Loading...
RC-10-1372Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 151392 Scheduled Inspection Date: October 07, 2010 Inspector: Bruhn, Norman Owner: RUDIN, DIETER Job Address: 477 NE 92 Street Miami Shores, FL Permit Number: RC -7 -10 -1372 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060140270 Building Department Comments REPALCE TILES TAKE OLD TILES OFF PUT SHEET ROOF WHERE NECESSARY AND PUT NEW TILES UP. PUT TOILET AND SINK BACK IN PLACE. Passe 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- 149500. Not ready /work not complete. NB October 06, 2010 For Inspections please call: (305)762 -4949 Page 16 of 31 • • • • •••S••• • • • • • • • • • • • • itY did 2010 B • •• • •• • • • • • • c9-0 e2W- f Tels 6—S Tav Quo -N,,� NIM'ami Shores Village APPROVED BY DATE\. ZONING DEPT BLDG DEPT SUBJECT (0 CCMPLIANCE WITH ALL FEDERAL STATE AND CC,UN IY RULES AND REGULATIONS pLC • •.••• • •• •• • • • • • • • • • • • • • • • ••• • •••••• .• . 1-1. T.I. • • • • •. • • • • • • • • • • • • • • • • • . ••• •• •• • • • • • • •. • • • • • • • ..• • • •• • • • • • • •- • • • • •• • • • • • • • • • • • •._ • ••_ _• __ • •• • • • ■ • ••• •• • 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 02106/2011 Parcel Number Applicant 477 NE 92 Street Miami Shores, FL 1132060140270 Block: Lot: DIETER RUDIN 1 Owner Information Address Phone CeII DIETER RUDIN 477 NE 92 ST MIAMI SHORES FL 33138 -3154 Contractor(s) HOME OWNER Phone CeII Phone Valuation: Total Sq Feet: $ 3,000.00 200 1 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: BATHROOM REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee Radon Surcharge Scanning Fee Technology Fee Total: Amount $1.80 $1.00 $0.60 $5.00 $100.00 $1.00 $3.00 $2.40 $114.80 Pay Date Pay Type Invoice # RC -7 -10 -38540 08/09/2010 Check #: 451 $ 64.80 $ 50.00 07/29/2010 Credit Card $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy August 09, 2010 Date August 09, 2010 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 APPLICA ON FBC 20 Permit Type: BUILDG RO;6 Owner's Name (Fee Simple Titleholder) Owner's Address City 1t t*c3Q tte -t Rtry c�K�► S1 Y Tenant/L,essee Name Permit No. 10372 -- Master Permit No. ui>1 N Phone 4 Zip Email _.__. j & J1 -1 €. _ Y A '3(3 Phone # Job Address (where the work is being done) k 1 1 N C7 j City Miami Shores Village County Miami-Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO ✓ Contractor's Company Name kii�:)E- i�;�C1 C jam_ Phone # Contractor's Address C''>`.. State Zip Phone # Contact Phone or'Rebisti.ation No. Certificate of Competency No, Architect /Engineer's Name (if applicable) Value oltWOrk For this Permit $ c7X Type of Work: ❑Addition ❑Alteration E -mail A Describe Work: h-E'_ 2.. T t oC6-_ Wile f __-.p I ac _ Phone # %1 A Square I Linear Foota e Of Work; L�4 [�R [New Repair/Replace Demolition ►mac ,e--s r c : - p f , — ►A-12 ) ***********k!:**k*****.* ** ,.. ******Fees**-, tick ****:;:;*>k**- Ak-A— *,-kJr* *** *** *****k ** ** — **'; Submittal Fee $ 50 .00 Permit Fee $ _ C'CF $ Notary $ Scanning S Training/Education Fee $ Radon $ DPBR Double Fee $ '.71olation date: Total Fee Now Due $ ', See Reverse side —> CO /CC $ Technology Fee $ Bond $ L Structural Review. Bonding Company's INTaine (if applicable) N ,4 `3adig: Company's Address City. State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City S lr-'t t. L Stat e zip Ll c, p C Application is hereby made to obtain a permit tb do the work and installations as indicated. I certify that no wor 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, SIQNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 3 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 10 Applicant; As a condition to the issuance of a building permit with an estimated value exceeding 52500, th promise in iat a copy of t notice of com nonce OWa ruct -wn lien lcro b are will he `i ver •;z. , `� _.� �•�_s�ach �xi+. Ctertified coli'L b 1 f"� 3`c` d8d noi`fce of comtnc Cement must s . oste tfP fc j013 "s? "e )ec i , =' 7 ::rays after the building permit is issued. In the absence of such posted notice, the red and a reznspection fee will be charged, Signature. Signature .. Owner or Agent Contractor �' G The foregoing instn t was acknowledged before met as / the foregoing instrument was acknowledged before me this day ofi`. , C) . by T)1i,1l a_ VA_, 1 t`J day of . 20 , by who is personally known to neei "v � gi,py,Qduced who is personally known to me or who has produced`: `: as id 'cation and who did take an oath. NOTARY PUBLIC: As entif Cafi "ii pi i. id take an oath. NOTARY PUBLIC: . ., • 16',7,9 /'n , 3 S4:5-14',. ��' , ign: . Print: ;:�( GRID A ..:. "' My Commission Expires: Sign:. • ' ;7101!nt;in��� •Print: .: l..*******kkkkkk�:* * *.,,,,,' i...,,,,Xk'i ;;*******—)r A•l:k-i ****;,* „,57,,..-- APPROVED BY My Commission Expires: r .*- MA********: * *k*kkx i, ****k-k*k***k ***** *k;l'hk* Plans EXairliner 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: . (AL-) DATE: ,4c -e.G 2 ADDRESS: -ri �2` ��� t4f ACS 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; I 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 applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building 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 3. I 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 licensers on permits and contracts. Initial 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 ubstantially improved it for sale or lease, which violates the exemption. Initial k_- 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 17->i2___. 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. Initial 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, may be 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 homeowner's 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 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 I 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. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem 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 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 I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpdprokilb/index.html Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 14-11 1.).c.- 12 --11) ktA4kt s+L gems Initial 12. I 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 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 civil 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 retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners 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 day of , 20 ByeD`.,C16. ,l--s who was personally known to me or who has Produced there License or as identification. OWNER NOTARY Permit No: 10- / Job Name ,2010 Miami Shores Vivage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 1 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 477 NE 92 Street Miami Shores, FL 1132060140270 Block: Lot: DIETER RUDIN Owner Information Address Phone CeII DIETER RUDIN 477 NE 92 ST MIAMI SHORES FL 33138 -3154 Contractor(s) PRONTO PLUMBING INC Phone (305)978 -7755 CeII Phone Valuation: Total Sq Feet: $ 500.00 0 1 Type of Work: PLUMBING Type of Piping: BATHROOM REMODEL Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -9 -10 -39005 10/01/2010 Credit Card $ 159.10 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground 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. October 01, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 01, 2010 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 Permit No. \ ' 0'1109 Master Permit No. PC- - f ©— (S BUILDING PERMIT APPLICATION FBC 2,0 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) ate_ Phone # Owner's Address Lnl 72_"8 ST City ____ t Q, $jE� S State -C r GN�4N/��j EP 2 1 201Q Tenant/Lessee Name Email zip 33(35 Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # [ 2_ Cam® Is Building Historically Designated YES Contractor's Company Name Contractor's Address , 2 / :? ( iruz, 1) City Cityja,_Yja,Z, P Phone # 411 L V S� County Miami -Dade Zip g.31 36 NO Qualifier Name Flood Zone Phone #sos g'17 z -2.2i� 1.L State Certificate or Registration No. C, p c b 5_567 c Certificate of Competency No. o� 3 a ' 2 R 9 J,c E -mail Zip 5/0/ Phone# 30S-- ?iD-'77 ( Contact Phone Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ co?) Type of Work: ❑Addition ❑Alteratio Describe Work: Square / Linear Footage Of Work: ❑New ❑ Repair/Replace tai;'.: ❑ Demolition Submittal Fee $ Permit Fee $ Notary $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 15 9 ° LO Training/Education Fee $ CCF $ CO /CC $ Technology Fee $ Bond $ See Reverse side ---> Bonding Company's Name (if applicable) Bonding Company's Addess City State Zip Mortgage Lender's Name, (if applicable) Mortgage Lender's Addre$s 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 AFFIDAVI741: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatini construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMINT 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 Y pUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject'I to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection v4iich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap oved and a reinspection fee will be charged. Signature The fo day of O er or Agent goin:, instrumentljwas ac . owl dge befo me this 21 The fo 20 —+�' by 1 , day of kn.wn1to me or who has produced'G Y who is p identification and who did take an oath. Contractor NOT Sign: Print: My Commission Expires:1 LIC: i 4 ) "1 onally known to me or who has produced ltification and who did take an oath. OTARY PUBLIC: /1 -�ReA Sign: a �. ��ji 2C��print: NOTARY 1"JR:Ie -9g ,?'1; PROEM N� ' SSiC^ 4"' "."77% .tis` �� �i,�,Y1u`'l.��r9 „Sp`SQ∎.� C� ��,' e�y�co" My Commission Ex 'r'� can ��is.ai^u,LB71723 G } yew ' g � : b : 23, 2C11 c��ti l'xp s.. BONDS anitu ATLAN1`IC BONDING COONC. °",e ..... ****AC?Y*****:Y*: ****BC* * ** * * * * * ** C **** ** *3t ****3f****** *** **************: F*ae'**** *$*$) Y: Y: FiF: FaC*3C:F **9e3C** ***:Y**** APPROVED BY i /1 'Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06/ 0/2009) Engineer Clerk checked 09/26/2010 23:33 3058916367 AGORDeI PRODUCER INST./10MR I1113US11'RURS INC 953 NE 125th St N Miami, FL 33161 (305)891 -2808 INSURANCE INDUSTRIES PAGE 01/01 bATE(MM/ SNYYY) CERTIFICATE OF LIABILITY INSURANCE 9/27/2010 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAICft INSURED PRONTO PLUMBING, INCORPORATED INSURER A IRIITFD RTATRR r...me LI0.T r,Iq$U5MHOE GROUP INSURER B; U8 SECURITT INSURANCE INSURER C: INSURER D; INSURER E: COVERAGES THE ANY MAY POLICIES, _LTR A B POLICIES REQUIREMENT, PERTAIN, INSRp OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE,AFFORDED AGGREGATE LIMITS SHOWN MAY TYPE nc IructlaAN0 HAVE BEEN ISSUED TO THE INSURED OF ANY CONTRACT OR OTHER BY THE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMSER NAMED ABOVE DOCUMENT WITH RESPECT IS SUBJECT TO ������ fSPAOi�IryMpDENyyYtE FOR THE POLICY TO WHICH ALL THE TERMS, pppp DA MIANb/YYYYIN PERIOD INDICATED. NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONtITrONS OF SUCH LIMIT$ GENERAL X LIABILEry COMMERCIAL GENERAL LIABILITY CL2350439A, 06/28/10 02/12/10 06/28/11 02/12/11 EACH OCCURRENCE "DAMAGE S 140, 000 ( G� S 50,000 CLNMSMADE i- I OCCUR MED EXPiny one perm? $ 5,000 PERSONAL &ADVINJURY $ 100,000 $ 200,00 0 GENERAL AGGREGATE (UM% AGCREgATC LIMIT APPLIED PER; X AUTOMOBILE POLICY f P CT 7I LOC PRODUCTS . COMP/OP Ma $ 200 0 00 LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS AUTOS NON -OOWNED AUTOS CA- 0000113419 -00 COMBINED SINGLE LIMIT I accident) $ — --- (Per pers n) RY $ 10,000 , X _HIRED BODILY 'lr accident) A 20,000 — PROPERTY t() $ 10,000 GARAGE LIABILITY ANYAUTO AUTO ONLY ,- EA ACCIDENT $ OTHER THAN EA ACC $ —1 (OCCUR AUTO ONLY: AGO $ / UMBRELLA LIAJ Lrry EACH OCCURRENGE $ OCCUR C CLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION 5 $ a — $ WORKERS AND EMPLOYERS' ANr FROPRIkTOI+VPARTHERJEXECUTIVE oFFineRNENBER akapertory In If Yes, describe SPECIAL PROVISIONS COMPENSATION I:Amur), *GE TORVTIA - I S . OT . E.L. EACH ACCIDENT EXCLUDE"? $ NHj under btllnw EL DISEASE . EA �iNIPI.OYEE 5 E.L, DISEASE - POLICY LIMIT 5 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 vE HICI.FES / EXCLUSIONS ADDED BY ENDORSEMENT, SPECIAL PROVISIONS RESIDENTIAL PLUMBING rorrriCN. ATtl INA. m.. -. MIAMI SHORES VILLAGE 10050 NE SECOND AVE MAXI SHORES, FL 33138 ACORD 25(2009101) CANCELLATION MOULD ANY OF THE ABOVE DIMMED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE MIMIC INSURER WIRL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE eRRTRdcATI; Ha.OBR NAMED TO THE LEFT, BUT FAILURE TO DO CO SHALL IMPOSE No OBLIGATION OR LIABR.TY OF ANY KIND UPON THE pU0URER, ITS AGENTS OR REPRESENTATIVES. ® 988-2009 ACORD CORPORATION. AU rights r©servltd. The ACORD name and Ingo 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 BUILDING PERMIT APPLICATION FBC 2004 raviv31 oiLzt; n Permit No. EL... O" 1 2373 Master Permit No. Permit Type: Electrical ''IIn A ' Owner's Name (Fee Simple Titleholder) D t' E� g It U // V Phone # Owner's Address 41-7 612. City /Vb ( State Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City FOLIO / PARCEL # Miami Shores Village Zip 3l3g Phone # County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name l i L /L_ Phone # C�Contractor's Address G 1 kW 40 lj 1 City nhi A7Y State f (i Zip Qualifier Name ©HL) . j- Mon AL7 Phone # State Certificate or Registration No. --' D/ /9 9 Certificate of Competency No. E -MAIL: 30,s-_ 75-g- cam 331S-0 Architect/Engineer's Name (if applicable) Value of Work For this Permit $ 67C10-6 Type of Work: Describe Work: Phone # Square / Linear Footage Of Work: ❑Addition ❑Alteration [New Repair /Replace ❑ Demolition //).34ll SiY le- d& ec o nuE_ ailef ok y MO.C. o/DE Per-- ril l ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees********* xxxxxxxxxx * * * * * * * ** * * * * ** * * * * * * * * ** Submittal Fee $50- OD Permit Fee $ /J ®e — CCF $ CO /CC Notary $.''raining /Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ Double Fee $ Zoning $ Total Fee Now Due $ 10 9 . (470 See Reverse side -> Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Sta Zip Application is hereby made to obtai 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. 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: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent Contractor The fo i g instrument was acknowledged before me this The foregoing instrument was acknowled ed before me thist9? day o , 20/0 , by 0 / 0---r---R. lt? Gt D / , day of at , 20 /0(:), by 6 h i) - 41 ICS 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: NOTARY PUBLIC: Sign: Print: My Commission Expir xr, isxr. ******xxxxxx* MY COMMISSION # DD 979267 14 EXPIRES: May 11, 2014 AV Bonded Thru Notary Public Underwriters APPLICATION APPROVED BY: (Revised 02/08/06) Sign: Print: My Co :xxxxxx xxx x xxxx xx --Ex • PP�Y PAT BRIGGS t(XP9MMISSION # DD 979267 Bonded Thru lr ftg Und+l4*: otary Public Umlerwdf Plans Examiner Engineer Zoning