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RC-11-1858Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Typ ROOFING ECEIED OCT 112.011 Permit No.1 Master Permit No. —� C 1 _ S S.r"--. OWNER: Name (Fee Simple Titleholder): Elan & Anne - Camille Hersh Phone #: 305 764 6542 Address: 102 NE 109th St. City: Miami Shores State: FL Zip: 33161 Tenant/Lessee Name: Phone #: Email: elanandcamille@gmail.com JOB ADDRESS: City: Miami Shores Folio/Parcel #: //2 /7k)67,4 /00 Is the Building Historically Designated: Yes NO 1 SE 3rd Av loa u_r- iO4sr County: Miami Dade Zip: 33131 X CONTRACTOR: Company Name: {tt.#‘CCA■ Cc' .i' Address: i3/ia>t 3kS.1 2O .sr mot City: 4 fit- State: � telQb Qualifier Name: Il'L`• State Certification or Registration #: �C 1SL72'4 Contact Phone #: -86404 92 Email Address: Flood Zone: /VP Phone #: q34 ec4 ZI414 t2 Zip: Phone #: 4211-ec=4,04ci.? Certificate of Competency #: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $1'* Square/Linear Footage of Work: Type of Work: OAddition ?Alteration New ORepair/Replace ❑Demolition Description of Work: ME04 1ateirWs/ e-isT HALF ll,, ctil Tesp - + x**************************** ******* ** *11Fees **** * ** * * *** * *** * * *** *x *** * * * **** * **** * * * * ** Submittal Fee $ Permit Fee $ Co„L S" CCF $ CO /CC $ Scanning Fee $ ` Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 1��. S R - ' 'tV! / r-577 Mortgage Lender's Address 5157 P- City 77407 State 41 Z- zip ` FOie 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 promise in good faith that a copy of the notice of commencement and construction lien law brochure will whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemen for the first inspection which occurs seven (7) days after the building permit is issued. In the abse inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of 9 , 20 ,�,, by ""x`13 a who is personally known to me or who has produced Arlimrve As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: f .S My Comtission Exp' SHERRIE S. SMYTH Signature 00, the applicant must elivered to the person e posted at the job site of such posted notice, the Contractor The foregoing is r• ment was acknowledged before me this day of (� , 20 a L. by lip , who is personally known to me or who has produced / 0 as identificationoudityho4id take an oath. NOTARY PUBLICa\���`�- a,, ..... ... °• %,mil a s- -+-, . c,; ,, c. : it * •- Sign: Print: My Commission Expires: * * *: *************************** * * * * * * **>K��>k//h**/* ** * *** *�k *** Kok #*** ** * * * *>K�k>k� **** �k***** �k�k> H** * * *�k>K�k>k�k>k>k>k�k�k*** * **** /� "d6.1/Plans f /Plans Examiner APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 184502 Permit Number: RF -10 -12 -1858 Scheduled Inspection Date: January 23, 2013 Inspector: Bruhn, Norman Owner: ARTIEDA, LUIS Job Address: 9350 NE 9 Place Miami Shores, FL 33138- Project: <NONE> Contractor: TOP SEAL SERVICES Permit Type: Roof Inspection Type: Final Roof Work Classification: Tile Phone Number Parcel Number 1132060070040 Phone: (305)754 -7844 Building Department Comments RE -ROOF TILE USING EASGLE MALIBU COLOR TRU TILE Infractlo Passed Comments INSPECTOR COMMENTS False 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- 182538. CREATED AS REINSPECTION FOR INSP- 179518. Vent penetration at nw corner is not flashed. Attic vent is at the same elevation as roofing material. Water must not drain into attic Provide re -nail aff Tile is broken and does not have enough foam. Qualifier to contact BO. NB January 22, 2013 For Inspections please call: (305)762 -4949 Page 25 of 34 S 4 -1 CON51417N, EJ4 %AER4, .Vt ROOF PROBLEMS ? ?? UPLIFT TEST EXPERTS A -1 CONSULTING ENGINEERS, INC ROOF STRUCTURES CONSULTING ON SITE CONCENTRATED UPLIFT LOAD TESTING ROOF TILE IN ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE TAS No. 106 SITE SPECIFIC INFORMATION Owner's Nam / f Permit #: Job Address: .Z , mil & # IS Roofing Contractor: P e7e,;&.- Type of Tile: 7:47-,4.s -i /04=2 Approximate Roof Height: /2 z'' feet Roof Pitch: �2 Date installed: Type of Access to Roof: V Scaffolds Ladder Other Approximate Square Footage of Roof: a, ft 2 Required Testing Force: 35 lbs. Testing Equipment: F.G.E. 100 Date Tested: /2// /Z f 2— TEST LOCATION UPLIFT PULL TEST TEST LOCATION UPLIFT PULL TEST TEST LOCATIO UPLIFT PULL TEST TEST LOCATIOA UPLIFT PULL TEST TEST LOCATIOI, UPLIFT PULL TEST TEST LOCATION UPLIFT PULL TEST 1 4455 26 ,� 51 A,.. 76 101 126 2 27 52 77 102 127 3 28 53 78 103 128 4 29 54 79 104 129 5 30 55 80 105 • 130 6 31 56 81 106 131 7 32 57 82 107 132 8 33 58 83 108 133 9 34 59 84 109 134 10 35 60 85 110 135 11 36 61 86 111 136 12 87 62 87 112 137 13 38 6 � 88 113 138 14 39 89 114 139 15 40 \V 90 115 140 16 41 66 , / ,,, 1 141 17 42 67 92 6 18 43 68 _' y ,; 143 19 44 69 ily 94 119 144 20 45 70 95A-'2 °'2 ©OI(a 7 _VW � i6c [ ,5 46 71 NyA, 96 .� 121 146 22 47 72 WAIL .97 ° 147 23 48 49 73 74 / 98 99 Dio__ 3 124 148 149 24 25 pAas 50 75 . 100 125 150 IN ACCORDANCE WITH THE CR TERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CON- TROL TEST. THIS TAS 106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. THIS REPORT SUBMITTED BY: JoseA. Martinez P.E. # 031509 A -1 CONSULTING EN Lab. Certificatio Renews: 01- 1224.05 4383 S.W. 70th Ct, Miami, Florida 33155 • Telephone (305)740 -9550 • Fax (305) 740 -9550 ENGLISH: Cell (305) 609 -6388 • SPANISH: Cell (305) 498 -9804 CONSUL t G ENGI LNC STUCTURES CONSULTING UP TEST LA t. CERTIFICATION No.01-I 5 133 SW 70 CT, MIAMI FL 33155 TL-305-7A a 9550 FAX. 740-9550 name: BERTA AYALA jolt address: 9350 NE g PL MIND SHORES F Rooting Catittra::: TOP SEAL SERVICES Type of tale: EAGLE CARS 10_ App of 1iht 12 et Tipe of access to roof: Scaffold: Appro. !:,e square footage of roof: 45 Required bmting force: 35 Lbs Date d- Number of ft2 Date Roof p. '4,- 312 der: Other: SKETCH OF R 6 0 Reviced: Date: 12142012 43 47 45 44 3:3 40 42 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 172226 Permit Number: RC -10 -11 -1858 Inspection Date: April 16, 2012 Inspector: Bruhn, Norman Owner: HERSH, ELAN AND ANNE - CAMILLE Job Address: 102 NE 109 Street Miami Shores, FL 33161 -7042 Project: <NONE> Contractor: SERVILACON CORP' Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1121360090160 Phone: (954)804 -0492 Building Department Comments NEW KITCHEN CUT HALF WALL FOR COUNTER TOP Passe • / 4 / Inspector Comments CREATED AS REINSPECTION FOR INSP- 171566. CREATED AS REINSPECTION FOR INSP - 171443. MISSING ELECTRIC FINAL. JR NO ACCESS. NB ea— Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until April 18, 2012 For Inspections please call: (305)762-4949 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE 101/11 D/YYYY) /1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) 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 Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone 30 266 -6493 Fax 305 262 -0679 ( � ax ( ) CONTACT MARTA ALONSO PHONE FAX A/C No. Ezt) (305) 266 -6493- (A/C, No): (305) 262 -0679 -MAULgg marta@floridabankersInsurance.com ODUCER CUSTOMER Ip# INSURER(S) AFFORDING COVERAGE NAIC # INSURED SERVILACON CORP. 15761 SW 20 St MIRAMAR, FL 33027- (954) 704 -2110 INSURERA: AMERICAN VEHICLE INSURANCE COMPANY INSURER B : 06/03/2011 INSURER C: EACH OCCURRENCE INSURER D : DAMAGE SES TO occcu once) INSURER E : MED EXP (Any one person) INSURER F : PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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. ILTR TYPE OF INSURANCE ADDL INSR SUBR WVO POLICY NUMBER POLICY EFF (MM/DO/YYYY) PQUCyy E�X_�P��� (M /DD/YYYYJ UNITS A GENERAL 0 ■ LIABILITY COMMERCIAL GENERAL LIABILITY ❑ CLAMS -MADE V OCCUR GL- 050400005100 -01 06/03/2011 06/03/2012 EACH OCCURRENCE $ 1,000,000.00 DAMAGE SES TO occcu once) $ 100.000.00 MED EXP (Any one person) $ 5.000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 ❑ - GEN %AGGREGATE LIMIT APPLIES PER -s# PRODUCTS COMP/OP AGG $ 1,000,000.00 V/ POLICY • PRO- • LOC " �r� ;, " _r +�i d `� x '., $ AUTOMOBILE UABIUTY ANY AUTO a ALL OWNED AUTOS r " •9 i � � � ' COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ :BODILY INJURY (Per accident) $ • SCHEDULED AUTOS ( ❑ HIRED AUTOSt 3 $D }) � P" ❑ NON -OWNED AUTOS s J ❑ '.a`U"� t4'� �' vyW i {�k.,�bl ;mot¢ .. i.' ! ?f�,'.`.•($.. PROPERTY DAMAGE (Per accident) $ $ $ - — UMBRELLA UM) EACH OCCURRENCE $ ❑ ❑ OCCUR 1 r l; , ❑ EXCESS LIAB ❑ CLAIMS -MADE Cy "x ,:AGGREGATE $ $ ❑ DEDUCTIBLE ei, al` i 4 - ° arpa e DELI s t ❑ RETENTION $ (( kr 2',1°- t } a1 si j i0°l WORKERS COMPENSATION ) AND EMPLOYERS' LIABILITY €f a 4 3 3 _' f y. '� c h WC STATU- OTH- s I TORY LIMITS ❑ ER E.L EACH ACCIDENT $ ANY PROPRIETORFPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe uncle DESCRIPTION OF OPERATIONS below R E.L DISEASE - EA EMPLOYE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) QF ©1988 -2009 ACORD CORPORATION. AU rights reserved. The ACORD name and logo are registered marks of ACORD 06 -06 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 06/06/2011 EXPIRATION DATE: 06/05/2013 PERSON: FEIN: PEREZ MIGUEL A 371498056 BUSINESS NAME AND ADDRESS: SERVILACON CORP 15761 SW 20TH STREET MIRAMAR FL 33027 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR * IMPORTANT: Pursuant to Chapter 440 . 05414), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-160f. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 08/08/2011 EXPIRATION DATE: 06/05/2013 PERSON: MIGUEL A PEREZ FEIN: 371498058 BUSINESS NAME AND ADDRESS: SERVILACON CORP 15761 SW 20TH STREET MIRAMAR, FL 33027 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election I- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. H E R E QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: SERVILACON CORP Receipt #: 180-8944 Business Type:GENERAL CONTRACTOR (GENE CONTRACTOR) Owner Name: MIGUEL A PEREZ Business Opened:07 /06/2009 Business Location: 15761 SW 20 ST State /County /Cert/Reg:CGC1517294 MIRAMAR Exemption Code:NONEXEMPT Business Phone: 954 - 804 -0492 Rooms Seats Employees 2 Machines Professionals For Vending Business Only Number of Machines: Vendine Tvae: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 2.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MIGUEL A PEREZ 15761 SW 20 ST MIRAMAR, FL 33027 2011 - 2012 Receipt #04A -11- 00000002 Paid 10/03/2011 29.70 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 1121360090160 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements 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. 1111111111111111111111111111111111111111111 11 - N 201 1 FR045 61520 OR $I; 27345 P9 3391 °v (1P3) RECORDED 10/03/2011 11 :24 31 HARVEY RUVIN, CLERK OF COURT lIIAt1I -DADE COUNTY r FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of r0 102 NE 109th St, Miami Shorea, FL 33161 g property and street/address: 2. Description of improvement: rsitUJ, i4 TGIAte t 3. Owner(s) name and address: Interest in property: Fee Simple Name and address of fee simple titleholder: Elan and Anne- Camille Hersh 102 NE 109th St, Miami Shores, FL 33161 4. Contractor's name, address and phone number: ; 3::?..11ALnIbC43t1 Qgbity 'fAtEsL3 ?+ t°a7G( SEIJ Ztt, ITO Jag ".:5Z-1 PV • Z45e1) 8c4o4°IZ. 5. Surety: (Payment bond required by owner from contractor, ff any) Name, address and phone number: C)° Amount of bond $ 8 V� 6. Lender's name and address: 0 Q) 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, Name, address and phone number: `; Oil 8. In addition to himself, 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. u. Name, address and phone number 0 &1 9. Expiration date of this Notice of Commencement: LL } Em g ca Elan and Anne - Camille Hersh 102 NE 109th St. Miami Shores, FL 33161 (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 TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT Signature(s) of Owner(sl o O�wner(s)' Authorized Officer/Director/Partner /Manager Prepared By _ Cif �t ly,,� / — Prepared By Print Name i Print Name Title/Office CV, K1 C.Q,_, Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE �L The fore, going instrumen was acknowledged before me this 247 day of By -1A' K3 1-1(4_ �' S-1-' At-x7 At h . - L t. t=- -) { ❑,� �1¢dividualiy, or Cl as for ' _ 3 : ± 67 l.d'Personally known, or ❑ produced the following type of identificationia 1 _ Signature of Notary Public: IL�4 _______' #� ' — Print Name: r►f47[;' l�iii+ (SEAL)r�� �` IXPIRES� 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(s) •, '+ er(s) or Owner(s)'s Authorized Officer/Director/Partner /Manager w �(P By 23.DI.52 PAGE 311D By Permit No: 11 -1858 Job Name: October 19, 2011 Miami Shores Viiiage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Provide all permit applications prior to any further reviews.(electrical and plumbing) Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 11 Inspection Number: INSP- 167662 Permit Number: PL -10 -11 -1952 Scheduled Inspection Date: December 14, 2011 Inspector: Hernandez, Rafael Owner: HERSH, ELAN AND ANNE - CAMILLE Job Address: 102 NE 109 Street Miami Shores, FL 33161 -7042 Project: <NONE> Contractor: V &V PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360090160 Phone: (786)281 -9960 Building Department Comments NEW KITCHEN SINK REPLACE NEW TOILET AND VANITIES Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 165727. not ready December 13, 2011 For Inspections please call: (305)762 -4949 Page 31 of 53 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 No. rfl-' t PERMIT APPLICATION Master Permit No. 10- k 1- l8 FBC 20 RECEIVE OCT 2120,1 Permit Type: LU NG Elan & Anne- Camille Hersh 305 764 6542 OWNER: Name (Fee Simple Titleholder): Phone #: Address: 102 NE 109th St Miami Shores City: State: FL zip: 33161 Tenant/Lessee Name: Phone #: Email: elanandcamille@gmail.com JOB ADDRESS: 102 NE 109th St City: Miami Shores County: Miami Dade zip: 33161 Folio/Parcel #: 1121360090160 Is the Building Historically Designated: Yes NO X Flood Zone: No CONTRACTOR: Company Name: \/ l Ni PI (A "A ti rvi Phone #: 7C72 A Address: Cc) ea S Q.. '-k- City: 4 i a 1 e .M State: L. Zip: 3 3 1 3 Qualifier Name: \/ c p & a r-C)Z c<1 Phone #: State Certification or Registration #: (' c.0 1.41 Q "k 5:—.. Certificate of Competency #: Contact Phone #: Email Address: \J ry\ l r\ `ci Co DESIGNER: Architect/Engineer: -Phone #: I Value of Work for this Permit: $ ) Square/Linear Footage of Work: `�� Type of Work: ❑Address ❑Alteration UNew ❑Repair/Replace ❑Demolition sO4a,u kitt r �t'eUPc, 08/9/A Cc? /Wet) XiCe 1.0A yes Description of Work: **+x ***** *�x ****** *********** *** **** ** pees"` p**** ******** ***w***** ***** *************** Submittal Fee $ 5'o , v` 10 Permit Fee $ / °U CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ J a Q.(/ li' a 4P Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) P, kv< '" Mortgage Lender's Address 51f% Zrti City TA1 State Zip Ve".a`'` 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 The fore day of Gwner or Agent oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 9 day of OC-ArdOL.V , 20 Il , by V i (-kw 9 • C c,NrC who is personally known to me or who has produced "P- woom y v.rri as identification and who did take an oath. 201L , by k * who is personally known to me or who has produced e'Vt/N. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: SHERRIE S. SMYTH i? MY COMMISSION #DD 832343 EXPIRES: October 20, 2012 ;i9(,d; Bonded Thru Notary Ng* Underwriters NOTARY PUBLIC: Sign: Print: ormArr- r GyGO My Commission Exp' *:'********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review JESSICA GARCIA Notary RibHo, State of Florida Commission My Canmmsslon Eggs Mar. 21, 2015 * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk ALEX SINK CHIEF FINANCIAL OFFICER cr STATE OF FLORIDA ARTMENT OF FINANCIAL, (''VICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EX ? 1 FRONT FLORIDA WORK ENSATII LAW C s ` STRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. Et) ±CTIVE DATE PERSON: 01/07/2010 EXPIRATION 'ATE: 01/07/2 2 GARCIA FEIN: : t t : P Bg BUSINESS NAME AND ADDRESS: V & V PLUNBIr+G INC 880 E 28Th STREET HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLU' a INS CONTRACTOR VICTOR R IIPORTANT: Pursuant to Chapter 440 . 06(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter. 440.06(12), F.S., Certificates of election to be exempt.. apply only within the scope el the business or trade listed ea the notice of election to be exempt. Pursuant to Chapter 440.06(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 11 at any time after the filing of the notice er the Issuance of the certificate, the person atoned on the notice or =Mileage no longer meets the requirements of Ibis section far issuamce of a certificate. The depttrtntem shall revoke a certiiicate at any time (or 1 allure of the person enured on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA 6iEPARTME14T OF FINANCIAL SERVICES DIVISION OF WORKERS' CObi4PENSATION CONSTRUCTION TION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 01 /07/2010 EXPIRATION DATE: 01/07/2012 PERSON: VICTOR R GARCIA FEIN: 800484758 BUSINESS NAME AND ADDRESS v & v PLUMBING INC 660 E 20114 Surat' HIALEAH, FL 33013 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election �- under This section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt_ apply only within the scope of the business or trade listed on the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if at any time after the filing of The notice or the issuance of the certificate, the person named an the notice or certificate no longer one the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1601 Carry bottom portion on till CUT HERE Job, keep upper onion for your records. 1,10 TV EV.rSGBL Zfl £ 1St 'FLOOR Mat L 33130 MUST IE DISPLAVE0 Kr PLACE OF auswess PURSUANT TOCOUNTY CODE CHAPTER 8A -ART. & 10 655143 -7 BUSINESS NAME/ LOCATION V & V PLUMBING INC 860 E 25 ST 33013 HIALEAH THSISMOT ,. BILL. - PAID MIAMI, FL PERMIT' NO. 231 RENEWAL RECEIPT No. 682209 -3 STATE* CFC1428152 OWNER V & V PLUMBING INC Sec. Type of Business WORKER /S 19NLY 6 A PLUMBING CONTRACTOR 3 19 O LOCAL r£SS TAX RECEIPT. IT NOT PERMIT THE ER TO VIOLATE ANY iNG REGULATOSY OR IG LAWS OF THE TY OR arms. NOR R EYELIPT THE ER FAOLi ANT OT ER IT OR UCERSE MEE By LAW. THIS IS a CERTIFICATION OF IOLOER'6 OUALERCA- • MT MOWED -DAD E CURT( TAU 'cCTOR: 09/12/2011 09010041001 000045.00 SEE OTHER SIDE DO NOT FORWARD V & V PLUMBING INC VICTOR R GARCIA PRES 860 E 25 ST HIALEAH FL 33013 II1111111111111S1111111,, 1111112111 1,111111111,1I1111111►„1151 111 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) r An. Fop (4-.5-"Y Mortgage Lender's Address St3'/ (1 %�Z � AlAi-e City T/1,�0a State /u4 Ziprefi 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 einspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day ofWailibth 201 L , by % N II H- who( is perrsso � lly known to me or who has produced Signature Contractor The foregoing instrument was acknowledged before me this day of 6-4t , 20 0 ( , by a(114th As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: _ sue! My Commission Expires: **** * ***** * ***** * * **** APPROVED BY ,•, * SHERRIE S. SMYTH .:s MY COMMISSION # DD 832343 EXPIRES: October 20, 2012 •'�� Bonded Thru Notary Public Underwriters * * * * * * * * * * ** r who has produced identification and who did take an oath. NOTARY " LIC: Sign: Print: F My Commission Expires: OPa ,P46<<, MARILEN MONTES DE OCA * MY COMMISSION # EE 094840 ,Pr ;'`n!t'`s EXPIRES: June 15, 2015 'Ilk-of no Bonded Thru Budget Notary Services ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ,/aPVt Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 OCT 212011 Permit No. EL \ -19 5i Master Permit No. ° I ` (b58 OWNER: Name (Fee Simple Titleholder): Elan &Anne - Camille Hersh Phone#: 305 764 6542 102 NE 109th St. Address: Miami City: State: FL Zip: 33161 Tenant/Lessee Name: Phone #: Email: elanandcamille @gmail.com JOB ADDRESS: 102 NE l09th St City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 1121360090160 33161 Is the Building Historically Designated: Yes NO x NO Flood Zone: CONTRACTOR: Company Name: eF57 6e' Phone #: 9-1 Z 6®4 6/ .Gigs./ s74 Address: City: a�—� Qualifier Name: Gz. f.if7 State Certification or Registration #: Contact Phone #: � W2-e State: b5 W I /36,11- Certificate of Competency #: Zip: 33 v/z) Phone #: % i._ 44/2," 0 a ,6 ` 2 ~ 00 .)-9 v 6°6:72 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ -do Type of Work: ❑Address ❑Alteration Description of Work: Square/LinearF,00tae of Work: l]New �epair/Replace ODezolition Al ea) Ot LLt 4(3 kitCn-W ��Frf b Rgst oC4 sj kt COST L&j 5f` fttc,®®, 6y-tS 11 Submittal Fee $ u 0 0 Permit Fee $ , '®P'‘694:P CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 10 ,/[0 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 Owner or Agent ��yJ�� L, The fore oing instrument was acknowledged before me this 1 of day of l 20 , by V k1L) 1-442.Vi who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission,Expire Signature Cr-e4:7—j -7C,.... "s/9... Contractor The foregoing instrument was acknowledged before me this vi 3 day of a3 , 20kQ-, by *- e=a-rl 11- CA-Mc wh• s personally known t• me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: L A'1vonitic i TL�� • ItL?Il•:!,1 . a • : a My Commission V00 -167— akin,' „ 4 (407) 39 8 0i53 Fitt! EK4lay 09, 2012 F IoridallotaryService.00m **s k*r ;:sk**'k*skiM**** aksk sksksk kik> Li****** sksk*s h*iMnk*ik*******B *******N, ********N<< ksksk*Hk**sR*****Nh> k******iksk+ ksls*slssk**ds****+k**** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk ti3n12- "- BUILDING PERMIT APPLICATION FBC 20 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 RE V JAN 0 4 ZO12 Permit No. t Master Permit No. Permit Type: Electrical /% /T J am /t Phone #: G p S 2-OWNER: Name (Fee Simple Titleholder): Address: /1/F MT". 5Y City: M' /Aititl s/h t& i State: Tenant/Lessee�N�ame: / /� Phone #: Email: ,Y.�('./A/14ivLbl CSO rle, 0 , f ,?'^- JOB ADDRESS: 1 0 N 6 1001 Zip: '3704/ City: Miami Shores County: Miami Dade Zip: 3 511p Folio/Parcel #: 11, —Q131.0^ o (-, q- O I co Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: U3 if -IF__ rri C..S4eAf5 Ve c*n C, j e r)C.. Phone #: (3o5) 5 i & " L% 1) 1 1 Address: 1 Q-0-0 e `lc. 9 1 --g Cc 5N.s V *') S t 1 i - C 1 01 City: 1' (1. ■ State: r Zip: 3 -5 1 K Qualifier Name:. r1+ T. Cr 1YD 01L Phone#: (.0S) 1 — C State Certification or Registration #: � SD O #lo f J Certificate of Competency #: Contact Phone #: C.51.) S- - D 1 1 Email Address: C')t 7 b T u-% 1 r-• m t S-1 -ers 1 Pc*r- c - CASTYI DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1g D 0 1 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New lepair/Replace Description of Work: ine- -}°CY rz. po,_,6 y Recce r-Q A C- Lr ., t S ❑Demolition ********* :****** ****** **** *** ******* * * ** Fees************* *** **** * ***** *** * * **** * * ******* Submittal Fee $ 53 « h Permit Fee $ /��'' 49P CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $_,_110 -1(3 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169096 Permit Number: EL -1 -12 -115 Scheduled Inspection Date: February 08, 2012 Inspector: Devaney, Michael Owner: HERSH, ELAN AND ANNE - CAMILLE Job Address: 102 NE 109 Street Miami Shores, FL 33161 -7042 Project: <NONE> Contractor: WIREMASTERS ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360090160 Phone: (305)378 -4011 Building Department Comments METER REPAIR AND REWIRE AC UNITS Passed C� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments FA_ February 07, 2012 For Inspections please call: (305)762 -4949 Page 10 of 19