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RC-12-1382f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176303 Permit Number: RC -7 -12 -1382 Scheduled Inspection Date: March 29, 2013 Inspector: Bruhn, Norman Owner: KARLSON, THOMAS Job Address: 1000 NE 91 Terrace Miami Shores, FL Project <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050010290 Building Department Comments REMOVE AND REPLACE KITCHEN CABINETS NO STRUCTURAL WORK, ALL EXISTING APPLIANCES REMAIN. BATHROOM REMODEL. REMOVE TUB AND REPLACE IT WITH SHOWER, FLOOR, WALLS REMAIN AS IS. NEW TOILET AND SINK 08/07/2012 - RECEIVED NOC.AS Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 28, 2013 For Inspections please call: (305)762 -4949 Page 3 of 32 11111111 111111111111111111111111111 1111111111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE -AT TIME OF FIRST INSPECTION PERMIT NO.V J ) FOUO NO. STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be property, and in accordance with Chapter 713, Florida Statutes, the is provided in this Notice of Commencement. STATE OF F'L 1 HEREBY CERTh Y ve f a mriate to° '�'in; CFN 2O1.2R 24 -322 OR Bk 28203 Ps 15161 (fps) RECORDED 07/25/2012 16:02:27 HARVEY R1JV'IHr CLERK OF COURT MIAMI-DADE COIJNT`t`r FLORIDA LAST PAGE HARVEY EY RUVW ,. CL By OF DADE isd2rriay Ow Space 1. Legal description of property above reserved for use of recording office p perty and street/address: i Nett t i—� I t.`t . 1-ksl.4 / . 3 2. Description of improvement: 1 "4S .3 co d< uPCSc 20.s Pert. AC.* C i -711 . i tcrwe -+"C / r ev Trit u, 3. Owner(s) name.and address: C t-kr2 t STIP HC---a, tt r+. -'CT t e p rr, `Y i. TL- ::eK v rfivt.p. S3 tar Interest in property: ita w NJ eft f P t2.1% A.ar2y Re t g e+., CF Name and address of fee simple titleholder: C_012 rt tN 4. Contractor's name, address and phone number_: cs-v+E. • 7?t Z 2199 5. Surety: (Payment bond required by owne ' r from contractor, If any) Name, address and phone number. Amount of bond $ 6. Lender's'name and address :' 7. Persons within the 'State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., .Florida Statutes, Name, address and phone number- 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. Name, address and phone number: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of ring unless a different date Is ,specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE 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 •OB?SETE 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(s) or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAM) -DADE The for By ❑ Individually; or ❑ ❑ Personally known, or Print Name Title /Office k before me this -CV kVA IA for roduced the following type of Identifi Signature of Notary Public: Print Name: stk. ( ) t1�IFlCATION PURSUA TO SEC ON 5195 F OR • DA STATL»� • 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. day of �% I •• IIIK , r �����tt�►1�ir, ml ►try Signature(s) of er(s) By r Owner(. Authorized Officer/Director/Partner/Manager wh 123.01 -62 PAGES 3/10 CLAUDIA '. . . -'zP"Y °6e�•�' Notary Public - State of Florida '_9 '� .1 My Comm. Expires Sep 23, 2015 Commission # EE 128810 Bonded Through National Notary Assn. • By 313" 1tli2 UR- Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: 100 City: Miami Shores Folio/Parcel#: NE 9 mr JUL 2 4 26'12 Jijj FBC 2010 Permit No. C Master Permit No. ROOFING County: Miami Dade Zip: 3 13 S Is the Building Historically Designated: Yes NO ✓ Flood Zone N 0 OWNER: Name (Fee Simple Titleholder): C-1412 I.S k Phone#: 786 9 9- 9.5-23 Address: f C7 C' " ei I ,- City: m (AAA, S State: F 33 1 3 Tenant/Lessee essee Name: 14-1 J A Zip. Phone#: N /A Email. C- -I'2 IS k ∎f∎ICr t o A; ` Gcoem CONTRACTOR: Company Name: Address: City: Qualifier Name. Owir Phone#: State: Zip: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: ' Address: DESIGNER: Architect/Engineer. Value of Work for this Permit: $ 1 Type of Work: °Addition °Alteration Description of Work: , 4"&+-t CIvE RC°5 LACE �?CC S1 Ont.. 4s-sce i eGi..tproa a BAcitatiCsa,, Phone#: Square/Linear Footage of Work: °New GIRepair/Replace °Demolition t 5 catt3 h c 4 %Jc'fuAA_ c.siNal.t o diet � F4n►.�yF -2 e- . eti& - 4 2 C -Putee i Tti tac --e- Al f S iS , 1 ■G: i ^Vt (L fi S , Color thru tile: ****** * * * * * * * * * * * * * * * * * * * * * * * * *** ** ** *F ************* * * * *** * ** ** * * ** *** * * ****** * **** co Submittal Fee $ Permit Fee $ ,S7'o d 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) czetol �.s r 0 & tae" - t C C' Mortgage Lender's Address f 100 Lo G� ST s e . 0 &f'T 2- c)C City DeS AAo Evc:S State ( Zip Sb 3 9 ) 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, FTC 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 appro d and a reinspection fee will be charged Signature Own The foreeloin instrument was day of W , 20 . by and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this day of , , 20 ._, by ho is personally known to me or who has produced identification and who did take an oath. Sign: Print: My Commission Expires: NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** *ate ** ********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Structural Review (Revised 3 /12/2012)(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 OWNER BUILDER DISCLOSURE STATEMENT NAME: Cr -cts.t c4- DATE: ADDRESS: I a3 NE. 9 1 M 1.4k-K;;“ FL 2313 ' Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor,1 further understand that I as the owner must appear in person to complete all applications. State Law requires, construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one family or two - family residence. You may also build or improve a commercial building at a cost of $25;000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have lied for permit under an exemption from the law. The exemption s v app an owner-builder pti specifies that 1, as the owner of the properly listed may act as my own contractor with certain restrictions even though I do not have a license. Initial C I understand that budding permits are not required to be signed by a property, owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial a-14 3. 1 understand that as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial C-1-k 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial CSC 5. I understand that, as the owner- builder, I must provide direct onsite supervision of the construction, Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Intial C £ 7 I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, maybe held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees' while working on my property. My homeowners insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial c_ 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that 1 must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial C 9. I agree that, as the party legally and financially responsible for this proposed Construction actvity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial G 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that -1 may contact the Florida Construction Industry ; Licensing Board at 850.487.1395 or htto://www.mvfioridalicense.corn/dbpdoro/cilb/index.html Initial CA. 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that l am the party legally and financially responsible for the proposed construction activity at the following address: ( o7e7 ks E 1 -rest f f t �kvtiia S f}DC -3 / Pt s s 13?. Initial' C CA- 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial C ee Licensed' contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civiI court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this (24' day of k-A 1� Produced there License or I 1 o 0991 )9'2-OI identification. 20 7 who was personally known to me or who has C� NOTARY Vip CLAUDIA V. CUBILLOS .o ������� Notary Public Expires State Florida 015 P� 23. a* * .1 f y Comma sion # EE 128810 r. yin c Assn. = .. o?r' Through National Notary ` Bonded 't'1-'ror, 2- 'C (=CZc Gz F P-?P L-4 gorNICel C••DI c�cs. b� :-7)zo)1Z r of j c -fe-^A. vc LAUNb i 5,. r co ADD SMOKE/CARBON MONOXIDE D RUBBER TORS ANY AND ALL CLOTH N INSULATED CONDUCTORS TO RE REPLACED. ¢ ►N\cs.s Gr. A� r A'vPQ &i -s LAJ ooc, & 9 M fAVKA S 1- el 3 13 I c- r*c-f 1 S tc 14v C; 1.4 T'C-MC—'^' C.A'( (tve -Pfd i F etc- ru2CS/ -ri Lc- (3frrIh'Zoo �t ► s try. S H%C-f Z , Re -work Soffit to suit Appliance and Fridge Cabinets. NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F..I PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. Natasha & Chris King Thomasville Ashton Maple, White Finish. All plywood construction Small Scribe Upper Moulding. Light baffle lower moulding. No Glass Inserts. Final Design: Date: All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 6/30/2012 Printed: 6/30/2012 610055b8 All ., #1 No Scale. w BATHROOM RECEPTACLE ON 20 AMP CKT AND O.FI PROTECTED All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. 61000fc0 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 6/18/2012 Printed: 6/29/2012 All Drawing #: 1 No Scale. Permit No: � `/�" Job Name: Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: // Z /�Z MECHANICAL Critique Sheet $cD eft b5 - 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. Review Complete by: Jan Pierre Perez Chief Mechanical Inspector 786- 412 -5318 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I JP Inspection Number: INSP - 180496 Permit Number: MC -10 -12 -1995 Scheduled Inspection Date: November 14, 2012 Inspector: Perez, JanPierre Owner: KARLSON, THOMAS Job Address: 1000 NE 91 Terrace Miami Shores, FL Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Contractor: RELIABLE AIR CONDITIONING REFRIGERATION & APPLIAN Phone Number Parcel Number 1132050010290 Phone: (305)325 -9283 Building Department Comments INSTALL EXHAUST FAN IN TWO BATHROOMS Infractio Passed Comments INSPECTOR COMMENTS False Vc1( k'kbv Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 13, 2012 For Inspections please call: (305)762 -4949 Page 22 of 42 Miami Shores Village Building Department 2 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 l/ /l4 INSPECTION'S PHONE NUMBER: (305) 762.4949 DING Permit No. M0 12 l c b V PERMIT APPLICATION Master Permit No. 4G I2-- I,3g FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): C- We--1 S 7 Phone #: Z6 $3 8 2 117 Address: 000 E City: M I e S C—S State: F L Zip: 3' Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: SP(//A 6 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: 0 CONTRACTOR: Company Name: f C't_a LC- Al rt -avb 94- phone #. Address: U.) / 6 City: -" State: Qualifier Name: /4607 H c,e a./Lb Zip: T3/37-' Phone#: Os° 3 2.S' q 2. ,T3 State Certification or Registration #: ( 4,' a1 it t D Certificate of Competency #: (ikc C P t ` t 1 ( O Contact Phone #: 3 C 3 q 3 Email Address: A — 4J— fM E. &A p f:.. G (ye-j DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ WC) Square/Linear Footage of Work: Type of Work: OAddress ®Alteration ONew ORepair/Replace ODemolition Description of Work: i NI S i 1 -CA– ` rd, 15 A'1 c a s (z) ..- `);1A -4 * * *************** ********* **way ****** * * ** ****** * * * * * *,x ************** ** ** * ***** Submittal Fee $ Permit Fee $ V CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5°1 - L� to12-4 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 Ale1411)AVIT: 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 • ent Contractor The foregoing instrument was acknowledged before me this 7-3 The fo of day of 04-1— , 20 t Z , by C ! IS lk ! v , day o who is person ly known to me or who has produced iJ ' ho is pe `° Sign: Print: My Commission Expire Sign: Print: My Commissio * * * * * * * * * * * * * * * * * * * * ** APPROVED BY pdg r l 41► "p "• otar Public - State of Florida ,,. _ = My Comm. x., s + is ` QQ Commission # EE 125810 ''' fig; ' ; °os Bonded Through National Notary Assn. ** axe e ► * **+s***+> * * ** ** *** * * * ** ** x *** * **** ** *a **** ****+r*** ** ** lans 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 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES 0 NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A _ AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO . YES NO REPLACING THERMOSTAT YES NO . YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO _ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480)• 4. Size Disconnecting Means' Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: (Qualifier's signature only) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188006 Scheduled Inspection Date: March 26, 2013 Inspector: Devaney, Michael Owner: KARLSON, THOMAS 0-kgr- Permit Number: EL -7 -12 -1383 Job Address: 1000 NE 91 Terrace Miami Shores, FL Project <NONE> Contractor: MOODY ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050010290 Phone: (305)758 -2000 Building Department Comments KITCHEN REMODEL AND BATHROOM REPAIRS 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 INSP- 181518. CREATED AS REINSPECTION FOR INSP- 176311. Not ready for final. 4-z s �- 9rz - dell>/ 2/? March 25, 2013 For Inspections please call: (305)762 -4949 Page 19 of 19 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 Permit No. E 1°'' 13 83 Master Permit No. kCj 1 2,-4 13 BUILDING PERMIT APPLICATION FBC 20 JUL 2 Y ZU 2 Ji Permit Type: Electrical dhri S k-sni OWNER: N e (Fee Simple Titleholder): Phone #: Address: g i Ttirr(,$„c City: I IOre, S. State: Ft— Zip: 313' Tenant/Lessee Name: /4 Phone #: Email: P / Jc JOB ADDRESS: 5II4 City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: MOOdy 6/ %7c, /Joe. Phone #: t cO -Z(XO Co bet (p'ba Qb City: l` 104A, r State: ILL Zip: 3 8 -!) Qualifier Name: John Z 111 Phone#: State Certification or Registration #: eG oC !I q ? Certificate of Competency #: Contact Phone #: woo Email Address: DESIGNER: Architect/Engineer: /4 Phone #: Value of Work for this Permit: $ . (DO Square/Linear Footage of Work: Type of Work: DAddress OAlteration New l epair/Replace Demolition k i einn k. enocie.1 d ba+hrooni rcral r� Description of Work: ***************** ***** * * *** ** * ***** ** *oFees ***** dr /Pip Submittal Fee $ Permit Fee $ /Y ®b CCF ', CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ * * * * * * * * * * * * * * * * * * * ** * * * * * ** Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 110 ' 6 l J Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby ade 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 b '.%. proved and a reinspection fee will be charged. .400, Signatur // O if or Agent Contractor 1 The for : of : instrumen as ac . • wled d b fore me . so(' The foregoing instrument was acknowledged before me this / day of , 20 —.y by 6• day of , 20 I ; by - k t�tY) � Y ��s who is ,- rsonal ,` known to me or who has produced ' who is personall known to me or who has produced and who did take an oath. as identification and who did take an oath. NOTA Y PUBLIC: .. NOTARY PUBLIC: Signature Sign: Print: My Commission Expires: Up1Ay. 0.�1100� otkd15 OLA , State 20 ,,.��,� P„e� %. Nota�Y � Ex4i�eg 8x10 4\tik•. OM. : EE 12 y Assa. .� �omm►s" aai�onat a tt a`r dZntoe9 :�sr �i � gollde .�, "'O11 ,°,•:* Sign: Print: My Commission s onto. /•, MY COMMISSION # DD 979267 -° EXPIRES: May 11, 2014 E-ift `�` BOnd� ThN Nay Publc UHde4 rfte s MARY PAT BRIGGS * * * * * * * * * * * * * * * * * * *; sksh***** 1s+ ks k**sk*******+k*****sk*sg*ek+k+N**** k**+ ksk+ k**N:. k**sk*** *+ h****** *+ k****+k***sksk******ak *+ks *** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 - SY2, Inspection Number: INSP - 181482 Permit Number: PL -7 -12 -1384 Scheduled Inspection Date: November 13, 2012 Inspector: Hernandez, Rafael Owner: KARLSON, THOMAS Job Address: 1000 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: LASSETER PLUMBING CO INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050010290 Phone: (305)525 -5075 Building Department Comments PLUMBING WORK FOR KITCHEN & BATHROOM REMODEL, CONVERT TUB INTO SHOWER 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 INSP- 177274. CREATED AS REINSPECTION FOR INSP- 176314. not ready rough only November 09, 2012 For Inspections please call: (305)762 -4949 Page 32 of 36 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 177274 Permit Number: PL -7 -12 -1384 Scheduled Inspection Date: November 05, 2012 Inspector: Hernandez, Rafael Owner: KARLSON, THOMAS Job Address: 1000 NE 91 Terrace Miami Shores, FL Project <NONE> Contractor: LASSETER PLUMBING CO INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050010290 Phone: (305)525 -5075 Building Department Comments PLUMBING WORK FOR KITCHEN & BATHROOM REMODEL, CONVERT TUB INTO SHOWER 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- 176314. not ready November 02, 2012 For Inspections please call: (305)762 -4949 Page 8 of 37 Miami Shores Village w $uilding Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2040 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) 61-1- . r i'%4) Owner's Address /6 t 0 � V / 7 4,64c 6-. City S . State. Tenant/Lessee Name. E -MAIL: Job Address (where the work is being done) City Miami Shores Village r--- JUL 2 Lt L0 ie _> BY:- Permit No. Y 13 2 — 0E4_ Master Permit No) 2- ) M2— Zip . 7f4-- f3I - -)/79 Phone ##- 'v- gr. U 33/32 Phone # X/4- FOLIO / PARCEL # County Miami -Dade Zip S3/ 3f Is Building Historically Designated YES NO Contractor's Company Name 1-4-SS Ede PLO ir), //t) phone # Contractor's Address 6 /3 - City ) L State eC • Qualifier Name 37),M) 36u 193 7/I Zip 33) 4 / art Phone # �,3t23 So�.s -S 7 J� State Certificate ificate or Registration �Noo. r" "�t°� q 9( Certificate of Competency No Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration Describe Work: Square / Linear Footage Of Work: ['New cO/Repair /Replac ❑ Demolition ******** * * * * * * * * * * * * * * * * *x * * * * * * * * * * * ** Fees************** * * * * * * * * * * * * * * * * * * ** * *r. * * * * * ** Submittal Fee $ Permit Fee $ /50 , /tie CCF $ CO /CC Notary $ Training /Educatk n Fee $ Technology Fee $ Scanning $ Radon $ D:PBR $ Zoning $ Bond $ ' Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ (12... 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. 1 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. 1 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 oiAgent The foregoing instrument was acknowledged before me this day of 20 31472, 0t2.,by ( s''/A/ who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: a //l mod- 4 . Print: My Commission Expire Signature Contractor The foregm mg instrument was acknowledged before me this 'l0 day of who is ,20 /e_ by t /16 fee-0 me or who has produced as identification and who did take an oath. NOTARY PUBLIC: al..11 Sign : !4 Print: e r/A/* f ,e ,Yxxx xx 'cat x x,t,Yx9r,Y*** My Comrniss * *******x**xxx*** ** APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Zoning ACCAPRO CERTIFICATE OF LIABILITY INSURANCE DATE (IMMIDD/YYYY) 8/26/2011 ' 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(les) 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 fins certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Mack, Mack & Waltz Insurance Group, Inc. 1211 S Military Trail Suite 100 Deerfield Beach FL 33442 NncT Diana Garcia PHONE . -K,m. (954)640 -6225 /AAX iC. N0): (954) 640-6226 ADDRESS: dgarcia @mackinsurance . coo INSURER(S) AFFORDING COVERAGE AMC INSURED Lasseter Plumbing Company, Inc 865 N.E. 130 Street North Miami FL 33161 INSURER A Mid- Continent Casualty Company INSURER B :Travelers indemnity Company 25658 INSURER C Bridgefield Employers Ins Co . 10701 INSURER D : INSURER E : COVERAGES INSURER F : REVISION NUMBR. 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. LTSRR TYPE OF INSURANCE MISR yyVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 041X;000830044 9/1/2011 9/1/2012 EACH OCCURRENCE $ 1,000,000 PREMISE S (Ea occurrence) ) $ 100, 000 CLAIMS-MADE X OCCUR ED (Any we person) $ EXCLUDED PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS -COMP/OPAGG $ 1,000,000 $ 2,000,000 $ 2,000,000 GEM. AGGREGATE LIMIT APPUES PER: JL I POLICY [1 n LOC $ AUTOMOBILE LIMEY BK94858,68 .__ MBINED SINGLE LIMIT $ 1,000,000 X 9/1/2011 9/1/2012 ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUTOS BOD Y INJURY (Per person) $ LY INJURY (P�axldont) $ PERTY DAMAGE (Per accident) $ Uninsured motoi1st combined $ 1,000,000 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENTION $ $ C WORKERS COMPMSATION ANND EMPLOYERS* UABIU Y Y/ N ANY PROPRIETOR/P� N /A 83021471 -- -- -- --- -. -._� S/25/2013 WC STATU- OTH- X 1 TORY LIMITS I I ER 5/25/2012 EL EACH ACCIDENT $ 500,000 (OMandatory In NH) EXCLUDED? n If yes, describe wider DESCRIPTION OF OPERATIONS below EL DISEASE - EA EMPLOYEE $ 500,000 EL DISEASE - POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace m regulred) Plumbing Contractor Work Only. MOTICIfnArm unr nines (305)756 -8972 City of Miami Shores Village Attn: Eiviva 10050 NE 2 Ave Miami, FL 33138 ACORD 25 (2010105) INS025r�mrnm m 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 Greg Waltz /DIANA © 1988-2010 ACORD CORPORATION. All rights reserved. The Af`ARfl non* anti !neon ana naniaforo.I rnar&a of AC`-Ann • ,. ADDITIONAL COVERAGES Ref # Description Medical payments Coverage Code MEDPM Form No. Edition Date Umit 1 5,000 Umit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Foreign Coverage Coverage Code FORGN Form No. Edition Date Umit 1 TRIA Umit 2 Umit 3 Deductible Amount Deductible Type Premium $48.77 Ref # Description Increased employer's liability Coverage Code INEL Form No. Edition Date Umit 1 Limit 2 Umit 3 Deductible Amount Deductible Type Premium $65.51 Ref # Description Expense constant Coverage Code EXCNT Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium $200.00 Ref # Description Experience Mod Factor 1 Coverage Code EXP01 Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium $1,844.21 Ref # Description WORK PLACE SAFETY CREDIT PROGRAM Coverage Code SAFET Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium - $165.07 Ref # Description Drug Free Credit Coverage Code DRUGF Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium - $404A3 Ref # Description Coverage Code Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Umit 1 Umit 2 Umit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Umit 1 Limit 2 Umit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. FIRST -CLASS 1J.S. POSTAGE PAID MIAMI, FL PEtMIT NO. 23 THIS 18 NOT A BILL - DO NOT PAY 092209-7 RENEWAL BUSINESS R'PUJMBTNG CO INC STAT rC 0 1696 092209-7 865 NE 130 ST 33161 NORTH MIAMI OWNER LASSETER PLUMBING CO INC s Typ9 PLBtiMNG CONTRACTOR THIS IS TAX ONLY T GOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR HHOLDgER FROM A Y OTt PERMIT OR L1IOCN ENSE P CE�FICA THE 0 HOLDER'S GUALUFIOA -. WORKERR /S 7 DO NOT FORWARD LASSETER PLUMBING CO INC 865 NE 130 ST N MIAMI FL 33161 G0LLE;CTORaCOU TAX 07/06/2011 60040000099 000045.00 SEE OTHER SIDE 11E111EEIlE11EIldh llE11111111EiEEEIE111EI11EIlEuhkUld E3ATCH NUMBER