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RC-11-1360Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162569 Permit Number: RC -7 -11 -1360 Scheduled Inspection Date: September 08, 2011 Inspector: Bruhn, Norman Owner: SUNSHINE, EDWARD Job Address: 290 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Contractor: EJD CONSTRUCTION CONSTRACTORS & INVESTMENT CO Phone Number Parcel Number 1132060190400 Phone: (305)433 -4843 Building Department Comments 2 BATHROOM RENOVATIONS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 07, 2011 For Inspections please call: (305)762 -4949 Page 19 of 47 BUILDING PERMIT APPL FBC 20 Permit Type: B Miami Shores Village Building Department JUL 2 7 RECD '10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. 42NC _' CATION ROOFING Master Permit No. OWNER: Name (Fe : e Titleholder): edWA0-€1 SU"SA ",0 Phone #: 30S' • .316(2 Address: .290 Am- 9/ srf • City: I'M ern I SNa2E3 State: FL Zip: 33/3e Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: a 1 D A/( 9/s,71. City: Folio/Parcel #: Miami Shores County: Miami Dade 3313 8 Is the Building Historically Designated: Yes NO Flood Zone: Gf CONTRACTOR: Company Name: f ) J GOY? Cv1 ( uc,tto f\ Phone #: 505 q3 Address: 1/11;:010n 7e7c7 City: Qualifier Name: L! State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: Lf3 CGC State: ( Zip: 7`a (Y Phone #: `SOS L(33 Lf 'I,$ 1,5 t 5 g o 1 Certificate of Competency #: Email Address: Phone #: Value of Work for this Permit: $300 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration New ❑Repair/Replace Description of Work: ®/' ❑Demolition Wrak Afe Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Mao]; to Oa lug rsle ,Ca .w try aquya fainViirlitiO IM 44 t8rNIi 00 to nai`sermrn;i3 nealk leivikY90 ui`; * CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ (9 2 55 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 commen ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu a� absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this Contractor t R The for ng i' � ment was acknowledged before me this E? g p day of, 20 f , by day of , 20 1�� by ��`�' l� u who is personally known to me or who has produced' L III # who is sonally know o me or who has produced . identification and who did take an oath. as identification andewkkoN Q} &g4✓oath. NOTARY PUBLIC: NOTARY PUBLIC: `a�� "II"' ° ®��'' %� • r 108591® �f = Ruoissiu�rso�' `�cn nd Sign: a _ AM. Print: u► y,p My Comm Noisy Public - Slate N Florida My Commission EON Oct le, Mitt 0. Commission rr DO 726183 ''%.4;AI Bonded Through Maim' WOW * * * * * * * ** - * *- * ** * oralirik itallterPIPM********m *a: a: a: *: x********m**x:*:x ******* * ***** ** * * **************** Sign: Print: My Commission Expires: a ZIOl1901g0 ✓ ✓ ✓�"111111111110\\\ APPROVED BY V /er( Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ADD SMOKEICARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. Smoke Detectors • JUL 2 2011 • ale Womb Ottawa aWpaeNmpmms. Upprisde *Wail m dmedva end tar All aaredmd and baton Rmndm VA. end dapea end Instal w., awned beard m*near Nee to dmaellinA and repV1 m mamnasm awe TD tome aeam .., awn aewmwonmeee rtorrA and ai balI eam roam Ra9n4M1 end waa maw alarm oft Fan No rceniombdwYto as dorm tome ®Iwmmns Al work Mall to awnpArlstl bl amgYmme ada ma 7007 +3,v :,s CITY COP Smoke Detector r�: ❖- •XIC.5:_:_.:�t _. 2ZKAX._._r.3L= AT.X.i.i.: ❖Z. =._ti 7s- .ztszAZAA O . °- - -'- -'-' °-.ei._.:. r Z.�.'.ZS_.s -. r_.3-sie`s-.- .zc's:.z.-.'e.:l LIVING AREA 2108aqa BATHROOM RECEPTACLE ON 20 AMP CKT AND 6.EI PROTECTED I. -- t c mope tlndn•mash Miami Shores Village APPROVED BY ZONING DEPT DATE BLDG DEPT Sl JR.IFCT TO COMPI IANCE WITH ALL FEDERAL `; T ATI AND COI 1Y fill! FS AND REGULATIONS 7.Li- it SCA : 4/4" = 2'6" € 4 l`_ 2e444'YI' a DATE: 7/24/2011 SHEET: A -1 a �: / 19'-11" 13' -6'� • Scope ofwork. Renvate 2 bathrooms. Change out plumbing fixtures. Upgrade electrical to NEC 2009 requirements, including removal of cloth and rubber Insulated wiring. Add smoke detectors and 1 carbon combo. All hardwired and battery backup. Remove all the and drywall and Install new cement board in shower area to the ceiling, and regular drywall throughout bathroom. Comply with superfluous materials in shower area. file to the ceiling in shower area, 4' from floor throughout bathrooms, and on bathroom floors. Refinish and paint walls of owner color preference. No mechanical work to be done li these bathrooms. All work shall be completed in compliance with the 2007 FBC. E CD 4i�• o = t g v8N N O m U / / ''11 " e —r 0 • —.',4 l' 1' , J �� V►_4 1 S M � � uJ. I-- N y o� s° c w rn o i w 1 N + m oFC� /// �� :_;;?�'�� a 04 w e Slope to drain - no curb. SCALE: 1/4" =1' ♦ 4 , 4 � 1 •4 i -7-, -. 4 c • e 0'-6" x 15' -3" / / / / DATE: 7/24/2011 SHEET: A -2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162600 Scheduled Inspection Date: September 07, 2011 Inspector: Hernandez, Rafael Owner: SUNSHINE, EDWARD Job Address: 290 NE 91 Street Miami Shores, FL 33138- Permit Number: PL -7 -11 -1364 Project: <NONE> Contractor: NELSON G CLIVE PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060190400 Phone: (954)801 -6038 Building Department Comments 2 BATHROOM RENOVATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 06, 2011 For Inspections please call: (305)762 -4949 Page 8 of 19 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Pe r1r Type Plumbing ' "esid ark a e# 4tz: Addi Sta; Parcel Number Applicant 290 NE 91 Street Miami Shores, FL 33138- 1132060190400 Block: Lot: EDWARD SUNSHINE 1 Owner Information Address Phone CeII EDWARD SUNSHINE 290 NE 91 ST MIAMI FL 33138 -3128 1 Contractor(s) Phone CeII Phone NELSON G CLIVE PLUMBING INC (954)801 -6038 Valuation: Total Sq Feet: $ 600.00 100 Type of Work: 2 BATHROOM RENOVATION Type of Piping: 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 Amt Paid Amt Due Invoice # PL -7 -11 -41587 08/02/2011 Credit Card $ 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. August 02, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date August 02, 2011 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 JUL 2 Permit No. _ Master Permit No. P4 — Permit Type: PLUMBING Ed 5 (� OWNER: Name (Fee Simple Titleholder): 5 � f ✓1 j 11 !. a Phone #: Address: SAO ../�l/ L cy t JT City: /1/1 ;Ce 5 ko f P S State: Tenant/Lessee Name: Phone #: Email: Zip: ,S- S JOB ADDRESS: 2 al D /V l City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: C� �� < id i'% 9 , hone #: 9±9 3%9- Address: / ®.%' 4' ` 2 a C 7* City: 47) L"11 State: � Zip :336 --5 Qualifier Name: e �'� • . // J Phone #: 9's-03W-37A-7 State Certification or Registration #: C ®�� ®%� Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ �- ( Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Descrip ❑New ❑Repair/Replace ❑Demolition `w:ak 9TuRf�, =-;te; , ********- • *** ****** ******** Submittal Fee $ Permit Fee $ A/5 a. - CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 15 q • I 0 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 reins ection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this A day o , , by Contractor The foregoing instrument was acknowledged before me this >2 7 ,20 ,by who is personally known to me or who has produced PL b who is personallv_snosvn to me or who has produced , identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: day of Sign: Print: My Commis NOTARY PUBLIC: Sig -/-4A-M. Ja407 Dlt Print. �.N�ye�., RAQUELA.SCARBORt H Notary Public - Slate of Flarl4a My C1: Arsi r WNW !listen Oct 18,2011 ( .,'� ..-- Commission It DD 726183 1 �' �4..., t' Ba ded Th►ou9h NaUonat Notary Assn 'INOtaV*il L ,x*+x******* * ********* * ><,�., ., :. ,< * ****,x ****+x********** ** *****41***a:* �x* :11""ua a::x,xx:m.+x *** * *,u* APPROVED BY f‘..6%. _ � •?, -ifplans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2OO9)(Revised 3/15/09) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 —15e0 Inspection Number: INSP - 164186 Permit Number: EL -7 -11 -1365 Scheduled Inspection Date: September 07, 2011 Inspector: Devaney, Michael Owner: SUNSHINE, EDWARD Job Address: 290 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: BROWER ELECTRIC LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060190400 Phone: (954)748 -6236 Building Department Comments RENOVATION OF 2 BATHROOM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 06, 2011 For Inspections please call: (305)762 -4949 Page 16 of 19 Aug 02 2011 11:11:20 EDT FROM: F214/711118943430 M5G# 36455078 -087 -1 PAGE 083 OF 003 AcoRtf CERTIFICATE OF LIABILITY INSURANCE UO22 ikilm- 1 DATE (MM /DD /YYVY) 08 -02 -2011 THIS CERTIFICATE'S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATION'S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()- F:(888)443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAMES PHONE I raNOIr (888) 443 -6112 -M/C IA No. Ent): A IL ADDRESS: PRODUCER CUSTOMER ID*: INSURER(9) AFFORDING COVERAGE NAIC V LN&/RED BROWER ELECTRIC LLC 8630 NW 53RD ST FORT LAUDERDALE FL 33351 _ __ INSURER A : Twin City Fire In Co INSURER B 1 INSURER O: INSURER D : INSURER E : 8 INSURER P I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EVSR LER TYPE OP EYSIRANCd M ' NNN D POLICY NUMBER (MM rMPMQYW LEWIS GENERAL LIADJJTY COMMERCIAL GENERAL 1CLAIMS-MADE LIABILITY OCCUR EACH OCCURRENCE 8 VAMAIah U a PREMISES (Ea oaaurr rrenae) • MED EXP (Any one pereon( 0 PERSONAL & ADV INJURY 8 GENERAL AGGREGATE • GGEL EN AGQREQAT LIMIT APPLI S PER: PRODUCTS - COMP/OP AGO • 7 I POLICY LOC 8 AUTOMOBILE LL4D2ITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT 1E8 eooioem) 8 — _ BODILY INJURY (Pie person) 8 — BODILY INJURY (Per eCCIdertt) 8 PROPERTY DAMAGE (Per eoddent) • • — 8 — UMBRELLA LlAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE 0 AGGREGATE 8 DEDUCTIBLE RETENTION • • • A WORXERS COMPENSATION AND EMPLOYERS' LIABILITY AN Y OFFICE//MERUDE PROPRIETOR/PARTNER/EXECUTIVE (MendatoryI7M) If Y88, E880,ibe Under DESCRIPTION OF OPERATIONS N/A 76 WEG ZX7411 06/21/2011 06/21/2012 X I OR STATUS I IOTH- roRr uMlrs ER E.L. EACH ACCIDENT 8 100,000 below E.L. DISEASE • EA EMPLOYEE • 100, 000 E.L. DISEASE - POLICY LIMIT 8 500,000 DESCRIPTION OF OPERATIONS / LOCA7jONS / VEHICLES 'MOW. ACORD 101, Adddtlona/Remarks Sth,duh, if man maw a nquhd) Those usual to the Insureds Operations. Re: Permit ,' ?IeII+A Te LJnI ne . Miami Shores Village Bldg. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORMED REPRESENTATIVE 74-' 74j -/ ACORD 25 (2009/09) -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 01/29/2012 Applicant 290 NE 91 Street Miami Shores, FL 33138- 1132060190400 Block: Lot: EDWARD SUNSHINE Owner Information Address Phone Cell EDWARD SUNSHINE 290 NE 91 ST MIAMI FL 33138 -3128 Contractor(s) BROWER ELECTRIC LLC Phone Cell Phone (954)748 -6236 Valuation: Total Sq Feet: $ 500.00 100 1 Type of Work: RENOVATION OF 2 ABTHROOM 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 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # EL -7 -11 -41588 08/02/2011 Credit Card Amt Paid Amt Due $ 159.10 $ 0.00 Available Inspections: 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. August 02, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date August 02, 2011 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 JUL 2 7 1E :VA_ BUILDING Permit No. I l ea0S PERMIT APPLICATION FBC 20 Master Permit No. I 1 — Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): edWRad S °ASA 1/7.4., Phone #: 3OS 7S 3/02_ Address: 2 gtO NE 9/ • City: on/09.n SbP'ze State: PL. Zip: 33IS Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: a 90 Nf 9/ s#• City: Miami Shores County: Miami Dade Zip: 33/3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Fm .` L I e;.# Phone #: 9' / 7'fB b 3C Address: e hey 5, 7 City: LA--'der', -II F State: Zip: 3335 / Phone #: 901 q8 (23 6 Qualifier Name: J jq 01.e5 %r e„) et State Certification or Registration #: EC / 3 as gob ti Certificate of Competency #: Contact Phone #: 95-4 /`` s- y J /r Email Address: drool er e let, is r . e 8 4ol , eV.'" DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ F CjL Square/Linear Footage of Work: Lce. Type of Work: DAddress UAlteration UNew ❑Repair/Replace ❑Demolition Description of Work: Si ��i'�i — c 4?--L pik'a8413 tok.a Fe9 `;s4rewitVxaigrvisiwod4;w1,4: 4* :: :4: ** *** *****Fees * *** * * * * * * ** Submittal Fee $ Permit Fee $ 44.W, 'DO CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ISa V V Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this l q The foregoing instrument was acknowledged before me this .7 day of 3 , 20 d / day of 751,LIAF_, 20 /i/ bye �! who is personally known to me or who has produced 6'L - who is personally known to me or who has produced Ft . identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Signature /- !Colley Public • Stele of Florida llyr Coffin Expo Oct i8, 2011 ;r' Commission 0 00 728183 I• Bonded Through Menai Notary Assn *** * **** *it*TE*****-**Alkfilk. APPROVED BY ,2 Sign: a Jeaik,74" Print:e, — ... � J, .4s— op AO. _ —_i 40 ow RA0t1EL A. SCARBOROUGH My 1° ' ' 'yam "Ex�i Public - State of Florid I • e MY Cate on Expires Oct 18, 2011 , ce., Commission 0 00 728183 2Cv(( /� 1744/Plans Examiner Structural Review (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) * * * * * * ** Zoning Clerk