Loading...
ELC-12-1921r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 c� nspection Number: INSP - 186130 Permit Number: ELC -10 -12 -1921 Inspection Date: February 20, 2013 Inspector: Devaney, Michael Owner: VILLAGE, MIAMI SHORES Job Address: 10021 NE 2 Avenue Miami Shores, FL Project MIAMI SHORES VILLAGE Contractor: MOODY ELECTRIC INC Permit Type: Electrical - Commercial Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134650 Phone: (305)758 -2000 Building Department Comments MOVE ONE OUTLET Infractio Passed Comments INSPECTOR COMMENTS False I``t-":"L. Passed Inspector Comments -`E� c, (3' ® r 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 February 20, 2013 Page 1 of 1 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 Permit No. OCT ?522 BY: �mamvn�eeaoo.�oa000 Master Permit No. 6R0 6 py OWNER: Name ( Fee Simple Titleholder): Address: /�/ /J 1 AJV E' City: PI /A1711. 5 kibees State: � ,Zip: 33/321 z zo7 Tenant/Lessee Name: /CVA Phone#: Email: JOB ADDRESS: SangJ City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: / ! l ' ..C7 -e_,/ C. /A) C., Phone #: Address: '7 6(1 And o Jai^ City: /NAM /j� IJ,� 1 ' State: Z J( Qualifier Name: ©!1/i / L CIL Q Q State Certification or Registration #: (G 06o // / / Phone #: Zip: .di,c6) Certificate of Competency #: Contact Phone #: n Email Address: P/ 7 t o °Alteration DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Type of Work: °Address Description of Work: Phone#: Square/Linear Footage of Work: UNew URepair/Replace Anoue- oou�(/ ) nvT�r °Demolition �x�x+x�x * +x+x�x+�a �x +� a�+x�a �x x��x�x�x�x�x�x �u+r+x*�+xg�u F/ees�x�xx�+x *�x�x****** ** �+ x****�x�x+x+��x****�x+x�x** **** *mgr ** Submittal Fee $ Permit Fee $ C7 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) I Bonding Company's Address J City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address �Yv' 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 The foregoing instrument was acknowledged before me this The foregoing instrument was acknow before day of , 20 _, by , day of /v� 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: Contractor PP 11 this // , 20a, by �,/® 0, 1 Oda NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: .:s rp MARY PAT BRIGGS ,r MY COMMISSION 400 979267 ;47; EXPIRES: May 11, 2014 A'.. Bonded Thru Notary Public Undewiters ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED B ,1� 5Z �� 47-er- Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 192561 Permit Number: PLC -10 -12 -1901 Scheduled Inspection Date: June 10, 2013 Inspector: Hernandez, Rafael Owner: VILLAGE, MIAMI SHORES Job Address: 10021 NE 2 Avenue Miami Shores, FL Project: MIAMI SHORES VILLAGE Contractor: PUBLIC WORKS Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134650 Phone: (305)795 -2210 Building Department Comments PLUMBING WORK FOR LIBRARY KITCHEN 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 CREATED AS REINSPECTION FOR NSP-179797. FBCP704: REQUIRED PIPE SHALL BE SNOUTH WITHOU LEGDE. ACCORDIAN OR CORRUGADED PIPES IS PROHI : ED. OSI 5/29/13 June 10, 2013 For Inspections please call: (305)762 -4949 Page 15 of 25 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 j,® Permit Type: PLUMBING j OWNER: Name (Fee Simple Titleholder): t,` Sii0eXt- Z -Phone Address: 1, MS() 1\Z Permit No. 1 t2 -. 190 1 Master Permit No. C -1 Z- -No J ,3) City: State: Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 10024 A f L C_Le_Pu A'` ( Cnf' raffLeAr''- Leabai1 City: Miami Shores County: Folio/Parcel #: `, o tool 34(,,s0 Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: .5) 6LAC- L 0065 !' ! Phone#L) t 15 `-29 c C� Address: 17O\ N) 1(33 3,T City: f ' l b6s1•-1.,l Sttatte: r, — Zip: 3 31 T•! `7 Qualifier Name: 5 C( t' D l3 • w Id Phone #: 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 UNew DRepair/Replace ODemolition rn''' ► o -WCY) fc..12 U iS 12.Y Description of Work: + x* ***x: ******** x: *+ x****+x************** *** Fees******** *+ x**** ******************* * * *** * * ***m Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 refnspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this IS'k The foregoing instrument was acknowledged before me this day of ' 4t , 20 a , by Ci6 40-Y\ , 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: Sign: Print: My Commission Expires: NOTARY PUBLIC: Sign: Print: My Commission Expires: ****** ** **m***m**** *** ** x****** ******** **+ x*****+ x*****+ x**+ x*** ********** **************+ x***: x************+x+x***** APPROVED BY / (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Zoning Structural Review Clerk ' iami Shores Village DATE es"'b-/xtv, f relf /07//7__ cl L- Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. EC eaigne inted: ELIZABETH ESPE1. ELIZABETH ESPER N 4 4 1� � All dime ens size designations given are subject t verification on job site and adjustment to fit job conditions. /'� mhl THCHNotoGwl @9 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 3/8/2012 Printed: 9/25/2012 ELIZABETH ESPEIt l All f Drawing #: 1 I vc cj Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 191549 Permit Number: CC -10 -12 -1865 Scheduled Inspection Date: May 28, 2013 Inspector: Bruhn, Norman Owner: VILLAGE, MIAMI SHORES Job Address: 10021 NE 2 Avenue Miami Shores, FL Project: MIAMI SHORES VILLAGE Contractor: 09BS00193 PANDA KITCHEN & BATH Permit Type: Commercial Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060134650 Phone: (954)885 -3993 Building Department Comments REPLACE KITCHEN CABINETS AND STAFF OFFICE SUPPLY CABINETS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed e1/4 5 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 24, 2013 For Inspections please call: (305)762 -4949 Page 9 of 24 Danny, Attached please find the Contractor license with Panda Kitchen and Bath as DBA. Sean Huang Panda. Kitchen & Bath From °Imagination Straight to installation 3250 NW 77 CT, Miami, FL 33122 Tel. (305) 639 -6010 Fax.(305) 392 -6992 www.pandakitchen.cam Miami -Dade County - Building and neighborhood Compliance Office Page 1 of 1 Horne I Product Control I Contractors Building Officials I Contact us Contractor License Information 09BS00193 PRODISO KITCHEN & BATH EXPO CENTER OF KENDALL LLC 12853 SW 88 ST MIAMI (305) 385 -1915 Contractor Number: Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D /B /A: Contractor Status: (305) 392 -6992 S EAN ATPAN DA@ G MA I L. C O M PANDA KITCHEN & BATH ACTIVE FL 33186 Class Category Category Description Expiration Date BLDG 53 FINISH CARPENTRY 09/30/2014 CONTRACTOR INQUIRY COMPLETE — on tra <,tor in uir. and Com taint Search I No: DF ?ate I State License Search Menu 0 Home I Using Our Site 1 About 1 Phone Directors' Privacy I Disclaimer E -mail your comments or questions to SLDCDe.rt �rruar;u<ade.,.ov © 2001 Miami -Dade County. All rights reserved. http: / /egvsys. metro- dade.com: 1608 / WWWSERV / ggvt /BNZAW941.DIA ?CNTR= 09BS00... 1/25/2013 Miami -Dade County - Local Business Tax - Receipt Details Page 1 of 1 BUSINESS NAME: MIAMI -DADE COUNTY - LOCAL BUSINESS TAX Receipt Number: 736743 -6 PANDA KITCHEN & BATH EXPO MAILING 3250 NW 77 CENTER ADDRESS: CT BUSINESS 14768 BISCAYNE BLVD MAILING CITY: MIAMI ADDRESS: BUSINESS ZIP: 33181 MAILING STATE: FL MAILING NAME: PANDA KITCHEN & BATH EXPO MAILING ZIP: 33122 CENTER Description: SPECIALTY BUILDING CONTRACTOR MESSAGE: This Local Business Tax Has Been Paid https: / /was8exp. miamidade. gov/ OCLWeb /OCLLicenseDetail.jsp ?ln= 7367436 &bn= PAND... 1/25/2013 -i LOCAL BUSINESS TAX RECEIPT; 2013; DADS COUNTY= STATE; OF,FLORIDA, EXPIRES SEPT 30. 2013 ST BE DISPLAYED AT PLACE: OF BUSINESS IT4TO COUNTY CODE CHAPTER 8A ART. 9,& 10 591093 -1 BUSINESS NAME / LOCATION PRODISO KITCHEN & CENTER OF KENDALL 12853 SW 88 ST 33186 UNIN DADE COUNTY OWNER PRODISO KITCHEN & Sec. Type of Business 214 RETAIL SALES THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. FIRST -CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 616589 -8 BATH EXPO LLC PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR 09/05/2012 60010000271 000075.00 SEE OTHER SIDE BATH EXPO EMPLOYEE /S 2 DO NOT FORWARD PRODISO KITCHEN & BATH EXPO CENTER OF KENDALL LLC XIANG HUANG PRES 3250 NW 77 CT MIAMI FL 33122 i /72FiFiiii 1124 PANEX03 OP ID: A9 ,acs ----- CERTIFICATE OF LIABILITY INSURANCE DATE 10124IDDIYYYY) 1 arz4r2a12 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 Phone: 561- 964 -9190 Gateway Insurance Agency West Palm Beach Branch Fax: 561 - 964 -9401 4524 Gun Club Road - A101 West Palm Beach, FL 33415 ACT NAME: PHONE FAX (A /C No Ext): (AIC, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC q INSURER A: Associated Industries 23140 INSURED Panda Kitchen & Bath 3250 N.W. 77 Court Miami, FL 33122 INSURER B: INSURER C INSURER 0 : $ INSURER E : $ INSURER F : OVERAGES 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. INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM!DDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP An one person; $ 0003 PERSONAL 0 ADV INJURY $ G ENERAL .AGGREGATE $ AGGREGATE POLICY LIMIT APPLIES PRO - JECT 1 PER LOC PROD0CTS- COMPIOP 000 $ $ AUTOMOBILE LIABILITY ANY AU-0 ALL OWNED AUTOS HIRED AUTOS SCHEDULE) AUTOS NON- OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE _Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below Y 1 N N I A AWC1012832 04111/2012 04/11/2013 v WCSTATU- TORT LIMITS OTH- ER EL EACH ACCIDENT $ 100,000 E L. DISEASE- EA EMPLOYEE $ 100,000 E.L DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Prodiso Kitchen & Bath Expo Center of Kendall CERTIFICATE HOLDER CANCELLATION MIASH01 MIAMI SHORES VILLAGE 10050 N.E. 2 AVENUE MIAMI, 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 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD R WINE INSURANCE AGCY Fax:3055986552 Oct 23 2012 15:00 P. 01 AC. CahCLT ERTIFI ATE OF LIABILITY IP� URAI`+L., E DATE (MMlat7lYVYY) , ;10/23/2012 . -, . .. - THIS CERTIFICATE IS ISSUED MATTER AS A OF INFORMATION ONLY AND QDNF NEGATIVELY AMEND, AND CQ FERS NO RIGHTS_UPON. THE CERTIFICATE HOLDER THIS. CERTIFICATE DOES NOT AFFIRMATIVELY OR R ALTER THE C0VER.A E:- AFFORDED' DY THE _ POLICIES BEI.OW. THIS CERTIFICATE OF ... INSURANCE CONSTITUTE . A CONTRACT BETWEEN THE ISSUING INSURER(S), AU7HORf2ED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilCy(ias) must be endorsed;,. If SUBROGATION IS WAIVED, SubjaCt.tO the terms and conditions of the policy, certain p, Iikiat ma y require an end,rsfment. A statement t on this certifcate :does not confer.ri9hts;to op, cartfficate holder In lieu of shell aidorsem h qy , . PRODUCER EuyWisc Insurance Agency, Inc PO BOX 162600 Miami, FL. 3311,67 2600. ,. . NAME: RICHARD E E. WINE PHONE {305) 598 -6549 A� Nc ES tvc No) (Q5} 596 -Q862 AI?URE 1$cut17 ,net ss ravine @be ny m' .4;I i, :n: .Iii' s ,CL ," ` .: .iv I RERB N3Li j) A�F 4 COVERAGE INS73RAi*TCE 7:� ..... • NAIC4 INSURED PRODISO KITCHEN,,, AND BATH EXPO CENTER OF KENDALL 'LLC.DEA PANDA. KITCHEN AND BATH, CHAU CHEONG 3250 NW COURT 77TH MIAMI L 33122.E _ r INSURERSTi;INCZALTY E INSURER G : . - v INU1R R E 4,:;:=.1.,.t:'.. „, 111 INSURER.F . COVERAGES CERTIFICATE. NUMBER: . NUMBER; ....REVISION THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO, THE INSURED, NAMEIa,AB0VE,FOR,THHi POLICY. PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR 'CONDITION OF ANY CONTRACT R. OTHER .Dp..C.UMENT_V�{1TH,RESPECT, TO ;WHICH •THIS CERTIFICATE MAY BE ISSUED OR MAY-PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED ,HEREIN.:,IS,SUB.JECT ",TO -:ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN,REDUCErD SY PAID CLAIMS. ... NM };TR A TYPE OF INSURANCE ADOL MR BURR wvo POLICY NUMBER POLICY E-E (MM/DD I 04/12/12 POLICY-EXP' (MMIDDIYVYY .,I i'X ': r.'iMEDEXP(Anyar68 041/1'2/1 ..: r 'LIMITS, _ GENERAL - 0900101475 ' LIABILITY COMMERCIAL GENERAL LIABILnY ,:EACH H 'OCC"t7ERNOE y $ 1 ;.000 , Q00 PR EMISES' ,(E9 edebi!Mr ) . ) ..:3':' ..50..0.015. • CLAIMS-MADE .. OCCUR 5:;;.000' PERSONAL &ADVINJURY GENEFiAil ik6ci Et+ATE: :PRCDi T CO`Mf IC}l? Ai3D $ 1 ,000:, 000,000 ,'$..2,,.000:,000' 3': 1 , O00', 000 GEN'L AGGREGATE LIMIT APPLI jES PER: AUTOMOBILE; POLICY LIABILITY FS T I wt ■COMBINEETSINGLE44MIT $, : ANYAUTQ BOOlLY�INJUR'Y (Pef, perl5on): -.$ ALL OWNED AUTO$ HIRED AUTOS — SCHEDULED : AUTOS NON -OWNED :AUTOS . BODiL j FY CPa 9dtln; $ -� .;i, ',PROPE AGE. . '(P5r accident} . $: '. ,; $ UMBRELLA •LiAB EXCESS LIAR : OCCUR GLAIMS-NtAQR .' .,''EACH ,:'IAGeRE-6ATE . CJLCURRENEC ' 'I' • .,R; LIED. RETENTIONS $ WORKERS COMPENSATION EMPLOYERS ':LIABILITY �I. � r ;. WC TORT LIMITS '' � ER AND . ANY PR4PRIFT oR� ARrnERrE�cECIrrIVE OFFICER/Mb/1 ER EXCLUDED? .. (MRr toffy En NH)' y1N NJ : E.L. EACH A CCIDSNT' , EACH 3 Et 01SF;4E: - 6A'ENi130 E $ Ifye s 'ddscniie under .' 'DESCRIPTION DF OPERATIONS:beloW . E.L. DISEASE POLjcv LIMIt $ • DESCRIPTION OF OPERATIONS I.LOCATIQNS 1 VEHICLES (Attach ACORD ici, Additional F6merPe Schedule if mere',,P6 8 18 requirad) „ GENERAL LIABILITY INSUiANCE FOR CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NL, 2ND AVENUE MIAMI SHORES, FL 33138 I SHOULD ANY OF,THE ABoy REsCRiB>=t5 POLICIES BE' CANCELLED BEFORE THE EXPIRATION GATE THEREOF '" �NOTI , (/51LL �BE DELIVERED IN ACCORDANCE WITH THE t altY PROVISIONS AUTHOR ' ED -EPR - ENTATIV ACORD 25 (2010/05) © „3 988 0.11 Q ACOi3D C QRPGi AVON. All rights reservad; The ACORD name and I0g4 are registered marks of•ACORD 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 lo a9 - rcAt- C-t-t .(Z Qe e AP' 6tao ,12-1? IIZ Permit Type: BUILDING Cam`", rr ` Ind JOB ADDRESS: =:m� City: Miami Shores County: OCT 0 5 2012 FBC 20 Permit No. Master Permit No. CL.) 1 Tsto5 ROOFING Miami Dade zip: 138 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): k c�l —iC`t V +ne #: t Address: 1,DLIS 1\--6-- E� City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: c--PA 11 a 61-atoll t°q 6001-k Phone #: � — SRS_ 3q43 Address: City: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: 0q 6900 /q3 Contact Phone #: �S - 3q q.3 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 3 5-0 j o 9° Square/Linear Foo ge of Work: Type of Work: DAddition OAlteration ONew epair/Replace ❑Demolition Description of Work: ? 1.Pre-L ���C �-t�i v i� t t, UD Color thru tile: * * * * * * * ***** * *m *************** * *** ** Fees* *** * * **** * * * * ** x *** ***** * ******** *:x**** * ** 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 $ s • 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 VSh` The foregoing instrument was acknowledged before me this day of �_l h , 20 -, by Mil. , day of , 2Q/ ; by X1/ , V - , o me or who has produced �d who is personally known to me or who has produced w As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: s perso all . .. ,,. as identification and who did take an oath. j. 4 Print: `44 �is3` �Q My Commission Expires: 7/ v NOTARY Sign: IC: *** * * * * * * * * * * * * * * * * * * * * * * * * sk*sksk*s #skR+*sk*Ht*** **** k** k**sksksksk*sksk*sksk***sk sksk# sk*** ***********sk ***** *********** APPROVED BY /e,! l °` Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Bfr 4:-.2,717....Le' •-•,,....,.".5,,,,:i•-• ..,.-4,...,,,,,,..., ,tr'o,...°,,,,,^*,,,,,..,- .s. 579-14 . -t,,,,A45 . • "Itt4:1:•1:Y•... etk-raltP-..r..P--.....--,--- - t,,.3:1. S I) : 00.4-s.,Ens...sn-,--,...--,,,----..--..,..e.,'00-."....--,..,"-";-,...!..---'1.,....,...--•-•,,.,,,,,-.--..-,.,,,,,s.,_-,,-,....-,,,,,--z, , ...-..:--.7..(*-.,...,,-,,,111.e.......x, ......v...„ „ ..7,....,,,-,...,,„„,...,,,,,,,,....,,,•-•-•---....,--------,...14.A.Pueckr.rcuogg ,,gfitt.„..1;ica '',Zeliej,:mtee3i t;°- ,...,----,,-,-..:1 -“-......4"-........w. . .,„ ....--,,,,-..---- ,--.....---,-,-,-,,,--...,,,- ...”, ..... -,.. , ,..., - -,...... ....., -........ • ,.....-.....--,,,,,,,-;....'--.-.---;,,,,,...„.-.