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RF-10-11051 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Parcel Number Applicant 9990 NE 2 Avenue Miami Shores, FL 1132060132080 Block: Lot: MIAMI SHORES VILLAGE Owner Information Address Phone Cell MIAMI SHORES VILLAGE Contractor(s) Phone OBENOUR ROOFING SHEET METAL 4 305 - 757 -2612 CeII Phone Valuation: Total Sq Feet: $ 750.00 1200 1 Type of Work: Repair Additional Info: FLAT ROOF Classification: Residential Scanning: 1 Fees Due CCF Education Surcharge Permit Fee - Repairs Scanning Fee Technology Fee Total: Amount $o.00 $o.00 $o.00 $o.00 $o.00 $0.00 Pay Date Pay Type Amt Paid Amt Due Invoice # RF -6 -10 -38209 $ 0.00 Available Inspections: Inspection Type: Roof Repair Final Roof Roof Review In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 23, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 23, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building lam/ Electrical Owner's Name (Fee Simple Titleholder) f" ` )414.4 t <SA) ,eJ Phone # 9q9.9 N ✓6 X10 Permit No. ck Q.-11OD Master Permit No. Plumbing Mechanical Owner's Address City AA-AA t Sht7J SState , Zip Tenant/Lessee Name /4//,-014) �(5 r 5 �© e Phone # Job Address (where the work is being done) 9i-'-0 L i- e2Z4 d ,4v e Zip 33/ 3 S City Miami Shores Village County Miami -Dade FOLIO / PARCEL # f ( i°` � 3 6/ 3 - 76670 Is Building Historically Designated YES NO Contractor's Company Name CO c %v (�Vt� U 6 I' •? P Y Contractor's Address / r 5 ji.f E t3 7 S--/' City A/ t /14 ! S ii 6 r c g' State 1 Zip 33 1 3 Qualifier Name i9,,-01 c› b 0 CAJ Qc/V Phone # 345- 75'? -d 6/2- State Certificate or Registration No. e ee 0 j ¥3 o 6, Certificate of Competency No. dOfad 0. f l f ArchitectlEngineer's Name (if applicable) Ai A Phone # Phone # 76-/ 7 (2 Value of Work For this Permit $ Type of Work: Describe Work: Square / Linear Footage Of Work: 4- 2 0 ['Addition ['Alteration ['New Repair/Replace 0 Demolition epe /12 RI-5 e �tA c Cke y f tt, 42`°' eye , ere tiLe,41-wr,h cd0 1- Jg4.tr / //( 1I kA &r t/ei. CIA-a1t ®t-e2 00 it * ** * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ * *Fees * * * * ** ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF$ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ Structural Review. $ 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+'FIDAVIT: 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 <1i/ At Signature Owner or Agent / <y Contractor The foregoing instrument was acknowledged before me this 17 The foregoing instrument was acknowledged before me this fig day of , 20 60 , by "CC7 b C , day o€ J 1 dJ C , 20 /0 , by C s ge'C3t ii° who e or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: • : 1 444. = • ®a°' • ** * * * * * * * * * * * * * * * * * * * * * * * * ?Apet** * Y.* as identification and who did take an oath. Sign Print: -I+ My Commiss * * * ** * ** * * ******* * ** * ** * ** /1/41//11Nt‘ \\ 11111 2M OF MUM, MAR 07, 2013 APPLICATION APPROVED BY: 6c° m4 76 a 141917 A ad, ■ 7,7 V.C2,TDEIG CA En Plans Examiner (Revised 02/08/06) Engineer Zoning SECTION R4402.14 - t-IIGRVELOCITY HURRICANE ZONES -- UNIFORM PERMIT Florida Building Code Edition 2004 High Velocity Hurricane Zone Uniform Permit Applicatio Roof System INSTRUCTION PAGE COMPLETE THE NECESSARY SECTIONS THE UNIFORM ROOFING PER APPLICATION FORM AND ATTACH T REQUIRED DOCUMENTS AS NOTED BELO Low Slope Application Prescriptive BUR -RAS 150 1,2,3,4,5,6,7 4,5,6,7 Asphaltic Shingles 1,2,4,5,6,7 Concrete or Clay Tile A,B,D,E Metal Roofs 1.2.3.4.5,6,7 1,2,3,4,5,6,7 1,2,4,5,6,7 As Applicable 1. 3. 4. 6. 7. ATTACHMENTS REQUIRED: Fire Directory Listing Page From Notice Of Acceptance: Front Page Specific System Description Specific System Limitations General Limitations Applicable Detail Drawings Desigg Q0lcpIati©ns per Section R4403, or If Applicable, RAS 127 or RAS• 28 • • • 1,2,3,4,5,6,7 • • OthenLo,nrpottent Nbtice'of Acceptances Municipal Peril lt,Application Owner*: : ° otlfoh ;n for ado ing Considerations (Re- Roofing Only) Ane • ifet'Ro ling Palculation Documentation ,•. -,,•* •6 \. c Florida Building Code Edition 2007 High Velocity Hurricane Zone Uniform Permit Application Form Section A (General information) Master Permit No. Contractor's Name Proeess No. 040(4- ri/07 Job Address q I l NE AvE- )3( Low Slope ❑Ac Shingles ROOF CATEGORY ❑ Mechardcally Fastened Tile ❑ Mortar/AdheslveSetThe ❑ Metal PanoIlShingles ❑ Wood Shingles/Shakes Are there ❑ Prescriptive BUR -RAS 150 Gas Vent Stacks? Yes No ROOF TYPE Type: Natural U LPGXU ❑ New Roof ❑ Re- Roofing ❑ Recovering XRepair ❑ Maintenance . ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep.Slop ed Roof Area (SF) Total (SF) Section B (Roof Mani Sketch Roof Plarr Illustrate ail levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include, dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. summuu:: rMMMMMMMMMuu mpruMMMMMMMMMMMMMMMMMMmmuumuMMMMMMMMMMMMMMpurrrrrrrrrrrr iMMSMMMM MMMMMmOMMMMMMMMMSM immmrPMMMMMMMMMMM MMMMMMMMMMMMMMMMMM IMMMMMMMMMMMMMIM■ MMMMMMMMMMSiigamtlMMMMMMM■ M MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM■ IMMMMMMMMMiMMM MMMM! 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Furman, Inc 1314 East Atlantic Blvd. P. 0. fax 1927 Pompano Bach FL 33061 ._ INSURED ObanOU.r Roof Intl Shalt Metal & Supply Co 159 NE 97th Street Miami Shores FL 33138 COVERAGES ITY INSU T IS CERTIFICATE 1S IS LY AND CONFERS • LDER. THIS CERTIFIC TER THE COVERAGE • 1. IN INS INS INS INS INS RERS AFFORDING CO RER A: First Koran_ RER s: aridgefield RER C: RER D: RER E: NCE PAGE 01 PATE (MM/DD/YYYY) 5/27/2010 ED AS A MATTER OF INFORMATION RIGHTS UPON THE CERTIFICATE TE DOES NOT AMEND, EXTEND OR FFORDED BY THE POLICIES BELOW, RAGE _ Xnilvlranca Co • loysrs ins CO NAIC # 10701 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIM iMIA Will S__ " - PO j It LTR_ TYPP OF INSURANCE POLICY NUMBER GENERAL LIABILITY X I COMMERCIAL GENERAL LIABILITY -1 CLAIMS MADE EX :1 OCCUR 001533 j_X Per ProjSOt v/ prior t' j wDittan dontract GEML AGGREGATE LIMIT APPLIES PER: 1 POLICY 1L, SECT 1 'I LOC A• AUTOMOBILE LIA8IUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ..J 6/1/ NAMED ABOVE FOR THE ENT WITH RESPECT TO S SUBJECT TO ALL THE TE ICY PERIOD INDICATED. NOTWITHSTANPING ICH THIS CERTIFICATE MAY BE ISSUED OR 3, EXCLUSIONS AND CONDITIONS OF SUCH EOfI POLICY EXPIRAT1O r•u 03.0 6/1/2011 • EACH CcCURRENGE _ $ 1, 001,090 m .T 0116EITED PR Asgg (Sal otaxrenrasJ $ 50, 000 UMITS MED EXP (Any one perm/ PERSONAL, & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG S EXCLLTDSD 1,000,000 2,000 000 2,0004_000 GARAGE UASILITY a—� ANY AUTO • I COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per parson! BODILY INJURY (Par aQ Idant) PROPERTY DAMAGE (Pat ac1Jtlatlt) AUTO ONLY - EA ACCIDENT EA ACC OTHER THAN AUTO ONLY: $ $ $ $ $ S AGG $ EXCESS / UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE AGGREGATE $ WORT ERR COMPENSATION AND EMPLOYERS' LIABILITY y t N . ANY FICERIMEMBER EXCLU �ECUTIVE (MandMty In NH) W yy•ss dasorbe undet SPECIAL PROVISIONS DIMOw OTHER 183036966 10/ /2009 10/6/2010 x P Y V STATU- 1OTH- LIMITS E.L EACH AOCIDENT E.I.. DISEASE - EA EMPLOYEE E,L• DISEASE - POLICY LIMIT 100,000 $ .3.00,000 $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS t V8j DLES! EXCLUSIONS ADDED 8Y ENDORSEMENT/ ECIAL PROVISIONS - - -- City Of Miami Shores vil lage 10050 shores. 2nd Ave 16Riam3 Blaoras. 8 p L 33153 ` S [N1TE N IMPOSE R!P iOULDANY OF THE MOVE 0E3G141IED POLICIES BE CANCELLED BEFORE THE EXPIRATION mentor, THE ISSUING DMLLIER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN nce TO THE CERTIFICATE 1401 NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR Lw8I OF ANY KIND UPON THE INSURER, ITS AGENTS OR AT1V8S �6a1Cy�� AUf NOR= TA ___1.4. _1.3.4 w ---... i ACORD 25 (2009101) . INS025 (200801 } The ACORD name and logo are / • 1911- 20094 gistared rlow of ACO RA N. All rights reserved.