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RC-12-434
r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 185106 Permit Number: RC- 3- 12-434 Scheduled Inspection Date: February 05, 2013 Inspector: Bruhn, Norman Owner: Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project <NONE> Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Garage Enclosure Contractor: FORMULA DEVELOPMENT & CONSTRUCTION MANAGMEN Phone Number Parcel Number 1131010330280 Phone: (305)725 -6264 Building Department Comments GARAGE CONVERSION TO BECOME BEDROOM, BATHROOM AND LAUNDRY ROOM Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 04, 2013 For Inspections please call: (305)762 -4949 Page 25 of 30 Miami Shores Village 10050 NE 2 Ave, Miami Shores FI, 33138 Tel: 305- 795 -2204 Fax: 305- 756 -8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Permit Type RESIDENCIAL CONSTRUCTION Bldg. Permit No. RC -3 -12 -434 FORMULA DEVELOPMENT & Owner USA RE ACQUISITIONS LLC Contractor CONSTRUCTION MANAGMENT Subdivision/Project NONE Date Issued 2/5/2013 Occupancy Construction Type R-3 Load N/A Occupancy SINGLE FAMILY HOME Square Footage 362 SQ FT Type Description of GARAGE CONVERSION Work 53NW97ST Miami Shores FL 33138 - Location Build i Officials Ap Not Transferable POST IN A CONSPICUOUS PLACE Norman Bruhn, • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 184877 Permit Number: RC- 3- 12-434 Inspection Date: January 30, 2013 Inspector: Bruhn, Norman Owner: Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: Permit Type: Residential Construction Inspection Type: F. Insulation Certificate Work Classification: Garage Enclosure FORMULA DEVELOPMENT & CONSTRUCTION MANAGMEN Phone Number Parcel Number 1131010330280 Phone: (305)725 -6264 Building Department Comments GARAGE CONVERSION TO BECOME BEDROOM, BATHROOM AND LAUNDRY ROOM Infractio Passed Comments INSPECTOR COMMENTS False Passed /KO Inspector Comments hd, 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 January 30, 2013 Page 1 of 1 A A- Miami -Dade County Building Department INSULATION CERTIFICATE. BUILDING PERMIT Nn: Project Name: Job Address: era GV ' �-- $7- STATEMENT OF COMPLIANCE: We, the undersigned, hereby certify that the THERMAL INSULATION has been installed in the above referenced project, in compliance with the latest edition of the STATE OF FLORIDA ENERGY CODE, the APPROVED ENERGY CALCULATIONS, and Plans, and in accordance with good construction practice. The insulation fumished and installed has the characteristics shown below: (Check only applicable boxes) C 1). Exterior CBS Walls Insulation: R- Thickness: inch(es): Density: ❑2). Exterior Frame /Metal Stud Walls: R- Thickness: inch(es): Density: ;Min.): Material: lb/fl: Mfgr: _ (Min.): Material: Ib /R: Mfgr: 3). Exterior solid concrete walls: R -4 ,/ (Min.): Material: Thickness: — inch(es): Density: °® lb/ft: Mfgr:® ❑ 4). Interior walls separating A/C from non – A/C spaces insulation: R -- Material: ; '1ltickness: inch(es); Density: • ❑ 5). e (Min.) lb /ft MULTI-FAMILY RESIDENTIAL CONSTRUCTION ONLY: The COMMON (Party) walls separating different tenants shall be insulated as follows: FRAME/METAL STUD WALLS R -I I (Min.: CBS or Concrete walls R -3 jMin.) by Energy Code requirements. See ENERGY CODE, Rev. 1/87, paragraph 903.2 (b), on page 9 -27, latest edition. These "minimum levels of insulation ". are not included in the Energy Calculations, but shall be installed in the field. ,l 6). Above deck type ROOF INSULATION: R- (Min.) Material: Thickness:. _ inch(es): Density: lb /ft: Mfgr: ) Ceiling insulation R- en (Min.); Material: /' /o 3/ Thickness:t'inch(es): Density: �, lb/11: Mfgr: ee� ❑ 8). NOTE – Densities of sprayed -on, loose fill, or any other composed -on -site insulation shall be the P.C.F. (Ib/ft3) average of three (3) "DRY SAMPLES" of accrual installation. Make photocopies of this sheet in your office, as req ' d for fu Installed by: r4l`yyC ►,rSGehe71 /4i►, Insulation Company Name Insulation Contractor CC #: ( r..4t, 3 .o O.C. /Builder: Company Name G.C. /Builder's Signature Insulation Contractor Signature Date Certified: Building Contractor CC #: Insulation Certificate /Revised 12/99 Date Certified: v Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: S3 t11l�lJ �- t '9cr D 5 '1Z FBC 20 Permit No. Master Permit No. gva a-L-1 c39 ROOFING City: Miami Shores County: Miami Dade Zip. U Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder): Address: Mao I V-#,- L4` NO Flood Zone: $Ar U. - 'hone #: City: State: 1 Zip: .4"1 Tenant/Lessee Name: Phone #: d' 2'VS E, C312=0 Email: CONTRACTOR: Company Name: .?% fLUh eil d 0 Address: City: Qualifier Name: 45.6.r 0 coxiN 101512 Phone #: �os----7t( �2tS1 State:, •^ Zip: 009 ""— 4J b) Phone #: State Certification or Registration #: Certificate of Com Contact Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 140. ----- Square/Linear Footage of Work: Type of Wotk: "DAddition DA1te ationn ONew Repair/Replace D �. ription of Work: - 4 1 4 1,0 —b On 0 O ODemolition vAt /1f- Color thru tile: + *****m ix***** *+ x** ***********nix:**x:**:x*** Fees: ****x: **►:+ x***********+ x***+x+x***** *** ********* Submittal Fee $ Scanning Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Permit Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond ,$ 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 inspectio whi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be �. pr., ed and a reinspection fee will be charged. Signature wne or Agent Contractor The foregoing instrument was acknowledged before me this Ofk-. The foregoing instrument was acknowledged before me thiP4' .. day o"; 20 by , day of 0\10 C', 20 a, by who i 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,tdY Po 4) .••• moo FERNAN MONTEiRO 4, MY COMMISSION # DD 904327 EXPIRES: April 22, 2014 Sign q ,o, Print: > My Commission Expires: NOTARY PUBLICLY Pie fERNA14D0MONTEIRO MY COMMISSION # DD 984327 EXPIRES: April 22, 2014 Sign: Print: My Commission Expires: flea Su* &buySan * * * * * * * * * * * *** *** ** ****:x+ *** **** * *x::x**** ***** ******** **+ x**a< a<*: x***** x: *> x****** *+ x: x***: x*+ xm ****x+*** ************mix APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CERTIFICATE OF OCCUPANCY /COMPLETION CHECK LIST Building permit card. Surveys (2 copies) Final as built - Required Items: Elevations of buildings showing all intended setbacks from property lines and other existing structures. Ingress+ Egress, required parking spaces, Wheel stops, stripping, and all paving to exterior. ❑ Certificate of Elevation — (Sealed by surveyor). Expiration date required on the form. ❑ Certificate of Insulation. ❑ Certificate of Soil Treatment (Final treatment- original)1 CHAPTER 2913 -5 TERMITE PROTECTION: "This Building has received a complete treatment for the prevention of subterranean termites. Treatment is in accordance with the rules and law as established by the Florida Department of Agriculture and Consumer Services." alth Department Approval Letter (On septic or private water). Note: If the house is on septic tank, approval letter is required from Health Dpt. ❑ Soil Compaction Letter (Density report is required) ❑ Final certification letter from the Engineer /Architect (on masonry, trusses, special structure, etc) ❑ Backflow preventor certificate (Required on commercial projects only) ❑ Certificate of use. (Recorded in Miami -Dade Clerk of Courts) PLEASE NOTE THAT THE SAME ITEMS ARE REQUIRED FOR TEMPORARY CO • Emergency CO (Without 24 Hrs Processing) Additional fee is $80.00. • Temporary CO (Up to 90 days max) $75.00. • Residential CO fee is $150.00 • Commercial CO is $200.00 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: I NSP- 184878 Permit Number: RC- 3- 12-434 Inspection Date: January 30, 2013 Inspector: l Owner: Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Residential Construction Inspection Type: HRS Approval Work Classification: Garage Enclosure Contractor: FORMULA DEVELOPMENT & CONSTRUCTION MANAGMEN Phone Number Parcel Number 1131010330280 Phone: (305)725 -6264 Building Department Comments GARAGE CONVERSION TO BECOME BEDROOM, BATHROOM AND LAUNDRY ROOM Infractio Passed Comments INSPECTOR COMMENTS False Passed iev Inspector Comments . 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 January 30, 2013 Page 1 of 1 ;CON #:AP1061659 4IT #:13 -SC- 1392771 ,NT #:F1861929 ;PAID: 02/13/2012 PAID :200.00 PT #:13 -PID- 1814150 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION [01] TANK SIZE [1] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI- CHAMBERED [05] OUTLET FILTER [06] LEGEND 1..70_111 -09DC3 [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1] 240 [2] [11] DISTRIBUTION BOX [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ 'ABOVE / [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH 900.00 [2] Polyethylene [I Y k Polylok N .] SQFT HEADER X 1. 4.00 2. IBELOW I IBM 38.64 FILL [22] [23] [24] [25] [26] Comments: / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL [ [ J SETBACKS [27] SURFACE WATER [28] DITCHES [29] PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS [32] POTABLE WATER [33] BUILDING FOUNDATIONS [34] PROPERTY LINES [35] OTHER. FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION FT FT FT FT FT 15 FT 12 FT 7 FT 15pool FT [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR Roberto Rodriguez (Southern [48] OTHER ADS ARC 24 ABANDONMENT [49] TANK PUMPED 02/17/2012 [50] TANK CRUSHED & FILLED 02/17/2012 CONSTRUCTION IAPPROVED I DISAPPROVED ]' FINAL SYSTEM [I APPROVED I/ DISAPPROVED (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous Incorporated: 64E- 6.003, FAC EH Database v 1.0.1 l: Ronald E Cave (Dade County Environmental Health) Dade CHD Ronald E Cave (Dade Gounty Environmentaa neaith) editions which may not be used) AP1081659 Dade EID1392771 DATE : 02/17/2012 CHD DATE: 02/17/2012 Page 2 of 3 Miami Shores Viiiage Building Department RECEIPT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT #: Y I2, `t'* DATE: /Q 14 Z Contractor n Owner Architec Pi ed up 2 sets of plans and (othe A WS Address: " 4� From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: �^ PERMIT CLERK INITIAL: h, RESUBMITTED DATE: PERMIT CLERK INITIAL: BUILDING CODE COMPLIANCE OFFICE (BCCO) PRODUCT CONTROL DIVISION NOTICE OF ACCEPTANCE (NOA) ECO Window Systems, LLC 745 West 186 Street Hialeah, FL 33010 ovivsLA, *abinrn4 t- Cortm9GOTE iNcorysinz- 4N,..6-rn Cr-74k—, MIAMI-DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 \/ \ MIAMI, FLORIDA 33130-1563 id\ / (305) 375-2901 FAX (305) 372-6339 *dade. ov/huil • SCOPE: i This NOA is being issued under the applicable rules and regulations governing the Use of construction materials. The documentation submitted has been reviewed by Miami-Dade County Product Control Division and accepted by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami-Dade County Product Control Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right to revoke this acceptance, if it is determined by Miami-Dade County Product Control Division that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and bas been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone. DESCRIPTION: Eco-Gnard Series-200 " Aluminum Horizontal Rolling Window – L.M.I. APPROVAL DOCUMENT: Drawing No. W09-12, titled "Eco-Guard Series-200 Aluminum Horizontal Rolling Window (L.M.I.)", sheets 1 through 7 of 7, dated 02/24/2009, last revision #A dated 04/17/2009 prepared by Al- Farooq Corp., signed & sealed by Arshad Viqar P.E., bearing the Miami-Dade County Product Control Approval stamp with the Notice of Acceptance number and approval date by Miami-Dade County Product Control Division. MISSILE IMPACT RATING: Large and Small Missile Impact LIMITATIONS: Miami-Dade County Product Caarol Appnwed Shutters Or Ilirtection Devices Are Not Required. LABELING: Each unit shall bear a exit label with the manufacturer's name or logo, city, state and following statement 'Miami-Dad sunty Product Contr91.4gpromedunles ted herein. RENEWAL of this NOA s be . filed has been no change in the applicable tive y affecting the product ere has been a revlsion or change in the Misuse of this NOA as an end& ement of any allure to comply • , i VOA i'kf_ li ir TERMINATION of this NOA. ,,.,, i after tea iii4 materials, use, and/or maniztctine of the product or product, for sales, advertis*fisM,§Thefa' with any section of this N41404.1*.ca,us9rfctrt, ii*f 4ii Ivo ,e,..r. f nt ADVERTISEMENT: The NOA number Titetida'-bf'ilie 71149B.A:::-i-;t;toAtgaty da, and followed by the expiration date may 134 4plaire4 in advertising" *,r'.°.,4,e ' -' - ' ' - liorif 4'11 be done m its rsitiretyl *-12..,:i flY44"'GfititIt s displayed, then it INSPECTION: A copy o ' • entire siiiiitllprovided ;-11 Ile Pr.:5:1 : k! and shall be available for • t ,,,, r., job -,,..i._,-, ,. e1.' tiMu6let ).iit the or its distributors mentioned above. A antt—evickShesa.. cl , • ' Ofli§iitst.-.k0 This NOA consists of this p u* me 3°D .I'm at 'M.9,reclugst of The subinitted documentati f ,-, i. c-:-.ir.',;'.',t'm1---.' ctg"TA -1 .& 412 af44,411610pa' document *as reViettiad tly '' ' ''. v 5 c ': ''''''t1°' tS'*I''3htiC:11;4"4 ili,d't: A No. 09-0312.0S ?19-a& igz-xtrigt.i5;fzi, c,,, c ivit Expiratio* Date: 05/27/2014 1 t d Dii 0,z-ls iiiTLV Approval Date: 05/27/2009 and t.,ztlsia,t,,,, lth IGU OM foSiliC .. Page 1 . . ECO Window Systems, LLC NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Manufacturer's die drawings and sections. 2. Drawing No. W09 -12, titled "Eco -Guard Series -200 Aluminum Horizontal Rolling Window (L.M.I.) ", sheets 1 through 7 of 7, dated 02/24/2009, last revision #A dated 04/17/2009 prepared by Al- Faroog Corp., signed & sealed by Arshad Vigar, P.E. B. TESTS 1. Test reports on: I) Air Infiltration Test, per TAS 202 -94 2) Uniform Static Air Pressure Test, Loading per TAS 202 -94 3) Water Resistance Test, per TAS 202 -94 along with marked -up drawings and installation diagram ofXOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI- 08-2226A, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 2. Test reports on: I) Large Missile Impact Test, per TAS 201 -94 2) Cyclic Wind Pressure Test, Loading per TAS 203 -94 along with marked -up drawings and installation diagram of XOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI-08-2226B, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 3. Test reports on: 1) Large Missile Impact Test, per TAS 201 -94 2) Cyclic Wind Pressure Test, Loading per TAS 203 -94 along with marked -up drawings and installation diagram ofXOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI -08 2227, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 4. Test reports on: I) Air Infiltration Test, per TAS 202 -94 2) Uniform Static Air Pressure Test, Loading per TAS 202 -94 3) Water Resistance Test, per TAS 202 -94 along with marked -up drawings and installation diagram of XOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI-08-2228A, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 5. Test reports on: 1) Large Missile Impact Test, per TAS 201 -94 2) Cyclic Wind Pressure Test, Loading per TAS 203 -94 along with marked -up drawings and installation diagram ofXOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI- 08- 2228B, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 6. Test reports on: 1) Large Missile Impact Test, per TAS 201 -94 2) Cyclic Wind Pressure Test, Loading per TAS 203 -94 along with marked -up drawings and installation diagram ofXOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI 08 -2229, dated 01/15/09, signed and sealed by Candido F. Font, P.E. H y A. Makar, P.E., M.S. Senior Product Control Examiner NOA No. 09- 0312.08 Expiradon Date: 05/27/2014 Approval Date: 05/27/2009 E -1 ECO Window Systems, LLC NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED 7. Test reports on: 1) Uniform Static Air Pressure Test, Loading per TAS 202 -94 along with marked -up drawings and installation diagram ofXOX aluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI- 08- 2230A, dated 01/15/09, signed and sealed by Candido F. Font, P.E. 8. Test reports on: 1) Large Missile Impact Test, per TAS 201 -94 2) Cyclic Wind Pressure Test, Loading per TAS 203 -94 along with marked -up drawings and installation diagram ofXOXaluminum horizontal sliding window, prepared by Hurricane Engineering & Testing, Inc., Test Report No. HETI- 08- 2230B, dated 01/15/09, signed and sealed by Candido F. Font, P.E. C. CALCULATIONS 1. Comparative analysis and Anchor verification calculations and structural analysis, complying with FBC- 2004/2007, sheets G -1 to G -2, CR -1 to CR -27, DC-1, TR -1 to TR -5, Ca -1 to CA -26, GL -1 to GL-3, A -1 to A-4, R -1 to R -3, prepared by Al Farooq Corporation, dated 03/02/09, signed and sealed by Humayoun Farooq, P.E. Complies with ASTMEI300- 02/04. D. QUALITY ASSURANCE 1. By Miami -Dade County Building Code Compliance Office (BCCO). E. MATERIAL CERTIFICATIONS 1. None. F. STATEMENTS 1. Statement letter of conformance, dated April 28, 2009, signed and sealed by Arshad Vigar, P.E. E -2 Mt y A. Makar, P.E., M.S. Senior Product Control Examiner NOA No. 09- 0312.08 Expiration Date: 05/27/2014 Approval Date: 05/27/2009 3 1/2" MAX. HEAD /SILL CORNERS m 72" FALSE MUNTINS (SURFACE APPUED) MAY BE USED ECO -GUARD SERIES -200 ALUMINUM HORIZONTAL ROLLING WINDOW DESIGN LOAD RATINGS FOR THESE WINDOWS TO BE AS PER CHARTS SHOWN ON SHEETS 2. 31 1/4" D.L OPG. 35 3/8" VENT WIDTH APPROVAL APPLIES TO SINGLE UNITS OR SIDE BY SIDE COMBINATIONS OF H.R. /H.R. OR HORIZONTAL ROLLING WITH OTHER WINDOW TYPES IN MODULES OF TWO OR MORE WINDOWS USING MIAMI —DADE COUNTY APPROVED MULLIONS IN BETWEEN. LOWER DESIGN PRESSURE FROM WINDOWS OR MULLION APPROVAL WILL APPLY TO ENTIRE STSI tM. THIS PRODUCT HAS BEEN DESIGNED AND TESTED TO COMPLY WITH THE REQUIREMENTS OF THE FLORIDA BUILDING CODE 2004 /2007 EDITION NCLUDNG HIGH VELOCITY HURRICANE ZONE (HVHZ). WOOD BUCKS BY OTHERS. MUST BE ANCHORED PROPERLY TO TRANSFER LOADS TO THE STRUCTURE. ANCHORS SHALL BE AS USTED, SPACED AS SHOWN ON DETAILS, ANCHORS EMBEDMENT TO BASE MATERIAL SHALL BE BEYOND WALL DRESSING OR STUCCO. ANCHORING OR LOADING CONDITIONS NOT SHOWN IN THESE DETAILS ARE NOT PART OF THIS APPROVAL A LOAD DURATION INCREASE I5 USED IN DESIGN OF ANCHORS INTO WOOD ONLY. LATERALS INCLUDING BUT NOT LIMITED TO STEEL /METAL SCREWS, THAT COME INTO CONTACT WITH OTHER DISSIMILAR MATERIALS SHALL MEET THE REQUIREMENTS OF 2004/2007 FLORIDA BLDG. CODE SECTION 2003.8.4. 32 3/4" D.L OPG. 3 1/2" MAX. HEAD /SILL CORNERS 0 FALSE MUNTINS (S .JRFACE APPLIED) MAY BE USED TYPICAL ELEVATIONS 1/8" HEAT STREN'D. GLASS .090" INTERLAYER BUTACITE PV8 8Y 'DUPONT' 1/8" HEAT STREW!). GLASS z SILICONE DOW CORNING 899 pp.. GE SCS 2000 m GLASS TYPE 'A' a 1" ° WINDOW WIDTH 10 5/5° MAX. WINDOW WIDTH :I__. 1� .I = II II �I , //./1c _O IfI 11 rI 11 /,1t © II , '' I CORNERS 1 I 1 1 FALSE MUNTINS (SURFACE APPUED) MAY BE USED ECO -GUARD SERIES -200 ALUMINUM HORIZONTAL ROLLING WINDOW DESIGN LOAD RATINGS FOR THESE WINDOWS TO BE AS PER CHARTS SHOWN ON SHEETS 2. 31 1/4" D.L OPG. 35 3/8" VENT WIDTH APPROVAL APPLIES TO SINGLE UNITS OR SIDE BY SIDE COMBINATIONS OF H.R. /H.R. OR HORIZONTAL ROLLING WITH OTHER WINDOW TYPES IN MODULES OF TWO OR MORE WINDOWS USING MIAMI —DADE COUNTY APPROVED MULLIONS IN BETWEEN. LOWER DESIGN PRESSURE FROM WINDOWS OR MULLION APPROVAL WILL APPLY TO ENTIRE STSI tM. THIS PRODUCT HAS BEEN DESIGNED AND TESTED TO COMPLY WITH THE REQUIREMENTS OF THE FLORIDA BUILDING CODE 2004 /2007 EDITION NCLUDNG HIGH VELOCITY HURRICANE ZONE (HVHZ). WOOD BUCKS BY OTHERS. MUST BE ANCHORED PROPERLY TO TRANSFER LOADS TO THE STRUCTURE. ANCHORS SHALL BE AS USTED, SPACED AS SHOWN ON DETAILS, ANCHORS EMBEDMENT TO BASE MATERIAL SHALL BE BEYOND WALL DRESSING OR STUCCO. ANCHORING OR LOADING CONDITIONS NOT SHOWN IN THESE DETAILS ARE NOT PART OF THIS APPROVAL A LOAD DURATION INCREASE I5 USED IN DESIGN OF ANCHORS INTO WOOD ONLY. LATERALS INCLUDING BUT NOT LIMITED TO STEEL /METAL SCREWS, THAT COME INTO CONTACT WITH OTHER DISSIMILAR MATERIALS SHALL MEET THE REQUIREMENTS OF 2004/2007 FLORIDA BLDG. CODE SECTION 2003.8.4. 32 3/4" D.L OPG. 3 1/2" MAX. HEAD /SILL CORNERS 0 FALSE MUNTINS (S .JRFACE APPLIED) MAY BE USED TYPICAL ELEVATIONS 1/8" HEAT STREN'D. GLASS .090" INTERLAYER BUTACITE PV8 8Y 'DUPONT' 1/8" HEAT STREW!). GLASS z SILICONE DOW CORNING 899 pp.. GE SCS 2000 m GLASS TYPE 'A' a 1" ° WINDOW WIDTH 10 5/5° MAX. 1 1 CORNERS 1 I 1 1 - / _ -yr -� p // I; /,I 1C -_ I, , , /, ,1 i I __ r -'` TC-_ i I // - •/ . . I 1 32 3/4" D L OPG. 36 7/8" VENT WIDTH 1/8" HEAT STREW!). GLASS .090" INTERLAYER SENTRYGLAS PLUS 8Y 'DUPONT' 1/8" HEAT STREN'D. GLASS SILICONE DOW CORNING 899 GE SCS 2000 GLASS TYPE 'a' GLAZING OPTIONS 32 3/4" D.L OPG. Airmail e`rrw100e Merida Berms NOM Nand to THESE WINDOWS ARE RATED FOR LARGE & SMALL MISSILE IMPACT SHUIILK'S ARE NOT REQUIRED. Engr: NOMAD VXMA CIVIL. FUL PE 1 39863 C AH. 3336 APR 2 4 2009 Z g 6 81 of 0 S drawing no. W09 -12 sheet 1 of 7 DESIGN LOAD CAPACITY - PSF (X0. OE OR )12 SEES) WINDOW DIMS. A W/0 REME. WITH REINF. GLASS TYPE 'A' GLASS TYPE "B' YOOTH HEIGHT EXT.( +) INT.( -) EXT.( +) INT.( -) 26 -1/2` 4 70.0 80.0 80.0 90.0 37' 26" 4 70.0 80.0 80.0 90.0 53 -1/8" (3) 8 70.0 80.0 80.0 90.0 74' 38 -3/8" 8 70.0 80.0 80.0 90.0 26 -1/2" 70.0 4 70.0 80.0 80.0 90.0 37' 38 -3/8" 4 70.0 80.0 60.0 90.0 53 -1/8' (3) 6 70.0 80.0 80.0 90.0 74" 90 -5 /6" (4) 8 70.0 80.0 80.0 90.0 26 -1/Z' 63" 4 70.0 80.0 80.0 90.0 37° 50 -5/8" 4 70.0 80.0 80.0 90.0 53 -1/6" (4) 8 70.0 80.0 80.0 90.0 74' (5) 8 70.0 80.0 80.0 90.0 26 -1/2" (2) 4 70.0 80.0 80.0 90.0 37' 63 4 68.9 77.5 80.0 90.0 93 -1 /8" (5) 6 70.0 70.0 80.0 90.0 74" 36° 8 70.0 70.0 80.0 80.4 24" (3) 4 70.0 80.0 80.0 90.0 36' 36" 4 70.0 80.0 80.0 90.0 48" (4) 6 70.0 80.0 80.0 90.0 60" M� 6 70.0 80.0 80.0 90.0 72" 8 70.0 80.0 80.0 90.0 24" 48" 4 70.0 80.0 60.0 90.0 36' (4) 4 70.0 80.0 80.0 90.0 48' 8 70.0 80.0 80.0 90.0 60" (�3) 6 70.0 80.0 80.0 90.0 72' 60" 8 70.0 80.0 80.0 90.0 24" (5) 4 70.0 80.0 80.0 90.0 36" 4 70.0 80.0 80.0 90.0 48" �) 6 70.0 80.0 80.0 90.0 60" 6 70.0 80.0 80.0 90.0 72' 8 70.0 80.0 80.0 90.0 24" 4 70.0 80.0 80.0 90.0 36' 4 70.0 80.0 80.0 90.0 48' 80 6 70.0 70.0 80.0 90.0 80" 8 70.0 70.0 80.0 90.0 72' 8 70.0 70.0 80.0 87.6 A = N0. OF ANCHORS PER HEAD & SILL ( ) m NO. OF ANCHORS PER JAMB LEFT AND RIGHT VENTS TO RE OF EQUAL GLASS DLO WIDTHS 'XO OR OX' DESIGN LOAD CAPACITY - PST OWE SIZES) WINDOW DIMS. A 11/0 REINF. will REINF. GLASS TYPE 'A" GLASS TYPE '9' WIDTH HEIGHT EXT.( +) INT.( -) EXT.( +) INT.(-) 74' 9 70.0 80.0 80.0 90.0 106 -1/4" 26" (3) 12 70.0 90.0 80.0 90.0 111" 12 70.0 80.0 80.0 90.0 74" 38 -3/8" 9 70.0 80.0 80.0 90.0 12 70.0 80.0 80.0 90.0 108 -1/4" (3) 111" 12 70.0 80.0 80.0 90.0 74" 50-5/8' 9 70.0 130.0 80.0 90.0 106 -1/4' 90 -5 /6" (4) 12 70.0 80.0 80.0 90.0 111" 63" 12 70.0 10.0 80.0 90.0 74' (5) 9 70.0 7110 80.0 90.0 106 -1/4" 12 70.0 70.0 80.0 82.9 111" (5) 12 70.0 70.0 80.0 80.4 72' (2) 9 70.0 80.0 60.0 90.0 84" 24" 9 70.0 80.0 80.0 90.0 98" (2) 12 70.0 80.0 80.0 90.0 108' 36° 12 70.0 80.0 80.0 90.0 72" (3) 9 70.0 80.0 80.0 90.0 84" 36" 9 70.0 80.0 80.0 90.0 98" (3) 12 70.0 80.0 80.0 90.0 108' M� 12 70.0 80.0 80.0 90.0 72" 9 70.0 80.0 80.0 90.0 84" 48" 9 70.0 80.0 80.0 90.0 96" (4) 12 70.0 80.0 80.0 90.0 108" 12 70.0 80.0 80.0 90.0 72' 9 70.0 70.0 80.0 90.0 84" 60" 9 70.0 70.0 80.0 90.0 98' (5) 12 70.0 70.0 80.0 90.0 108' 12 70.0 70.0 80.0 87.6 A NO. OF ANCHORS PER HEAD & SILL ( ) = NO. OF ANCHORS PER JAMB (1/38) 4 (1/38) (1/38) 4- OPERATING VENTS TO BE 1/3 OF THE WINDOW WIDTH 'XOX. DESIGN LOAD CAPACITY - PSF (XOX SIZES) WINDOW DIMS. A 8/0 RE1NF. WITH REINF. G1A89 TYPE 'A' '6 GLASS TYPE ' WIDTH HEIGHT EXT.( +) INT.( -) E1R.( +) IM.( -) 74" 9 70.0 80.0 80.0 90.0 106 -1/4' (3) 12 70.0 80.0 80.0 90.0 111" 12 70.0 80.0 80.0 90.0 74' 8 70.0 80.0 80.0 90.0 108 -1/4" 38 -3/8' (3) 12 - - 80.0 90.0 111" 12 - - 80.0 90.0 74" 50-5/8' 9 70.0 80.0 80.0 90.0 (4) 74" 63" 9 70.0 70.0 80.0 90.0 (5) 72" 9 70.0 80.0 80.0 90.0 84" 24' 9 70.0 80.0 80.0 90.0 98" (2) 12 70.0 80.0 60.0 90.0 108" 12 70.0 80.0 80.0 90.0 72" 9 70.0 80.0 80.0 90.0 84' 36° 9 70.0 80.0 80.0 90.0 96' (3) 12 70.0 80.0 80.0 90.0 108" - - 80.0 90.0 72' 9 70.0 80.0 80.0 90.0 84" M� 9 70.0 70.0 80.0 90.0 96" 12 70.0 70.0 80.0 90.0 72' 80" 9 70.0 70.0 80.0 90.0 (5) A NO. OF ANCHORS PER HEAD & SILL ( ) o N0. OF ANCHORS PER JAMB (1/48) i. i (1 /2W) s (1/48) OPERATING VENTS TO BE 1/4 OF THE WINDOW WIDTH ALL EXTERIOR(+) LOADS SHOWN ON THIS SHEET ARE FOR WINDOWS WITH ADD -ON RISER AT FRAME SILL FOR STD. SILL (NO RISER) LIMIT EXT.(+) LOADS TO 67.0 PSF SEE SHEET 4 FOR DETAIL. J 6 NOTE: GLASS CAPACITIES ON THIS SHEET ARE BASED ON ASTM 61300 -02/04 (3 SEC. GUSTS) AND FLORIDA BUILDING COMMISSION DECLARATORY STATEMENT DCA05 -DEC -219 Engr AB$IAO WOAR RA. aun 4 38883 CA N. .N. 3539 APR 2 4 2009 k drawing no. W09 -12 (sheet 2 of 7 j 1BY WOOD BUCK °d 4 a a 4 TYPICAL ANCHORS SEE ELEV. FOR SPACING TYPICAL ANCHORS SEE ELEV. FOR SPACING TYPICAL ANCHORS SEE ELEV. FOR SPACING WEEPHOLES; Wt - 3/8" X 2 -1/4" WEEPHOLES AT EACH END AND 37° 0.C. MAX. SEALANT: ALL JOINTS AND FRAME CONNECTIONS SEALED WITH JOINT SEALER. SEE ELEV. FOR SPACING WOOD BUCKS AND METAL STRUCTURE NOT BY ECO WDW. MUST SUSTAIN LOADS IMPOSED BY GLAZING SYSTEM AND TRANSFER THEM TO THE BUILDING STRUCTURE. TYPICAL ANCHORS; SEE ELEV. FOR SPACING 1/4" DIA. TAPCON BY 'ITW' (Fu ..12O KS. Fy-92 KSI) INTO 2BY WOOD BUCKS OR WOOD STRUCTURES 1 -3/8" MIN. PENETRATION INTO WOOD THRU 1BY BUCKS INTO CONC. OR MASONRY 1 -1/4° MIN. EMBED INTO CONC. OR MASONRY DIRECTLY INTO CONC. OR MASONRY 1 -1/4" MIN. EMBED INTO CONC. OR MASONRY 1/4" DIAL TEKS OR CFLF DRILLNG_ SCREWS (GRADES CRS) INTO METAL STRUCTURES STEEL : 1/8" THK. MIN. (Fy = 36 KSI MIN.) ALUMINUM : 1/8" THK. MIN. (6063 -T5 MIN.) (STEEL IN CONTACT WITH ALUMINUM TO BE PLATED OR PAINTED) 114 SMS OR SF F ORI IN SCREWS (GRADE 2 CRS) INTO MIAMI -DADE COUNTY APPROVED MULLIONS (MIN. THK. = .090 ") (NO SHIM SPACE) TYPI A EDGE DIST NCI INTO CONCRETE AND MASONRY = 2 -1/2" MIN. INTO W000 STRUCTURE = 1" MIN. INTO METAL STRUCTURE = 3/4" MIN. CONCRETE re = 3000 P51 MIN. MASONRY f'm = 2000 PSI MIN. TYPICAL ANCHORS SEE ELEV. FOR SPACING TYPICAL ANCHORS SEE ELEV. FOR SPACING APR 2 4 2QU9 drowing no. W09 -12 1/4" MA%. SHIM TYPICAL ANCHORS SEE ELEV. FOR SPACING TYPICAL ANCHORS SEE ELEV. FOR SPACING METAL STRUCTURE 1BY WOOD BUCKS XO LAYOUT TYPICAL ANCHORS SEE ELEV. FOR SPACING 1/4• W. VENT WIDTH VENT WIDTH SHIMS TYPICAL ANCHORS SEE ELEV. FOR SPACING 0 1BY WOOD BUCKS XOX LAYOUT MIAMI-DADE COUNTY APPROVED MULLION SEE SEPARATE NIOA TYPICAL ANCHORS SEE ELEV. FOR SPACING WINDOW WIDTH WINDOW WIDTH Engn ARSHAO HOAR FLA. PE f VAS CAC/. MM APR 2 4 2009 droving no. W09 -12 (-sheet 4 of 7 ) METAL STRUCTURE TYPICAL ANCHORS SEE ELEV. FOR SPACING TYPICAL ANCHORS SEE ELEV. FOR SPACING MIAMI -DADE COUNTY APPROVED MULLION & MULLION ANCHORS SEE SEPARATE NOA TYPICAL ANCHORS SEE ELEV. FOR SPACING i /4" MAX. TYPICAL ANCHORS SEE ELEV. FOR SPACING • 1'- .775 1.067 3/16 1• ITEM PARE j QUANTITY DESCRIPTION MATERIAL MANF. /SUPPLIER /REMARKS J 1 FY20t 1 FRAME HEAD 6063 -T5 - 2.750 - 2 :Y202 1 FRAME SILL 6083 -T'S 3.249 .813 .500 } �@ 1 j� { I I I 3 _ 5 FY203 1 SILL TRUCK INSERT 6063 -T6 - -+-- ® VENT 082 1.140 1 TOP /BOTTOM 1.434 9a3 - FY205 FY101 AS RE00. AS REOD. MOV. FRAME JAMB FIXED FRAME JAMB 6063-T6 6083 -T6 - ¢ //�� �4 �!���/a - �2 t�0 HEAD 1.718 12 tl STEEL REINFORCING 6 FYI 1/ PENT FIXED MI6. RAIL 8065 -TB - I RAIL 7 FY105 1/ VENT VENT INTERLOCK 6063 -TB 8 FY206 1/ VENT JAMB STILE 8083 -T8 - 9 FYIO7 2/ VENT TOP AND BOTTOM RAIL 8063 -T8 - 10 FY108 AS REDO. GLAZING BEAD 8063 -T6 - 2.095 1.250 .519 719 - j- I 11 - AS READ. REINFORCING 8AR S 1. - ® 1.140 FRAME 12 - AS REDO. REINFORCING BAR STEEL 803 .045 13 FY204 AS RTEQO. AI -ON SILL RISER 8063 -T8 USE AS REOD. 14 FY208 4/ VENT ROLLER HOUSING & GUIDE CELCON - I 15 77209 2/ VENT ROLLER BRASS - 1.140 2.248 .062 1.140 1.8/0 -o. °1 1.047 10 GLAZING BEAD 18 FY210 2/ VENT ROLLER PIN ST. STEEL - 17 18 X 1• AS RECD. FRAME/VENT ASSEMBLY SCREWS CRS P.H. 898 18 p6 X 3• 2/ VENT FIX. RAIL SILL SCREWS (SILL ENO) CR5 P.H. 5M5 ® 1.344 JAMB S1TLE 19 823181 AS REOD. FIN SEAL W'STRIPPING - UI.TRAFAB .813 20 03001190 AS REOD. BULB SEAL 0 -LON SCHLEGEL 21 E207 AS REDD. BULB SEAL. SANTOPRENE ULTRAFAB 3978 .078 1.058 2.501 .500 22 E203 AS REGD. GLAZING BEAD RULE SANTOPRENE ULTRAFAB r 2.083 1.250 - 23 - AS READ. GLASS SPACER SILICONE FRANK LOWE 24 SL203P 2/ VENT SWEEP LATCH - SULLIVAN & ASSOC. 25 18 X 1/8' 2/ LATCH LATCH INST. SCREW ST. STEEL OH 5M5 1.1� 082 1.340 26 8A2L 2/ WM. WEEP VALVE PREFERRED ENG. PRODUCTS 27 - 1/ VENT 5/18• Box SCREEN - OPTIONAL 28 FY120 FLUSH FRAME ADAPTER 6053 -T6 OPTIONAL. L1.344 ® MEETING RAIL e4stt11tl11M i Za.500 / . / BT i� 2.r. .G 2.750 O FRAME SILL 2.188 1.314 .250 IIIIIII ^'eCIIIp 'It; s •t C •--• 9 4 If II k 1.422 ''� 912.2 .340 (� j�� .312 .08 2 Q SILL TRACK © 1.375 FIXED MTG. RAIL .187 "''� I I 2.812 2.750 2.750 dlll .082 -. 2912 Env' A MOM CIVIL FI.C, N• t 38883 p. 7838 t/' APR $ 4 20Q9 '5 2.868 062 !'ice 769 `drowing no. 809 -12 ® MOV. 974 1.687 FRAME JAMB ® FIXED I4. 989 1.688 FRAME JAMB 2.611 0 FLUSH FRAME ADAPTER (sheet 6 of 7J VENT TOP /BOTTOM CORNERS FIXED MTG. RAIL CORNER FRAME BOTTOM CORNER L'3,E- ?RiF)Y.�fr E gn ARSHno VK AR av�L :L0. PE f __ L3t883 C.e N. 3578 APR 2 4 2009 6 drawing no. W09 -12 (sheet 7 of 7 ►,T [--+ i Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No.t --93(1 Master Permit No. CATION REC I° MAR 12 2012 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): 0514% R O.1 toPS Phone #: 466 ZS 6ezo Address: ■NC0311. 1.4 LO City: (5 knurly ?v State: O s Zip: 31 ( Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 5 Go l Q33 O2 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 't l •; ti •‘) 6, 41 X177' Phone#: 3 5 7 6 4fi Address: ( � 6)c1' C242 p r - ( - i City: 11 60_ C L4 1� // f State: .L— / Zip: 3 3' Qualifier Name: f��e Y 2 f�, �; jsp / ( ) I Phone #: r2 State Certification or Registration #: � � 5 a? 6,2 Certificate of Com etency #: Contact Phone #: 5 7 J.5 /7 a 4/Email Address: C T 74 S� 7 z d ?�� 3 DESIGNER: Architect/Engineer: Value of Work for this Permit: $ g j L Type of Work: G'Addition , °Alteration °New °Repair/Replace °Demolition Description of Work: cc Phone #: ear Footage of Work: r' e ° ® rte. **** * * **** **************** ******* ***p es******************************************** Submittal Fee $ il9 Permit Fee $ �''J 01 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Ca.9 . '` j.) f.:1, 1 60 . l' TOTAL FEE NOW DUE $ i Q 4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AF'F'IDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ai proved and a reinspection fee will be charged. Signature e or Agent The foregoing instrument was acknowledged (���� before me this 1�' day of �, 20 Eby �W., U X.., k who is personally known to me or who x fp� 1Ib� dsti ice aoath. 0310612012 ' t�C p�Y PUBIIC As identifica` NOTARY PUBLIC: Sign: (l � Print: My Commission Expires: ►� fission # ' ///01111100 Contractor The foregoing instrument was acknowledged s ledged before me thi day of er�7 , 20 1'2. , by . ^ 1� � t , who is personally known to me or who has produced 1 as identification and who clid101 Dill _. ,T \ \a ��p�%'•,, m• an "� Sign: �`• -%:°Z<:(1.**. Sypl •. F1 rkil\ '1111111ill 1k' ®• \ NOTARY PUBLIC: My Commission Expires: *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY �l%'/J-(444- /eh 7. (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review * * * * * * * * * * *as * * * * *ix * * * * * * * * ** /�/� Zoning Clerk FORDE02 OP ID: LD '`4,.....--- L CERTIFICATE OF LIABILITY INSURANCE DA,E('�9/12"r' 04/009/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certfficate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 954- 735 -5500 Gateway insurance Agency Surety Corp 954- 735 -2852 2430 W. Oakland Park Blvd. Ft Lauderdale, FL 33311 Lawrence T Dwyer Mar PHONE FAX (Arc. No. ExtN (A/C. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Nautilus Insurance Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Formula Development & Construction Management, Inc. 1865 S Ocean Dr #14-M Hallandale, FL 33009 INSURERS: NN103841 INSURER c 07/07/12 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF IMMIDD/YYYYI POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY NN103841 04/07/11 07/07/12 EACH OCCURRENCE $ 1,000,000 DAMAGES (RENTED PREMISES (Ea occtt/rrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE X 'L AGGREGATE POLICY UMIT APPLIES PER: JECT n LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO AAUT� ED HIRED AUTOS SAUTOS LED NON -OWNED AUTOS COMBINED BBrtSINGLE UMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccddent) $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- TORY UMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) CERTIFICATE HOLDER CANCELLATION MIASH01 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2 AVENUE MIAMI, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9QQk ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Rick Scott Governor go ) Z- 434- Steven L. Hams, M.D., M.Sc. Interim State Surgeon General Edith White 1865 S Ocean Dr Hallandale, FL 33009 RE: Contingency Letter Application Document No: API068136 Centrax Permit Number: 13 -SC- 1403107 OSTDS Number: 53 NW 97 St Miami, FL 33150 April 25, 2012 COPY Miami -Dade County Health Department O.S.T.D.S. & Well Program (nzp/13- Lot:20 Block:19 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 04/06/2012 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. Converting existing garage into a bedroom with bathroom and a new laundry room. There is not increase in sewage flow, change sewage characteristic, or any alteration that change the conditions under which the system was approved. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. If you have any questions on this matter, please call our office at (305) 623 -3500. Sincerely, Carlos Icaza, Enclosures cc: Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com DAVID A. DACQUISTO, AICP PLANNING & ZONING DIRECTOR DEVELOPMENT ORDER ore3 Vi�Ca, 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA .33138 -2382 Telephone: (305) 795 -2207 Fax: (305) 756 -8972 DACQUISTOD MIAMISHORESVILLAGE .COM File Number: PZ -1 -12 -20122 Property Address: 53. NW 97th Street Property Owner /Applicant: Address: Agent: Address: USA Re Acquisitions LLC 11601 NE 10th Ave, Biscayne Park, FL 33161 Miguel Gonzalo Negrete 11601 NE 106 Ave, Biscayne Park, FL 33161 Whereas, the applicant. USA Re Acquisitions LLC (Owner), has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Special site plan review and approval. Garage conversion. Whereas, a public hearing was held on February 23, 2012 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code; The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1.) Approval is granted to convert a 308 square foot garage to a 143 square foot bedroom, 99 square foot laundry and 39 square foot bathroom. 2) Applicant to provide and maintain not less than two (2) parking spaces on the plot. 3) A five (5) foot landscape strip shall be provided between the driveway and residence. 4) Applicant to obtain all required building permits before beginning. work. DO PZ -1 -12 20122 USA Re Acquisitions Page 1 of 2 5) Applicant to meet all applicable code provisions at the time of permitting. 6) Applicant to complete a covenant in the form of a "Declaration of Use" assuring the property is used only for a single family purpose, record the covenant with the Miami-Dade County Recorder and provide the planning director with a copy of the recorded document prior to the final inspection by the Building Official. 7) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair, or if the work authorized by it is suspended or abandoned for a period. of at least one (1) year. The application with conditions was passed and adopted this 23rd day of February, 2012 by the Planning and Zoning Board as follows: Mr. Abramitis YES Mr. Busta Mr. Reese YES Mr. Madsen YES Chairman Fernandez y.M. 2-, 2-- Date DO PZ-1-12.20122 USA Re Acquisitions chard M. Fern Chairman, Planning Board Page 2 of 2 Permit No: 12-434 Job Name: March 23, 2012 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Building Critique Sheet 4zr‘/1' ,Provide approval from Miami Dade County Health Dept. (DOH /HRS) Plans must be signed and sealed by the designer of record. Provide all permit applications prior to any further review. rovide corrections for plumbing and mechanical Provide heat load calculations for the additional conditioned space /load. I NI rYt 1 2—ri'sl Provide energy calculations. - IN) r. 4'-i i °°z 7) R -5 is the minimum r -value for masonry exterior walls. e Show all require filled cells on floor plan. All altered openings require filled cells at sides and openings exceeding 6' require 2 each side. / Provide details of window openings including water proofing (bucks). 14) Provide product approval for all components of new windows that have been reviewed and signed approved by the designer of record. to Show required insulation in ceiling. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 762 -4859 hfi,j, 4a�' iudll J 4, ai4eS. 4b, JL1 trAkAi) miami Shores Village Building Department ife&LAArt,t-ca-1 CRITIQUE SHEET 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name Date )z- 43f Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: f `'s<'r Z Permit #: 1 Z_ '13 y Plumbing Critique Sheet Review Completed by: Rafael Hernandez Chief Plumbing Inspector 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Folio Number:1131010330280 Owner's Name: Job Address: 53 97 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: 362 Total Job Valuation: $ 25,000.00 Contractor(s) Phone FORMULA DEVELOPMENT & CONSTRUCTION (305)725 -6264 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 3/26/2012 : Yes Comments: Miami Shores Viiiage Building Department RECEIPT PERMIT # : ' I . 13 DATE: (o - 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 a Contractor o Owner o Architect Picked up 2 sets of plans and (other) Address: CVArb13 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: 4___C,A RESUBMITTED DATE: PERMIT CLERK INITIAL: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fox: (305) 756.8972 Permit No. 2 .. Job Natnee l t Z fr 7 rr- Date STRUCTURAL CRITIQUE SHEET /0/ 0- NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED. ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. R e- a -'3'f TAX FOLIO No. j/ -3/41-433 -e-Lisa STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 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. 1111111 11111 11111 1111111111 11111 111111111 1111 CFN 201280395239 OR Bk 28136 Ps 3404; Uips) RECORDED 06/05/2012 13:48:49 •• HARVEY RUIIIHr CLERK OF COURT MIAMI -DADE COUNTYr FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: ' cU 1 7,1-6 Si- ` !t -;' 4. nr1 c760 aT Ste, 73 315 2. Description of improvement: G In q- 4, .t /P yl r/�v y‘ S: .4/ 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 4. _ \a/oho e, dress d p ne number: 4, a' 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons wfthin 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: S. 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: 9. Expiration date of this Notice of Commencement expiration date is 1 year from the date of recording unless a different date Is specified? WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU t p D TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR N 71 O • COMMENCEMENT. Signature(s) of Owners) • • s)' Authorized Officer/Director/Partner /Manager Prepared By Prepared By Print Name / PAIWIWINIIIM Print Name A7. :.. Title/Office STATE OF ' RIDA COUNTY OF MIAMI -! >ADE The f. . okng instrument was acknowledged before me the • day of By - a Individually, or Q as t1/i) 1.• for 14.5asertally known, or 0 • uced the following type of fde n Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA.STATUTES • Under penalties of perjury, I declare that I have read the foregoing and that the facts stated In it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized L ) Q r a►ho n By sTATE � tit �ESert °i3crdpyE1f4tr� C�=P� b� 3 oY tUd EAU: 44, cti 123.0142 PAGE 3 3110 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 181616 Permit Number: EL -3 -12 -522 Scheduled Inspection Date: January 16, 2013 Inspector: Devaney, Michael Owner: Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: URBAN KO Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330280 Phone: (786)251 -5607 Building Department Comments ELECTRICAL WORK FOR GARAGE CONVERSION 06/06/2012 - NEED TO UPDATE LIC AND INS BEFORE INSPECTIONS. OK NB Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 171562. Add the following: Intersystem bonding bar. 2 G. F. I. protected receptacles to the patios. Straps for 1/2" and 2" conduits. Connector for A. H. U. t -stat cables. 0_1"60--fri /.5 January 15, 2013 For Inspections please call: (305)762 -4949 Page 9 of 37 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 53 NW 97 Street Miami Shores, FL 33138- 1131010330280 Block: Lot: USA RE ACQUISITIONS LLC Owner Information USA RE ACQUISITIONS LLC Address 11601 NE 10 Avenue BISCAYNE PARK FL 33161- 11601 NE 10 Avenue BISCAYNE PARK FL 33161- Phone Cell Contractor(s) URBAN KO Phone CeII Phone (786)251 -5607 Type of Work: ELECTRICAL FOR GARAGE CONVERSION Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $4.20 $3.57 $3.57 $1.40 $238.00 $3.00 $5.60 Total: $259.34 Pay Date Pay Type Invoice # EL -3 -12 -43757 06106/2012 Check #: 1034 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. DH IEOF T10 Applicant Copy For Inspections, Call (305) 762 -4949 or Log on at https : / /bldg.miamishoresvillage.com /cap /. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. June 06, 2012 2 Mop,. LErtm: D fQ yet w3-1 cnkPam1 SYLPD!. Miami Shores Village Building Department B_0 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 No. l 527-- PERMIT APPLICATION Master Permit No. 1 FBC 20 Permit Type: Electrical *��� aco OWNER: Name (Fee Simple Titleholder): 5 V'i c i 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 MR 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 o curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app %# ved ' nd a reinspection fee will be charged. Signature O' r o Agent The foregoing instrument was acknowledged before me this day of \,5 X 201i. , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: _I+ Print: Q Z.,1 rp,o, 1 C NOTARY PTIBLIC-STATE OF FLO My Commission Expirg•g: ^''•o' LUCCiZ Patricia ano is A. Commission # DD812348 Expires: AUG OS * * * * * * * * * * * * * ** cif x:: �k�k�k�k�ka : *�Na:�kH��k+x�k+k�k+x�k k�NN�N **13'� � �A' , 'i�'c�`�i ' ,'rt'4J` h' �k�k�k�k�k*** *** BONDED %Ft The foregoing instrument was acknowledged before me this b day of 6 S kOf O V "�, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Comm a STATE OF FLORIDA •,•' ''ao,, LA} r.ilai o P tAcia A. ^ CommisSion 4 DD312348 i1' ires: AUG. 05 2012 APPROVED B 7 ^2 - .2�Yb Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk JEFF ATWATER CHIEF F1NANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION 11-14 -2011 This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 11/14/2011 EXPIRATION DATE: 11/13/2013 SCARFO WALTER G 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH FL 33139 -7157 SCOPES OF BUSINESS OR TRADE 1- REGISTERED ELECTRICAL CONTRACT * IMPORTANT: Pursuant to Chapter 440 . 05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing • tertiticate of election ender this section may not recover benefits or compensation trader this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at soy time after the filing of the notice or the issuance of the certificate. the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate al any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 11/14/2011 EXPIRATION DATE: 11/13/2013 PERSON: WALTER G SCARFO FEIN: 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH, FL 33139 -7157 SCOPE OF BUSINESS OR TRADE 1- REGISTERED ELECTRICAL CONTRACT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no 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. IMPORTANT QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 11-14-2011 JEFF ATWATER 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: PERSON: FEIN: 11/14/2011 EXPIRATION DATE: 11/13/2013 DE LOS RIOS JAVIER 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH FL 33139 -7157 SCOPES OF BUSINESS OR TRADE 1- REGISTERED ELECTRICAL CONTRACT * IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender this section may not recover benefits or compensation ander this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named 00 the notice or certificate 00 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. QUESTIONS? (850) 413-1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 11/14/2011 EXPIRATION DATE: 11/13/2013 PERSON JAVIER DE LOS RIOS FEIN: 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH, FL 33139 -7157 SCOPE OF BUSINESS OR TRADE 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no 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. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 11 -14 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DIVISION OF WORKERS' NCOMPENSATION * * 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 taw. EFFECTIVE DATE: PERSON: FEIN: 11/14/2011 EXPIRATION DATE: 11/13/2013 LOCCIZANO PATRICIA A 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH FL 33139 -7157 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT: Perssant to Chapter 440. 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may sot recover benefits or compensation under this chapter. Pursuant to Chapter 440.051121. F.S., Certificates of election to be exempt... apply only within the scope of Me limitless or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.051131. F.S., Notices of election to be exempt and certificates of election to be exempt Mall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no logger meets the regeiremeuts of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the person named oa Me certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 11/14/2011 EXPIRATION DATE: 11/13/2013 PERSON: PATRICIA A LOCCIZANO FEIN: 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 3D MIAMI BEACH, FL 33139-7157 SCOPE OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election•to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no 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. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 e4R °® CERTIFICATE OF LIABILITY INSURANCE DA'�`�'"' 06/04/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pohcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER USA INSURANCENET CORP PO BOX 770158 MIAMI, FL 33177 EACT HECTOR DE ARMAS p;PH:786 293 3637 �,No):786- 293 -3669 "AIL S :SERVICE @USAINSURANCENET.COM INSURER(S) AFFORDING COVERAGE NAIC • INSURER A: INTERNATIONAL INS. CO. OF HANNOVER LIABILITY COMMERCIAL GENERAL LIABILITY INSURED URBAN KO INC 220 WASHINGTON AVE APT. 3D MIAMI BEACH, FL 33139 INSURER B : 1G011000719 -00 INSURER e : 04/12/2013 INSURERD: $ 1,000,000 INS °RERE` $ 50,000 INSURER F : $ 5 000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OP INSURANCE AMYL KM SUER WM POW/NUMBER POLICY EPP (WNDEdYYYY) POLICY ENP IMMIDD/ YY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 1G011000719 -00 04 /12/2012 04/12/2013 EACH OCCURRENCE $ 1,000,000 (Ee RENTED PREMISES TO $ 50,000 MED EXP (Any one person) $ 5 000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 GEN'L X AGGREGATE POUCY LIMIT APPLIES PER: JPERC LOC $ AUTOMOBILE LIABIU ANY AUTO ALL OWNED AUTOS HIRED AUTOS Y SCHEDULED AOS E N ON-OWNED AUTOS COMBINED SINGLE UMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Par accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CAMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORD COMPEN$ATIC*1 AND EMPLOYERS LIABILITY ANY PROPRIETORWPARTNEEXECUTIVE Y / N RI OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ E.L DISEASE- EA EMPLOYEE $ E.L DISEASE - POLICY OMIT $ DESCRIPTION OP OPERATIONS /LOCATIONS / VEHICLES (After& ACORD 101, Additional Remarks Schedule, B more space Is required) GENERAL CONTRACTOR OFFICE LOCATION: 429 LENOX AVE SUITE 504 MIAMI BEACH FL 33139 MIAMI SHORES VILLAGE HALL 10050 NORTHEAST 2ND AVENUE MIAMI SHORES, FLORIDA 33138 FAX : 305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VITh THE POLICYPROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 2642010/061 @1988- 0 0 ACORD CORPORATION. All rlgh/,3 resent The ACORD name and Joao are realstered marks of ACORD VONOTFORWARD URBAN KO INC WALTER ER SCARFo pRKs MIAMI B �� BEACH FL 33139 k�/ 5t8 ut lIf�l� fl 3ftlfY 4 ?9 33f8 1bfi171 4 1E h�+li�C URBAN KO INC WALTER 5CARP0 PRES 220 WASHINGTON AVE t30 MIAMI BEACH FL 33139 h, nt DSatb Fbb 3b7blibd�Y ". l CH CERTIFICATE E - USE, FIRE FEE, 1700 Convention Center Drive Mkt - -a Florida 33139 - 1819 TRADE NAME: URBAN KO IN SCAR- ° AC E WASHINGTON A , BEACH, Ff331 7157 A certificate of Use / Busirtoss Tax does not value ar she air Cry; approval of a particular mss teemer, hero all ate laws apaftilb This Receipt ntsy be tarn d: A. Within 30 days at a torafee SAL otherete a awe ennual payment ea due, tinder t r not E= To enattcer location within the City / proper approvals and the •g1 opined ; . to the apes rra of the Heir location . FROR CITY OF MIAMI BEACH 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FL 331381819 URBAN KO 429 LENOX AVE, #4C08 MIAMI BEACH, FL 331394532 hill itilhtttlhtlhhhttlinelshttl ltttlhhltl Ness Ti PRESORTS) PM57 MASS 0.. PAW httAidi SEAM TNc FL MIS JEFF ATWATER CHEF MARCIA. DFFTCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL =_' VICES DIVISION OF WO Sr COMPENSATION * CERTIFICATE of ELECTION TO ®E CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed heltlw has elected to be exempt from Florida Workers` SaBtioiA Taw. IDA 4 -2011 EFFECTIVE DATE PERSON: FEIN 11/14/2011 EXPIRATION DATE 11/1312013 DE LOS RIOS JAVIER 205475557 BUSINESS NAME AND ADDRESS: URBAN KO INC 220 WASHINGTON AVE APT 30 MIAMI BEACH FL 33139-71 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT 1CItP€,l 'I'Aatr. Irani t5 t iaa 440 �nfi1146 F.a. sn r laer of a eor et.ao afq tacos seeeK11e0e Prate teas T Per tiA2R a teerfffee0 1fetiele ttodet Ois NCO** cap eel eeeevar Wee, Pwrimill le Deeper 440.I)5112?: F.S„ Ct7tutice -Ms e1 &fib M 6t eon ti... Y oaf ivatip th scope of toe i0een ea utee IMO air i emEita r1 oleara€ ro be exempt Ftutiueet to ewe; 4;9.9641at B.S., *olive* raei M oottiolol nerd +remit» O atettlaa to be onsitt e1111 to ae11ie€t to recotttiea it ai say Nree &or tto litirg at tia e31.1c,7 aV tlor helgaaae o1 Ella 11atT1icato, tee pima rime 9t MO Mite tit ctrifficate no low mem dm tog ir4iasnts of eits se€> ee fart 4tainite of a cer3fUej The 41 1ttorn alai rata o zortilitAti 11 rte': Gb -tar UMW* CA p€r» mood no 1111 ctrtiNtt:4to to Brett tea maitama i4 al toss PA : PONS? KiSto DWC °251 CERTIFICATE OF ELECTIAN To BE EXEMPT REV1SE_ -D 01'11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTUR STATE OP FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIM ON OP WORMERS etittntistimon CONSTRUCTION if18JIJS.TRY CERTIFICATE OF ELECTOR TO BE T Mote FLORIDA WORKERS' COLIPENSATApTii LAW EFFECTIVE 11/14/2011 €XPIRAT!'1: DATE: PERSON JAVIER OE LOS RIOS FEN: 208478557 BUSINESS NAME AND ADDRESS: ARAN KO 3C 223 wASNAZTON 4 F AR', 39 WA* U.Ar<r+, e, 98159 1151 SCOPE OF BUSINESS OR TRADE � - F_ GIS•EIrc) 11E:TRIM CONTRACT 13/2013 F Pursuant to Chapter 440.05(14), F.S. art officer of a © e�eets emanation f�rmtn this chapt 1iilrrg a rt ifiorte of el L s1nder this seem rimy not recover benefits cif wripetlset"ron under this D chapter. Pura ier tt 10 Ch 440,0V1li. FS. Certifiers of election to be H exempt. apple only oaten Otte scope of the bosiness of try Tit Etee notice of erection ID he exempt E Furs tan I to meter 440.05(13). FS. Mohan of e1 to be 'memo artd certificates of election to be exempt shell be Siege= t9 relocation if. er any tuns; after the filing et the use r2r the issuance of tbe certificate, the person named on the mice or certificate no lamer meets' the reetnrernents of this acacia for isStigaite of a cerf Haste„ The department shyl revoke a certificate et one time for feature of the person neniteri on rile certificate to meet the requirements of this section. R f850 413-1039 CUT HERE Calm bottom portion OW the job, keep OWE -252 rII I ,TE IJF a BE EX for y records. 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECD I> SET COUNTY - STATE OF CODE SEC. 10-24 FLORIDA EXPIRES SEPT. 30, 2012 THIS IS NOT A BILL — DO NOT PAY CC N0: 09E000268 RECEIPT NO. 02- 6803929 BUSINESS NAME / LOCATION URBAN KO INC 429 LENOX AVE OWNER :URBAN KO INC RESTRICTED TO THE CITY OF: MIAMI BEACH Receipt holler must register in the city where work Is to be done. PAYMENT RAVED M MU -DADS COUNTY TAX X11/2011 02220012002 000077.65 I U.S. PD POSTAGE FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD URBAN KO INC WALTER SCARFO PRES 220 AVE MIAMIABEACHTFL 331393D Ir rll,,, ll,,!l„l1,1,1 „1,,,!,,,11,!,!,!,,,1 „!! „1 „1,l :Ill 66 SEE OTHER SIDE R DO NOT FORWARD URBAN KO INC WALTER SCARFO FRES MIAMI ABEACH TFL 331393D I4F11,,,11,,,,11.11IlL1„ }1,,,11MIl,F, }AF`fAA Rt A°R°® CERTIFICATE OF LIABILITY INSURANCE DATE 06104/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER USA INSURANCENET CORP PO BOX 770158 MIAMI, FL 33177 NAME: CONTACT HECTOR DE ARMAS 293 -3669 (ac0. Ne, Exo: PH:786- 293 -3637 —1 ac, Ner.786- ADDRESS: SERVICE USAINSURANCENET.COM INSURER(S) AFFORDINO COVERAGE NAIC # INSURER A: INTERNATIONAL INS. CO. OF HANNOVER INSURED URBAN KO INC 220 WASHINGTON AVE APT. 3D MIAMI BEACH, FL 33139 INSURER B : INSURERC: 04/12/2012 INSURER D: EACH OCCURRENCE INSURERS: 1,000,000 INSURER F : PREM SES (Ea occurrence) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY EFF POLICY NUMBER (MM/DD/YYYY) POUCY EXP (MM/DDIYYYY) LIMITS A GENERAL UABILITY COMMERCIAL GENERAL LIABILITY 1G011000719-00 04/12/2012 04/12 /2013 EACH OCCURRENCE $ 1,000,000 X PREM SES (Ea occurrence) $ 50,000 ,, ; CLAIMS -MADE [ X 1 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT F APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 X I POLICY 1 5' 1 LOC $ AUTOMOBIL= LIABILITY ANY AUTO ALL OWNED HIRED AUTOS SCHEDULED NON- OWN r± , AUTOS COMBBIINdEeDtSINGLE UMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS UAB L I OCCUR 1 J CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N NIA WC STATU- ' OTH- TORY LIMITS I ER E.L EACH ACCIDENT $ /EXECUTIVE E.L DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltonal Remarks Schedule, K more space Is required) GENERAL CONTRACTOR OFFICE LOCATION: 429 LENOX AVE SUITE 504 MIAMI BEACH FL 33139 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE HALL 10050 NORTHEAST 2ND AVENUE MIAMI SHORES, FLORIDA 33138 FAX : 305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/051 @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and Ioao are realstered marks of ACORD / 7 -.E1' _4/14 4 1 f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 183531 Permit Number: PL -2 -12 -264 Scheduled Inspection Date: January 14, 2013 Inspector: Hernandez, Rafael Owner: Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SOUTHERN SEPTIC CONTRACTORS INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1131010330280 Phone: (305)598 -8266 Building Department Comments REPLACE TANK AND DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 169982. HRS IN FILE broken sidewalk January 11, 2013 For Inspections please call: (305)762 -4949 Page 14 of 33 21 i 2" UILDING PERM FBC 2 Miami Shores Village '�i Buildin Department artment Building p iv• 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Co 1 Vi Permit No. ` PPLICATIO �, ° � i Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): USA< VI- A45CRUM CCt.otJ Phone #: 41 6,0( ►J* (4 State: (.— Address: City: e L Vzs 'lam • zee• �2 Zip: 331.6. ' Tenant/Lessee Name: Phone#: Email: ?o KZZL • Go 'M JOB ADDRESS: 531`1 W "044 City: Miami Shores County: Folio/Parcel #: 4 1 31 01 0 .5-5 c7 2-11 0 Is the Building Historically Designated: Yes Miami Dade Zip: '31 1 5 D Flood Zone: CONTRACTOR: Company Name: S p J kiN e Y r �' G Phone #: 3 is-ii $ -$2-6 Address: 1 o 11 S S- -; x t 4 t�‘.w r s\ S d i�C e. Li 0 7 City: i•''■1 Aa-4.s: State: ¶ t.. Qualifier Name: -Z O U ER 10 iR 0 D R.. J 6 U t Z State Certification or Registration #: ..5°R 0 0 Z ('i 2.1 Certificate of Competency #: -1 Contact Phone #: 7466 2S$4,- 05.31 Email Address: rr ob e(L C O A 0 b t l } S 0N1'IA , n T ►J 1v.. Phone #: Ni 11.41 Phone #: Zip: 331 S 7 3/sR8 -46266 DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 2 L( 0 0 Square/Linear Fpotage of Work: Type of Work: ❑Address ❑Alteration New 'Repair/Replace ❑Demolition Description of Work: ��1ttce .41C. * J7( cAZ ********** * * ** +x+x********** ** *+ x******** Fees****** ******* ************************ ***+ *** Joel, _Atil Submittal Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ermit Fee $ 3610 CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address - City State Zip Mortgage Lender's Name (if applicable) 'V i A .. 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 AI'F'II)AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr � eiI and a reinspection fee will be charged. Signature 0 . 'er i r Agent The foregoing instrument was cknowledged before me this t4- Signature a Con t, actor The foregoing instrument was ackno = 4 before me this Li day of , 20 IL, by 1 k &-(z 7n , me or who has produced who is personally known to me or who has produced 0--°t 0 as identificatio ati iskili i4id take an oath. NOTARY PUBL C•,` ° ° o'�'//� As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commiss • =My. o' Expires Jun 8, 2013 G < DD 897282 Bon e Through National Notary Assn. Sign: Print: = •. ZLOZ190It0 ' . say i �'��i.••.,�"� �,� My Commission Expires, • 9\ •- 0 / / /1 /fl,f;1l110l‘\ * * * * * * * * * * * *************** **** % N k********: k****= kH= *+ k*****: k********+Nds***********H= + ******** **+kN=*****Nk******** APPROVED BY 3- (1--/ ans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 12/06/2012 12:05 3052645382 JIMENEZANDCO PAGE 01 DATE (MMIDDIYYY'r7 CERTIFICATE OF LIABILITY INSURANCE 12/06/12 T THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TWE CER IFICATE HOLDI =R. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE POES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER _, _,.•., ,,,, IMPORTANT: If the certificate holder Is as ADDITIONAL tNSUREti, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, sub)ect 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). PRODUCER Jimenez & Co., Inc. 8000 Coral Way Miami, FL 33155 Phone (305) 264-9900 Fax (305) 264.5382 SOUTHERN SEPTIC AND LIFT STATION CORP 15715 S DIXIE HWY STE 402 _misuI _. . . __...__. -- Miami, FL 33157 INsuaafib: , _ ,•, —__ INSURER 305 -598 -8266 1 CONTACT -• JU L10 JIMENE2 NAt_ litTr�� PH�Qg t4 (305) 254 -9900- 2645382 i , F.xt) ) �(A<C. No)i tom) PRODUCER opwroME'_io. #: ..._.... -_ .. ... —_.. ......_._ .._._.. --.. • -- INSURER(S)ArFORbING COVERAGE — , •__ # NAIC •— IN$LIRERA; • MESA UNDERWRITERS SPECIALTY INSURAN • 1N$URE ;. FLORIDA CITRUS BUSINESS & INDUSTRIES F - COVERAGES —_ ' • • - _..__._ • •CERTIFICATE NUMBER:.. • •• ___._.. - REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED t0 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 SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �g •— FDLICYEFF POD• 101. . ••__—•TYPEOFINSURANCE __INS'- WYD.__ —_. pour( NUMBER__. ,. tram r? !z (MIdIDD1YYYY) _rs ..__-- -•• .._. GENERAL LIABILITY EACH OCCURRENCE __ l._ __— 1,000,000.00 COMMERCIAL GENERAL LIABILITY I �Ei]SMAGTs 1OD,OflO.00 PREMISES a Wm:E}p A. 4 ❑ ❑ cLAIME -MAD[ © OccuR SC0061003000740 M-- EXP (Any ono person) - L s . 1,000.000200 GENERALAGGRE■ATE $ 2,000,000.00 _ PRODUCTS - COMPIOP AGO ..$........_1,000.,929.00. GEM% AGGREGATE LIMIT APPLIES PER: • I ❑ POLICY �� - n as - AUTOMOBILE LIAaILrrY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS • HIRED AUTOS f J NON -OWNED AUTOS B L'1 UMBRELLAUAB ❑ ERCE.$ ma ]❑ DEDUCTi5i.E _❑ .BETENTIQN $ ❑ DCCUR ❑ cLAIMS•MADE 1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANy R/ XCLUE)E CUT NEI O OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ii yea describe under £,OtufriON OF OPERATIGNE eslow, _•_•• .J_ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES CERTIFICATE HOLDER - -- VILLAGE OF MIAMI SHORES 10050 NE. 2 AVE MIAMI SHORES, FL 83138 FAX - 305 -758 -8972 ACORD 25 (2009109) QF 106 -50116 COMBINED SINGLE LIMIT $ (Ea accident} BODILY INJURY (f'ar pnron) S _ -_ BODILY INJURY (Per accident $ PROPERTY DAMAGE (Per madam) - EACH OOOURR£NCE �• __ AGGREGATE 6bL3S2S7LLl ITa_i --i_ � • EL EACH ACCIDENT $ 100_000.00 07/17/2012 07/17/2013 •- - -' •• - - • • - -- E.L DISEASE _EA EMPLO $ 100,000.00 E,L. DISEASE_ POLICY LIMIT •$•,•_ ___ 500,000.00 (Attach ACORD 101, Additional Remarks Schedule, If more space 1x required) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOR WITH THE POLICY PROVISIONS. 1988 -2009 ACOR L«• RPQRATION. All rights reserved. The ACORD name a :1" go are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (USA RE ACQUISITIONS LLC) PERMIT #:13 -SC- 1392771 APPLICATION #:API061659 DATE PAID: FEE PAID: RECEIPT #: DoctMENT #: PR866758 PROPERTY ADDRESS: 53 NW 97 St Miami, FL 33150 LOT: 20 BLOCK: 129 PROPERTY ID #: 11- 3101 - 033 -0280 SUBDIVISION: Miami Shores Sec 6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D R A I N F I E L D 0 T H E R [ 200 ] SQUARE FEET SYSTEM [ 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [x] BED [ ] LOCATION OF BENCHMARK: FFE : 13.22' NGVD ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 24.20 l [I INCHES I FT ] E ABOVE /) BELOW b BENCHMARK /REFERENCE POINT [ 60.24 ] 11 INCHES r FT ] [ ABOVE A BELOW I] BENCHMARK /REFERENCE POINT [ 0.00] INCHES EXCAVATION REQUIRED: [ 36.00] INCHES - Install 900 g septic tank. - Install 200 sq ft drainfield. - Elevation of bottom of drainfield to be no Tess than 8.20' NGVD. - Not for additions The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. The contractor !or designee) it r.L,,,,i ed o perform a soil boring ad enr is,, the drain'riekl e >.cavation at the time of r`Ina; r,, ,E,ecti , Prior to Final approval, the U( inspector shall witness the sbii br:ri cy and compare tr results to the original site evaluarion submitted. A reinspection tee will be assesses it the contractor is n' at the jobsite at the arranged `irne. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Roberto Rodr' A Jos- ,,r R P7‘.. 0 2012 TITLE: H e TITLE: Engineer Specialist II DH 4016, 08/09 (Obso,7et s all previous editions which may not be used) Incorporated: 64E - 0 3, FAC v 1.1.4 AP1061659 Dade cHD EXPIRATION DATE: 05/14/2012 SE862795 Page 1 of 3 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172058 Permit Number: PL -4 -12 -604 Scheduled Inspection Date: November 14, 2012 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: Work Classification: Addition /Alteration Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: LONCUS PLUMBING CONTRACTORS INC Phone Number Parcel Number 1131010330280 Phone: 305 -383 -9259 Building Department Comments Plumbing for garage enclosure Passed Failed Correction Needed Inspector Comments iiiiy Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 13, 2012 For Inspections please call: (305)762 -4949 Page 5 of 42 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: PLUMBING OWNER: Name (Fee Simple Titleholder): Li A P -L Address: 6) j L) City: AA l c a L Vi P 5 State: —� I Permit No. ip /COMMIE' Lqt APR 0.6 2012 µ B Y .----- ....�e....... P1 12 - Master Permit No. RC— 4!- y. ty /r bceu 5 *ions #: I l c�� -3d4 (6) zip: 3 %3�' Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: /1/4t../ Lt/ f 7 - /t Pe 7e City: Folio/Parcel #: Is the Building Historically Designated: Yes Miami Shores County: Miami Dade Zip: CONTRACTOR: Company Name: 6 5l.J Address: City: Qualifier Name: NO _ Flood Zone: Loi1wS flaw*a Zli Phone #: N✓ a t cr` lac( S .te: Zip% Phone #: S a 1 x' 1c-) - / `f 00 (op Certificate of Competency #: State Certification or Registration #: Contact Phone #: S �� gc CrOl Email Address: C C..e ^ ©L ° DESIGNER: Architect/Engineer: Phone #: ��pp o Value of Work for this Permit: $ (�LJ o Square/Linear Footage of Work: Type of Work: °Address Description of Work: Alteration ONew URepair/Replace a vl ? eerid ®,'.e t/5 e ` ®r' .-- - ,. °Demolition * * *** * * * * ** : *+x***u:****************** Fees**** ****** *****+x*******+x**** * * ** x ****x:****** Submittal Fee $ Permit Fee $ Sunning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ DBPR $ CO/CC $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ `f' 5 i Bonding Co p ny'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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whicA occurs seven (7) days after the building permit is issued. In the ab nce of such posted notice, the inspection will not be appfove a . a reinspection fee will be charged. Signature // pr y1 r Agent Signature ontractor The foreg ng instrum nt was acknowledged before me this !� The foregoing instrume t was acknowledged before me thi day of __ 10�, 20 , by , day of , 204>,-by who is personally known to me or who has produced r-- k' who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission APPROVED BY • lit• -;,i.. MY COMMISSION # DD 9B1 7 * EXPIRES: April 22, 2019 aos ` Bonded TMu Budget *ICY Serlice$ 11.-104— /1-- Plans Examiner NOTARY PUBLIC: Sign: Print: �a' URY 111 My CommissiorMiet iI.4 • Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) RECEIVED FORM 1100A -08 MAY 4 FLORIDA EN , PY . + Y CODE FOR BUILDING CONSTRUCTION Florida Department of Community Affairs Residential Performance Method A Project Name: Street Gay, State, Zip: Owner Design Localism GARAGE CONVERSION 53 NW 97TH ST MIAMI SHORES , FL , GARAGE CONVERSION FL, Miami Beads Builder Nary Pernik Mot MIAMI SHORES Pa nift timber: JunsdldlOn: 1. New aruction re *adding 2. Single family ormuftis family 3. Numberofunb, email* fan* 4. Number of Bedrooms 5. Is this a worst one? 6 Conditioned floor area (f) 7. WIndo x(58.0 sgf) Descrigan a. U- Facer: Sgi. U=1.10 SHGC: SHGC=0.30 b. U- Factor. NA SHGC: c. U- Factor N/A SHG d. • Ufactor: NFA SHGC: e U- Fader: N/A SHGC: 8. Floor Types (375.0 soft.) a. Slab-On Gmde Edge Insulation b. NA cr. N/A New (Faam Ptans) 1 1 No 1750 Ares 58.00 It* A* 6* Insolation Area R=0.0 376006* Its R= A; 9. Wag Types (395 0 set) u. Concrete Hoek - bit Ord, Exterior b. WA o. NIA d. WA 10. Cuing Types (375.0 sett) IL UnderAtHc (Vented) b. WA c. WA 11. Ducts a. Sup Air Ret Dior Att Maria 12. Cooling &yams a. Ceram Unit 13. Hang systems a. Becht Strip Heat 14. Hot water systems u Electric b. Conservelion i Nana 15. Credts Irwu -eon Ares R=4.1 395.00 ft R= tp R= $' R= 6* !ruination Area R=30.0 37600 to R= 6* R= fP Si. m R=e, 5706* Cap: 38.0 kStuntr SEER 13 Cap: 260 kBtallw COP: t Cap 40 gallons EF: 0.92 Glass/FIoor Ate: 0.033 Total Asaufft Modified Loads: 28.65 Total Sasebo Loads: 42.51 PASS 1 hereby certify that the plans and speciScations covered by this calculation are In compliance with the Florida Energy Code. PREPARED *► y DATE: / 1 hereby certify that this bulcring, as Is in comiAience with the Ftotida Energy Code. OWNER/AGENT• DATE: Review crthe plans and especifications covered by this calculation indicates compliance with the Rasta Energy Code. Before corstruction is completed this building will beinspected for comoNance with Section 553.91193 Fitt Statutes. O *E! . t v � r q1 t:.- • 4 • FbII► •a a WC��3� BUILDING OFFICIAL DATE: • Compliance requires certification by the air hander unit r auwtfacturer that the air handler enclosure qualifies as certified factory-sealed in accordance with N1110,A.3. F1/11Mfl19 2.211 PM Faatamrr3musabli 1 IRA _ FlaIitaIMSi Pam%1 nf b h i96- /ea ( '1 5 -44 c20 3 FORM 1100A -08 l�1DAENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION Florida Department of Community Affairs Residential Performance Method A Project Name: GARAGE CONVERSION Street: 53 NW 97TH ST City, State, bp: MIAMI SHORES , FL , Owner. GARAGE CONVERSION Design Location: FL, Miami Beach 1. New construction or existing 2. Single family or mutilple family 3. Number of units, If mink► fanny 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned floor area (ft') 7. Windows(58.0 sqft.) a. U-Factor SHGC: b. U- Factor: SHGr:: c. U- Factor. NIA SHGC: d. U- Factor. N/A SHGC: e. U- Factor: N/A SHGC: 8. Floor Types (375.0 win.) a. Slab -On -Grade Edge Insulation b. N/A c. NIA Description Sgl, U =1.10 SHGC=0.38 NIA Builder Name: Permit Office: MIAMI SHORES Pena Number: Jurisdiction: -1i*S 1i �'%'` TOZ, 7� o New (From Plans) Single -family 1 1 No �tTypes(395.0 alt.) a. Cone Block - Int nisi'', Exterior b. NIA c. N/A d. N/A 10. Ceiling Types (375.0 soft.) a. Under Attic (Vended) b. WA Area c. WA 58.00 fly tt2 ft' insulation Area R'0.0 375.00 ft2 R= R= IP Glass/Floor Area: 0.155 insulation Area Rm4.1 395.00 ft. R= ft' R' 1t= Insulation Area R=30.0 375.00 ft2 R= ft* ft* 11.E a. Sup: Attic Ret interior AH: Interior Sup. R'' 8, 57.6 ft2 12. Cooling systems a. Central Unit 13. Heating systems a. Electric Strip Heat 14. Hot water systems a. Electric b. Conservation features None 15. Credits Total As -Built Modified Loads: 16.87 Tonal Baseline Loads: 19.76 I hereby certify that the plans and specifications covered by this calculation are in compliance with the Florida Energy Code. PREPARED BY: DATE: 3/r I hereby certify that this building, as designed, is in compliance with the Florida Energy Code. OWNER/AGENT:__._.___- DATE- Review of plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance with Section 553.908 Ronda Statutes. BUILDING OFFICIAL: DATE: Cap: 36.0 katu/hr SEER: 13 Cap: 25.0 kBtulhr COP: 1 Cap: 40 gallons EF: 0.92 Pstat PASS S CO - Compliance requires certification by the air handier unit manufacturer that the air handier enclosure qualifies as certified factory- sealed hi accordance with N1110.A.3. 0L-.6 400E6 is 11-0 s Rinnn1? 9•7R PM FnArnsonastriclib I Lan - Fnalzr,a,rnuna Panty 1 ref !S w ° v w.~ ` PROJECT Title: GARAGE CONVERSION Bedrooms: 1 Adress Type: . Street Address Building Type: FLAsBukt Conditioned Area: 376 Lot 5 Owner. GARAGE CONVERSION Total Stories: 1 : 5 of Units: 1 Worst Case: No PlatBoolc Builder Name: Rotate Angle: 0 Street 53 NW 97111 ST Pemdt Office: MIAMI SHORES Cross Ventilation: County: DADE Jurisdiction: Whole House Fan: City, State, Zip: MIAMI SHORES , Family Type: Single-family FL NewlEsdsting: New (From Plan) Comment: CLIMATE IECC Design Temp Int Design Temp Heating Design Daily Temp Design Location TMY Site Zone 97.8 % 2.5 % Winter Summer Degree Days Moue Range FL, Miami Beach F LMIAMI_INTL, AP 1 51 90 75 70 149.5 58 Law FLOORS # Floor Type Perimeter R Value Area Tile Wood Carpet 1 Slab -On -Grade Edge !mulatto 57 ft 0 375 fP 0 0 1 ROOF Roof Gable Roof Soler Deck # Type Materials Area Area Color Absor. Tested Insul. Pitch 1 Hip Composition shingles 406 ft* 0 ft* Medium 0.98 No 0 22.8 deg ATTIC 0 Type Ventilation Vent Ratio (1 in) Area RBS IRCC 1 FuU attic Vented 300 376 ft* N N CEILING # Ceiling T . - R -Value Area Framing Frac Truss Type 1 Under Attie (Vented) 30 375 ft' 0.11 Wood WALLS # Ornt Adjacent To Wall Type Solar Area R Vea PT= Aor. 1 N Exterior Concrete Block - Int inset 4.099999 131.6868 0 0.15000000 2 S Exterior Concrete Blodc - Int maul 4.099999 131.8668 0 0.15000000 3 W Exterior Concrete Stook - Int Insul 4.099999 131.E 0 0.15000000 1 • WINDOWS • Orientatlakn shown Is the entered, asBuilt orientation. Overhang NFRC U- Factor' SHOO Storms Area Depth Separation Int Shade Screening Yes 1.1 0.36 N 9 ft2 13 f 6 in 1 ft 8 in HERS 2006 None Yes 1.1 0.36 N 32 ft2 1 ft 6 in 1 ft 6 in HERS 2006 None Yes 1.1 0.36 N 12 itt 1 ft 8 in 1 ft 6 In HERS 2008 None Yes 1.1 0.36 N 6 ft' 1 ft 6 In 1 ft 6 in HERS 2008 None / �/ Omt Frame Panes 1 2 3 4 N Metal Single (Tinted). S Metal Single (Tines) W Metal Single (Tinted) W Metal Single (Tinted) r INFILTRATION & VENTING Method SLA CFM 80 •--- Forced Ventilator --- Run Time Fan ACH 50 ELA EgLA Supply CFM Exhaust CFM Fraction Watts Default 0.00036 384 7.08 19.4 36.6 0 elm 0 dm 0 0 COOLING SYSTEM J # System Type Subtype Efency Air Flow SHR Ducts 1 Central Unh None SEER 13 36 kBtuthr 1080 o8n 0.75 sys#1 HEATING SYSTEM 0 System Type Subtype Efficiency Capacity Duds 1 Electric Strts Heat None COP: 1 25 kBtulhr sysOi HOT WATER SYSTEM e System Type EF Cap Use SetPrit Conservation 1 Electric 0.92 40 gal 40 gal 120 deg None SOLAR HOT WATER SYSTEM FSEC Cert 0 Company Name Collector Storage System Model 0 Collector Model* Ares Volume FEF None None fla DUCTS — Supply — 0 Location R Value Area — Return — Air Percent Location Area Leakage Type Handler CFM 28 Leakage GIN RLF 1 Attic 6 87.6 ft' Warier 14.4 ft* Default Leakage Interior (Default) (Deftarlt) % 1 'TEMPERATURES Progremable Thermostat Y Doffing Fans: Aug Oct DOC X C Dec mra, I Vne Iii Jan Jan ab Iiiir RIZ IIiIMeY l�51 W9 W^P Dec Thermostat Schedule: HERS 2008 Reference Hours Schedule Type 1 2 3 4 5 6 7 8 8 1a 11 11822p Coaling (WD) Pill 88 80 78 78 78 78 TB 78 78 7d 78 78 Cooling (WEN) PM 8 1 78 T8 78 7788 78 7788 78 7788 Heating (VW) PM 8�8. 6�8 88 8�8 6�8 6�8 176 68 8778 68 8b 66 6688 Heating (WEF) AM 66 68 66 66 PM 68 68 8 68 68 68 . 68 88 68 88 88 68 68 68 68 68 a 68 - FORM 1100A -O8 Code Compliance Checklist Residential Whole Building Performance Method A - Details ADDRESS: 53 NW 97TH ST MIAMI SHORES, FL, PERMIT #: INFILTI(A IRAN IWULU 1 non WIUW L n. "- ws ■• -�”.-^R SECTION • COMPONENTS SECTION REQUIREMENTS FOR EACH PRACTICE CHECK Maximum: .3 cfm/sq ft. window area; .5 cfm/sgl. door area. Caulk, gasket, weatherstrip or seal between: windows/doors & frames, surrounding wall; foundation & wall sole or sill plate; joints between exterior wall panels at comers; utility penetrations; between wall panels & toptbottom plates; between walls and floor. EXCEPTION: Frame walls where a continuous infiltration barrier is installed that extends front, and is seated to, the-foundation to the top plate. Penetrationsfopenings >1/8" sealed unless backed by truss or joint members. EXCEPTION: Frame floors where a continuous infiltration barrier is Installed that is sealed to the perimeter, penetrations and seams. _ Exterior Windows & Doors N1106AB.1.1 NI 106AB.1.2 Exterior & Adjacent Walls Floors NI 106AB.1.2 Ceilings NI 106.AB.1.2 Between walls & ceilings; penetrations of celiktg plane to top floor, around shafts, chases, soffits, chimneys, cabinets sealed to continuous air barrier; gaps In gyp board & top i plate; attic access. EXCEPTION: Frame ceilings where a continuous Infiltration barrier is Installed that is sealed at the perimeter, at penetrations and seams. Separate readily accessible manual or automatic thermostat for each system. Ceilings -Min. R-19. Common walls-frame R -11 or CBS R-3 both sides. Common ceiling & floors R-11. Recessed Ltghting Fldures NI 106AB.1.2 Type IC rated with no penetrations, sealed; or Type IC or non-IC rated, installed inside a sealed box with 1/r clearance & 3" from insulation; or Type IC with < 2.0 cfm from conditioned space, tested. Multi-story Houses N 1106.AB.12 Air barrier on perimeter of floor cavity between floors. Exhaust fans vented to outdoors, dampers; combustion space heaters comply with NFPA, have combustion air. Additional Infiltration reqts NI 106AB.1.3 THER PRESCRIPTIVE MEASURES (most be met or exceeded by all residences.) ' COMPONENTS SECTION • ` REQUIREMENTS CHECK Water Heaters N1112.AB.3 Comply with effde ncy requirements in Table N1112.ABC.3 Switch or clearly marked circuit breaker (electric) or cutoff (gas) must be provided. External or built-In heat trap required. Spas & heated pools must have covers (except solar heated). Non - commercial pools must have a pump timer. Gas spa & pool heaters must have a minimum thermal efficiency of 78%. Heat_pump pool heaters shall have a minimum COP of 4.0. Water flow must be restricted to no more than 2.6 gallons per minute at 80 PSI3. All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, sealed, insulated and installed in accordance with the criteria of Section NI 110AB. Ducts In unconditioned attics: R-6 min. insulation. Swimming Pools & Spas NI 112.AB.2.3 Shower heads NI 112.AB.2.4 Air Disbibution Systems N1110AB HVAC Controls NI 107AB.2 Separate readily accessible manual or automatic thermostat for each system. Ceilings -Min. R-19. Common walls-frame R -11 or CBS R-3 both sides. Common ceiling & floors R-11. Insulation NI104AB.1 NI 102.B.1.1 ENERGY PERFORMANCE LEVEL (EPL) DISPLAY CARD ESTIMATED ENERGY PERFORMANCE INDEX* = 67 The 6awer the EnergyPerfonnance Index, the more efficient the home. 1. New construction or existhrg 2. Single family or maniple family 3. Number of units, if multiple family 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned fir area (its) 7. Windows** Description a. U- Fadar: SHGC: b. U -Factor SHGC: a U -Factor NIA SHGC: t U- Factor NIA SHGC: e. U- Factor. WA SHGC: 8. Floor Types a. Stab-On -Grade Ewe insulate b. N/A c. N/A Sgt, U=1.10 SHGC=0.36 N/A 53 NW 97TH ST, MIAMI SHORES, FL, New (From Plans) Sib4amlly 1 1 No 1750 9. Wa0 types a. Concrete Black - Inthaul, Exterior b. NIA a N/A d. N/A 10. Ceiling Types a. Una Attic (Vented) Neu b. WA 58.00 fe a NIA 11. Ducts si. Sup: Atilo Ret interior Ali: interior 12. °s arrg systems ft* a Central Unh it* 13. Healing systems a E eddc Strip Heid 1i= hdatigr Area it=0:0 375.00 W ft' R' tt' 14. Had renter systems o.Electric b. Conservation features None 15. Cremes I certify that this home has compked with the Florida Energy Efficiency Code r B Ting Construction through the above energy saving atureswh h WI be instaked (or in this home before final inspection. Otherwise, a new EPL Display Curd will be based on installed Code compliant nt features. Builder Signature: Address of New Home: Date: City/FL Tip: Insulation Area R=4.1 30500IP R= ft' A* haalatian Area R=30.0 375.00 tr;2 Res 1ta Sup. Rzt 8, 57.6 ft* Cap: 36.0 k61u/hr SEER: 13 Cap 25.0 kl#ulhr COP:1 Cap: 40ga1 EF: 0.0.2 *Note: The home's estimated Energy Performance Index is only evadable through the Enei yGauge USA - FlaRes2008 computer program. This is not a adding Energy Rating. If your index is below 100, yaw hone may qualify for incentives if you obit a t o Enemy Gauge Radng. Contact the Energy Gauge Hotline at (321)038 -1492 or see the Enemy Gauge web site at energygaug e.c om for htformation and a bit of certified Raters. For information about Code far fikalling Conshuction, ciordatt the Department of Community Affahs at (860)407 -182 **Label rsec uke' f by Section 13- 104.4.5 of the Florida Bidding Code, Budding, or Section 02.1.1 of Appendix G of the Raids Budrimg Code, Resklential, if not DEFAULT. EllertNOcude. USA - FIB ENERGY PERFORMANCE LEVEL (EPL) DISPLAY CARD ESTIMATED ENERGY PERFORMANCE INDEX* = 8$ The lower the EnergyPerformance index, the more efficient the home 1. New construction or existing. 2. Single family or multipte family 3. Number of units, if multiple family 4. Number of Bedrooms 5. Is this a worst case? 8. Conditioned floor area (ft') 7. Windows" a. U- Factor. SHGC: b. U- Factor. SHGC: a. U- Factor: N/A SHGC: d. U- Factor: 'WA SHGC: e. U- Factor. N/A SHGC: 8. Floor Types a. Slab -On -Grade Edge insulation b. N/A c. N/A Description SgI, U =1.10 SHGC=0.38 N/A 53 NW 97TH ST, MIAMI SHORES, FL, New (From Plans) Single - family 1 1 No 375 9. Wan Types a. Concrete Block - Int Insul, Exterior b. N/A c. N/A d. NIA 10. Ceiling Types a. Under Attic (Vented) b. N/A Area c. WA 58.00 it' 11. Duda ft, a. Sup: Attic Ret Interior AH: Interior Sup. R= 8, 57.8 fP 12. Cooling systems 1P a. Central Unit Cap: 38.0 kid SEER: 13 Insulation Area R=4.1 395.00 ft* R= 1(° R= g' Rost ft' Insulation Area R=30.0 375.00 ft' R= fl' R= 0' tP 13. Heating systems a. Electric Strip Heat fla insulation And R=0.0 375.00 fP R= 5' b. Conservation features R= ft2 None 15. Credits 14. Hot water gems a. Electric (< certify that this home has compiled with the Florida Energy Effidency Code for Building Construction through the above energy saving features which will be installed (or exceeded) in this home before final inspection. Otherwise, a new EPL Display Card will be completed based on installed Code compliant features. Builder Signature: Address of New Home: Date: City/FL Zip: Cap: 25.0 k8tulhr COP:1 Cap; 40 gallons EF: 0.92 Petat a *Note: The home's estimated Energy Performance Index is only available through the EnergyGauge USA FlaRes2008 computer program. This is not 'a Building Energy Rating. If your index is below 100, your home may qualify for incentives if you obtain a Florida Energy Gauge Rating. Contact the Energy Gauge Hotline at (321) 638 -1492 or see the Energy Gauge web site at energygauge.com for information and a list of certified Raters. For information about Florida's Energy Efficiency Code for Building Construction, contact the Department of Community Affairs at (850) 487 -1824. **Label required by Section 13- 104.4.5 of the Florida Building Code, Budloing, or Section 82.1.1 of Appendix G of the Florida Building Code, Residential, if not DEFAULT. EnergyGauge® USA - FlaRes2008 Project Summary En re House MIKEL ABBOTT ENERGY CALCS 4820 N'MIX E HWY, FT LADERDALE, Phors 864776 -2003• Jobe ' GARAOECONDIEGO97Sr Date: 313112 BY: For: Notes: GARAGE CONVERSION 53 NW 9TH ST, MIAMI SHORES, WHOLE HOUSE ADDITION PLUS EXISTING WINDOW SHADING COEF MUST BE .36 Weather: Miami Beach CO, FL , US Winter Design Conditions Outside db 48 °F D esiign TD 70 DF Heating Summary Building heat loss 24632 Btuh Ventilation air 0 cfm Ventilation air loss 0 Btuh Design heat load 24632 Btuh infiltration Method Construction quality Fireplaces Area me OP) ur Equiv. AVF (cfm) Simplified Average Heating Colin g 14472 79 14472 050 170 120 Heating Equipment Summary Make GOODMAN Trade AWUF360S16BA Efficiency 1.0 AFUE Heating output 25000 Btuh Heating temp 0 b dA n fa 1200 m Heating air flow factor 0.049 cfm/Btuh Space thermostat Summer Design Conditions Outside db inside db Design TD Relelaytivvee h midity Moisture difference 89 F 75 50 % 56 gr/lb Sensible Cooling Equipment Load Sizing 26710 Btuh 0 Btuh 3.0 °f 267 0 Btuh Structure Ventilation Design temperature swing Use Mfg. data Rate/9%1a q multiplier Total sens. equip. load Latent Cooling Equipment Load Sizing Internal gains nfaillratition Total latent equip. load Total equipment load Req. total capacity at 0.70 SHR 1200 Btuh 4609 6388 �h 33098 Btu h Cooling Equipment Summary Make GOODMAN Trade VSX130361DA Effidency Sensible cooling Latent cooling Total cooling Actual cooling fan Coding air flow factor Load senses heat ratio 81 % 13.0 SEER 10800 Btuh � Btuh 0.045 cfm/Btuh ladesII ;ratan lava boo nmanually overrtikkes Printout certified by ACCA to meet all requirements of Manual J 8th Ed. wvte^ttghtscift Right - trite Restdent al .18 6.8.17 R8R31066 CA00t8C%Wrightsoft HNAC\GARAGECOND1EG097$T.ncp Cato= Md6 Orientation = N 2312 -M8r 0413:44:32 Pagel Short Form Entire House MIKEL ABBOTT ENERGY CALCR 4920 N WOE HWY, FT LADERDALE, Phone: 984^778- Zo0,$. Job: GARAGECONDIEGO>�7St Date: 313112 By: For. GARAGE CONVERSION 53 NW 9TH ST, MIAMI SHORES, Outside db (°F) Inside db ( °F) Design TD ( °F) Daily range inside humidity (%) Moisture difference (gr/lb) Htg 48 70 22 Clg 89 75 14 60 56 HEATING EQUIPMENT Make GOODMAN Trade AWUF360S168A Efficiency 1.0 AFUE Heating input 25000 Btuh Heating output 25000 Btuh Healing temperature rise 19 °F Actual heating fan 1200 cfm Heating air flow factor 0.049 cfm/Btuh Space thermostat Method quality Fireplaces Infiltration Simplified Average 0 COOUNG EQUIPMENT Make GOODMAN Trade VSX130381 DA Efficiency 13.0 SEER Sensible cooling 25200 Btuh Latent Total cooling 36000 Btuh Actual cooling fan 1200 cam Cooling air flow factor 0.045 cfm/Btuh Load senhlble heat ratio 81 % ROOM NAME ( Htguh� C a�d (cfm) I AVF (cfm) Cl. g AVF ADDITION 375 4613 4835 225 217 EXISTING 1434 20019 21875 975 983 Entire House d 1809 24632 ' 26710 1200 1200 Ventilation air 0 0 Equip. @ , 1.00 RSM 26710 Latent cooling 6388 TOTALS 189 014 WV) .1•Sifno Arshrt eald9bulla values have bun manually ors�rkkli Printout certified by ACCA to meet all r quiremer�ts of Manual J 8th Ed. 7200 v ricifitscCi RipM -8 a Residential J6 6.8.17 R8R31055 • C:ICOMC \WrightaaB HVAC%GARAGECONAtEG097S{'.rte Cola to MJ8 Orientation = N 2012 -M r-04 1344:2;2 Pap1 Right-J8 Worksheet Endre House MIKEL ABBOTT ENERGY CALCS 4020 N DUDE HWY, FT LADERDALE, Phenix 954-776-2003 Job: CARAGECONDIE00979t Date: 313112 B$ 2 3 4 6 Room name Eseci wall Room =one Room area Entire House 302.0 ft 8.0 ft d 1809.0 ft 2 AMMON 67,0 ft 8.0 ft heat/cool 375.0 x 1.0 ft 375.0 fta TV Construction number U-value flitiuhiffvf) Or HTM puha" Area OrpelinTer On Load (Elhat) Area tr) or Perlfmfter (ft) Load (OW Heat Cool Gross WM Neat Cool Gross WPM Heat Cool 8 • • • 11 13A-4ocs 1A-r1om 1140 13A-3oos 1A-rlom 13A-3oos 1A-rlom 1110 13A-40as %glom 1140 13A-3oos 1A-rlan 1344oca 1A-rlom 1110 13A-3o� 1A-Mom 120.Osw 1100 13A-4o es 1100 18A-30ad 20P-19c 0.143 1.270 0.800 0.167 1.270 0.167 1270 0.400 0.143 1.270 0.600 0.167 1.210 0.143 1.270 0.800 0.167 1,270 0.097 0.390 0.143 0.390 0.032 0.050 n n n n n e a a a a a a a w w w w w - n - n - - 3.15 27.94 1&20 3.67 27.94 3.67 27.94 13.20 3.15 27.94 13.20 3.87 27.94 3.15 27.94 13.20 3.81 27.94 2.13 8.55 3.15 8.88 0.70 1.10 2.78 25.12 18.30 3.22 23.12 3.22 51.41 18.30 2.78 26.57 18.30 3.22 23.57 2.76 51.41 18.30 3.22 57.75 1.72 11.89 1.70 11.89 2.37 an 152 9 0 350 89 350 80 30 152 32 0 350 92 152 5 0 350 43 0 0 0 0 1809 1809 143 0 0 281 0 240 80 30 120 32 0 258 92 147 5 0 307 43 0 0 0 0 1809 302 450 251 0 959 2487 882 2236 396 3711 894 0 948 2570 462 140 0 1128 1201 0 0 0 0 1274 1990 395 228 0 841 2236 774 2009 549 331 804 0 822 2311 408 128 0 989 1233 0 0 0 0 4284 1268 152 9 0 0 0 0 0 0 162 32 0 0 0 152 5 0 0 0 0 0 0 Os 375 375 143 0 0 0 0 0 0 0 120 32 0 0 0 147 5 0 0 0 0 0 0 0 375 57 450 251 0 0 0 0 0 0 378 894 0 0 0 482 140 0 0 0 0 0 0 0 284 413 395 226 0 0 0 0 0 0 331 804 0 0 0 406 128 0 0 0 0 0 0 0 888 262 1 ,,TJ Envelope losslgain 18645 19811 3252 3437 12 a) Infiltration b) Ventilation 4113 0 1848 0 1011 0 454 0 13 14 15 Internal gains: Occupants Cli 230 Appliances dtlt 1200 Less exterrxd load Less transfer Redistribution Subtotal Duct loads 8 1 8% 11% 0 0 0 22768 1874 1380 1200 0 0 0 24039 2871 2 0 8% 11% 0 0 0 4262 351 480 0 0 0 0 4351 484 - _ Total room toad Air required (oh) - 24832 1200 28710 1200 4813 225 4836 217 Printout certified by ACCA to meet all requirements of Manual J 8th Ed. • ..weirssatt-sita=;IFit Right-Suite. Residential 48 8817 RSR31050 • • •-• C:tOOMO0Nrightsoft HVAGI0ARA0ECONDIE60975trip Cain MJ8 Orientation N 2012411er-04 13:44:32 Page 1 Right-J8 Worksheet Entire House WEL ABBOTT ENERGY CALM Job: GARAGECONDIE009781 Date: $13M2 WM DIXIE tiwr, FT ttummtom.u. rnone: vow.. rsr.snmr 1 2 3 4 6 Room name dwail C height Room clhnertakme Room area EXISTING 245.0 It 8.0 ft heat/cod 1434.0 x 1.9 It 1434.0 f(S Ty 1 Construction number ti•value (13tutiMP-°F) 0.143 1.270 0.800 0.167 1.270 0.187 1270 0.600 0.143 1.270 0.800 0.167 1.270 0.143 1.270 0.800 0.187 1.270 0.097 0.390 0.143 0.390 0.032 0.050 (Stuttifta) Area (IP) or perimeter (ft) Load ONO) Area or perinea* Load n n n n n e • e a 5 s e s w w w w w - n - n - • Neat 3.15 27.94 1320 3.87 27.94 3.87 27.94 13.20 3.15 27.94 13.20 3.87 27.94 3.15 27.94 13.20 3.87 27.94 2.13 8.55 3.15 8.58 0.70 1.10 Cool 2.78 25.12 18.30 3.22 25.12 3.22 51.41 18.30 2.76 28.57 18.30 3.22 26.67 2.78 51.41 18.30 3.22 87.75 1.72 11.89 1.7.0 11.89 2.37 0.70 Gross 0 0 0 350 89 350 80 30 0 0 0 350 92 0 0 0 350 43 0 0 0 0 1434 1434 RPM 0 0 0 261 0 240 80 30 0 0 0 258 92 0 0 0 307 43 0 0 0 0 1434 245 4 rr 1�� i�EN{Si�s1�i 4000 O §x000 0110 001/0/100 0 50000110004 10001O*000 Gross NIP1S Hoat 6 • • 11 13/1/44o� 1A-riom 1140 134-3ooe 1A-rlom 13A-300s 1A-rlorn 1140 13A-400s 1A-rim 1140 13A-3oos 1A-r1 am 13A-4oes 1A-dom 1140 13A400s lArblom 128.0aw 1100 13A-4oes 1100 18A-30ed 20P-190 "Cr Envelope loss/gain 15393 18173 12 a) Infiltration b) Ventilation 3103 0 1394 0 13 14 15 Internal g ains: i 230 Appliances i 1200 Less edema) load Less transfer Redistribution Subtotal Duct loads 11% 0 0 0 18498 1523 920 1200 0 0 0 19687 2188 Total room load Air required (550) 20019 975 21875 983 Printout certified by ACCA to meet all requirements of Manual J 8th Ed: '4kA•r-ICalt-Ilte=writ RIW-Stft Residential a 6.8.17 R$R31055 CACOMO1Wrionteoft liVAMGARECONDIE0097STirp Cilia M48 Orientation N 2012-Mar-04184411 P8082 r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 172742 Scheduled Inspection Date: November 14, 2012 Inspector: Perez, JanPierre Owner: Permit Number: MC -4 -12 -735 Job Address: 53 NW 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: CENTRAL AIR PLUS CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010330280 Phone: (786)295 -3861 Building Department Comments REPLACE NC 3 TONS AND REPAIR DUCTS 06/06/2012 - NEED TO UPDATE LIC AND INS BEFORE INSPECTIONS. c� jr��tz Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 13, 2012 For Inspections please call: (305)762 -4949 Page 6 of 42 ACORD� CERTIFICATE OF LIABILITY 'VOMIT INSURANCE PRODUCER (305) 512-5880 FAX: (305) 512 -5881 Torres Insurance Agency Inc. • 61.35 NW 167 STREET # E25 Miami. Lakes FL 33015 INSURED Central Air Plus Corp 4759 palm Ave Snits #124 Hialeah FL 33012 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON ALTER THE COVERAGEIAFFORDED BY THE OF INFORMATION THE CERTIFICATE MEND, END OR INSURERS AFFORDING COVERAGE . IN$URERA:ACCid.9n't Insurance NAIC # INSURER s :Moiint Vernon Fire INSURERC :ASSociated Industries INSURER D: INSURER E: COVFRAGES 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 POL CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEE 1J EDUCED BY PAID CLAIMS, INSR I. ADDn. .E.,.. TYPE • INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD u POLICY £XPIRATi °N DATE MMID • LIMITS A GENERAL X LIABILITY AG1,9008E72 9/23/2011 9/23/203.2 EACH�G,OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE t X OCCUR DRRMISERATOcur.0 $ • 100,000 MED EXP (Anyone eersan1 $ 5 1 000 X $1,000 PD Ded PERSONAL aADVINJURY $ 1,000,000 per Claim GENERAL AGGREGATE PRODUCTS •COMP /OP AGO $ 2,000,000 $ 1,000,000 GEM. AGGREGATE POLICY . LIMIT APPLIESPER z T n LOC COMBINED SINGLE LIMIT (Es saddens) AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 1?IODILY INJURY (Par parson) $ I BODILY INJURY (Per aCddenE) PROPERTY DAMAGE Per acddent) $ i GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ AUTO ONLY; AGG $ EXCESSIUMBRELLA LIABILITIP OCCUR ri CLAIMS MADE ]a'.25E04E8 10/15/2011 10/13/203.2 FM W OC.CIRRENCP $ 5,000,000 AGGREGATE $ 5, 000,000 _ I %ERUCTIBLE RETENTION PROD /CONPL OPERATION 5,,000,000 PERsowu. s ADVERT/SI $ 5,000,000 0 RKi €R COMPENSATION AND UAsILLItY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXGLUDED? 11 yes, describe under SPECIAL PROVISIONS below 120-1418 6/2/2012 6/2/2013 X r RYi"Ms °P:EEMMPLO E EAON ACCIDENT $ 1,000,000 E. L. DISEASE •EAEMPLOYEEs 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1, 000 000 OTHER , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - Air Conditioning (Installation a Repair) Machanical Contractor Blanket Additional Insured Included CERTIFICATE HOLDER (305) 756 -8972 Miami Shores Village Buiding 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, DuT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATI OR LIABILITY OF ANY (KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE tNS025 mire ail. 'd 6985 ' °N r hS ly(`17RIT minpnRATION 1988 A3N3JV 33NWSNI S3H01 Wv : << MI6 'lZ 'Ufa Panela1'2 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: MECHANICAL Permit No. Master Permit No. APR 2 4 2612 J111 BY.............. 1241 OWNER: Name (Fee Simple Titleholder): d%��Qr RI' CAE ugh t �'iAlJiS ' Phone #: 86 2Q Address: City: ylii ?State: ' Zip: 3316 \ Tenant/Lessee Name: Phone #: Email: lag Wed, 407 tL<. ®i m+1- 110 JOB ADDRESS: « 1❑ 4.3 City: Miami Shores Folio/Parcel #: 1 • ',(o Q 0.52 O2 f County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: CompanyName: CENTieRL r41re PLUS LAPP. Address: 476f PRIM ,Glee /` /2 S` City: i9f»/.eAli State: PC Qualifier Name: /26f4'4i CC tbcP 2 State Certification or Registration #: i /344072e6 Contact Phone #: 0L0,14'zz!1 3 DESIGNER: Architect/Engineer: Phone #:614 )96ZV 7 3 Zip: 33 ®/Z Phone #f Email Address: Certificate of Competency # :: eali 9L97.80 Phone #: Value of Work for this Permit $ //19 e 196) Square/Linear Footage of Work Type of Work: DAddress ❑Alteration ❑New if/Repair/Replace Li Demolition Description of Work: eeezACM" 44 3nws. 4N1D dei PA /R Pears • *.. *` 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 A)E'IiIllAVIT:' I certify that all'the foregoing information is acdurate 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 approve ,, a ;' a reinspection fee will be charged. Signature 1' Signature Own gent Contractor ." , The foregoing instrumept was acknowledged before me this 4 The foregoi ins ment was acknowledged before me this / 5/ day of , 20 12, by day of (G ,Q 20 / 2--,- by who is personally known to me or who has produced who is personally known to me or who has produced �p0.Y PLpt� Ail who did take an oath. as identification and who did take an oath. �' • o MY COMMISSION *DD98+1W NOTARY, ' � C�: to ,r EXPIRES. Apt 22, 20 `.mot. Sign: Print: My Commission Expires: APPROVED BY * * * * ** * * * * * *:: * * * * * * * ** 4************************** * * * * * * ***** ** * * * * * * * * * * * * * *** NOTARY PPtBU . s;�+,._. OFFLORIDA • us`? ' gatrneh0 Cotnnnissi:;tl 952610 ;► �.,� -s; 06, 2014 Signs + +Y . r, • Print: My Co /1 G Mans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 53 L9 GU . % 7 7' #6,47-4W. S 4? &, City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO E ARHI Sheet Attached: YES ❑ NO Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 6- &N,4 Al AHU or PKG. UNIT MODEL # Pt Val u 7 3c.- O 6 13 t4 COND.UNITMODEL# \US 19)03 61 0A KW HEAT /Jn"3 / 20 NOM TONS T AHU CU .PKG 1) M.C.A AHU CU PKG AHU CU PKG° 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER 1 3 scc5A_ YES NO REPLACING DUCTS YES ' NO YES NO REPLACING THERMOSTAT NO YES = NO NEW 4 "CONCRETE SLAB Y) NO YES . NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): - 10/.,7 2. Maximum Overcurrent Protection (Fuse /Breaker Size): c726i - C) 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: CEV17'.4 "Me A2 eeleg Phone: < State Certificate or Registration N. E 13e:672496 Certificate of Competency N. 0.71, i9e3,e% Signature %f / signature only) Date: �'�-2 /,, -_ CERTIFICATE OF COMPETENCY i__, CLASS 'B" AIR CONDITIONING CONTRACTOR CENTRAL AIR PLUS CORP. CC# 03-CML -904 -X Expires 8/31/2013 Ref. 3896451 CtrI# 11 -14097 STATE OF FLORIDA A Ca DEPARTMENT OF BUSINESS AE":='` PROFESSIONAL REGULATION RA13067206 08/12/11 110053139 REG AIR CONDITIONING CONTRACTOR LOPEZ, REINALDO CENTRAL AIR PLUS CORP (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 expiration date: AUG 31, 2013 L11081200920 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 02M000930 CENTRAL AIR PLUS CORP D.B.A.: LOP t REINALDO is certified under the provisions of Chapter 10 of Miami -Dade County FC)R vim.. ,T ^Tx. L 0 1 )1 3 L?CENSE CLAa .' 1345 4 AYE 405 HIALEALf. Fi 'wr - r. ==:aEs 05-2 1DKi'PAY . .4100040030:- ZAGE PATIMOVECIEMOI mammammumic x,4001:. 75-i00 _ .. . as N*FCRrami CENTRAL AIR PLUS CORP JESUS RESO PRES 4759 PALM AVE STE 124 HIALEAH FL 33012 ���ffflfRi�fff Hiiltii�ll�ltf�iiff�if�ftf lH� DOMOTFORMARO CENTRAL AIR PLUS CORP JESUS REM PRES 4759 PALM AVE STE 124 HIALEAH FL 33012 SEE OMER SOE Ltnfft &Lfs rf1staum. .a.uJJusstJ Miami Shores Vuiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 4\ Permit No: Date: Job Name: MECHANICAL Critique Sheet ,-(> ///Lcy-f 4_ -I-- 0 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Review Complete by: Jan Pierre Perez Chief Mechanical Inspector 786- 412 -5318 PERMIT #:u_-/I `-71s3s% Miami Shores Village Building Department RECEIPT DATE: Contractor o Owner o Architect 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 aC Ca�� ce-0,011 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: 5 PERMIT CLERK INITIAL: