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RC-12-1280Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 175721 Permit Number: RC -7 -12 -1280 Scheduled Inspection Date: January 07, 2013 Permit Type: Residential Construction Inspection Type: Final Owner: LERET, LILIANA Work Classification: Alteration Job Address: 52 NW 99 Street Miami Shores, FL 33150- Inspector: Bruhn, Norman Project: <NONE> Contractor: A&J GENERAL CONSTRUCTION CORP. Phone Number Parcel Number 1131010330050 Phone: (305)599 -2782 Building Department Comments KITCHEN CABINETS WERE REPLACED BY PREVIOUS OWNER WITHOUT PERMIT. REPAIR AND REPLACE CELING DRYWALL DAMAGED BY ROOF LEAKS (AFTER THE FACT PERMIT KITCHEN) AS PER BO. ALL PERMIT ON HOLD 9/10/12 Failed Inspector Comments C°G Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 04, 2013 For Inspections please call: (305)762 -4949 Page 4 of 25 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: 5g. AA.1.9 F. c2 �� SEP 21 2012 FBC 20 Permit No. Master Permit No.gC42°' 1 MO ROOFING City: Miami Shores County: Miami Dade Zip: .33 (/s-0 Folio/Parcel #: //3 /O/ 6_33-0 05 /7 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): l /Q, a /-e _ Phone #: Address: 6j a /i%%(,l) City: /Cita J / 64 D /e5 State: /1-(et rlCX Ct Zip: 33 / 5 c) Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: AdSger7efn / 69/2 /74C-4 /0/— dew- Phone #: 2G l -o2 -7tZ Address: 79q 7 tiu) 64/61" City: / `a�n® State: %G'O!<Lly Qualifier Name: /VI i (mead 6a-e.crt r State Certification or Registration #: C l S la S� Contact Phone #: z DESIGNER: *A ct#E#tgitleer: Email Address: Zip: .3-3/‘ Phone #: 3d5 ,$6 c(---434/0 Certificate of Competency #: Phone #: Value of Work for this Permit $ e27 UC) Type of Work: ❑Addition ❑Alteration Square/Linear Footage of Work: ❑New Description of Work k/ (Aft; 64-4/ in ,7" /CJr®d4 O 7-1 9osie ❑Repair/Replace UDemolition wa /I eiaa<eg f,�J ii._ DO' C O Color thru tile: * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * ** *Fee ,x�r * x �x ,� *�r ,x �x ,�* Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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) 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�ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will 'o be ap ved and einspection fee will be charged. wner or Agent The foregoing instrument was acknowledged before me this /2 day ofS9,r1 , 20 ea., by h./4 /2a /'re who is --q to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: . Sign: Print: / f/r /,O' /' 4 My Commission Expires: ‘74,-c,6 X - 40ef1 M1GU71. GUERRERO MY cc r: .SSION # DD973716. EXPIRES March 22, 2014 Signature Contractor The foregoing instrument was acknowledged before me this 13 4-0/y161,20 12 , by ri l E-is Pek 6Qerrcn) day of . who is A APPROVED BY lans Examiner Structural Review NOTARY o me or who has produced as identification and who did take an oath. IC: Sign: Prin:i� My Commission Ex (Revised 5 /2 /2012XRevised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007) rE fER+ilUD{ ,.� :,tPIRES:J1 it>J. 16 .1Aued Tin Notary Now Undervaiters Zoning Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.W. '7- /2- J a_ed Owner's Name (Fee Simple Title Holder): 4__( l to v o. Owner's Address: 5 2./ti/,J c/q 51— City: 44 f c m i 5 hags State : Gd Job Address (Of where work is being done): SI/a.% 5.71- City: Miami Shores State: a/ 1.4 Phone #: Zip Code:(3,3 /5_0 Zip Code: 3 3 f5-0 Contractor's Company Name: A it-3 6enerall -h'cccr . s hone #: 3 oS- S' - )7 2 Address: 79,7(7 /LW City: i`/,i/ -ns State: Zip Code:33 /� �. Qualifier's Name : M I &ue/ 6ueirreKO Lic. Number:.. ( . /ST /9 c/ 5 Architect/ Engineer of Record Name: Address: City: State: Zip Code: Phone #: Describe Work: tor' cLa Pcb■ I hereby certify that the work has been abandoned and /or the contractor /architect is unable or unwilling to complete the contract. I hold the Building Official and the Signature Mia or Agent Shores harmless for all legal involveme Signature The foregoing ins t men was aknowledged before me this . day of ,20lZ,by _`��, Who is personally known to me or who has produced as indentification. Notary Publ; Sign: Seal: A'44 ', MIGUEL GUERRERO cY ``' "" 'MY COMMISSION # DD973716 EXPIRES March 22, 2014 '' %tijyt ,,. (407))398 -0153 FlorldeNotaryService.cogn Contractor or Architect The foregoing instrument was aknowledged before me this day of ley k e who is personally known to me or who has produced Le.cIerO Notary Publi Sign: Sea as indentifiication. ARACELYS RIM= MY MASON #EE 192500 EXPIRES: Apiff 27, 2016 Bonded Um Notary Public Undeneleis 52N trq 9cis+ KtCCHE�A P &2 EL MC 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: 52 /V W 9( sTQX T City: Folio/Parcel #: Miami Shores County: If3 /0l033oo Is the Building Historically Designated: Yes NO V Permit No. JUL 1 1 t1�d MI OA 01""412.1111 FBC 2010 KC- 12. -128'b • Master Permit No. ROOFING Miami Dade Zip: 3 3 I 640 Flood Zone: OWNER: Name (Fee Simple Titleholder): L IL //94A/4 ,60R60.5 L-+ /QI1T_ Phone #(99 '/)605 9 %V Address: S2 Any 9 9 577-Y City: /`l f4A4 5 FOi 15 State: Tenant/Lessee Name: Email: AJMI Zip: -3 3,is-8 Phone #: L.IL./%i/.!.44 ' L V RGoS L -CRL -7 CONTRACTOR: Company Name: 6 viA/x-R U) L.. Da Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Phone; ti5) 605 P ?h 7 • Value of Work for this Permit: $ �_ 11 . Square/Linear Footage of Work: 90 ST Type of Work: ❑Addition DAlteration ONew CtiRepair/Replace ODemolition Description of Work: %i /TC',r•A/ C■4 /A/c T$ wtie4 gi_PL iyez ,j>/ PRLV /OtJS 0 w1.fg /TNOV P44,14170 /Qr M rA 400D Affil/ Cf CL /L/Al6 /#J Ulnriab 460011,, b o9P14eif Roof' L.E-4-X5 ( *7,M 71/4 MeT iWee 1./7''We/AO Color thru tile: ** ** * * ***** *tier * **,r*** * * * * * ***** * ******F *******************************4************ Submittal Fee $ SO -O 0 Permit Fee $ :�. , ?, CCF $ CO /CC $ Scanning Fee $ PA t0 Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ � Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 'I °� ' 9 �— Bonding Company's Name (if applicable) A/A Bon tig Cprnpany'stddress City F State Zip Mortgage Lender's Name (if applicable) f\J/4 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 insp ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will s ' e ap roved ' d a reinspection fee will be charged. •o ' Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this Ili The foregoing instrument was acknowledged before me this day ofak)1' , 20 I'Z, by . crifp 3y of , 20 by who is personally known to me or who has produced 1 9 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: �.��5\\vera ,'��.,,i NOTARY PUBLIC: Sign: '. Print: My Commission Expires: SSA °y°'' • 'ii,,jr�S TAT . 9,(1,\\\ o Sign: Print: My Commission Expires: APPROVED BY r 75104 Plans Examiner Zoning Structural Review Clerk (Revised 5/2/2012XRevised 3 /12/2012)(Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) 1111111 11111 1111111111 1111111111 1111111111111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FiRST IiNISSPECTiON PERMIT NO. AC $© TAX FOUO NO./ I ' 3!0%-633 -410o 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 folowing information Is provided in this Notice Of Commencement. 1. Legal description of property and street/address: SA dV ill/ 9 9' S %R o 2. Description of improvement: 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4/4/4 4. Contractor's name, address and phone number: _ L. 1 S CFN 2012F:10522733 OR Bk '23202 Ps 19 8-6i (1Ps) RECORDED 07/25/2012 12:39:25 HARVEY RUVIN. CLERK OF COURT FIIAIII -DADE COUNTY. FLORIDA LAST PAGE above reserved for use of recording office C goat 5. Surety: (Payment bond required . owner fro contractor, if any) Name, address and phone ber: Amount of bond $ 6. Lender's name and address: desi IV(A/L. 7. Persons within the State of Florida gnated by Owner upon whom notices or other documents may served as provided by Section 713.13(1 Xa)7., Florida Statutes, Name, address and phone number. /Oh 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor'.s Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: /l// 9. Expiration date of this Notice of Commencement OL reettari 2 5 Z0/2 (the expiration date is 1 yeadrrrom 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 793, PART I, SECTION 713.13. FLORIDA STATUTES; AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY 3EFOf3E-COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s Prepared By Print Name Title/Office 1 STATE OF FLORIDA COUNTY OF MIAMI -DADE The.fo :•. ing ins' ..nt was By . dividualiy, or ❑ as Personally known, or l produced the following type of identifi Signature of Notary Public: Print Name: MAO 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 Igrowiedge and belief. or Owner(s ' Authorized-Officer/Director/Partner/Manager Prepared By • Print Name Title/Office en ged before me.this X day of 3 L�� f . 0 1 s ] for Signature(s) of Owner(s) or Owner{s)'s Authorized Officer /Director/Partner/Manager By 123.01 -52 PAGE 3 3/10 STATE OF FLORIDA, COUNTY a'F DADE I HEREBY CERTIFY that this is a true copy of the lit ginal fled in this office on A D 2s dal' of 3L WITNESS r r 'and and Official Seal. HAR ? VIN, CLERK, of Circuit and County Courts D.C. 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee: I understand that my failure to follow these may subject to serious financial risk. /I Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfloridalicense.com /dbpr /pro /cilb/iindex.tytmI •^ Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tha have provided on this disclosure. �L Initial ' Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner. builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of :7UL2 , 20 By LIU ► c°S LilaitrAO was personally known to me or who has Produ ' - d ;There License or ation. OWNER Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: 1L/ /_ /4/4 $u, && 1.RL7' DATE: yit/ 12—.. ADDRESS: 5 2 A/W 99' 5 -rRac frtogit 5 Y44W ,ff 3 .3/S0 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license, nuns on permits and contracts. C�1 Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. i tU ut! rulworliP4. f tretvg,parjv I N. W. S fi�ir rrr ii II If ET MOO" PARKWAY 100.00' (R&M) 5.W CON C. SIDEWALA yr- aollaft* Sim P.1,12 F.LP./ III NO IO. .213.131 0 hal W 4II r D) ilattTlin r - 15' ALLEY mop' ASPHALT PAVEMENT ONE-STORY 1DENCE o.52 r— 15' ALLEY %Air ASPHALT PAVEMENT 5We/r/ 40%8- p #xd=. e'eer •Wb-pizePeeArc itieP7 ,c74. le,01 s:544e);- /)/At 1Z4-e-lE ;Lie,' fize97---er,EP, t. z - (2go Miami Shores Village APPRO\/ED BY DATE ZONING DEPT BLDG DEPT SUBJECT 10 CUR .!ANICE WI WITH ALL FEDERAL STATE AND CLAIN! RULES AND REGULATIONS L-ti-MN4 5oZG,5 LEAEr sz N Iiv 99 srRtz c.7` /tAr r1f sdvle -$ F4.33/577 3c, if �1 f 5c 1 = 2 Permit No: 12 -1280 Job Name: July 17, 2012 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Identify the location of the drywallwork and show the required insulation. 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 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 175734 Permit Number: EL -7 -12 -1284 Scheduled Inspection Date: November 21, 2012 Inspector: Devaney, Michael Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project <NONE> Contractor: ON CALL ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330050 Phone: (786)388 -5880 Building Department Comments KITCHEN REMODEL. Passed Failed Correction Needed Re- Inspection Fee No ,Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Co . i ents November 20, 2012 For Inspections please call: (305)762 -4949 Page 7 of 27 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 tO Permit No. `'`3-40 Master Permit No. ft.. C ' I -It- Type: Electrical OWNER: Name (Fee Simple Titleholder): t itt4. / L4 1-1A N P Phone#: Address: G2.Nkt$ Sit . City: u 1w1:b St4,orttS State: Zip: 3515 o Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 51 N 9 4 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ®M9 ClfAV t L5attiC. Address: 1G. Lb 00 City: tilt.pAPIA, a State: �l- Zip: 3 d' 122. Qualifier Name: VC0.11.0 atitis Phone #: q State Certification or Registration #: E CO 60 b ` Certificate of Competency #: Contact Phone #: l g(o ° 511-/ 5 i q Email Address: �bJ O ON D kt_. L tc . Cot$t DESIGNER: Architect/Engineer: Phone #: Phone #: Value of Work for this Permit: $ (4 2M .u® Square/Linear Foot3w of Work: Type of Work: OAddress ❑Alteration ONew ORepair/Replace ODemolition Description of Work: New .14 feilv DeD 'rib X1.5 pr `' 11 '� C* *** * **** *** ** ****, x** ***** ***: x***+ x*+ x*Fees*****m+ x***** *a,******* *+ x**x :** * *****+x ********* Submittal Fee $ Permit Fee $lam ®GS 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, BOli.RRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occ seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n »7 be ap. rov ;d an p reinspection fee will be charged. The foregoing in trume t was acknowledged before me this /Z day of SAS , 20 12,-by L liq,0-2q /e' ,,, , who is per to me or who has produced As ide NOTARY PU I LIC: Sign: Print: CeCtl—eo My Commission Expires: /t etc4 lei 2v, .1 I I I I take an oath. ;' ,�'`e`c. MIGUEL GUERRERO • 4ilrf,' # % „, F. %I.*, ' EXPIRES March 22, 2014 ` MY COMMISSION # DD973716 ' 396 -0153 .//111.---6----- ) FloddallotaryService.ogpi Contractor The foregoing instrument was acknowledged before me this day of 4 e , 20 by Vizt.v I' who is personally known to me or who has produced as identification and who did take an NOTARY PUBLIC: E .74:s WIRES: arc 'i<,5aa 9 iltogiPubhc Unl2tv+dteis * * ** * * ** * ** * * ** * * ** k **** **** *** * * * ** sffiskds+ k$ sq: ************** * *ihih*+k+kH=*sptp*+k*N+*** APPROVED BY44 L_ pT ac�iz- Plans Examiner Zoning Structural Review Clerk (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 / HINGE OF CONTRACTOR / ARCHITECT Permit N. ac e 7 /2 _/ �8Q Owner's Name (Fee Simple Title Holder): 4/d/2 ph, /' Phone #: Owner's Address: -592-410) 414'J -7L City: , 'a1-29i siero -ems' State : Job Address (Of where work is being done): City: Miami Shores £ 24 L) 99674 Zip Code: ,-43 3l State: Florida Zip Code: 3=5 Contractor's Company Name: 0 lU CO 1°‘ Cc/11W, Phone #:154- M C b Q Address: 7‘,26 25", City: State: Zip Code: Qualifier's Name : WCv Lic. Number: F,Zodoe Architect/ Engineer of Record Name: 4-)/if Phone #: Address: City: State: Zip Code: Describe Work: I hereby certify that the work has been abandoned and /or the contractor /architect is unable o nwilling to complete the contract. I hold the Building Official and the Signature hores harmless for all legal involvement. Agent as aknowledged before me The foregoing instrument was aknowledged before me this O day of g' , Mb by who is personally known to me or who has produced as indentification. as indentification. Signature The foregoing ins ,,� this Mday of � e?# ,20iZby t2 /f7d9 Who is personally nown to me or who has produced Notary Public' Sign: Seal: 04‘.4.4', MIGUEL GUERRERO • i IL r: MY COMMISSION # DD973716. '}• � EXPIRES March 22, 2014 (407) 388 -0153. FloridallotaryService.oq 1 Notary Public: Sign: Seal: uEUNECODA :*8 MYCOMMISSION d DD 972673 EXPIRES: March 22, 2014 5, Bonded Thru Notary Public Underwriters (.�. AC# 62 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET �µr TALLAHASSEE FL 32399 -0783 GILLI5, KEVIN ON CALL ELECTRICAL CONTRACTORS INC 13893 SW 102ND LANE MIAMI FL 33186 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business,anci Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better' For information about our services, please log onto www.myfloridaiicense.com. There you can find more information: about our divisions and the regulations that impact you, subscribe to department newsletters and learn metre about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your. new license! I ___ LETACH_HERE (850) 487 -1395 STATE OF FLORIDA ACS 7q Y° � ^ � i.7E?' tT ENT OF BUSINESS AND PROPESS I 4NAL REGULATION 000094'7. `. 08/17/12 128043303 CERTIFIED ELEC'T'RICAL" CONTRACTOR. GILLIS, KEVIN ' ON CALL ELECTRICAL CONTRACTORS I IS- CERTIFIED under the provisions o£. Ch. 4$9 FS' Expiration date; AUG 31,- 2014 i L120617D19'61 1� y X cfia °. { " (y QC�} Gki ,} si.'r. LIP,IP' STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL'' REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ# 1,12081701961 *04:000mtiEI 08/17./2012.1280433.03.: EC0000.947 The ELECTRICAL CONTRACTOR Named below , IS CERTIFIED - Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 GILLIS,,'KEVIN; ON CALL ELECTRICAL CONTRACTORS INC PO "BOX 1614 9 4 .._ L f., ..`S%, : F. tidy.,. „tr "y !'t:1". .�:r's:,::i i�; 1��. +�:�" ��:���.` �_.�:: '��e:��: .,�,:�; LAWS . RICK � SCOTT `a �<,;; ..;� -� �.�.. �..' .�.�; :.N � `'+ :j;.; ``;�p'. GOVERNOR SECRETARY r:. 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: Electrical p p JOB ADDRESS: 52. N W City: RECEIVED JUL 11 2912 BY FBC 20W Permit No. et--12." 12- g Master Permit No. j C -- 1 2. t a tO Miami Shores County: Miami Dade Zip: 3 /S0 Folio/Parcel #: !% 3/0/0 3 3 6) ®S■GD Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): L/ L/.9.df BU/2,60s 444E( Phone# (S'T)405 -/ %4' Address: S% A/Ui 79 317 - City: /t4 / 410 ( 5/10AL -9 State: 7-1- Zip: 3 3 /3-0 Tenant/Lessee Name: iti //9 Phone#: Email: L. /4/4Al4 $viez6oS L( i CONTRACTOR: Company Name: 0 G,11/1.4 Ruiz-1.44. Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 4.2 PSG ® Square/Linear Foote e of Work: 70 5/7- Type of Work: ❑Address UAlteration New Kepair/Replace ODemolition Description of Work: f' I e ' . � c ' e//L/E_ ?- tv,r wrc/ **** ********* **** ***************+a******Fees******+x*** ** ** :*********** :*****+x****+xx:+x*** Submittal Fee $ 50'00 Permit Fee $ /f27tmo CCF $ CO /CC $ PA Scanning Fee $ �o Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 11010 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Ai/i9 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip A/9 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, BOB .ERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: d 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 in ction which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil no ' be ... proved d a reinspection fee will be charged. Signature f/lr,'^- Signature Owner or Agent Contractor The fore oi`ng instrument was acknowledged before me this l The foregoing instrument was acknowledged before me this day of <-1-.) 20 by UU AL kUZCao Liter, day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: 0310612016•' NOTARY PUBLIC Commission # ,�'. EE113059.. ,Te/`y APPROVED BY Sign: Print: My Commission Expires: Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06!10 /2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE, STATEMENT NAME: L iefiri�,. "'ler 4 Ale DATE: ?//1// - ADDRESS: Sx- NV 97 s1/2 Mb int,XIIPXR1. PL .3.7 !Sb Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume thatyou built for Sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed bylaw. Your construction Must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and Initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that l as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. I understand that building permits are not required to be signed by a prope construction and is not hiring a licensed contractor to assume responsibility. Initial owner unless he or she Is responsible for the I understand that, aslan owner builder, I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk 'by 'hiring a licensed contractor and having the permit filed in his Or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to . list his �or;license nu rs on permits and contracts. Initial understand 4. I that may build or one family two-family outbuilding. b or g m m ay also build may acommercia commercial building if do not exceed $75,000. The building or residence must e fyuse or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built orlsu Sl agtally improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Intial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal Income tax and social security contributions under the Federal Insurance Contributions Act (FICA) anq must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner- builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or h. +aiwww.m 'oridalicense.com/dbo /.ro /cilbrindex.html initial I 11. I am aware of and consent to; an owner- builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatiop tha + Initial O f have provided on this disclosure. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this a day of U L`p , 20 I By LI. L_ft\NA' B`" g-Gt J'S who was personally known to me or who has Produ red the = icense .,01lIrII1111// /,� •`' ttents .4_, 1 *i.' i v47484 r(P.'•:FA 1: A OWNER y,;.•Fc1i3pS4 # 4/ /IIIIIIIIIg as identification. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \,(7,,y7,0 Inspection Number: INSP- 177514 Permit Number: MC -8 -12 -1567 Scheduled Inspection Date: December 19, 2012 Inspector: Perez, JanPierre Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project: <NONE> Contractor: RECAIR CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330050 Phone: (305)776 -1551 Building Department Comments REPLACE TWO AC DUCTS IN THE FLORIDA ROOM 1,4q)/1 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 18, 2012 For Inspections please call: (305)762 -4949 Page 3 of 33 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. M C42° Master Permit No ' v Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): J�/-� Address: , ti U% 9qb T . City: /t-1 i c r.+21` s by / state: ,lv /�GCGt zip: 3 3 /6 0 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: a /emu) 9'9 6:74- City: Miami Shores County: Miami Dade Zip: 33/ .S-C) Folio/Parcel #: //..3 / /W(2030 e 5 o Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: g —C el s r ee, e-1°41 Phone #: 3 o g ''7 '% 6 `° / i —�✓ Address: cs - (r O a. S L,, / „2 ®7 ti 14 t/ z° City: /`'l I't P). F L nState: I / l zip: .�.3 i % S A Qualifier Name: A C r .e � 2 60,13 e-- / `e) Phone #: .3 0 S) ' i 6 - / 41-sr/ State Certification or Re istration #: e e' / of 7 3 Certificate of Competency #: Contact Phone #: 3 0 7 rj 6° l i S/ Email Address: /2-e e e l- r C 1 w, 06 m a I f, e© w. DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ CTDU Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew °Repair/Replace ODemolition Description of Work: t2.-(2-4(CA. Le 2. 4% b0C4Sirl 1 /or4,C(q V-c70 -) o - c T L- * * * * * * ** Aiiiii Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ***** * **********,x*w******* Fees * *** ** ** * ***** ***** *x * ** **+x******** ****** ** 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 FT.ECTRICAL 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 insp tion which occurs even (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no ue app oved and inspection fee will be charged wner or Agent The foregoing i strument was acknowledged before me this 42_ day of , 20'2, by 4//Gr he, ,Lefre who is to me or who has produced As identifi NOTARY PUBLIC: Sign: Print: a oath. Signature Con actor The foregoing instrument was acknowledged before me this day of , 20 12 , by kec "e ;, who is persS Z 'nto me or who has produced MIGUEL GUERRERO ,a • MY COMMISSION # DD973716 ';igl ` EXPIRES March 22, 2014 (407) 398 -0153 FloridallotaryService.cgpc A7 My Commission Expires: APPROVED BY "n 4 z2 2c/f kke, Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) as iden OTARY PUBLI Sign: Print: A / f vs-e( poor a®' My Commission Expires: $.10.,--e a a 'Z o/fe pp and wh,, did take an oath. .•.rc" °.�dv MIGUEL GUERRERO •@ MY COMMISSION # DD973716. EXPIRES March 22, 2014 0153 FloridallotaryService.c ow 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): 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 ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS 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 AH CU PKG PKG UNIT / / PK IT I I EER/SEER YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT S NO YES NO NEW 4 °CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BO/ i YES / NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registration N. Certificate of Competency N. Nd\-1 hone: Signature Date: (Qualifier's signature only) BUI DING 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. m C I' 1 Master Permit No. f` C ' 7 %Z 1250 PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL ,q c�,� OWNER: Name (Fee Simple Titleholder): £`�'9 P11 1-JZ / Phone#f2539 665— ?'60 Address: 579 5 rst City: %14 ( ' g State: PL- Tenant/Lessee Name: Phone #: Email: Zip: 3 7/ ✓© JOB ADDRESS: S,% N Lt/ 9 S City: Miami Shores County: Miami Dade Zip: 33/00 Folio/Parcel #: d/ 3/O/6.930050 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 4/44 (M s (»p OWA—J / I Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: 6 pr Type of Work: OAddress OAlteration Description of Work: KE P4 rive hitc P TS , Z /I//4 At ONew ORepair/Replace ODemolition ** * * ** * *** * **** *** ****** ** * * ** * ** * * * * ******* *** * * * * * **** * * * * * **** ** *** ***** Submittal Fee $ Permit Fee $ 0 " CCF $ CO /CC $ Scanning Fee $ Radon Fee $ _ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 0$ 10 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, BOB ,FRS, 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 prope for the first inspection wi Signature is subject to atta ctio which o l not �be a 'proved ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site rs seven (7) days after the building permit is issued. In the absence of such posted notice, the a reinspection fee will be charged. er or Agent The foregoing instrument was acknowledged before me this �-, day of1r), 20 .a..by �--t%1 - lif 9 2 �-' 1 who is personally known to me or who has produced let.-1 '17 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: s.: 4' .•s ,• 5..,0 j o *m****** x ** ***+x**** ******,x *,,*** * **e° q: a�m��x s:*****+ +x*****+x**** ** * *** x*+ x*+ xx: ****** ** *x:*** ***** ******* Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY ans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 616711-0 THIS IS NOT A BILL - DO NOT PAY NAM/ LOCANN RECUR CORPORATOR stecaunt.ENEwAL . 2602 SW 120 AVE STATED 643131 -6 33175 UNIN DARE COMITY CAC1815b95 Sem Type R3R CORPORATON This is M Vac NECNANICAL CON7'RACTOR DODS NOT man HOLDER EINSIONS mass MN Or THE T° ON DOM wwir, PT THE HOLDER O ANYWISE _MUT =mum. ISO Nor A or is rn TAX NORKER/S. 1 00 NOT RECAIR CORPORATOR 268050120 0 LEZ PRES MIAMI FL 33175 07/13/2012 70001622 QQQ075.00 SEE OTHER SIDS 600 STATE FFLs TRENT DA CONSTRUCTION INDUSTRY Lit/WRING BOARD mm1,12092801236 OF Ensiburas AND PROFESSIONAL GOVERNOR SCOTT NEW WSON %SPi' Y AS REQUIRED BY LAW SE Sep 21 2012 11:4011M HP LASERJET FAX „r, CERTIFICATE OF LIABILITY INSURANCE 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 DISURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 01118 holder le an AOPf ft lvAL INSURED, the pollgt ) mull be dodar0ed• It 8 IBROSATIOis l8 WARI % sasjact to the tonne a n d conditions of t h e p o l l c p . certain poadss m a y require a n erelereantent. A stalwart on tide c a r d e r : M e does not canter i 5Mt to, the certificate holder In Wee of ouch oedora s). p.2 09121/12 FRooucca S.g, 8 Associates Insurance Brokers 9999 Sunset Drive, Suite #102 Miami. FL 33173 Phone (305) 279 -9002 eiguRED REPAIR CORPORATION 2602 SW 120 AVE Miarrll, FL 33176 Fax ( 279 -9008 305 CONTACT` NAPE: ELIOOUVA (305) 279-9002 EUt}engtnavancelooltani NITAIRER Iewie: I i' . Ne (305) 27x-90 ROBREN10110TOROVNLI COVIRtARE GRANADA INSURANCE COUP NAIL S 16670 sunk 000 6031 wsUR I s F: COVERAGES CERTIFICATE NUMBER: 1 THE O� THE INDICATED. NTWITHHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CST OR O INSURED NAMED DOCUMENTWITH RESPECT TO tNI4LICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TES„ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM. TYPE 1JF INe1JAANCE ) T mil , i �, 1110 01194 P!?,LT i r a u t::l 7 , ZiAA RE IM • 1 * 1,000,000.00 $ 100,000.00 0186FL00036766 GOMeIV: _ LIMT ODDLY INJURY (Per SOCILYINJURYIPO DE8GRIPTI0e OF OPERATIONS f IACATi15 1vEliMLES Itch MORE 101, /0101 00m1 Reataaks lk:bechile. It mare apace AIR CONDITIONING ,EQUIPMENT INSTALLATION.ING OR REPAIR. COMMERCIAL AND RESIDENTIAL CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND. AVENUE MIAMI SHORES,FL 33138 1 FATE 305- 599 -2783 PH 30549752 ACORD 25 (201005) OF CANCEUA SHOULD ANY OF 114E ABOVE DESCRIBED POuCtISS BE CANCELLED ED S€FOREE THE EXPIRATION DATE THEREOF. NOTICE VNi.L 8E CEi VEREA E1 ACCORDANCE INFI N THE ice,. PROVISIONS. � 11161-2010 ACORD CORPORATION. All eights re carved. The ACORD nomeand 1000 are rs9isteTd agsrhs o1ACORC liFF A7WATER CHIEF FINANCIAL STATE OF FLORIDA DEPFINANCIAL SERVICES s, � AON * * CERTIFICATE OF ELECTION TO BE EX T1 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= 08/05/2011 PERSON EXPIRATION DATE: 08/04/2013 FEIN: 089-05 -2011 GONZALEZ RECAREDO R 043627874 BUSINESS NAME AND ADDRESS: RECAIR CORP 2802 SW 120 AVENUE MIAMI FL 33176 SCOPES OF BUSINESS OR TRADE 1' A/C REPAIR 3— A/C MAINTENAME 4— REFRIGERATION 2— SALES imP€fftTAifi: Foment to Chaplet 440 . �f4) F.S., an officer of a scope of recover benefits to or eesatioo ender this section may business recover or ends listed corporation who elects exemption from tiff chapter of to tii #aS a be exempt—. of election under this � the notice of atetli�t chapter. to Chapter x-88 #Zf, f.S.. Certificates � election to tre scope to be exempt or be subject to revocation t#. at exempt Naar to Chapter 440.058) f 5 Notices of election to apply certificates of within the election tficate no former exem t she the rsgufec to of ats any time after ere Ming t the antics or the named eT the certificate to meet section for Issuance of a Issuance of the ccrr#ffcate the person named on the the person of the rntents atf this of this section. shelf revoke a certificate at DWC-252 CERTIFICATE OF any time for failure of the poraon ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS'? 1850) 413 -1601 JEFF ATWATER CHIEF FINNICIAL OFFICER DE ARTMEM' OF FINANCIAL DIVISION E NANCIAL SERVICES CERTIFICATE OF WORKERS' COMPENSATION TO FLORIDA CONSTRUCTION INDUSTRY EXEMPTION SSA LAW �e * This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE 06121/2012 EXPIRATION DATE: 08/21/2014 PERSON: FEIN: FERNAmEZ GONZALEZ RAFAEL A 043627874 BUSINESS NAME AND ADDRESS: RECAIR CORP 2602 SW 120 AVENUE MIAMI FL 3317S 06 -21 -2012 SCOPES OF BUSINESS OR TRADE: 1- A/C REPAIRS IMPORTANT: Pursuant to Chapter 440 . 05I14k f.S., � IMPORT NT: sot meant benefits or officer of a corporation who elects exemption from this chapter scope of the of reco or trade listed stn e of election chanter- P to Chapter 440.051174 E.S. b to be exempt... t etlytion anew it a scope be Certificates of election apply only rfce the of elective to no longer meets be subject to revocation if. at any time after � filing the Me 1s Fs.. N�Sens of election . the to exempt etTeifn ee or mimed the longer certificate [s the et the requirements of nos section for Issuance of a certificate. The i re of eetakato t6a y tim named the notice s of this oaf. shall reunite a certificate at any time i fate the person OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? 01510 413-1809 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: i f LIA ' E-T DATE: 3/-2,d/2-0/2 ADDRESS: Ma 9F 97R W-T t( ,tip' .54/e j 3/ / 0 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial GL 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license u rs qn permits and contracts. (_ Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substa tially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built r sung improved it for sale or lease, which violates the exemption. 11 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial Initial I l I" 6. I` understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htt .: /Iwww.m oridalicense .com /db.r /.ro /cilb /ind- x.ht Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 3 L_ 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatioh that have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 'J day of &Irk , 20 ('7 By U —^ (5-40-1 who was personally known to me or who has Produced h :re License or \D OWNER as i "rt ION* �. (. JJJ �e��� v •'o` �\ smut). iv„v•rit+L. rAVL SNOW/911038 OW S3-1(1H I ii0i4j 903d T1V Hi [AA N • idINO0 0 10]1‘91i NAV- 99th S 014:orm 4.1 mal • 20.0V • ofcc,..soc•Pco a6eim salmis pe!tni '.1/2 ID. • 41; . NORTH 1 00.00' (RAM) 23.00f 1\N\ 5.00' CONC. SIDEWALK •boo *No PA.P.1A NO ID. SCALE: FP:x/2C --24.851 STEP .82° tuuv _..17pa.4v 0 11 • `411.1.1111•0011.00.1•04/16..10■4*.......* Ills. t r 15i ALLEY 414.1.011010.11•11.1.10111111*••• t0.00. ASPHALT PAVEMENT •■••••••••kowalidoll••■••••■•14•400.011“0••■•■•• • Aoaloi••••■•00•16•101••••••• om•••••••••••••••••.•■•••■••W*.***10. Miami Shores Vitiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. 2_ c -7- /2.-/2.0 Owner's Name (Fee Simple Title Holder): / `61x0 Owner's Address: R City: Ail dtipt' 548 State : Job Address (Of where work is being done): 5- /Veti State: Florida Zip Code: 33 / b.) Phone #: Zip Code: 3 3 /S City: Miami Shores t/ Contractor's Company Name: keecti-e., Address: 02 X42 /7--e, fh City: State: Qualifier's Name : Architect/ Engineer of Record Name: Address: City: State: Zip Code: 43/44 Phone #: Zip Code: t 77,5 Lic. Number: Oi /�P /.��3 Phone #: Describe Work: I hereby certify that the work has been abandoned and/or the contractor /architect is unable or willing to complete the contract. I hold the Building Official and the Mia Shores harmless for all legal involve ent Signature The foregoing ins this li9 day of owner ment r Agent as aknowledged before me 20 /.2by 4/4-4 Who is persona) ly known to me or who has produced bLe/ as indentification. Notary Publi Sign: Se .01;4.4 (407) 398 -0153 MIGUEL GUERRERO MY COMMISSION # DD973716. EXPIRES March 22, 2014 Florida NotaryServIce.com Signature Con ctor or Architect The foregoing instrument was aknowledged before me this r ��JJ"" day of : , 2Oiay / Pulo who is personally known to me or who has produced �o ,2z e 2— as indentification. Notary Public: Sign: Seal: W^*' MIGUEL GUERRERO 'MY COMMISSION # DD973716 EXPIRES March 22, 2014 40,7 'AL-a153 FloddeNotaryServlce :0340 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176750 Permit Number: PL -7 -12 -1283 Scheduled Inspection Date: August 06, 2012 Inspector: Hernandez, Rafael Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330050 Building Department Comments KITCHEN RENOVATION. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments se /if° August 03, 2012 For Inspections please call: (305)762 -4949 Page 45 of 61 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 2010 EWE D JUL 112012 BY °,10 Permit No. PL 12 -128' 3 Master Permit No. Re.- 12 - Permit Type: yn ING .i , c/R LEREr OWNER: Name (Fee Simple Titleholder): - „ _ Phone#:s'f� ©S -` c 7[�'� Address: 9.2. vvlA% 99 57;471-c City: /u/ 9"fri / 5J14'LS State: _/ - Tenant/Lessee Name: Phone#: Zip: 33/5-0 Email: JOB ADDRESS: 52 A) W l 9 5 T-A T City: Miami Shores County: Miami Dade Zip: 33/50 FoliolParcel #: /1 310 /0 3 3 cis 5 O Is the Building Historically Designated: Yes NO !/ Flood Zone: L/L -14944 ,V u' GoS y T, CONTRACTOR: Company Name: U-9 Jig lJ(9 /G 'T Phonel %?5')6o5r'� Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1` dea,� Square/Linear Footage of Work: 9CJ Seirr Type of Work: DAddress DAlteration ONew bl epair/Replace DDemolition Description of Work: igrefi1".v C19 i37AJJ 7� ALA4-CliA 137 J LL/ /arm Gva i wf r,,`4 u7" ,C,-///77 * A.********a**** ******** ************a* ** Fees**** ** *********** ************* * * * ** *****• * ** Submittal Fee $ Sn. 0 O Permit Fee $._ ice CCF $ CO /CC $ Scanning Fee $ Vet l D Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I lQ -1 Q 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 ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site rs seven (7) days after the building permit is issued. In the absence of such posted notice, the a reinspection fee will be charged. whose property is subject to attac for the first ins • Lion which o inspection wil l • be a' 'roved Signature c en, Owner or Agent f The foregoing instrument was acknowledged before me this 1 ` day of 31) , 20 ftby U Li AYL l _ /t2 who is personally known to me or who has produced - I 0 As identification and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: Iluutttrgr -3. ` :Ores '•.ti '' Sign: . 0310612 Ui`1C ' . Print: tkt110 1 Z. My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * ** 44 r ta96A\- 0 * * * * * * * * * * * * * * * * *** * *a�** ** **** aa��x* x�+ �a�**** **** *�x�r�x�xa�*** * * * * ** --7—' /k/Z-- Plans Examiner Zoning APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: Li//41 A- $uri kJ 1»7 - DATE: i/11/1L- ADDRESS: S2 iw 9 9 jai. /wow � SHoxos9■ fL 3.1.115- Co hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And derstand that I adtun owner must t amlo an following person re statement, which ent'nles me to work as my own contractor I further appear pe to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence. You may also build or improve a commercial building at a cost of $251000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and Initial each paragraph. requires construction to be done by a licensed contractor and have applied for an owner - builder 1. contractor er a certain ri rom even . The exemption specifies that t, as the owner of the property listed, may as my own milt under an exemption from the lair. I do not have a license. Initial I understand that building permits are not required to be signed by a `property. owner unless he or she is responsible for the construction and is not hiring a' licensed' contractor to assume responsibi ility. lnitiaL. _ I understand that, ,as,an owner builder, I am the responsible party of record on a permit. I understand that I m ay protect myself from potential financial risk by hiring a licensed contractor and having; the permit filed in his or her name instead of my own name. I else understand that the contractor is required by, law to be licensed in Florida and to list his or license numbers on permits and contracts. Innia ' 4. I understand that I may build or Improve a one family or two - family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built . r su ntially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. � Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It Is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Intial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiting the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) arid must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. d.e Initial; 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial at- 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto:// www. mvfloridalicense .com/dbpdpro /ciibfindex.hjrnI Initial 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party Dally and financially responsible for the proposed construction activity at the following address: Initial' 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. :" initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working On your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged, before me this 11 day of , 20 t 2 By t_I1_ L A N (3 ut-w s LI- ETwho was personally known to me or who has s identification s ' • 131061 t. Commission i# I TARY EEl73059, 1�.`.� 4� I A. OF FO‘ \o —or iri tto.�� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 182053 Permit Number: WS -11 -12 -2241 Scheduled Inspection Date: December 19, 2012 Inspector: Bruhn, Norman Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project <NONE> Contractor: A&J GENERAL CONSTRUCTION CORP. Permit Type: Windows /Shutters Inspection Type: Final Work Classification: Door Replacement Phone Number Parcel Number 1131010330050 Phone: (305)599 -2782 Building Department Comments REPLACE EXTERIOR DOOR Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passer / Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 18, 2012 For Inspections please call: (305)762 -4949 Page 10 of 33 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 UILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 52 NW 99 Street NOV 2 7 2O1a FBC 20 k_C--3 Permit No. . u)3 -9a9 1 j Master Permit No. 9N, raICO ROOFING City: Miami Shores County: Miami Dade zip: 33150 Folio/Parcel #: 11- 3101- 033 -0050 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Liliana Leret Phone#: Address: 52 NW 99 Street City: Miami Shores State: Florida zip: 33150 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: A & J General Contractors Corp Address: 7947 NW 64 Street Phone#: 305 - 599 -2782 City: Miami Stare: Florida zip: 33166 Qualifier Name: Miguel Guerrero Phone #: 305 - 599 -2782 State Certification or Registration #: CGC 1519495 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ` Square/Linear Footage of Work: Type of Work: ❑Addition °Alteration UNew °Repair/Replace °Demolition Description of Work: Replace Exterior Rear Door 1 Color thru tile: **** x• *** ** *** * * * * * * + *** * * * * * * * * * ******* Fees** ** x*. x********** ****** ********************* Submittal Fee $ 5— Permit Fee $ 064) CCF $ CO /CC $ re— 711 Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ iL) • 20 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 insp . ion which curs seven (7) days after the building permit is issued. In the absence of such posted notice, the a rove d a reinspection fee will be charged. inspection will .� Signature �'�`� - gn Signature 0 . er or Agent The foregoing instrument was acknowledged before me this day of , 20 j2, by &::J d ;GC 1r■4:7• 2 -Q re + , who is personally known to me or who has produced As identification and who did take an o NOTARY PURL Sign: i_ Q Print: hr c t.�s9_L 5 tThrC -nC�`e _ My Commission Expires: i L -4 Zc112 *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Contractor The foregoing instrument was acknowledged before me this day of NOLi ,20,byd who is per�jezral y7Tiwwr to meor wkto has produc as ' s entifrcati Structural Review (Revised 3/12/2012)( Revised 07 /10 /07)(Revised 06 /1012009)(Revised 3/15/09) NOTARY 1 C: r Sign: Print: My Commission Exp " ARAMLYS M. MAN= MY COMMISSION EE 192600 • EXPIRES: Apt!! 27, 2016 Zoning Clerk Owner: Liliana Leret Properly: 52 NW 99 Street, Miami Shores, FL. 33150 Installation of Exterior Rear Door: NOA Drawing No. W01 -20 Series "100" Aluminum Out Swing Doors w /Sidelites - Impact NOA No.12- 0305.03 Approval: 4/26 /2011 - Expires: 4/12/2013. Revises & Renews NOA No. 07- 0109.08 NORTH 0 scomr.2v _____ ________. 70' R/W (TOTAL) 1800' ASPHALT PAVEMENT N.W. 99th STREET 4 tri BLOCK CORNER r 255.58' (R&M) " °�-- "" F.L.P.1 /2.., F.I.P.1 /2 No D. . ti No ID. .0` 20.00' ASPHALy &20' 18.00' PARKWAY 1(O.00' (R&M) 5.00' CONC. SIDEWALK F.LP.1 /2 NO 10. NOV 2 7 2092 -r-- 24.85' i7 12.&'1 �•=,�� 26.717' H 19.85' 5.00'- ONE-STORY RESIDENCE Location of Exterior N °.52 Rear Door STNS Installation - -- 12.15' 29.03• 30.78' 22.00' .I.P.1 /2 NO ID. r-- 15'ALLEY 10.00' ASPHALT PAVEMENT ENGCO, Inc. Engineering Services - CA 8116 5595 Orange Drive Suite 201 Davie - Florida - 33314 Tel: (954) 585 -0304 Fax: (954) 585 -0305 Email: Engco@AOL.com REF. #: w 12 -30 Contractor: Homeowner Date: 8/30/2012 52 NW 99 Street Miami Shores, FL - 33150 Job: Leret Residence 52 NW 99 Street Miami Shores, FL 33150 Wind Load Calculation for Components and Cladding under ASCE/SEI 7 -10 (chapter 30) Florida Building Code 2010 Mean Roof Height: (MRH) 15 Feet Cladding Elevation 15 Feet Minimum Width: (B) 45 Feet Low Rise: Buildings with MRH < = 60' and MHR <= B Roof Slope Roof Slope Reduction Factor 1.00 Basic Wind Speed Risk Category: 175 mph II Use Figure 26.5-1A or FBC 2010 Exposure (Section 26.7) C a 9.5 Zg 900 Exposure C: Open terrain with scattered obstructions height less than 30ft. Open country , grasslands Building Type Enclosed (Fully and Partially Enclosed - Section 26.10) Kd - Table 26.6.1 0.85 0.85 Use of .85 with Load Combination specified in 2.3 and 2.4 Wind load combination factor KZ - Table 30.3.1 0.85 zone 4 40.1 -43.4 Kh - Table 30.3.1 0.85 -53.6 Kzt - Section 26.8 1.00 To be used when hill height H > =15' Velocity Pressure (qz) Velocity Pressure (qh) 56.57 56.57 Psf Psf qz= 0.00256. Kz . Kzt . Kd . V ^2 qh= 0.00256. Kh . Kzt . Kd . V ^2 Section 30.3.2 Section 30.3.1 Tributary Area GCpi (Int. Pressure ) GCp (Ext. Pressure ) Figure 30.4 -1 (walls) 10 ft2 0.18 I -0.18 zone 4 ( +) Section 26.11 1.00 zone 4 ( -) -1.10 zone 5 ( +) 1.00 zone 5 ( -) -1.40 Wind load Psf positive Psf negative Psf Zone 5 for units located less than 54" from building comers Wind load combination factor 0.6 0.6 zone 4 40.1 -43.4 zone 5 40.1 -53.6 End zone (a) 54 INCHES Notation: (a) - 10% of the least dimension or 0.4 of mean roof height, whichever is smaller. Also (a) must not be less than either 4% of the least dimension or 3 feet. ENGCO INC HAS NOT VISIT THE JOB SITE WIND LOAD BASED ON CONTRACTOR INFORMATION. THE CALCULATED DESIGNED PRESSURE MUST NOT EXCEED THE PRODUCT APPROVAL DESIGNED RATING. 8/30/2012 PEDRO DE FIGUEIREDO, PE 52609 NOT VALID WITHOUT SEAL Sheet W 1/1 MIAMl'DADEDE COUNTY DEPARTMENT OF PERMITTING, ENVIRONMENT, AND REGULATORY AFFAIRS (PERA) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) MIAMI -DADE COUNTY PRODUCT CONTROL SECTION. 11805 SW 26 Street, Room 208 Miami, Florida 33-175-2474 T (786) 315-2590 F (786) 315 -2599 www,miamldade.aav /nera/ Doralum Corporation 7040 N. W. 77 Terrace Medley, FL 33166 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County PERA -Product Control Section 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 Section (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. PERA reserves the right to revoke this acceptance, if it is determined by Miami- -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product- is approved as described herein, and has been designed to comply with the Florida Building Code, including the High Velocity Hurricane Zone. DESCRIPTION: Series "100" Aluminum Out swing Doors w/ Sidelites - Impact APPROVAL DOCUMENT: Drawing No.W01 -20, titled "Series 100 Alum Swing Door w/ Sidelites", sheets I through 6 of 6, prepared by Al Farooq Corp., dated 01- 24-02 last revised on FEB 22, 012, signed and sealed by Javad Ahmad, P.E., bearing the Miami -Dade County Product Control Revision stamp with the Notice of Acceptance number and expiration date by the Miami -Dade County Product Control Section. MISSILE IMPACT RATING: Large and Small Missile Impact Resistant Limitation: See Design Pressure ratings Vs size & glass types per chart A or B in sheet 2, as applicable LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and series and following statement "Miami -Dade County Product Control Approved ", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises & renews NOA # 07- 0109.08 and consists of this page 1 and evidence pages E-1, as well as approval document mentioned above. The submitted documentation was reviewed by Ishaq L Chanda, P.E. NOA No 12-0305.03 Expiration Date: April 12, 2013 Approval Date: April 26, 2012 Page 1 Doralum C ornoration NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED A. DRAWINGS 1. Manufacturer's die drawings and sections (transferred from file # 07- 0109.08) 2. Drawing No.W01-20, titled "Series 100 Alum Swing Door w/ Sidelites", sheets 1 through 6 of 6, prepared by Al Farooq Corp., dated 01-24-02 last revised on FEB 22, 012, signed and sealed by Javad Ahmed, P.E. A. B. TESTS (transferred from file # 08- 0418.02) Original test conducted per SFBC, PA 201, 202 & 203 -94 now termed as FBC, TAS 201, 202 & 203 -94 1. Test reports on 1) Air Infiltration Test, per FBC, TAS 202 -94 2) Uniform Static Air Pressure Test, Loading per FBC, TAS 202 -94 3) Water Resistance Test, per FBC, TAS 202 -94 4) Large Missile Impact Test per FBC, TAS 201 -94 5) Cyclic Wind Pressure Loading per FBC, TAS 203 -94 6) Forced Rntry Test, per FBC 241132.1 and TAS 202 -94 Along with installation diagram of an outswing doors w/ sidelites prepared by Fenestration Testing. Laboratory Inc, dated March 21, 2001 Test Report No.1(1eI L- 2811), signed and sealed by Antonio Acevedo, P.E and revised by addendum letter, issued by FTL, signed and sealed by Luis Figueredo, P. E. C. CALCULATIONS 1. Anchor verification calculations and structural analysis, complying with FBC -2010, prepared by Al Farooq Corporation, dated 02/22/12, signed and sealed by Javad Ahmad, P.E. 2. Glazing complies w/ ASTME- 1300 -02 & -04 D. QUALITY ASSURANCE 1. Miami Dade Department of Permitting, Environment, and Regulatory Affairs (PERA). . MATERIAL CERTIFICATIONS 1. Notice of Acceptance No. 07- 1116.11 issued to Safe -glas L.L.C. for "SAF GLASS - polycarbonate interlayer", expiring on 12/16/12. 2. Notice of Acceptance No. 08- 0709.04 issued to Nebula Glass International Inc dba Glasslam. for "Safety Plus II Laminated Glass ", expiring on 08/07/13. 3. Notice of Acceptance No.11- 0325.05 issued to Solutia Inc. for "Saflex color & clear interlayer ", expiring on 05/21/16. F. STATEMENTS 1. Statement letter of conformance to FBC 2010 and letter of no financial interest, prepared by Al Farooq Corporation, dated 02/20/12, signed and sealed by Javad Ahmad, P.E. 2. Lab compliance as part of the above referenced test report. 3. Statement letter dated April 17, 2012, issued by Fenestration Testing Lab (FTL) for upcoming test schedule, signed by Jose sanchez. G. OTHER 1. This NOA revises & renews NOA # 07-0109.08, expiring on April 12, 2013. 2. One year conditional approval subjected to successful verification test E -1 4A41 • (-14ct tA.L. Ishaq i. Chanda, P.E. Product Control Examiner NOA No 12- 0305.03 Expiration Date: April 12, 2013 Approval Date: April 26, 2012 a° MAX. HEAD/SILL CORNERS BUFF APPUED FWOMB MAY BE USED 144" 2 1/2 .r =�cc I� II T II II n s,U 11 II _ :c =- j If I, II II I_ -c , I II II 0 3. a 3/18" ANN. GLASS .018' URETHANE ADHESIVE .070' INTERIAYER 'SAF —GLAS PCLYCARBONATE , BY 'SECURITY IMPACT GLASS' .018" URETHANE ADHESIVE 3/18" ANN. GLASS GLASS TYPE 'A' 3/16• HEAT STREND GLASS 3/18" HEAT STREND GLASS 71 3/4" AWL DOORS WITH SIDEUTES DOOR WIDTH ILA I BY 'OLASSLAM' 3/18" HEAT smolt GLASS 3/16" HEAT STREND GLASS BURIES -1,00 ALUMINUM SWING DOOR W/ SIDELITES APPROVAL. APPLIES TO SINGLE (X) AND DOUBLE (XX) LEAF DOORS WITH pa WITHOUT SIDEUTES. SIDE RITES CAN BE ON ONE OR BOTH SIDES OF DOOR. SEE SHEET 2 FOR DESIGN LOAD CAPACITIES. TYPICAL ELEVATION ( XXO) ) TESTED UNIT THIS PRODUCT HAS BEEN DESIGNED AND TESTED TO COMPLY WITH THE REQUIREMENTS OF THE FLORIDA BUILDING CODE INCLUDING HIGH VELOCITY HURRICANE ZONE (HVHZ). WOOD BUCKS BY OTHERS, MUST BE ANCHORED PROPERLY TO TRANSFER LOADS TO THE STRUCTURE. ANCHORS SHALL BE AS LISTED, 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 IS USED IN DESIGN OF ANCHORS INTO WOOD ONLY. MATERIALS INCLUDING 8UT NOT LIMITED TO STEEELL//METILL. SCREWS, THAT COME INTO CONTACT WITH OTHER DISSIMILAR MATERIALS SHALL MEET THE REQUIREMENTS OF THE FLORIDA BLDG. CODE SECTION 2003.8.4. mama woo 12-070 f 03 x,+43 GLASS TYPE 'B' GLASS TYPE 'C' GLAZII!1<G+* l B"... °"2 DOORS/SIDEUTES ARE RATED FOR LARGE MISSILE IMPACT. SHUTTERS ARE NOT REQUIRED. (sheet 1 of ) CHART A (FOR X & XX DOORS) DOORS W1TR01TT SIDEUITRS DESIGN LOAD CAPACITY - POP NOMINAL DD18. 61ASS TYPES 'A'. '8' OR 'C' PANEL %WN 00(51 HEW( .( +) ( -) 2/8 98 -7/6" 82.0 81.0 3/0 8/8 82.0 81.0 2/6 71 -3/4° 82.0 81.0 3/0 8/0 82.0 81.0 BEIGHTSt FRAME MOTH ( xX ) NOMINAL 16:10FIT FRAME 1050111 LEAF 1181447 OAYUTE 006. 6/6 78 -7/6" 77 -3/8° 87 -8/6" 8/O 98 -7/6" 93 -3/8" 83 -8/8" wIDTHBt NOMOIAI. W88H FRAME MOTH LEAF 310TH OAriOE OPO. 2/8 (X) 31-1/2' 28- 11/16" 18- 18/18" 3/0 (X) 37 -1/2" 34- 11/10" 24- 18/15" 5/0 (XX) 89 ■3/4" 28- 11/18° 16 -15/18 6/0 (XX) 71 -3/4° 34- 11/18" 24- 18/18" now ovum lNiyt is wo eta NOTE: GLASS CAPACITIES ON THIS SHEET ARE BASED ON ASTM E1300 -04 (3 S1:C. GUSTS) AND FLORIDA BUILDING COMMISSION DECLARATORY STATEMENT DCA05- DEC -219 STATIONARY PANEL (0) 014 000148 WTYR SIDELTfEB DESIGN LOAD CAPACITY - VIP 310744 (W) :RAMS NEIOHT 614tH TYPE 'A' MAW TYPE '3' & 'C' INCF FT./04. EXT. ( +) TNT. ( -) EXT. ( +) Ott. ( -) 32 62.0 81.0 62.0 81.0 33 62.0 78.3 820 81.0 • 34 7/0 62.0 69.8 82.0 81.0 38 62.0 86.5 620 81.0 36 620 63.1. 820 61.0 32 82.0 61.0 820 81.0 33 62.0 78.3 620 79.2 34 8/6 820 89.6 820 78.3 35 82.0 689 820 77.8 38 62.0 63.1 620 78.8 / \ \ / \ \ \ / / \ / / \ / / (xxox) (0) 1 _._ 32 _ WI 32 _ ( oxxo ) xxox ooxx EXTERIOR DOOR MOH drawing 00. WO1 -20 (sheet 2 of 6 METAL TYPICAL ANCHORS STRUCTURE SEE ELEV. FOR SPACING TYPICAL ANCHORS t e ''1 BUCK SEE ELEV. FOR SPACING WAMi —DADS COUNTY APPROVED MULLION "& MULLION ANCHORS SEE SEPARA NOA TYPICAL ANCHORS SEE ELEM FOR SPACING WOOD BUCKS AND METAL STRUCTURE NOT BY DORALUM MUST SUSTAIN LOADS IMPOSED BY GLAZING SYSTEM AND TRANSFER THEM TO THE BUILDING STRUCTURE. TYPICAL ANCHORS: sEE acv. FOR SPACING 1/4" DIA. ULTRACON BY 'FLCO' (Fu.ITJ KS. Fyw155 KSI) INTO 26Y 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 SMS OR SELF DRILLING SCREWS (GRADE 2 CRS) INTO METAL STRUCTURES STEEL : 12 GA. MIN. (Fy m 38 KSI MIN.) ALUMINUM : 1/8° THK. MIN. (8083 —T3 MIN.) (STEEL IN CONTACT WTTH ALUMINUM TO BE PLATED OR PAINTED) ij14 - OR 551 f DRI tNO LSCREWS (GRADE 2 CRS) INTO'MIAMI —DADE COUNTY APPROVED MULUONS (MIN. THK. 1/81 (NO SHIM SPACE) TYPICAL EDGE DISTANCE INTO CONCRETE AND MASONRY m 2 -1/2" MIN. INTO WOOD STRUCTURE ® 1° MIN. INTO METAL STRUCTURE ® 8/8" MIN. CONCRETE AT HEAD, SILL OR JAMBS Po - 3000 PSI MIN. C -90 HOLLOW /FILLED BLOCK AT JAMBS Pm • 2000 PSI MIN. S FRAME AND LEAF CORNERS, INSTALLATION SCREWS AT SILL AND ALL METAL PARTS CONNECTlO S • SS`{ 'A,,frIED 1 WITH CLEAR COLORED SEALANT. 0146,.AHIMD NON METALLIC GROUT ° KM MK TYPICAL ANCHORS NON METALLIC GROUT ELEV. FOR SPACING HORS 3 KSI I N, SEE ELEV. ELEVANC. FOR SPACING STATIONARY UNITS Mowing no. W01 -20 sheet of I droning no. WO1 -20 .848 �� .285 7, # PASS # RSRo. DESCRIPTION MATIGUAL MANP.JDUPPLUSR/REMARBB �tl y 1w 4.000 .078 TYP. 1 SW -28899 3 /DOOR HRMIE HEAD /JAMB 8083 -79 - 203 was � 2 SW -28800 2 /LEAF DOOR TOP /BOTTOM RAIL BO81 -T9 - LL Ta t3 '0 A y1 rWbS g tei .272 ' GLAZING VINYL ( la) 3 SW -28904 AS REQO. WEATHERSTRIP ADAPTER 6083 -T8 - 4 SW-2 98 1/0002 tF1 LD 8083 -T8 - 2.918 /JAMB 7 SW -28801 1/1EAF tads 811LE 8083 -T8 - FRAME - HEAD .526 .082 6 SW -28887 AS ROOD. &OEUTE JAMB 8083 -T8 - 9 SW -28803 1/CORNER ASSEMBLY STIFFENER 8083 -T8 - 10 SW -29244 3/LEAF HINGE DOOR PORTION 8003 -TO - .726 1.594 11 SW -20245 3 /LEAF HINGE FRAME PORTION 8083 -TO •- 4 GLASS 12 - 2/LEAF 3/8" X to X 32" LONG THREADED ROD STEEL ... LOW STOP 13 - 2/LEAF 3/8" X 16 NUT - .062 TAP. WEATHERSTRIP -1 ADAPTER 14 - t /HINGE 5/18° X 8' ROD STEEL RATED STEEL 15 - 8/LEAF 1/4° SUMO BLOCK NYLON - 875 466 GLAZING 1464 1.214 ADAPTER d 499 (DOOR) 18 - AS REGD. GLAZING VINYL VINYL - 17 PW -101 AS RECO. BIOS WEATHERSTRIPPWO VINYL L7'� 278 TYP. 16 PB -8400 AS ROOD. PRE WEATHERSTRIPPING - 80141000E 19 SILICONE PLUS - SILICONE DOW CORNWO [ SERIES - AALUM SWING DOOR WiSDEUTES 1 FQ t � z1 I 4.000 20 6025 AS REGO. P01514 BOLTS DELTA WD. I I _ 21 CP -Bt11 ENTRY LOCICSET TACO OR NESTLOCK 22 g113/4° ROMS AS REGD. ASSEMBLY SCREWS AT ALL FRAME ANTS 1985 1873. 23 DOR -018 AS ROAD. GLAZING ADAPTER (0002) 8003 -T8 - .. 24 OCR -017 AS REGO. DAZING ADAPTER (WDEUTE) 8063 -T8 20 DOR -019 AS REOD. MASS STOP 8063 -78 - 375 Joao r-- 1 1 LOCKS; . STANDARD STEEL THROW BOLT LOCK, KEY OPERATED ON EXTERIOR AND THUMB TURN ON INTERIOR AT EACH ACTIVE LEAF LOCK STILE, 45° FROM BOTTOM EXTERIOR AND THUMB TURN ONNINTERIOR OPERATED ON AT EACH ACTIVE LEAF LOCK STILE, 38° FROM BOTTOM ammo amps iJ.:..i --J ] .470 I.*-I323 GLAZING ADAPTER (SIDEUTE) TOP /BOTTOM RAIL 2.177 .644 r — 1375 1.547 ASSEMBLY STIFFENER r '' 500 f ( !_ I _ TYP. 2425 MANUALLY OPERATED CONCEALED FLUSH BOLTS UZI** AT TOP & BOTTOM OF EACH LEAF LOCK 5171.E 1IM+1+F70 .. • -03 (FLUSH BOLTS AT TOP & BOTTOM OF ACTIVE AND INACTIVE LEAFS . '?. TO BE ENGAGED DURING PERIODS OF HURRICANE WARD) 4 . HINGES; 4S THRESHOLD tLO93 ,. EXTRUDED ALUMINUM BUTT HINGE 1/8° THICK AND 7 -1/2° LONG WITH 5/18° PLATED STEEL ROD AT EACH LEAF JAMB STILE ONE EACH AT 14° FROM TOP & BOTTOM AND ONE AT MLOSPAN A' ' , ''' .'• 1J7 Ih6 A62 TYP. & n a I il ii i .718 H SIDE LITE `� L3T1 GLAZING BEAD rinkr SIDE LITE JAMB lF * 278 TYP. .078 -t'YP. iU III 1 ' • iP g I L750 [ L 1.750 �- - - - IJ aa7o #10-24 X 1/2" DRILLING SELF DRILLING scREWS 3 PIECE HINGE II ►. RS I`,,,,�'' 4.687 drawing no. W01 -20 3.999 HINGE STILE LOCK STILE C:ZT3. a