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CC-13-2343, Suite 311
Permit Number: CC -10 -13 -2343 J 4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209061 Inspection Date: May 23, 2014 Inspector: Naranjo, Ismael Owner: EDELMAN, ALEX Job Address: 9999 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: PRIME ONE CONSTRUCTION CORP Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number ()_ Parcel Number 1132060134490 Phone: (786)295 -1300 Building Department Comments PARTITIONS BUILD OUT FOR OFFICE LOCATIONS CARPET TILE UNIT 311 Infractio Passed Comments INSPECTOR COMMENTS False Passed � Inspector Comments CREATED AS REINSPECTION FOR INSP- 208975. Missing fire final 1101- t 35: S Li L( CI C.)_- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until May 23, 2014 For Inspections please call: (305)762 -4949 Page 1 of 1 1)11\ BUIL I G \,\ PERMIT APPLICATION Mi Shores Village Building Dep ent 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 Type: BunC--TiN_9) 901 //4 02110 JOB ADD City: Folio/Parcolit: Is the o ding • Shores County: • 6 t"3 90 ,3/, - • '• • - • JIVED OCT 15 2013 FBC 20 Permit N o. 1 .;-7TMaster Permit NorC75t13 ROOFING Miami Dade Gs/ 3// zip: 33 13,8 ; I : Y NO *3 7k-is 1/4-412-ortarz) OWNER: Name (Fee Simple Titleholder): ary /4720.0-Arc- p J&f 7610 77 07 Address: 9/9 / slArd, City: 'Item ..f*tees State: "6.40,14Pot Tenant/Lessee Name: Email: 7$4412b e *pt. . Coq • Zip: J3/30 Phone#: 714 -2/1- 7937 CONTRACTOR: Company Name: egi HZ 006 amsn2,4) air o i ay. Phone#: Address: sh (w FO 5 ttor.e_. City: 11,44t1 786 . °If 360 State: Qualifier Name: Oidorst- L qttorti g›-A" State Certification or 1.1 :it ,Fto ta-Ac 3317f Phone#: 704 499r- 130 6 tion #: Noe 1 53 2-4 Certificate of Competency #: Email Ad _To teo 'le IE 1. ausrigric 7°. ate Contact 704 -4qc - 1306 DESIGNER: ArchitectfEngineer P Value of Work for this Permit: $ 4-iroons,-.Nau Square/Linear Footage of Work: Type of Work: ClAddition 0Altemtion CINew 13 Description of Work: i Tioa moo ur -felt. 19 P g 6 04 to • •••3 t,t11 boo Mesa" Color the tile: Submittal Fee $ _ I t Permit Fee $ CCF $ CO/CC $ Fee $ Radon Fee S. DBPR $ 1 ,. .d$ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1, 51/3 . Iiing Company's Name (if applicable) Company's Address State Zip -Mortgage Lender's Name (if t Mortgage Lender's A City State Application is hereby ,; , , to a permit to do the work installations as indicated. I certify n€1 or has commenced prior to the issuance of a permit and that all work will be performed to meet the v .,,:t ; of all laws regulating construction in tills jurisdiction. I z, sip that a separate z , #'' 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 cm .kr= all applicable laws regulating construction zoning. "WARNING TO OWNER: YOUR FAIL 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 ■ . .,r, r $2500, the applicant must promise in . #.fi': faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab of such posted notice the inspection will not be approved and a reinspecdon fee will be charged. or Agent T h e f o r e g o i n g i n s t r u m e n t was acknow b e f o r e chi The foregoing in day of SQ$ 4,,, 20 I, by J pp��, �',,, 1 f . , day of eet As identification and who did take an oath. NOTARY PUBLIC: Sig: Print OIMeZt 4 My Commission Expires ,JO4►S' 4(/-., EUMELIA C GRANDA +u° E Notary Public - State of Florida T? My Comm. Expires Dec 1, 2013 o� Commission # DD 943472 Contractor acknowledged before me this Z3 f , 20 /3, by l/ rt L 044,10q', to me or who has produced tion and who did take an oath. NOTARY PUBLIC: My Commission sOrpSIV Pg I' hags EUMELIA C GRANDA • „' °= Notary Public - State of Florida e4 lit off; My Comm. Expires Dec 1, 2013 0ppio?o` Commission 0 DD 943472 wimirritiatitv*zativt* APPROVED BY P (Revised 512J2OI2XRevised 311 1 Structural Review 1 til 771 7a Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: COMPLETE CONNTTRACTOR'S INFORMATION liii O/)( jNtl/�✓�r o ) BUSINESS ADDRESS: p/#0' f ,A /a r 410Z Cry It / STATE L ZIP CODE 33 / 7 BUSINESS PHONE: ( eft) ) 9f' /g64 FAX NUMBER (3° ) 7(4 /d4 CELL PHONE (7I' ) 0` 9f /34 d QUALIFIER'S NAME: 0H/9/6 6«'P) 04" QUALIFIER'S LIC NUMBER: O /s-/r3.91. E -MAIL ADDRESS (IF APPLICABLE): /U/ ��)"4t s atrILJ(fl-. Created on 3119109 BY MLDV I RV 3126109 ML DV I RV 6127111 AS THIS DOCUMENT HAS A COLORED BACKGROUND * MICROPRINTING • LINEMARK PATENTED PAPER - BATCH NUMBER dr- "04,ge. t 151 SEC. MIAMI-MADE MEI Y.--1 ,.-----?..1 Is Local ststhess Tax only confirms payment a Loco rink or OtOcation Ider's basin oIongoviNORMal rep_ ws and requireme ich appl The RECEIPT NO above ho displayed on all commercialitittiCles do Code ■-,Sh For ore information, visit www.mituir I. Ifizaor ly with governmental . - Ni 01 -24 -2013 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATIQN * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 01/24/2013 EXPIRATION DATE: 01/24/2015 GRANDA OMAR L 261300388 BUSINESS NAME AND ADDRESS: . PRIME ONE CONSTRUCTION CORP 204 SW 105 PLACE MIAMI FL 33174 SCOPES OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of etectfon_under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no logger meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 01/24/2013 EXPIRATION DATE: PERSON: OMAR L GRANDA FEIN: 261300388 BUSINESS NAME AND ADDRESS: PRIME ONE CONSTRUCTION CORP 204 SW 105 PLACE MIAMI, FL 33174 SCOPE OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 OP ID: JOC "C VOW 4.,....--- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 10/11/13 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCER 516-294-1072 THE ROBERT C. MANGI AGENCY INC 152 MINEOLA BLVD. 516-294-1764 MINEOLA, NY 11501 CONTACT ac e o Est): FAX No): E -MAIL ADDRESS: PRODUCER PRIMEON CUSTOMER ID ft: INSURERS) AFFORDING COVERAGE NAIC S INSURED PRIME ONE CONSTRUCTION CORP 3575 SW 139 AVE MIAMI, FL 33186 INSURER A : PREFERRED CONTRACTORS INS. CO. 12497 INSURER B : X INSURER C : PCICSO2S- PCA08325 -MA-04 INSURER D : 05111 114 INSURER E : $ INSURER F : X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF IMM/DDIYYYY) POLICY EXP (MMIDDIYYYY7 LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X PCICSO2S- PCA08325 -MA-04 05/11113 05111 114 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 r CLAIMS-MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JE T Ti LOC PRODUCTS - COMP/OP AGG $ 1,000,000 X $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per acddent) $ $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER /EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) DESCRIPTION t L g AD ON1� L INSURED CERTIFICATE HOLDER C MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE 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 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PERMIT # 0 ( /3 w Q? a 9 a. , CONTRACTOR: Prime ale c JchC )( SUBMITTAL DATE: Jo -, / S - / 3 - ADDRESS: /'f2 2421/0 #3J/ / NAME: /7� )Vai/a l 4k RESUBMITAL DATES: .Cl.42 rni U t tZ ( r1 Cam"«, PROJECT TYPE: pad"7iti/ 4n S Eu1 d i o t C r d a C'. ZONING FIRE STRUCTURAL IMPACT FEES ELECTR < /�l " jHRS!DERM NOC PLUMBING /11,11111PwWir 11111111 0 ___ ji 4 12. 1 1 -�. i 0 ,- Miami Shores Village Building Department RECEIPT PERMIT #: (k2 DATE: (NAME) I, ntractor a Owner a Architect Picked up 2 sets of plans and ( other) Address: 9'J /i 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to Miami Shores Village Building Depa Acknowledged by: PERMIT CLERK INITIAL: it to continue pe ught back to mess. (Signature) RESUBMITTED DATE: PERMIT CLERK INITIAL: tub c aAL. 110 2q5 1306 lYliami Shores VHIage Building Department RECEIPT PERMIT #:(. C/ 3 —.2`-3 � DATE: / , /b alp/3 I k 6/r2A-0-1>-4--. , 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor a Owner o Architect Picked up 2 sets of plans and (other) Address: Ifff 7111Aef From the building department on this date in order to h :. corrections done to plans And /or get County stamps. I and - rstand that the p ns ne e'id to be brought back to Miami Shores Village Building De -'artm tto continu ='r - ►'nng process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOVEMBER 15, 2013 Permit No: RC13 -2587 Building Critique Review 1. PROVIDE FULL SET OF WORKING DRAWINGS SIGNED AND SEAL BY A STATE OF FLORIDA LICENSE ARCHITECT OR ENGINEER. 2. PLANS MUST BE APPROVED BY FIRE AND DERM 3. 1. FBC. 2010, SECTION 105.3.5,...EVERY EMPLOYER AS CONDITION TO RECEIVING A BUILDING PERMIT, SHOW PROOF THAT IT HAS SECURED COMPENSATION FOR ITS EMPLOYEES AS PROVIDED IN SEC440.10 AND 440.38. FLORIDA STATUTE THE EXEMPTION PROVIDED IS FOR THE CONTRACTOR OF RECORD. 11 -15 -13 I. NARANJO SEE COMMENTS ABOVE. Ismael Naranjo Building Official Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, replace them with new revised sheets and place behind the most current page. t Page _1_ of _1_ PfP /ME = -. • CONSTRUCTION Proposal License # CGC1515324 Expires : 08/31/2014 Omar L Granda, General Contractor 204 SW 105 Place, Miami, FL 33174 (786) 295-1300 PrimelConstructna email.com Licensed & Insured Submitted to: Jeff Miller Date:08/27/2013 Date of Plans: TBO Phone Number: Fax Number. Job name: Commercial Build -Out & 3 Electrical Outlets. Address: 9999NE2Ave #301 City, State, Zip:, FL Miami Shores, FL Job Location: Miami Shores We hereby propose to provide construction permit and electrical permit for project mentioned above. All labor & materials for build out stated on plans with the exception flooring. Time frame required on or before 2 weeks from the time of issuance of Permit. All the following is included in proposal... • Sheetrock partition wall build up.? a .s • Installation of 3 panel doors & trim. • Installation of 1 French door at reception entrance. • Installation of 3 electrical boxes and outlets with face plates. • Premier & Paint office in accordance to clients color selection. db-ar.te-il figs- Sub -Total ... $8,000.00 Payment is to be issued in draws of 70% at Start of Project 30% Final payment when job is completed. We propose hereby to furnish material and labor- complete and accordance with above specifications for the sum of : Eight Thousand .... xx/100 Dollars ( $8000.00) Payments are as follows: Check Payable to: Prime One Construction Corp , 204 SW 105 Place, Miami, FL 33174 Prime One Construction Corp complies completely with Florida Construction lien law and new construction prompt payment law ( Section 715.12 ) All material is guaranteed to be as specified All work will be completed in substantial workmanlike manner according to specifications submitted as per standard practices. Any alteration or deviation from above specifications involving cost will be executed only upon written order, and will become a charge over and above the estimate. If either party commences legal action to enforce its rights pursuant to this agreement, the prevailing party is said legal action shall be entitled to recover its responsible attorney fees and cost of litigation relating to said legal action as determined by a court of competent jurisdiction. Authorized Note: this proposal may be withdrawn by us Signature: Signed Via Email / Omar L Granda 8/27/2013 if not accepted within 3 days. Acceptance of Proposal: The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are Authorized to do the work as specified. Payment Will be made as outlined above. Date of Acceptance: "A A3 Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: CC -10 -13 -2343 Invoice Number: CC -10 -13 -49466 Applicant: ALEX EDELMAN Company Name: SHOREVIEW CENTER Date Payment Type Check Number 12/17/2013 Check 5068 10/15/2013 Check 5029 12/18/2013 Refund Amount Change $1,543.80 $0.00 $50.00 $0.00 ($1,322.80) $0.00 Total Payment: $271.00 Wednesday, December 18, 2013 Page 1 of 1 Eutwouir 43‘1._ -you)! qiudiAt 1)1111 ge. Quo Ave., 5'5" 9' 6.5" Room 12' 0" x12' 0" Room 12'0 "x10'0" 6'1" Room Room 12'0 "x8'0" Room 8'0 "x18'0" 2"5" 7'6" 4'2" to Main E Door 3'2 »From Main E Door kNe6: 0iC) ?Arm P'4^110"4" \/6)- `f�ubl�ovY (4 fib" Dooit.,5 7 eita.P�r Tcotrnsw two, sF . 4 NOTE: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Herbert S. Saf(ir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2000 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR ENVIRONMENTAL SERVICES PROVIDE MUNICIPAL PROCESS NUMBER HERE LOCATION OF IMPROVEMENTS Job ntitaif4) I? 9 k 3 313f CONTRACTOR(ti INFORMATION Contractor No. C&CISIs3a. 4 Last four (4) digits o Qualiffiier No._A. ! , Folio Z.) e-a u �' _ O Contractor Name7*i'NG age t;ert4'a'/L Lot Block Qualifier Name Cl -197C� ‘.0.14140/4-' Subdivision PBpg Address ¢ tor Pct. Metes and bounds ,rw City rt€4.14 I State Ft. Zip 33 )7 TYPE OF IMPROVEMENTS [ ] New Construction on Vacant Land Alteration Interior ] Alteration Exterior [ ] Relocation of Structure [ ] Enclosure [ ] Repair [ ] Repair Due to Fire [ ] Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only [ ] Tent Current use of property (fry Description of Work C f' f 54 LOCU1 Sq. Ft. 6415) Units Floors Value of Work / 311" PERMIT TYPE [ ] MBLD* ('� (\.category 0) REVIEW STATUS [ ] Chg. Contractor [ ] Re -Issue [ ] Re -Stamp [ ] Revision [ ] Not Applicable for Fire OWNER'S NAME Owner/ Address 99 9 fG P 44-4e— City// 4, State ctZip 33l p ] MELE [ ] MLPG Phone 30f' 7. i' "77 e7 Last four (4) digits of Owner's Social Security No. [ ] MMEC [ ] FIRE PERSON TO PICK UP PLANS Name Ka ( / ARCHITECT / ENGINEER Owner Address Address , 4 S w I° S City State Zip City L% -i'ki. ./ State_ ..2ip 31 ( 7 Phone Phone C 71 6 �— p2 / r" / 3 0 D FIRE SPECIAL REQUEST PLAN REVIEW (SRI) I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per each additional hour in addition to the review fees. Minimum charge one -hour. 1st Request: Date: 2"d Request: Date: 3'd Request: Date: PERA OPTIONAL PLAN REVIEW (OPR) 1 am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 1st Request: Date: 2"d Request: Date: 3'd Request: Date: 123_01-192 6/13 oS BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE BUILDING 01 GENERAL BUILDING - COMMERCIAL MBLD 02 SUB - GENERAL BUILDING - RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING & STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS (SURFACE PAVING) MBLD 86 TRAILER TIE DOWN MBLD 88 WALK -IN COOLER MBLD 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH MODIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROPANE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT /EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELE LPGX 01 LIQUEFIED PETROLEUM GAS MLPG 02 MISCELLANEOUS MLPG 04 LIQUEFIED PETROL. GAS /STATE MLPG MECHANICAL 09 ABOVE/BELOW GROUND TANKS /PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE