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RC-12-2408Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183270 Permit Number: RC -12 -12 -2408 Scheduled Inspection Date: May 15, 2013 Inspector: Bruhn, Norman Owner: GOLDENBERG, EVELYN Job Address: 1557 NE 105 Street 7 -2 Miami Shores, FL Project: <NONE> Contractor: PENINSULA PLUMBING INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530660 Phone: (305)310 -3676 Building Department Comments REPLACE TILE DOWNSTAIRS AND KITCHEN REMODEL Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 14, 2013 For Inspections please call: (305)762 -4949 Page 7 of 45 PERMIT # 40 )-2A'3 CONTRACTOR: kviirek) SUBMITTAL DATE: , pL 2i0 ! 12- ADDRESS: R ESS 1 '-1- NAME: 630fibikkon RESUBMITAL DATES: PROJECT TYPE: i��L� ` • bra ifia ZONING FIRE STRUCT IMPACT FEES Il r j ,� ELECTRICAL 'HRS/DERM /// PLUMB' NOC MECHANICAL BLbG 1 m o o. �1 m1" mm mori m a IA I IC o v J 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 Permit Type: Electrical /(52 E; 105 JOB ADDRESS: City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes NO / Flood Zo e: OWNER: Name (Fee Simple Titleholder): Eve! 4/ 3 Address: 7 /f//47. i trx5--. s City: AO / f 1 / / County: 2 5 2 i r T F 2 L FBC 20 Permit No. t-x./ Master Permit No. 41,10 6-Er zip: s a 4 ae. Miami Dade DEC Iciep State: hone#: Tenant/Lessee Name: Phone#: Zip: e 3) Email:/ / olae /P e, e).01 fag 0 4 •6 Ar) CONTRACTOR: Company Name: Pe gs 0 (L f(b °n 8 d,,, 1 Phone#: 3 CZ -' q0 3 3 Address: g O4 e t.) Z- 7... 14.4,0 _ 0 City: ��t1'•4 r State: /,/.� Zip: 0 2 9' Qualifier Name: rP2.- E l 5, D / l) ert, e1 z 2 Phone#: State Certification or Registration #: (- LT?' ( Certificate of Competency #: 5 S S 41$ 5 ..4 Contact Phone #: 5 ia ,1°7--3-- r Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Type of Work: OAddress DAlteration Descrip ; n of Work: a 1 `:' AL'._,`` ro fr _Square/Linear Footage of Work: 7i)® 9 DNew fliCp .. • /Replace ! Dem tion eg * * *** * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ e v CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Companys 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 exceed "g $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure , .-;1l be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence - %must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In : �.•; 'nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged Owner or Agent The foregoing instrument was acknowledged before me this day of_Lama, by /r who is personally known to me or who has produced As identification and who did take an oath. Signature The fo , day of NOTARY PUBLIC: sign: ,/ ,e e- earla.te,: Print: �;ts +e "..�••., MIQUELPAREDES M Commissi �: ',�E: My !� � MY COMMISSION r EE 062871 v gr `°•z EXPIRES: February 9, 2015 y, to Bonded nintyalary Public Undeniable APPROVED BY oing in by � L1 , �� ,� 1t"t o is onally known to me or who has produced 1 ) t t `ga ication and who did take an oath. 0.11-0/ !1- • lans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3115/09) N TAR PUBLIC: Sign: ° °b eS`1'datril "v o My Comm. Expires Sep 23, 2015 Pant. ��� Commission # EE 128810 My Co a SSnom ?:xpieesded Through National Notary Assn. Zoning Clerk J111111 Hill IIII 11111 Hill 11111 11111 Nil UIl NOTICE OF COMMENCEMENT CFN '7B-112R1-693B-5-4-67 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION A ' • - • - ' uR Bk 28415 P9 11-809e UPS; RECORDED 12/26/2012 143454 PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made t6 certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. r. HARVEY RUVINv CLERK OF COURT MIAMI-DADE COUI4TYr FLORIDA LAST PAGE ft 1 3. Owner(s) nape and add -w: ve - 0-13 iarmbto (60122&) Interest in property: 01/1017(24(' N and address of fee_simple title 101- /e.e„, 5 e-L.) 2- `0- f> 4. Contractor's name and address: 1 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond .$ 6. Lender's name and address: 7. Persons within the state-of Florida designated by Owner upon whom notices or other documents may be served as Pr a vi d 0byecn.7•113(1)(a)7,. Fla*Stattites. Name and .Address: 8. In addition to hirritelf; Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida' Statutes. N. and Address: / „. e A e) fallEONW7E21111,41, 44`-' 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) • Sigrature of Print Owner's Name Swam to and subsc Notary Public:. Print Notary's Na My commission expires: IRES: February 9 201', 114 C 0 RAOSSION. 41 . alir" 1(kap Nota/Y Public Or;eepATI):4 . , t • ' • t. • 4 Prepared by , 20 - Address: SWE OF ROMA, COUNTY OF LADE IHEREBY CERTIFY Met ' copy et the on Red too ott fitillAESSalyhmt 1 HARVEY RUM, OLP` vet BY DEC, _. 2612 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. Miami Shores Village APPROVED DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COI :KY RULES AND REGULATIONS 07L4, 6fr ' J249 l - rl 12 "V .0101110. MAP MO. ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AT AND CONDUCTORS ORS TO BEUR ��D. INSULATED s- og 5+ 3 `l' NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F..I PROTECTED RECEPTACLE. PUT DAN RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. NO POINT ALONG 2 FEET FROM G. PUT DM R pu, IDLED A,Pft OUNTERID BE MORE TIO PROTECTED RECEPTACLE EPTACLE UNDER IE WS. ANC§ L Q S_ T7 ,t,e /05- 5 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 V). -(219 nspection Number: I NS P- 183305 Permit Number: EL -12 -12 -2410 Inspection Date: April 23, 2013 Inspector: Devaney, Michael Owner: GOLDENBERG, EVELYN Job Address: 1557 NE 105 Street 7 -2 Miami Shores, FL Project: <NONE> Contractor: POWER BY PURKIS, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530660 Building Department Comments INSTALL HIGHLIGHTS IN KITCHEN, ADD SMOKE DETECTORS, UPDATE ELECTRICAL SERVICE FOR KITCHEN REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments i 47A 2or 9 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 23, 2013 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical I EC 23ii. IfI YV BY: ®vooeoeoao°eoeve FBC 20 Permit No. 1�_ 9 Master Permit No. JOB ADDRESS: 9 JV , /O6— M S%. City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes NO County: Miami Dade Zip: )6e OWNER: Name (Fee Simple Titleholder): Address: 55-- 7 /VL 1 C c„S' 4 City: Tenant/Lessee Name: Email: �- .11 Flood Zone: y es Phone#: 9 U (p J '2 99 / 6tes 1L Phone#: Zip: CONTRACTOR: Company Name: Address: Z ? 22L /3' Phone#: City: t 04-744 / State: Qualifier ct 0 / &I Z CaS�. State Certification o' gistration #: 61 `t''(=1 D Contact Phone#: ( &\ 9!( G�� c, Email Address: Zip: Phone#: E D©0o c/ -a! . eot c l cute of Co tency #: e42eCt.5 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ go 0 ° `° Square/Linear Footage of Work: Type of Work: ❑Address D pA1teratio i , om Wok �4 5 ri- cf t ti ❑Ne ❑Re lac-e - 4 -yr - 4-t- Get (-e ❑Demoli Nit I j ***************************************p * ***** axe **** • ►***** **** * ***** **** * * *** * * *** Submittal Fee $ Permit Fee $ /1_6'..2=v 42P CCF $ COICC $ , Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDTITONERS, 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 Ls subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur wner or Agent The foregoing instrument was acknowledged before me this day of 1/, 20 �by''6°Iety1. y I i,f Je i who is personally known to me or w.bcrbal As identification and who did take an oath. NOTARY PUBLIC: Sign: A/(A6 Print: /jv' MURRAY P. YANKS * MY COMMISSION # EE 432150 EXPIRES: September 14, 2016 no■ Bottled Tteu met try &Ow My Commission Expires: * * *** *** * * * *** * * * **** APPROVED BY Print My Commission Expires: ********************************************** *** ****** *** ********* ****** **** 2 m /7. Plans Examiner Zoning Structural Review (Revised 3/1212012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk OP ID: POP ACC QV �.,... -- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/26/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 305-444-2324 MDW Insurance Group Inc C AAA An 362 Minorca Ave 305-444-4980 Coral Gables, FL 33134 Tom Okeeffe COT: CT PHONE FAX (A/C. No. Ext): (A/C, No): E -MAIL ADDRESS: PRODUCER POWER -3 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Power by Purkis, Inc Michael Purkis 12222 SW 131 Ave # 13 Miami, FL 33186 -6402 INSURER A : Travelers Insurance Company 10647 INSURER B: X INSURER C : $ INSURER D : INSURER E : X INSURER F : $ COVERAGES CERTIFICATE NUMB THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER 6607693X08A POLICY EFF (MM/DD/YYVY) 04 /20/12 POLICY EXP (MM/DDIYYYY) 04/20/13 WAITS EACH OCCURRENCE $ 1,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X DMMS T R EoNccTuErreD nce) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L —1 AGGREGATE LIMIT POLICY n jE Q APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 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) $ $ $ UMBRELLA UAB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Electrical Work within buildings OLDER CANCELLATION Miami Shores Village Building Dept. 10050 NE 2 Ave. Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE /.A,�,4t1 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DO war Fos* POWER BY PURK1S /RC MICHAEL M1CRAEL, PURKIS PRES 12222.:',S14 131 ,AVE E IAI4% F . 331.44 thtl PI CTOM Construction Trades Quaiifying Board JSINE 3S CERTIFICATE OF CCDMPETENi ,Y A r E000048 1"11, g 7P+ e { rte. a ° + r► • * . .� :_ 1 4 r u is f vs ! b.o JEFF ATWAT t CHIEF FINAt+tCC AL OFFICER STATE FLORIDA DEPARTNIENT OF PINANCIAL SERVICES DIVISION OF ' . WORKERS' COMPENSATION SE EXEMPT CONSTRUCT OR! INDUSTRY 'EXEMPTION This certifies that the individual lisbd ovv has elected to EFFECTIVE DATE: PERSON: FELLA (NESS NAME A POWER BY PONCES INt 12222 Sld. '41 AVE MIAMI 082312011 Pu -IS. 650412525 ADDRESS: P1, 33188 SCOPES OF BUSINESS OR 1- REGISTERED EL/EMI -CAL. . RAcr EXPIRATION'1 MICHAEL IOM: WORKERS' F1or i 06-18-2011 PATE: 0812212013 centtrcane o0 118111t aa' the at 0WC -252 CERTIF1 PLEASE CUT OUT THE >rARD BEL, AND RETAt STATE' tiYlYl SERVICES tf'E i EXEMPT PROM PLoR DA EFFECTl11 PERSON FISK BUSINESS NAME AND POWER e9" PERMS INC 82222 SW :tat AVE et same TZON RATE; Q8/2 FOR FUTURE REPI IMPORTA... "Pursuant to Chapter 440.06(141, F.S.. ah *filter .Rif a aarparptiait who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or competisation under this 0 fir. Pursuant to Chapter 440.05(12}, F:S.. Certificates of election to be M exempt..: apply only within the ,scope of the 'business or trade listed on Rttm .notice of election to be exempt. E Pursuant to Chapter 440.05113. F.S., **cos of election to be exernl and certificates of election to be exempt ill be subject to revocation if, at any time atter the filing of the polite or the issuance of the certificate, the person named on fife notice or certificate no longer meets t e requirements .of this section for issvoce Of a certificate. The department shall revoke a certificate et arty time for failure of the on the certificate to meet the requirements of this SCOPE OF BUSINESS 9- maw- D iL tutiKAL: 1850} 413 - 6i 01NC -252 CE iTIFICATE OF QN TO BE EXEMPT REVISED 01-11 MIAMI-DADE COUNTY TAX COLLECTOR 140 W. Flaoler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 12/12/2012 1300/225/001JAZZ 0017-0001 Last Seci.W:0001 WI LBTW:30 326863-8 Local Business Tax $200.00 CK $200.00 CHANGE $0.00 MIAMI-DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. neater let Floor Mtami, Florida 33130 TEMPORARY RECEIPT 2012,2013 MUNICIPAL CONTRACTOR TAX Loral Business Ta0303268638 State/00C.94E000048 Issued to POWER BY PURKIS INC Type :of Business:, ELECTRICAL CONTRACTOR ,BAOIC.OF OFFICIAL REMPT fOR NONPARTICIPATING MUNICIPALITIES T141$ RECEIPT X$ ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU. WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT, Paymint Received as Certified Above Miami -Dade County Tax Collector = = 7. = = = = = Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 C �2 c) Inspection Number: INSP - 183297 Permit Number: PL -12 -12 -2409 Scheduled Inspection Date: May 15, 2013 Inspector: Hernandez, Rafael Owner: GOLDENBERG, EVELYN Job Address: 1557 NE 105 Street 7 -2 Miami Shores, FL Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530660 Contractor: PENINSULA PLUMBING INC Phone: (305)310 -3676 Building Department Comments PLUMBING WORK FOR KITCHEN REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 14, 2013 For Inspections please call: (305)762 -4949 Page 8 of 45 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. Permit Type: PLUMBING JOB ADDRESS: 5- 5' 7 PL'-' i p S City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes FBC 20 Permit No. Master Permit No. D Eo 2 262 I BY iZ-24 County: Miami Dade Zip: NO Flood Zone: OWNER: Name (Fee Simple Titleholder): e�mj Address: / cc) 4/0C �/ City: /'%! 01M4i 5-74 €‘041-5. 0415. State: /'ere, Tenant/Lessee Name: Phone#: ?? - % ° 7/ Phone #: Zip: '3'13 r Email: CONTRACTOR: Company Name: PC/A),, .1 ��d`' � t/ Phone#: l �� .?? Address: rJ City: / Qualifier Name: �'6� / , �% . j��LI' State Certification or Registration #: / Yz 7� Certificate of Competency #: Contact Phone #: ® ' Email Address: DESIGNER: Architect/Engineer: Phone#: ® S te: Zip: F. 3 4r Phone #: Value of Work for this Permit: $ �i °I° Square/Linear Footage of Work: Type of Work: DAddress DAlteration UNew URepair/Replace ODemolition Description of Work: rd le // % mss' A04. /410 /Z4,6 . **** * * ** **** x**** *******x: x: ************p ees******************* ** ** x*+x****************** Submittal Fee $ Permit Fee $ /6 C' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ c.J g. (ac0 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 acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _, by , day of , 20 _, by 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 PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: ************************************** * * * *** * * * * *********** *** ** x*********+ x******* * * ****************** ****** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 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 $254, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will b wered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement . e posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab , ; ' such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The foregoing instrument was acknowledged before me this The fo day of , 20 / 7, by / _. , day of who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: C P r i n t : ( try o E 1 My Commission MIGUEL PAREDES MY COMMISSION # EE 082871 II? b FXPIRES: February 9, 2015 It ulit• Bonded Tin Notary Public UndasarNer, * * * * * * * * * * * * ** APPROVED BY nc rete‘..oviz Ala " . AYE .� t '' . 0 o is rsonally known * * * * * * * ** lans Examiner r Structural Review (Revised 3/12/2012)(Revised 07 /10 /07)(Revised 06/1012009)(Revised 3/15/09) OTAR ontractor acknow .. ged before me thi .I Al OP me or who has produced fL by m pr PUBLIC: Sign: Print: My Commission . cation and who did take an oath. A :TIP' .11111111V t's' Notary Public State 01 Florida '!' ` My P : 5 •_ M Comm. xpir + "^ l Commission # EE 128810 '' •5,of 0,0' ��` Bonded Through National - Notary Assn. ************* * * * * ** *** * * * *** *** * * * *** * * * * * ** Zoning Clerk