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RC-13-962 4 t 4 � Miami Shores Village R P FMMAYY� Building Department ,� 013 40050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fag:(305)756.8972 .`� INSPECTION'S PHONE NUMBER:(305)762.4949 — _= FBC 2013 BUILDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: a D Ale //0 5-V City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I ° P-i 3 6 ° ®0 4e ® �' Is the Building Historically Designated:Yes NO /)x Flood Zone: OWNER:Name(Fee Simpl Titleholder): V/� `® `�� Phone# �G 5 —Z?Z 7 Address: I C City: t 4"; 1 State: Tenant/Lessee Name: 1 on Email: a n �'% S (F— /'�I°I C ✓-, CONTRACTOR:Company Name: S11YLive &Aqjr ,-,qA Phone# .a4rn oe?i!�6 Address: 561 A) 06 City: � State: Zip: Qualifier Name• a Lf Phone#:-70Z'6 V 12=49 State Certification or Registra n#: C Certifica7C71ILe-mpetency#: p� Contact Phon ®�Q Email Address: eaj 60� /u GL rn cp DESIGNER:ArchitectlEngineer. Phone#: O a / Value of Work for this Permit:$ D T L�®O $quareUnear Footage of Work: --- &Q.saf Type of Work: OAddition vAlteration ONew epair/Replace ODemation Description of Work: AEtA tk,-- 0-00A-ter -To Colon thru tile: �19W Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ TraininglEducation Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Arm. a , Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:' Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Li Signature / Owner or Agent ntractor The foregoing instrument was acknowledged bef re this The foregoing instrumea+as acknow ed ed pbefore me this 2L day of-F�b ,20 ,�,by L - T-' day of 20��by ®C who is personally known to me opwhe-hum-prodaeed who is personally known to me or b wduced As identification and who did take an oath. _ as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �m Sign: Print• ® Print B d� '10 a—A� My Commissi WON&MARYLIN TORANO My Commt �"° MY cobaussION#EM12630 Lmpi MARYLIN TORANO Jane 2S,2016 MY COMMISSION#M1200 EXPI1tffi:fime2$,2016 R$ 3eaBdaBk S9Rk 4e aA&i �a$eRak $e8cok$$aa +agak+kakksk+A�akdwkdazka8ak8�&flkxAB�RSAk APPROVED BY S--s/T Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 05/072013 09:21 386-775-3666 Karen Maride Page 1/1 ►� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/WY1� 05/01/13 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: Ethe certificate holder is an ADDITIONAL INSURED,the policypes)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 CONTACT NAME: Tony Cannizzaro First Commercial Insurance Agency PHONE (386)775-1781- Alc No): (386)775-3666 P.O.Box 295 ADDRESS: insuranceguyeDd.rr.com Cassadaga,FL 32706 CUSTOMER ID# Phone (386)775-1781 Fax (386)775-3666 INSURER($)AFFORDING COVERAGE NAIL INSURED INSURER A: State National Insurance Co Skyline Construction&Restoration Corp. INSURER B: Guarantee Insurance Co 5615 N.W.176th Street INSURER C: Miami,FL 33055 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MUM _MM LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 © COMMERCIAL GENERAL LIABILITY PREMISES Es occurrence $ 100,000 ❑ ❑ CLAIMS-MADE 0 OCCUR NS1214545 MED EXP(Any one person) $ 5,000 p` ❑ N N 03R4R013 03242014 PERSONAL&ADV INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 © POLICY 1:1 PECT F] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ F-1 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ ❑ ❑ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE El HIRED AUTOS $ AU (Per accident) ❑ NON-OWNED AUTOS (Per ❑ $ ❑ UMBRELLA LAB ❑ OCCUR EACH OCCURRENCE $ ❑ EXCESS LAB ❑ CLAIMS-MADE AGGREGATE $ ❑ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LABILITY Y I �/ TORY LI IT ER B OFFICERIME BEREXCLUDED? Y NIA N GWIC301000713112 08R42012 08R4R013 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory A undo E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yres�describe unda DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 7_7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village ACCORDANCE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Fax 305-756-8972 O 1988-2009 ACORD CORPORATION. AD rights reserved. ACORD 25(2009109)OF The ACORD name and logo are registered marks of ACORD E# 6118 3 J 6. STATE.OF FLORIDA DEPARTMENT OF SIISNESS: AND PROFESSIONAL RESTOATION CONSTRt7CTI0N INDITSTRY LICBUSING BOARD SEWL12062900529 .• :• : - LICENSE MR M72012-11-3.8212:91.6 CGC.1514936 The GENERAL CONTRACTOR Named ..below IS CERTIFIED Under the • rovi i p s oas of Chapter 489 �.FS. Expiration date: AUG 31, 2014 LOPEZ, YODALY . SKYLINE CONSTRUCTION & RESTORATION CORP 5615 NW 176TH ST MIAMI FL 33055 RICK .SCOTT GOVERNOR KEN LAWSON SECRETARY DISPLAY AS REQUIRED BY LAW kC#. 6178281 STATE OF FLORIDA DEPARTMENT OF•:EIIS1NESS, AND PROFESSIONAL REGULATION CONSTRUCTION CONSTRUCTION INDUSTRY 'LICENS.ING BOARD EQ#L12062900454 .• - LICENSE- NBR 06 29. 2012` 118212910 : CCC1329i37. The ROOFING CONTRACTOR. Named.below IS CERTIFIED Under the .provisions o€ Chapter. 4.8.9 F.S. Expiration date: AUG 31, 2014 LOPEZ, YODALY . SKYLINE 'CONSTRUCTION & RESTORATION CORP 5615 NW 176TH ST MIAMI FL 33055 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW i { ��?f�• a�`d'i �i -�yt .h 4.r �?'+ri^nt� kn.F,. : .r .. Y ! �. FDW-CLASS ' t U.S.POSTAGE � v x� WAFA R. PERWT No.cV t ......_ . _� ':.ice..:..+............ ...... .. _ .. 619284-3 THIS IS NOT A BILL—DO NOT PAY M11 MM NA LOCATION _RENEWAL SKYLINE CONSTRUCTION AND STATE# CGC 514936645722-0 RESTORATION CORP 5615 NW 176 ST 33055 UNIN DADE COUNTY owmm SKYLINE CONSTRUCTION AND ser-rfin of Busi"m WORKER/S rN� . J91¢AUFCIALTY BUILDING CONTRACTOR 1 M I No Tm R om Nor purr WE FICUMTO MUM AM ors goer os urns OF TM DO NOT FORWARD c�rr wt ass. NOR 9m R ear me i�=AM On= ex uv�ucom rws n ra V SKYLINE CONSTRUCTION AND DM HMAMM Q'"`W." RESTORATION CORP PAWWREMM PEDRO MINAS FIRES rax 5615 NW 176 ST couimm MIAMI FL 33055 60000000464 000075.00 1$011{If 11111„11111111111A oil isIII$+18,11,11,++fill,hall SEE OTHER SIDE Village Miami hores Building Department logo a 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 LpR�pP► Fax: (305) 756.8972 May 7, 2013 Permit No: RC13-962 Electrical CritiQue— Michael Devanev 1. Need electrical permit application. 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. 4011cloor ss A1114A41 c:)-A0,ol�- CEIVIED MAY 012013 BY: NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F I PROTECTED RECEPTACLE CITY PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. COPY kr OU,7 6(� ply a ADD SMOKE/CARBON MONOXIDE DETECTORS. ASIT10-0 70 -/;Wo v- ANY AND ALL CLOTH AND RUBBER 'OULATED CONDLOTORS TO BE RE TOD�171�r can 74)p N fxy ui 0 Lu a LJ 1ju Lu a. Te�pj.M ee �?4ete7 71e,4- 7or '7//1 gae/4n 12,ePZqce- X,17)e, NE //o AkIlAml S�ores At RATMMM REGEKIAGLE ON 20 AMP GKI MD G.FB PROTECTED � lG CD 13 Arty 2oom iv C– 1 w -r-r /VjIHIvfi —.+rtu/e�.c >M �a N el CMIDCO2 BAfiRROOM RECEPTACLE ON 20 AMP C AND G.FI PROD W l � G Q� y C=l I CD RZ./)1200 '7 .� Art+ Zoom , /� Pc,.9�C mix Trcre�r 01all 74,4 -1,0-eo I✓ I CF'CFH 2013RO374402 NOTICE OF COMMENCEMENT OR el. 28625 Pa 4785; tl.As) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 05/13/2013 11=24.,26 HARVEY RUVINP CLERK OF COURT MIAMI-DADE COUNTYP FLORIDA PERMIT NO. TAX FOLIO NO.%P�-2o3� ® ®� LAST PAGE STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement. 1. Legal description of props and street/ad 11 We al4m, -5horeA 2. Descrition ofmproverpe �,� la ,w Aft GG�� 41;4 OP 3. Owner(s),name and dglr Al 4 A4 I Interest in property: Name and address of fee simple titleholder: 4. Contractor's nam and address: eel W 176 J-? mta441 5. Surety: (Payment bond required by owner from contractor,if any) T HERESY CI=RT1FY11ta M jS a tote yofHte Name and Address: Amount of bond$ MAY 3 2 2 D S. Lender's name and address: W NE *hand attd HARM Rl IWN C1 7. Persons within the state of Florida designated by Owner upon whom notices or other d ay be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 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 and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner Print Owner's Name 01�( 4 e Prepared by b l �- Sworn to and subscribe fore me this day of 20 Address: �"�Ah%) Notary Public: m Print Notary's Nam a LOPEZ — My commission expires: IN. E XPIRES Jtdy 17.2018 a Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-197001 Permit Number: RC-6-13-962 Scheduled Inspection Date: August 12,2013 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: TIBBITT, DANIEL AND SERENA Work Classification: Alteration Job Address:11 NE 110 Street Miami Shores, FL 33161-7043 Phone Number Parcel Number 1121360040300 Project: <NONE> � Contractor: SKYLINE CONSTRUCTION&RESTORATION CORP Phone: (305)316-0906 Building Department Comments REPLACE COUNTER TOP WITH NEW MARBEL Infractio Passed Comments COUTNER TOP ONLY INSPECTOR COMMENTS False Inspector Comments Passed ` Failed Correction ❑ Needed Re-Inspection Fee I No Additional Inspections can be scheduled until re-inspection fee is paid. August 12,2013 For Inspections please call: (305)762.4949 Page 35 of 41