RC-11-303Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 156284 Permit Number: RC -2 -11 -303
Scheduled Inspection Date: December 11, 2012 Permit Type: Residential Construction
Inspection Type: Final
Owner: HUTCHESON, CRAIG Work Classification: Kitchen Cabinets
Job Address: 220 NW 112 Terrace
Miami Shores, FL 33168 -3332
Inspector: Bruhn, Norman
Project <NONE>
Contractor: SEARS HOME IMPROVEMENT PRODUCTS, INC.
Phone Number
Parcel Number 1121360010310
Phone: (305)341 -5663
Building Department Comments
KITCHEN REMODEL, NEW CABINETS AND COUNTER
TOPS
Inspector Comments
Passed
Failed
/2/Hi
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 10, 2012
For Inspections please call: (305)762 -4949
Page 1 of 26
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No. ,C.�o?^ 1 1 ®303
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): d'i Pb "�Ui S6 i\ Phone #:
� ��rtrt
Address :22,0 id 4.A.o 11 2, ��a_
Fit City: ' � ` 'aPe -a ivdi 6$ hace, State: R Zip: : } (a
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:2.20 i1A3 11 fl ?__.s \ ex
City: Miami Shores County: Miami Dade Zip: 3 D //to p
Folio/Parcel#: //' ZI 3 0 ' 4) d - 03 0
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: 'iF3Y..S. el,...� , Phone #:
Address: )0,24 I /s. Clem +ye -( //L-
City: L11PII, ,State: f I Zip: 3 2_7
Qualifier Nan!e: ' t 1 ',.141-
f (. man Phone #: QJ - t) '',/% if
State Certification or Registration #: �1��3 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address - e ❑Alteratii�on ❑New ❑Repair/Replace ❑Demolition
Description of Work: 1 t,h Qi QQ.rrN e _ i i
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
*** * ** ** * * * * * * ** ** * * * * * * * * * ** *** * * ** ** Fees, ************ * * * * * * * * * * * * * * * ** ** * * * * * * * * * * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 foregoing instrument was acknowledged before me
day of 7/3 j ,20J ,by
who is personally known to me or who has produced
As identification and who did take
Contractor
e foregoing instrument was acknowledged before me this,"
ay of Al ; , 201L, by I r Cr /0,1•774±4
ho i
ersonally . o
o me or who has produced
as identification and who did take an oath. g c
NOTARY PUBLIC:
4
0 z
8
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09Xrev6/4/1 0)
Plans Examiner
Structural Review
My Commission Expires:
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. 120 11-5cz
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
g FEB 23 2011
Electrical Plumbing Mechanical
Owner's Name (Fee Simple Titleholder) F / ()YUJ2 f /LQjihe cir)j Phone # JtiLh p-7—
Owner's Address ZZ Q//L. 7 ' 3 %► t) 4 o//
City 13Th State 4----1, i dey Zip 3.) / 441
Tenant/Lessee Name Phone #
Roofing
Job Address (where the work is being done) 2,7 _0 pLifiA9 /1
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 04.)) - / 3
Is Building Historically Designated YES NO
Zip 33r toe
Contractor's Company Y Name L5PAL � .ZirctIlib Phone # 9i 1,'"7 "i0
Contractor's Address /4.2r RtV4, eeNrerti ,y
City -it ir19 State %' Zip 452 ZS-6 .
Qualifier Name A / t� Phone #
State Certificate or Registration No. C L 1) / 1- 23 te
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
L
Value of Work For this Permit $
Square / Linear Footage Of Work:
Type of Work: ['Addition XAlteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: )� , e feinddety "EU.) c. 4G Cct,lo. it °
* * ** * ** * * * * **** * * *** ** ***** * * ** ** *, Fees ***** * **** * *** * * ** * * ** * * * * * * ***
Spas
Submittal Fee $
Notary $ Training/Education Fee $
Scanning $
Permit Fee $
Radon $
Bond $ Code Enforcement $
Structural Review. $
DPBR $
* * * * * * * * * * **
CCF $ CO /CC
Technology Fee $
Zoning $
Double Fee $
Total Fee Now Due $
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 re.' . ection fee will be charged.
Signature
tgreMOOffilir
viner or gent
The foregoin instrument was acknowledged before me this 17
day of
o is personally known to me ' who has produced
NOTARY PUBLIC:
Sign:
Print:
Contract
The foregoing instrument was acknowledged before me this
day of , 2011 by 441,r
oduced
identification and who did take an oath.
is personally known to me or who
°as identificatio.
who did take an oath.
NOTARY PUBLI
My Commission Expires:
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APPLICATION APPROVED BY: 7 „',..4,4:77
Sign:
Print:
(Revised 02/08/06)
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LaVon A Turnbull
My Commission EE049800
p ‘,,,ow Expires 12/16/2014
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PAGE 03/10
15615476657
11/11/2010
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NIILES TO H
This Instrument Prepared by:
Name:
SEARS HOME IMPROVEMENT PRODUCTS, INC.
1024 Florida Central Parkway
Longwood, FL 32750
Phone: 407 -551 -6000
NOTICE OF CO
Permit No.
Tax Folio No. It— c31..aC..v'00 C)•1"0
THE UNDERSIGNED hereby gives, informs you that the improvement will be made to certain real property, and in accordance
with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1. Description of property (legal description:)
,
11111111131111111111111111111111111111111111
F
IN 201180141003
OR Bk 27605 Ps 1538; this)
RECORDED 03/03/2011 14:14 :23
HARVEY RUVIN, CLERK OF COURT
MIAMI-DADE COUNTY, FLORIDA
LAST PAGE
STATE OF FLORIDA, COUNTY OF DADE
1 HEREBY CERTIFY that this is copy of the
of
original filod in this , !.1.:
A D 2014---- -
iL"'" i 0,a .. official Seat
Comfy Courts
HARVEY Fit1NIN, CLER = 7dj f D.G.
BY
a) Street Address:
2. General description of improvements: �r�
3. Owner Information Corl a) Name and address:
b) Name and address of fee simple titleholder (if other than owner)
c) Interest in property:.t.(NP_.k-
4. Contractor Information:
a) Name and address: SEARS HOME IMPROVEMENT PRODUCTS, INC.
1024 FLORIDA CENTRAL PARKWAY, LONGWOOD, FL 3 8506
b) Telephone No: 407- 551 -6000 Fax No. (Opt.)
5. Surety Information:
a) Name and address:
b) Amount of Bond:
c) Telephone No.:
6. Lender
a) Name and address:
7. Identity of person within the State of Florida designated by owner upon who notices or other documents may be served:
Phone No.:
a) Name and address:
8. In addition to himself, owner designates the following person to receive a copy of the Lien or's Notice as provided in
b) Telephone No.:
Section 713.13 (1) (b), Florida Statutes:
a) Name and address: Fax No. (Opt.)
b) Telephone No.:
9. Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different
date is specified:)
Fax No. (Opt.)
NOTICE
WARNING TO OWNER: ANY PAYMENTS MADE
IMPROPER PAYMENTS UNDER CHAPTER EXPIRATION p�T �
OF COMMENCEMENT ARE CONSIDERED SECTION
713.13, FLORIDA STATUTES, AND CAN RESULT M,UIN YOUR
E .RECORDED AND POSTED ON T13.� JOB SITE BEFORE
PROPERTY. A NOTICE OF COMMENCEMENT
'tilt FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FL A
COUNTY OF 1-0-11
ture of
I er o
er's A tho' ed Officer/Director/Partner /Manager
PRINT NAME
Thliorigoing< t was acknowledged before me this
officer, trustee, attorney in ct) for
party on behalf of who trument was executed).
Personally Known OR Produced Identification
day of &lc—
,2011 :by
(type of authority, e.g.
(name of
Type of Identification Produced Name (print)
AND
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of
the facts stated in it are true to the best of my knowledge and belief.
FORMS/NOCNER2007
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 156287
Permit Number: PL -2 -11 -305
Scheduled Inspection Date: June 10, 2011
Inspector: Hernandez, Rafael
Owner: HUTCHESON, CRAIG
Job Address: 220 NW 112 Terrace
Miami Shores, FL 33168 -3332
Project: <NONE>
Contractor: SKY SERVICE PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360010310
Phone: (954)655 -1127
Building Department Comments
DISCONNECT AND RECONNECT SINK & DISH WASHER
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 09, 2011
For Inspections please call: (305)762 -4949
Page 2 of 12
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 Type (circle): Building Electrical
Permit No.
paRg7n3j�j
r: FEB 2 3 POtp jJ
Master Permit No. .) 11— 505
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) rucmf ..c, /JU/ es a, Phone #3b % -..."2"//e
Owner's Address 22 ` J /2
City t1 . s h c ct6 State R6cdpi,
Zip 33)t -'
Tenant/Lessee Name Phone #
Job Address (where the work is being done) -7A 1 /IL-
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # l /' - I Jt k.i ° 63/p
Zip cJ 7yt
Is Building Historically Designated YES
Contractor's Company Name wi-ii
Contractor's Address 11
NO
6 q/
State P/
City P '11 n, A
Qualifier Name i i yP'1 ' A eO
State Certificate or Registration No. C Fe, A i 1
Phone #
Zip J3
Phone #
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: ❑Addition
Square / Linear Footage Of Work:
[alteration [New
❑ Repair/Replace
Describe Work: Di ,N rue_ e & -a' e un e ./- . Seel k.
❑ Demolition
******** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * ** * * * * ** * * * * **** r * * * * * * * * * * * * *** * * ** * * **
Submittal Fee $ Permit Fee $ /00
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
CCF $ CO /CC
Technology Fee $
Zoning $
Total Fee Now Due $
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 .: . and a reinspection f will becharged
fa. )
Owner or A
The fore .oing instrument was acknowledged before me this ii
who has produce ,ui it u'iikt
As identification and w0tide4 as identificatic� t� take an oath.
aber2raEf� � NOTARY PUBLIC:�•�`� ®. ••• ";�l�i�q /�%
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My Commission Expires: My Commission Expires: / /s��o��js�+AT �oi `�,�e‘�
Contract
The foregoing instrument was acknowledged before me this 17
day of , 20 `, by Jb
wh
produced
NOTARY PUBLIC:
Sign:
Print:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
From:Global Insurance Services Inc. 5614519825
03103/2011 15:29 #333 P.001/001
CERTIFICATE OF LIABILITY INSURANCE
OP ID: VL
DATE Voirsomrn1
03/03/11
THIS CERTIFICATE 18 MOW AS A MATT..EFt OF INFORMATION ONLY AND CONFERS NO mama LIMA THE CERTIFICATE HOLDER. THIS
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Global IMOMERCa Bandana, In
21301 PowaN610 Rand Bali
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011 - 4874001
661-451 -9828 MLA&
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200ULD ANY OP THE Aso* maws= POMO BE CANCELLED BEFORE
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A0fNOROEQREPREND TATNB
191338 -2009 ACORD CORPORATION. A11 right rid.
ACORD 26 (20091110) The ACORD nano and Ingo am ragisbrad marks of ACORD
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1158. Andrews Ave., Rm. AA,100. Ft. LaUderdate, FL 33301-1895 — ..831-4000
VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 301 2011
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Busing Name: 81tY SERVICI3 PLtIMITG INC Business P ( /TA SPE /
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Owner Name BREXCesgss JOHN D JR
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TIM RECENT .MUSY E1E POSTED CONSPICUOUSLY R4 YOUR PLACE OF DU$ NESS
THIS BECOMES A TAX RECEWt This taxis levied for the pdvuega of doing business within & o d County and Is
nce9uIetory in nature. You must meet 99 County snow Municipality plannktcl
WHEN VAUDATED and zoning requirements. This ensinass Tax Receipt must be transferred when
the business ti field. business mete has srheneed Or you have moved the
busing location. This receipt clues not indioate that the business Is legal or that
it Is In camptisurea with State or Wael taws and repulatiuns,.
Mailing Address:
$]GAR JOHN D JR
1410 NE 41. CT
PONPAI70 3EAC9, FL 33064
2010 M 2011
was mod 91419161114 IAt
Received on 3/4/2011 2:14:41 PM
Receipt *02A-10-00000222
Paid 10/05/2010 29.70
LeZ889Lps6 SS:9t ntnZtaBitt
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): CPlr Au_-ke hes an Phone #:
Address: Z Z c I■4 t) i 1 7.o � -fr-'0
State: Zip:
Tenant/Lessee Name: Phone #:
Email:
a
APR
a�
2011 IIE
BY: _ese • - - --
Permit No.'g" 11 " 3OL-1
Master Permit No. 12)C_, 1 1 -3-3
JOB ADDRESS: ZZ� ,,,.3 t 1 1� &t-
City: Miami Shores County: Miami Dade
Folio/Parcel #: Q —A 001 0 310
Zip: I l
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: ‘ CO C1 -€ C-k o C... Phone #:
Address:DS-0l) kirk. n"
3\4) )
City: t) flyeP'ej") State: p I Zip: 31 k (.1--L/
Qualifier Name: 1 ° -* x -Inoipn Q ) , E Phone #:3 =979i' —siAri-
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ ( Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration
Description of Work: non `
DNew DRepair/Replace
n `at_..
❑Demolition
***************************************Fees * * * * **** *****a *** * * * * ** **
Submittal Fee $
Scanning Fee $
Notary $
Double Fee $ Structural Review $
Permit Fee $ �� / 419,e2 CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
TOTAL FEE NOW DUE $
ionding 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 MR 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 COMMENCEMEN
Notice to Applicant: As a condition to the issuance of a building permit with an estimate" value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien 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 char
Owner or Agent 1 1
owledged be ore me this j
The fore
day of
who i . personally own to �r who has produced
As ident i alb ®®did take an oath.
NOTARY PUBLIC: ®�s •® ®•''o ®gym
�d
.�• •
1", q A c
"eL � � °�0, 0
® ®� ®®®® ®®/ / l l l l l 91 ' . O \ ® ® ® ®®
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * *
APPROVED BY
charged.
Signatur=e
BRENDA BURTCH
MMI$510N # DD 946522
V, ' ;., EXPIRES. January 1,
aofiaaged Tin Notary public Underwriters
The foregoing ment was ac . owledged befor
day of .1 • ,. I , 20 lD, by
who is personally own to me or who has produced
as identification and who did take an oath.
LIC:
me this
NOTARY
Sign:
Print:
My Commission Expires:
KA o\I■I.F
A/`Ylans Examiner Zoning
Structural Review Clerk
(Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09)
et+d
W3930
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MIMS
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S(I13JFCT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COIJN TY RULES AND GUI ; T
-► g
ore" rook^ Notary Public State of Florida
LaVon A Turnbull
My Commission EE048800
0, Or Expires 12/10/2014
All dimensions -size designations
given are subject to verification on
job site and adjusament to rn job
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
Designed: 31:
Printed: 11/3,
04- 11 —'11 16:38 FROM— T -717 801/001 F -174
Client 65690 EI.CEL
ACORN, CERTIFICATE OF LABILITY INSURANCE
DATE ONINNANYN
03/3112011
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS TITUTE A CONTRACT DEpArEEN THE 1SSUMNG INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: V the trrtMaute holder is an ADDITIONAL INSURED. the pollcyfies) must be endorsed. If SUBROIMTION IS +WAIVED, subject to
the tens and conditions of the policy, cs,'min p nI13es may require an endarae rant. A akdanTard an this tettificate doss not corder rights to the
certificate holder in lieu of such endorsement(4).
PRODUCER
Gulfshore Insurance, hic.
4100 Goodlette Road North
Naples, FL 34103 -3303
239 281-3646
-t"4-
ACT Ma R, LBbra, ACSR
x
E,ax 239430-754S lap,* 239 213-2830
elahratiguiishere hisurancemem
INSURERS) AM COVERAGE
NAM
INSURED
Elton Electric, Inc.
3900 Park Central Blvd North
Pompano Beach, FL 33064
INSURER A : Ametiisurr Inguratieet4Waliy
WIRER e :
INSURER C -
INSURE 0:
INSURER E
iaURER F :
t:OVERAGEB
CERTIFICATE NUMBER: REVISION MJAYER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE PENN ISSUED TO THE INSURED NAND MOVE PaRT The POLICY PERIOD
It4oicATRD moivantsrAtesiNG ANY Xrr. TERRAI OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CElTIFICATEMAY SE AWED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCWSIONiSAND COMMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS.
A
YirPE OP INNHANCE
gENENAL Ln1)NLW
cOMMEROAL GENERAL LABILITY
GEM ATE mar
POu0Y n
Alnumo®LE u*EUTY
X ANYAVro
ALL OWNED NUTS
SCHIMASO AuTOs
X IdR DAUTOS
X NON- ow4EDAUrOS
POLICY MINDER
UNITS
CPP2075752
11201109811/201 EACH OCOuRRENDE
P REMISES tat naninaned
LIED E(Ante= zunno)
PBISOIDE SACVINJURY
GENERALAGGREGATE
• .IIOPAGO
s1.00 000
dO0,000
519,000
s1,000,000
32,000,000
3$80DA00
CA2075753
04/0112011 0+4/0112012 oomalmo gyp.¢ i
enolenD
BODILY INJURY OW peesel)
31.000,000
s
t O o r L Y I N A R ft Y L P N
PROPERTY OnmAOR
Par anadenD
0
s
s
A
A
X
IIMIBRELLA LW9
OWES ma
OCCUR
CLAIMErMADE
1 EDUGT)SLE
X. RETENTION $ 6
Ct12O7Ei54
WORKERS COSPENSATION
ANO EMPLOYERS' LIABILITY
ANY PROPRETORIPARTNERIESECUTIVE
In NH)
vs, ensmaila
PION OPERATIONS Maw
WC2075755
04/01!201
04811/2092 EACH OCC JINSBlCE
AGeRztog
woman 04 01I"201* X rTS,M1
ES
35,000,000
45,009,000
$
EACII AOCITEERT
EL DISEASE - EA EMPLAYEI_
31,000,000
01,000,000
EL. OEASE-POLICY CBOT
A 04811120/1 04101/201 $50,000 Limit
048)112011 0410112012 $100,000 tjrnNt
DESCRIPTION OF OPERATIONS, LOCATIONS IVniIULES DittachACORD , AMINO R8a1A9 Ennetnnet. donne%pm i
LeasetiMented Equ
Int Raster
CPP20T5T52
CPP2075752
51,000,000
CERTIFICATE HOLDER
CANCELLATION
Village of Miami Shores
Building Department
10050 NE 2 Avenue
Miami Shores, FL 33138
SHOULD ANY OF YHE ABOVE INESCRIEED POLICIES an cANCELL80 BEFORE
THE EXPIRATION DATE TEREDF. NOT= WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORED REPRESENTATIVE
/11 40w-
61988 -2000 ACORD CORPORATION. AB rights reserved.
ACORD 25 (2000100) 1 of 1 The ACORD name and logo are registered marks of ACORD
#84770731111477554 ERL
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.
Master Permit No.
paMITVZI
at FEB � � 2011
504
Permit Type (circle): Building Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 11 --vo ' /�/2c_.J kimft n Phone # .3ZL -7X1 -07Y/ct
Owner's Address a i. ` /
City daTh; JA d're6
Tenant/Lessee Name
State FgeFY ;
Zip I4P
Phone #
Job Address (where the work is being done) Z 7-0 / 0-5 / / .1:t"
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # (i — 2 s d eD
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City eat/ ttel/j,l
Qualifier Name
vva
Zip JJihi'
a-n Phone# : 279- Vr
.S1CiZ) PAPA,
State f-/
State Certificate or Registration No. Ea_ 4.3 0 c1
Zip
Phone #
Certificate of Competency No.
f3�31.3
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 12'00 Square / Linear Footage Of Work:
Type of Work: DAddition Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: ` — i4t1V)
******** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * *, Fees**,********** * * * * **** * * * * ** * * * * * * ** * * *** * * **
Submittal Fee $ Permit Fee $ 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 -+
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 AI+N'IDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme ement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In t absent, of such posted notice, the
inspection will n. • ' approved and a reins, ection fee will be charged
Iv I
Signature
0
The forego' g instrument was acknowledged before me this 11
day of
r.
ersonally kno
to me o
Signature
Contract
The foregoing instrument was acknowledged before me this
day of
6 7:4h
w :. as produced who is personall
.�� \ \NBHIIIIIII / ®��
As identification • , o pt.1lake at�Vth.
®�'0 . •.•.•••.. r °°
a 'see;.ptEXP /qF�•. *
NOTARY PUBLIC: 0 v \ , Oz�, Zorn 2 • • % e. • .: S eOr,
• o 0* �a0\
Sign: p• p� :f �; "=
Print: °� . a �/,,,, of ... z,. f ���
My Commission Expires:
NOTAR
Notary Public State of onda
realiagnvAZIegailkoduced
•
My Commission EE049800
NW"; , ti n, ,. mho did take
4
('1:
oath.
Sign:` t/
Print: VD N 1 N LL-
My Commission Expires:
420 14
* * * * * * * * * * * * * **** *, rat * ** *** ** *, ******************************************* * * **** * **** * *** * * *** * * * ** ***, *** **
APPLICATION APPROVED BY: � -iT
—
(Revised 02/08/06)
„0"-e# .2e, 4/
Plans Examiner
Engineer
Zoning
W3-03-'11 16:52 FROM -Elcnn Electric Inc.
954979544°
T-341 1101/001 F 1i16
Received on 3/4/2011 2:14:41 PM
Wd 6V$SIZT TTOZ /OT /T uo pert-papal!
115 S. Andrews Ave., Rrn. A-1 00. Ft. 'THROUGH SEPTEMBER 42011 � 40
VALID OCTOBER 1 p ul#i
Buidness Nano: giros ELECTRIC INCORPORATED
tT1At t celaEal BLVD El
Businel3sLati0e: re ENRICH
MOON 305-9±9 -5445
Receipt #;1a1 -2961
FiEfilttetse '>3FP�:�L 0ICtwe.tAt 3 /tau
{ CTsI+M.O0N CTaR)
Biadagas 0pa%T6ck05 /OO1 /19B
Stutw/CountyleintiReg:Eco 001331
EXMOOR Code T
Seate Machines Professionals
Rooms 10
Tax Amouat
17.00
pwmb.r of Moo
r raster Fair NSF Fee Poem' Prim-Years Cabana Oast R4411234:00
El .04 T 8.00 0.01 0.00
fl,00�
ForVanNagEusmess Onty
Vand6r
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE Or BUSINESS
i S BECOMES ATAX RECEIFr This lac Mauled forte pelvUade el dog badness within Barnard Cour ,1 and Is
nue4egulatori in nature. You must meet all County andror Municipality planning
yyHE4VAUDATED and zoning reauirernerrta. This Business Tax Receipt must be transferred when
Me busing is said, business woe has changed or you have moved the
business location. This panelist does not indicate a Slate or local end re U $ s gel or that
it
Mailing Address:
JAM P mccoNcitiE
3500 pAEE cANTRAL BLVD 37
BEACH, PT.
33054 -2135
2010 - 201.1
Renetpa 11030 -u 0 -00022454
paid o /14/2010 27.00