PL-11-1895,�
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Td: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
MAR 0 L 2L i2
Permit No. PL.-10.11151s
Master Permit No.
OWNER: Name (Fee Simple Titleholder): J0W T 4 i" -A. Phone#: - 57 1-0
Address: 6 OD 1`.-Lt q Ettl S'' -t-- —
City: tiA sf's-t-t ( S iii ,=41-W- S State: ff I - Zip: 33 1 3 ED
Tenant/Lessee Name:" t1 Vf* Phone#: "— Email: ,I on loon t +t. Q q Y111D1d • COdV1
JOB ADDRESS: 61'O I s--01 S't 1
City: Miami Shores County: Miami Dade
zip: 313
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
Phone#: (.34- 5) �� r CONTRACTOR: Company Name: L Q ��� C o ��
Address: Cy, , 7
City: i,g/a, ,0 State: ,,1° 3--eA .
Qualifier Name: 14-1-14.--6, LQ,LW-' -j
State Certification or Registration #: Certificate of Competency #: / 3 P o E3 o 5' 3
Contact Phone # : ll S) 3-0(--; / Z `S-7 Email Address: al e "'`" ei1i� °°L.. o CA
DESIGNER: Architect/Engineer:
zip: 3 31-t 7
Phone#: 0A--) 3 b 5-1/ 5 7
Phone#:
Value of Work for this Permit: $ Square//Linear Footage of Work:
Type of Work: Address OAlteration UNew iyKiepair/Replace ODemolition
Description of Work: S ' ig1. t4 V - 51'1, c rt• 1
******** * * *** * * *** * * * * * * * * ** * ** * * * * ** ** Fees **** ** ****** *****sss*su* ****a *asss * *****a **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Edacation Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 3
)ding Company's Name (if applicable)
1 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 WITI! 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 $25L10, the applicant roust
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be appro ' ' a rte; pection fee will be charged.
Signature
The foreg
day of
i s ment�was ai nowIe bef is
1U1',20 �✓, by'"fiktit � �1!
to or who has produced
ntification and who did take an oath.
Signature
The foregoing instrument
(A day of
NOT
Sign:
Print:
My Commission Expires:
ntractor
as acknowl
;ed before me this T
20/2.by /z:;:/ 44 J ',
onally known to me or who has produced
"e",...-706. as identification and who did take an oath.
NOTARY PUBLIC:
Print-
APPROVED BY
My
g "/ V / 1----Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10/2009)(Rcvised 3/1/09)
Zoning
Clerk
1
02/21/2012 11:09 FAX 1 800 885 7530
DATA SCAN FIELD SERVICES
t 001/001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 758.8972
CHANGE Of CONTRACTOR! ARCHITECT
Permit N. fl— 10-I1. lS`l %—
owners Name We* Simple Title is J VWi1 H'L bon 6 t
Owners Address: to 14E rkvi 5
City: MlktH,l g( tor-ES
Job Address (Of wham work is being done):
City: MIami Shores
Contractors Company Name:`'
Phonet qe -ZS'4I
State : Jr
9tS01
State: —Florida
Zip : 3313b
sue' •
Zlp Code: 3313$
Address: t4.4 IT 7
Rhone It 0 14-6C 9 4)7 /
City: 1-114, State:
Qualifiers Name : P 12-i -� B Lic. Number i a ®.Q
Architect/ Engineer of Record Name: NIA- -
Address:
Cfty:
Zip Code: 3 3 t FS 7
Phone#:
State:
Describe Work: see- tw,K -t " -.
Zip Cade:
1 hereby certify that the work has been abandoned for the contractorlarchitect Is
unable or unwilling to complete the contract. 1 hold the Building Official and the
ores harmless for all Legal in voiv- -nt.
Signature
The foaming insw
this r% day of 20 /Lby A 0e'en r 5
who is pe y known to or who has produced
C rzi B L+: 4 as indeettication.
JEANNE ' VIGOA
My COMMISSION # EE91274
EXPIRES: Awe 27, 2015
1.80o. NarARY
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT1
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: L G i WS C
BUSINESS ADDRESS: 1 V l `1 7 - CITY f
STATE ZIP CODE 3 3 d '/
BUSINESS PHONE: ( 3- ) 6/42-Q 9 f'1 )
FAX NUMBER (3'(() 9ti 9 C (e 7
CELL PHONE ( 3 ) . `71 s°) QUALIFIER'S NAME: e' Lt5-74.013
QUALIFIER'S LIC NUMBER: q .2a f
E -MAIL ADDRESS (IF APPLICABLE): 04`1143 t -, tft% r �
Created on 3119109 BY MLDV 1 RV 312610.9 MLDV
LUL stamIWVYY)
03/02/2012
ACORQ,„ CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (305) 270 -1424 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
i ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AkTER THE: COVERAGE AFFORDED BY THE POLICIES BELOW.
P an Am AssuranoTe
9100 Sunset Drive
Miami
FL 33173 -3433
INSURED
Lanus Irrigation Inc
16120 SW 147th Avenue
Miami
FL 33187-
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: Nosth Pointe Ins Co
INSURER e: Busine88 First Ins Co
INSURER C:
INSURER D:
INSURER E:
CERTIFICATE HOLDER
Miami Shores Village Hall
10050 Northeast 2nd Avenue
Miami Shores, Florida 33138
SHOULD ANY OF THE ABOVE DE8C
EXPIRATION DATE THEREOF. THE
DAYS WRITTEN N01ICE TO THE
FAIWRETO DO SO SHALL IMPOSE NO 013
USURER, ITB AGENTS OR REPRESENTA
AUTHORIZED REPftESENTNIWE
ACORD 25 (2001108)
INS02B memos
ELECTRONIC LASER FORMS, INC.- (8ac)3x7 -O545 .
BE CANCELLED BEFORE THE
WILL ENDEAVOR TO MAIL
HOUR NAMED TO THE LEFT, BUT
R LIABILITY OF ANY KIND UPON THE
O ACORD CORPORATION 1858
Page 1 of 2
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE IFICATE 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.
AGGREGATE
TYPE OF INSURANCE
POLICY NUMBER
eFFECTiVEPtlIiCY
DATE (MMIDDIYY)
DAIS ��
LIMITS
A
GENERAL
LIABILRY
COMMERCIAL ��• . LIABILITY
3093001328
/ /
12/01/2011
/ /
/ /
/ /
EACH OCCURRENCE
$
1,0001000
a��QRl )
$
100, 000
X
12/01/2012
NEDE�(P(Aryoneperson)
$
5 , 000
I CLAIMS MADE X OCCUR
PERSONAL & ADV INJURY
$
1,000,000
/ /
GENERAL AGGREGATE
$
2,000,000
_ COMP/OP AG G
$
000,000
2,000,000
—
GENL AGGREGATE MIT APPLIES PER
n JpC& n LOC
_ „BM=
/ /
-
I
AUTOMOBILE
POLICY
LUBIU1Y
ANY ALTO
ALL OWNED ALTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
/ /
/ /
/ /
/ /
/ /
COMBINED SINGLE Uff
(Ea r
$
/ /
/ /
/ /
BODILY INJURY
(Per perm)
$
—
BODILY INJURY
(Per eoaft)
8
—
—
PROPERTY DAMAGE
(Per de d)
$
GARAGE
UMW,/
ANY AUTO
/ /
/ /
AUTO ONLY -EA ACCIDENT
8
OTHER THAN EA ACC
AUTO ONLY: ACG
$
$
EWESSWMBR
IA LIABIL 1V
/ /
/ /
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
8
OCCUR D CLAIMS MADE
DEDUCTIBLE
$
$
$
II
8
WOR1ERSc0MPEN9ATONAND
EMPLOYERS'
ANY
OFFICERIMEMBER
II yes,describeu
CERIM
RETENTION
LIABILITY
EETOWPACLUDEDI�CUTNE
0521- 05755 -0
07/13/2011
/ /
07/13/2012
/ /
XiaMal M.
E.L. EACH ACCIDENT
$
500,000
E.L. DISEASE - EA EMPLOYEE
$
500, 000
EXCLUDED?
Wow
EL DISEASE - POUCYLIMT
$
500,000
SPECIAL PROVISIONS
OTHER
/ /
/ /
/ /
/ /
/ /
/ /
DESCRIPTION
OF OPERATIONSILOCATIONSIVESCUINEXCLUSIONS
ADDED BY ENDORSEMENTfSPECOAL PROVISIMS
r)
navnGl t A77AM
CERTIFICATE HOLDER
Miami Shores Village Hall
10050 Northeast 2nd Avenue
Miami Shores, Florida 33138
SHOULD ANY OF THE ABOVE DE8C
EXPIRATION DATE THEREOF. THE
DAYS WRITTEN N01ICE TO THE
FAIWRETO DO SO SHALL IMPOSE NO 013
USURER, ITB AGENTS OR REPRESENTA
AUTHORIZED REPftESENTNIWE
ACORD 25 (2001108)
INS02B memos
ELECTRONIC LASER FORMS, INC.- (8ac)3x7 -O545 .
BE CANCELLED BEFORE THE
WILL ENDEAVOR TO MAIL
HOUR NAMED TO THE LEFT, BUT
R LIABILITY OF ANY KIND UPON THE
O ACORD CORPORATION 1858
Page 1 of 2
i
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165482 Permit Number: PL -10 -11 -1895
Scheduled Inspection Date: November 28, 2011
Inspector: Hernandez, Rafael
Owner: BONITA, JONATHAN & MELLY
Job Address: 510 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number (305)607 -5710
Parcel Number 1132060140830
Building Department Comments
IRRIGATION REPAIR & INSTALL AT SWALE PER PAVER
DESIGN DRAWING
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 23, 2011
For Inspections please call: (305)762 -4949
Page 10 of 23
Miami Shores Village
Building Department OCT 1 2011
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILD G
PERMIT APPLICATION
FBC 20
Permit No.f l•- 1' ' i 3't S
Master Permit No.
Permit Type: BUILDING y ROOFING
OWNER: Name (Fee Simple �Titleholder): 4C 4 F X11 Phone #: 305--(007 - 5710
Address: gt o t4Q 16" --
City: 1-1,1A1-1 l J t (L e-5 state: r t._. zip: ; 3 f 3 f)
Tenant/Lessee Name: N A% Phone #:
Email: J OA born 1 e
JOB ADDRESS: 6io NIG 4"641+
City: Miami Shores County: Miami Dade Zip: 3 313 €
Folio/Parcel #: 9 1– 32x09 0 t f -(.2 e:;5 0
Is the Building Historically Designated: Yes NO ✓ Flood Zone: 11 X It
CONTRACTOR: Company Name: {�I l s � .i 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: $ 100 Square/Linear Footage of Work: 14A-
Type of Work: DAddition DAlteration UNew ORepair/Replace
Description of Work: 1 -4L 1° 14 E,,'Ac1if_ A. (VII t".L.L- AT- ‘
p t'�au O s PItterbul
ODemolition
*********** * * * * * * * *** ********** *** ***** Fees***** ****** ******* x:*** *** ******* ******** ****
Submittal Fee $ Permit Fee $ /d d ° CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ ,, V I
TOTAL FEE NOW DUE $ h
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 A}FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved %'v spection fee will be charged.
Signature Signature
Owner or Agent I Contractor
The foregoin instrument was acknowledged before this The foregoing instrument was acknowledged before me this
day of It) , 20 (t, by -S64° L - +, .t . ' olv , , day of , 20 _, by
who is personally known to me or who has produced I® who is personally known to me or who has produced
As identification \ *14: #4 ���an oath. as identification and who did take an oath.
NOTARY PUBLIC: '' NOTARY PUBLIC:
Sign: --___,---� r _ : ei- ° O� va = Sign:
",e X49 ®�.
Print: % �'..'vy � vla Print:
s,P; a 3
s ./6.;
My Commission Expires:
My Commission Expires:
'',i„ 81u ,\\
1/1/1/1111 i 1 ��\\\'�
** **************** ****x *** �xx�x�+ ********* x��x�xx�x�x�******************** �x********** �x* �x�xx�x��xx� **** *�x*** * **** *** ** ***
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner Zoning
Structural Review Clerk
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
ter-tel—ft
.k.4 •
SUB6,ECT TO COMPLIANCE ITH ALL FEDERAL
pOitWAND COLINTY_RUL*ES A REGULATIONS
. - • '••
COPY
IL •
1
43
I•
4..
tolet-1114 s
OCT 1 4 ri
21i
BY:
-24
..................
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