RC-12-232Permit Number: RC -2 -12 -232 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 - 169841
Inspection Date: April 12, 2012
Inspector: Rodriguez, Jorge
Owner: LEGO, JAMES REGIS
Job Address: 163 NW 100 Street
Miami Shores, FL
Project <NONE>
Contractor: LES FAUNCE INC
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
Phone Number
Parcel Number 1131010230310
Phone: (305)606 -1853
Building Department Comments
REPLACE KITCHEN CABINETS
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
April 12, 2012
Page 1 of 1
12,R /24D t 2 - U-7
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 ����
Permit No. 10 2 --4.?3/2"-*
FL V
9I _______a_o_o_amo
ROOFING
OWNER: Name (Fee Simple Titleholder): :Slek ' S L6 ® Phone #: 7b(- Z23 -%B
Address: 16 1.00 ST
City: IWO MAI S .S State: — Zip: 33t o
Tenant/Lessee Name: Phone #:
Email: r t ✓le. ® 4,LO ®.Cerro,
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone: _
CONTRACTOR: Company Name: i P f1XJtJ(e /VC Phone #:
Address: 43 Y /U4 7o? Telt /�
City: /lI /.4 ' State: t"
Qualifier Name: Phone #:
?3
State Certification or Registration #: CAC, 0 YY Certificate of Competency #:
Contact Phone #: 4-grit - 9 Email Address: U
DESIGNER: Architect/Engineer: Phone #: N) 1 ` 7 0LtS
Value of Work for this Permit: $ 1'3'73 v Square/Linear Footage of Work:
Type of Work: DAddition DAlteration DNew I epj�air/R„ep1ace U1 molitiofi
Description of Work �j J 7 + LC� C,it_ ol c /` F• P
********** ** * * * ** *********************Fees******** ***** ****** ****+x+n*******a:****** ****
Submittal Fee $ Permit Fee $ ifS°Cri) CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1.0 •O(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 ail 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 `^- --..----Q-42°--41,
Owner or Agent
The foregoing instrument was acknowle,,.ed
day of J 3N1 , 20 0. , by i, _ r�
>'� ' Pet v6Ls
who is personally known to me or , . pr i duced u c Ens C
L2 -4S'(A.s- 3 o
s identif % ion and who did take an oath.
Contractor
The foregoing instrument was acknowledged bef
, day of J , 20 /2., by
NOTARY PUBLIC:
Sign:
Print:
My Co
Notary Public State of Florida
N
s is ,ir°s:
who is personally known to me or w
as identification and who did take an oath.
NOTARY PUBLIC:
* * * * * * * * * * * *** x***+ x********* ******** ***x: a: ** ************ ********************* ***+ x***** **** +x***+x+z*x:*******x ***
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
DAM
, czpy 1.113
131-4_.
cv
41,,r
OTC: OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO
STATE OF FLORIDA
COUNTY OF MIAMI-DADF:
TAN' FOLK) NO.
1111111111E1111111111 1E11 1111111111 11111111
Tur utqnrRSIGNED hereby gives notic.e that anproverrients mil be made to crmarn real
property, and in accordance with Chapter 713 FI0 rir,u1StatLres intotinatror,
is provided rn thrs Noticte of Commencernent
CFN 2012R0119575
OR Bk 28003 Ps 4082; (1Ps)
RECORDED 02/21/2012 155400
HARVEY RUVIN, CLERK OF COURT
' MIAMI-DADE COUNTYp FLORIDA
LAST PAGE
Space above reserved for vs e of recording office
1 1.gal spton re.a
A /-12' 514 r" •
e decrii sit crorrertt; be-id steVddre sS _ '
Z...
4^, - •
_
"1'AI t. I
nerisi name and address r
IntereSt fl rn)Derry
cf tee s,rttpie. o
Contractor 's name . addres $. and phane numbet-
jt, e 44,113- .r 5_11_
Sutely (Par, merl bond requifea t -Owner bort-, contractor if
Jame. addre.ss and pflf.-ne. /1/./../+
An7.7.,.int of bond
S
f Lender's name and address-, it r -
Penerns within the F.tar,:-.. r fl j ne,5rgna1 .;,0 c , !, , (_%,:7,TiertiS nay be sere a as ornyirird hy
secti..,11 71`..3 Stalutvt, e't / •
/f
address and rploni:F- A / 0 A 1 5 .ee L
7 - crt r
ACIdil'on to
ru-t`l Ctert:le-r, desrdnaleS Dertt:tri'F.: :1 7-Z.f.:-■ pr.tv.ciru ir
1ri1 ftfi Ftnrirla
Name. actdre.st: and pricno norot,c..!
Eptrr datr., tjc..1,ce c,orr.rr.ncem...:-n-
WARNING TO OWNER ;HE ',7•1■:,-P Al-1F
f.A,vENTE., • F14` 7. rErz!,11 ■,.:
virrif.DPEPP,. A N:..TrIC.f. EEr 7 Pi
INTer-Nr... 1-C Ciii-FAINI Hrti4Ni
■•",,ar‘alLiretS' Ow;'ef AtIthOri.7ezi Otirt:ertOre:tcr
Preco.red
l-'reLareo
Prir.: Name :ammo",
Print. P',,t-re
Tode fl
STATE' CF FLORIDA
COUNTY OF MIAMI-
fregrn ..
3--g—J039-1Aa-Priet0 .
0.614.44,,.. ta
J Indiv al a
Persr_trially c uceraxPkluggliagatelyoe of /den
Punt Name
fSEAL
YERBacATTOIDA STATUTES
Under penalties of perjury, I declare mat 1 have read the foreco■nn
that the facts stated in are true. to the best of triv knbiwtectge
E.ionaturets) of Ownerts'i or Ovaler(sYs Authorized Ottiber/DirL:clor-F•airle-t.12^.ager -who s:oned above'
02/22/2012 13:49 3056668014
ACORIC7'
MCCARTNEYINS
CERTIFICATE OF LIABILITY INSURANCE
PAGE 01/01
OP ID: AM
DATE (MMFDD/YYYYj
02/22/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policles may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorseme s
PRODUCER
McCartney Insurance Agency,lnc
6739 Bird Road
Miami FL 33165.3705
Don nlicCartney
305 - 666.4444 MVP/.
INSURED Les Faunce Inc.
834 N.E. 72nd Terrace
Miami„ FL 33138
PHONE
A/C No extr
{A NON
ADDRESS:
C(WIOMEKO p: L,ESFA -1
want 6Rts) AFFORDING COVERAGE
INSURERA:AmerlCan Vehicle Ins. CO
INSURER B
INSURER C
INSURER D:
INSURER Q t
NAM 0
INSURER F
•
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR 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,
1 SR
. is
TYPE OP INSURANCE
ADDL
SUER
,{
POLICY NUMBER
POLICY EPP
MM , , M
POLICY EXP
,. ,, •
(IMPfS
A
GENERAL.
X
LIABILITY
COMMERCIAL GENERAL
LIABILIfY
X
OCCUR
GL0504008797 -00
02/18/12
02/18/13
EACH OCCURRENCE
8
300,000
DAMAGETO RENT-f13
PB,EIY0 S tEs octxtrre�al
$
100,000
CLAIMS -MADE
MED EXP (Any one Durso':)
$
6,000
PERSONAL & ADV INJURY
$
300,000
GENERAL AGGREGATE
$
600,000
GEN'L AGGREGATE OMIT APPLIES PER;
PRODUCTS - COMP /OP AGO
8
600,000
POLICY I LJ I— LOG
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON •OWNED AUTOS
COMBINED SINGLE LIMIT
(En Aatlaant)
$
--
BODILY INJURY (Per WW1)
$
BODILY INJURY (Per aoddent)
$
PROPERTY DAMAGE
(Pere)
$
$
$
UMBRELLA LIAR
EXCESS UAB
OCCUR
CIAIMS•MADE
EACH OCCURRENCE
$
—
—
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
5
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
1 In )
If Yyoeaa,, describe under
Dt.$CRIPTI0N OF OPERATIONS
Y t N
N IA
WC STATU. OTTi-
EL_
E,L, EACH ACCIDENT
$
ii
E.L DISEASE • EA EMPLOYEE
$
ttelow
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS !LOCATIONS / VEHICLES (Atree& ACORD 101, Additional Romarke Senoduin, Itr lara Wes Is:equIr d)
CERTIFICATE HOLDER
CA CELLATION
VILLAG3
Village of Miami Shores
100 NE 2nd Avenue
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL MB DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Don McCartney
00
ACORD 25 (2009/09)
@ 1988 -2009 ACORD CORPORATION. All hts served.
The ACORD name and logo are registered marks of ACORD
ADD SMOKE/CARBON MONOXIDE DETECTORS.
ANY AND ALL CLOTH AND RU ER
INSULATED CONDUCTORS TO BE REPLACED.
BY
RH ALL FEDERAL
Gep Asti afs
3 - /JMJPK (?o o i /' .,yts
- Nea
/e 71-5
NO POINT ALONG COUNTER TO BE MORE THAN
2 FEET FROM GI I PROTECTED RECEPTACLE
PUT D/W RECEPTACLE UNDER SINK.
ALL FIXED APPLIANCES ON DEDICATED CKTS.
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
1 Q W E
L J
Designed: 1/11/2012
Printed: 1/11/2012
egleddiemiller.kit All Drawing #: 1
NO POINT ALONG COUNTER TO BE MORE THAN
2 FEET FROM G.F.I PROTECTED RECEPTACLE.
PUT D/W RECEPTACLE UNDER SINK.
ALL FIXED APPLIANCES ON DEDICATED CKTS.
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
Lo a w E S
J
Designed: 1/11/2012
Printed: 2/1/2012
egleddiemiller.kit I All I Drawing #: 1