- Top Plate Tie SIMPSON Strong-Tie 15" These products are available with additional corrosion protection. Additional products on this page may also be available with this option, check with Simpson for details. Model No. L Fasteners DF /SP Allowable Uplift Loads' SPF Allowable Uplift Loads Code Ref. 10d 10dx11/2 10d 10dx1Y2 10d 10dx11/2 (133/160) (133) (160) (133/160) (133) (160) LTS12 12 12 -100 12- 10dx11/2 775 720 720 665 620 620 3, 28, 39, 104, 121, 140 LTS16 16 12 -10d 12- 10dx11/2 775 720 720 665 620 620 3,39,121,140 LTS18 18 12 -100 12- 100x11/2 775 720 720 665 620 620 LTS20 20 12 -10d 12- 10dx11/2 775 720 720 665 620 620 MTS12 12 14 -10d 14- 100x11/2 1000 840 1000 860 730 860 3,28,39,104,121,140 MTS16 16 14 -100 14- 10dx11/2 1000 ` 840 1000 860 730 860 3, 39,121,140 MTS18 18 14 -100 14-10dx11/2 1000 840 1000 860 730 860 MTS20 20 14 -100 14- 100x11 1000 840 1000 ` 860 730 860 MT$30 r30 14 -100 14- 100x11/2 1000 i , q 1, ! "100 " 1860 730 860 MTS24C 24 14 -100 14- 10dx11/2 1000 840 1000 860 730 860 125 MTS30C 30 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 HTS16 16 16 -10d 16- 10dX11/2 1260 1005 1150 1085 865 990 62123140 HTS20 20 20 -100' 24- 100x11/2 1450 1450 1450 1245 1245 1245 HTS24 24 20 -100 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS28 28 20 -100 24- 100x11/ 1450 1450 1450 1245 1245 1245 HTS30 30 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS30C 30 20 -100 24- 10dx11/2 1450 1450 1450 1245 1245_11245 1. LTS12 hru LTS20, MTS16 through MTS30, HTS24 through HTS30C (except HTS30) have additional nail holes. 2. install half of the fasteners on each end of strap to achieve full loads. 3. Loads have been increased for earthquake or wind loading; no further increase allowed; reduce where other loads govern. 4. All straps except the MTS30 and HTS30 have the twist in the center of the strap. 5. Twist straps do not have to be wrapped over the truss to achieve the load. 6. May be installed on the inside face of the stu 7. NAILS: 10d = 0.148" dia. x 3" long, 10dx11/2 = 0.148" dia. x 11/2" long. See page 16 -17 for other nail sizes and information. d. �" LTS12 (MTS and HTS similar) 20' 15" ;v' MTS30 (HTS30 similar) 11/4u MTS30C (HTS30C similar) Typical MTS30 Installation MTS30 Installation with I -joist Rafter HH Header Hangers For fast, accurate installation of door and window headers and other cross members. HH header hangers can speed up the job, strengthen the frame, and eliminate the need for trimmers. MATERIAL: 16 gauge FINISH: Galvanized INSTALLATION: Use all specified fasteners. See General Notes. CODES: See page 12 for Code Reference Key Chart. Model No. H Fasteners Allowable Loads Code Ref. Stud Header (100) (133) F1 F2 F3 F4 HH4 31/2 213/16 9 -160 4 -16d 1195 710 710 1085 3, 39, 88, 121 HH6 51/2 51/2 12 -160 6 -160 1595 1065 1065 1085 1. F, Loads may be increased up to 25° for short-term loading in accordance with the code. 2. The supporting post thickness mus be a minimum of 21/2". 3. NAILS: 16d = 0.162" dia. x 31/2" long. See page 16 -17 for other nail sizes and information. Typical HH Installation 212, HH Load Directions co y Ito y 159 December 10, 2010 Norman Bruhn, CBO Village of Miami Shores Building Department 10050 NE 2nd Street Miami Shores, FL 33138 RE: Response to Building Critique Sheet Permit No. 10 -2082 Dear Mr. Bruhn: Thank you for your review of the above referenced permit. I am pleased to provide the following responses and corrected plans. Please note that responses are shown in bold italics. Comment No. 1 Corrections for electrical must be completed. A separate response to the electrical comments is attached hereto. Comment No. 2. Provide level of alteration/repair per FBC Existing Buildings Plans have been prepared per 2007 FBC Existing Buildings Alteration Level 1. This note has been added to the Sheet C -1. Comment No. 3 Identify R -Value for new insulation in ceiling Insulation is to be replaced with R -Value equivalent to 18. This note has been added to Sheet A -1. Comment No. 4 Identify foundation for the new wood posts at interior bearing wall removal. Existing continuous footing has been shown on sheet A -1. Please feel to contact me if you have any additional questions. Sincerely, ````�,/' t t ttt• 1 // ,i 'd �`lpg�-'� H,y •:, T: 'debt icp ' %- .- : to 66794 STPTE OF : w -Po .•FtORVO***���'`ems December 10, 2010 Norman Bruhn, CBO Village of Miami Shores Building Depaitnient 10050 NE 2nd Street Miami Shores, FL 33138 RE: Response to Electrical Critique Sheet Permit No. 10 -2082 Dear Mr. Bruhn: Thank you for your review of the above referenced permit. I am pleased to provide the following responses and corrected plans. Please note that responses are shown in bold italics. Comment No. 1. No point along kitchen counter to be more than 2 -feet from a receptacle that is GFI protected. GFI receptacles have been added along the countertop on Sheet E -1. Comment No. 2. Put dedicated receptacle under sink A dedicated under sink receptacle has added on Sheet E -1 Comment No. 3 Show receptacles with circuit numbers all areas Receptacles have been added with circuits shown all areas on Sheet E -1. Comment No. 4. Add smoke /carbon monoxide detectors to code. Smoke /Carbon monoxide detectors have been added on Sheet E -1. Note that detectors will be networked and connected to dedicated circuit. Comment No. 5. Need circuit breaker panel schedule and load calculation Circuit breaker panel schedule and load calculation has been added on Sheet E -1. Comment No. 6. Any and all cloth and rubber insulated conductors to be replaced. Please efe'1' H b ct me if you have any other questions. +40 ' • Sincerely, N -: N 6 6794 o r. �Todd:HeE OF �� •'• fi'. ' /, '9/0W- /it I NGELMO ASSOCIATES • PA Miami Shores Village: Building Department: Permit # 10 -2082 Job Name: Todd Hendrix 210 NE 102nd. Street, Miami Shores The following are our responses to the structural comments- Civil/ Structural Engineering Design Consulting C.A. No. 26864 pinaelmo(c■inbelmo.biz www.ingelmo.biz 1. We have added a note in the Section and the Detail to clarify the condition. 2. Plywood is noted on the section, see arrow from note on left of detail. 3. We have added elevation as requested. 4. See Architectural Responses for this comment. 5. See Detail A /S -2. Ingelmo Associates, PA Paul Ingelmo, PE. PE No. 29310 250 Catalonia Avenue, Suite 301 o Coral Gables, FL 33134 o Tel: 305 - 461 -6009 Fax: 305 -461 -6010 •-t.TS /MTS /HTS Twist straps Twist straps provide a tension connection between two wood members. They resist uplift at the heel of a truss economically. The 3" bend section eliminates interference at the transition points between wood members. MATERIAL: LTS -18 gauge; MTS -16 gauge; HTS -14 gauge FINISH: Galvanized. Some products available in stainless steel and ZMAX® finish; see Corrosion Information, page 10 -11. INSTALLATION: • Use all specified fasteners. See General Notes. CODES: See page 12 for, Code Reference Key Chart. MTS Installation as a Truss -to- Top Plate Tie SIMPSON StrongTie 15" . These products are available with additional corrosion protection. Additional products on this page may also be available with this option, check with Simpson for details. R a a a a Ze„ Model No. w Fasteners' DF /SPAltowable Uplift Loads' SPFA towable Uplift Loads Code Ref. 10d 10dx11/2 10d 10dx1�/2 10d 10dx11/2 (133/160) (133) (160) (133/160) (133) (160) LTS12 12 12 -10d 12- 10dx11/2 775 720 720 665 620 620 3, 28, 39, 104, 121, 140 LTS16 16 12 -10d 12- 10dx11/2 775 720 720 665 620 620 3,39,121,140 LTS18 18 12 -10d 12- 10dx11/2 775 720 720 665 620 620 620 LTS20 20 12 -10d 12- 10dx11/2 775 720 720 665 620 MTS12 12 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 3, 28,39,104, 121,140 MTS16 16 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 3, 39,121,140 MTS18 18 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 MTS20 20 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 MTS30 30 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 MTS24C 24 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 125 MTS30C 30 14 -10d 14- 10dx11/2 1000 840 1000 860 730 860 HTS16 16 16 -10d 16- 10dx11/2 1260 1005 1150 1085 865 990 62,123,140 HTS20 20 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS24 24 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS28 28 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS30 30 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 HTS30C 30 20 -10d 24- 10dx11/2 1450 1450 1450 1245 1245 1245 1. LTS12 thru LTS20, MTS16 thro gh MTS30, HTS24 through HTS30C (except HTS30) have additional nail holes. 2. Install half of the fasteners on each end of strap to achieve full loads. 3. Loads have been increased for earthquake or wind loading; no further increase allowed; reduce where other ioads govern. 4. All straps except the MTS30 and HTS30 have the twist in the center of the strap. 5. Twist straps do not have to be wrapped over the truss to achieve the load. 6. May be installed on the inside face of the stu 7. NAILS: 10d = 0.148' dia. x 3" long, 10dx1 Y2 = 0.148" dia. x 11/2" long. See page 16 -17 for other nail sizes and information. d. LTS12 (MTS and HTS similar) 15" MTS30 (HTS30 similar) 13/4g MTS30C (HTS30C similar) Typical MTS30 Installation MTS3O Installation with 1 -joist Rafter HH Header Hangers For fast, accurate installation of door and window headers and other cross members. HH header hangers can speed up the job, strengthen the frame, and eliminate the need for trimmers. MATERIAL: 16 gauge FINISH: Galvanized INSTALLATION: Use all specified fasteners. See General Notes. CODES: See page 12 for Code Reference Key Chart. Model w H Fasteners Allowable Loads Code No. Stud Header (100) (133) Ref. F1 F2 F3 F4 HH4 3 1/2 213/16 9 -16d 4 -16d 1195 710 710 1085 3, 39, 88, HH6 51/z 51/8 12 -16d 6 -16d 1595 1065 1065 1085 121 1. F, Loads may be increased up to 25 °/ for short-term loading in accordance with the code. 2. The supporting post thickness must be a minimum of 21/2'. 3. NAILS: 16d = 0.162" dia. x 31/2" long. See page 16 -17 for other nail sizes and information. Typical HH Installation HH Load Directions 159 Miami Shores Village: Building Department: Permit # 10 -2082 Job Name: Todd Hendrix 210 NE 102nd. Street, Miami Shores The following are our responses to the structural comments- 1. We have added a note in the Section and the Detail to clarify the condition. 2. Plywood is noted on the section, see arrow from note on left of detail. 3. We have added elevation as requested. 4. See Architectural Responses for this comment. 5. See Detail A/S -2. gelmo Associ tes, PA , PE Paul Ingelmo E. PE No. 29316 Miami Shores Village: Building Department: Permit # 10 -2082 Job Name: Todd Hendrix 210 NE 102nd. Street, Miami Shores The following are our responses to the structural comments- 1. We have added a note in the Section and the Detail to clarify the condition. 2. Plywood is noted on the section, see arrow from note on left of detail. 3. We have added elevation as requested. 4. See Architectural Responses for this comment. 5. See Detail A/S -2. Inge o Assoc: es, PA Paul Ingelmo,l PE No. 29310 I NGELMO ASSOCIATES•PA R_(-1(3 )6?t,2_ field visit report Report No. 1 PROJEC T: Todd Hendrix Residence Miami Shores, Florida CONTRACTOR: Todd Hendrix DATE: January 18, 2011 TIME: 1:OOPM BY: Paul Ingelmo, PE: Did d S E I Y A t 10 NS The site visit was to observe the construction progress as it relates to the structural drawings. The following observations were made during our inspection at 210 NE 102nd. Street: 1. The steel column to steel beam connection was welded in lieu of the bolting indicated on the permitted plan. The welding appears visually acceptable. 2. There are some variations in the as -built condition. The hip member at the southeast corner of the residence should be anchored to the existing roof truss. Provide a new 2x4 PT member vertically on either side of the existing truss and connect to the truss with 5/8" dia. thru bolts at top and bottom. The 2x4 on the east side of the truss should be connected to the hip member at the top with an H2.5AZ Simpson brand metal hurricane clip and at the bottom to the existing concrete tie beam by a 5/8" dia. expansion anchor. Additionally, all members framing into the hip member shall be connected with an H2.5AZ clip. 1 2x4 WOOD MEMBERS (TYPICAL) PROVIDE SIMPSON BRAND "LTP4" PLATES, ONE AT EACH SIDE ON EVERY CONNECTION PROVIDE SIMPSON BRAND "HR56" STRAP TIES, ONE AT EACH SIDE ON EVERY CONNECTION TYPICAL DETAIL; NEW HIP & JACK TRUSSES Scale: N.T.S. PO v i 2x4. — &r�Ji2 64060fillP % df uSE 06,4 e 5/nlp o/z Sa nD CLIPS'1 OP imecruitat 4 0,104J. 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 it NO, Permit Tyke: Electrl'car Parcel Number pate: 12122120 1} 2107 esidentiai Alteration :APPROVED Expiration: 06/20/2011 Applicant 210 NE 102 Street Miami Shores, FL 33138 -2427 1132060480010 Block: Lot: TODD HENDRIX Owner Information Address Phone Cell TODD HENDRIX 210 102 Street MIAMI SHORES FL 33138- (305)915 -4899 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 1,000.00 2650 1 Type of Work: REPLACE LIGHT FIXTURES, SWITCHES Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $225.00 $3.00 $0.80 $234.10 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -11 -10 -39524 12/23/2010 Check #: 750 $ 234.10 $ 0.00 Available Inspections: Inspection Type: 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 23, 2010 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 NOV 2 J 2010 BUILDING Permit No. EL-10 16-1 PERMIT APPLICATION FBC 20 Master Permit No.12C., CJCA1 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) acv) 92, Phone # 34C" 7/-57" 4/89f Owner's Address 7 14-' /1-'6 City erg V-At 'sf� r State -- Zip Tenant/Lessee Name Phone # Email Job Address (where the work is being done) �tv e- /' L1 Si' City Miami Shores Village County Miami -Dade Zip 5.513, FOLIO / PARCEL # fl - 57,66' - ooJV Is Building Historically Designated YES NO Flood Zone e3,-6 Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ /66° Square / Linear Footage Of Work: S o Type of Work: DAddition DAlteration DNew ° Repair/Replace ep lace p ❑Demolition Describe Work: /' ' rM' ( +u� l 5Jt4f �C e- eae$c ,.G ******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************ * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ �® 3' /A- �� CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection , hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ; #proved and a re- inspection fee will be charged. Signature Signature Owner or Agent Contractor The foregt u' g instrument was acknowledged before me this / The foregoing instrument was acknowledged before me this day of / , 20 (a , by `t D , day of , 20 _, by wh s personally known tame 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: Print: My Commission Expires: APPROVED BY /14016 OP appr Sign: 03/46/200 ° . Print: DIA cn Co�m�yPU�ll� ���� 11 111111����\ 0y �G s0Plans Examiner Engineer (Revised 07 /I0 /07)(Revised 06/10/2009) My Commission Expires: Zoning Clerk checked -/ NAME: /o DATE: //ilk 71; frid/44 l f/1 ) fC ?7,,7/ 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 ADDRESS: Z(' 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 -b 'Ider permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may a my own contractor with certain restrictions even though I do not have a license. Initi 2. I understand that building permits are not required to be signed by a property owner unless he or she is responle for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may prote myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license umbers on permits and contracts. Initial 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 impr >ve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially proved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or stantially 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 Initi 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my bu' ding or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by aunty or municipal ordinance. 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. 1, 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 emplo ees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully cling as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who ie'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 incom tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers co ensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initia 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abi by all %plicable 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 S:rvice, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I mad ' ntact the Florida Construction Industry Licensing Board at 850.487.1395 or httrllwww.m loridalicense .com /db.r /.ro /cilb /ind -.html Initia 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am t party legally and financially responsible for the proposed construction activity at the following address: Inifi'' 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informa'- that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who r 'es 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 returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's 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 , 20 By —T-COD —T—COD NC who was personally known to me or who has Produced ere License or as identification. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. ge-te' –z,- Job Name //04-°,17 "7/' /5-=-1,e)/ CRITIQUE SHEET t.7,-) 03/4— 7-71err p/2e,y`--t=,c7 i4 • /7c/7 Ave- 5'446 916t„e- /zve cfi7-Ao‘‘' /17-A /7-7- ,»j hLL.L Sii-e>/re ax- P 7:e ie7945 Yo eePciel a_ f`,,,z V_AccA e-1-ALV e ter/hi 0- e;64,-1 Aiy A-"ck /A-/i 4--et e- )--afF 4-e ,tc Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 to - 2.©52. Inspection Number: INSP- 159544 Permit Number: EL -11 -10 -2107 Scheduled Inspection Date: May 11, 2011 Inspector: Devaney, Michael Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)915 -4899 Parcel Number 1132060480010 Building Department Comments REPALCE LIGHT FIXTURES, SWITCHES, RELOCATE AC DISCONNECT Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. AK0 v May 10, 2011 For Inspections please call: (305)762 -4949 Page 17 of 25 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 210 NE 102 Street Miami Shores, FL 33138 -2427 Owner Information Parcel Number Expiration: 06/20/2011 Applicant Address 1132060480010 Block: Lot: TODD HENDRIX Phone Cell TODD HENDRIX 210 102 Street MIAMI SHORES FL 33138- (305)915 -4899 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 1,000.00 2650 Type of Work: REPLACE FIXTURES Type of Piping: PLUMBING Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # PL -11 -10 -39528 12/23/2010 Check #: 750 Amt Paid Amt Due $ 159.10 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 23, 2010 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) �'�!� 4AV/el NOV 3 02010 Permit No. pi_ 10-- 2 11 1 Master Permit No. Owner's Address 2' 1,>1.- 5r Phone # 3"5- - %�- cirri City At /d-/ 5-i6/-4.5 State Tenant/Lessee Name Email Zip 3311( Job Address (where the work is being done) Ulu /vt- S/ Phone # City Miami Shores Village County Miami -Dade FOLIO / PARCEL # // - 3 Z' ° 0116 — OJT 0 Zip 333/ Is Building Historically Designated YES NO Flood Zone Contractor's Company Name /6JiLa__. Phone # Contractor's Address City State Qualifier Name Zip Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ['Addition ['Alteration Describe Work: loa) Square / Linear Footage Of Work: sic) ❑New jg Repair/Replace ❑ Demolition % t6 LCD r" /- (5 �'o/L4r7 7 aj (� s/r ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee Permit Fee $ % �� CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days afier the building permit is issued. In the absence of such posted notice, the inspection will not be appro ed and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this LI The foregoing instrument was acknowledged before me this _ day of / , 20 1 by -1(.1,0 A P 4, , 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: ImuuIJIIII /,/ �° \\� Nrl@/J4s' / /�. Sign: - %. ;., Sign: Print: = c� °' ®f�� �8/,, ' ' Print: —1; rod r : I) �, :,p0 Air: l/®� My Commission Expires: IIIIIII111\ APPROVED BY �, ,,,,:,2- /l °ie , Plans Examiner Zoning My Commission Expires: (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Clerk checked Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUI DER DISCLOSURE STATEMENT NAME: DATE: / ADDRESS: Z® /4-)(--- ` l f .W7317 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 -b ' er permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may a s my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is respo ible 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 pr ect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name inst :`s of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or lice' "e 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 built- .r improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occ�,• /ncy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or subst- ally improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I e or substantially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons worklfg on my uilding or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and y county or municipal ordinance. Initia 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 emplo ,- - while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully ;`ing as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is qt licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct suservision and must be employed by me, which means that I must comply with laws requiring the withholding of federal inco tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers co ,1, -nation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abi . e by all plicable 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 Se ice, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may ntact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.myfloridalicense.com /dbpr /pro /cilb /inde tml 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 p 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 inform at 1 have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does 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 owner's 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 , 20 By 6 t-L Produced the :' License or who was personally known to me or who has 0\‘ 0111111111/0„, as:idlsrit'p : I o, • O ORIDA � %ffglflll{I�� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 (d 2602 Inspection Number: INSP - 153777 Permit Number: PL -11 -10 -2111 Scheduled Inspection Date: May 11, 2011 Inspector: Hernandez, Rafael Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)915 -4899 Parcel Number 1132060480010 Building Department Comments REPALCE TOILETS AND BIDET AND SINKS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 10, 2011 For Inspections please call: (305)762 -4949 Page 5 of 25 1 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Reps• ent Expiration: 06/20/2011 Applicant 210 NE 102 Street Miami Shores, FL 33138 -2427 1132060480010 Block: Lot: TODD HENDRIX Owner Information Address Phone Cell TODD HENDRIX 210 102 Street MIAMI SHORES FL 33138- (305)915 -4899 Contractor(s) Phone Cell Phone K &K AIR CONDITIONING & HEATING (786)487 -9853 Valuation: Total Sq Feet: $ 5,000.00 0 Tons: 2.5 X 2 Additional Info: 2 UNITS A/H & COND UNIT INSTALLAT Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: MECHANICAL Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.63 $2.63 $1.00 $175.00 $3.00 $4.00 $191.26 Pay Date Pay Type Invoice # MC -11 -10 -39533 11/30/2010 Credit Card 12/23/2010 Check #: 750 Amt Paid Amt Due $ 50.00 $ 141.26 $ 141.26 $ 0.00 Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhemiore, I authorize the above -named contractor to do the work stated. December 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 23, 2010 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL )‘i ;a) LUIO Permit No. IV by 10 —all (12 Master Permit No. - 9 d - - 7'6'7? Owner's Name (Fee Simple Titleholder) 1-47P ��1 1=� y Phone # ` - `� �5` fl Owner's Address t City G�;tt,A"-n.'!,t �i� -v 5 State s - Zip -51. Tenant/Lessee Name Phone # Email Job Address (where the work is being done) City Miami Shores Village County Miami -Dade FOLIO / PARCEL # =� N' �)c) i 0 Zip .� Is Building Historically Designated YES NO Flood Zone f..1-^ Contractor's Company Name Re / /VP t v & d/ ii(C1941 f ggr(16 r, Phone # 7 1-1 7 c S- 5 3 Contractor's Address 3 7 l 7 '%� a �i I City 1-16'1.4 -i Y9eaci, State t t • Zip `S 0 3 "S Qualifier Name 12e iz2 ¶ v'¢C Cst�i ve Phone # 7g6 Y9-7 ? State Certificate or Registration No. t . C t 5 ' t 3 Certificate of Competency No. Contact Phone 7 ra i q 33 E -mail Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: Phone # Square /_Linear Footage Of Work: ❑Alteration [New -) Repair/Replace ❑ Demolition r- **************,*************************F s******************************************** Submittal Fee $ Permit Fee $ 7 CCF $ CO /CC $ Notary $ Training/Education Fee $ Scanning $ Radon $ Double Fee $ DPBR $ Violation date: Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ See Reverse sid iifrz 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 jab site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o such posted notice, the inspection will not be approvedand a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this Zsr1`' The for day of i "c 20 I, by -"add btievrl y , day o who is e'sonally known t ..m or who has produced As identification and who did take an oath. 02-. Signature who is om: Contractor was ackn e , 20 l Oby 1 ed befor e ersonally known to me or who has produced iidentification and who did take an oath. - - NOTARY PIIBT :. __ O'rARY PUBLIC: MV MNISM Sig \ '<<` I YtRtlRELlen ►42.4011 Print: My Commission Expires: ******•it********ii ********** ** AT,4 APPROVED BY Sign: Print: eta C , fl s My Commission Expires : y',��� y v,:; ****.*******.*** (.***** (.****.A.**** (.********.******************* lans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) CHECK LIST D COMPRESSOR O SUCTION PSI O HEAD PSI El VOLTS AMPS o ELECTRICAL CONNECTIONS El CONTACTS TIGHT & CLEAN 0 OIL LEVEL & CONDITION 0 CONDENSER COIL 0 CLEAN COIL & CHECK FIN COND D ENT ---°F LVG °F o REFRIGERANT 0 LEAK 0 CHARGE 0 FAN AND MOTOR 0 VOLTS AMPS 0 ELECTRICAL CONNECTIONS 0 CONTACTS TIGHT AND CLEAN 0 FAN PULLEYS (ADJUST BELT) 0 CHECK. LUB BEARINGS & MOTOR 0 CFM 0 EVAPORATOR COIL El CLEAN COIL & CHECK FIN 0 ENT DB -°F I LVG DB °F 0 ENT WB -°F LVG WB 0 CONDENSATE AREAS O INSPECT & CLEAN DRAIN PAN 0 INSPECT AND CLEAN DRAIN 0 AIR FILTERS 0 CLEANED 0 REPLACED FILTER SIZE 0 HEATING ASSY. 0 BURNER & HEAT EXCHANGER 0 FUEL SUPPLY & PRESSURE O PILOT ASSEMBLY O FLAME ADJUSTMENT 0 PRIMARY RELAY & FLUE El FAN & UMIT SWITCH OPER. O BLOWER ASSEMBLY O RV VALVE DI STRIP HEAT O DEFROST CYCLE 0 ELECTRICAL COMP'TS. 0 RELAYS 0 CONTRACTORS 0 OVERLOAD 0 PRESS SWITCH 0 THERMOSTAT 00.K. REPLACE 0 RELOCATE 0 QUANTITY ITEM OR PART DESCRIPTION c )±. f K & K AIR CONDITIONING & HEATING 3717 NE 16th STREET HOMESTEAD, FL 33033 TEL: 786-487-9853 Lic. #: CAC1815813 1525 (DATE , -(/ -7C)/ DATE ORDERED / / NAME DATE SCHEDULED / / STREET 2- ozs� PHONE 67".. (ti CITY , t---*/ g STATE ZIP WK. PHONE /-( 4/00, I)c) MAKE MODEL SERIAL NUMBER TRAVEL TIME TIME ARRIVED TIME DEPARTED TRAVEL TIME MILEAGE ENDING START- MILES .A X X /MI.= ,‘• ,•°r: c c4 cz, 4 0) LAI+ er) P Cif' 2,- (1 JOB LOCATION REPAIR NUMBER DESCRIPTION ACCEPT PRICE DECLINE LINE der or7 We wish to provide the highest level of professionalism and quality service along with Ott best custom* assurance policy In the industry. Our service repair warranty policy is: 1. All parts replaced by us will be warranted to be free of defects for the period of Many service companies provide 30, 60 or 90 day warranties. We feel that the parts we Install have been carefully selected and meet or exceed manufacturer specifications. For this reason we feel comfortable offering this excellent warranty. The labor to install the warranted part(s) is discussed in item #2 below. 2. Our repair labor is warranted for the period of This Is the labor to repair or replace the part we Installed In the Initial repair, and not to correct other problems that may have arisen in the interim. 3. In the case of refrigerant (freon) leak repairs, our parts and labor warranty is as stated above with the following clarifications: a. You are strongly urged to let the technician show you the location of the leak prior to and after the repair If this is not possible due to attic or other inconvenient location, be sure the technician accurately describes the leak location on his service ticket. Our warranty is for the specific leak repaired. b. Unfortunately, many times there can be more than one leak in the system. We may only locate one and complete an effective repair only to be called out again later and find another one. Our warranty on the previous leak repair would not cover the new one. However, if within 90 days of the first leak location, we will provide a no charge diagnostic and leak search. You will then only pa Y for the repair of the leak, just as you would have done if we had located it on the first trip. ENVIRONMENT CHECK LIST R E F R G E R A N T CHRG. CODE TYPE REFRIG. RECOVERED? YES SYSTEM QTY QTY NO RECYCLED? RECLAIMED? RETURNED TO THIS SYSTEM? DISPOSAL E1 YES YES YES NO NO NO QTY QTY QTY E 0 U MP E N T CHANGED OUT (OR REPLACED)? DIS- MANTLED? YES NO YES NO REFRIGERANT DISPOSAL e o WARRANTY o CONTRACT O SERVICE CONTRACT O NORMAL O RES 0 COMM. 0 SERVICE 1 a tie • 14-1 /0 Le Po t„-Cri tt,2t CY Ow& TRAINED PERSONNEL meeturtafead: .6" / C-4 CUSTOMER REQUEST: (cf. c / IicO10 c) e 7C--ck to-t, OUR PERSONNEL RECOMMEND: TECHNICIAN SIGNATURE CERT.# TERMS: DUE UPON COMPLETION.' I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS OUTLINED ABOVE. IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL AND COMPLETE PAYMENT IS MADE, AND IF SETTLEMENT IS NOT MADE AS AGREED, THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FORM THE REMOVAL THEREOF. AUTHORIZED SIGNATURE TOTAL OTHER CHARGE SUB- TOTAL DIAG. CHARGE TOTAL AMOUNT DUE NON USEABLE n YES NO QTY. DISPOSAL OWNER'S INITIALS ACCEPTED DECLINED ABOVE ORDERED WORK HAS BEEN COMPLETED AND I ACKNOWLEDGE RECEIPT OF MY COPY. // DATE i This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Certificate of Product Ratings AHRI Certified Reference Number: 3412355 Date: 11/30/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM30 Indoor Unit Model Number: RHLL- HM3617+RCSL -H *3617 Manufacturer: RHEEM MANUFACTURING COMPANY Trade /Brand name: RHEEM 14AJM SERIES Manufacturer responsible for the rating of this system combination is RHEEM MANUFACTURING COMPANY Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored, independent, third party testing: Cooling Capacity (Btuh): 29200 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 • Ratings followed by an asterisk O indicate a voluntary rerate of previously published data. unless accompanied with a WAS. which Inc icates an involuntary rerate. DISCLAIMER AHRI does not endorse the productjs) listed on this Certificate and makes no representations, warranties or guarantees as to, and a$sumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not in whole or in part, be reproduced; copied; disseminated; entered into a computer latabase; or otherwise utilized, in any fomi or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on 'Verify Certificate" Ink and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute 14 Air - Conditioning, Heating, SIM and Refrigeration Institute CERTIFICATE NO.: 129355995386483417 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): & (0 e&E 10 Z City: Miami Shores Village County: Miami Dade Zip Code: 3 3 L3 $' ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES E41=I Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER f I✓ cei, -- - AHU or PKG. UNIT MODEL # ROLL- fu'l`l ?TA COND. UNIT MODEL # r ' i /4-4 3040 f KW HEAT Me 0 40 T NOM TONS 2. . 5 T t".% AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER C 3 em l c s6E YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT NO YES NO NEW 4 "CONCRETE SLAB (S NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 0-o V 4. Size Disconnecting Means: Contractor's Company Name: kA 4c G- -r e®e 5t't fir ke i Phone: 1-T6 z( g. 79-C3 3 State Certificate or Registration N. CAS ( S 5'13. Certificate of Competency t Signature Q - er's signature only) Date: f(- 30 -fO Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 2 i0 Aft- to 05-f City: Miami Shores Village County: Miami Dade Zip Code: � ° I' 3 tg° ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES Contract Attached: YES 11(''' UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER ghee 4-e-- AHU or PKG. UNIT MODEL # IR fL L - fIA< 36173 -1f COND. UNIT MODEL # 1 =-t' A zr -c 3O .4® KW HEAT R WI) tf ( 7A 0FX- NOM TONS Z • S ( 0 '- S AHU CU PKG 1; M.C.A AHU CU PKG AHU CU PKG 2' M.O.P AHU CU PKG AHU CU PKG 3, VOLTS AHU2Y®CUeY ®PKG PKG UNIT / / PKG UNIT / / EER/SEER 13 FE% 16 SEY 1R YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT ■V NO YES NO NEW 4 "CONCRETE SLAB EtD NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES tr 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 2. e(0 V 4. Size Disconnecting Means: Contractor's Company Name: /(t A ,4 it"(e.ec. i Phone: 786 4 87 gs- State Certificate or Registration N. C 4C erg--® IS Certificate of Competency N. Signature (Qua er's signature only) Date: 11.— 30 - (O 04-23-2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS:, COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 05/20/2010 EXPIRATION DATE: 05/19/2012 ALVAREZ PEDRO P 261386068 BUSINESS NAME AND ADDRESS: K &K AIR CONDITIONING & HEATING CORP 3717 NE 16TH ST HOMESTEAD FL 33033 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR Nev * IMPORTANT: Pursuant to Chapter 440 . 05114 ►, F.S., an officer of a corporation who elects exemption from this chapter by fling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113 ►, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 11, 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 tor failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTIOt■ "' rV DT RFVICFn 09 -06 PLEAS STATE OF FLORIDA DEPARTMENT OF FINANCIAL SER' DIVISION OF WORKERS' COMPEN: CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BI WORKERS' COMPENSATION LAW MIAMI -DADE COUNTY 1 0 W. FLLAEGL RRST. 1st, FLOOR MIAMI, FL 33130 624636-7 BUSINESS NAME / LOCATION K 8 K AIR CONDITIONING AND HEATING CORP 3717 NE 16 ST 33033 HOMESTEAD OWNER 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA SEPT. MUST BE D SPPLAY D AT PLACE OF BdSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY EFFECTIVE: 05/20/2010 K $ K AIR CONDITIONING AND PERSON: PEDRO P ALVL Sec. Type of Business FEIN: 261386068 THIS is + A 1g i:C MECHANICAL CONTRACTOR BUSINESS TAX RECEIPT. IT BUSINESS NAME AND ADC ALDER rooR�M K &K AIR CONDITIONING & HEATING EXISIINGREQULATORyOR ZONING LAWS OF THE 3717 NE 16TH ST COUNTY OR CITIES. NOR DOES IT EXEMPT HOMESTEAD, FL 33033 HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS.. SCOPE OF BUSINESS OR 1- CERTIFIED AC CONTRACTOR PAYMENT DECEIVED MIAMI- DADECOUNTY TAX COLLECTOR: 60000000199 000045.00 SEE OTHER SIDE DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 I FIRST -CLASS U.S. POSTAGE I PAID MIAMI, FL ■ PERMIT NO. 231 RECEIPT RO NEWAL STATE# CAC1815813 651097 -9 WORKER /S 1 DO NOT FORWARD K 8 K AIR CONDITIONING AND,/ HEATING CORP PEDRO P ALVAREZ PRES 3717 NE 16 ST HOMESTEAD FL 33033 1.11,n11D1lrlttDl } t!1`lt t�tt�t�4ttlet l }rtl�lttr ff�rtr�]ft7t� its on pt don meets 1609 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ALVAREZ, PEDRO PABLO K &K AIR CONDITIONING & HEATING CORP 3717 NE 16 STREET HOMESTEAD FL 33033 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from arghitects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! • DETACH HERE SATE OF .FLORIDA AC# 4 9 7 40,8 DEPARTMENT OF BUSINESS AND_; RO ES:SIONAL FtEGTJLA`, I-ON COND COWER RO,PABLO I T.IONIN( & HEATING IS,: CERTIFIED under the provisions of cn.489 Fs ' tatiot� date AUd 31; 2412 a LICENSE N O`5 27 201.10 ,'x,9':81,6. 647 j,; C` 1 The CLASS B ASR C TDI`1?IONI Named below IS CERTIFIED Under- the provisions of Cha Expiration date: AUG 31, 20' ALVAREZ,{ . PEDRO PAELl4 K&K AIR COND,I'TION0:1 3717 NE,' ,16 STREET HOMESTEAD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYY) 11/29/10 PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED K & K AIR CONDITIONING & HEATING CORP j 3717 NE 16 St Homestead, FL 33033 INSURER A: NATIONAL GROUP INSURANCE CO. INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 POLICY EFFECTIVE DATE (MM/DDIYY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS A ❑ GENERAL LIABILITY V COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE d OCCUR ❑ GMG- 0000003353 11/14/10 BEACH v 11/14/11 OCCURRENCE 300,000.00 DAMAGE TO RENTED PREMISES (Ea occurence) 100,000.00 MED EXP (Any one person) 5,000.00 PERSONAL & ADV INJURY 300,000.00 GENERAL AGGREGATE 300,000.00 ❑ PRODUCTS - COMP /OP AGG 300,000.00 GEN'L V AGGREGATE LIMIT APPLIES PER POLICY ❑ PROJECT ❑ 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 LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION \-1 MIAMI SHORES VILLAGE v BUILDING DEPARTMENT 10050 N.E 2nd AVE MIAMI SHORES, FL 33138 1 FX. 305 - 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MARTA M ALONSO iltAillt ACORD 25 (2001/08) QF © ACORD CORPORATION 1988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 to - 20Sz Inspection Number: INSP- 153822 Permit Number: MC -11 -10 -2116 Scheduled Inspection Date: May 11, 2011 Inspector: Perez, JanPierre Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: K&K AIR CONDITIONING & HEATING Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)915 -4899 Parcel Number 1132060480010 Phone: (786)487 -9853 Building Department Comments REPLACE TWO 2.5 TONS A/C SPLIT SYSTEMS. REMOVE VENTS AND DUCT WORK FROM ILLEGAL PORCH ENCLOSURE tl Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 10, 2011 For Inspections please call: (305)762 -4949 Page 6 of 25 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i0-2-082- Inspection Number: INSP - 153822 Permit Number: MC -11 -10 -2116 Scheduled Inspection Date: May 11, 2011 Inspector: Perez, JanPierre Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: K &K AIR CONDITIONING & HEATING Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)915 -4899 Parcel Number 1132060480010 Phone: (786)487 -9853 Building Department Comments REPLACE TWO 2.5 TONS A/C SPLIT SYSTEMS. REMOVE VENTS AND DUCT WORK FROM ILLEGAL PORCH ENCLOSURE )-6' ) Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 10, 2011 For Inspections please call: (305)762 -4949 Page 6 of 25