RC-13-253Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 185473
Permit Number: RC -2 -13 -253
Scheduled Inspection Date: April 30, 2013
Inspector: Rodriguez, Jorge
Owner: SWICK, KATHY ANN & BOB
Job Address: 138 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: DAVID HESLER INC
Permit Type: Residential Construction
Inspection Type: Oripms
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060133270
Phone: (786)294 -0954
Building Department Comments
INSTALLING NEW KITCHEN CABINETS
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 30, 2013
For Inspections please call: (305)762 -4949
Page 9 of 20
PERMIT # 1 o e4
CONTRACTOR: N 1
SUBMITTAL DATE: -
43
ADDRESS: h
ci a_ T
NAME: 5 LK, 1
RESUBMITAL DATES:
PROJECT TYPE:
Gc
ZONING
FIRE
STRUCTURAL
IMPACT FEES
//, /`) t°�
eg, K7
ELECTRICAL
HRSIDERM
PLUMBING
NOC —/ = -_.
MECHANICAL
te-
BLDG
13
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Horida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
City: Miami Shores cam, t County:
Folio/Parcel #: 3 1C `3'^ 3 X)0
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple T' hol er
Address:
FBC 20C
Permit No.
Master Permit No. c2—C- 3 ° 5
ROOFING
Miami Dade
Zip: 3 3 17'
Hood Zone: C�
Phone#: ?63L?/)
City: 1 YVl Ils�t V � �rY State: r zip: ,✓ ` �,`?
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
L ) '(NY \ 6�
Address:
City:
Qualifier Name:
State: �7
\n� kk-e Phone: {1, �S. W1/
State Certification or Registration #: Certificate of Competenc
Contact Phone #: 11 g --14 1— b Email Address: .14 PS e r 1) to 1 ' _ #c o rk.
Phone#:. -Nb1_ 1 i OVy
231‘i
DESIGNER: Architect/Engineer:
Phone #:
Value of Work for this Permit: $ ` 0 0
Type of Wprl ; JAdditison CI Iteration
Description of Work: --`� I t l \/A1
Square/Linear Footage of Work: q-,60
lew.'
NLu)
p • /Replace
UDemolition
Color thru tile:
******** ****+ r**** **** ***** *+ x*** ******** Fees*7+ x********* ***********+x*************x * **
Submittal Fee $ 0 ` Permit Fee $ /C CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ t 1,5
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 pe , In the abs ce of such poste otice, the
inspection will y. t be appro ed an? . a reii' spection fee will be charged.
Signature
The foregoin instrument was acknowledged before me this 7
I2v
day of a , 20 6i' by 13 :1
who is personally known to me or who has produced A-1 0
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
-G7
�un1►tttt��'I,
do
on• p /0
Signature
___Contractor
The foregoing instrument was acknowledged before me this
day of & 6 Ptt4v , 20 3, by ✓e, rfti"e -"°
who is personally own to me or who has produced pl
as identification and who did take an oath.
NOTARY_PUBLIC:
Sign:
Print:
My Commissio
BARBARA J. BRUNET
MY COMMISSION # EE 114698
EXPIRES: August 8, 2015
Bonded Tin Budget Notary serves
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *+ 14 * * *+x�x+x�x *,x,x ****+n***,x,x**** **** x, x*+ x, x*****, x***** *x,* ******* *********+x***
Plans'Examiner Zoning
Clerk
APPROVED BY
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
1391"
3n
11" 8
39"
831"
B27 BUTT
co,"
B27 BU
rd-FY mr- 6 7--7
(.14 X
iw I
36REF-2D
r, 310"
i
Miami Shores Vil age
APPROVED
BY
DATE
ZONING DEPT
PI n(71 117i -T
C E WI fl-i ALL FEDERAL
' LES AND REGULATIONS
ITY
Y
co
Kathy Swick
American Woodmark, Townsend Cherry
Cabernet Finish.
Standard Non - plywood Construction.
No Glass Inserts.
Shaker Crown Upper Mouldings.
Countertop Edge Lower Moulding.
Cust. Install
Final Design:
Date:
FS4812
Use Finish Shelf for
Valance over sink.
fve
3 t3
All dimensions _size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
n.y t:
�
�1
'�
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
Designed: 12/18/2012
Printed: 1/13/2013
c1808866 All
I Drawing #: 1 I No Scale.
/0100 ga2- Od Alt 5 /46€
&Orli i Owl PRA WACO 4.-J
/1/1/A* iv p leaCi LiLA OCATION
il,t ei0A 1)
ads Pc l Po-VW °Plc D fl 0,0
SrvPPAy MDOsmitC
40 AV 4414) le/IC/NO 138" la 92 41.. .4/i/11" r/710AX
ao;//t/4 Ceivi(eger6A-f
7't cl:CD399:57‘
a
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF MIST INSPECTION
PERMIT NO.- 1-abill TAX FOUO 0-3Q0106(S432.1t
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby _gives notice that improvements will be made to certain real
propen and in acconlance with Chap-W713, Floflda Statutes, the following Information
is providiad in this Notice of Commencement
1111111 1111111111 IIU 11111 11111 11111 1111 1111
CFN 2013R0156134
OR 8k 28507 P9 2036; (1139)
RECORDED 02/27/2013 11:43:03
HARVEY RUVINe CLERK OF COURT
MIAMI-DADE COUNTY, FLORIDA
LAST PAGE
. - • t/a k Ih t t 4
Space above reserved for use of recording office
1 Leg descri
iimPuNstiorattiorawalotaninvie,
cription of improvement iumrimiAmta).. -
2. D
3. Owner(s) name and address:
Interest In property:
Name and address of fee simple titleholder
4. Contractor's nErrne, address and phone number:
47777,141ThrIMMILWAVIM711111111MMOLTIMIC
,a,1""/"MMiSrMatlIIIMMIP5,..
1051111101111.111.11M1010111110111%
a
Q
A
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number
Amount of bond $
6. Lender's name and addrese:
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 Uenor's Notice as provided in Section
713.13(1X13), 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 recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY:THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE 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 JOB SITE 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 e(s) or )' wind Officer/Director/Partner/Manager
Prepared Eiy • Prepared By
Print Name Print Name
Title/Office Title/Office
STATE OF FLORIDA
COUNTY OF M MI-DADE
The fo men
BY
Di Individually, or as
I] Personally known, or 0 produced the following type of identificatlo
" •
:64" jkla
ed
before me thlti 5 day of
,
-Baumnn=
for
• 1. ;
Al
Signature of Notary Public:
Print Name:
(SEAL)
rr
1111111ZA 11111111,1K.
/IMP A INVISIMMI.
ortrottnissem.
le WV . ,71•5,1111 11
A g !;1_ '; I AA'
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.
Signs
By
•
Owne orized Officer/Director/Partner/Manager who sig
rtntk.
123A1-52 PAGE3
CLAUDIA V. CUBILLOS
Notary Public - State ot Florida
My Comm Expires Sep 23. 2015
Commission # EE 128810
Bonded Through National Notary Assn.
BY
0
141
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 190206
Permit Number: EL -2 -13 -254
Scheduled Inspection Date: April 30, 2013
Inspector: Devaney, Michael
Owner: SWICK, KATHY ANN & BOB
Job Address: 138 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LS CURTIS INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060133270
Phone: 305 - 892 -0115
Building Department Comments
INSTALL GFI OUTLETS IN KITCHEN
Infractlo
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
,g/vr- 2 0 /
April 30, 2013
For Inspections please call: (305)762 -4949
Page 15 of 20
02/25/2013 03:57 3059402138
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ACCORD CERTIFICATE OF LIABILITY INSURANCE
DATE IMM DD•YYYY1
04 -17 -2012
THIS CERTIFICATE'S 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 ADDITIONALINSURED, the policy(les) must be endorsed. If SUBROGATIONIS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statementon this certificate does not confer rights to the
certificate holder in lieu of such endorsement(a).
PROOUCER
AUTOMATIC DATA PROCESSING INS AGCY
250717 P: (877)287 -1316 F: (888)443 -6112
PO BOX 33015
SAN ANTONIO TX 78265
CONTACT
NAME:
PHONE FAX
°"E`a' (877)287-1316 tAC.NoI: (888)443-6112
EI.d1
ADDRESS:
PRODUCER
CUSTOMER ID 1:
INSURERS) AFFORDING COVERAGE I NAIC 0
INSURED
L. S. CURTIS INC.
20341 NE 30TH AVE APT 108
AVENTURA FL 33180
INSURERA: TVAn City Fire Ins Co
INSURER B :
INSURER C
INSURER D :
INSURER E :
INSURER F ;
CERTIFICATE NUMBER:
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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.
itsr TYPE OP INSURANCE SOUR
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POLICY EFF POLLI�CY E►iP
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r!CRTICIrATC unI nen -
Miami Shores Village
Building Department
10050 N.B. 2nd Ave.
Miami Shores, FL 33138
Vn•MV,.,.V.•',. p. uV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIE EBENTATIVE
42_ "7aile^\--•''
ACORD 26 (2009/09)
-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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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
4V40//.3--07
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: i 3cY we
City: Miami Shores County:
FBC 20 CD
Permit No. ELI 3
Master Permit No. 12_,C-
Miami Dade
Zip: I3
Folio/Parcel #:
Is the Building Historically Designated: Yes
OWNER: Name (Fee �SA� 1
Simple Titleholder):
VU
Address: le31c dO tik
City: 01 (. : \hd'e$$
Flood Zone: Vw
State:
Phone/4: ( ` 3.9 ( 03
Zip: 33 VU
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: COst Phone #: 3 OS(T -0, �J
Address:- ,746 y °%d S
_j j Pry lJs State:
Qualifier Name: Phone #:
State Certification or Registration #: �j �� �C`ei ificate o omp�teno}� #: u C� l 75
Contact Phone #: 7 e </ /'d /7(( Email Address: Aft crate C dy® z.
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 'LC) v a Square/Linear Footage of Work:
Scti
Type of Work: DAddress CIAlteration UNew ORepair/R-,,lace
Description of Work: G i\ 0 U
` k eA1/41/4 ‘L.eS�� V
UDemolition
ear
******* * * * * * * * **** * * * * ** ** ** ** * * ****** *Fees * *** ****** ***** * * *** * **** *** **x* * * * * ** ***
Submittal Fee 63' Permit Fee $ /-00',0 P CCF $
fVfID
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO /CC $
TOTAL FEE NOW DUE $ 11 0 '
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 AN'N'IDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of 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 approv ., and a einspection fee will be charged.
Signature
Own or Agent
The foregoing instrument was acknowledged before me this
day of , 2d5 , by 7
who is personally known to me or who has produced L. t
As identification and who did take an oath.
NOTARY PUBLIC: -' NunuiUi�
Sign:
Print:
My Commission Expires:
Contractor
The foregoin instrument was acknowledged before me this 7
day of , 20 / ; , by t� /j (2/-.A./0,
who i or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Co
CASSANDRA N NEBBIA
%AAMISSION 8 EE219418
WIRES ►25,2016
(407)3884153 RorideNoterjeente.com
APPROVED BY , /1 e',0 Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12 /2012)(Revised 07 /10 /07XRevised 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- 185496 Permit Number: PL -2 -13 -255
Scheduled Inspection Date: April 24, 2013
Inspector: Hernandez, Rafael
Owner: SWICK, KATHY ANN & BOB
Job Address: 138 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ALL COUNTY PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060133270
Phone: 305 - 796 -6124
Building Department Comments
KTICHEN REMODEL INSTALL SINK AND DISHWASHER
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
April 23, 2013
For Inspections please call: (305)762 -4949
Page 8 of 43
i
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: PLUMBING
JOB ADDRESS: �3 8 Kt-
FBC 20 L`D
Permit No. FL 13 -2,s-5
Master Permit No. , 0 3 s.
City: Miami Shores , County: Miami Dade
Folio/Parcel #: 11-- SW Cie) -.3270
Is the Building Historically Designated: Yes
zip: 3713/
Flood Zone:
OWNER: Name (Fee Simple Titleholder): (2pt.kp
k3 6 ci,
Address:
City:
Tenant/Lessee Name: Phone#:
State:
Phone#: 7d14:-46713 - f 03
Zip:. ), 7 (vS)
Email:
CONTRACT : Company Name: A-11 GY)
it/' v b'MN hone#:
Address: 0 0,4?? /i 1' 5a J
City: OC :V rafe4,4e08ti/C State: �,ti
Qualifier Name: (2J/ �.( /-1 � y�(�®� /�!'�J.� State Certification or Registration #: C_C'.,,3 � C(& 1C�
Certificate
Contact Contact Phone#: 9T7 _ i /Z'z--- Email Address: /A't afi1
DESIGNER: Architect/Engineer:
Zi JJ ?
Phone#: �S"-V --324r- Z Z
of Competency #:
Gth (5)Vif1 ezi 4-/h , CO Ai
Phone #:
e�
Value of Work for this Permit: $ (DM
1
Square/Linear Footage of Work: (�
Type of Work: DAd ss� UAlteration 1 "` ew ORepair pla ODemolition
Descripton'`of ' ork \� W t� l� ��� � 9 eA • QrAkC
*** **** *+ x**** ****** **** ******* **x:****** Fees ************ * ******* ** :****** ***************
Submittal Fee
Scanning Fee $
Notary $
Double Fee $
Permit Fee $ r ®�� CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Structural Review $
TOTAL FEE NOW DUE
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th ence of such posted notice, the
inspection, ill not be ap rove. ' a reinspection fee will be charged.
Signature � �-�' �1 � � � � ®/ Signature
Contractor
The foregoing instrument was acknowledged before me this ( The forego' g instrum nt was acknowl ed before me this
day of '� "(CLG) , 2013, by - CS"Ah� , day of �' k, 11-x\ 20 13 , by 1 \11 P1-0\ L?J rS i\ C r
who is personally known to me or who has produced -1 C) o is $ersonally known to me or who has produced P I-44 .
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
E• :CO:‘ .4■••••,
�'-• o' C,70- o) ::
fp °•,3 !i `��
/4Allrrp n i I1N����
APPROVED BY / P-I'L) Plans Examiner
as identification and who did take an oath.
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
NOTARY PUBLIC•
Sign:
Print:
My Co
L_`v0)
xp�fliry Public State of Florida
David P Hester
gs My Commission EE1109$19
Oi �` Expires 0111512014
* * * * ** * ***
Zoning
Clerk