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RC-12-282Miami 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. <<`` Master Permit No. 2.-. 2 c OWNER: Name (Fee Simple Titleholder): .._L e. 11-x, -mu( r &J T-ran k 'hone #: � 1 -3( Q St 1 I Address: —1 � 0 N v V 1()D-141 J �2 City: 1 , `t CLm, 5h O lr-%S State: FL— Zip: 33 /50 OVA' TenantlLessee Name: Phone #: Email: JOB ADDRESS: / D IJ / QY City: Miami Shores County: FoliolParcel #: //'31 01– 01 a- 01100 Miami Dade Zip: 33/5o Is the Building Historically Designated: Yes NO ✓ Flood Zone: CONTRACTOR: Company Name: Plvn ,bl Fxpe r is ZINC Phone #: (.�41 ''J W g S II/ Address: /0(00 Holland bnV-e . l -fe B City: Roca. IQa� / State: FL.. Qualifier Name: C a "P" h State Certification or Registration _ . 4 �� 11a1 Email Address: ale nil Certifica Zip: 33Y g� "7p- Phone#: `�� 3(0 o 5/1 / of Competency #: �C Ln') fr7q xper% ' cow) Ph e#: ` -- Contact Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ a , . ab Square/Linear Footage of Work: TZ Type of Work: °Addition °Alteration New tepair/Replace °Demolition Description of Work: Re PLACE. $ W A LL.S. I Al �)(1.s 77 /J' Sner,-t0 att. dry ******* * *** * * * **** * *** ** *** * ** ***** * ** Fees******************************************* Submittal Fee $S– Permit Fee $ / 0 CCF $ CO /CC $ Scanning Fee $ ' Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 8 13110-) PERMIT # aG! 2. - 22 CONTRACTOR: T}-[ R l c31 EX' SUBMITTAL DATE: ADDRESS: 1 0 f'.L 3 1 CO '.--r NAME: RESUBMITAL DATES: PROJECT TYPE: ZONING FIRE STRUCTURAL IMPACT FEES .; ;- ' .(if ELECTRICAL , ' /Z HRSIDERM 6 PLUMBING NOC MECHANICAL ,y ,..5 BL - A Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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, BOTI,FRS, 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 s, n reinspection fee will be charged. Signature Signature Owner or Agent The foregoing iinstrument was acknowledged before me this! 6 The foregoing day of f2 ,20f L by o is personally known Con? (or /� strument was acknowledged before me this/ 20 /1, by -30.6//' IthAf� , e or who has produced e or who has produ identification and who did take an oath. NOTARY Sign: Print: UBLIC: My Commiss. ' "' ,` #EE1 1 s: EXPIRES: July 25, 2015 OF .oe.0 Baled Thru Budget Nola) SaWces as identification and who did take an oath. x***************************w **** * ******* ****+e+x+x ***x **** *+ x*w ***** ** ***a<**** ****** ** *** ******** ***+x+x**w****** APPROVED BY c2-),P/ Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk dice4r9AV' M plumbing APPRO\rED eXPertS 0 N1NG DEPT SUBJECT 10 CCNIPI JANICE WI PH ALL FEDERAL ANU CC UN j Y RULES A.18 REGULATIONS A / CO ./Z92,4 ('6 A- #.43 ISOMETRIC Plumbing Experts I Master Rooter 1060 Holland Drive ( Suite B 1 Boca Raton 1 FL 1 33487 561.368.5111 1 contact@plumbingexperts.com ! c. FEB ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. Liz( ckoo pA) BATHROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED REPIA4k7 r,tiSrhot; TuLE.A. piku rti ixE03 Dukow wo,t,ts -rivt TLCIOC_ IF g r I; t r iu or 7touctiE4 E:14, tsnym e; vio:/ skeeAtr, ) 174 L FAA) 4+ 4'2"' ""ELIENT reiamte ) 0 AN 100 57L .. Mk ilen/1 I ho-r-% Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 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. v COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. 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 DEPT) 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 11 Iw COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: PlUnh hcpa-t3 In( 3 BUSINESS ADDRESS: IO O IQnI� �Y V� � CITY i ITY &CQ. Ra-bn STATE I- ZIP CODE 334V BUSINESS PHONE: (541 ) 31 g -511i FAX NUMBER (511 I) 5(02-- 8332 CELL PHONE ('() 9-1,30 QUALIFIER'S NAME: JO ph din K-e QUALIFIER'S LIC NUMBER: le, PC, 11'2-113 O E -MAIL ADDRESS (IF APPLICABLE): Cl i m urn ex rii • wrn 9 Created on 3119109 BY MLDV I RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 WINKE, JOSEPH C THE PLUMBING EXPERTS INC 1060 PLUMBING EXPERTS C/O JOE MINIS HOLLAND DRIVE SUITE B BOCA RATON FL 33487 ..c,ngratulations! With this license you become one of the nearly One million •10-i dins licensed by the Department of Business and Professional Regulation. professionals and businesses range froM architects to yacht brokers, from loxers to barbecue restaurants, and they keep Fkirida's economy strong. very day we work to improve the way we do business in order to serve you better. or information about our services, please log onto www.rnyfioridelicense. COM. There you can find more Information about our divisions and the regulations that mpact you subscribe to department newsletters and learn more about the epartment's initiatives. ur mission at the Department Is: Ucense Efficiently, Regulate Fairly. We r-ailstantly strive to serve you betters° that you can Serve your customers. 1.1)30k you for doing business In Florida, and.congratulatIons on your new lic,ensel DETACH HERE '''1••'4y4;v‹.,,q57Zins 4.114.4W DATE, *orrix—• IST4M07:' STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PRmanotaa, REGULATION =SU:CC= 194 0 NOR rams= Boa= (890) 487-j395 TALLABASIEME IL 32399-0783 WINXE S.PREFR C THE PL . e EXPERTS INC 10 60 PLUMING EXPERTS C/O JOE NI:=1. HOLUM DRIVE SUITE 13 SOCA RATON :FL 33 4 87 Congratulations! With this_itoense-yOu becoraearteof. Our professionals and. Floridians rreensed:by Z;Itsessetraera • ranfrom boxers tobtarbequeirestataenik aru Everyd# For our There:you. Oarilind rnore infeat000 Impeotyou subscribeto dannant Department's fnftiati Our mission at the pepertnaara. constantly sblvetO serve you Thank you fix:doing business ANNE s PAN L+i PJ!W P.O. Box 3353, West Palm Beach, FL 33402.3353 e — 1711..! ecusaiiiie www.taxcollectorpbc.com Tel: (561) 355 -2272 Solt* Paha Brat* TYPE OF BUSINESS Y)69 PLUMBING CONTRACTOR 1 OWNER WINCE JOSEPH C 1 "LOCATED AT" 1060 HOLLAND DR STE B BOCA RATON, FL 33487 CERnFICATION # j RECEIPT/MATE PAID 1 AMT Pan CFC1427238 J 011.504884- 097x'/11 • 6327.54 I Buie 840164874 iment is valid only when receipted by the Tax Collector'. ollector's Office. ,3. PLUMBING EXPERTS INC THE PLUMBING EXPERTS INC THE 1060 HOLLAND DR STE B BOCA . RATON, FL 33487 ulfnallnfaallufafnaf STATE OF FLORIDA PALM BEACH COUNTY 2011/2012 LOCAL BUSINESS TAX RECEIPT LBTR Number: 201103593 EXPIRES: SEPTEMBER 30, 2012 This receipt does not constitute a franchise; agreement, permission of authority to perform the services or operate the business described herein when a franchise, agreement or other county , c o mission, slate or federal permission of authority is required by city, state of federal law. N Pit >r iV , r 9111 N NON P.O. Box 3353, West Palm Beach, FL 334023353 *LOCATED AT .. u s www.taxcollectorpbc.com Tel: (561) 355.2272 Sowing Palm Beach C2351617 x.51 GENERAL CONTRACTOR I WINKEJOSEPH vent is valid only when receipted by the Tax Collector's Office. PLUMBING EXPERTS INC THE PLUMBING EXPERTS INC THE 1060 HOLLAND DR STE B BOCA RATON, FL 33487 IlaaallaafaaHaafaLaal 1 060 HOLLAND DR STE B BOCA RATON, FL 33487 CERTIFICATION* J RECEIPT *MATE PA O t AMT PAID 1 BILL # GG01606546 011.504873 - 0a2 2/11 059.50 840184675 STATE OF FLORIDA PALM BEACH COUNTY 2011/2012 LOCAL BUSINESS TAX RECEIPT LBTR Number: 201103589 EXPIRES: SEPTEMBER 30,2012 This receipt does not constitute a franchise, agreement, permission of authority to perform the services or operate the business described herein when a franchise, agreement or other county commission, state or federal permission of authority is requited by county, state of federal law. A•Rtr CERTIFICATE OF LIABILITY INSURANCE L -r"'"- DATE(MM/DD/YYYY) 2/16/2012 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(les) 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 Keyes Coverage, Inc. 5900 Hiatus Road Tamarac FL 33321 CONTACT NAME: (a�NN0 ), (954) 724 -7000 FAX , No): (954) 724 -7024 E-MAIL ADDRESS: PRODUCER 00012289 CUSTOMER ID #. INSURER(S) AFFORDING COVERAGE INSURERA:Allied Property & Casualty Ins NAIC # 42579 INSURED The Plumbing Experts, Inc.&Remodeling Experts, Inc. dba Master Rooter of Florida 1060 Holland Drive Suite B Boca Raton FL 33487 IN SURERCNationwide Depositors Ins Co 42587 INSURER C X INSURERD: « GLPO INSURERS: 5/13/2011 INSURERF: EACH OCCURRENCE COVERAGES CERTIFICATE NUMBER:11 -12 Master Cert 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMA A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR X « GLPO 5905052545 5/13/2011 5/13/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 300 000 $ r CLAIMS -MADE MED EXP (Any one person) $ 10, 000 GEN'L PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE UMIT APPLIES PER: POUCY X JEC7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LUUBILnY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X « BAPC 5905052545 5/13/2011 5/13/2012 COMBINED SINGLE UMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ Uninsured motorist combined $ 1,000,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE = 1151310044 5/13/2011 5/13/2012 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ 0 $ $ WORKERS AND EMPLOYERS' UABILI Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yyes describe under DESCRIPTION OF OPERATIONS Y / N N /A WC STATU- OTH- TORY LIMITS _ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ below E.L DISEASE - POUCY UMIT $ B Inland Marine - $500 Ded Installation Cov-$10,000 «• CPPD 5905052545 5/13/2011 5/13/2012 Equipment 43,000 Leased/Rented Equipment 50, 000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedu e, K more space Is required) MIAMI SHORES VILLAGE BLDG DEPT HEREBY LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE Carey Keyes /DE Gam .. _ . .. ""' ACORD 25 (2009/09) INS025 (200909) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: Al ACC,FtEr CERTIFICATE OF LIABILITY INSURANCE ° DATE(MM/DD/YYYY) 02/15/12 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 BETWEEN 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 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 561- 994 -2210 CBIZ Meridian 567_9944292 301 Yamato Road, Suite 3150 Boca Raton, FL 33431 R. Tucker Kirk CONTACT PHONE FAX (A/C. No. Ext): (NC, No): E -MAIL FtESS : PDD PRODUCER PLUMB -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Plumbing Experts, Inc.& Remodeling Experts, Inc. dba Master Rooter of Florida 1060 Holland Drive Ste B Boca Raton, FL 33496 INSURER A : Bridgefleld Employers Insur. 10701 INSURER B: INSURER C` INSURER D : $ INSURER E : $ INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: THIS IS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) OMITS GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ GEN'L PERSONAL &ADVINJURY $ GENERAL AGGREGATE $ AGGREGATE UMIT APPLIES PER: POLICY JECOT- LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE y LIABILITY 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 DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE 1 RETENTION $ $ $ WORKERS DYERS' UABIUTY AND A ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, DESCRIPTION OF OPERATIONS /N NIA 830 -48380 06/30/11 06/30/12 X TORY OMITS OER E.LEACHACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEE $ 500,000 below E.L DISEASE - POUCY UMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village MIAMISH Building Department 10050 NE 2nd Avenue 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) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 170112 Permit Number: PL -2 -12 -283 Scheduled Inspection Date: September 06, 2012 Inspector: Hernandez, Rafael Owner: FRANKS, IRENE Job Address: 10 NW 100 Street Miami Shores, FL 33150- Project: <NONE> Contractor: THE PLUMBING EXPERTS INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010180400 Phone: (561)368 -5111 Building Department Comments REPLACE SHOWER PAN SHOWER VALVE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 05, 2012 For Inspections please call: (305)762 -4949 Page 4 of 26 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 RECEI FEB 1B2012 BY: Permit No. RA Master Permit No. 12 '^ 28 2 Permit Type: PLUMBING ,", - ` L� � V Q OWNER: Name (Fee Simple Titleholder): Ir'Cnc. Q n Phone#: -� S/� w Address: 10 NW 1 DU I' 5tY'c-c. I .'t- City: ► 1, t nn t Shore-5 O r e s State: Zip: 33/ 50 Tenant/Lessee Name: N / il Phone#: Email: - JOB ADDRESS: / 0 NW I DOm 5t't e t City: Miami Shores Folio/Parcel #: 11 -3101- 010 -h� �TO0 County: Miami Dade Zip: 33/50 Is the Building Historically Designated: Yes NO t Flood Zone: CONTRACTOR: Company Name: Pi txn bn- E pert, J ne Phone #: 5�I- 310 r Address :; ) () /.(Ol /QfCi Drive• Sul'-I-c B. City: / ra ' 3Y) State: PC Zip: 33 SI? 7 Qualifier Name: SOSi'Ph (,.)In k-e Phone#: k.5 t0 3(08'-511 / State Certification or Registration #: CF C.. 11fVl 2-3 g Certificate of Competency #: Contact Phone #: 51,1- 3C(1 g' '5 / 1 I Email Address: stern �plc,m by-3-eX its -eo DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Oa. Square/I.inear Footage of Work: v Type of Work: ❑Address /DAlteration ( ❑/New ' epair/Replace DDemolition Description of Work: g 1i!`LA C5 $/I -w f" k ©A " S/ tJ' e✓ e V AL PIZ ** axe * ** ** * ******** **************x ***Fees************ * * ****+x**** ******** * * ***** * Submittal Fee $ 07-449 Permit Fee $ /5D 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 applic .le) 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 A1' Flu)AVIT: 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 a approved and a reinspection ee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this j1 , 20 ilrIcy !WAle R day of e or who has produced entification and who did take an oath. Sign: Print: My Commissi S* MY COMMISSION # EE 1. EXPIRES: July 25, 2015 p ,�� L .._ e 9 QFF1.°Q�� Bonded Thai Budget Signature ICo tor The foregoing strument was acknowledged before me this/ AtiiO4f 4. , 20l? , by .7.0 Meg, w is personally known—firms or who has produced- - identification and who did take .._oath. NOTAR LIC: Sign: Print: My Comnmissi 1 .1, N. II, . EXPIRES: July BcededTlvu6 ** *************** ********•It****** - N•• k• k*. Y. k*N. *. k+ k. h• l• **. k*. k. k. ksk** **tl.. k*N•* *+ l• N.. k. k*+ l< ****N.. kk=+ k+ k*. N. kskHsN•*** *N.&*.k*.kN=.k****.k***** APPROVED BY 2i'7 /—tilans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk