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RF-12-1134Miami 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 1 i I `" 146 -W2dr BU I. ING PERMIT APPLICATION Permit Type: BUILDING FBC 20 (© Permit No. 12 t'2 —1134 Master Permit No. ROOF} JOB ADDRESS: al +.0 f 1 g C/ Y4E. ALV0 City: Miami Shores County: Miami Dade Zip: 2 313 Folio/Parcel #: I/ ^22 e %C- ©/y -3(% V0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Lf-t /Cf ,4 Nt/#V O. Phone #: Address: / 5 Yr 4 t.5 C p 4/c 11.46<b City: ,t-4(4-11, .'Ifoa 4c State: 'L Zip: . Email: Name: 1�Qr Phone#: Email: / /�� CONTRACTOR: Company Name: 4)/( C 'r 't caws W--TN 4- /tee- Phone#: 71 .gSf 7136 -fir Address: /7/09 oV'' // eve/ MrM! ae Y/ Pz_ 33 /Sa City: �1 e`/0 / 8C'/State: fit– Zip: 3? /6 2 Qualifier Name: ' t/V1t. k 1....6:74/* 57,---- 9 Phone#: 7(61.5S-7,361 State Certification or Registration #: C.-----e..- /2 Z 2, 7 Certificate of Competency #: Contact Phone#: 7gC 3 7'7 3 6 Email Address: /'E' ,' 15t# )sit .,ever 1 DESIGNER: Architect/Engineer: /j*_ Value of Work for this Permit: $ �� Square/Linear F e of Work: �� Type of Work: °Additioon °Alteration °New ��' epair/Replace . °Demolition Description of Work: ! t oike 4 f# .420e J)iU l) 1,-'72,cee CJ'/P 7 7746 J Phone #: Color thru tile: *******************+ x*********+x**+x ****** Fees************* **** ************ **** ** ********* Submittal Fee $ 5D '* ; ' Permit Fee $ Ae °'' CCF $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CO /CC $ TOTAL FEE NOW DUE $ I v — Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for FT.ECTRICAL WORK, PLUMBING, SIGNS, WET J .S, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant:. As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ignature gent - one ac .r The foregoing ins i ment was acknowledged before Mme this 1-0 The foregoing instrument was acknowledged before me this Z- U day of cJ Qi f e , 20 it, by 'cif Jt/t�IY Q , day of .�,a (1e , 201Z., by °1 -\efYU lC , who is b me or who has produced As identification and who did take an oath. NOTARY PUBLIC: who is eisonallyn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign•_ le Nla Sign: '- Print: AIL, ATE Print: My Commission Expi APPROVED BY M °r CC?`' ;; +'a; iiON " r;L 188640 My C stXF.,:. w A,.. '416 IB.' ecG! —Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 06/21/2012 10:00 P.002/002 "itik,..c...fc.i.., CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/21/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Assure US, Inc. 1880 NE 163rd Street North Miami Beach, FL 33162 Phone (305) 956 -7818 Fax (305) 956 -5946 CONTACT Patricia Fernandez ANN Extl: (305) 956 -7818 N); (305) 956-5946 nDFRsS: patricia @assureus.us INSURER(S) AFFORDING COVERAGE NAIC d INSURER A; MARKEL GENERAL LIABILITY IV COMMERCIAL GENERAL LIABILITY INSURED HK Contractor Consulting, Inc. 17100 NE 11 Th Ct N Miami Beach, FL 33162 (305) 974-5461 (TAM*Ar:RS INSURER B : 1648173 INSURER C: 02/15/2013 INSURER D : s 1,000,000.00 INSURER E s 10,000.00 INSURER F: MED EXP (Arty one person • THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER (MM/DCYD/YYFYY) (IYMIDDIYYYYI LIMITS A GENERAL LIABILITY IV COMMERCIAL GENERAL LIABILITY Y Y 1648173 02/12/2012 02/15/2013 EACH OCCURRENCE s 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) s 10,000.00 E CLAIMS -MADE OCCUR MED EXP (Arty one person S 5,000.00 E PERSONAL & ADV INJURY S 1,000,000.00 E GENERAL AGGREGATE S 2,000,000.00 GEEN'L AGGREGATE LIMIT APPLIES PER: l I POLICY L P U LOC PRODUCTS - COMP /OP AGG S 1.000,000.00 S AUTOMOISLE LIABILITY L ANY AUTO ALL SCHEDULED AUTOS J AOS E HIRED AUTOS _j AUT.WNED OS �� g (Ea ardent) SINGLE LIMIT s BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S $ L UMBRELLA LIAB U OCCUR I EXCESS LIAR n CLAIMS -MADE EACH OCCURRENCE S AGGREGATE 5 E OED E RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y IN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERAIBEMBER N IA WC STATU• OTH- C TORY LIMITS = ER E.L. EACH ACCIDENT 5 EXCLUDED? ❑ (Mandatory In NH) E.L. DISEASE - EA EMPLOYE S It yes. describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space la required) General Contractor. CERTIFICATE Wm nmo _ --- --- _ Miami Shores Village Building Department 10050 Ne 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) QF ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ABC REC ? 2111 ATE OF FLAB 1 E� SEIF 80, 2042 UST BE DISPLAYED ° AT PLACE OEBB ONESS ANT TO COUNTy�GODE . a ..i� NOT A, R CONSU TI AGE. RENEWAL NO. A`tE CPO a K K CONTRACTOR CONSULTING Type of ., 1116A ECIALTY BUTID NG CONTRALTI X9/15/2 0010040003: 00075 SEE OTHER SIDE 1 DO NOT FORWARD H K CONTRACTOR CONSULTING INC HENRY KLEINER PRES 17100 NE 11 CT MIAMI FL 33162 1110 1hmOdinnit uIIhuIuuha)u40 IHl,)ri VIrsLIfll ID 1.Vaf* f the fwsinDss ar mpit esata *** Onititate att Itit*Pc Sta* IIP TI innte# 11* MIMI** $* **4 tho th* *WA! fit*2 wow* onithau,4- 40 be- es*Alitt +MO" Val Att - lite *13) 41/-1 14,00 00 Oil THE RD BELOW AND WON FUTURE REFERENCE lfl COTIACTOR 17104 ite 11TH rf nisz To: Miami Shores Village Building department Page 2 of 2 2012 -06-29 16:49:23 (GMT) 13055039449 From: HENRY KLEINER A'" WNIXI • STATE # ''FLOR bA, :•EEPAPTMT EN '4F`•FINANCIAL ' x C. S. .EE,Itlpftillit .EX.. Pr, MO CON fit preo I. z 8 �7�QV: nip CT) IR`.'i'i1ituBt,li;T '•rN 11. • gikt '; C.ERT3.A.iEci.:li[i4t�7CR!I(�:c NTRAGTOR:.: • ate' t;RT1.P2 o. ±RPIERAL;..: TIYAcro1 ' • 14ARAIlTA - .1,1 8111 10 :c6iitar4 0 ; '.0.61 4AS,; 4t111:14t111:10. : 'i. OM oum't?s nl rr *by TIFag .a'ke if 0eieglup'ritet14seivai .y.an?:reeoxer.91B tra n4.nttio tiew:;•Piunatt ls. ` • i, I *plbr'.f49.�i6ll�h FS, tinnom, ; g.esyiwIo1ie . xelnwl:<r,soplY'•s91...,s'intirt •sctpp• 4 I>r* 8agi@aaa, pr .• Auto ^ge 40 O - �. Ctaptar * A.6I37, wtte xaaPr,•ead :xaiflaaia a •etsego Awls- asettjit *dl• pp 1 4.sta 0.•rivormiTo5. v-;a0r tnt ;cdtr.aelrng•o•a4tta the. cocnreso ,he :nerQo na(aw10tiCe ;pr • ,egnAicot.:kl► Jgiper :101e1s' U1e'rmgres?en, :dlt •tt4a' soktlti4 lar:' zoo:1cg..u! s .ctatil[gn{1ir' T11• d{pd101pa!t:5411 :�1apke e.'Of/Firoa s:a .atyit, MOO fur • !It dip •af Aka Isarantt oe�9d: hr i 44d,pert111rotb , c rgeeE .tha. t .gaErenieala .4t :tlsr seeflothoi. :. • • T(1t¢C�252 ! E1!TU I1�A1�: O.F'EI rT1131IT:1 !E. E LE11 1' .ii�V15E1 0,1 7 usrl . •STATE:+QP.FLCij 1]A • DEPARTMENT OF FugApscuu. Smitvf,Cl $: WORKERS" :. . • caRucTx1• xiu44iasTRY • ••• . tERTIFICATI6OF EILEPTKIN 7IJ.SE SKIEfsi ft ' Gtil.f.49.R11:* . 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F':5.:.Ratines'.4i•,.ninctipil ' _ .. and carts #!:Castle" :af • (1ta ctitin to:.:be+ t.uternpx'..shatl Igo •:subiect. if: v.-Am-400 .after•ilio dUlna..Af ttle..noticA:.or':tije:4 sbAgice of •t#Ie . • certilICOV..;. •the WWI mats. on : the ..A0. tic.A :or + Ftefioeta" nh .0410er::fn •. ih�g �.re WIY:Wo. n its .aN 1-1n -far suNnn 'Of .a;• •t tilt. :'lkte' : *. ig. • i alit. : F iliuQ : f• the' • ROOF ASSEMBLIES AND ROOFTOP STRU ( -7 t13`k Miami Shores Village BLDG DEPT Florida Building Code Edition , ® �y,ECT 10 CCMPl.lf\ricE WITH ALL FEDERAL High- Velocity Hurricane Zone Uniform Permit Appl cation Fm. c or Arm Section A (General Information)' J (,C,IJ,N { RI,LES AND REG' ULATIONS Master Permit No. Process No. Contractor's Name //k te4/ % TOA- Job Address olds'' & S cop-Arc ❑ Low Slope ❑ Asphaltic Shingles ❑ New Roof ❑ Reroofing Low Slope Roof Area (SF) ROOF CATEGORY ❑ Mechanically Fastened Tile Mortar /Adhesive Set Tile ❑ Metal Panel/Shingles ❑ Wood Shingles /Shakes ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ Recovering Repair ❑ Maintenance ROOF SYSTEM INFORMATION Steep Sloped Roof Area (SF) Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scupper Include dimensions of sections and levels, clearly Identify dimensions of elevated pressur parapets. 15.34 Total (SF) �io ov drains. •■■I, � •■ ■ ■ ■ ■ ■ ■■111■ ■ ■111■111111111IIIN■■ ■I:■ ■ ■ ■/ ■ ■111I1101■1 \1 ■■ ■■ ■ ■ ■ ■■ ■ ■ ■■ ■ ■ ■■ ■1 ■ ■■ ►fir ■iii //■■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■■ ■1111■ ■ ►`!111/%■■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■111■ ■ / ■ ■ ■ ■ ■■ 1111111111111111111111M1111111WINEMIMEIR11111111111111111 ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■I MINIF ".a g 7n TA ! ■■ 2010 FLORIDA BUILDING CODE -- BUILDING