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DEMO-10-1587
iami Shores Village Building Department ;0050 N.E,2nd Avenue, Miami Shores, Florida 33138'. Tel: (305) 795,2204 Fax; (305) 756,8972 CTION'S PHONE NUMBER: (305) 762.4949 BUILDIN PERMIT APPLICATI FBC 20( Permit Ty e: BUILDING Owner's Name ee Simp e Titleholder) Owner's Address /OW A/6 City /ft/1AI/ .3,/ef e75 State Tenant /Lessee Name �� ,� I() Permit No. z, _/ 1 t �� i �, j aster Pertni.t. No. Email A k/'� 77/1/ --C -' y., OFIN %l Z / /NIj�t_�. l Phone# T �J f CJ3 s-1)-1()1/(////,)//)// r'/c% c f S 12- ?`_, ' Zip t > j ! Phone # Job Address (where the work is being done) AN/ A e 2(; S % City Miami Shores Villaee * -> y County Miami -Dade Zip .�-57 < FOLIO / PARCEL # (Li \\,; ._ t�? Lc`.'C . l� � Is Building Historically Designated YES Contractor's Com any Name ?l1.irac.toC „s fiVF NO (` Phone Flood Zone --f Ct i P1/16iie.# Mate Certi irate or RegiOi Contact Phone Architect /Enginee Certificate of Competency No. Value of Work For this Permit $ Type of Work: Describe Work: Addition ❑Alteration Phone # Square / Linear Footage Of Work: ❑New ,67)0 _sv ❑ Repair /Replace EAN c_. /7L !/L isA7/�c, ✓I_,S' G� %AIL emolition ** r * *** * ** :* * * ** *:4* * * * * * * ** *. ** * * * * * * ** Fees * * :i * ** * * * * * * * * Submittal Fee $ Notary $ Scanning $ Double Fee $ Pernut Fee $ *F * ** *** * *** ..•; * *;tr. ** ; CCF $ Training /Education rW'S Radon $ DPBR $ Violation date: Structural Review. CO/CC $ Tecliiiologr Bond $ Total Fee Now Due $: —RD See Reverse side --> Bonding Company's Naive (if applicable) Bonding Company's Address City Mortgage Lender's ie (if applicable) Mortgage Lender's ess City State ` Zip Zip Application :as. ereby Made MI: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 ,l eritiit and that all work will be performed to meet the standards of all laws regulating - construction'imt this jurisdiction. I understand that a separate pernut must be.secttred for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS and AIR CONDITIONERS, ETC... - OWNER'S AFFHI?AVIT: Z certify that -a 1 tie foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction. and Mining. "WARNING TO O ER; 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 ATTORNE Y BEFORE RFCORDING YOUR: NOTICE OF COMMENCEMENT.r . Notice to Applicant: _Asa condition to the issuance oj'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 deli-vered.w the person whose prop § zs ubj o attachment. Also,, a eert0g41 copy of the recorded notice of cc!. fnt must be posted at the job site for OOP OptionliAich occurs .seven (7) days- r the budding pe. riit is issued. 't a /once of such posted notice, the inspectiati. iw2'be approv:i anda reinspection fee will be charged. Signature The t1 day wh er or Agent it was acknc le .:, • vital a me or who has produced ®, MP b l a s dentification and who did take an oath. n NOTAR UBLICr _ Signature Contractor The, foregoing instrument was acknowledged before me this , by yrho is personally known to nee or who has. - produced as identification and who did take an oath. la-`) NOTARY PUBLIC: Sign: Print: My Commission Expires: Sign; Print My Commission Expires: -}r****** .•** *** *- k**-:rir ;c:4t*A-k**** ;i;:'. ****:T:: * ***kr. z::ific *-,k *:4irir*:4* ********-kk-Y. ;t ****.A- 'k***:4A-****** APPROVED BY ,U P tans _Examiner Zoning * ** * ** ** ** **l:* Engineer Clerk checked (Revised 07 0 /(MilTtevised 0611.0/1009), 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: /1�1A/Cr ?rC /A-�U�/ DATE: YAM) ADDRESS: /OW T/ A/L '7 St ft- 53/3(i 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 IAA 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. 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 license numbers 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 substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. In +al 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. Initial 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. 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.mvfloridalicense.com /dbpr /pro /cilb /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: 1041 AC Q(o s7 M (Mt ®RSS PL .s313 8 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 contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of By M MK NWA,` rc LNS& -14 ,2 who was personally known to me or who has Produced there License or ;` �- .1 U' Ml) , identifica ion. NER 4:` F LDRIDI, C.".031.6s aisnd - ]-D727923 EF,E, 23, 2C 1 BONDED THRU ATLASNTIC BO DIING CO., INC. NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO./0-151T TAX FOUO NO STATE OF FLORIDA COUNTY OF MIAMI -DADE: 0 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: 111111111111 1 11111111111111111111111111111111 CFN 2010R0681046 OR Bk 27446 Ps 3977; (1ps) RECORDED 10 /07/2010 09:04:10 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTYr FLORIDA LAST PAGE Space above reserved for use of thug office /ow /fre 9'6v- /1/fl4/ CA/cheer 33/3 2. Description of improvement: pt/&1° OF l4freieu C_. -Ls ,e0A �►�t [ z/ wD�•S Lt �f) J?.4rftiuVAC- dF peru rt L d- free-Ile 4.e- s ' (..l ,$ 3. Owner(s) name and address: /f14 UrCil!/4tS,AI Interest in property: i M1/4/4,41.... Name and address of fee simple titleholder: 4. Contractor's name, address and phone number. ( vA, ,t- %WUL-4e -O _ 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone n /V/44 Amount of bond $ ,!� A 6. Lender's name and addrEiss: AVA 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(1xa)7., Florida Statutes, Name, address and phone number I1A1Q 1//ITC,E/ #A.1'OM/ /t9 ¥/ /I/4 P6 4r /F /Am'/ )// f i. ?,3/38 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, address and phone number. + r r v 6 L !b (/1 AV,. "6 ,4 q/lit 5,6(002 401' c 33/343 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 AI- I H 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 Owner(s) or Owner(s)'.Authorized Of icer/Director/Partner/ManagerI 7,, Print Name r r v c yPrepared By ns "j Prepared By r ,i&1 % S7 Print Name Title/Office ., . lieL, Title/Offlce STATE OF FLORID ��' COUNTY OF MIAMI-DADE tsr m nt C v, f The foregoing instrument was acknowledged before me this day of Q Individually, or ❑ as for C] Personally known, or tql6rroduced the following type of identification: Signature of Notary Public: • Print Name: (SEAL) Under penalties of perjury, I declare that I have read the foregoing and that theiacts stated in It are true, to the best of my knowledge and belief. Signatures) of Own sj • r Owner(sys Authorized Officer /Director/Partner/Manager who signed above: By 129.01.621PAGE 3 ono By STATE OF FLORIDA, COUNTY OF DADE HEREBY CERTIFY that this 1s a tru py of the rngmal filled in t office on day of , A D 20 NITNESS,p hand and Official Seal. HARVE VIN, CLERK, of Circuit and County Courts By 111111111► 1-1.7)g D.C. 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1041 NE 96 Street Miami Shores, FL 1132060143720 Block: Lot: MARK HUTCHINSON Owner Information MARK HUTCHINSON Address 1041 NE 96 ST MIAMI SHORES FL 33138 -2551 Phone Cell Contractor(s) HOME OWNER Phone CeII Phone Type of Demo: Building Additional Info: INT. DEMOLITION Classification: Residential Scanning: 3 Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee Radon Surcharge Scanning Fee Technology Fee Total: Amount $0.60 $2.50 $0.20 $5.00 $100.00 $2.50 $9.00 $0.80 $120.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9 -10 -38855 09/30/2010 Credit Card $ 70.60 $ 50.00 09/03/2010 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final 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. September 30, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 30, 2010 1 q11,4 (ID Permit No: 10 -1587 Job Name: September 23, 2010 Miami Shores Viiiage Building Depart ent Building Critique Sheet 2nd 10050 N.E.2nd venue Miami Shores, Florid 33138 Tel: (305) 7 5.2204 Fax: (305) 7 6.8972 Page 1 of 1 1) A demolition permit application for electric, plumbing, and Mechanical are required OK 2) A demolition permit for the exterior items will not be issued until a permit to close LIp has been applied. Not corrected 3) Identify all interior bearing walls on plans. OK 4) Provide temporary shoring plan for areas that bearing is to be removed.OK Plan review is not complete, when all items above are corrected, we will do a complete pl review. If any sheets are voided, remove them from tl-e plans and replace with new revised sheet include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 n and Miami Shores Vivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT x(X)1-4.oi0is%/Dnre aOh() ❑ Contractor (t�Owner © Architect Pic Address: a XC$t S4 J From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand tha . e plans need to be brought back to Miami Shores Village Building Dep ment continue permitting process. Acknowledged by: r1 PERMIT CLERK INITIAL: RESUBMITTED DATE: gin I 0 PERMIT CLERK INITIAL: Permit No: 10 -1587 Job Name: September 7, 2010 Miami Shores Viiage Buildin g p De artnfent 10050 N.E.2nd venue Miami Shores, Florida 33138 Tel: (305) 785.2204 Fax: (305) 756.8972 Building Critique Sheet Page 1 of 1 1) A demolition permit application for electric, plumbing, and Mechanical are required; 2) A demolition permit for the exterior items will not be issued until a permit to close up has been applied. 3) Identify all interior bearing walls on plans. 4) Provide temporary shoring plan for areas that bearing is to be removed. Plan review is not complete, when all items above are corrected, we will do a complete pl n 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 Prepared by and return to: Eric van der Vlugt, Esq. Vice President Clear Title Services, Inc. 1111 Kane Concourse Suite 209 Bay Harbor Islands, FL 33154 305 - 865 -5718 File Number: 10 -0406 Hutchin Will Call No.: [Space Above This Line For Recording Data Warranty Deed This Warranty Deed made this 23rd day of August, 2010 between Clara Isabelle Trustee(s) of the Clara Isabelle Washington Revocable Trust under Agreement address is 98 -1094f Komo Mai Dr, C/O Carla Uestato, Aka, HI 96701, grantor, an whose post office address is 1041 NE 96 St. , Miami Shores, FL 33138, grantee: (Whenever used herein the terms "grantor" and " grantee" include all the parties to this instrument and the individuals, and the successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/ good and valuable considerations to said grantor in hand paid by said grantee, the rece has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns fo situate, lying and being in Miami -Dade County, Florida to -wit: Lot 14 AND THE EAST 1/2 OF LOT 15, in Block 82, OF MIAMI SHO thereof, recorded in Plat Book 10, Page 37, of the Public Records of Miami - Parcel Identification Number: 11-3206-014-3720 SUBJECT TO: 1) Taxes for the year 2010 and subsequent years and all applicable governmental regulations. 2) Conditions, restrictions, limitations, and easements of record; if any, but reimposing same. Together with all the tenements, hereditaments and appurtenances thereto belonging or To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized grantor has good right and lawful authority to sell and convey said land; that the grantor h land and will defend the same against the lawful claims of all persons whomsoever; encumbrances, except taxes accruing subsequent to December 31, 2009. In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and y Washington, Individually and as ated 4/19/1988 whose post office Mark Hutchinson, a single man heirs, legal representatives, and assigns of 00 DOLLARS ($10.00) and other whereof is hereby acknowledged, ver, the following described land, S, according to the Plat ade County, Florida. zoning ordinances and without the intention of anywise appertaining. f said land in fee simple; that the reby fully warrants the title to said and that said land is free of all first above written. DoubleTimee Sign :T•jj jI!r�: vered in our presence: Witness Name: State of Florida County of Miami -Dade 6.19".4.4.-- 9"/ Clara Isabelle Washington, Trustee d Individually The foregoing instrument was acknowledged before me this 20th day of - % ��,∎ by Clara Isabelle Washington, Trustee and Individually, who [, is personally known or [X] has produced a ., as identification. // [Notary Seal] 1 Warranty Deed - Page 2 GEROLD VAN DER VWQT MY COMMISSION 6 DD 958939 Bonded Til u Notary Public Un 1 lip Printed Name: My Commission Expires: DoubleTlme® Sep 27 10 08:02p • Joseph B Keller & Associa Kalle, 9549262841 p.1 FAX TRANSMITTAL SHEET architecture - interiors - planning JOSEPH B. !CALLER + ASSOCIATES PA 1 us 26001212 date: q- 2$' --10 time: �: attention • g-- look min) ]-(so -7os ' Ai p- o ki1d - fax: from: reference: T tC11 Q (DkiJCC — f .04/ /Jp f,, 4= project # : PM141Ti ii PT Number of pages including this one: f ri 2417 Hollywood Blvd. kaller@bellsouth.net Hollywood, Florida 33020 -6605 (954) 920 -5746 phone (954) 926 -2841 fax www.kallerarchitects.com Sep 27 10 08:03p Joseph B Keller & Assooia Y• KaIIe; JOSEPH B. !CALLER + ASSOCIATES PA) AA* 29001212 9549262841 p.2 architecture - interiors - planning September 28, 2010 Miami Shores Village 10050 Northeast 2 Avenue Miami Shores, FL 33138 Attention: Mr. Norman Bruhn Reference: Hutchinson Residence 1041 Northeast 96Th Street Miami Shores, Florida Permit #10 -1587 Architect's Project #10129 Dear Mr. Bruhn: This letter certifies that there will be no exterior demolition to the existing residence, nor any replacement of windows at 1041 NE 96th Street, under this Demolition Permit. Should the Owner request exterior demolition or window replacement, it will be applied for under a separate Permit. Should you have any questions, please feel free to contact this office. Sincerely, Joseph B. Kaller & i s . ci ; tes, P.A. oseph k3. Kaller, LEED AP President 2417 Hollywood Blvd, Hollywood, Florida 33020 -6605 (954) 920 -5746 phone kaller@bellsouth.net (954) 926 -2641 fax www.kalleran�itects.com 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 f ��y Permit No0e Q � f )'r' BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: N. e (F Simple Address: 0" ff : Sall City: TJEC. 9 2010 BY:.. ..... ..... .......... Master Permit No. 7Cv '74/ o hone #: 9 1: W5- 970S— State: ft__ Zip: Tenant/Lessee Name: Phone #: Email: 41m/m rC #`/'S /rj- t' eCkimA/DE ®Cviek, JOB ADDRESS: /0 y! /we._ 7 City: Miami Shores County: Mb Miami Dade Folio/Parcel #: 1/- 3z9&— 9/% '-3 W Zip: 337 3 a Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: WA/ /9Lt Flood Zone: Phone #: Address: 5 A me. 44$ ,4 & 0-V' City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: DESIGNER: Architect/Eng�,xe Ei mm ail Q .dress: e i — C 7P` h one #: ?5L/ ? Z/ 57(l, Value of Work fo Square/Linear Footage of Work: Type of Work:, ❑Alteration ONew URepair/Replace ODemolition /� GvS ti ®. ,,00 �/ Descriptio�ta °° �, r;a`� t V% �C/1%C!— � / � aP I w � d (l 0{� COLON, HROUGH ROOF TILE IS REQUIRED acknowledged by: ********* * * * * * * * * * ****** * ***** * ****** ** Fees * * ** ******** * * * * * * *** * * * * *** * ****** * * * ** * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ° Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) OWN LINK PENCE 0.2.0' EAST OR-IJNE CHAIN UNK RICE 0.80' wEsr 7.00' PARKWAY Property Address: 1041 N.E. 96 STREET, EL PORTAL FLORIDA 33138 • mateszsgssmismsn, ottussiczarrerria rasa isoutinmy ow& ta tows moo rxworaiscsuourarnotwo. sumer PlaIPMED MOM trrancox.rtestcowvue; wrnt Tits intwarrescoateAL • 4k1, SZTRIRIK Mete sure MFLORICAnciARD PRORMIONAL Sitrira PLORICARIMMISTIMTPACOM PM:MAIM 1042.024RLOiliMST tOts,tec • ke• • SIGNED Walla ESP BOVE OF FOR J$E WOW P.3.144. NO sic!. torbuzikatmwr emitrilanKituatemattelbatpzummosamsaifitameneaszcoulentumwori 1401awansinytm4.10eancus 1014051411.518100 0240:11131701X,076BDSHAMW LICIDIZOSIMITOPI DACOOPOIP. Notes: NO NOTES MIGUEL ESPINOSA SURVEYING INC 10665 SW 190 Street Suite 3110 MIAMI, FL 33157 PRONE:(305) 740-3319 FAX #:(305) 669-3190 LB # 463 Accepted By Survey: A-16947 PAGE 1 OF 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 151113 Permit Number: DEMO -9 -10 -1625 Inspection Date: February 14, 2011 Inspector: Hernandez, Rafael Owner: HUTCHINSON, MARK Job Address: 1041 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: PROFESSIONAL PLUMBING CORP Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 1132060143720 Phone: (305)822 -8282 Building Department Comments REMOVE FIXTURES PLUMBING ABD TRIM IN 2.5 BATHS AND KITCHEN & CAP WATER SEWER. Passed Inspector Comments They would like a partial inspection. l *A 2-:" ' E, ` Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 February 14, 2011 Page 1 of 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1041 NE 96 Street Miami Shores, FL 1132060143720 Block: Lot: MARK HUTCHINSON 1 Owner Information Address Phone CeII MARK HUTCHINSON 1041 NE 96 ST MIAMI SHORES FL 33138 -2551 1 Contractor(s) Phone Cell Phone PROFESSIONAL PLUMBING CORP (305)822 -8282 Valuation: Total Sq Feet: $ 1,000.00 40 1 Type of Demo: Plumbing Additional Info: PLUMBING DEMO Classification: Residential Scanning: 1 Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee Radon Surcharge Scanning Fee Technology Fee Amount $0.60 $0.20 $0.20 $100.00 $0.20 $3.00 $0.80 Total: $105.00 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9 -10 -38902 09/30/2010 Credit Card $ 55.00 $ 50.00 09/10/2010 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final 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. September 30, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 30, 2010 1 BUILDING 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) 762.494 L Permit No. PERMIT APPLICATION FBC 20' Permit: Type: PLUMBING Q 41, t�v +t:C� I e' _I,� / - (�(f '7a Owner's Name (Fee Simple Titleholder e/ 1 . ''� Phone # Owner's Address 0 ti l %� =.tto : S City f w S o/ c i State r SEP 1 0 }� V1t:1 (� -1Lt, 010 Master Permit.No.'DPmo— el- .Ito - iSB1 33 l 3g Tenant/Less Zip Name Phone # Email %Yl v t d %7/'v pq(o►..rld t : Coivt /J Job. Address (where the work is being done) i O 84 ( NE qr. S7' City Miami Shores it a County _Miami Dade Zip . es :38 " 2.551 FOLIO/ PARCEL # Is Building Historically: Designated. YES NO .: Flood Zone Contractor's Company Name f r9 SjtfV i( a vd1)a: in CO Phone # acts- 8 22- 8Z !M. Contractor's Address 115s u) 3 cN eq... City .1410! 1 e0,00.% . .. t�State FL. Zip 8301.2.. • Qualifier Name m01 r V tk. 1. ` i " 1 On S� Phone # .' .�js*- —,01‘.. , �G� Q State Certificate or Registration No. .fG 'OSOS 4 Certificate of Competency No. �+ Contact Phone3 05 9 2;,,z, 8 f,,,' Z„ E-mail rnotI bns0 174-7-,---- . Architect/Engineer's Name (if applicable) Phone # Off Value of Work For this Permit $ 1 1 0 0 0 --- Type of Work:.. ❑Addition ['Alteration :New ❑ Repair/Replace "Demolition Describe Work: Square / Linear Footage Of Work: * * * * * *:* * * * * * ** Submittal Fee $ Notary $ Scanning $ ******************** * * * *Feee * * *fi* * * ** * * *#* ** * * * ** *air* * *A* * * * *** * * ** *114* Permit Fee $ Il� Training/Education Fee $ CClr $ .CO /CC $ Radon .$ Technology Fee $ DPBR $ Bond $, Double Fee $::. Violation date: Structural Review: $ . Total Fee Now Due'.,, 5 CO 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 arid 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 certed copy of the recorded notice of commencement must be posted at the job site for the first: inspection which occurs seven (7) days after the building .permit is issued: in the absence of such posted notice, the inspection will not b %r !' and a reinspection fee will be charged 1. Signature or Agent The foregoing instrument was acknowledged before me this %O day of Sep ,20 1(.t , by . "9(1 -k- ' .( , who is personally known to me or who has produced - --°- As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 5f-err a My Commission Expir c9. 4 1 P * * ** * * * * *** * ** * ** ** 0,1111,1,! BRENDA E. FERNANDEZ +� o �. yo: Notary Public State of Florida : .? My Commission Expires Feb 4, 2012 sa Commission # DD 754950 %Far, FL° ° . Bonded Through National Notary Assn. lrla�t otSSat .6.f,, a APPROVED BY • • 1. Plans • Examiner • Signature. Con ' actor The foregoing instrument. was acknowledged before me. this :IV day of , 20 VA by 1440.11144 g who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: �,,, ",•,•,; Eddy Jimenez J pRY plj p **********************70; , plfe5 * 'ET. .111 LU (1erdrdrsl Engineer (Revised 07/10107X Revised 06 /10/2009) Vie 0440F C4.0, Zoning Clerk checked ACORD CERTIFICATE OF LIABILITY INSURANCE DATE TYPE OF INSURANCE PRODUCER (407)628 -3441 FAX (888)883 -8680 Lassiter -Ware Insurance of Orange/Seminole, Inc. 9 PO Box 940159 Maitland, FL 32794 -0159 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Professional Plumbing Corp. Roma Corp. 1755 West 39th P7 Hialeah, FL 33012 INSURER A: Amerisure Mutual Insurance Co. 23396 INSURER B: Amerisure Insurance Company 19488 INSURER C: 09/04/2011 INSURER D: $ 1 000,000 INSURER E: $ 300,006 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. INSR LTR ADD'L NSRQ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATF (MMInr)/YYI POUCY EXPIRATION DATE (1 1nD/YY) LIMITS A GENERAL X LIABIUTY COMMERCIAL GENERAL LIABILITY GL20130350500 09/04/2010 09/04/2011 EACH OCCURRENCE $ 1 000,000 DAMAGE TO RENTED PRFMISFS (Fa nnafranca) $ 300,006 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10, 000 X Contractual PERSONAL &ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n JECT n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 8 AUTOMOBILE LIABILITY ANY AUTO ALL OWED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -0WEDAUTOS CA20022790601 09/04/2010 09/04/2011 COMBINED SINGLE OMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per acddent) $ GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA X LIABIUTY OCCUR CLAIMS MADE CU2064256 09/04/2010 09/04/2011 FACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,006 X DEDUCTIBLE RETENTION $ 0 $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC2025619 12/12/2009 12/12/2010 X TORY LIMITS 9N - E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Miami Shores Village Building Department 10050 NE 2nd Ave 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 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGAT1ON OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Christopher McClain /LORRIL ACORD 25 (2001/08) FAX: 305.756.8972 ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) 4 • _ --• - • - e ■ 0451 BUSINESSNI PROFE, 1755 O;NOT pAY 77 045166-6 STATE# CFCO5356O DO NOT FORWARD SEE OTHER SIDE PROFESSIONAL PLUMBING CORP MANUEL ALONSO 1755 W 39 PL HIALEAH FL 33012 1111111111111111111-11114013111111 31111111311111131.111 PRINTED WITH ENVIRONMENTALLY FRIENDLY GREEN INKS FSC Mixed Sources Product group horn well- managed forests and other controlled sources Cent no scs- cocooz>n www.fs .org City of Hialeah Business Tax Receipt Manor Julio Robaina 2010 -11 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION L/ CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 Ai,Ja4SC, �:tANC E PROF SSTO N r, PLUMP :Nc CORP 5305 SW 186 AVE SOUTHWEST RA CHFS FL 33332 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 TATSOFfFt FIOA : t 59 2 PART i OF BUSINESS AND AO SS A REGULATION 1080188,92 Hr th6''proV 33 BATCH NUMBER'';` Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 10--(sw-+ Inspection Number: INSP- 157722 Permit Number: DEMO -9 -10 -1665 Inspection Date: April 05, 2011 Inspector: Devaney, Michael Owner: HUTCHINSON, MARK Job Address: 1041 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: HI TECH ELECTRIC & FIRE CORP Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1132060143720 Phone: (786)543 -5216 Building Department Comments DEMOLITION OF WALL WIRING AND EXPOSED CONDUITS DURING WORK Passed Inspector Comments CREATED AS REINSPECTION They would like a No access. Remove FOR INSP- 151416: partial inspection. E.N.T. from outside. Need G.F.I.protected receptacle. ,,� f� 00 (/ I Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. . i° ,42,/ / 1/2"� ®f� d // (-''/ -+ � until For Inspections please call: (305)762 -4949 April 05, 2011 Page 1 of 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 Permit Type: L 7 / C OWNER: Name (F - Simple Titleholder): RA/4C— / i reAff/ 'Sett✓ Phone #: 9517-4457: J `7 /' 5 7 0 Address: 14.4 < S7 City: State: Zip: 3/ 3 g Permit No. 0'76 Master Permit No. /0- e Tenant/Lessee Name: �� Phone #: Email: JOB ADDRESS: 54,011/6,E City: Miami Shores p{� p� County: Miami Dade Zip: Folio/Parcel #: < 1 °3OC 0 6 ©/ V "/ 2-O Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: '4 t T'-w EC ecy, C * f Phone #: 7e6 3 74 0 ` 3( Address: /si90 Ste.) //" �f City: Rol ,i State: A//.1/ Zip: 3 3/ 74 04- Qualifier Name: /1W6 °`•7° l✓0 x Phone #: 1e Z6 o 3 / 2 Z ; .73j a State Certification or Registration #: 1.6 / .e9.-')2.6-e9 g' Certificate of Competency #: Contact Phone #: Email Add ess: DESIGNER: Architect/Engineer: j E l/C#A1A iA/ 64/4 ' hone #: Value of Work for this Permit: $ 6720 Square/Linear Footage of Work: ./t/A Type of Work: UAddress Alteration New ORepair/Replace ❑Demolition Description of Work: 9D/ ft CO( 7(0^/-5 11/175 �a f r-0lt ¢/L A4 0 61117f 1 X940 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ********** ** * * *** * * ** ** * * * *,r ** *** * * ** * *F *, r*********** * *** * * * * ** * * ******* * *** ** * * ** ** Submittal Fee $ Permit Fee $_/—r:'-'`- -_ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Sta 4 Zip 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 subje,t t6 attachment. for the first inspection h' h occurs inspection will not b, ap,�ro -d n Signature Also, a c copy of the recorded notice of commencement must be posted at the job site sev days after the building permit is issued. In the absence of such posted notice, the einspection fee will be charged. Agent The foregoing instrument ,as acknowledged before me this t The foregoing instrument was acknowledged before me thisl day of , 20 \ \, by DANA- �+IA (RCH ( , who i rsona y to me or who has produced 1 who is personally known to me or who has produced As identification and who did take an oath. J (.0.5).09 51�1'diiation and who did take an oath. NOTARY PUBLIC• , \\\\\ulnuiin,, Signature Contractor day of , 20 I I , by Sign: Sign: Print: ' �� �O� `s:_ % Print: My Commission Expires: : Co ��` >,� : My Commission Expires: DOifs� /o�UBlf� Y P tpiltt *** *, ********** �r* �r, r�r�r�r ****�r,�**** * ** *�r **** * *** *tie * *** * * * * * ** ****ter * ** * * * * * * * * * * * * * * * * * * * * ** /�%,Q. aa`,°. „ `'ter „ c_ / /,,/r / ??, D lA i l 1 \1 \\ \,0\`e 11111)1111 \ \ \``` APPROVED B % Z. 13,,9/L Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR 1 ARCHITECT Permit N. /6.-/6 Owner's Name (Fee Simple Title Holder : 11 iA 4,tr NUN' Owner's Address: 0 4 1' ' c ST City: r> ' r 65 State : Job Address (Of where work is being done): City: Miami Shores Phone #: (?5-4-1(417--`77.05— Zip Code: "53 (r5 Q State: Florida Zip Code: 0(''9 Contractor's Co ny Name: gain/6A gr fLa2f /Ji1 EteC7 4Fone #: 30 C-8 5-5-CO Address: '7 O W 2-5 L 1i/- City: L State:_ Zip Code: -3Of Qualifier's Name : Lic. Number: Architect/ Engineer of Record Name: Jolt /((_u - ifgo/Tz? r Address: c7.iffi 444 3,1 V City: 1IWO Describe Work: RtMV 4'77b,✓ State: FL- Phone #: ?5/-772-0-5-f77- ' Zip Code*) 20 I hereby certify that the work has been aba unable or un Ilin ' to com oned andlor the contractorlarchitect is e contract. I hold the Building Official and the ores harmless for all legal involvement. Signature 0 The foregoing instrument was aknowledged before me this f day of Ilkged ,20 lk,by Who istratipri to me or who has produced Notary Public: Sign: Seal: oaRlincigtification. 00\ wn i S S,; 0EXpir�J..�°��lo 3 /p6 /pjr 1, r N' Cpmm,fg � t O Ipn to F.L� Signature Contra Architect The foregoing instrument "s aknowledged before me this k, day ofl"c , 4 t by who is pattaHq Ianr�me or who has produced as indentification. `\`���Illltllllllll�e� •` \ nis ,, Notary Public: 'p ••. %''s, Sign: ' ' "4w,�'� .0% Seal: in Cod `s ,414/,( syf,'''. 86 ion ''''' Q� F FC Q R' ''P,''`'• l`ill►Ir111111,‘P` SOUTHEAST FLORIDA ELECTRIC, INC. 7880 WEST 25TH AVENUE HIALEAH, FLORIDA 33016 Phone #305- 822 -5500 Fax #305- 822 -0239 E -mail: southeast_ele@bellsouth.net March 9, 2011 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Re: Hold Harmless Letter Permit #10 -1665 1041 NE 96th Street Southeast Florida Electric, Inc. is submitting this Hold Harmless Letter to notify The City of Miami Shores Village Building Department that we are to be removed from the above permit #10 -1665. The owner of the property (Mark Hutchinson) has decided to have another contractor perform this work. Southeast Florida Electric, Inc. obtained the permit, but Southeast Florida Electric, Inc has not started actual work on the jobsite. If you should need any other information please do not hesitate to contract us at our office. . Horns #EC13002253 Date: 3/9/2011 Subscribed and Sworn before me this the By Richard . Hornsby Notary: Print: Barbara J. Gribbons My Commission Expires: 11/19/2013 9th day of March year 2011 sonally known. March 1, 2011 Attn: Rick Hornsby Southeast Florida Electric 7880 W. 25th Ave. Hialeah, Fl 33016 Re: Miami Shores Permit # 10 -1665 Property address: 1041 NE 96 St. Dear Mr. Hornsby: By means of this letter I am letting you know that the above referenced demolition permit from the Village of Miami Shores will be changed to a new electrical contractor. The electrical permit application that was left at the building department by your company will be voided since I have obtained a new electrical contractor. I therefore release your company of any previous responsibilities. If you have any further questions I can be reached at 954/445.9705, Sincerely, SENDER: COMPLETE THIS SECTION • Complete items 1, 2, and 3. Also complete item 4 If Restricted. Delivery Is desired. II o Print your name and address on the reverse- so o that we can return the card you. • Attach this card to the back of the maiiplece, or on the front if space perm. 1. Article Add ` Soo- '? f ,0�b@ �% g-t �,�o v� 9 P4 330tko 2. Article Number (Transfer from service label). PS Form 3811, February 2004 COMPLETE THIS SECTION ON DELIVERY ❑ Agent ddressee C. Date of Delivery D. Is delivery address different from item 1? in Yes No if YES, enter delivery address below: � 3. Service Type • yeas Mail CI Certified Mali D Return Receipt for Merchandise Registered CI Insured Mall CI C.O.D. 4. Restricted Delivery? (Extra Fee) 7008 2810 0002 2069 1303 Domestic Return Receipt O Yes 102595- 02-M-1540 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1041 NE 96 Street Miami Shores, FL 1132060143720 Block: Lot: MARK HUTCHINSON 1 Owner Information Address Phone Cell MARK HUTCHINSON 1041 NE 96 ST MIAMI SHORES FL 33138 -2551 1 Contractor(s) Phone Cell Phone SOUTHEAST FLORIDA ELECTRIC INC (305)822 -5500 Type of Demo: Electric Additional Info: DEMOLITION Classification: Residential Scanning: 1 Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee Radon Surcharge Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $0.20 $100.00 $0.20 $3.00 $0.80 $105.00 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9 -10 -38950 09/30/2010 Credit Card $ 105.00 $ 0.00 Available Inspections: Inspection Type: Final 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. 1 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 September 30, 2010 Date September 30, 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 Permit No. k SEP 1 7.2M BY:— Y O O1O- f(o(r5 Master Permit No. DEMO -9 -10 -1587 Permit Type: Electrical OWNER: Name (FeeSimpleTitleholder): MARK. \ kl4 t(1tisoNI Phone #: Address: 10 C—' N %L ST City: N I 12 S State: Tenant/Lessee Name: N X Email: M 6L._ Tit.m.tretP G-&A M0 a e O N&. 95q-445- Rgo-5- Zip: 331 Phone#: AKA JOB ADDRESS: 1041 NE 96th Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Southeast Florida Electric, Inc. Phone#: 305- 822 -5500 Address: 7880 West 25th Avenue City: Hialeah State: Florida Qualifier Name: Richard G. Hornsby State Certification or Registration #: EC13002253 Contact Phone#: 305- 822 -5500 Email Address: southeast_ele@bellsouth.net p DESIGNER: Architect/Engineer: ../O X,/ f.-L47 - Phone#: J w —62 Q 2 V20 O V fj° alue of Work for this Permit: $ Squar inear Footage . f Work: Zip: 33016 Phone#: 305- 822 -5500 Certificate of Competency #: 16138 Type of Work: ❑Address OAlteration ❑New ❑Repair/Replace emolition Description of Work: R.E.Wt Q VJ *L C9 F earvvAulptAs-ce,eu P A cr t 101/ p Tw o '"i"t I--rE - - fieTi4 (teS APiNC- OFF OE ,,q iy ELI_C C R-t e Ail.. (Alt 121 146-/C © nib u t Z F x.Po s Ep a 2r A16- DEjit a r»kIL ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fees * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ®O' 6' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ * * * * * * * * * * * * * * * * * * * * * * * * * ** CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $_ / () S of Bonding Company's Name (if applicable) Bonding Company's Address City State Zip NVA Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip NlA 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 properly 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'd and a reinspection fee will be charged. Signature 11 ■ r ■111r `swn-r • Agent Contract The foregoing instrument was acknowledged before me this 0 The foregoing instrument was ackno dged before me this 9th day of •Jf ,F.e , 20!D , by ( d «U YU-fl-Cr) , day of September , 20 10, by Signature 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: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * ** APPROVED Notary Public - State of Florida .E My Commission Expires Feb 4, 2012 ,o;; Commission # DD 754950 ;� °� ''' Bonded Through National Notary Assn. C' Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: _ � , p . a 11 '-' Print: Barbara J . Gri • ons My Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. x COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Southeast Florida Electric, Inc. BUSINESS ADDRESS: 7880 West 25th Avenue CITY Hialeah STATE Florida ZIP CODE 33016 BUSINESS PHONE: ( 305 ) 822 -5500 FAX NUMBER ( 305 ) 822 -0239 CELL PHONE ( 786 ) 258 -1590 QUALIFIER'S NAME: Richard G. Hornsby QUALIFIER'S LIC NUMBER: EC13002253 E -MAIL ADDRESS (IF APPLICABLE): southeast ele @bellsouth.net Created on 3119109 BY MLDV 1 RV 3126109 MLDV V' 43 44 4 3 V4r 1 11111AMMADE TAX comecroR W MASLEN SS 1st FLOOR M LOCAL BEIONESS TAX Riaapr 2040 . . MEAMI -DARE CO - STATE OF FLORA EXPIRES SOM. 34 PURSUANT TO comm.! T BE DISPLAY AT PLACE OF B CODE 8*- tSa10; '40T RENEWAL ' 471932-5 42803 - 3 PRDA ELECTRIC INC - NICIPALITIES LOC C?r ei -7 FIRST-CLASS MS. POSTAGE PA FL X231. amEn SOUTHEAST sew This IS OHM A LOCAL J Dos For pow TOE MOM Ta HOWE AST UMW ROSSAMA OR COMO LASS OP THE =MC Oft ann. SOH DOES Or paw Inim SUM MOS ANT OASES moor OR SCRAM SOSAHLS MESAS IC NTT A. TEE OE Of SISAL FLORI ELECTRIC INC xe' CI /ROUST /OFFICE SPACE rourearmesmo swilmmAnzeoutortTAN catterase /19/2009 02280021001 800075.00 SEE OTHER SIDE TM .E OR 14W Pk FILACII130 lst FLOOR FL 3130 AGOR.S4 FT 9977 DO NOT FORWARD SOUTHEAST FLORIDA ELECTRIC INC RICHARD 8 HORNSBY PRES 7880 W 25 AVE HIALEAH FL 33016 1,,11111 11911 111,ttl1tltuliltptttitII!MI tltill8 N,Il LOCAL RUSINESS TAX men ano ADE ODY -STATE OF ILO A POSTAGE , ;i PAM gusragotspuirmATPLACEOFBUSINIESS PURSUANT 0E CHAFFER OA -ARTS & D ROHM 140- 231 RENEWAL DA ELECTRIC INC STATE 02253 136868-7 7 •;:,U W 25 ABBE 33016 HIALEAH OWNER SOUTHEAST FL IDA ELECTRIC INC CAL CONTRACTOR SEE 15 ONLY it LOCAL HUSESESS TAX OGEE MEER TO COMM LAWS THE Ott STEM- NOS Fr mow THE MOST FROM ANCOTHISI poor cat mem netraptosiw For OE- INIUMFIS OUNinaik-; s seasammeozmarrouc /19/2009 0002001 1108135.00 SEE OTHER SIDE WORKER'S 40 00 NOT FORWARD SOUTHEAST FLORIDA ELECTRIC INC RICHARD 8 HORNSBY 7880 W 25 AVE HIALEAH FL 33016 ,Il i II7tilll11lltiUthjj$J ttliI11t 11$1illt7lll$ill1illiJlB II s I ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KV SOUTH2O DATE(MM/DD/YYYY) .09/09/10 PRODUCER SLATON INSURANCE P .0. Box 220537 West Palm Beach FL 33422 Phone:561- 683 -8383 Fax:561- 684 -5995 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 Southeast Florida Electric Inc 7880 W 25th Avenue Hialeah FL 33016 INSURER A: FCCI Insurance Company 10178 INSURER B: BridgeEield Employers Ins. Co. 10701 INSURER C: GL0002829 -7 INSURER D: 04/01/11 INSURER E: $ 1,000,000 - 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. INSR LTR AMYL INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE ( MM/DD/YY) LIAAITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL0002829 -7 04/01/10 04/01/11 EACH OCCURRENCE $ 1,000,000 PREMISES(Eatocxurence) $100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY X jEa LOC PRODUCTS - COMP/OP AGG $ 2, 000,000 AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0004659 -7 04/01/10 04/01/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGELIABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLALIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ UMB0002363 -7 04/01/10 04/01/11 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If es, describe under SI�ECIAL PROVISIONS below 830 -32746 09/27/09 09/27/10 X TORY LIMITS OER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE $ 500, 000 E.L. DISEASE - POLICY LIMIT $ 500, 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village Building Department 10050 NE 2nd Ave 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 10 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. 'ACORD 25 (2001/08) AUTHORIZED PR SE ©ACORD CORPORATION 1988 DO NOT FORWARD SOUTHEAST FLORIDA ELECTRIC INC RICHARD G HORNSBY '7880 W 25 AVE HIALEAH FL 3386 iWiil1i111114111111 111 4 1 1JAM 111111 t1t11i111{1illaa DO NOT FORWARD SOUTHEAST FLORIDA ELECTRIC INC RICHARD G HORNSBY PRES 7880 W 25 AVE HIALEAH FL 33016 � .. SEE OThER y s SIDE � ..x ftaflsuifillttsttlltffsltt1t r y w a y -ary r —roe. - -ate $iHiitaffrfltfts.130141 tt 1 09/28/2010 1:39 305-822-0239 CERTIFICATE OF LIABILITY INSUIRANCE op "IL SO1=2 0 SE FL ELECTRIC ELM INSURANCE 2.0. Sox 220537 Moot PaZni Beach, FL 33422 ?handl:561-683-0393 Fax:561-684-9995 INauReo PAGE 02 DA11(ARAMMINTY) 09 24/10 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALTeR THE COVERAGE AFFORDED BY THE POLICI es BELOW. . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURERS AFFORDING COVERAGE INIRAER A LIVCX trieuz:12:_ Cm:3a7a INSURERS. INSURER p, INsuREN p. FotAcctiold •,33. Fool to Zoo.CA. COVER' att . , :INSURER E THE FM IcIES OF etsuEAN"-------"--"—""------'-------."--"'"—"'--"—ETED DELow RAFE BEEN IssUSD TO THS INSURED NAMED AO VE FOR THE Faun* PERoD IND. A N Y NE( LIIREMENT, TERM O R C O N D I T I O N OF ANY CONTRACT DR oThENnoCumENT WTTN REepacY VI miler! MIS CERTIFICNIE fAci BE !SEM oR WAY PEI TAN, 714E INSURANCE moonteD BYTt4E POLICIES DESCREIEDNENCIN IS scanty TO ALL NE TERNS, EXCLUSIONS AND COMMONS OF SUCH POLICIEI: MO$E:14 UM' sHOWNAtsy HAW KEN REDUcED SY PAM CLAIMS '10Y- littLICY *WOW ■••• ■■•■••• ■••■■■■■••■•••■ GL0002929-7 04/01/10 occumnipo •1' 000. 000 ,PERECNAL ArAv INkirt EENERAL AEcREGATE 5. 000 s 1.,000 .000... CA0004659-7 04/01/10 04/01/11 Obus00 023 63-47 04/01/10 DisoucTlatz RETENTION s 04/01/11. 1. 111'24000%000 . di 2 000 000 930-32746 09/27/11 eLmsmul.em*Lom ,CERTIFIcATI: HOLDER zitamisu 1 Miami Shoran Village' Xlmi4ding Department 30030 MX 2nd Ave bilemi Shores FL 33120 RD 29(2( 111/04) CANCELLATION SHOULD ANY OF NE AIME alumna, Inman g CANCELLED BEFORE THE EXPIRATION aux mrtemik me music immoral 'ITLL ENDEAVOR TD NAIL 10 Days vpuTTEN TO CERTIFICATE Room Nam To Toe LIFT, our FAILURE TO P050 BEALL, • WOOS PO OkICATION OR LIAINLYIt OF ANY IOND UPON THS IMAM% Ire AUDITS OR REPRESRNiATIVES. AUTPTORzsa ID CORD CoRPoRATION19811 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Mnspection Number: INSP- 151417 Permit Number: DEMO -9 -10 -1666 1 Inspection Date: February 14, 2011 Inspector: Perez, JanPierre Owner: HUTCHINSON, MARK Job Address: 1041 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: JORDA MECHANICAL Permit Type: Demolition Inspection Type: Final Work Classification: Mechanical Phone Number Parcel Number 1132060143720 Phone: (305)262 -0095 Building Department Comments DISCONNECTING TEMP. NC MECHANICAL SERVICES. -"cV Passed Inspector Comments They would like a partial inspection. �, -4,--.,.;„g:=...., „- 17 Id Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 February 14, 2011 Page 1 of 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1041 NE 96 Street Miami Shores, FL 1132060143720 Block: Lot: MARK HUTCHINSON Owner Information MARK HUTCHINSON Address 1041 NE 96 ST MIAMI SHORES FL 33138 -2551 Phone Cell Contractor(s) JORDA MECHANICAL Phone (305)262 -0095 Cell Phone Type of Demo: Mechanical Additional Info: DEMO Classification: Residential Scanning: 1 Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee Radon Surcharge Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $0.20 $5.00 $100.00 $0.20 $3.00 $0.80 $110.00 Pay Date Pay Type Invoice # DEMO -9 -10 -38951 09/30/2010 Credit Card Amt Paid Amt Due $ 110.00 $ 0.00 Available Inspections: Inspection Type: Final 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 1 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. September 30, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy September 30, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, MMliarai 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: MECHANICAL Permit No.(›M 0 1O1o((p Master Permit No. V14 © - q10-158ii Owner's Name (Fee Simple Titleholder) —f' (luSc� Phone # 9' � i 61 1143 6 Owner's Address t D14 1 Nt . 5-7" City Mt towi cistalus State f -C._. Tenant/Lessee Name A VA Email MM l4. Job Address (where the work is being done) Slott City Miami Shores Village County Miami -Dade Zip 'j t 3 FOLIO / PARCEL # Zip '3313 Phone # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 7O IQ 7a.Mifteitee/0 C Phone # 7615 ZGT d0gj Contractor's Address Y®/ / A.0 iyi .5 City 4'/.) 41/ State Z Zip .3„7 /Zt Qualifier Name DG EC E G-2/16 4.5044 Phone # G5 zaz. Grp ?S State Certificate or Registration No. 6/46 cicG ef/4'R Certificate of Competency No. CC QO/Y 777 Contact Phone .7G3$ 2GZ O0 % E -mail Architect/Engineer's Name (if applicable) Wit-- A (.( Phone # i�7 7'" a 4-0642-0 Value of Work For this Permit $ / Type of Work: []Addition Describe Work: TC4s []Alteration Square ❑New linear Footage' f Work: V(% Repair/Replace Demolition ees* * ******* * * ** *,** ** * *;* ** * ** *. * **** * * * * ** 0 Submittal Fee $ Permit Fee $ Notary $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $: 1 1 0 CCF $ CO /CC $ Training/Education Fee $ Technology Fee $ Bond $ 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 WITii 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 ; sled at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absent of : posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The fo day of who 's er or Agent going instrument was actin ,20 In by ally known to me or who has produce Contractor The foregoing instrument was acknowledged before me this f ,20 /0 ,by OJ 3E 6-(4sA.t'0 /¢t JAS identification and who did take an oath. NO Y� t LIC: Sign: Print: My Commission Expires: who is personally known to or whered asp- idlejrtian and who did take an oath. NOTARY PUBLIC: x4 c, o Sign. .c Print: * ** * * * ** * * * * * * *** * * *+4 * ** APPROVED BY My Commission Exp * * * * * * * * * * * * * * * ** Plans Examiner Engineer (Revised 07t10/07XRevised 0611 12009) JOSE A. AI:ONSO i *= CsF1 DD Expires February 22 2014 , Bonded ThN Tmy Fain Instance 800-385-7019 * * * * * * * * * * *** ***d ******** **************** Zoning Clerk checked `ccu piiy 24m 9 : - . - LoOA4>SMIkE T Jam_ 2018 .: FIRST-CLASS MVO ° teif AkTit F'f4.UAIOIk; us POSTAGE PAID T S-.. _ ( . MIAMI.F! O_ O 8RAR : PERMIT NO. 23i 118336 -7 BUSINESS NAM ( LOCATION JORDA MECHANICAL CONTRACTOR 8011 NW 14 ST 33126 DORAL THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 118336 -7 STATE* CMC008499 OWNER JORDA ENTERPRISES INC Sao. Type of Duelnaes WORKERJS 1996 GENERAL MECHANICAL CONTRACTOR 10 TAE RECEIPT. IT PERMIT 11TE 0 1EOF.ATE PAY $Iilijlm a T RY COtl � OPC MOH eOEEI IT E►Z Wt TM@ rosaal PROMANIZIER . MOT A CYPI�IROA� N OF tREOROLt W$ WMUFj -M �PAyYylNERN�Ip aeNED ■ COTElm& TA% 07/19/2010 60080000423 000045.00 I SEE OTHER SIDE DO NOT FORWARD JORDA MECHANICAL CONTRACTOR JORGE GUISASOLA 8011 NW 14 ST DORAL FL 33126 111 �1te11 Fi11r IJ t] �I�I�f1trF�r�llltlr7 111r�ljfatJ1�11111t�e F1 ACORD. CERTIFICATE OF LIABILITY INSURANCE 912812 Pacouces A. TOme S Associates, Zoo 13190 SCd. 134th Stet Suite: 201 Miami, FL 33166 305-233-2780 THIS CERTIFICATE IS is$usD AS A MATTER OF HOLDER. AND CONFERS NO RIM'S UPON THE DER. THIS CERTIFICATE DOD NOT AMEND, ALTER THE COVERAGE AFFORDED BY TfiE POLICIES INFORMATION CERTIFICATE EXHENID OR BELOW. INSURERS AFFORDING COVERAGE NAIC# "mf m dorda Enterprises, Inc 'lords Mechanical Contractor 8011. N.W. 19th Street Idiemi, , ]I'L 33126 3055.77080 newer. AAffiNt INBueaamft _- :' 1' ??4'ii INSURER a SOURER Q MSURE D TTectsnoioay Tosuranc8 Co SWUM E; EACH OXU THE ANY MAY POL.ICIES.ASSREQATEOARS PODS REQUIREMENT. PERTAIN. OP INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR colon* OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY EIE MEUEA OR THE INSURANCE AFFORDED SY THE POUC.IE S DESCRIBED HEREIN 15 SUk.IECT TOO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH SHOWNmAymavp Deem RE[ucEosYPNDCIANS. IT QTR • 6045RAL inuassamalicysk.iseft MOWN COAS.FRCIAL UNARY gglagare :' 1' ??4'ii • EACH OXU w n�w�t� i + CLARASIACC U OCCOR AIED IMP (Am Dunmong _ $ PERSONALS AM INJURY $ 5645RAL ACMCGAYE, $ OWL AG61EGATB 1.0.417 APPLES Pelt FROMM•COMPOPMOO S a AusvuaBidE3JASRITir ANYAUTO ALL OWNS) AUTOS SCHEDULED AUTOS H ALTOS NON.OWN AUTOS faa =Wad) ' . i�I%P Y1:a+T $ {A 3Q s .y OARAsSuAsAnY iii ANYAUTO AUTOOPLY- EAACODENT 5 MERMAN EAACC S AUTOOM.YI AGO 5 L` EXCESSANISREU.A 1.14151UTY OCCEER D CLAIMS MADE DEDUCTIBLE storeroom s . MOH 003UNROCE 5 • AQt T5 $ s $ s WORICEMSOMPENUTIONAND MY o� ormtasansmen Ilowdescramurider SPECIAL PROYItIONS below TC3212211 10/07/09 10/07/10 I 1 X I°Iik ELF s 500.000 S 500,000 $ 900,000 E1, D1$!A$E. EA 1WWEE E.L OWAstg PeLlar '- O11iER gaga8Yotops E)ESCRII'TIONt OPMY10NS�LOCA7foreivEFxustaxcLU marr,SPECIALPROVSiON.S Miami Shores Building & Zoning 10050 NE 2nd Avenue Miami Shores, Florida 33138 -2304 (305) 795 -2204 ACORD25(20o7/OS) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POU015$ BE oveittmSEFORETHEEARRAATION DAIS THEREOF. THE is5U1NG WILMER WILL 5VDI AVOR 7Q MAL 3. DAYS WRITTEN ND'rICE iu ME CERTIFICATE HOLDER NANICI TOTES LEFT. OR E'AWMS 70 DO so SNAIL iM1POSE NO ofB.E5ATIoN oR LIABILITY OF ANY KIND UPON IHE INS ITS AOENTS on REPRESEIvricnves. AUTHORIMO At 9ACORD CORPORiATION 19s "r..--.7 CERTIFICATE OF LIABILITY INSURANCE DATE (pVEDDIM I 9/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND.THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL. INSURED. the colicyges) must be endot sed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holler in lieu of such endorsement(s). BPRODUC a Brown of 7F.., Mac. - Port Myers 3820 Colonial Blvd., Suite 200 Fort Myers FL 33966 NAME �StsP enie Wilkinson f No. En* 239- 278 -0278 J (+IC.N09239 -278 -5306 vRm;_asrilkinsoa®bbftmvers•cam tUffroMF.R ID es INSURER(B)AF9ORDINGCOVERAGE NAICA MUM Jorda E 1te rprieee, Inc- DBA Jorda Mechanical Contractor 8011 N.W. 14th Street Miami FL 33126 hA.aeo. n ACa ------- - — _ -- -- _– -- naIRnASNP,TI TRUST INS CO 20141 INSUIsRS: INSIIRERC: GL00026121 imam D: 12/31/2009 INSURER E EA C0iI pies INSURER P: X • THIS PERIOD WHICH TO .lf U l\. IS TO CERTIFY THAT TI-1E POUCHES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FQR THE POUCY INDICATED. NOTWITI (STANDING ANY REQUIREMENT, TERM OR CONDr0N OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INSURANCE INSR INvo POLICY NUMBER Jil -..e , .Yyyn (MWO> 7 iJeNY3 A GENERAL UABIIJTY COMMERCIAL GENE L OCCUR GL00026121 12/31/2009 12/31/2010 EA C0iI pies 51,000,000 X D mamma fEeQ 1 SUS .000 ! CLAIMS -MADE X NEC EXR (Any one ; omen) 15,000 PERSONAL &*DV INJURY 51.000.000 GEpERALAGGREGATE 12 ..000,000 GEML AGGREGATE UNIT APPLIES PER: PRODUCTS- COMP/OPASS 52, 000, 000 PRC>. POLICY X , y LOC 5 A AUTOMOBILE X LIABILITY ANY AUTO 41.010WEDAIROS SCHEDUL[DAUTOS HIRED AUTOS NON-0W4mAUTQ$ cA04180331. 12/31/2009 12/31 /2010 COMBIVEDSIGLELiM1T (Ea &weans $1,000,000 X BODILY AWRY ( mem) $ X BODILY INJURY (Per aa aro) $ X (Per rrY (mediae ec doent) $ X S 1 umBREuituAE 10(CESSUAS X OCc* CIJ ADE OM600099101 12/31/2009 1$/31/2010 EACH oCCURRENDE 53,000,000 AGGREGATE 83.000, 000 DEDUCTIBLE REIEktrioN 110.000 1 X WoRCERk COMPENSATION AND ENPLOYBRS• LIA$AUTY ANY PROPRIETOR/PARTNER/EXECUTIVE IONS Y., N N / A 1 TRY rer} S 1 I ER E.L. EACH ACCIDENT 1 (MaOFF EXCIIIDE04 11 IrAps_ owes D RIP OF PERAT EL D 1 9 E A S E -EA EAPt OYES i balm EL DISEASE - POLICY OMIT $ DESCRIPTION OP OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD Iii, Addittonat REITIZAS Schedule. If ewe space is eegld:e$1 *30 days notice of cancellation, except 10 days notice for non- payment CERTIFICATE HOLDER CANCELLATION Miami Shores Building E Zoning 10050 NE 2nd Avenue Miami Shores FL 33138 -2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 8XP RATION DATE THEREOF. NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AiJrkUraksn 15$N rA1 VE M 1988 -2009 ACORD CORPORATION, An rights reserved ACORD 26 (2009109) The ACORD name and logo are registered marks Of ACORD AC# 5038641 • . . pwrg4F--F1.031DA: • • • „- , ::1UXTSTRUCWIOW.M U.8TRYA:Mar tiglY„ DO.tit141110,1T VIStitta Niro- . . PATE BATCH NLJME3F ;:xi..o.o=p1p..o 67 . CijOLO 0.11:4344 xIte ME •• • • • • • - • -• . •-• • -••• •• 'E-he pitotfiii'dna Ore : '-• Expiration date: AUG - 31, 2012.. ••• -'. • - -* " aviajtOoL , ...aoRGE aoRDA:;'-mE " .CAL tOOT-Ri.61Z0.0- . 8 71-41-:. SW:1 MIAMI • . • CUMMIE. thfor .ciovEraToR-- iL 33173 - --.!-..,-- . ., • ... ,-.: . • -. :.. .:-...- -- -:;:.. . • :...:.-• ::::: •:---- • . -- -- - :. . .. • • . . .. . . . • - • . ..• .-. ---- -.. - lEi..-...,.$4;;; -.:- • :OrSPLA-i',•-At- §tQuiliEo-tiii, LAW • ----:' .. - -7 -r4tIm . g.E.ariVv. *. : • • - • - • - : • . • - • • .. .• • • . • . • • -• • • • • . -• • • • • . • . • JOSEPH B. KALLER + ASSOCIATES PA AA# 26001212 September 17, 2010 Miami Shores Village Building Department 10050 NE 2' Avenue Miami shores, Florida 33138 architecture - interiors - planning Re: Renovation to Residence of Mr. & Mrs. Mark Hutchinson. 1041 NE 96th Street El Portal, Florida 33138 Architect's Project #10129, Permit # 10 -1587 Mr. Norman Bruhn: The following are our responses to your Review Comments for the above referenced Project. Demolition Plan Review Comment 1: A demolition permit application for electrical, plumbing and mechanical are required. Response 1: The subcontractors will apply for the permits requested. Comment 2: A demolition permit for the exterior items will not be issued until a permit to close up has been applied Response 2: The general contractor will apply for the permit to close up. Comment 3: Identify all interior bearing walls on plans. Response 3: Interior bearing walls have been identified. Comment 4: Provide temporary shoring plan for areas that bearing is to be removed. Response 4: No bearing interior or exterior walls will be removed therefore a shoring plan is not needed. Sincerely, 4 �r rceph, 4 , •se 1,1 e 'res'dent 2417 Hollywood Blvd. kaller @bellsouth.net Hollywood, Florida 33020 -6605 (954) 920 -5746 phone (954) 926 -2841 fax www.kallerarchitects.com