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RC-10-706Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 141504 Permit Number: RC -4 -10 -706 Scheduled Inspection Date: April 21, 2011 Inspector: Bruhn, Norman Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: RHINO CONSTRUCTION Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Addition /Alteration Phone Number Parcel Number 1132060136130 Phone: (305)206 -6761 Building Department Comments MASTER BATHROOM REMODEL Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 20, 2011 For Inspections please call: (305)762 -4949 Page 4 of 12 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 150388 Permit Number: FW -8 -10 -1522 Scheduled Inspection Date: April 12, 2011 Inspector: Bruhn, Norman Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project <NONE> Contractor: RHINO CONSTRUCTION Permit Type: Fence/Wall Inspection Type: Final Work Classification: Masonry Phone Number Parcel Number 1132060136130 Phone: (305)206 -6761 Building Department Comments WOOD FENCE -REAR ALLEY 02/01/2011 - REVISED: CHANGED TO MASONRY WALL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 11, 2011 For Inspections please call: (305)762 -4949 Page 4 of 22 Permit No: 10- -7696 Job Name , 2010 Miami Shores Village 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 2 t cJ/ Q e /u/u eti .7 ,D�ca� -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 Permit No: 10- Job Name , 2010 Miami Shores Village 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 ../Z CIiJ/e- L(L L" / 1 G./ /K 177 %'■E'F( "1 .1 /t Cir/i ../�� Roc 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 mtimEwmip it APR 27 MO Jij BY: MMMMMMMM 0011,1•Ma0■21■Monsciac.<01191 ALLEY 1 AREA OF WORK PRST FLOOR I-ALL MIRY FLORIDA ROOM LIVING ROOM FIRST FLOOR KITCHEN DINING ROOM FAMILY ROOM CARPORT SIDEWALK PARKWAY NE 94Th TREF' • • • • • • • • 4 • • • • • • • • • • • • • • • • • PARKWAY JONES RESIDENCE 379 NE 94th ST • A pp 5l-ft,ffe or ruP c—re")? 3' 14' /t.i a-A74 tov, frov,4,---1(tee 696/-t xeei rPp Olt): it/1 /-/- r‘' e 6- -• iPell/13-rt4624 f; r‘cd "P/2/- /#174 1/4°5 &iv d / t 21-f,P/z 7fie,,o' 9 rk'i`c te5 Pt6 6k P'72 i-127 Miami Shores APPROVED Y R 1 7i,,7,77- ....-':-:---;-_. ZONING DEPT1 _ _ BLDG DEPT L _ SUBJECT CO CCMPUANCE WITH ALL FEDERAL STATE AND MUNN aULES AND REGULATIONS CROWN MOULDING BY OTHERS DRYWALL SOFFIT BY OTHERS RIBBED GLASS 4 ADJUSTABLE SHELVES 1 I 1 1 1 I I I I I I 1 1 1 1 Ell NM rj■■i■I■■ri umumPromm O 0 0 f° 31-4" 31_51. JONES BAN VANITY V2 =1'-0 BUILD DESIGN 4/6110 zIct V U') • •••• • • • • •••• • • • .... • .• • •••• • •••. •• • •• • • •••• • •• • • • • • •• •• • • •• •• • • • • • • • • • • • • • •• • • • • • • • • • • • •••• • • • • •••• NEW TOILET IN EXISTG LOCATION TWO NEW SINKS IN EXISTG PEDESTAL LOCATIONS NEW 24" X 36" MED CABS JONES BATH PLAN V2 =I-0° BUILD DESIGN 416110 NEW SHOWER IN EXISTG TUB LOCATION GLASS TO BE TEMPERED NEW PCKT DOPOR TO REPLACE EXIST'G SWING DOOR Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 379 NE 94 Street Miami Shores, FL 1132060136130 Block: Lot: WILLIAM JONES Owner information WILLIAM JONES Address Vets 379 NE 94 Street MIAMI SHORES FL 33138 -2842 Phone Cell Contractor(s) RHINO CONSTRUCTION Phone (305)206 -6761 Cell Phone Atari Valuation: Total Sq Feet: $ 10,000.00 75 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: BATHROOM REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certficate Date: Bond Retum : Occupancy: Single Family Exterior. Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $8.00 $0.38 $2.00 $300.00 $0.38 $9.00 $50.00 ($50.00) $8.00 $325.76 Pay Date Pay Type Invoice # RC -4 -10 -37683 05/04/2010 Credit Card 04/26/2010 Credit Card Amt Paid Amt Due $ 275.76 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss Insp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Declaration of Use F. Termite Letter F. Elevation Certificate 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 May 04, 2010 Date May 04, 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 APPLICATION FBC 20 Lat /PR 26 2010 PI BY: Permit No.0 O'lao Master Permit No. Permit Type: BUILDING ROOFING �r Owner's Name (Fee Simple Titleholder) U. 0 l�l C 4.-LA i . J �SPhone # K. Owner's Address 2 `� 1/444-- Ste, city kt- L S QD state Zip 2 3 1 3 Tenant/Lessee Name Phone # Email K Job Address (where the work is being done) City Miami Shores Village, FOLIO / PARCEL # County Miami -Dade Zip Is Building Historically Designated YES NO 'r— 33 � 38- Flood Zone trk b Contractor's Company Name LAJ NO s44 0.4 Phone # 3�S ZO 6 - 61-4 305,84)04q Contractor's Address 1 o (+J 46 (. e, i) 4 p - 4'-0j,042j ti r City (AA / /'� n State i� I Zip 3 3119 Qualifier Name iii/ `+MA Y tre Phone # 3 0 S $ 0 ( — 0 £a5-1 State Certificate or Registration No. C G C.. 0 . i3 Certificate of Competency No. Contact Phone 305-- sot-0 co S I E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 10 006 Type of Work: (Addition DAlteration Describe Work: off''°`( ®off \6 V /fr kr Square / Linear Footag New f Work: Repair/Replace 1" ******* * * *x * * * * * * * * * * * * * * ** * * * * * * * * * ** *Fees * * * ** * * * * ** Submittal Fee $ ^' 50040 Permit Fee $ Notary $ Training/Educ tion Fee $ 0 Scanning $ ° �1 O Radon $ 0 • DPBR $ Double Fee $ Structural Review. $ Violation date: * ** * * * * * * * * * * * ** CCF $ ( • * * * * * * * * ** fA /Cf- Technology Fee $ Koe9 Bond $ Total Fee Now Due $ 0,15 :1(.0 • 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be ivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commence nt mus be ..sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the of Y,ch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Ag The foregoing instrument was acknowledged before me this /3 The fore day of /9721(f t , 20 /0 by a`z-6- c.f \ ®ti-t= S � day o who i' personally known to me o who has produced who As identification and who did take an oath. Signatue.. NOTARY PUBLIC: Sign: Prin My Commission Expires:4 I * * * * * * * * * * * * * * * * * * * * ** APPROVED BY JULIE BLOK x• •1 pip Can elion Eons Writ 2011 6, ►,,pp. commission., DD * * * * * * * * * ** omg erson ll known to me o Contractor t was acknowledged before me this ,20 (0,by.. who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: - -- `'� , G A My Commission Expires: SUSAN DBEsafe * d1Y COMMON t DD 584885 F PIRE$ S Aba 17, 2010 "8dii l'iliiii9 lot4m*411rIbN3 ** **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * **4: 9 ##Gtf 4I4Vd %czbrapl Plans Examiner Engineer (Revised 07 /t0 /07)(Revised 06/10/2009) Zoning Clerk checked NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO `YiO T, X FOLIO NO. fl - Z7V a °' d71 "J -660 70 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: STATE OF FLORID I HEREBY CERTIFY original filed in this 11111111111111111101101111111111111111 CFN 2010R0275179 OR Bk 27261 Ps 3656; (1Ps) RECORDED 04/26/2010 10:09:55 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST FADE COUNTY OF.DADE Mists 3jopy offhe THE UNDERSIGNED hereby gives notice that improvements will be madmig property, and in accordance with Chapter 713, Florida Statutes, the folldiftaillItidibe is provided in this Notice of Commencement. By day of A 0 20.Ze _- Tidal S i.. Ircult -nd County Courts D.C. - 1. Legal description of property and street/address: iri1AL-1 t ,ttttv,e 5 c- t Ac-k- 1 o-9 5 t O - vc r IS -Ic4• Iq tIJC 3t— 45 t---07- 5•17_E tSD x 1245 6+-Ia I1 32a -D I3- (4t30 S4n S , h_ 3 13 $' kUow S ?i17 q +uE 9 2. Description of improvement: T VT PT 10 3. Owner(s) name and address: (A! f NA" 3 ) o -1 ke.- `7 ')19 1 9 5 + AA114 ; 5(+111.51 -1 /17313t Interest in property: Name and address of fee simple titleholder: Contractor's name and addres • 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: 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 01.6,O/L ,1 Sb {{J `� 5Y_, iv1( ar„s 1 `%1l X71 provided by Section 713.13(1)(a)7., Florida Statutes, (75 Name and address: 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(1)(b), Florida Statutes. Name and address: 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) Signature of Owner (Print Owner's Name W 4 LL_.I A LA S Sworn to and subscribed before me this /3 Notary Public Print Notary's My commission expires: 123.01 -52 PAGE 4 8/02 day of 479/6/ ,20(0. Prepared by J bl(U .- v 1410. if‘i °1 Address: PAPARNISS Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 149914 Permit Number: MC -7 -10 -1273 Scheduled Inspection Date: September 23, 2010 Inspector: Perez, JanPierre Owner: JONES, WILLIAM Job Address: 379 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: AIR COOLING INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060136130 Building Department Comments REPLACE EXISTING EXHAUST FAN FOR NEW EXHAUST FAN PANASONIC 110 CFM /14'3/2 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- 148401. no one home @4:15 jpp September 22, 2010 For Inspections please call: (305)762 -4949 Page 8 of 16 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 379 NE 94 Street Miami Shores, FL 1132060136130 Block: Lot: WILLIAM JONES Owner Information Address Phone CeII WILLIAM JONES 379 NE 94 Street MIAMI SHORES FL 33138 -2842 Contractor(s) AIR COOLING INC Phone CeII Phone Valuation: Total Sq Feet: $ 200.00 0 1 Tons: 0 Additional Info: EXHAUST FAN Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $0.80 $154.60 Pay Date Pay Type Invoice # MC -7 -10 -38422 07/19/2010 Check #: 1243 $ 104.60 $ 50.00 07/13/2010 Check #: 1189 $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Ventilation Final Hood Rough Duct 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy July 19, 2010 Date July 19,2010 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 07/12/10 PRODUCER Exclusive Underwriter Of S. Florida 2760 W 84 Street #5 Hialeah, FL 33016 Phone (305)827 -3536 Fax (305)827 -7868 THIS CERTIFICATE IS 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 NAIC # INSURED AIR COOLING, INC. 7966 West 30 Lane HIALEAH, FL 33018 INSURER A: AMERICAN VEHICLE INSURANCE CO. INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS A ❑ GENERAL LIABILITY V COMMERCIAL GENERAL LIABILITY GL- 0504002830 -00 09/23/2009 09/23/2010 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) ❑ ❑ CLAIMS MADE V OCCUR ❑ MED EXP (Any one person) 5,000 PERSONAL 8 ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: ❑ POLICY • PROJECT ❑ LOC PRODUCTS - COMP /OP AGG 1,000,000 ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE • RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVEYM OFFICER / MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER IS LISTED AS CERTIFICATE HOLDER WITH REFERENCE TO GENERAL LIABILITY CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE agLas A Lam. __ © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 01 -25 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 02/27/2010 EXPIRATION DATE 02/27 /2012 PERSON: BUENO JOSE L FEIN: 208400758 BUSINESS NAME AND ADDRESS: AIR COOLING INC 7986 WEST 30TH LANE HIALEAH FL 33018 -3830 SCOPES OF. BUSINESS OR TRADE 1- CERTIFIED AC .CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . OSf14T, F_$.. an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover beoeffts or compensation ander this chapter. Pursuant to Chapter 440.05112►, F.S.. Certificates of election to be exempt... apply only within the scope of the business or trade fisted as the nntice• of election to be exempt. Fromm to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to he exempt shall be subject to revocation if, at any time after the filing of the nofite or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issue of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMP, REVISED 09 -06 QUESTIONS? (850) 413 -1609 01 -25 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE 02/27/2010 EXPIRATION DATE 02/27/2012 PERSON BUENO JOEL FEIN: 208400758 BUSINESS NAME AND ADDRESS: AIR COOLING INC 7988 WEST 30TH LANE HIALEAH FL 33018 SCOPES OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR IMPORTANT:- Pursuant to Chapter 440. 05114; F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election coder this section may not recover benefits or compensation ender this chapter. !tenant to Chapter 440.05112) F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the cotte of election to be exempt. Pursuant to Chapter 440.0503) F.S., Notices of election to be exempt end certificates of election to be exempt shall be subject to revocation t, at any time after the filing of the notice or the issuance of the tertifcate, the person named en the notice or certificate on longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413 -1609 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 No. mc (V Master Permit NoR C 4,/O ka Permit Type:. Mechanical / / Owner's Name (Fee Simple Titleholder) LV s 1/, CJV .S Phone # Owner's Address 37 1 A/6 9d/ st City /`4, •S‘ore...S State TL Zip 33 /3 r Tenant/Lessee Name .S,4' 6 Phone # E -MAIL: Job Address (where the work is being done) _9 4 ,vg- 94s 1` City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Zip .3,) /ce Is Building Historically Designated YES NO Contractor's Company Name /4/E. c)/ oe+ C Phone # 416 2 / Contractor's Address 7 1I/6s/ er € City ,44 e .c4 State d Zip �©/8 Qualifier Name .../Cse 64.".e Ted Phone # 7-417‘ 6 941 State Certific a or Registration No. 'CA G /K/3 ?,2? Certificate of Competency No. E -MAIL: selrit.. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ['Alteration IDNew Repair/Replace ❑Demolition Describe Work: RE LA C e 'i .S°77 ,cr t/s T4& To/ ,f,96 L) g®c ez5 r 4 4,v4 50 c. ^�✓` -4 % rH gty O�c.c. r `Td c/���to... /i.AJ i�A't -11 0 0 xx* se*********************w is xxxx **9r Submittal Fee $ Notary $ Scanning $ Radon $ Permit Fee $ x xx x x xx>: W xx ltx Xxxx J% x xxxx*r. xxx xxx CVO CCF $ Co /Cc Training /Education Fee $ Technology Fee $ Bond $ Code Enforcement $ Structural Review. $ DPBR $ Double Fee $ Zoning $ Total Fee Now Due $ See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 9 P Mortgage Lender's Address. City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior . to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate_and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs Seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be-approved and a reinspection fee will be charged. Signature Owner or A The fore:.'ng instrument was ackn day of :fib , 20/0 , by who . . known t me or who h.- /roduced fore me th. Signature 546"/ r The foregoing instrument was ackn ' ledged be day of _ who is rsona y, known to me or who has produce 1 " i As identification and who did take an oath. NOTARY P , :' IC: Sign: P 4ntification and who did take an oath. TARY PUBLIC: Sign: My Commission Expires: 4°1,: h, SUSANDEESCHNUR TAY CCDy1�IAM S�fONItDT) P'Y8/�r {fib. 0161701 /.L�Mxx kaYx iliugigatlictaiy Services xxxxx****xxxx *xw****,.* cxxiexx*Ii ry�,F(IEFto' APPLICATION APPROVED BY: (Revised 02 /08/06) " Li,i Z.10 Print: (� t� l�r 1 li ,a ,� ;;E • 23,1011 My Comm fission Expires: , �. �'�, x xx xr NDflII3C. x* xoi,,;.*, xxxxxxx xxa a l ' xixTIx &x *II* G*C**** Plans Examiner Engineer Zoning ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNERS NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPUCATIONS. PERMIT # lZG �l l d b PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY NC (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER : WATER HEATER U.F. PRESSURE VESSELS SINK POT/3 =COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1-3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3-5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-8 HP s LIES URINAL MOTORS OVER 8-10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION NC UNIT NC WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLERWEU. GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY-WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 142048 Scheduled Inspection Date: September 24, 2010 Inspector: Hernandez, Rafael Owner: JONES, WILLIAM Permit Number: PL -5 -10 -755 Job Address: 379 NE 94 Street Miami Shores, FL Project <NONE> Contractor: DESMAR PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060136130 Phone: (305)594 -4930 Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 23, 2010 For Inspections please call: (305)762 -4949 Page 1 of 4 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 Noll iO ,..1 3 Master Permit No.PC 10 —'SOD 302$: ?oi -0654 ''SPhone # 3DS- 7 S q- to :37 BUILDING PERMIT APPLICATION FBC 20 `71 --.Owner's Type: PLUMBING 7e..Owner's Name (Fee Simple Titleholder) Owner's Address ,3 °? 9 City WWI S ,PI , State Tenant/Lessee Name Email Irsosaval MAY 0 3 Z019 VI Zip a' %`Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Phone # 3'm uE q `t County Miami -Dade 3a (p d u 3°- k, n T- Zip Is Building Historically Designated YES Contractor's Company Name NO R 1:31.14„,;6, r. ;IAC Contractor's Address y3 City VAA-' QA ere 9 State r Phone # Flood Zone cn 2s " 5Yt/s-- VP re Zip Qualifier Name Pc-De A y I> co tr' A LA ' % Phone # "..s ? ® S State Certificate or Registration No. Cr F s' 2 ,> / "2 Certificate of Competency No. .9v----y.avg Contact Phone 6 S ` ` Fe/ .,,c�? .6;) E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ � 5-1) Type of Work: ❑Addition Describe Work: ❑Alteration 4 /3o-n1- 54 Submi Notar a ee$�q . Yet Scanning $ W Double Fee $ I Square / Linear Footaje Of Work: [New Repair/Replace [ Demolition 0.44/o a/t ' ,° le- - 4-ie * * * * * * ** *Fees CCF$ Lcation Fee $ O.40 Radon $ �. (' DPBR $ lJ' 5K- Violation date: If*********************** CO /CC $ Technology Fee $ 1.00 Bond $ Structural Review. $ Total Fee Now Due $ lap • 9c, See Reverse side —* Bonding Company's Name (if applicable) Bonding Company's Addr;ss City State Zip Mortgage Lender's Name,(if applicable) ,3t) A 1 v15 k +1 K 6- • Mortgage Lender's Address R. ®. 5 71 0 4 City PjCa—k—tom ®dam State Zip d 1 -% e'@ 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 Y o UR 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 The foregoing instrument Was acknowledged before me this l 3 day of 43, , 20(0 , by tJ(& t /444 ✓ � � %ti S who i personally known to me r who has produced As (identification and who did take an oath. NOTARY PUBLIC: ent Signature Contractor The foregoing instrument was acknowledged before me this 20 day of 499'11.-- , 20/0 , by ZiJJt(Z -nso , who is personally known to me or who has produced 'dentification and who did take an oath. NOTARY UB.: IC: Sig Pr' My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY ,,*g litiCtomMioaraiOnseti17,2011 .7 air BoatIedItwoughNatiotatNetatyAsen. Sign: Print: My Commission Expires: * ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/(b/2009) Clerk checked Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address 379 NE 94 Street Miami Shores, FL 7,,,VeNSAWAS,Mal.41..6V VIM Owner Information Address Parcel Number 1132060136130 Block: Lot: 379 NE 94 Street MIAMI SHORES FL 33138 -2842 Applicant WILLIAM JONES Phone Cell Contractor(s) DESMAR PLUMBING INC Phone Cell Phone (305)594 -4930 (305)345 -0538 Valuation: Total Sq Feet: Type of Work: PLUMBING Type of Piping: BATHROOM REMODEL Additional Info: Bond Retum : Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Technology Fee Total: Amount $1.20 $0.38 $0.40 $150.00 $0.38 $3.00 • $1.60 $156.96 Pay Date Pay Type Invoice # PL -5-10 -37746 05/04/2010 Credit Card Amt Paid Amt Due $ 156.96 $ 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 04, 2010 Date May 04, 2010 1 PLD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138. Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL JUL 20 7010 Y•....�iw®e.e�en�- Y16 ,3.. Permit No ..I( - 4 Master Permit No. Owner's Name (Fee Simple Titleholder) MI Lti AriA J . ltklf SPhone # Owner's Address "7 g k) City MAUI c°}in. S State _ Zip Tenant/LesseeName Email L1/41%. LLt C 3° - 9q� 11, Phone # Job Address (where the work is being done) OE City iami Shores Village County Miami -Dade FOLIO / PARCEL # t I 3 D- - 0 (. - ! 3 0 roe? Zip •� 1 3 Is Building Historically Designated YES NO Contractor's Company Name ` 6 G zr G'7� e„�,ez ,.6 Contractor's 7/ �' a ,t.Z co City 0 ,cg State Qualifier Name - Flood Zone in 0 .3e61 .3e61 X93- 3a 63 to Zip B'��x' Qua /7/4 State Certificate or Registration No. ail fa i V'3'/ ,61" Certificate of C3 0'6 Z,C Phone # (7.'°" r1' - 63 f Competency No. �?} Contact Phone (5o5) 773 -.8_243_ E -mail ►f.r .46 i7-E+ ' , J,L"Gz'.i zud Architect/Engineer's Name (if applicable) Phone Value of Work For this Permit $ y'%,Q, Type of Work: DAddition [Alteration Describe Work: if/V ' ' ' ' J Sub Square / Linear Footage Of Work: [New 9/Repair/Replace Permit Fee $ eesw [] Demolition CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ : DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City ti State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 5u u si To -7 I04 ( l Zip l ? 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 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 ' 's ; , notice, the inspection will not be approved and a re- inspection fee will be charged. Signature Owner The foregoing instrument was acknowledged before me this g g day of ,20 IQ, by who i( personally known to 14or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires :: ** **** * ** APPROVED BY AKA KOK Kg Comiliastalsoller n. Cam C .0033 Mie1A )MKeediell r 8e'iexY4r***** **************** b* f® 2- Li fans Examiner e�C Contractor The foregoing instrument was acknowledged before me this day of d .' , 20 /d, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 4 Sign: Print: NOTARY PT nLtC -e? err OF FLORIDA My Commission E ,� t_ 'l1 �7 *a Martinez Gorn,nissicn #DD918302 yw,„ ,, ;wires: SEP. 15, 2013 BONDED A.'iZ..i..4TIm BO? DING CO.,U c * * * * * * ** * * * * * * ** * * * * * * ** * * *qtr * * ****,Y****** Engineer (Revised 07 /10/07)(Revised 06/10/2009) Zoninj Clerk checked MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A RILL — 00 NOT PAY RENEWAL RECEIPT NO. 142247-6 CC # 000016300 142247 -6 BUSINESS NAME / LOCATION EFJ ELECTRICAL CONTRACTOR 7166 SW 47 ST 33155 UNIN DADE COUNTY OWNER FRANK M DIAZ Sec. Type of Business 196 ELECTRICAL THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. CONTRACTOR FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 23 WORKER /S 1 PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR 09/13/2010 02230009001 000075.00 SEE OTHER SIDE MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 DO NOT FORWARD EFJ ELECTRICAL CONTRACTOR FRANK M DIAZ PO BOX 347905 MIAMI FL 33234 laa�Laas�ia aala�aai�a alrai,aaal'a�ri��aa ra�alajtalaala�a�ali�l 2010 MUNICIPAL CONTRACTOR'S 2011 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10 -24 EXPIRES SEPT. 30, 2011 RECEIPT NO. 30- 1422476 CC NO: 000016300 BUSINESS NAME / LOCATION EFJ ELECTRICAL CONTRACTOR 7166 SW 47 ST OWNER :FRANK M DIAZ SEE BACK OF RECEIPT FOR A LIST OF NON- PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI -DADE. COUNTY TAX COLLF.GTp713 / 2 010 02230009002 000200.00 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 23 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD EFJ ELECTRICAL CONTRACTOR FRANK M DIAZ PO BOX 347905 MIAMI FL 33234 16 taa tia rallaaa 1, laa lla A.. iL-11ataatlaraalrirliaaa,lalal; or! CT B Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETEN 00001 6300 EFJ ELECTRICAL CONTRACTORS D,B A Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 13°'"1 MAF 2 3 201@ BY: . ...................... Permit No. El -4 4 Master Permit No. Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) :.4.4 Phone # 3 . 7 " p5 99r Owner's Address 03 79 ,414 70;5, City Aff / crone , 4ort /State Zip 0.30 Tenant/Lessee Name Phone # -� Email Job Address (where the work is being done) 37f ‘ 744 -gfr. City Miami Shores Village County Miami -Dade Zip 3,1,0c' FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name a A Phone # 40 vygo °`,11‘ff Contractor's Address 7/ 44, 4? - 1 City 10 a e ;° State Zip 3 5 /.f Qualifier Name "� ��� Phone # State Certificate or Registration No. a iZ 1,541 /Aril' Certificate of Competency No. Contact Phone e z 74,:o -JZ E -mail 4C 4.4. "' wig' . Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 19. Square / Linear Footage Of Work: Type of Work: DAddition []Alteration ❑New l R e air/Re p lace Demolition Describe Work: �.0 �e4p;,2„,70_40,„40; � pleesi ,. , 6411, ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fees 'i bmittal Fee $ . Permit Fee s_; ®Prv® Notary $ Training/Education Fee $ Technology Fee $ i -1A05-- ' �" Scanning $ '3 00 Radon $ DPBR $ _ Bond $ Double Fee $ Violation date: Structural Review. $ * * * * * ** * * **** * *** * * *' * * * * * * * * * * ** CO /CC $ Total Fee Now Due See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip //,n Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip (4 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 p to the job site for the first inspection which occurs seven (7) days after the building permit is iss In the absence of such poste notice, the inspection will not be approved and a re- inspection fee will be charged. The foregoing instrument was acknowledged before me this day of ,20 ,by Ali 4/ ' QT P4 Signature The foreg day of who is personally known to me or who has produced _ who is As identification and who did take an oath. NOTARY PUBLIC: ontrac ment was ackno ,20I Sign: Print: ,e)ht/ 69 My Commission Expires: known to me or who has produced ification and who did take an oath. OTARY PUBLIC: l� �N� Y � " q DANIEL yI, BARCIA s1± $ Notary public - stab d Roma • 3»'� A n MY/ ionE APr 21.201 � * * * * * * * * * * * * * * * * * * * * ** *�;< , * * *�x1Itte7 ** . nom BaldedTMOughNaomi Mal AM APPROVED BY ie, Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Sign: Print: My Commission Expires: e) ate'.' sO ,4 %."421y ; 1 ". ***************** *** ** * ** *** * * �FSf�e* ** ******* *** Zoning Clerk checked Protect Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 09/20!2010 Applicant 379 94 Street Miami Shores, FL 1132060136130 Block: Lot: WILLIAM JONES Owner Information WILLIAM JONES Address 379 94 Street MIAMI SHORES FL 33138 -2842 Phone CeII Contractor(s) Phone CeII Phone EFJ ELECTRICAL CONTRACTOR (305)793 -3263 Valuation: Total Sq Feet: Type of Work: ELECTRICAL Additional Info: FIXTURES & RECEP. REPLACEMENT Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.40 $300.00 $3.00 $50.00 ($50.00) $1.60 $306.20 Pay Date Pay Type Invoice # EL -3-10 -37374 03/26/2010 Credit Card 03/23/2010 Credit Card Amt Paid Amt Due $ 256.20 $ 50.00 $ 50.00 $ 0.00 $ 1,200.00 0 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 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 March 26, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy March 26, 2010 Date 1 ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/30/2009 TYPE OF INSURANCE PRODUCER (305) 270 -1424 Pan Am Assurance en Agency, 9100 Sunset Drive Miami FL 33173 Inc -3433 THIS CERTIFICATE IS 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 NAIC # INSURED FRANK M. DIAZ D /B /A EFJ ELECTRICAL CONTRACTOR LIC # 000016300 7166 SW 47 ST MIAMI FL - INSURER A. NORTH POINTE CASUALTY INS GENERAL INSURER B: 3094121191 INSURER C: 12/01/2010 / / / / / / INSURER D: $ INSURER E: X COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IDS RD TYPE OF INSURANCE POUCY NUMBER DATE (MM/FDD/ POUCY YjN LIMITS A GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY 3094121191 12/01/2009 / / / / / / 12/01/2010 / / / / / / EACH OCCURRENCE $ 1,000,000 X PREMISES (Ea occurrence) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JEC ' I LOC PRODUCTS - COMP /OP AGG $ 2,000,000 A AUTOMOBILEUABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 3094121191 12/01/2009 / / / / / / 12/01/2010 / / / / / / COMBINED SINGLE LIMIT (Ea accident) $ 100,000 BODILY INJURY (Per person) $ _ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) GARAGE UABIUTY ANY AUTO / / / / AUTO ONLY - EA ACCIDENT $ —1 OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / / / / / EACH OCCURRENCE $ —1 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below / / / / / / / / WC g T� 7H I TORY LIMBS I I OER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER / / / / / / / / / / / / DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION ( ) - CITY OF MIAMI SHORES 10050 NE 2ND AVE MIAMI (305) 756 -8972 FL 33138- SHOULD ANY OF THE EXPIRATION DATE THEREOF, DAYS WRITTEN ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE THE ISSUING INSURER WILL ENDEAVOR TO MAIL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE - REPRESENTATIVES. FAILURE TO DO SO SHALL INSURER, ITS AGEN AUTHORIZED REPRESEN , `'f/ L��� ®,`" // J --! ACORD 25 (2001/08) A� INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327 -0545 © ACORD CORPORATION 1988 Page 1 of 2 Prepared by and return to: Balzli and Associates 1111 Lincoln Road Suite 400 Miami Beach, FL 33139 (305) 538 -1765 File No.: 10 -0007 Recorded Electronically ID 3tsc K 7.21:3 P1,6C 7'?O County td/1 iNc Date t :2c:40 Time ; Y I A Simplif Ie.com 800.460.5657 WARRANTY DEED This indenture made on March "Z-, 2010, by Robert G. Hawk, a single man whose address is: g I If 5!. Wl j kKi s c es F� 3 c3 j� O hereinafter called "Grantor ", to William J. Jones whose address is: 379 N.E. 94th Street , Miami, FL 33138 hereinafter called "Grantee ": (Which terms "Grantor" and "Grantee" shall include singular or plural, corporation or individual, and either sex, and shall include heirs, legal representatives, successors and assigns of the same) Witnesseth, that Grantor, for and in consideration of the sum of Ten Dollars, ($10.00) and other valuable consideration, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto Grantee, all that certain land situate in Miami -Dade County, Florida, to -wit: Lots 15, 16 and 17 inclusive, of Block 45, of AN AMENDED PLAT OF MIAMI SHORES SE .trION NO. 1 according to the plat thereof, as recorded in Plat Book 10, Page 70, of the Public Records of Miami -Dade County, Florida. Parcel identification Number: 11 -3206- 013 -6130 Subject to all reservations, covenants, conditions, restrictions and easements of record and to all applicable zoning ordinances and/or restrictions imposed by governmental authorities, if any. Together with all the tenements, hereditaments and appurtenances thereto belonging or in any way appertaining. To Have and to Hold, the same in fee simple forever. And Grantor hereby covenants with said Grantee that Grantor is lawfully seized of said land in fee simple; that Grantor has good rightand lawful authority to sell and convey said land; that Grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances except taxes accruing subsequent to January 1s'.,2010. F1, FA DEED - Warranty Individual Join By Spouse Rev. March 8, 2010 Page 1 of 2 File No.: 10 -0007 In Witness Whereof, Grantor has hereunto set their hand(s) and seal(s) the day and year first above written. s and delivered in our presence: Wit ess Print Na Witness Signature Print Name: State of Florida: County of Miami -Dade: Sworn To, Subscribed and Acknowledged before me on 3 R &?U) by Robert G. Hawk who is /are personally known to me or who has/have produced a valid drive 's dense as ' • tifi . do >+it` °ot Notary Public State of Florida Mark 0 Balzli My Commission 00678768 0,0- Expires 06/28/2011 FL FA DEED- Warrant} individual Join By Spouse Rev. March 8, 2010 Notary Public 01 ague_ teLA Printed Name of Notary My Commission Expires: 5 / Z 51/.--2-c5 r / Page 2 of 2 File No.: 10 -0007