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RC-09-408Miami 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 aster Permit No. 9\ BUILDING PERMIT APPLICATION FBC 20 ECENE OV 13 ±09 _wo _ .. _ .. _ Permit Typ( BUILDING° ROOFING F, t Owner's Name (Fee Simple Titleholder) �.31 , , r ran O'i eMjv Owner's Address 6 b �`� . 1�) \ 0 Cityj�i c ` OftcJw , State L Tenant/Lessee Name jct L Email bt3 V.rbf 5cv1 ( c c' o c '� ri2.,7 Job Address (where the work is being done) 1 " t o A) E. k, 05 -fie.% Phone # t O5 ' � 6 ' g Z-Z Zip Phone #� tom, City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO SA- County Miami -Dade Zip '22'; 1 ?j Contractor's Company Name Contractor's Address Flood Zone Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. 'Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ .21000 Square / Linear Footage Of Work: Type of Work: ['Addition Alteration DNew ❑ Repair/Replace ❑ De molition Describe Work: .e41-cA,J f/LeA vti� vi-C, - '. -di Lt O% 40 cc Vt c- �-tv, (c,Aat riled f Submittal Fee $ =—perrarrFee $ +r * * * *,r,rFees * * * *1 * ** • 26 . °° ** Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ A * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ CO /CC .$ Technology Fee $ Bond $ See Reverse 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.. Owner or Agent The ftrument was acknowledged before me this 03 day of foregoing , 20 C , by � �' l: yes , who is personally known to me or w dh produc IF1-- 19 p Y p ation and who did take an oath. (Q --{� NOTARY PUBLI Sign: Print: 1 My Commission Expires: APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this day of ,20,by -.who is personally known to me or -who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: • Plans Examiner Zoning Engineer Clerk checked (Revised 07/1 0 /07)(Revised 06/10/2009) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 108850 Permit Number: RC- 3- 09-408 Scheduled Inspection Date: December 21, 2010 Inspector: Bruhn, Norman Permit Type: Residential Construction Inspection Type: Final Owner: BURGESON, WILLIAM Work Classification: Kitchen Cabinets Job Address: 1618 NE 105 Street A-8 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Phone Number Parcel Number 1122300530080 Building Department Comments INSTALLATION OF NEW KITCHEN CABINETS , CARPENTRY (MULDING) FOR ENLARGED OPENING, AND INSTALL SHEET ROCK CEILING TO REPLACE DROP CEILING. Passed /`" Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 20, 2010 For Inspections please call: (305)762 -4949 Page 1 of 28 II(E* 4„l 8' 4" a File name:Kitchen 3 Your note: " Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Reci4.44 mos Mite OVED C3 S A -- ed: ` 5 f (4c C ti • ,r DEPT DEPT A I L AND polifiV RULES ... MO TIONlS l 2' 10" 2' 9" 8' 4" 2' 9" T'WW Are e 0 re, 88 ;, a Arvil 417 Fitt / y BO'''O ')' G Re ,„„., I ICE* File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Your note: ' !I CT TO COMANDE 1E AND COUNTY AMES AND MailtATIONS (>04:0142/9 10 • • . . . - 2' 10" 2' 9" 2' 9" 8' 4" ift.44 Ar/ i,"---4e, ir,c, 8e. e,Z) pwdik /27-t c/el• rrie reVA-r 0,v eawi,reA- re, 13 e fra/2e 71,74,- adieAP7 •-r17 /2q7C- re 71 P 4, .9 • 41, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Cflwa Inspection Number: INSP- 108868 Permit Number: EL- 3-- 09- 410 Scheduled Inspection Date: April 16, 2009 Inspector: Devaney, Michael Owner: BURGESON, WILLIAM Job Address: 1618 NE 105 Street A -8 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530080 Building Department Comments APR 2 0 ENT's Passed Failed D' Correction Needed ,/ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Gt2,r tel- A�l S � oA e-- CP‘07/ P7e ° /6-,/ All Vo A" Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Date: April 16, 2009 Inspector: Devaney, Michael Owner: BURGESON, WILLIAM Job Address: 1618 NE 105 Street A-8 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER -10 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1122300530080 Building Department Comments April 16, 2009 Page 1 of 1 APR 2 0 ENT1) Passed Inspector Comments ' /3" (6 - , r 1.0/ Failed 4 f'/ Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled re-inspection fee is paid. until April 16, 2009 Page 1 of 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 oi4-Lio8 Inspection Number: INSP - 111887 Permit Number: EL- 3- 09-410 Scheduled Inspection Date: December 20, 2010 Inspector: Devaney, Michael Owner: BURGESON, WILLIAM Job Address: 1618 NE 105 Street A -8 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530080 Building Department Comments INSTALL POT LIGHTS IN NEW CEILING INSTALL NEW CIRCUIT FOR WALL OVEN. RELOCATE 2 15 A RECEPTACLES (MORE UP TO COUNTER LIGHTS) INSTALL 3 PENDANTS LIGTHS ON BREAKFAST BAR. Passed 27. 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- 108868. DEMO IS OK. NEED MORE UTLETS. MD 04/16/09 December 17, 2010 For Inspections please call: (305)762 -4949 Page 2 of 28 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number 1618 105 Street Number: A -8 1122300530080 Miami Shores, FL Block: Lot: LOUIS WOODRUFF 1618 105 Street MIAMI SHORES FL 33138 -2118 Contractor(s) HOME OWNER Phone Cell Phone ................. Phone... Expiration: 09/30/2009 Applicant LOUIS WOODRUFF CeII Valuation: $ 1,000.00 Total Sq Feet: 112 Available Inspections: Type of Work: ELECTRICAL Additional Info: KITCHEN REMODEL Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $159.99 $3.00 $50.00 ($50.00) $4.00 $172.79 Invoice # Total Amt Paid Amt Due EL -3 -09 -34267 $ 172.79 $ 50.00 EL -3 -09 -34267 $ 172.79 $ 172.79 $ 0.00 Inspection Type: Underground Rough Final Meter Box Alteration Relocation Fire Alarm Service Change W. W. 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 it 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. April 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 03, 2009 1 Miami Shores Village Building Department f0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical, w�v 2 Owner's Name (Fee Simple Titleholder) ttt[ fa,yv nj ,SVP Phone # j p 1 S / 2--(6 Permit No. £1oa • 410 ster Permit No. /EMI "40.8° Owner's Address 1618 # C �, OS City l co_ Ct t ' 04— -1 State Zip 3-5 t1Cth Tenant/Lessee Name Nfrk Phone # IU ) E -MAIL: Job Address (where the work is being done) 1 (:,1 l ©S +lam S4- City Miami Shores Village County Miami -Dade Zip 3 Zj 1 3 S FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name b1A--I"'te- Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Valve of Work For this Permit $ Square / Linear Footage Of Work: 1 t Type of Work: ['Addition [OAlteration ❑New /❑ Repair/Replace ❑ Demolition Describe Work: VA 9r j % S- t U 964- Ll 51-1-1 . 1 /i Rabe ...1.4d C e ( i yi [$ S�C�QLL to e- J €,4 r' i,fc �)t* 00..e.�t .. Rab Cte, a �5 WE, A t-e `‘i -t c 14.0 t d"Vvc- LIT 4 c rqur v in ► S L,. f) . [ it cA-cil 3 4e,4 &i 1 t 54 S 0-i2- r tj sec t4 Ctv+ b6.kr , et ll * * * * *r*** * r rr**r****** ** *** ** ***Feesr * ** * * ***** * **** r** r*rr *** *t*** **** ** a Sub�i ° Fee $ ) Permit Fee $ 1168"0G CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -3 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 The fore oing instrument was acknowledged before me this IT day of AI by 41011 0,14'41a 1).0 c. 42iir who is personally known to me or who has produced LiC ge0.-0 As identification and who did take an oa NOTARY PUBLIC: Sign: Print: My Commission Expires: Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced as identification and who did take an oath. Sign: Print: My Commission Expires: *** * * ** r* * ** **** ******* rr, wr********* * * *,r*** * * *,t*** **** ** * ******** * * *** * * * *,t*** **,r,t t***** ** APPLICATION APPROVED BY: (Revised 02108/06) t'iFS ` Plans Examiner Engineer Zoning 1 ECENVED MAR 17 tad rr VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: ( l (i Qv" 16 4.)Vr-Sc.n^ DATE: 3) l 1 Zv `off ADDRESS: Lbt 8 iJ 2- LVSt V14i, &w.l C6 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will . presume that you built fot sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law: Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Myself. 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstatement of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understand than this department and its inspectors are there to help enforce and interpret the ode. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial (.1 5. 1 understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Iiiti al `�" 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial ,k k 4 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this 1'l Initial (,/ 2,..) day of firth , 20 (� 7 By glum elpigs Ul 26! who was personally known to me or who has Produced there License or fl.' ivdrs tit 601.0 as identification. Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Expiration: 09/23/2009 Project Address Parcel Number Applicant 1618 105 Street Number: A-8 1122300530080 LOUIS WOODRUFF Miami Shores, FL Block: Lot: -wg*mmm,:...:k4wzzzzzzmmz*xz,mg:mmzzi:imzszmzggmmzzmzsmmlmmmgmzzzitmimmzozzzzmwmgsgozmkmw.mmzzm Owner Information ...... ....... CeII ................ LOUIS WOODRUFF 1618 105 Street MIAMI SHORES FL 33138-2118 'wommmvsmmo=mmwsmz=mmlwoz.wamommxtmoaxammtwommmaimmiamonmmmigmmwmammanivmmomomommamamA Contractor(s) HOME OWNER Phone Cell Phone I i* i Valuation: $ 1,000.00 •• : •• •• •• •• •• • • i Total Sq Feet: 112 •• ::>.:A..x,x.:...t:w..x,:.:.:..x.:.:44.):**x+:+:o:•:•:•:.:.:.:.:.:•:•:•: Type of Work: ELECTRICAL DEMO Additional Info: LIGHTS AND FAN IN KITCHEN Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Fee SubmittatReyersal Fee TechnolcigY-Fee Total:' A Amount $0.60 $0.20 $5.00 $100.00 $3.00 $50.00 ($50.00) $2.50 $111.30 Invoice # Total Amt Paid Amt Due EL-3-09-34269 $ 111.30 $ 61.30 EL-3-09-34269 $ 111.30 $ 111.30 $ 0.00 Available Inspections: Inspection Type: Underground Rough Final Meter Box Alteration Relocation Fire Alarm Service Change W. W. 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 n 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. April 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 03, 2009 1 BUILDING PERMIT APPLICATION FBC 2004 Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type: Electrical EC E MAR 1 j 2009 NNW OW OM Permit No. EL V I -ti 13 aster Permit No. Sit° a -40'6 Owner's Name (Fee Simple Titleholder) -gcl t (5'4 S t /to• Phone # U� — 391 Owner's Address k b N `( 4 SA- state c- City tM:ddvt't 'rJ\tl?r t- Tenant/Lessee Name E -MAIL: Zip Job Address (where the work is being done) City Miami Shores Vill FOLIO / PARCEL # Is Building Historically Designated YES NO )X 33�3� Phone # A1A I t Os +4- {- County Miami -Dade Zip 1 i 8 Contractor's Company Name 42) ` 12,-A Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: Describe Work: Square / Linear Footage Of Work: t ['Addition ['Alteration ['New ❑ Repair/Replace VI Demolition {e ct, -F (o' ■'et �t�1• ' x� V-A C v l A • e ! C' �' i t ti � w - r/trvt VV.. k` Q w ec. i3/5 31171D4 ********* W***************************** Fem************** * * * * * * * * * * ** * * * * * * * * * * * * * * * * * ** Submittal Fee $ a�U Permit Fee $ eG CCF $ v' / J CO/CC Notary $ Training/Education Fee $ 0 • Technology Fee $ Scanning $ �D Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ Cal • O See Reverse 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 Signature Owner or Agent Contractor The foregoing instrument was n acknowledged before me this ft The foregoing instrument was acknowledged before me this day of ►firth , 2001, by \ tltllA" �'htI krb7 40t {•, day of , 20 , by who is personally known to me or who has produced TV :DMA who is personally known to me or who has produced /IAL, (go 601..b As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: & NOTARY PUBLIC: Sign: Print: Sign: Print: My Commission My Commission Expires: **** ****** ******* **** r************************ ,r*** **** * ****** ** ** ********* ** r***** APPLICATION APPROVED BY (Revised 02/08/06) L o�i - +13 RECEIVED MAR 172 Plans Examiner Engineer Zoning VILLAGE OF MIAMI SHORES EL Off - +I3 OWNER BUILDER DISCLOSURE STATEMENT NAME: Ua t t t i 4 vw g.) r q0e DATE: t� 10 /047 ADDRESS: t 1 t S., l ()S 'S -E- I ''1.ic itt 5!we-Li cL- 1,3 L 3 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial vJ-' Q7 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial h Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 108860 �G Permit Number: PL- 3- 09-409 Scheduled Inspection Date: December 20, 2010 Inspector: Rodriguez, Jorge Owner: BURGESON, WILLIAM Job Address: 1618 NE 105 Street A -8 Miami Shores, FL Project: <NONE> Contractor: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530080 Building Department Comments RELOCATE COLD WATER LINE, AND DRAIN FOR DISH WASHER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 17, 2010 For Inspections please call: (305)762 -4949 Page 1 of 28 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 09/23/2009 Project Address Parcel Number Applicant 1618 105 Street Number: A -8 1122300530080 Miami Shores, FL Block: Lot: Owner Information Address LOUIS WOODRUFF 1618 105 Street MIAMI SHORES FL 33138 -2118 .•• ....... .. ....:.. .•.•.•.•.•:.,..,.: :. ........y :.. ...•...,.....•:•.•:............ y,.,.. . :.........•..•.• 5.;. .•.•.•.•.•or••• :,ii }i }iii ......... ......... :•. :: : - ............. ... LOUIS WOODRUFF CeII Contractor(s) HOME OWNER Phone CeII Phone Valuation: $ 1,000.00 Total Sq Feet: 112 SS533.•.... ' :, ............. .�. Type of Work: PLUMBING Type of Piping: COLD & HOT WATER CONNECTION Additional Info: Bond Return : Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions /Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology f=ee Total: Amount $0.60 $0.20 $5.00 $180.00 $3.00 $50.00 ($50.00) $4.50 $193.30 Invoice # PL -3-09 -34266 PL -3-09 -34266 Total Amt Paid Amt Due $ 193.30 $ 50.00 ?'- $ 193.30 $ 193.30 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Underground Rough Heater Water Service Final Water Main Lavatory 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. April 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 03, 2009 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �j BUILDING f Permit No. LY `- 1 PERMIT APPLICATIO FBC 2001 Permit Type: Plumbing ((�� pp Owner's Name (Fee Simple Titleholder) 'J � �✓ 11 0(be., S iP0" Owner's Address NS eD.}- City A' -V i efv...a State (/- ECM 'E 7 2009 Tenant/Lessee Name ster Permit No. Re0 -408 Phone # b5.381.dZ)2-8 Zip 327i344 Phone # 914 E -MAIL: Job Address (where the work is being done) I (;1 1%It \, v e* City Mianu Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name O'- 1\52-'ir- Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: ' Type of Work: ['Addition NAlteration ❑New ❑ Repair/Replace n ❑ Demolition Describe Work: rF O c CAC- C r� 1 d laJ� ✓ l h-.t. el V cc t r Ai—i1/4 AtSIA V.kS\.--t V , Submittal Fee $ ) Permit Fee $ if CCF $ 0'00 CO /CC Notary $ 5-00 Training/Education Fee $ V .coo Technology Fee $ 4.50 Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 43 :to See Reverse 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 ,r► Signature Owner or Agent Contractor The fore_oing instrument was acknowl -.:ed before me this (I The foregoing instrument was acknowledged before me this day of ,t', : '':•A 261, by 1104 '` �yn, \jI( at ! r., day of , 20 , by who is personally known to me or who has produced 7 xS who is personally known to me or who has produced LIC g Oab As identification and voa as identification and who did take an oath. NOTARY PUBLI • \GPI \g� `� Z�O6 NOTARY PUBLIC: \fie o�Pa% Sign: r fI a� Sign: Sl ��.,�� 7� ►._ Sl Print: � 1,02.---c , Jo - - Print: My Commission Expires: :, My Commission Expires: *it** *** *,rar******* *** *rr**** ***/ * � �r = ,u*** f********* t* *s *** `+ ********** ******* ** ** v** ** ******** ****** ** 1 APPLICATION APPROVED BY (Revised 02/08/06) VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: 03:. Sri, % Gt,Vvl, not; ,Jcf," DATE: 3 l (1 1 0, ADDRESS: 1, l (6 Are `, jam. Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less: The building must be for your own use and occupancy. It may not be built for sale-or lease. If you. sell or.lease building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make-sure the people employed by youhave licenses required by state law .and by county or municipal licensing ordinances. Any person working on your building who is not licensed must-work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. I. I hold title to the above property and I am planning on doing this construction Myself. Initial U41(6 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstatement of the permit. Initia 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial (j..)»Y't7 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Initial V1 7. I understand that if any person .gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. • Initial VJ? 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial 00C- Was acknowledged before me this fl day of yttdA ,20 Oct By W:Il(U>it dola bp'I I i who was personally known to me or who has Produced there License or ll .7nva /S l,(G. 46b6Z6 as identification. J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, F Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 108870' Permit Number: DEMO-3-09-412 Scheduled Inspection Date: April 16, 2009 Inspector: Bruhn, Norman Owner: BURGESON, WILLIAM Job Address: 1618 NE 105 Street A -8 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Demolition Inspection Type: Final Work Classification: Phone Number Parcel Number 1122300530080 Building Department Comments Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments G� • Project Address • Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 1618 105 Street Number: A -8 ....................... ........................ ....................... ........................ •iii >fi�i!Y.{: {sffi:•>.Y.: R6SAf!!?•::�F3:!f:�: Expiration: 09/2712009 Parcel Number Applicant 1122300530080 Miami Shores, FL Block: Lot: Owner Information Address LOUIS WOODRUFF 1618 105 Street MIAMI SHORES FL 33138 -2118 Contractor(s) HOME OWNER Phone Cell Phone LOUIS WOODRUFF Phone Cell Valuation: $ 1,000.00 Total Sq Feet: 112 Type of Demo: Walls & Signs Additional Info: PARTITION WALL Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $100.00 $3.00 $50.00 ($50.00) $2.50 $111.30 Invoice # Total Amt Paid Amt Due DEMO -3 -09 -34268 $ 111.30 $ 61.30 DEMO -3-09 -34268 $ 111.30 $ 111.30 $ 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. April 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 03, 2009 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit No.tl Oct -412_ ter Permit No. Ott ° VW Permit Type (circle): Buildin Roofing 3 Owner's Name (Fee Simple Titleholder) t �� t l t 4 vie, 'Airy J �,. Phone # 7 65 3 8( �✓ 57-S Owner's Address t do t /Ai f e ` 0534. C, City 1 " Ctivt t 561.0t, State Zip 3 313 rb Tenant/Lessee Name N' & Job Address (where the work is being done) City Miami Shores Y. as! :e FOLIO / PARCEL # Phone # vi$ oS-44 5+ County Miami -Dade Zip 35i36 Is Building Historically Designated YES NO Contractor's Company Name °(it) `\.Q,-v" Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit ei D 6' Square / Linear Footage Of Work: )' al� Type of Work: ['Addition ❑Alteration ['New ❑ Repair/Replace (( Demolition ` Describe Work: `►4-.4- tLi- -C-6J t, r e ' _ ' t t t -i stto a,-e, sec4tyt" ( 4-4 et lcr fu, �l�`tlati Submittal Fee $ Permit Fee $ CCF $ n•�e��Z'""" 'Notary $ '5 Training/Education Fee $ (.1.9® Technology Fee $ Ot`S"l,/ Scanning $ OD Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ Ql - See Reverse 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 properly 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. Signatrur ,((jp� '-� Signature Owner or Ag Contractor The foregoing instrument was acknowledged before me this 11 The foregoing instrument was acknowledged before me this day of rk G , 20 041 , by h ((litg '(,L!id &) el do" Ft., day of , 20 , by who is personally known to me or who has produced f i,'tvVIi who is personally known to me or who has produced Lie ((b(,2 b M identification and who did take an , - A.. as identification and who did take an oath. NOTARY PUBL : , ! NOTARY PUBLIC: Si Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** Sign: Print: My Commission Expires: ***************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: ,/� '�r Plans Examiner Engineer Zoning (Revised 07/10/07) EMEWE 7 2009 'xo oc -1XL 5. I understand that as an owner - builder, that any contractor • isputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. '' ,, Initial l .2-4 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Initial A"" 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial Oria 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial Weill Was acknowledged before me this 11 day of %YC,1t , 20 M By Vtlet N OAS born xr • who was personally known to me or who has Produced there License or - 1I1' uogo as identification. ()Lite-we-. OWNER • IKEA E•'i. ?. • �'i.. • • • • • • • • • • • • • • • • • • • • .. .• • • File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Your note: 8' 4" 4 aevet ,/ ;ex ice . , `O 5 e = t- . " 1�� ���-r NILE* • �.i.i�i� � €. • • .•• • •.• • • • • • • • • • • • • • • • • • • • • • • • • •.• • • • • • • • • • .. • • • • • • • • • • . • • • • • • • • • • • • • • • • • 0** • • File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Your note: 3' 1" 3' t IC EA :..:::::. • 00 • • • 410 0410 00 • • • s • 00 2r' • 0 0 • • • • • 0 41 0 0* (71 File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Your note: 2' 1' 3, • • • • • • • • • IKEA) •* • • • • • • •• • • • • • ••• • • • • • • • • ••• • • • • • ••• • •.• • • • • • •• • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • ••• • • •• • • • • • • • • • • • • • • • • • • • • • • • • • • File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Your note: • . IKEA' ' ••• . • • ••• • • • • • • • • • • • • • • • • ••. • • . •••• •. . ••••• •••• • •.• • ••• • • • •. • • • • • • • • • • • • • • • • • • • • . ... • • • • • • • • • •• i�- •• . • • • • • • • • . • • • • • .• • • • • • • • • • • • ••• • 2'6" • • • • • • • ••• •• File name:Kitchen 3 Date:3/17/2009 Scale:Print to fit paper size Dimension:8' 4" x 14' Living Room /Dining Room Stairway to 2nd floor Kitchen • • • •• • • • • • • • • • ••• •• • • • ••• • ••• • • • • • • • • • • .... • • • • • • • • • • • • •• • • • •• ••• • • •• •••• • •• • • • • ••• • • • • • • • • . . •• • •••• • ••• • • Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 ................. ................. ................. ................. ................. Expiration: 09/27(2009 Project Address Parcel Number Applicant 1618 105 Street Number: A -8 1122300530080 Miami Shores, FL Block: Lot: Owner Information Address LOUIS WOODRUFF 1618 105 Street MIAMI SHORES FL 33138 -2118 ..�,.. �•Y,:• YYY> YY>:..: Y>:. Y>:..:,.:e,,:.:.:::.::: Y: .YYYYYY:YY:.:.:.::.:•Y >:,.:..;: Phone LOUIS WOODRUFF Cell Contractor(s) HOME OWNER Phone Cell Phone Valuation: $ 8,000.00 Total Sq Feet: 112 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: kitchen cabinets Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology 'Pee Total: Amount $4.80 $1.60 $5.00 $225.00 $9.00 $50.00 ($50.00) $5.62 $251.02 Invoice # Total Amt Paid Amt Due RC -3 -09 -34265 $ 251.02 $ 50.00 RC -3 -09 -34265 $ 251.02 $ 251.02 $ 0.00 Available Inspections: Inspection Type: Drywall Final Framing Insulation 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. April 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 03, 2009 1 Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATIO FBC 2004 ECEIVE MA r 17.009 Permit No.. 0 l -1 V aster Permit No. Permit Type (circle): wild' Roofing "3c4 �3 Owner's Name (Fee Simple Titleholder) �e,1(L & p\. " Phone # 3 T� 1, 53 ZS Owner's Address t 6 t ® /use dS+tA 9 City At q wn t 6 State {i L. Tenant/Lessee Name NI Zip '22 13 8 Phone # Job Address (where the work is being done) k GL t5 i L LO7 "N'�^ 4 City Miami Shores Villa a Comity FOLIO / PARCEL # Is Building Historically Designated YES NO Miami -Dade Ati4- Zip 3z7 t Contractor's Company Name Contractor's Address City State Zip Qualifier Name Phone # Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # i5®® Value of Work For this Permit $ Type of Work: DAddition Describe Work: fkr-e. 4Vc), Square / Linear Footage Of Work: l(1 DifAlteration ❑New ❑ Repair/Replace lug+ 11.e -a.1 Vi 4-eE tw e C 3 : 'ECK (f!,* re; v 11 ('4w (c ,0 i� . Ihs�r t� <111/412.4-k- ,rode rear 1 a '� • ❑ Demolition C. Y315 ***************************************Fees* ' * ****,r, *** **** *** *+t,r,r,r**,r r*,r*, *** *** *x*** Permit Fee $ �/ CCF $ 4'x) ca�e- ub �Ottal Fee $ 0 • Notary $ Training/Education Fee $ Scanning $ 3 190 Radon $ Bond $ Structural Review. $ Code Enforcement $ DPBR $ Technology Fee $ Zoning $ Double Fee $ Total Fee Now Due $ P.01 • Oeg s See Reverse 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 rreinspection fee will be charged. Owner or Agent The fore oing instrument was acknowledged before me this 11.1 day of Y 2001, by 1fki t atIT, who is personally known to me or who has produced ft r� t �h 0t16 As identification and who did .. e an oath. NOTARY PUBLIC:% war ci3 Sign: Print: My Commission Exp * * * * * * * * * * * * * ** * * ** Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced as identification and who did take an oath. * * * * * * * * * * *** * * * * * * * * * * * * * ** NOTARY PUBLIC: Sign: Print: My Commission Expires: ****t *****,r,r *** *, ter *art s****,t r************* *,wt**** APPLICATION APPROVED BY: (Revised 07/10 /07) Plans Examiner Engineer Zoning r" q ./ ) OVER MAR 17 zoos s NMI MIN WNW .•.... moo 0. --4 Nom mom - w��bbw r.. MIAtII -DADE COUNT Yr This Instrumeptj'repared By: ri Name W t 1 ytA 'PS Permit No.Koq -405 Tax Folio Not NOTICE OF COMMENCEMENT Address it ' STATE OF FL COUNTY OF . THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. -1. Description of property: (legal description of property, and street address if available)" (cry /.tiwsk 4- i6 (G6 .NBC. 10S S4 *' , W1tawti .2. General description of improvement: (PQ( ci, g sq - 3. Owner information ,` f ,o 4C) 1 J� � a. Name and address: i "t '� � �� b. Interest in property: 00.102 c. Name and address of fee simple titleholder (if other than owner): • 4. Contractor: a. Name and address: I}o,x,.e, 0w`=+1l01. b. Phone number: '505 5b1 5 3 VS 5. Surety a. Name and address: b. Amount of bond $ c. Phone number. 6. Lender a. Name and address: b. Phone number: vvtt�u�'t 't r (1�t VIA 6UMe.5 eN 1Lk.55 k,oc ic. St tn�t�c trot S` cAtve-n 14L 35C5% 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: a. Name and address: b. Phone number: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 7.13.13(1)(b), Florida Statutes: a. Name and address: b. Phone number. 9. Expiration date of notice of commencement (the expiration date Is 1 year from the date 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 TtMCE 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. The foregoing instrument was acknowledged before me this (name of person) as authority, ...e.g. officer, trustee, attorney in fact) for behalf of whom instrument was executed). gnature of Owner or Owner's Auth o� Officer/Director P artner /Manager � i „t4�M. 34,e SCA,-1 Signatory's Title/Office ay of e . year) by ` ov Signet Print, pe Commission fc - State of Florida Commissioned Name of Notary Public umber (type of _(name of party on Personally Known — or Produced Identification 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. Signature. of Natural Person Signing Above VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEME NAME: 'A ` (1 Gtm Ssv-y. DATE:3) 11 12-o C ADDRESS: 66' m e t O S 4 cS# Oki tw S Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that T as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violdtion of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law .and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Myself. Initial 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstatement of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initia0\-L1711 I understand that the building official and inspectors are not thereto design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial 0 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and rnyself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial t)\- -- / 8. I understand that under state and local laws I can not do any Electrical; Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this el Initial day of Jlait , 20 d9 By QM 1 aur1Q316 0511 who was personally known to me or who has Produced there License or fl:'va'i It (6 NZ D as identification. Miami -Dade M My Page 1 of 2 Show Me: Property Information Search By: Select Item C Text only Property Appraiser Tax Estimator s• Portability S.O.H. Calculator Summary Details: Folio No.: 11- 2230 - 053 -0080 Property: 1618 NE 105 ST A8 Mailing Address: WILLIAM C BURGESON 1618 NE 105 ST #A8 MIAMI SHORES FL 33 1 382 f h8°'- -"°-".-` - Floors: Property Information: Primary Zone: 26277 -0459 CLUC: 0007 RESIDENTIAL - CONDOMINIUM Beds /Baths: 2/2 Floors: 0 Living Units: 0 Adj Sq Footage: 1,728 Lot Size: 0 Year Built: 1971 Legal Description: HARBOUR CLUB VILLAS CONDO TOWNHOUSE A -8 UNDIV 1/79TH INT IN COMMON ELEMENTS CLERKS FILES 69R143006 & 70R100201 OR 18122- 3282 0298 5 Sale Information: Sale O /R: 26277 -0459 Sale Date: 2/2008 Sale Amount: $352,000 Assessment Information: Year: 2008 2007 Land Value: $0 $0 Building Value: $0 $0 Market Value: $357,630 $357,630 Assessed Value: $139,848 $135,775 Exemption Information: Year: 2008 2007 Homestead: $25,000 $25,00.0_ 2nd Homestead: YES NO Taxable Value Information: ear: 2008 2007 Applied Applied axing Authority: Exemption/ Exemption/ Digital Orthophotography - 2007 My Home 1 Property Information !Property Taxes 1 My Neighborhood 1 Property Appraiser 0. 200 ft Home 1 Using Our Site 1 About 1 Phone Directory 1 Privacy 1 Disclaimer 121111111111111111. ANIL If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. 1 1• • u u • •• 111 ■•es - • ••u.• • • Web Site © 2002 Miami -Dade County. All rights reserved. 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 204 Permit No. i\a/ FEB 1 s zoo_ NJ BY: a9,9 Master Permit No. RC- 3Q14o' Permit Type (circle): Building Electrical Plumbing Mechanial Ryo�ofing ? Owner's Name (Fee Simple Titleholder) 1 BU R1 ESOL Phone # 1 ' 305- ?-1Q ©- ©c a l Owner's Address 0 (OI a l oS STET City ILA \A l S % F.3 State FL- Tenant/Lessee Name Zip 3313' Phone # Job Address (where the work is being done) )(PI I•L 10S ST? T City Miami Shores Village County Miami -Dade Zip .33132 Is Building Historically Designated • YES NO tl Contractor's Company Name M `AtAk — 1 ru Phone # 3o5 - R (91' aZo Contractor's Address 1 a SIr-S 1 13 c.T PNikji t State F- Zip 33 i 2 L 41ifiet M 1 CIAA State Certificate or Registration No. CIA cos 8 0 S S Certificate of Competency No. Architeet/Engineer's Name (if applicable) Phone # $Value of Work For this Permii Type of Work: ['Addition i Alteration [New Describe Work: ��/ £�rl 140 Square Footage Of Work: ❑ Repair/Replace fr ❑Demolition Fwd Submittal Fee $ Notary $ Scanning $ Code Enforcement $ **** ** x *******************Fees****************************** *, *j * ** *, Fees* * * **** * * * * * * * * ** * * * * * *** * * * ** 1 !/ D 1,00 CCF $ CO /CC Technology Fee $ Zoning Bond $ Permit Fee $ Training/Education Fee $ Radon $ Total Fee Now Due $ Structural Nan Review. $ (Continued on 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 IMPROVEIVIENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY RECORDING YOUR 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 inspectio occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approve# rnd a reinspection fee will be charged. Owner or Agent Contractor The foregoing instrument was acknowledged before me this /5 The foregoing instrument was acknowledged before me this / 5 day of 1Zeol/f, 20 /0, by , day of em, , 20 /0, by j°1 c40,1 ' / r who is persoi,2ally 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 PUBLIC: Sign: Print: My Com - ssii,n * * * * * * * * ** a oaoeeeewaeaa „ " ° °� Cr n# 0)07 1 Ares 1012312011 NOTARY PUBLIC: Sign: Print: My Comthissior ®]gq Comm* pp0728221 anum„ * * * * * * * * * * * * ** * ** a*,tf2 0a.* _. * * ** 4* Expo ?i gmae ®n.eeee..au.unSS APPLICATION APPROVED BY: Chc 05/13/03 emeseinissesesessawasesesell Aa .� .mro Assn” * * * * * * * * * * * * * * * ** • Plans Examiner Engineer Zoning Au 3934281 STATEQF FLORIDA DEPARTMENT OF ROSINESS- AND PROFESSIONAL REGULATION CONS TR1:TMW INDUSTRY LICENSING BOARD .--s- , SEQ# L08082100936 DATE •+,.■,. - BATCH NUMBER LICENSE NBR. 08/21/2008 080094618 CAC058055 The CLASS A AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter, 4A$9 FS. Expiration date: AUG 31, 2010 PERTIERRA, MICHAEL. 17: MIAMI DADE AIR INC -' 12223 SW 133 CT MIAMI CHARLIE CRIST GOVERNOR FL 33176, DiSPLAY AS REQUIRED BY CHARLES W. DRAGO SECRETARY Au 4439566 STATE OF FLORIDA DEPARTMENT OF BUSINESS-AND PROFESSIONAL REGULATION 'CONSTRUCTION -INDUSTRY--LICENSING BOARD L09061201289 DATE ':""r*BATCHNUMBER 06/12/2009 060515987 LICENSE NBR QBQO14.464 The BUSINESS ORGANIZATION Named below IS QUALIFIED Under the provisions of Chapter 48 Expiration date: AUG 31, 2011 (THIS IS NOT A ICENSE TO PERFORM COMPANY TO DO BUSINESS ONLY IF IT MIAMI DADE AIR INC 12223 SW 133 CT MIAMI FL 33186 CHARLIE CRIST GOVERNOR WORK. THIS ALLOWS HAS A. QUALIFIER.) , . DISPLAY AS REQUIRE 8Y LAW CHARLES W. DRAGO SECRETARY COUNTY TAXCOLLECTOR W.'FLAGLER: let FLOOR 9 IOC BUSINESS TAX RECEJPT 7.g 2010 MIAMI- DADE, - tTA14 fLP3 Ex PIESEP'30I 010 MUST BE DISPLAYED A T P JA CE OF BUSINESS DIIRSUANT TO COUNTY CHAPTER 0A ' ART 9 & 10 FIRET,CLAESei MIAMI, FL -IT NO BLISINEss NAmEaocATIoN 'MIAMI'llABE, 1'22$ :SW 1• ,CT ' 134:.f..40INI'D,A4E. COM 1 DADE AIR INC Sec Type at Busi n ess 196 SPEC'EMECHANICAL CONTRACTQ THIS is ONLY A LOCAL MAINESSMSERECEEMIT , DOES NOT Pena ma - ', , , HOLDER TO VIOLATE ANY 'EXISTING REGULATORY OR , "thi" LAW" T C0UNT 11 OR SMEI • N DOES IT EXEMPT HE HOLDER PROM ANY DINER Potter OR LICENSE REQUIRED BY LAIN. THIS IS NOT A VERTIRCATIOI2LOF uALIRCA- - . PAYMENT RECEIVED MIAMI-DADE COUNTYTAX COLETOR: DO NOT FORWARD MIAMI DADE AIR INC MICHAEL PERTIERRA PRES 12223 SW 133 CT MIAMI FL 33186 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CP MIAM207 DATE(MM /DD/YYYY) 04/20/09 TYPE OF INSURANCE PRODUCER FILER INSURANCE , INC . 9440 S .W. 77 Avenue P - mi. , FL 33156 1 .ie: 305 -270 -2100 Fax: 305 - 270 -2195 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Miami Dade Air, Inc. 12223 SW 133 Court Miami FL 33186 INSURER A: FCCI Insurance Company 33472 INSURER B: Associated Industries Ins. Co. 23140 INSURER C: 04/20/10 INSURER D: $ 1, 0 0 0, 0 0 0 INSURER E: PREEMMISES(Eaoccurence) COVERAGES THE ANY MAY POLICIES. 1NSW LTR INSRD POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD`L TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM /DD/YY) LIMITS A GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY GL0004168 04/20/09 04/20/10 EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 X PREEMMISES(Eaoccurence) $100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE , $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 1 POLICY ^JET LOC AUTOMOBILE 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) $ GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND WORKERS EMPLOYERS' UABIUTY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below AWC1000994 04/24/09 04/24/10 X TORY IMITS X 01H- E.L. EACH ACCIDENT $ 500, 000 EL DISEASE - CA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE .,, " F <..' CHRISTINE PIERSOL- A207301 ACORD 25 (2001108) Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1618 105 Street Number: A-8 Miami Shores, FL 1122300530080 Block: Lot: WILLIAM BURGESON Owner Information Address Phone Cell WILLIAM BURGESON 1618 105 Street MIAMI SHORES FL 33138 -2118 Valuation: Total Sq Feet: MKOMENEVM Tons: Additional Info: SUPPLY DROP EXTENTION & KITCHEN HOO Classification: Residential Approved: In Review Comments: Date Denied: Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $0.80 $154.60 Invoice # MC -2 -10 -37051 Invoice Total Amt Paid Amt Due $154.60 $154.60 $0.00 Building Department Copy For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final Rough February 19, 2010 2 Arlenis Silvers From: Bill Burgeson [bburgeson @comcast.net] Sent: Thursday, August 19, 2010 2:09 PM To: Arlenis Silvers Subject: Permit Extension I would like to extend Permit Number MC -2 -10 -229 for 10 days to allow for an inspection. My address is below. I would like to schedule an inspection for Tuesday August 24, 2010 for a final Mechanical - residential inspection to close this permit. Thanks, Bill BILL BURGESON 1 618 NE 105TH ST, A -8 MIAMI SHORES, FL 33138 H: 305.890.8221 C: 646.425.5302 "WORK IS THE CURSE OF THE DRINKING CLASS" - OSCAR WILDE "I LOVE DEADLINES. I LIKE THE WHOOSHING SOUND THEY MAKE AS THEY FLYBY. "- DOUGLAS ADAMS "THE PROBLEM WITH THE WORLD IS THAT EVERYONE ISA FEW DRINKS BEHIND." HUMPHREY BOGART "AN INTELLIGENT MAN IS SOMETIMES FORCED TO BE DRUNK TO SPEND TIME WITH HIS FOOLS. "- ERNEST HEMMINGWAY, FROM FOR WHOM THE BELL TOLLS 1 f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 150230 Permit Number: MC -2 -10 -229 Scheduled Inspection Date: August 24, 2010 Permit Type: Mechanical - Residential Inspection Type: Final Owner: BURGESON, WILLIAM Work Classification: Kitchen Hood Job Address: 1618 NE 105 Street A -8 Miami Shores, FL Inspector: Perez, JanPierre Project: <NONE> Contractor: MIAMI DADE AIR, INC Phone Number Parcel Number 1122300530080 Phone: 305 - 969 -2300 Building Department Comments EXTEND EXISTING SUPPLY DROP IN KITCHEN & HOOD DUCT. Passed \Ix 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- 135561. August 23, 2010 For Inspections please call: (305)762 -4949 Page 24 of 35