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RC-11-1498
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 163325 Permit Number: RC -8 -11 -1498 Scheduled Inspection Date: January 23, 2012 Inspector: Rodriguez, Jorge Owner: BARBARA BONDRA, RANDALL KING Job Address: 10634 NE 10 Place Miami Shores, FL 33138- Project: <NONE> Contractor: MACROS CONSTRUCTION & SERVICES Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1122320280850 Phone: (954)632 -9877 Building Department Comments KITCHEN AND BATHROOM REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 20, 2012 For Inspections please call: (305)762 -4949 Page 7 of 47 CA-4Z•S3' b�2�1�► Gen Miami Shores Village ZOMMIS m `l `i 2Q11 Building Department pY :...... wwww-- w -..,.a 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. ) 4 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING //�� // OWNER: Name (Fee Simple Titleholder): /- a n c'Z- l f C (11 t tr Phone#: 7) 7-3S-S--(195-3 J Address: /0 40 3 n. E. ! ® PL ,rte e City: Y ' 1 ` CC m i h ®r e-.$ State: l7-> L_ Zip: 3 3 i 3� Tenant/Lessee Name: Phone #: 0 /A Email: rancQa 1,`n3 MQiI.00n-) JOB ADDRESS: 1 0 (D 8 ti ()E. el. City: Miami Shores County: Miami Dade Zip: 3 3 I 3 ? Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: inaCif6S eoitS i-rUC *I®nan rQSprt;'ce_t,Phone #: ?S ti" 6?-)-g187/ Address: 1 (p Cp n l,u 7a Dr0 t,0 0 City: P € oY) b f Q me. P i n es State: r/_ Zip: -A 3 0 a ti Qualifier Name: e a r l O5 ('f ir1 Q CQ 0 Phone #: q S-6/- (' 3. - ?g 77 State Certification or Registration #: 6C 15 / '-/ 0 1 Certificate of Competency #: Contact Phone #: Email Address: C►° iC.41QCQQ 2Il'1u areas asri sfrue ap ,C0VT DESIGNER: Architect/Engineer: Phone #: tOO Value of Work for this Permit: $ Square/Linear Footage of Work: ` f5-.409.- ri. _ Type of Work: ❑Addition ®Alteration New GaRepair/Replace Demolition Description of Work: 0.e WI o cQ e- 1 ( h t 4-C° h e 0 and h o.1-hc' 0 6 **** Submittal Fee $ Permit Fee $ . o0 oCJ CCF $ CO /CC $ Scanning Fee $ 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 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 a nce of such posted notice, the inspection will e approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this ____ day of j,L (./L3 , 20 t l , by 120 fl (I / I Pit' G , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: «o 4 n My Commission Expires: `�pµY " „PVC• � CONNIE J. GUNN - State of Florida 3 • �� My Cor ssa Expires Jan 27, 2012 , -� -� Commission # DD 752149 ® v- 4,-tea, ‘S(e2,--‘7. Signature Contractor The foregoing instrument was acknowledged before me this 1.54► day of , 20 11 , by e c 1 aS j Yjjct e aqc, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: Print; 1 ic="4c/no,D Eo ni Grkn "'ra �i ( ;�,,� �e, CON EJ. ~.�.` % Notary Public - State of Florida -` : • My Commission Expires Jan 27, 2012 . • * **tiSiMa .may ** • ,,,,,, ” Bonded Through National Notary Assn. Clerk NOTICE OF COMMENCEMENT A RECORDEEDD COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. f" L- gc' 1I -1 S3 AX FOLIO NO. / I -62 4,2 -(,i '--( `r. i STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements willpia property, and in accordance with Chapter 713, Florida Statutes, Ijn is provided in this Notice of Commencement oifr'ai fi(a gH 1111111 I I1I1 1111111111 11111 11111111 11 1111 1111 CFN 201 1R05841 71 OR Bk 27810 Ps 1993; Ups) RECORDED 08/31/2011 12:59:52 HARVEY R'UVIH r CLERK OF COURT MIAMI -C'ADE COUHTY2 FLORIDA LAST F'AGE copyei r tAt thi' IS a true fi �Y nre ation p 4i• ,R s Space above reserved for use of recording office 1. Legal description of property and street/address: Lo /4i nlccA 5) mat 7i t 5 h p p CS es+ct±eS) P Lal- 47, Pie S c> M41376- axebe Coixri +y d''e.LDvols, 'bb qi o.t, 11)-6, PL,riVarnt shpresi FL 36 tag 2. Description of improvement: 6 , F t rn i I I jp t t e 3. Owner(s) name and address: t \ck,t-t rQc t--1.1 � 11, , i p lo .5 (, 1. ID -H1 1 ) (p ti CtAM 6 h 0 C e s PL 35 138' Interest in property: )D D dtlb, r✓ ee 5 ? rn of e Name and address o f e sir plp titleholder. (\ (a,.t17Q.r_t 0 C Kt n3 101034 (i,E, .t6 ,P�..) C)'l Q 1711. j'}t,0res3 15z, 33 r, $ 4. Co l itractor's name, address and phone number: Ma ( ) 0 r') 11 &f C- ike, ri 4— . r u i ce's 1 ectrit6 1774p.4igrdo 9`die ('kt 7af)(9 u)a.+97 Peambrof-{e ;0esiFL 50Q Li qSy- /o 9r7j 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: (1 Pr Amount of bond $ 0 1 i� 6. Lender's name and address: '1` C e e CX..n CQ clear 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, r� Name, address and phone number. i anCQCt -1( �.. ll); ng) to (p 3 i.1 �7� £, 1b4-V1 PL Th.0.m ShAceS1 FL '3 '6S "7 17 - aS-S - Lii -3 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 n o o n'e. 9. Expiration date of this Notice of Commencement: t ear" -c f o f l D &-i- e a ° (82 ?ilq Ifhe expiration date Is 1 year from the date of recording unless a different date is red) 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 ., :.r(s) or Prepared By Print Name rX p 'a (1 14 i' r 1 Title /Office C_i e STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this 1( day of By ❑ Individually, or ❑ as for Personally known, or ❑ produced the following type of identification: 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. Signat of efOwner(s 9 wner(s)' spithorized Officer/Director/Partner/Manager w s Au zed Officer/Director/Partner/Manager Prepared By A 5 Print Name Title/Office By �. t--- /. `. �-�' By 123.01 -62 PAGO3 3/10 CONNIE J. GUNN Notary Public - State of Florida r. ' Commission Expires Jan 27, 2412 Commission # DD 752149 pndedThrough National Notary Assn. CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: Q (1 &CLJI C 14 c rl9 PERMIT # ADDRESS: 1 CO 8 `i IL . 10141 P (. f m;0 _rn Shores Ft 33 (6g FOLIO NUMBER: 3Q- Egg- O F60 FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): 1 j 1 g Sr5.- (-see a+4-0-61€19) COST OF PROPOSED IMPROVEMENTS: 9`81-1,60 C s ee (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): 5) } 4.0g0 VALUE OF PRINCIPAL STRUCTURE (attach appraisal): S 13 Sol 60 d per °Lo 1t fty e{.P'P' i OWNERS SIGNATURE: \ l 3.-�' DATE: 31/31" 1 PLANREVIEWER: PLAN REVIEWER SIGNATURE: DATE: Created on June 2009 08/22/2011 09:33 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES eon * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 1691 RECIPIENT ADDRESS 919549867481 DESTINATION ID ST. TIME 08/22 09:32 TIME USE 00'34 PAGES SENT 2 RESULT OK Permit No: 11 -1498 Job Name: August 19, 2011 Miami Shores Village Building Department Building Critique Sheet 1) Provide electric and plumbing permits. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will doa 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 FAx : �(-- cil 19 Permit No: 11 -1498 Job Name: August 19, 2011 Miami Shores Viiiage Building Department Building Critique Sheet 1) Provide electric and plumbing permits. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will doa 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 FAx a (31- -- 9 si Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. ,Zc- // 4/p Job Name fe," P.4 CRITIQUE SHEET g A— A we e")---1-e- le A P4e `erg ADD SMOKE/CARBON MONOXIDE DETECTORS. A AV A4D AL o G = gran aiin E INSULATED CONDUCTORS TO RE REED. NO POINT ALONG COUNTER 10 BE MUKtt CLEF, • t r t. PUT DIN RECEPTACLE UNDER SINK. ALL FIXED APPLIAI19Ct5 UN utDtCPTED CPS. BATHROOM RECEPTACLE 20 AND G.F.I "" OTECTED nugmuuuuuunuua' [1:1 AU i72001 0 43211321113D 0IMMSO •=12111 EXISTING CONDITION Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS KITCHEN EXISTING CONDITION I ) GUEST BATHROOM EXISTING CONDITION SCALE: 118° = 1' -0" 0 4' 8' 18' es • • • • • • •••, ,•• • �'s,fli: • •• • • •• • 00 Cr) Cr) J LL • • • • • • • t••• • • • • A -1 • El =!1 uuuunuunuunnu= PROPOSED PLAN SCALE: 1/8H = 1' -0" 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, ADD SMOKE/CARBON MONOXIDE DETECTORS ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED THROOM RECEPTAL.Lt �IkID G.FI PROTECTED KITCHEN RENOVATION Replace all tile, fixtures, cabinets, countertops, and lighting in original location TNROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED GUEST BATHROOM RENOVATION Replace all tike, fixtures, and lighting in original location. Install exhaust fan. 0 4' 8' 16' • • • • • •• • • • • •••'•i• • • •• •• • • • • • • • • ••ff • • ••• • • •••• •• • • • • •• • • • • • • •• • co M M -J LL • • • • ••••• • • Cn••••• \./ • i • CI)' •••• VJ• • .i■•s•••• E: • cu U Co 0 O W d- M CD A -2 =1 uuumI- unuI -un —I Existing Window New GFI Receptacle Existing GFI Receptacle O Existing Light Switch O New Wall Light O Existing Ceiling Light O New Exhaust Fan Existing Ceiling Fan/Light 09 Existing Smoke Detectors PROPOSED PLAN KITCHEN RENOVATION Replace all tile, fixtures, cabinets, countertops, and lighting in original location GUEST BATHROOM RENOVATION Replace all tile, fixtures, and lighting in original location. Install exhaust fan. SCALE:1 /8" = 1' -0" 0 4' 8' 16' AUG 2 2011 l�Y: co M CO CO J LL D) c a) 5- t/) O 0 0) co r' U 0 z CO CO A•3 Renovation Cost: Kitchen & Bathroom KITCHEN: $4,916 • Demolition $350 • Cabinets $787 • Cabinet Installation $450 • Sink & Faucet $370 • Stove Hood, non - venting $399 • Countertops $1340 • General Carpentry $300 • Plumbing $320 • Electrical $300 • Misc. Materials $300 Bathroom: $3,068 • Demolition $200 • Toilet $169 • Shower $1200 • Vanity w /sink $199 • Facet $75 • Accessories $75 • General Carpentry $300 • Plumbing $350 • Electrical $300 • Misc. Materials $200 CUMLATIVE RENOVATIONS Prior Renovation Costs $11,885 New Renovation Costs: Storm Shutters $3,950 Kitchen /bathroom $7,984 Floor tile $7,861 TOTAL RENOVATION: $31,680 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. 1 1H � 31 Master Permit No. 01 - ) - I BUILDING PERMIT APPLICATION FBC 20 powynt AUG2 5 2011 tij Permit Type: Electrical OWNER: Name (Fee Simple Titleholder) : C4O \ if1 C) ( Vi i 11- -3S Address: 1-5"-D L\ sIa led city: O lerIr n i`-)bolo State: p Zip: I1 Ca5s-- Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: I OLC L)E IG C' . City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 1 \ - 22:n'2- ° C 2- ~CAS Is the Building Historically Designated: Yes NO Flood Zone: CO NTRA CTOR: Company Name: inc,, 0, C - 1fi0,c Phone (4 22 Address: lSC-) P\CC,z► City: V - iC& ( en b State: [-- Qualifier Name: 'J1- ICJ /y� © (0 1 OYl I e b� Zip: PD 0 7 Phone #: . c11-5 , 35-;))y State Certification or Registration #: Certificate of Competency #: 0 )- Contact Phone #: CVC I CI O inC(l Email Address: C' _ S 0ie.. K.11 ( Le, ow C6t C off) DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: °Address °Alteration New ORepair/Replace °Demolition Description of Work: *************************************** F************* * * * ***** ** * * ************** *** ** Submittal Fee $ Permit Fee $ /i r 67 CCF $ CO /CC $ Scanning Fee $ 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will t be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foregoing instrumentt was ac .1 wledged before me this day of ,20/9 ,by � �__., who is personally known to me or who has produced As identification a n d w h o did t 1 ilttathl NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged bef re me this-9 9+-A.-- day ofC? .JG S)' , 20 , by ((C 101 D IQ1�4� who is personally known to me or who has produced .`‘\\\ �� as identification and who did take an oath. �.......... . ,9 %, NOTARY PUBLIC: 07) . t = _ cc e Sign: r _ o,y• 'oc4' Print: ` 0 My Commission Expires: *** *** *** ***** ***** ** APPROVED BY `\a\ ��!!llllll11111 \ \ \ \�` My *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 7/ Plans Examiner }on'MH. P ADRON .•r •, MY COMMISSION # DD791671 14 EXPIRES May 26, 4t* * * * *+Iq /may **** * ** ry .wm * * * * * * * ** Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) 08/24/2011 11:56 3052616277 POWER INSURANCE PAGE 01/02 ,ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYW) 8/24Ja01ti PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION POWE t INSUMNCE AGENCY 7221 Coral Way #204 Miami, FL 33155 (305)261 -2559 INSURED ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NOVOA ELECTRICAL CONTRACTORS, INC 1580 WEST 38TH PLACE HIALEAH, FL 33012 COVERAGES INSURERS AFFORDING COVERAGE NAICO INSURr•.R A; ASCENDANT INSURANCE CO . INSURER 8: CASTLEPOINT FL. INS. COMPANY INSURER C: INSURER D: INSURER E; THE ANY MAY POLICIES. INDR LTRNoo POLICIES REQUIREMENT. PERTAIN, TDOlr OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED OP ANY CONTRACT OR OTHER DOCUMENT BY THE POLICIES DESCRIBED HEREIN HAVE SEEN REDUCED 8Y PAIb CLAIMS. POLICY NUMBER NAMED ABOVE WITH RESPECT IS SUBJECT TO PDOAY MF0$CB FOR THE POLICY TO WHICH ALL THE TERMS, Pp bf PERIOD INDICATED, NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH LIMITS TYPS.O.EINSURANCE A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL33697 09/23/10 09/23/11 EACH OCCURRENCE $1,000,000.00 'PRMlMIS (UIe.N1rv PREMISES Ma oaurence) $ 100 000.00 (`� CLANSMAN I„ ?s l OCCUR MED ExP(Any one parson) $ 4,000.00 PERSONAL 88ADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER; A I POLICY f JEC P � LCIC PRODUCTS - COMP /OPAGG F INCLUDED AUTOMOBILE — LIASILITY ANYAUTO ALL OWNED AUTOS $CHEDUI.ED AUTO$ MIRED AUTOS N0N- OwNEDAUT08 NOT COVERED Ma COMBINED SINGLE LIMIT EXCLUDED BODILY INJURY (Per Person) EXCLUDED _ BODILY INJURY (Peraecldem) $ EXCLUDED — PROPERTY DAMAGE (Pnreecldent) $ EXCLUDED GARAGE LIABILITY ANVAUTO NOT COVERED AUTO ONLY •EAACCIPENT $ EXCLUDED orHERtHAN F.AACC $ EXCLUDED Auto ONLY: AGG $ EXCLUDED EXCESS1UMBRELLA LIABILITY NOT COVERED EACH OCCURRENCE. $ EXCLUDED $ EXCLUDED OCCUR CI CLAIMBMADE DEDUCTIBLE RETENTION I; AGGREGATE $ EXCLUDED _ $ EXCLUDED $ EXCLUDED 8 WORKERSCOMPENSAT)ONAND EMPLOYERS' LIABILITY ANY PROPRRITORIPARTNERlEXF.CUTIVF. orncER /MEMBER EXCLUDED? 1?yyee deealbeunaer SPECIAL PROVISIONS below WCP760428501 i . 08/21/11 08/21/12 � � 0 YIA1U- 91 n l TOjiY41MlT$ ER F.J. EACH ACCIDENT $100,000.00 E.L. DISEASE - EA EMPLOYEES 1OO—, 000.00 E DISEASE • POLICY LIMIT $ 300,000.00 OTHER DESCRIPTION OF OPERATION8) LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVIS ONS ** FOR INSURANCE•VERIFICATION PLEASE CONTACT:MILAGROS C. NOVOA 305 -261 --2559 ** CERTIFICATE HOLDER MIAMI SHORE VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 ACORD25(2001 /08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIE8 BE CANCELLED BEFOR$ THE EXPIRATION DATE THEREON, THE ISSUING INSURER MILE ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER. ITS AGENTS OR ES TATI S IZED >- RESCJQ'1ATIV$ ACORD CORPORATION 1988 THIS !-S OTABILL-DONOTPAY RECEIPTNO. 30-6259691 CC NO; 07E000277 BUSINESS E / LOCATION NOVOA ELECTRICAL CONTRACTOR INC 1580 W 38 PL OWNER ;NOVOA ELECTRICAL CONTRACTOR INC SEE RACK OF'RECEIFT FOR A LIST Of NON-FAITXCIPATINO MUNICIPALITIE$' Receipt holder most r,qister in the city where work is to be done PWWWIREGEIVED WAMMMOIXIMII'VbX cc41 "'1.7/2011 02290004001 000200 00 MAW-DADE CEADiTX TAX COLMOM4 -140 'W. POMO et. FIRST-CLASS U.S. POSTAGE PAD MIA trl , PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTFIACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD NOVOA ELECTRICAL CONTRACTOR INC OSVALDO MONIER PRES 1580 W 38 PL 3 HIALEAH FL 33012 L SWIrESTAX RPT STATE Of $Wr-.304011 ATPLACE , CWAN cODE HAPTE� & THIS IS NOT A 01 NOT PM FIRST-CLA U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 0Q, 599947-0 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 625969-1 NOVOA ELECTRICAL. CONTRACTOR INC CC 0 07E000277 1580 W SO PL 3 33012 HIALEAH OWNER NOVOA ELECTRICAL CONTRACTOR INC SimTimme wOrman A T. THE 4ODR TO MLA %WING REGULATORY OR ZDUING LAWS OF THE TY OR CERES, NOR IT EXEMPT ME MEM ANT OTHE OR LICENSE 1:5Y LAIN. MES NOT A CERTIFICATION OF ots iioutor.Frs QUALM0iL CTRICAL CONTRACTOR mutentiftcomm mmAmmecoomTwa COLamm 09/09/2010 60010000294 000045.00 I SEE OTFIE SIDE WORKER /S 1 00 NOT FORWARD NOVOA ELECTRICAL CONTRACTOR INC OSVALDO MONIER PRES 1580 W 38 PL 3 HIALEAH FL 33012 5244 093001592 BATCH `:NUMBER The ELECTRI _ COQ;` Named below HAS RIT] Under the provisions of _. ration date I AUG 31f 201 II VIIRJAL MUST MEET ALL L REQUIREMENTS PRIOR TO MONIER 0 •. S NOVOA ELECTw:I+ CONTRALTO 1580 WEST 3 S CZ SUITE 3 HIALEAH FL 33012 CHARLIE CRIST GOVERNOR 'OISPLAY AS REQUIRED PRINTED %MTH ENVIRONMENTALLY P RVENOLY GREEN INfi5 ESQ. City cif ' Iialeah Business Tax Receipt Mayor Julio Robaona CEARLTZ LI SECRETARY 2010 -11 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 � v —1 'Acw Inspection Number: I NSP- 168023 Permit Number: PL -8 -11 -1558 Scheduled Inspection Date: January 18, 2012 Inspector: Hernandez, Rafael Owner: BARBARA BONDRA, RANDALL KING Job Address: 10634 NE 10 Place Miami Shores, FL 33138- Project: <NONE> Contractor: SKYLA PLUMBING INC Permit Type: Plumbing - Re Inspection Typ Work Classification: Addition Phone Number Parcel Number 1122320280850 Phone: (786)260 -2296 Building Department Comments REPLACE SHOWER VALVE, SHOWER PAN, ONE TOILET, ONE LAVATORY, KITCHEN SINK AND DIISHWASHER. 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- 163696. kitchen only January 17, 2012 For Inspections please call: (305)762 -4949 Page 27 of 49 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 IJG 2(111 Permit No.VI, J 1 J S 11 Master Permit No.Q' — [ (- (1-(9 5? Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): IR AATZ � (L �`� AlC—% Phone #: '3t9 — 3 5 97'3 Address: /0639 1® Pr. City: /A i Jam; c5'�®ia (S State: #4$c Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: '(0 6 3 6( AL , to 'PC. City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: /A20/3 0 o2 9©"r2, 5 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: S iQ• 61) A1 l /s/C- Phone #: 95'L1 — 9.3 3 -5302 2 Address: a0 ?or}, City: 61/O‘04QO®a State: ,4"e • Zip: —1-1 o eQ 0 Qualifier Name: SA ) Cd £ NliteD oev A eb Phone #:3c ^ 9•90- zi 1 9 State Certification or Registration #: CPC 14/o2 9-® 9-1 Certificate of Competency #: Contact Phone #: < f 99®- W99- Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 1 1 &SD . eD 60 Square/Linear Footage of Work: Type of Work: Address UAlteration UNew SRepair/Replace UDemolition Description of Work: R E - ? C A C ( S i d ( ' v t , , g f 2 t / I t I y c5 l%O -e 2 P4 tvo , 0 /vg et:7 G c't 0 A/ g 2,4V 4 r"®,y / J yc'i ' cS i eve df <v i, D i .C� (t/A..sev Z ***** *+ x*x: ***** *x:* ******** *a: **+ x*+x+xn:****Fees********* ***** ** * * * *** ******•xm*x+********* Submittal Fee $ Permit Fee $ / r0 `-- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 11 ` 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. Signatur The fo day o identification and who did take an oath. Signature 271 Contractor The foregoing instrument was acknowledged before me t is day of Lt , 20 11 ., bySQ-4iit,L�l r Me a(LL who is personally known to me or who has produced as identification and who did take an oath. BLIC: - My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY b Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: A4\1-1 ? ? rLl6 -� �C My Commi _` ires: MARIA 8. RODRIGUEZ *. ! s MY COMMISSION B EE 086673 EXPIRES: June 22, 2015 'I *,;7111,,. Bonded Thu Notary Peek UndenvnUeTs �m+t•mm9• oral .n'nmwnmanmm�+s.t.+I•a.�muro -om * * * ** Zoning Clerk STATE OF FLORIDA • AC# -511;39660 DEPARTMENT OF • - - • • -.-rPRONES3pOISIAL.,:REGULATION • • . • . CFC1427_07I 09/01/10 100112328 CERTIFIED PLtThIBING . • ' - - CONTRACTOR 14ctioNA,tv,:;`S.ZINITEL. - •-•• SKYLA.PLUNBING INC • . • ... . . , 'IS CERTIFIED under the provisions of _C11-48P:FS - . . • .-.....-erpiraition'Ciitieli:- AUG 31 r 2012 L10000101865.1. • 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2010 THROUGH SEPTEMBER 30, 2011 DBA: F,usiness Name: SKYLA PLUMBING INC Owner Name: SAMUEL MCDONALD Location: 2230 POLK ST 20 HOLLYWOOD rhone: 954-773-5323 Rooms Seats Employees 1 Receipt #:182-1670 Business Type: PLUINBING/LWN SPRNKL / CON (CERT PLUMBING CONTRACTO Business Openedao/23/2007 State/County/CertiReg:CFC1427071 Exemption Code:NONEXEMPT Machines Professionals THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or 'Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: SAMUEL MCDONALD 2230 POLK ST #20 HOLLYWOOD FL 33020 2010 - 2011 Receipt #03A-10-00000496 Paid 10/09/2010 29.70 CTOR For vowing tsusmess vmy Number of Machines: Vending Type: i Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collodion Cost Total Paid I 27.00 0.00 0.00 2.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or 'Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: SAMUEL MCDONALD 2230 POLK ST #20 HOLLYWOOD FL 33020 2010 - 2011 Receipt #03A-10-00000496 Paid 10/09/2010 29.70 CTOR STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION y. CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 12/28/2010 EXPIRATION DATE: 12/27/2012 PERSON: SAMUEL MCDONALD FEIN: 900198914 BUSINESS NAME AND ADDRESS: SKYLA PLUMBIN; INC 3070 NW STH AYE 13 WILTON MANOR, FL 33311 SCOPE OF 3USINESS OR TRADE: 1 • PLUMBING 1,000,001 100,001 5,001 1,000,001 2,000,001 1,000,001 T 1 1NSU NCE PRODUCER Anne UtfiNis insu anc_ 4759 N.W. 183rd St Miami, FL 33055 Phone (305)625 -8131 ax (305) INSURED SKYLA PLUMBING INC 2230 Polk 5W4 HOLLYWOOD FL 33021 COLIERASES IS BBB ONLY AND CONFERS NO HOLDER, THIS CERTIFICATE ALTER THE t” :. AFFORDlNO CAE wuRER A: NATIONAL INS CO. SOURER 8: al oolitic l A 041 OF 1f1F©R ATION 9DPOEe1 THE CERTIFICATE NOT ABIEND, EXTEND OF ED EY 111EPOLICIES BELOW. 1NAIC INSURER C: INSURER ts: INSURER E: INSURER F: THE POLICES OF SUBIRANCE USTEp HAVE BI N ISSUED TO THE INSURED NAKED ABOVE FOR THE POLICY PERIOD MDICATED. ANYRECRINEWENCTERNI ORCONDITIONOFANY CONTRACT OR OMER DOCUDIENTINITH RESPECTIO VOUCH THIS CERTIFICATE MAY Elf ISSUED OR MAY PERON. THE =AFFORDED BYTHE POLIDES DESCRIBED HERM SUBIECTTO ALL T E EXCLUSIONS AND CON0moMs OF SUCH pow. AG ATE LENTS SHOWN MAY HAVE BEEN REDUCED EXPAND D UATEMINNANYI mammal, MR ARM LTILIZEIL- 0 TYPE OF INSURANCE POLICY NIMBI CAMERAL LIABIUTY 00 cusntnou ® OCCUR 0 0 GE WL AGGREGATE LBMITAPPLESPER ❑ Pot= ❑ PROJECT ❑ IOC AUTOMOBRELIARRITY ❑ ANYAUUTO ❑ AU- OWNED AUTOS. B ❑ ❑ SCHEDULED AUTOS ❑ LURED AUTOS ❑ Now maw AUTUS GARAGE n UAW= c ❑ ❑ ANY AUTO 0 n GMG0000002252 04/29111 04/29112 EACH OCCURRENCE Exp rapine pessoaj PERSONAL & AOV INJURY PRODUCTS- COMPIOP AGE COMBINED SINGLE uMrr (Ea eloideo0 BODILY I NJURY (Per person) BODILY INJURY PROPERTY DAMAGE (Far =Nerd) AUTO ONLY- EAACCIDENT OTHERTiWWN EAACC MOM. MAMMY ❑ OCCUR ❑ ❑ assucriatE • RETENtION INOSIEW tInND EINPLOVINIS VIABILITY ANY HV PROPRIETOR I EXECUTIVE under Ryes, deoolbe Sew EACH OCCURRSICE AGGREGATE ❑• EL. Mal ACCIDELT EL. UISEASE -EA EMPLOYEE EL DISEASE - POLICY UMIT INESCRIFEONCtf OPERATIONS I LOCATIONS F 1 ig7 ENDORSIENS3411 *SPECIAL MONSOONS CIE HER ACORD 2S CANCB-LATION Miami Shores Village Building Department 10050 N. E. rt Avenue, Miami Shores, FL. 33138 SWUM AHYOFTHE BE CANCEU.ED BEFORE THE 10 asaamattring MINCE Tows IIMISFICATE HOLDER NAMED TO THELEFT, Bill FAMINE TO DO SDSRALL NO OBILANTION OR VIABILITY OF ANYHOW ISPOWITIE ` `' ASENTS OR REPRINSIOATNES. AUFROTISZED am ACORD CORPORATION len Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 163931 Permit Number: MC -8 -11 -1599 Inspection Date: January 04, 2012 Inspector: Perez, JanPierre Owner: BARBARA BONDRA, RANDALL KING Job Address: 10634 NE 10 Place Miami Shores, FL 33138- Project: <NONE> Contractor: C&R AIR CONDITIONING CO Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122320280850 Phone: 305 -685 -6394 Building Department Comments INSTALL NEW CEILING MOUNT BATH ROOM 80 CFM EXHAUST FAN AND DUCT TO EVE qig \i 1 IA, ')_/. 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 January 04, 2012 Page 1 of 1 I Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 10634 NE 10 Place Miami Shores, FL 33138- Owner information Address Parcel Number 1122320280850 Block: Lot: Applicant RANDALL KING BARBARA BON Phone CeII RANDALL KING BARBARA BONDRA 10634 NE 10 Place MIAMI SHORES FL 33138- 10634 MIAMI Place FL 33324- Contractor(s) C&R AIR CONDITIONING CO Phone CeII Phone 305 - 685 -6394 (954)680 -4494 Tons: 0 Additional Info: EXHAUST FAN & DUCT Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL 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 # MC -8 -11 -41891 09/01/2011 Check #: 154 $ 109.10 $ 50.00 08/30/2011 Check #: 11350 $ 50.00 $ 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. Futhermore, I authorize the above -named contractor to do the work stated. September 01, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 01, 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 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) Owner's Address 10639 PE 101.D. (� City State X- Zip 32 13 a' Permit No. Master Permit No. tg8° 1 1 1498 AiU6 1 2011 PY Phone# 304-- 014 • 766r Tenant/Lessee Name Email Phone # Job Address (where the work is being done) 106 ZI y / ( 10 PL City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name C t ft r CO h d , CO . Phone # .10T6 h- 609L/ Contractor's Address 607 N L i ()*7 T c_ City pi ' (C( Vi'L l State F) _ Zip 001s- Qualifier Name R Qbe rfi e3 C t `', .f T Phone # O j 8S-4 2 1 it State Certificate or Registration No. C. A C ©a 614(y Certificate of Competency No. 0 E -mail CQ Vj t(. CO ►'►'1 i H() A O L Coin Contact Phone Architect/Engineer's Name (if applicable) Phone # (9© Value of Work For this Permit $ q � • Type of Work: IN Additio ❑Alterati Describe Work: Square / Linear Footage Of Work: New ❑ Repair/Replace ❑ Demoli'on ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ee3 * * ** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ✓t/ CCF $ CO /CC $ Notary $ Scanning $ Double Fee $ Training/Education Fee $ Radon $ Structural Review. $ DPBR $ Violation date: Technology Fee $ Bond $ 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. Owner or Agent ll The for going in trrumen1tlwas ac ... owledg befo e me this 31 day of t\ ST , 20 11 , by GIA r` 9 ntification and who did take an oath. NOTAR Sign: Print: My Commission Expires: Signature 1 0/ Contractor The foregoing instrument was acknowledged before me this day of b t) ,20 IL , by ho i personally known.to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 'tilign: $ _ �'b'cP Print: k******* * * *****x* *'k**.- 'Yew -. :F�F F.T. SYtk�F*** .l 9: e: .,' - Y +�Fik9;:F:FgC**********k. ****:FeY'k: ****** ** * ** *dC** ** *** *k7F9: ****k*** My Commission xp APPROVED BY Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked 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): City: Miami Shores Village County: Miami Dade Zip Code: 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 ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS 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 / / EERISEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO 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): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: (Qualifier's signature only)