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RC-12-169Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INS P- 178344 Permit Number: RC -1 -12 -169 Scheduled Inspection Date: September 17, 2012 Inspector: Bruhn, Norman Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SOURCE REMODELIN Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)329 -0222 Parcel Number 1121360050090 Phone: (786)897 -2760 Building Department Comments INTERIOR ALTERATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 169426. Not ready. Clean up debris and resod. NB September 17, 2012 For Inspections please call: (305)762 -4949 Page 21 of 35 MIAMII DE COUNTY Miami -Dade County Building Department 11805 S.W. 26 Street, Miami, FL 33175 -2474 www .miamidade.gov /building ENERGY, SOUND AND IMPACT CERTIFICATE Building Permit No: -- 1 -12 - 16 9 Project Name: AA r� rvN k S in a (e -Job Address: 104 N G 106 STATEMENT OF COMPLIANCE, We, the undersigned, hereby certify that the ENERGY. SOUND AND IMPACT.' INSULATION has been installed in the above referenced project, in compliance with the latest edition of the FLORIDA BUILDING CODE. the APPROVED ENERGY CALCULATIONS and Plans and in accordance with good construction practice. The insulation furnished and installed has the characteristics shown below: (check only applicable boxes). 11) Exterior CBS Walls Insulation: R -4, I (Min.): Material: F'1 Thickness: 3/4 inch (es): Density: lb/ft: Mfgr: ❑ 2) Exterior Frame/Metal Stud Walls: R- (Mm.): Material: Thickness: inch (es): Density: lb/ft: Mfgr: ❑ 3) Exterior solid concrete walls: R- (Mn.): Material: Thickness: inch (es): Density: lb/ft Mfgr. ,riff y ❑ 4) Interior walls separating A/C from non A/C spaces insulation: R- (Mm.) Material: • Thickness: inch (es); Density: lb/ft ❑ 5) MULTI- FAMILY RESIDENTIAL CONSTRUCTION ONLY: The COMMON ( Party) walls to two separate conditioned tenancies shall be insulated to a minimum of R -11 for frame walls, and to R -3 on both sides of common masonry walls See ENERGY CODE, 2007, paragraph 13 -602. ABC.1.1, on page 13.74, latest edition. These "minimum levels of insulation" are not included in the Energy Calculations, but shall be installed in the field. Eff6) Ceiling insulation R- 32) (Min.); Material: E(i ercjIci, Thickness: I " inch (es): Density: lb/ft: Mfgr: ❑ 7) Walls, partitions and floor /ceiling assemblies between dwelling units or between dwelling units and adjacent public or service areas such as halls, corridors, stairs, etc. must have a sound transmission class (STC) of not less than 50 (penetrations must maintain the required rating). ❑ 8) Floor /ceiling assemblies between dwelling units or between dwelling units and public or service areas such as halls, corridors, stairs, etc. must have an impact insulation class (1(C) rating of not less than 50. Make photocopies of this sheet in your office, as required for future jobs. Installed by: Ou '(c e g perottel I ^J Insulation Company Name Insulation Contractor CC# C. R C 13 3 ©3'`) N O.C./Builder. S Ulf 9(C e 'm() d e I t iNty Company Name 3 Building Contractor CC#: CRC I 3 3 c 31 t� 1 Insulation Con JSignature Date Certified: G ,' / 1� G.C./Builder's Signature Date Certified: / h2 Note: For lightweight Insulating concrete, use appropriate forms, separate from this one. Revised 02-26-2009 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 tvi INSPECTION'S PHONE NUMBER: (305) 762.4949 B DING Permit PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): lie 1rn o\ r c\ 0 G {-e Ln r‘ Cl‘ Address: l (b \ J J e 1(r) S -� ,� J N3 i. : :;2 Be , oomeoo_0. 0 0mr Master Permit No. City: Mtcnm\ ,5it)reS Phone#: �Q6�',J a� w DA as State: Zip: 3 3 138 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: ) (.) I IU E ) 0 City: Miami Shores County: Miami Dade Folio/Parcel #: 6 1 —A \3- 0 05- 0090 Is the Building Historically Designated: Yes NO )c Flood Zone: CONTRACTOR: Company Name: 50L) Yce APmoae 11 n 9 Phone#: 36.5-- 3S6.°i4%71-/ Address: (2») N V / IA) 54- , I r i l i f l : 7 '■17 Z7 D City: 1A1a)eo.% (Jc„rd.-kAS State: FL Zip: 33018 Qualifier Name: 3 0 f9 R08Y►9L/ez Phone#: State Certification or Registration #: C-R c 133039 q Certificate of Competency #: Contact Phone#: 6 i q '1' 3' 6(1 Email Address: �� 6 .500 rce gernode l i n5 e (I®>\ DESIGNER: Architect/Engineer: S Dm co n S u j i- i r\9 E r 9 n Qe ifs Phone#: 30:S - N L b -R3- RA Value of Work for this Permit: $ 3 0100 0 Square/Linear Footage of Work: " 100 SC? FA- Type of Work: ❑Addition GIAlteration New ❑Repair/Replace UDemolition Description of Work: 1 n ,f 1 c.) _ Zip: 331.3e *** ** **** ************* ** **** **s **** *** ** Fees ****** * ******************x *** :** **** ** »say * ** do a V Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education F Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ L CY ZJP a CO Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 2-0 day ofiNa el 20 1 Z, by &P1(11a40 f)Y -) who is personally known to meor who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print Signature Contractor The foregoing instrument was acknowledged before me this 2 a day 00=k70 U14 , 20) z, by F rye ROC riipe7 , ho is ersonally known fo mj or who has produced as identification and who did take an oath. "" VIOLET BOVIL ;'i MY COMMISSION # EE091622 EXPIRES May 14, 2015 FlwidallotarySeroice.com My Commission Expires: ** *q:***** * *** **** * ** * ** * ***** **** APPROVED BY L 14 20 t< OTARY PUBLI ign: Print: My Commission Expires: ILA.- 9 (L{) 2 r VIOLET P BOVIL °c MY COMMISSION # EEO91622 gSMay14,2U15 Plans Examiner Zoning /01,44 /44- '2,.///i2, Structural Review Clerk (Revised 07 /10/07)(Revised 06/10 /2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. Z2 ! (j TAX FOUO NO. STATE OF FLORIDA: STATE OF FL I IDA, COUNTY OF DAD COUNTY OF MIAMI -DADE: I H_FRE,-',Y CF_ R ° 1' filet this is r.5 copy of the „ r i g i n IilwctHrt= _ i`�acr 2 qef THE UNDERSIGNED hereby gives notice that improvements will be made A U 20 11111111111111111111111111111111111111311M CFN 211 12RO0 6F;i a52 OR Bk 27978 Ps 41824 (1cs))) RECORDED 01/30/2012 15:41:74 HARVEY RLIV'I)(r CLERK. OF COURT MIAMI -DADE COUNTY r FLORIDA LAST PAGE property, and in accordance with Chapter 713, Florida Statutes, the followi of ti; hr r rat � na.�f9Iil is provided in this Notice of Commencement. 8y 1. Legal notion of roperty d streetaddress: L. 33 tl- A13._ -co to 2. Description of improvement: ti"V'e{ eY 14') + VEEP -Hi O Space above reserved for use of recording office 3.Owner(s) name and address: F C ( e %J -0 oye of (\ c Interest in property: Name and address of fee simple titleholder. _ 4. Cpn I = ctor's name, a dress and phone number. 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: 4//k 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the daze 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 Owne s) or Own (s)' Authorized Officer/Director/Partner/Manager Prepared By s / _ I • ( J . ` Prepared By Print Name i+am' s . .. ' Print Name Title /Office Title /Office STATE OF FLORIDA COUNTY OF MIAMI-DADE The f, - • oing instrume , was acknowledged before me this 1) day of To, n ✓d\'C ) A 0 9 Yl• A /_ • vtom ❑ Individually, or Di as for ,Personally known, or LI produced the following type of identification Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated In it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director /Partner/Manager who sig By 723.07•52 PACE 3 3/10 • ' VIOLET P BOVIL •- MY COMMISSION ft EE091622 EXPIRES May 14, 2015 F rvice.tom By BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) Sunshine Windows Manufacturing, Inc. 1745 West 33`a Place Hialeah, FL 33012 SCOPE: This NOA is being issued under the applicable rules and regulatiou.saur a use of construction materials. The documentation submitted has been reviewed- Miami ade f o my Product Control Division and accepted by the Board of Rules and A...-'ls (BORAX) to ` e used n Miami-Dade County and other areas where allowed by the Authority Having Jun fiction ( U) This NOA shall not be valid after the expiration date sta Division (In Miami -Dade County) and/or the AHJ (in County) reserve the right to have this product or material tested for quality as r, o es Ifis p duct or material fails to perform in the accepted manner, the manufacturer will in " these \f suclisting and the AHJ may immediately revoke, modify, or suspend the use of such � is 1 within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is dot - i s . - , by Giiami Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone. DESCRIPTION: Series 2000 Aluminum Single Hung Window - L.M.I. APPROVAL DOCUMENT: Drawing No. SH08 -01, titled "Series 2000 Aluminum Single Hung Impact Resistant Window ", sheets 1 through 6 of 6, dated 04 /02/08, revised and dated 03/04/10, prepared by manufacturer, signed and sealed by Francisco Hernandez, P. E., bearing the Miami Dade County Product Control Revision stamp with the Notice of Acceptance number and Expiration date by the Miami Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact Resistant LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami-Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises NOA No. 08- 0219.03 and consists of this page 1 and evidence pages E-1 and E-2, as well as approval document mentioned above. The submitted documentation was reviewed by Jaime D. Gascon, P. E. MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1107 MIAMI, FLORIDA 33130 -1563 (305) 375-2902 FAX (305) 372 -6339 www.maimidade.Gov/buildingcode County Product Control ;APPROVED;` NOA No. 09- 1217.05 Expiration Date: April 24, 2013 Approval Date: March 24, 2010 Page 1 Sunshine Windows Manufacturing, Inc. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Manufacturer's die drawings and sections. 2. Drawing No SH08-01, Sheets 1 through 6 of 6, titled "Series 2000 Aluminum Single Hung Impact Resistant Window", dated 04 /02/08, revised and dated 03/04/10, prepared by manufacturer, signed and sealed by Francisco Hernandez, P. E. B. TESTS 1. Test reports on: 1) Air Infiltration Test, per FBC, TAS 202 -94 2) Uniform Static Air Pressure Test, Loading per FBC TAS 202 -94 3) Water Resistance Test, per FBC, TAS 202 -94 4) Large Missile Impact Test per FBC, TAS 201 -94 5) Cyclic Wind Pressure Loading per FBC, TAS 203-94 6) Forced Entry Test, per FBC 2411 3.2.1, TAS 202-94 along with marked-up drawings and installation diagram of series 2000 aluminum single hung window, prepared by Fenestration Testing Laboratory, Inc., Test Report No. FTL- -5253, dated 10/02/07, signed and sealed by Carlos S. Rionda, P. E. (Submitted under previous NOA No.08-0219.03) 2. Test reports on: 1) Air Infiltration Test, per FBC, TAS 202 -94 2) Uniform Static Air Pressure Test, Loading per FBC TAS 202-94 3) Water Resistance Test, per FBC, TAS 202 -94 4) Large Missile Impact Test per FBC, TAS 201 -94 5) Cyclic Wind Pressure Loading per FBC, TAS 203-94 6) Forced Entry Test, per FBC 2411 3.2.1, TAS 202 -94 along with marked up drawings and installation diagram of series 2000 aluminum single hung window, prepared by Fenestration Testing Laboratory, Inc., Test Report No. FTL -5252, dated 08/17/07, signed and sear by Carlos S. Rionda, P. E. (Submitted under previous NOA No.08 -0219.03) C. CALCULATIONS 1. Anchor verification calculations and structural analysis, complying with FBC -2004 and FBC -2007, prepared by manufacturer, dated 12/22/07, signed and sealed by • Francisco Hernandez, P. E. Complies with ASTM E1300-02 (Submitted under previous NOA No.08-0219.03) D. QUALITY ASSURANCE 1. Miami -Dade Building Code Compliance Office (BCCO). Jaime D. Gascon, P. E. Chief, Product Control Division NOA No. 09- 1217.05 Expiration Date: April 24, 2013 Approval Date: March 24, 2010 E -1 Sunshine Windows Manufacturing, Inc. NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED E. MATERIAL CERTIFICATIONS 1. Notice of Acceptance No. 09- 0312.02 issued to E. I. DuPont DeNemours & Co., Inc. for their "DuPont Butacite® PVB, Interlayer" dated 05/13/09, expiring on 12/11/10. F. STATEMENTS 1. Statement letter of conformance, dated December 08, 2009, signed and sealed by Francisco Hernandez, P. E. 2. Statement letter of no financial interest, dated February 6, 2008, signed and sealed by Francisco Hernandez, P. E. (Submitted under previous NOA No.08- 0219.03) 3. Laboratory compliance letter for Test Report No. FTL =5252 issued by Fenestration Testing Laboratory, Inc., dated 08/28/07, signed and sealed by Carlos S. Rionda, P. E. (Submitted under previous NOA No.08-0219.03) 4. Laboratory compliance letter for Test Report No. FTL -5253 issued by Fenestration Testing Laboratory, Inc., dated 10/10/07, signed and sealed by Carlos S. Rionda, P. E. (Submitted under previous NOA No.08-0219.03) G. OTHERS 1. Notice of Acceptance No. 08- 0219.03, issued to Sunshine Windows Manufacturing, Inc. for their Series "2000 Aluminum Single Hung Wmdow - L.M.L", approved on 04/24/08 and expiring on 04 /24/13. E -2 Jaime D. Gascon, P. Chief, Product Control Division NOA No. 09- 1217.05 Expiration Date: April 24, 2013 Approval Date: March 24, 2010 m HEAD ANCHORS SEE CHART 10"MAX. FALSE MUNTINS (SURFACE BE USED APPLIED) TIPICAL ELEVATION I OVER I GENERAL NOTES: 1: FOR NUMBER OF ANCHORS FOR EACH UNIT SIZE REFER TO DESIGN PRESSURE CHART. 2.- REFERENCES: TEST REPORTS FTL -5252 AND FTL -5253. 3.- THIS PRODUCT MEETS THE REQUIREMENTS OF THE 2007 FLORIDA BUILDING CODE, 4.-FASTENERS MUST BE MADE OF STAINLESS STEEL OR HAVE ADEQUATE PROTECTION AGAINST CORROSION AS PER DIN 50018, ALUMINUM CONTACTING METALS SHAD. BE PROPERLY PROTECTED. MIAMI- DADE IMPACT RESISTANT SHUTTERS ARE NOT REQUIRED DESIGN PRESSURE CHART - PIG' SEEMS-2000 ALUMINUM SINGLE HUNG IMPACT IMISIBTANT WINDOW WINDOW ANCHOR DBIION DIMENSION SCHEDULE PRESSURE.PSF WIDTH HEIGHT PER HEAD AND say, PER IAMB EXT. TNT. 19 1/B" 3 90.0 90.0 28 I/2' 3 90.0 90.0 37" 28" 4 3 90.0 90.0 53 1/8' 6 75.0 75.0 19 1/8' 3 80.0 90.0 28 1/2' 3 90.0 90.0 37' 39 3/8" 4 4 90.0 90.0 531/8 ". 6 75.0 75.0 19 1/8' 3 90.0 90.0 28 1/2' 3 90.0 90.0 37' 50 6/8' 4 6 90.0 90.0 53 1/6" 6 75.0 75.0 19 1/8' 3 75.0 75.0 28 1/2" 83' 3 75.0 75.0 37' 4 7 75.0 75.0 53 1/8" 6 75.0 75.0 18 1/8" 3 75.0 75.0 26 1/2" 3 75.0 75.0 37" 74 1/4' 4 8 75.0 75.0 53 1/8' 6 75.0 75.0 IMPACT RESISTANT WINDOW 1745 M. 3M4 Platy I141416, Fiafdo 33012 PIn (305)334 -6522 Fao(3056 -6116 'RODULTREVISD Is =plying w55 lbs Florida kdadiag Coda tomato= Flo 7' [swieiam t2 -8 -oq FRANCISCO HERNANDEZ FLORIDA PE # 51393 SPAWNS N0. SHOE -01 SHEET 1 OF 6 2 1/2" MIN. 2 1/2" MIN. DETAIL AI ATTACHMENT TO MASONRY GLAZING DETAIL 0.080" DUPONT BUTACRE PVB 1YPION. ANOORS 1/4" TAPCONS 1 1/4" MIN. EMBEDMENT INTO MASONRY THROUGH 1" BY WOOD BUCK (FOR MM. SPACING AND NUMBER OF TYPICAL ANCHORS I/4" DES 1 ,1/2 MIN. PENETRATION INTO WOOD. (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 11) DETAIL A2 ATTACHMENT TO WOOD TYPICAL ANCHORS 1/4• SMS THROUGH METAL OF ANCHORS REFER TO SHEET 1 OF 6) DETAIL A3 ATTACHMENT TO METAL STRUCTURE DETAIL (STEEL OR AWIINUM 1/B" MIN. THICKNESS) TYPICAL HEAD SECTIONS IMPACT RESISTANT WINDOW (2$-00( FRANCISCO HERNANDEZ FLORIDA PE # 51393 Manufacturing, 1G5. MHO Mt ►k (388)334 -8082 F®(3C8)828 -8115 tom RF 11e6a 12� 1541515712-11-0S RaNYOna DRAWN Kt SH08 -04 SHEET 2 OF 6 TYPICAL ANCN0i6 1/4" TAPCONS 1 1/4" MN. EMBEDMENT MITO MASONRY (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL CI ATTACHMENT TO PRECAST SILL 2" BY WOOD BUCK 1YPICAI. ANCHORS 1/4" EMS 1 1/2" MN. PENETRATION INTO WOOD. (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL C3 ATTACHMENT TO WOOD 3/4" VAX. NCM- SHRINK GROUT OR 1" BY MOD RUCK 2 I/2" MIN. TYPICAL. ANCHORS 1/4" TAPCONS 1 1/4" MN. EMBEDMENT INTO MASONRY THROUGH 1" BY WOOD BUCK OR NON SNRBO( NON METALLIC GROUT (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL C2 ATTACHMENT TO MASONRY TYPICAL ANCHORS 1/4" SMS THROUGH METAL. (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL. C4 ATTACHMENT TO METAL STRUCTURE (STEEL OR ALUMINUM 1 /B" MN. THICKNESS) TYPICAL SILL SECTIONS IMPACT RESISTANT WINDOW PRODUCT RBYNSEO raaomplyIngwKNtBe Saida Bui141101 Coda AompOsum No - ' t' lob DM31011 12 -8.O FRANCISCO HERNANDEZ FLORIDA PE # 81393 TYPICAL ANCHORS 2' BY WOOD BUCK TYPICAL ANCHORS 1/4" 9K4 1 1/2' MK PENETRATION INTO WOOD. (RAN MAX. ANCHOR SPACING AND ANCHORS REFER TO SHEET 1 OF NUMBER ) OF H DETAIL DZ ATTACHMENT TO WOOD 1/4' TAPCONS 1 1/4' MIN. EMBEDMENT INTO MASONRY THROUGH 1' BY WOOD BUCK (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL DI ATTACHMENT TO MASONRY TYPICAL ANCHORS 1/4' SMS THROWN METAL (FOR MAX. ANCHOR SPACING NAG NUMBER OF ANCHORS REFER TO SHEET 1 OF B) DETAIL YAUDS FOR JAMBS, HEAD AND SILL MBA -DADE COUNTY APROYED tuWON ATTACHMENT TO MULLION DETAD. TYPICAL JAMB SECTIONS IMPACT RESISTANT WINDOW TYPICAL ANCHORS 1/4' SUS THROUGH METAL (FOR MAX. ANCHOR SPACING AND NUMBER OF ANCHORS REFER TO SHEET 1 OF 8) DETAIL D3 ATTACHMENT TO METAL STRUCTURE (STEEL OR ALUMINUM 1 /B' MIN. THICKNESS) I¢.S -o9 FRANCISCO HERNANDEZ FLORIDA PE Q 51393 (SEE DETAILS Af. A2 AND A3 ON SHEET 2 OF 8) 3/4' x 3/8' STEEL (SEE DETAILS C1, C2. C3 AND C4 ON SHEET 3 OF B) VERTICAL SECTION (SEE DETAILS 01. 92 AND 93 ON SNEEr 4 OF 8) WINDOW WIDTH HORIZONTAL SECTION VERTICAL SECTION WITH TOP LOCK IMPACT RESISTANT WINDOW PRODUCT REVISED xx asoplykas whhamFIwWs Bw14Ng Cow AxxxPlanx No AO +e -6.124 FRANCISCO HERNANDEZ FLORIDA PE # 51393 + L _.._I 1 °m° FRAME HEAD x'75 I 0 ,2 0504 MATERIAL 0.912 —T +� 1 Li ,.280 o '�'" GLAZING 1 BEAT 6083 -76 • Mt �G RAIL 8083 —TS 2. 27 1 0937 6083—T8 1.825 0.062 2.514 1T - ...... OAM 1.870 I SASH i 1 TOP OBS -T6 B F- I 0.050 RAIL 5 2.078 ^-I � 60053 -75 2.375 FRAME JAMB TB £*H2 SAS 1.850-1 1Jm0 - 8083 —T8 RUL 5W43355 0350 SLOE RAIL Witlk C4113" 1,000 SASH 0.710 1324 SASH BOTTOM RAIL PLASTIC FACET& 5300 SW -43363 MATERIAL LIST Maas PARTS LEAD. DE8001P170N MATERIAL 1 SW -014 1 FRAME HEAD 5063 ■TO 2 SW52101 1 FRAME SILL 6083—T8 3 SW-011 2 FRAME JAMB 8083 —T5 4 SW40111 1 MEETING RAIL 8083 -1B 5 SW -017 1 SASH TOP RAIL 5053 -75 6 5W43355 1 SASH BOTTOM R12 5063 —T8 7 SW82028 2 SASH CAM NYLON 8 SW -012 2 SASH SIDE RAIL 8083 —TB 9 SW—AS AS REO ASSEMBLY SCREWS # 8151' PH PIILUP CRS 10 SW8202A 4/VENT FACE GUIDES NYLON 11 SW43353 2/VENT LATCH BOTTOM RAIL PLASTIC 12 SW1820 AS ROD SEAL PILE FELT 13 SW3257 AS ROD WEATHER STRIP BULB VIM. 14 — AS ROD SILICONE DC -869/0E -1200 15 SWW101 AS ROD CRAZING BEAD 5083 —T8 18 SW540 2 SPIRAL BALANCE ALUMINUM 17 SW -687 2/VENT LATCH ZINC 18 SW3082 AS ROD WEATHER STRIP BULB VINYL. IMPACT RESISTANT WINDOW R2_$ _09 FLORIDA RANISCO HERNANDEZ W001.65-13f1.— sohnikftl 1 2 e1 R toad 12_6 -00 Wilco Draws No. SHOE -03 SHEET 6 OF 6 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CL- Rc -121&A Inspection Number: INSP- 173770 Permit Number: EL -4 -12 -664 Scheduled Inspection Date: May 21, 2012 Inspector: Devaney, Michael Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FIALLO ELECTRIC CORP Permit Type: Electrical - Residential Inspection Type: 1=tIsI Work Classification: Temp for Construction Phone Number (786)329 -0222 Parcel Number 1121360050090 Phone: (786)399 -0832 Building Department Comments TEMPORARY FOR CONSTRUCTION f/"fL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Corn May 18, 2012 For Inspections please call: (305)762 -4949 Page 31 of 38 BUILDING PE ' r PLICATION FBC 2 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. 12-11-- Master Permit No. 1109 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): teir1Anlwo(n ' O V G(P f0 n r(OUD._Phone #: ((Ai (,) Address: City: State: Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: l. © 1 City: Miami Shores County: Miami Dade Zip: 331? 0 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: U I 4 t Q j� �j o). CONTRACTOR: Company Name: fA!/ , " �1 l�iT�1 Phone #: ��1 b-3 ® Address: 0 City: A-itz7 State: ° Zip: 3J5 5- Qualifier Name: G,Ch t5 A� %.5 4 -i9 f _ Phone #: State Certification or Registration #: ,gi a 0003i b 3 Certificate of Competency #: Contact Phone #: b..38/ =3I5) Email Address: DESIGNER: Architect/Engineer: Phone #: /0,5- 54- Value of Work for this Permit: $ C' 00 0 0 Square/Linear Footage of Work: Type of Work: Address Alteration New ❑Repair/Replace ❑Demolition Description of Work: ' 1/'/O ********** *u+ ***+ xa:***+k ********** * ******* Fees°" ********* *w ***+ k******+ k***+ x*+x**+k******nt*.x*** Submittal Fee $ D,- Permit Fee $ /00> 6' ® CCF $ CO /CC $ ory,. Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5(" 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ,T rtt� Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this / 1 The foregoing instrument was acknowledged before me this 13 ('" day of Z 7V' ( , 20 1Z, by ry '4\ 40 W1 0 hit Atr 0 01644 of 14,1V V , 20 , by To L, L) QM- 41, who is personally known to me or 'who has produced l' k C� w l �H g�vho is personally known to me or who has produced LKkilX 1ri53(Z A danfi icatiieon and who d' oath. �sa +v►�� %as identification and who did take an oath. NOTARY PUBLIC: S � ®�a� p ��l®9g,9 ® ® ® ® ® ®�� Sign: .i �< = Sign: _ : ... ....... • CASTILLO �a #EE26515 � T� Print: d �h ��� �,�� 3., . ze Print: \-dam + m# DD0866299 ge My Commission Expires: �`i,t 4N . • • F� �� My Commission Expires 3/3/2013 �e���io�iOC;11 1 o� ���```` z, lDo FlOf�B A89I1, Inc li NOTARY PUBLIC: ***+ k* *$s**Na*nkih+h ***ik*N=*** APPROVED BY }bNa****+ ******* **iksk******sk+k****+k*+N k*+ k*+ k*N=+ k*Ass ksk********sk******sk*H+ **sh******+k+k* k*** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09) Miami Shores Village APPROVED BY .7OPi1NG DEPT BLDG DEPT 0100114.j. Electric Corp. �6ce ed and -Insured ec SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS President Robert Fiallo Vice: 305.263.1447 Cell: 786.389.7152 P77/ AM/ 6 #1610y--iaJ / # 0003163 ATF: Miami Shores Village 10050 NE 2 Ave Miami, FL 33139 4013 aktemec,5 : t 01 Me 65' srreet- t- t�4+ -1 i Silo �i (die Rrte °32c3ci Temporary Electrical Service Service size 70 amps #3 single phase 11/2 conduit wire size 3@ #3 Awg 100 amp meter grounding #6 panel 2 @ 20 amp 70 amp panel 41) j 2 GFCI 20 amp outlets ''�— (� 4 x4 pressure treated ,ground rod #6 wire resident Robert fiallo QUI i +a■ LIOSCiala..........aaaaaI mo vpJU CASTILLO �� Comm# D00866299 Expires 3/3/2013 dd', Florida NotaryAssn, OTC naq.buu.au..uoue.re.n Miami Shores Village APPROVED BY riff 1_ w■ !� • fii-11 ZONING DEPT BLDG DEPT eep � -lit.„ `1--0-- " E CG[, SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS President Robert Hallo Office: 305.263.1447 Cell: 786.389.7152 J. Electric Corp. d and Insured # 0003163 ATf: Miami Shores Village 10050 NE 2 Ave Miami, FL 33139 4°9 ACvp- 6 i co i tst* tiSS M LAM/ s va (I.age meta 33t3'i Temporary Electrical Service 4/V4( 4C #3 11/2 conduit 100 amp meter 70 amp panel 2 GFCI 20 amp outlets 4 x4 pressure treated ground rod #6 wire resident Robert fiallo Service size 70 amps single phase wire size grounding panel e„./442,..LFS L ✓! $/1Li19 to C. CASTtuo .......,., 4P" I S" • Comm* DD0866299 Val: ° moires 3/3/2013 Florida Notaryasq. eneum.mKn..e -^��., Inc • 3@ #3 Awg #6 2 @ 20 amp PERMIT # 142 —1 b CONTRACTOR: 0 actin SUBMITTAL DATE: 1 S I I . 12 ADDRESS: 1 D I 4C� 1 C (3-1 NAME: RESUBMITAL DATES: PROJECT TYPE: ZONING FIRE `G )f-N �'Lr j j11i STRUCTURAL IMPACT FEES i2 ,..r` - 2- P= 40a e--,' ELECTRICAL HRS/DERM i3O III I Z PLUMBING NOC Vi\P( MECHANICAL BLDG ) D Miami Shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: IL; 1C09 DATE: 9`513,012---- I, � i' e P\ocYi9c/e 7 Contractor o Owner o Architect wicked up 2 sets of plans and of r 1114C) 'e/C-1 Address: 10l From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name CRITIQUE SHEET Ii.— i /7) , rS % � L° %�l� s 7-67z- %7%Ze'~ &l e> 5.E7 ? ,#dd. A?°c1e/>Ti9 -eit -9 IL /t1L. 1,/ 11-- S 4viC1 / U 7 zortne 4/DivGe.iy 11 S e e S e T, 2 "D/? Z '/2 February 28, 2012 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 Re: Permit No: 12 -169 Review Responses Dear Building Official: The following responses are intended to clarify the permit review comments received on the above project. Building Critique Sheet 1) Provide all permit applications prior to any further review Response: General Contractor to provide as requested 2) Provide corrections for electric Response: Correction made as requested. See responses below 3) Identify the second means of escape from the master bedroom Response: See revised sheets D -1 and R -1. The existing awning window in the master bedroom has been noted to be replaced with an egress window to comply Electrical Review 1) Where is the master bedroom closet Response: Closet has been added as noted. See revised sheets R -1, P -1, E -1 2) Add receptacles to new area in living room to meet minimum spacing Response: A new receptacle has been added in the new section of interior wall being provided iin the living area. See revised sheet E -1 3) All bathroom receptacles to be on 20 amp ckt and GFI protected. Response: Both bathroom receptacles have been noted to be on a dedicated 20 amp circuit (P -33) and GFI protected. See revised sheet E -1 SDM CONSULTING ENGINEERS, INC. Manuel P. Montoya, P.E. 135 ALMERIA AVENUE CORAL GABLES, FL 33134 TEL 305 446 -2788 FAX 305 443 -5944 WWW.SDMCORP.COM AItlf IL. -4-1-1 /s(4546 Permit No: 12 -169 Job Name: February 14, 2012 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide all permit applications prior to any further review. 2) Provide corrections for electric. 3) Identify the secondary means of escape from the master bedroom. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 762 -4859 Miami �+ Shores Viiiage 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 ( CER11FICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT1 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 DEPTI 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: 50u rc e Q e (ro d k \; BUSINESS ADDRESS: 9 6I N v'/ I i 5--h CITY ); \Pck\ &c Y( \ens STATE FL ZIP CODE 3 -3( I BUSINESS PHONE: (30 ) 3 y '7'/ FAX NUMBER ( ) CELL PHONE ( 3e, ) X39 3-- QUALIFIER'S NAME: rcje. I Od v i9%Pe 2- QUALIFIER'S LIC NUMBER: C 13 3 0 3q/-) E -MAIL ADDRESS (IF APPLICABLE): SO v rc. I; P1 o d e I i A j co rn Created on 3119169 BY AB_DV I RV 3126109 MI.DV CERTIFICATE OF LIABILITY INSURANCE o,{°;�°°"Y"r' 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 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 Just Insurance Brokers 1200 NW 78 Ave Sidle 105 Miami, FL 33126 Phone 418 -4701 Fax (305) 418 -4706 (305) ( } CONTACT CT Ma Maria Arenas PHONE FAX Fir EYtj; (� 41&4701 -214 (AO, Nok (305) 41814706 ARC: anamarenasjustinsurancebrokers .com PRODUCER CUSTOMER IDs INSURER(S) AFFORDING COVERAGE NAIC # INSURED Source Remodeling, LLC 9261 NW 121 Street Hialeah Gardens, Fl 33018, FL 33018 (786) 897-2760 INSURER A : American Vehicle G10000005254 -01 INSURER B : 08/31/2012 INSURER C : $ 300,000 INSURER D : DAMAGES (RENTED PREMISES (Ea occurrence) INSURER E : ❑ ❑ CLAIMS -MADE d OCCUR ❑ INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THUS 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. INSR LTR TYPE OF INSURANCE ADDLSUBIf INSR WO POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY N G10000005254 -01 08/31/2011 08/31/2012 EACH OCCURRENCE $ 300,000 ye COMMERCIAL GENERAL LIABILITY DAMAGES (RENTED PREMISES (Ea occurrence) $ 100,000 ❑ ❑ CLAIMS -MADE d OCCUR ❑ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 300,000 ❑ GENERAL AGGREGATE $ 600,000 GEML AGGREGATE OMIT APPLIES PER ❑ POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP /OP AGG $ 600,000 $ AUTOMOBILE UABILITY ❑ 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 (Per accident) DAMAGE $ $ $ ❑ UMBRELLA LIAB ❑ OCCUR D EXCESS Lim ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE n RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIEFOR/PARTNER/DECUTIVEE OFFICERIMEMBER EXCLUDED? N 1 A WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, desaibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village bldg dept 9 9 p 10050 NE 2 Ave Miami Shores, Fl 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE • ACORD 25 (2009/09) QF 1989-2009 ACORD CORPORATION. AO rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEpARTMENT OF -BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 -1980 NORTH MONROE STREET TALLAHASSEE FL32399-0783 RODRIGUEZ, JORGE L SOURCE REMODELING LLC 9261 107121ST STREET HIALEAH1GARDENS FL 33018 C.ongratulaticms1 With this llama you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects 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 mme information about OUT division and the regulations that impact you, subscribe to department newsletbss and team more about the Department's iniliatives. Our mission at the Department is: License Effidently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing bushwes in Florida, and congratulations on your new license! DETACH HERE 09.17.2010 ALEX SINK STATE OF FLORIDA map FLWANC6111. CFMER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FFIOM I A WORKERS COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This candies that the individual listed below has elected to be exempt hale Florida Wafters' Cam ti , i taw. EFFECTIVE DATE: 08d31l2010 EXPIRATION DATE; 08/36I2O12 PERSON: RODRIGUEZ JORGE L FEIN 27/831236 BUSINESS NAME AM ADDRESS: seems RE1IQ10ELING LLC OM NW 121 STREET HHIALE#1 filARDENS FL 33019 SCOPES OF BUSINESS OR TRADE: IMPORTANT; Rrrautit m adMMI 440 _ tt3I11 FA., M Mlles el r Ieepowia® Ma Marls emempel* Iran In semen ae Map a taIt kom ei tutim wits late melon Rev aal retort bemflita ar omemeanalla atm Me segpm. Ratanall r Gee 440.DMITA F_L Camfl4Ttlats ai ati r u ea euUpL. *ply My slain ttt mope of Oa dnaass ar nKI Matti ea Om antra of alseaum se be eraosea. Oman to tteausr 440.0FMITO LI, WIw-an elatltn m bill eraa ni genalsen al ItIMAN t. No atonal. ata l w slEiatl m aaraaren N. el Imo Wm ehla IM hgle9 at 1Ma cabals. as Oa Wawa oaetlllsne Nat pomp amerce as RIM west of stellfleuee as haw emu Rao tagaiemgla st ila tiCIMe MI [wool of a tletlNawa. Tae Orsostaase saft1 f11iMa a mama teem a8 ear Maio 1m Mho All Itaa [saran calwid au IM4 aanitRe-ge +mss'! Ma two:sw Irma et NM aett&aa. QUISTMe41 (5 +412 -11139 DINC-2E2 CERTIFICATE 6[F ELECTION ID BE EXEMPT REVISED D -08 TkiisiSNOTABILL— DONOTRAY' 66 ?827 -1 t tOr LLC ESs )EL NC STATEe * SOURCE ;RW B 9261 NW -121 S7'R S 33018 #AEAN iDE CRa ! OWNER SOURCE sea 194SUB- TS IS 4MY A 13C`A4 WO p /VIM- 0010404243 00045.811 SEE OTHER SIDE DO NOT FORWARD SOURCE REMODELING LLC JORGE RODRIGUEZ MGR 9261 NW 121 ST HIALEAH GARDENS FL 33018 1 Jhnllrlhundlinhdr,irJdud l,rlranfillal