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RF-14-8745`b/M BUILDING PERMIT. APPLICATION Miami Shores Village_, r� �- g Buildin Department; y-- ©�i�% � 90050 N.E.2nd Avenue, Miami Shores, Florida 331 8 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4 Permit Type: BUILDING JOB ADDRESS: t7 r'BC 20 Permit No. Master Permit No. I3F / ! 8Y, ROOFING City: Miami Shores County: Folio/ Parcel #:'t -32. 0(40-0/ 3 —v .50cT Is the Building Historically Designated: Yes NO Miami Dade Zip: 3.3? Flood Zone: OWNER: pNaame (Fee Simple Titleholder): T� ��4 ) Phone#: Address: b V , r City: ' am.) Sk1C Y `e State: Zip: ' - Tenant/Lessee Name: Phone#: Email: CO TOR: Company Name: � wer �� 4C»') Cr/3' Phone#: ` )8� Z i � Address: 0 6 x�>G 19 633 City: (.. 0 .) State: �_ Zip: Qualifier Name: r—Pe- 'e Ca-T-6.2/0 im n —7 State Certification or Registration #C (1J ""[ I 1 Certificate of Competency #: Contact Phone#: -7 (60`-k0` 404-0/ Email Address: liQ F1S UC..i • -F DESIGNER: Architect/Engineer: Phone#: Phone#: Value of Work for this Permit: $ l 3l O(-D Square/Linear Footage of Work: Type of Work: DAddition ❑Alterati n UNew Kl' e• air/Re .lace _ ❑Demolition Description of Work: � � �2 A . r-`�� Color thru tile: * *** *** **** ** •*** *•x*****•x•x•r********** *Fees******************************************** Submittal Fee $ 7 O'(J Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 6 6- 90 ding 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 ojr 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 comme �„ent must be posted at the job site for the ft , t ins , ' -'on which occurs seven (7) days after the building permit is issueAre sence of such posted notice, the inspec '� ill �,�proved and a reinspection fee will be charged. u" Sig � aturc - -. Signature Owner or Agent The fore ping instrument was acknowledged before me this 1C The foregoing irttstrume as 20 Contractor knowledged before me this /0 by PTil Z, ed r day of , 20 by 1;l /fl (}-f�i1 1J L.jf'l day of 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 P Sign Print: who is personally known to me or who has produced Notary Public State of Florida • Geoconda Bonilla • My Commission FF 084475 Expires 01/05/2018 My Commission Expires: Sig Print: My Commission Expires: +x*******+r** ** * *** ** **** * *a* ******************************************* * ** * ** *** ** ** **** * * ********** ** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Apr. 17. 2014 11:59AM Florida Land Use Consultants No.2971 P. 1 A`°R° CERTIFICATE OF LIABILITY INSURANCE DATE(M 6DmYY) • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 'CERTIFICATE HOLDER. THIS CERTIIICATE 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 the terms and conditions of the policy, certain policies may require an endorsement. certificate holder In lieu of such endorsement(s). polloyges) must be endorsed. If SUBROGATION IS WAIVED, subject to A statement on this certificate does not confer rights to the CONTAOI NAME PRODUCER Marsh USA Mo. 100 North Tryon Slteel, Suite 3600 ChatIolle, NC 28202 Alin: ForquesWorm pentad: insursnoeregvegtgewes.COm 47095 •CASUA- OWLY -14 -15 Limns FL LHC ONE PH N Fyd). PAL X am 'MML55: INSURER(S) AFFORDING COVERAGE NAICB Il5URERA r National Union Ere Ins Co Pittsburgh PA 19445 INSURED Lowe's Companies. Inc, and Subsidiaries 1000 Lowsre Blvd. Mooresville, NC 28117 COVERAGE8 ^� ^�� "^ a �^ ,�• •••� �� INSURER B: New Hampshire Insurance Company 23941 INSURER O: Illinois National Insurance Company 23817 INSURER D r WO/ National Casualty Corp. 15105 INSURER 0: Steadfast Insurance Company 28387 INSURER F I vr� r urwh I rvurvroCn: ArL-up t 2- 1 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. IN SR TYPE OF INSURANCE ADOL &uBR POLICYJFIIxro°f ,[MAD YEP INSR_W1�. POLICY NUMBER A B 'A E B A B C GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE ❑ OCCUR GENT AGGREGATE LIMIT APPLIES PER POLICY - Pay - LOc AUTOMOBILE UABILITY X X ANY AUTO ALL OHINED AUTOS !IMAMS SCHEDULED AUTOS NON-OWNED AUTOS UMreREUA LAB I X I OCCUR EXCE$$ LIAR I�-�jt CLAIM$.MADE DEO I I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS, LIABILITY OFFlCER/M OFFICER/MEMBER EXXCCLUD 7 PROPRIETOR/PARTNER/EXECUTIVE (Myaenndatory in NH) ID DES DESCRIPTION PON under PERATIONS below Self Insured -See Below CA2248403 AOS CA2248404 MA CA2248405 VA 04/01/2014 09101/2014 04101/2014 04/01/2015 04101/2015 04,01/2015 LIMITS EACH OCCURRENCE DAt(AGIT6 RENTED PREMISES (Ea occurrence) MED EXP (Any are person) PERSONALSADV INJURY S 5 S GENERAL AGGREGATE S PRODUCTS - COMP/OP AGO S MEWED SINGLE M eeedeno BODILY INJURY (Per parson) $ S S 5.000,000 BODILY INJURY (Pet accident) S PROPERTY DAMAGE /Fetaocidarrn 8 N/A IPR37923041 WC019901319 ADS, WC019901317 MN WC019901320AK AZ WC019901321 NH, VT WC019901318 ND. WA WI, WY 04/01/2014 04,0112017 EACH OCCURRENCE S S 5,000,000 AGGREGATE 8 5,000,000 09/01f2014 04/01/2019 04/01/2014 04/01/2014 04101/2015 04/0111015 0410112015 04101/2015 X I WOSTAYU- I IoTH TORY LIMBS ER S EL EACH ACCIDENT S 2.000,000 E.L DISEASE - EA EMPLOYEE S 2.000,003 A A Excess WC Excess WC XPIC8836270 ADS XWc8638271 FL 04101/2014 04/01/2014 04/01/2015 04/01/2016 EL DISEASE.. POLICY LIMIT WC :Sial/EL:S3m6; xs S2m0 SIR WC:SIaVEt53m0: xs $2m;I SIR S 2,000,000 DESCRIPTIONOF OPERATIONS / LOCATIONS /VEHICLES (ADAM ACORD 101, Acsmonat Rema eeSchedule.UmomapaceIsrequired) Insured is sefinsured for General LlabRd for the period o 4/01/2014 to 4/01/2015. Lowe's Home Centers, Inc. and Lowe's Home Centers, LEG is a named insured under Iha Captioned patoes. Florida Contractors License Na CGC1508417, PeterAnihony Cafaro III, Certified General Contractor. Florida Contractors [tense No. CCC1328824. Peter Anthony Cararo III. Certified Roofing Canraolor. (Please see Page 2 for additional Informldon.) CERTIFICATE HOLDER CANCELLATION City or Miami Shores 10050 N.E. 2nd Avenue Miamle 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. AUTHORIxSD REPls $ENTA11VE or Marsh USA toe. Paula Slaptelon ACORD 25 (2010/05) ®1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4) 0--)07+C• %%c./ SA JTI AA" h aJ ,q ,c,! /,vir)c/A^ c/F 2 " r S14, iry10-1-frq goi4G 94- st- L2'qmi , shores/. fit- 331 Miami Shores Village P.PPROVED BY DATE ZONING DEPT BLDG DEPT / Wit FEDERAL IECT TO COMPLIANCE WITH ALL ;LATE AND COL INTY RULES AND REGULATIONS CI Y COPY Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 212749 Permit Number: RF -4 -14 -874 Scheduled Inspection Date: May 28, 2014 Inspector: Rodriguez, Jorge Owner: DAVIS, KARIN AND TIMOTHY Job Address: 80 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: LOWES HOME CENTER INC Permit Type: Roof Inspection Type: Final Work Classification: Gutters Phone Number Parcel Number 1132060130300 Phone: 407/370 -2872 Building Department Comments REMOVE AND REPLACE GUTTERS Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 211594. Need permit package May 28, 2014 For Inspections please call: (305)762 -4949 Page 10 of 16