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MC-06-1175Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -16584 Permit Number: MC -5 -06 -1175 Scheduled Inspection Date: July 08, 2013 Inspector: Perez, JanPierre Owner: SOUTHARD, ROBERT Job Address: 351 NE 103 Street Miami Shores, FL Project: <NONE> Contractor: COOLING PROFESSIONALS Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)756 -5067 Parcel Number 1121360130260 Phone: (305)494 -9026 Building Department Comments EXACT REPLACEMENT OF AIR CONDITIONING UNIT Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 05, 2013 For Inspections please call: (305)762 -4949 Page 1 of 33 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 No, Master Permit No. '1 S Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): '3 JCC- JOv f 'm CA A Phone #: Address: 3 S (O3rd s÷ City: M `Q. M e State: F zip: g3 13 8 Tenant/Lessee Name: Phone#: C3) 7 '— 5C6®7 Email: ti 105 -f- JOB ADDRESS: 135 C City: Miami Shores County: Miami Dade Zip: 33 l 38 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: CC-CA n � Q�C'� Y e ° 5 w i t ��c. l Phone #: 3 ' ; L 9 1 / Address: ?( 5 G /00 77 Tesc- city: Arlec.(t°y State: R Zip: 33 L �� Qualifier Name: A c-03 S= fek0 Phone#: State Certification or Registration #: C OZ r V+5 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: �i Value of Work for this Permit: $ , l' G 2.L. Square/Linear Footage of Work: Type of Work: DAddress , DAlteration ONew DRepair/Replace /� Description of Work: l� IA10 ` 09e 00 4--4-112,6f..711-12„. SZen\Ccp ® ' cS(sr\ 4 4 ' /1°l C -S 0-6-P 175 ODemolition ********** * * * * * *+ * * * * * * * *.** * * * * * * * * * * * *F *********+*** * * * * * * * * * ** * * * * * * * * ** * * * ** * ** ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Nil 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. I the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature . amA .e, Signature Cif' Owner or Agent / ontractor The foregoing instrument was acknowledged before me this a errh The foregoing instrument was acknowledged before me this fl day O , 20 II by r u c hl -rha. h CI, day of l) Y1-e._ , 20 , by '-`yc) (lac 7 ) p who is personally known to me or who has produced who is personally known to me or who has produced, as identification and who did take an oath. As identification and who did take an oath. NOTARY P . LIC: NOTARY P LIC: Sign: Print: My Commission Expires *0 MY COMMISSION # EE042118 EXPIRES November 16, 2014 (407) 388 -0153 FlorhtallotaryService.com Sign: Print: My Commis YOLA. A o P`�`, EXPIRES November 16, 2014 Moo' (407) 398-0153 FlorioallotaryServke.com ***** *rk**************** Nr*+ 1*********** ****k********* I' **ri***** *+ RrM**+ k* ***** ***rk +k*W*** ******#**4r+hik********* *** ** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT ',Permit N. en c — S— 06 liner's Name :(Fee Simple Title Holder): i3 C' e-) C C 5OutirtarcA Phone #: Owner's Address: 3- ( Ad E /c & S f City: / r o / 5 In ®s c 5 State : f i Zip Code: 33 136 Job Address (Of where work is being done): 5 i Iii 100 S fi City: Miami Shores State: Florida Zip Code: 3313 t Contractor's Company dame; COCA ;Ai ?e CeS5c c�n.Q. C Phone #0 ) J ti �'l Address: 7 i. `cJ )2 Ft City: (heel le/ State: F ( Zip Code: Qualifier's Name : notc so • V cy) Lic. Number: CA C. 02.1345 Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work ? \acennPn 1 59 \(. 57 -Fcen .9 /c I hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwilling to complete the contract. I hold the Buildin fficial and the Mimi Sho armless for all legal involve , X Signatu ��- ownet or-Agent The foregoing instrument was aknowledged before me thi dda of ,20 ,by Who is personally known to me or who has produced L , ( as indentific nott nott Notify Pub Sign: Seal•' YOLAN', A .. *: MY COMMISSION # EE042118 ,, EXPIRES November 16, 2014 ' rv�e.com (407)388-0153 FlorloallomrySe Signature ntrutor. or Architect The foregoing instrument was aknowledged before me thisday of tJ 20 by who is personally known to me or who has produced L as lndentification. Notary Pub Sign: Seal: *: *e MY COMMISSION # EE042118 'r EXPIRES November' 16, 2014 (407) 388-0153 8 Florld8NotaryServIce.com COOLING PROFESSIONALS INC 10209 SW 224 TERACE CUTLER BAY FL 33190 PHONE (305)871 -6512 FAX (786)250 -5748 COOLINGPROS©HOTMAIL.COM To whom it may concern Central Air Repair has recently changed their name to Cooling Professionals and will be obtaining all responsibilities from previous costumers that Central Air Repair has acquired from previous years of service and business. Cooling Professionals is under the same management- owner that has run the company in previous years; (Ignacio F Vigo) is also the license holder and qualifier from the past, our licenses number has not changed (CACO21345) Best Regards Ignacio F Vigo LOO/ 1.00'd 065b# a /'d 7 1VL3AI LE3HS ti: SLOE Z6S SOE Lb :80 ETOZ /8Z /0 09/20/2012 12:18AM FAX 3055699633 STATE OF FLORIDA - DEPARTMENT OF BUSINESS'AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE ,FL 32399 -0783 VIGO, IGNACIO F COOLING PROFESSIONALS INC 7150 NW 77TH TERRACE MEDLEY FL 33166 Congratulations' With this license 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 bette For information about our services, please log onto www.myf'Iorldalicense.com. There you can find more Information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives, Our mission at the Department Is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license' DETACH HERE I j0001 /0001 (850) 487 -1395 STATE CSF•F,!-"IAA .,: , AC,!' '•'; Fa', i00 DSF,ARTNEN'1' '`OP' BUSfXNE8SS AND =. PROFESS I '1 , _•REGULATION ;•mom ,,� ..,.�;��;., CAU02''I`3 ?45 e• .- ,.,yu:`' ..::'.:;, 2 1280:52412 C$RTiF X :.: Y,.i•VVJ, :.. CQOLIN+ R• ES csaTXF ?8'a Under tee: provisions 4;4 c .4U9 re xvirscton d.tu AVG1 31 01 , 24 :L120.82, 01626 "THIS DOCUMEN r HAS A COLOIIE1) HACKG1101)NI) • MICROPRINTING • LINEMARK "' PATENTED PAPER SEW L1208240.1626 0.8v 2.4, .202 2 .1,218'.G5,5,4:7'1 Th' CLAgg' H` ASR COND Named, be' .0w .:TA Ct3R1 I Under tTha .piovia•iitine Expirat O ;date.:..AUP:. ITION N of Cha al, , 2.0:1 as 0144di Jr "COOL ±NGPR 0 EaB*QY+TAL5 Ii+1C °o F .'_ 71150 NW ' 77T TERRACE •°* MEDLEY FL 3:31664-: 4) l0;y''„ SECRETARY SN Jul 03 2013 3:07PM HP Fax page 1 ACORD- - CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, the IMPORT-MI terms TA T: c ins ions of th holder Is e an t ADDITIONAL policies INSURED, require an endorsement. statement on this certificate does not confer rights to the the tstrrts and conditions of the policy, certain Policies may req T� certificate holder in lieu of such endarsemen_s }. coNYacr PR000CER Name. Keen Battle Mead & Company JA5, No ExtP PHONE 305.558.1101 ,F5•szz•aT2a _ 7850 Northwest 146 Street at DRis: R Suite 200 PRODUCE PROPUCERiDD Miami Lakes FL 33016 INSURER($) AFFORDING COVERAGE G INSURED DATE(NauaoMYYYY) 6/12/2013 Cooling Professionals, Inc. 10209 SW 24th Terrace Cutler Bay COVERAGES CERTIFICATE NUHIBERI12 /13 WC FL 331.90 _INSURER A -.MCI Insurance roue INSURER B : INSURER C : INSURER U INSUREA E : INSURER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FF Pmm TYPE OF INSURAN ,INSR W CE vg POLICY NUMBER GENERAL LIABUJTY NA)C INSR LTR POUCY COMMERCIAL GENERAL LIABILITY J CLAIMSdIADE OCCUR GENT. AGGREGATE UMIT APPLIES PER POLICY l 1 1F I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS %menuI£D AUTOS HIRED AUTOS NONOWNED AUTOS A UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS•MADE DEDUCTIBLE RETENTION $ WARNERS COMPENSATION AND EMPLOY0R$' LIABILITY ANY PROPRIE oR/PARTNERJEXECUTAIE E OFFICER/MEMBER EXCLUDED? (Mandatory in NHI 11 DESGRI�PTION OF OPERATIONS he•mv NIA EXP LIMITS EACH OCCURRENCE •OAMAUt TO REN1 LD PREMIS 1Eaooeurrencal neEO EXP (Any one person) PERSONAL 8 APY INJURY GENERAL AGGREGATE S PRODUCTS • COMP/DP AGO coMBWED SINGLE LIMIT (Ea eo bait) BODILY INJURY (Perperam) $ BOO4Y INJURY (Portoadenn $ 3 $ $ PROPERTY DAMAGE (Per aaadvn) $ Nol.196221 82/12/2012 EACH OCCURRENCE AGGREGATE; E $ 12/121201.3 Y4C STATU• pTH TORY LIMITS I -CR E.L.EACHACCIDENT $ 1,00,0,00 . E.L. DISEASE • EA EMPLOYEE $ 1, 000. 000 E . DSEASE • POLICY Lima $ 1,000,000 DESCRIPTION OF OPERATIONS 1 L� CATIONS 1 VEHICLES (Attach ACORD NT, Addiponal Remarks $chedole, tr more apace is NquN d) CERTIFICATE HOLDER MIAMI SHORES BUILDING DEPARTMENT 351 NE 103 STREET MIAMI SNORES, FL 33138 ACORD 25 (2009/09) INS02S(200509) . ZOO/ ZOO 'd VLS>i# CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL )SEE DELIVERED IN ACCORDANCE BIRTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTAT)1tE Timothy cattle /LV S €/1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD o/�rsaysxJ33Hslir SLOE Z68 ;OE tt :Bi EtOZ /Zt /90 CERTIFICATE OF LIABILITY INSURANCE i OATS (MNIDDIYYYY) I 06/12/13 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 ACONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Tithe certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION I8 WAIVED, subject to the term, 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 endorsament(s). PRODUCER Schilling insurance II 901 E Sample Road, Suite OH Pompano Beach. FL 33064 Phone (954)545,5999 INSURED Cooling Professionals, Inc. 10209 SW -224 Terrace Cutler Bay . FL 33190 Fax (954)545 -5998 NAMCONTAE: CT Christiana Pp! o,.Falty (954)545.5999 1 INC. Not 084)545-598 RE s;l, m schipm9insurance@yanoo.co INULIER(S) AFFORDING COVERAGE sacs INSURER A : Federated National Insurance Company ,r INSURER e : INSURER C INSURER D POURER E MBURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATED NOTWITHSTANDING ANY REOUIREMSNT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR ADD vB—RI POLICY EFF POLICY ElCP LTR gO4SUsit.L_� POLICY NUMBER Ut�A)ALZ ..tNMIDDIYYYYS A TYPE oR INSurtmcs GENERAL LIABILXTY ❑/ COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS.MAD6 © OCCUR 0 0 GEN'L AGGREGATE LIMIT APPLIES PER POLICY ❑ Ifei ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL ❑ ❑ HIRED AUTOS ❑ ❑ ❑ AUTO ED NON -OWNED AUTOS •❑ UMBRELLA LIAS ❑ OCCUR ❑ EXCESS LJAB ❑ CL A .P44DE ❑ OEO Q,RETENTIONS N N GL -0504009441.00 wORNFRS COMPENSATION AND EMPLOYERS' UATILRY Y I N ANY PROPRIETOWPARTNERfEXECUTNE OFV ER0,1ABER EXCLUDED? ., N ! A (Mandatory in NN) ` I If yyo�c��, emceed undue OF,SCRIPTION OF,4QJ RATPDNS Delay 07/17/2012 07/17/2013 OMITS EACH OCCURRENCE OA 'MACE TO RENTED PREMISES,(E`JLgcck,trence) �)M 0 CXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE s 1,000,000.00 100.00).00 $ $ 5,000.00 $ 1.000,000.00 $ 2.000,000.00 PROOUCTS • COMP/OP AGG s 2,000,000.00 COI+BINEO slNGLe Liken IEA 'modem) B ODILY INJURY (Per omen) a BODILY INJURY (Per eec dent PROPERTY oAmAGS Per eeedOEU $ S EACH OCCURRENCE $ AGGREGATE $ $ ❑ ,QR T.A u. 7414 E.L EACH ACCloprr s E.L DISEASE • EA esoinCres, $ El_ DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (Attach ACORD 101, Addleona' Remarks $chedu(e, if more spare is required) AIR CONDITIONING SYSTEMS, INSTALLATIONS. SERVICE OR REPAIR WITH $250.00 DED PER CLAIM "'CERTIFICATE HOLDER IS NOT LISTED AS ADDITIONAL INSURED UNDER THIS POLICY'*' CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES 351 NE 103 STREET MIAMI SHORES,FL.33138 , FAX:(305)592 1956 ACORD 25 (2010105) QF Z00/ t00'd bL51# SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION$. AUTHORIZED REPRESENT 1 I Christ(ane Almeida 0 /t[ 9 T J3N 1E31-1S tIP 84010 ACORD CORPORATION. All rights reserved. ORD name and logo are registered marks of ACORD SLOE Z6S SOE tt :St EtOZ /Zt /90 Permit Receipt Permit Number: MC -5 -06 -1175 Invoice Number: MC -5 -06 -24751 Applicant: ROBERT SOUTHARD Company Name: Date 05/12/2006 Payment Type CheckNum Cash Amount $182.80 Total Payment: $182.80 Friday, May 12, 2006 Page 1 of 1 Miami Shores Village 10050 N.E. 2nd Avenue ' Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Issue Date: 5/9/2006 Owner's Name: ROBERT SOUTHARD Permit Type: Mechanical - Residential Permit Expires: 10/31/2006 Work Classification: New Job Address: 351 103 Street NE Miami Shores Village, FL 33138- Contractor(s) CENTRAL AIR REPAIR Phone 305 -666 -5386 Primary Contractor Yes Comments: EXACT REPLACEMENT OF AIR CONDITIONING UNIT Additional Information Tons: Classification: Residential Additional Info: 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. Parcel #: Block: Section: Permit Status: APPROVED Permit Number: MC -5 -06 -1175 Phone: (305)756 -5067 1121360130260 Lot: PB: Total Square Feet: Total Valuation: Required Inspections 0 $ 4,900.00 Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $3.00 $1.00 $171.50 $3.00 $4.30 $182.80 Building Department File Copy Applica Invoice Number Amt Due MC -5-06 -24751 $182.80 Total: MAY 12 PAID Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. q �0(0 i i . za Atv,MMiarni Shores Village Building Department BUILDING PERMIT APPLICATION 1� FBC 2001 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No.M COQ � . aster Permit No. Permit Type (circle): Building Electric • lumbing Mechanical ' oofmg Owner's Name (Fee Simple Titleholder) CCAYillA ' . one # • 7SG G m v ©.7 Owner's Address , 351 &) , i; 103 s-r City dt°°i e a i-i i S-Noet. F3 State FL- Tenant/Lessee Name Phone # Zip Job Address (where the work is being done) 25/ /.L g. 402 57 City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Ce.A.7712itL AI /(-- oeEpogik, Phone # 30S 6 6 G — 6 3* 4 Contractor's Address 67 i , 3 Sic.) 21 S City I-1( a 411, / State / Zip 33 / (1 `al Qualifier 1-04)4 Cr O 14 V C�0 Architect/Engineer's Name (if applicable) Architect/Engineer's Address City State Zip - Phone # Value of Work For this Permit L7 Square Footage Of Work: Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition ['Alteration [New ► Repair/Replace ❑ Demolition Describe Work: 1 A/c u'w f ., ****************************Fees****************************** County Escrow Fee $ DcD Permit Fee $ 7 a 1 Notary $ Education/Training Fee $1 ° CO Tech $ 4 . Scanning $ 3 ` Radon $ Code Enforcement $ Bond $ Struct. $ f A S t Minus Plans Check Fee $ Total Fee Now Due $ A CUR opposite side) 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 K?-iefi Owner or Agent Signature _ ) Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 by day of 20 d by who is personally known to me or who has produced who is -rsonaliv Icnnvvr, me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ������.a,, �Fu �� 6 r!'ov , Ccma' Sanchez Sign:. • /pgY1' ,. 6aeli a Sanchez Print: �t t r Commissian #AD435394 Print: ,P�,4 f �'' ommission #DD435394 q '�``' @ `fxpites: MAY 30 2009 :,, 4- •o- My Commission Expires ° °, of r oQ`e� :91� og�ew Expires: MAY 30, 2009 My Commission Expires,, of * * * * ** **** . ** * * * *** ** * *, *** * * * * * **** *,r ** * * ** * *** *, *** * * * *** * ** * *** * *** *,gar * * * * * * *** * ** **** * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** t 1 APPLICATION APPROVED BY: Chc7t7 /03 Plans Examiner Engineer Zoning