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PL-13-1922I` Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-197872 Permit Number: PL -8-13-1922 Scheduled Inspection Date: June 19, 2014 Inspector: Diaz, Osvaldo Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138 - Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)329-0222 Parcel Number 1121360050090 Contractor: CASTELLON PLUMBING CORP Phone: 305-553-1490 suuamg uepartment comments GARAGE ENCLOSURE INSPECTOR COMMENTS False June 18, 2014 For Inspections please call: (305)762-4949 Page 3 of 39 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 18, 2014 For Inspections please call: (305)762-4949 Page 3 of 39 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 st INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 k� BUILDING Permit No. .171 PERMIT APPLICATION Master Permit No: '� '3 Permit Type: PLUMBING JOB ADDRESS: _-- - . I o I I V - JE-: . 10S s4 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titlehol& Address: f o f M, E�: City: Me %M\ Tenant/lessee Name: 10 State: m NT 0► I� CONTRACTOR: Company Name: hone#: C1 ffJ Z Address:. /lam& City: a 4600 CState: i��� Zip: � ` /T er Name• //� Qualifi �/1���a �G� S.:.T �' � .��� Phone#: �'Z��,�7 State Certification or Registration #: _. f ro"',_ 10A .,47 1V Certificate of Competency #: Contact Phone#: �e��� 2- ,<-. 5: -. !°'l'��Email Address: 4:::;? x ire &'gge DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 314 ,Square/Linear Footage of Work: Type of Work: OAddress OAlteration Dewription of Work: /1.0�.r je,-- 14New ORepair/Replace ODemofition Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Senning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ TraininglEducatiou Fee $ Technology Fee $ Doable Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address Acity 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 COMNIENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the perm whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature _ i�_-�� Signature , Owner or Agent The foregoing instrument was acknowledged before me this 23 day of • , 20 L'�, by 1 ' 4 -r- , who isknown to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: J -mss Print: ��\ S \ rl C�► (L My Commission Expires: CWSTINA CU MLLERA NOTARY P11BUC STATE OF FLORIDA -TIMP-Mr, The foregoing instrument was acknowledged before me this lAv day of Iq I/ r , 20 f3, by • ZGlS li&-//�.< who is personally known to me or who has produced as identification and who did take an oath APPROVED BY -- Plans Examiner Structural Review (ReAsed3/1=012)(Revised 07/10W)(Revised O6/10/2009)(Revised 3/15/19) NOTARY PUBLIC: Sign: ee= Abft—�� Print: My Commission Expiresa°`:!!N,, BEATRIZ A BURGM * * W COMMISSION # EE 052014 EXPIRES: April 7, 2015 wr9TFOF "o-leMed Tisu Budd SrAw Zoning Clerk FROM:CRSTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. 06 2013 05:03PN P1 ' .,.• CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDiW M THIS CERTIFICATE IS ISSUED AS A MATTER OF uvORMA-WN ONLY AND CONFERS NO RIGHT$ UPON THE CE -ling IMEATHIS CERTIFICATE DOES NOT AFFIRMATNELY 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 REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certlfloate hald®t i eri ADDITIONAL INSURED, the policy(les) must be endorsed. If 8tIB1i0tiAT1ON IS WAIVED, NWed to the terms and conditions of the policy, certain PWltubM may M4ulre an emtoraanuft A statement an this Certificate does not aoaftr rlgideja th eerMcAe holder_In Ifeu of each wuuwzamangsB _ PROWUOER Noorg First Class Insurance Market PH 1- ^.,, (905)441-2N7•• j' Nm, (305)441.8443 4101 NW 8th Street L=n Miami, FL 33128 +oRDlnlcicovg a Naa:Q Phone(305)441-2997 Fax. . (30$)441 8443A: _ WILSHIRE INSURANCE COMAPNY _„.......... INSURED CASTELLON PLUMBING CORP 9841 NW 130 ST BRa HIALEAH GARDENS,FI.33018 -= ... _.. fta) COVERAGES CERTIFICATE NUMBER: _ REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOW HAVE 955* 06WED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM ORCONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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 PAI? CLAIMS. _........_ of TYPE OF INSURANCE AM SM 4514RAL LIABILITY _ C 1 000 000.00 ® COMMERCIAL GENERALLmiuTv i 100,000.00 A ❑ ❑ %A-s—zg 2 Dom N 01026613 I MED EXP oro S 8,000.00 _ Q 10028/2013 90/29/2014 PI OVAL b ADV INJURY S 1,000.000.00 O O6NERALA00R60ATIi 6 2;D00000.00 GEWL AWREGATE LIMRAPPLIES PER. PRODUCTS - comp P AOti s 2.000.000.00 ❑ PoucY ❑ P ❑ Loc S AUTOMOBILE LIABILITY Iw ❑ ANY AUTO 8040.Y u'WURY jPar Phi S ALL OWNED SCHEDULED BODILY INJURY IPeraool w a _ ❑ AUTOS ❑ o8 N ❑ HIREDAUTOS ❑ AUTOS D (?A!ePr�er1U ._ $ OS 8 p UMBRELLA LIAB p =Up EACH OCCLIRRENCL' $ ❑ Iacm uAa ❑ m AIMS•MADE I A00REQATE $ .._.. _ ... - -0 R S - - — WORK= COMPENSATION _ _a gANNyDpEraPr.OVWWLItMLLrIY/g YIN OFFIC�O�EXCLUtlED7 @�Ei .. • i INIA E L. H ACCIDENT $ lyda�mgdmm in NW) U I .&6.1W$ - 9A OEM D6SC�PERATSQNS bbigq E.L DISEASE - POLICY Lw+rr 9 .... . N DESCRIPTION CP OPENATIONS I LOCATIONS IVEI4CLP.B {Alfmch ACOim 101, Adffi§0” ttS Sob, it more specs N required► PLUMBING CONTRACTOR HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI $HORES,FL 33138 ACORD 25 (2010105) OF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TTIfMOP, NOTICE WILL BE DBLNBRBD IN ACCORDANCE WITH THE POLICY PROVISIONS. 7.. WQR P ENTATTYB 19 B•201D ACORD CORPORATION. AU rlgttla reserved. T /1 , D nems and logo are registered marks of ACORD R! m'. M N f ta LL L 000797, Local ReceiptBusiness Tex Miami -Dade County, State of Florida THIS IS NOTA BILL — DO NOT PAY 4&748 I5, Tl0N CAVELLON PLUMBING CORP 9841 NW 130 ST H1AfM GARDENS FL 3 018 RECEIPT "m EXPIRES MAEwAL. SEPTEMBER 30, 2014 466748 Must be displayed at place of busines Pursuant to Courtly Code Chapter SA — Art. 9 & 10 OWNER, SEC._ TYPE OF BUSINESS PAYMENT RECEI1NBa CASTELLON PLUMBING CORP 196 .'LUM$ING CONTRACTOR BY TAX=LL.ECMI: Wodw(s) 10 CFCD19059 $45.00 07/02/2013 FPPU07-13—W1200 This local BuEsiaess Tex Receipt vrdg canfmns paymeet of the Local Business lax. The Receipt is not a license, peaviL or a certificetioa of the b*Ws qua�lificeffam to do business. Halder nwst camplg with any gavernmental or r MnBosrmmer" veguimary laws acrd requrremests which spi ft to the busirmm The RECEIPT ISO. above smstbe displayed an aH commercial vehicfet-- . dit,$ec •sem � �• •. �t Far am lefarmation. visitmmfflaniamidade.os • r 1 C FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. 06 2013 05:04PM P3 STATE OF FLORIDA DUPARMUNT olp SII MMS MW PROVESSIOMML REGMATICK • COINSTRUCTION INDUS LICENSING BOARD 1��Szx 9� NORTE MONROE - PL 32399-0783' CASTMLOK, GIRALDO P84STRLLON PLMMING CORY 9 1 NW 13 0 ST. ALEM - GAR FL 33018 COngmtuiatiOnsf With #* Omm you become me of the needy am - mn Flormane 9censed by the DepwUnent of Susi on ness and PrOftsfanal RepWm Our Professionals and bwk4sm range from Nddeft to yedt brokers, *wn boxers to barbeque restaurants, and #*y keep FWdWs S=mny 0mg. Every day we'work to bnpmm the way we do business ses ln order to :terve you belts:rvr Wome,11on about our servkw, pkaw 4 onto www-n"crldWkwi%owm Them you can find more Wonnation about cur &1slons aW the regulations that impact you, NAMWI).- tO dqwbnOnt WwWatters and Imm nwm about the Departfnentla ird"aftwes. Our mission at the Deputnent 1w Ucem EMolently. Regulate Fairly. We cmSt0ftUY Skm to serve you better So Can serve your c4stbrnsr& 'Thank you for doing business in Florida.=VnituaM= = WCC an -your now Ltensel (850) 487-1385 DETACH HERE 9TR-Y Lai ..3EQ#Li2u.530010 C C P !30!40 T_x lc�, A AW4 d C11M, Flil did i'd" 'A'*#,. df i- 0"-h*a`t***,i6c 0xPira'tioU dato -CAB T=iL N 0 M VLMMZ?$ w - T P.L I ' 0, HTL 0 1 U ON Sco 16V AS $PLAY'REOUIRE FROM :CASTR LON PLUMBING CORP FAX NO. :305 558 1617 Nov. 06 2013 05:05PM P4 10-11-2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL 011FIC41t DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WQRKEiRS' COMPIwN —ION CERTIFICATE OF ELECTION TO BE . EXEMPT FROM FLORIDA WORKERS' COMPENSATION LANAI ft CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individgal listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/23/2011 PERSON: CASTELLON FEIN: 581676886 BUSINESS NAME AND ADDRESS: CASTELLON PLUMBING CORP 9841 NW 13M STREET HIALEAH GARDENS FL 33018 SCOPES OF BUSINESS OR TRADE: 1, REPAIR SERVICE 3- PLUMBING EXPIRATION DATE: 11/22/2013 GIRALDO ' 2- SERVICE CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 06(14). F.S., so officer of a co(petatlea wife elects exemptNle from Ibis cbaPlor by filing a cerlUieue of election under Ibis section may net recover benefits or compensation nn4or Chia Chapter. Purooam-to Wills! 440,051121: r,$*,, CerNfit;MS of election to be oxampt... 41111111F 041Y 11111110 Ike scope of the basiaeaa or trade listed e0 Iba notice of election to be eitpospt. putsuast to' Chipter 440,06113{, f.S„ 11911492 of election to be exempt and 94 019 19 as o) election to be e11o011t shall be sullied 19 1`041441104% it. at say time +lief tale Miag of tht notice or the iseaagm ece of the Canifl4et9. the person aen an the silica or c411ilieate no long" mesio ilia raquiremects of this section lot issoance of i cerplicye. The deperltant skoll resoto a certificate 41 my lima iso failure of the versos named on the cenillcale to meet the roquim enls of this section. QUESTIONS? (860) 413-1809 NC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD ftE40W AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF 19NANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO 09 EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE: 11/23/2011 EXPIRATION DATE: PERSOtt exRALDO CASTELLON F15%ML 591078996 BUSINESS NAME AND ADDRESS: C49TCLLON PWMa1110 CORP 9041 NW 130TH STA68T HIA46AS (148061111, Ft 33019 SCOPE OF BUSINESS OR TRADE t. Remit SERVICE 2• SERVICQ CONTRACYcR 3, PLUM91110 IMPORTANT FFPursuant to Chapter 440.05(14). F.S., an officer of a corporation Who elects exemption from this chapter by filing a ctirtificete of election L under this section may not recover benefits or compensation under this D chapter. 11/22/2013 Pursuant *to Chapter 440.051121, F,S., Certificates of election to be H exempt.•, apply only within the scope of the business or trade listed on E thq notice of election to be exempt R' f; Pursuant to Chapter 440.05(13), F.S„ Notices of cloction to be exempt and certificates of 0141111011 10 be 413111"1 shall be sublOct to revocation ii, a1 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 eertificato at any time for failure of the person narned on the certificate to meet the requirements of this section. QUESTIONS? (650) 413-1609 CUT HERE Carry bottom portion on the jab, keep upper portion for your reoorde. IWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. IVW13 RepertMen r JWF AMAFSR CHIEF FtlrtMIC[& OFFICER 27 2013 10:47AM P2 '' ciammTEaFELEctmTo aE EzBwr FRoM fL.OWp/ women 'o' toIP>mAmm L.Aw * * CONSTRUCTION INDUSTRY EXEMPTION This certfies thatths Individual Itsted belay has•elecled to be emmpttrom Rlodds Wodceis'Compsnsa8on law. EFFECTIVE DATE: 1122/2013 EXPWATIONDeATR 11P2212015 PEF48W. C W EL.LON 8111AMO FEIN. 591t37688s BUSDIESS NAMI"IN DADORM; CMTLLLON PLUMBING CORP 9841 NW i30 ST. H ALEAH GARDENS FL 83018 SCOPES CFS XRMSS ORTRADE: LICENSED PLUMBING CONTRACTOR Wsfm ]wC-252 cmR ns cxm of @.Ewan -m aa mampr Remm ama ouessONS3 (e5m413-1609 tgtp WIappsUci s ooWc rreporWmw7repo Mevier asp ddaw--kM3g vM7Q3gHOTER(**MtONZ° v4NPOPN42CeirDRGXV VVbM... 1/2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 F, - Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 6 I ( FBC 20 II BUILDING U Permit No. \0 PERMIT APPLICATION Master Permit No.��' Permit Type: WELDING ROOFING JOB ADDRESS: 10 I) G r® 5 s 2 City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): f e-& AIP DO Kk®O E-OC+'JC� Phone#: Address: �C)a Iy4& /t®!& _TT ' City: (PA t S'tko (QS state: � VL 0 Tenan see Name: Phone#: Email: Yllse�.-oc fid Sf-uer®�r C o C 33 t CONTRACTOR: Company Name: ®`dgenpael\n,,Phone#: 3os Address: q a 6_I_ /U W I a 1 S+ _ State Certification or Registration #: CKC,. I ,S,6 Q,�S `°I Z -j Certificate of Competency #: C� Contact Phone#: ajbin - ea :+ ` Email Address: Q+So uY 'A Q o C 0.V-) DESIGNER: Architect/Engineer: V I CA -n 3 rV t.:( Phone#: Value of Work for this Permit: $ 0 0Sgnare/Linear Footage of Work:0 S�'f Type of Work: OAddition NAlteration UNew ORepair/Replace ODemolition Description of Work: 1 Ti -- -- . Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning X4 $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ U0110 40. Technology Fee $ TnTAT. FF.F NnW D1W.. t [4FS a I C�- ^" PERMIT # CONTRACTOR: SUBMITTAL DATE: ADDRESS: lol NAME: RESUBMITAL DATES: PROJECT TYPE: `-�- a FIRE l STI UCT RAL IMPACT FEES t ELECTRICAL%3 RS(DERM y C�- ^" PERMIT # CONTRACTOR: SUBMITTAL DATE: ADDRESS: lol NAME: RESUBMITAL DATES: PROJECT TYPE: `-�- lZ NI f - FIRE l STI UCT RAL IMPACT FEES ELECTRICAL%3 RS(DERM PLUMBIN ,. ld4) lot - ;�'• � i � ,h .-r �" _sem f, ME . A ,Bonding Company's Name (if applicable) Bonding Company's Address T City State ortMe 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 constriction 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Owner or Agent The foregoing instrument was ac�owledged before me this day of 9 U S 120 Yom, b`y�" Ct 2 w who is personallyknownto me,or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: V L U vGj --A Print: I—b - My Commission Expires: APPROVED BY VIOLET P'BOVIL X11, M May 14, 2015 Contractor The foregoing instrument was acknowledged befo a me this day ofA-uA- 201- , byJ tic o ® �; ✓+`c ho is personally known to ­ma or who has produced identification and who did take an oath. NOTARY PUBLIC: 1 1-�-- . •r::��c.c:��• Iii Plans Examiner —tI Z J Cl,4 Xs ) Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07O"ised 06/10/2009)(Revised 3/15109) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD 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 EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER 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 WORKER 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 ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrrrrrrrrrrrrrrrrrr� COMPLETE_ CONTRACTOR'S INFORMATION BUSINESS NAME: auYc-e Ken--\0AA1n BUSINESS ADDRESS: J2 � I AW I D� � 8 :� CITY` e ✓a rn S STATE l" L ZIP CODE 3 3 d I BUSINESS PHONE:f OS 3s 6 - 1 FAX NUMBER ,p CELL PHONE QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: ��Z_C I � 3 0 � 9 E-MAIL ADDRESS (IF APPLICABLE): �°`) S 0 V n t U o a P, ng • cum Cvp*donX190BYNMI RV OWMUN 66 tl ISM THIS IS NOT A BILL — DO NOT FAY mans rrwvr. NME I LOCATION CE REMODELING LLC 1 NW 121 .ST 8 HIALEAH GARDENS OYMER SOURCEREMODELING LLC CONTRACTOR SOURCE REMODELING LLC FMQWM CE AWT JORGE RODRIGUEZ MGRauauFlCA 9261 NW 121 ST TWW HIALEAH GARDENS FL 33018 PAY10W RECINM WA1 MMM CMW" TAR COQ 07/17/2012 60010000489 000000.00 10 _ SEE OTHER SIDE .4 07-24-2012 JEFF ATWATER STATE OF FLORIDA CNEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO IE EXWT 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. r EFFECTIVE DATE 08/$0/2012 EXPIRATION DATE: 08/3012014 PERSON: RODRIGUEZ JORGE L FEIN: 271831236 BUSINESS NAME AND ADDRESS: SOURCE REM BELIN13 LLC 9261 Nit 121 STREET HIALEAH GARDENS FL 33019 SCOPES OF BUSINESS OR TRADE: 1— LICENSED RESIDENTIAL CONTRACTR IMPORTMRT. Personal to iapter 440 . 05110, F.S., on officer of a corporation who elects exemption from On chapter by filing a ce"Icate of Wall= tinder On section any not recover beaatim 0r 00,011 usatfon under INS comer. Pntaeat to Chapter 440.05{12), F.S., Certificates of election to be exempt... only only wMa the scope of the- babfaess or trade limed 00 the notice of election to be exempt. Pursuant to Chapter 440.06(13), F.S.,. Notices of election to be exempt and certificates of election to be exempt shall be sobleet to revocatlon If. at SOY than after the filing of the notice or the tssoaace -at the certificate, aha person named on the notice or certificate to longer meets the r"alrements of this section for laminate of a certificate. The department sbati revate a certificate at any time for failure of We 110,1302 mmed a0 the certificate to meet the ratintremems at this section. QUfSTiQrdit {85M 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EX WT REVLJEO 01-11 #-%I%- ^� vrr=n �r�vri c yr ra_�riv�rl_� n�vvtrv+��vrr= 01/13/13 THIS CERTIICATt 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 poilcypes) trust be endorsed. H SUBROGATION IS WAIVED, subW to the terms and conditions of the policy, certain policies may moire an endorsement. A statement on this certificate does not confer rights to the cerHHcate holder in neu of such end s PRODUCER MACT Odalys Vak a ve Just Insurance Brokers P 305 418-4701- 214 FAX 305 418.4706 ffin Kok 1200 NW 78 Ave Suite 105 AQRB= .00171 Miami, FL 33126 PRODUCER Phone (305) 418-4701 Fax (305) 418-4706 MWERN AFFORDpN(;s COVERAGE Nair # UMFIED INSURER A: Federated National INBIIRER B: Source Remodefmg, LLC 09ORER C: 9261 NW 121 Street D : Hialeah Gardens, FI 33018, FL 33018 INBURER E: (786) 897-2760 P GEESWS accurvertoel TO $ 10000 MED EXP (Any one person) $ • 5,000 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 ORCONDITION OF ANY CONTRACTOR 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. 10050 NE 2nd Ave TYPE OF DIIIRANCE Miami Shores, FL 33138 ANDLPOLICY NUMBER POLICY EFF f LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 COMMERCIAL GENERAL LIABILITY P GEESWS accurvertoel TO $ 10000 MED EXP (Any one person) $ • 5,000 A ❑ ❑ CLAIIAS-MADE ©OCCUR ❑ N GL0000005254-02 08/312012 08/31/2013 PERSONAL & ADV INJURY $ 500,000 ❑ GENERALAGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPfOP AGG $ 500,000 ❑ POLICY ❑ PRO- ❑ Loc $ AUTOMOBILE LIABILITY ANY AUTO ❑ ALL OWNED AUTOS El SCHEDULED AUTOS El HIRED AUTOS COMBINED SINGLE LIMIT $ (Ea accident) BOD&YINJURY(Perposm) $ BODILY INJURY (Per acwtt) $ PROPERTY DAMAGE (Per ) $ ❑ NON -OWNED AUTOS $ ❑ $ ❑ UMBRELLA VAB ❑ OCCUR EACH OCCURRENCE $ AGGREGATE $ El DCCESSLIAB CLAIMS -MADE ❑ DEDUCTIBLE $ $ RETENTION VIIORICERS COMPENSATION WC STATU- 0711- THAND ER ANDEMPLOYERS' LIABILITY Y/ fl ANY PROPRIETORIPARTNER/DCECUTNE OFFIGERIMEMBEREXCLUDED? N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ In *Q I(MmxWW RDdoscI under N OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ FT -F-,- DESCRY WN OF OPERATIONS/LOCATIONS/VEHICLES Mitch ACORD 101, Addsional M marts SclwdUle, B morespace B CERTIFICATE HOLDER CANCELLATION O 1988-2009 ACORD CORPORATION. All rights reSwved. ACORD 25 (200910 OF The ACORD Terme and logo are registered marks of ACORD MOULD ANY OF THE ABOVE DESCRIBED POLIOS BE CANCELLED BEFORE Miami Shores Vftge Bull ift Department THE MaIITION DATE BE DELIVERED IN ACCO SCE WITH THE POLICY NOTICE WILL 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. All rights reSwved. ACORD 25 (200910 OF The ACORD Terme and logo are registered marks of ACORD 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA 33138-2382 Telephone: (305) 795-2207 Fax: (305) 756-8972 DAVID A. DACOWSTO, A1CP PLANNING & ZONING DIRECTOR DEVELOPMENT ORDER File Number: PZ -5-13-201332 Property Address: 101 NE 105`h Street Property Owner/Applicant: Fernando Monedero and Mercedes Plaza Address: 101 NE 105`h Street, Miami Shores, 33138 Agent: Victor Bruce Address: 370 NE 101 St., Miami Shores, FL 33138 Whereas, the applicant Fernando Monedero and Mercedes Plaza (Owner), has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Special site plan review and approval. Addition, main floor expansion and new second story. Whereas, a public hearing was held on June 27, 2013 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village, 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1) Approval is granted to convert a garage creating 2 studies without closets, 1 bathroom and a storage area. 2) Approval is not granted for the new westerly door leading from the studio to the side yard, existing door to be removed. Page 1 of 2 DO PZ -5-13-201332 Monedero-Plaza 3) Applicant to provide and maintain not less than two (2) parking spaces on the plot. 4) Applicant to obtain all required building permits before beginning work. 5) Applicant to obtain all required permits from the Miami -Dade Department of Regulatory and Economic Resources, Environmental Plan Review Division (DRER, EPRD) and the Miami -Dade Department of Health (DOH/HRS). 6) Applicant to meet all applicable code provisions at the time of permitting. 7) Applicant to complete a covenant in the form of a "Declaration of Use" assuring the property is used only for a single family purpose, record the covenant with the Miami -Dade County Recorder and provide the planning director with a copy of the recorded document prior to the final inspection by the Building Official. 8) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair, or if the work authorized by it is suspended or abandoned for a period of at least one (1) year. The application with conditions was passed and adopted this 27" day of June, 2013 by the Planning and Zoning Board as follows: Mr. Abramitis YES Mr. Busta Yds Mr. Reese YES Mr. Zelkowitz YS, Chairman Fernandez YEs -7 2 2©( � Date and M. Fernandez Chairman, Planning Ism Page 2 of 2 DO PZ -5-13-201332 Monedero-Plaza MPA Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 September 18, 2013 Permit No: RC13-1919 PLUMBING — OSVALDO DIAZ x%107.1 PROVIDE SIZE AND LOCATION OF EXISTING SEPTIC SYSTEM &-'2. FBC 107.1 PROVIDE HEALTH DEPARTMENT APPROVAL abovePlan review Is not complete, when all Items voidedplan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and Include one set of sheets In the re -submittal drawings. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 September 13, 2013 Permit No: RC13-1919 Building Critique Review 1. 1. PROVIDE SURVEY AND ELEVATION CERTIFICATE LESS THAN 1 YEAR OLD. 2. PROVIDE CERTIFICATE OF WORKERS COMP. FOR WORKERS AS REQUIRED UNDER SECTION 105.3.5 OF FBC 2010. 3. DETAIL 5, SHEET A-3. PROVIDE 30" MINIMUM SPLICE OF THE VERTICAL BARS. 4. REFLECT CHANGE OF ELEVATION AT NEW DOORS 5. INSULATION ON PLANS SHOULD MATCH WITH ENERGY CALCULATIONS. 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, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: �j,- 3 - i -3 Permit No: ��v 1 SPI 91 C 'Atiaue Review PDG • to -1. ® s1 1" �C-- V�i I S S C-7 �/Q 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. Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT: Y-h"�^ 1 C� I I DATE: f --E- L J AN D---) c Contractor (NAME) X,Owner ❑ Architect Picked up 2 sets of plans and (other) Address: k'O \ � �- � ® S R -C, 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 be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: (Signature) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: September 17, 2013 111 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Responses to Building Comments Permit Number: RC 13-1919 Address: 101 NE 105th Street SEP 17 2013 A. Building Critique: 1) Provide survey & elevation certificates less than I year old See attached Miami Shores Survey Affidavit prepared by Owner; 2) Provide certificate of workers copm for workers as required under Sectdion 105.3.5 of FBC 2010 By General Contractor, 3) Detail 5, sheet A-3. Provide 30" minimum splice of the vertical bars Please see changed note in sheet A-3, signed & dated by Architect of Record; 4) Reflect change of elevation at new doors See sheet A-1 for demolition of existing door, see sheet A-2 for new door, see sheet A- 3 for new elevation for work to masonry wall; 5) Insulation on plans should match with Energy Calculations , See sheet A-2 for added R-19 roof insulation and glazing information for SHGC and U - factor, wall insulation in drawings is higher than Energy Calcs.; Sincerely, Victor J. Bruce A.I.A., LEED R AP Vice President & Architect AR -0017103 A&I associates, Inc. 370 NE 10 10 Street Miami Shores, Florida 33138 telephone 305-310-5030 tax 1-877-408-8280 email vbruce@ai-associates.net 4 .. A 9 C/A A Anil -90A LOT: 9 BLOCK: 201 SUBDIVISION: PROPERTY ID #: 11-2136-005-0090 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAIL ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND T [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N I I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLOAZSI••i• K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PE& 24•H+RS • #Pumps [ •••s�• D [ 334 I SQUARE FEET bed confiquration drainfiel SYSTEM • 00 *see 0*0000. R [ 334 l SQUARE FEET •••••• • • • bed confiquration drainfiel SYSTEM • .... •. A TYPE SYSTEM: [x] STANDARD [ l FILLED [ I MOUND [ ] • • • • • x CONFIGURATION: [ I TRENCH [x] BED [ ] '_ • ...... .... ..... N • • • •• •• •••• •••••• F LOCATION OF BENCHMARK: F.F.E., 11.66' NGVD • • • • • . • I ELEVATION OF PROPOSED SYSTEM SITE [ 19.90 I 5—;C­E—m—sT FT ] [ ABOVE BELOW BACHL"/REFIiREN •••••. POIN! .... • • E BOTTOM OF DRAINFIELD TO BE [ 49.90][ INCHES FT ][ABOVE BELOW BE$CM$W/REFLRENCE POINS • L • • • D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED.: [- 30.00I INCHES Inspector to verify the existing septic tank is properly abandoned before final approval. 0 *Invert elevation of drainfield to be no less than 8.00' NGVD. T *Bottom of drainfield elevation to be no less than 7.50' NGVD. H The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 400 gpd. E The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with R s. 64E -6.013(3)(f), FAC. SPECIFICATIONS BY: Barry TITLE: Master Septic Tank Contractor APPROVED BY: 1 --lid.-/ TITLE: Dade . CHD DATE ISSUED: 10/21 EXPIRATION DATE: 04/21/2015 DH 4016, 08/09 (Obsolete r����ijit be used) Incorporated: 64E-6.00 1 ffNg adjacent to the drainfield excavation at the time of final iniptction. Friar to Final ao3he DOH SE910752 Inspector shall witness the soil boring and compare the results to the o6ginat site evaluation submitted. A reinspection fee will be assessed If the contractor Is not at Me jobsite at the arranged time. Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703: The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available -as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. • 0000 •000.0 • • • • • 8094•• 0000•• • 0• 000••• • • • • 0 • • It STATE OF (FLORIDA) COUNTY OF (DADE) 172013 Miami hores Wage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT The undersigned Affiant, MC&f k 00 N , does hereby attest that (Property owner) The attached survey, performed by Unitec Surveying Inc. (Name of surveyor's company) Foraddre�: 101 NE 105th Street in Miami Shores, Florida Performed on May 19th, 2013 (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as prod owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Affi ay eth naught. Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of r h e'`( 7oI­_-� Affiant is �)4personally known to me, pr�luced as identification. ,NN1 I ,,,- Revised an &22aM ReYWW on 6/120 SEP ] _NE c --.-r. . C1 LEGAL DESCRIPTIOH:Lot 9,Block 201,DD WIC'S KL4M SROM iDITESSIO'M MD. l,according to the Plat thereof as recorded in PLat Book 41,Page 51 of the Public Records of Miami -Dade County, Florida. - 11 owNifdow is suea= = To oPdaN ov TtnE. 21 IMAMMATIMI OF THE ABSTRACT OF TITL8 W LL HAVE TO HE MADE TO AWE ROCOROHD Ui;•;TRIMHNra, If AW, AFFECTING TraS PROYBRTY. 31 (LM OENOTES TN08E UWYATmW t IRRSO ra 111f:0 OAT M '41 LOQAVOX AMD I &MFICATtON OP UTILMES Ot4AWM ADJACBNT TO THE PROPER}Y MERE NOT sSWOURO AS W*i TWOMATtON WAS NOT W41,19STIM 81 TNIS PINWERTY IS WM M M LW I OF TME FLOW WM X e1 NO UNDERGROM LOCATIONS WOW DOW BY TM COMPANY. Updated sMay 13 , 2013 CEItTiil[EUTO: Gladys A. Carden" Esq.,persiando Monedero Orejana and DATE: Mercedes Plaza &Mchez, MOvember 15,2011 American Bancshares Mortgage.LLG APPUCAME XOIUNti. UNOZR0R WMU NG AND KOLOINO BHT BACIIS. MUST BE CN6OWD By OIAP M A*CH1T1tCT OR W.UO36t WPM 0£s M OR COMMUCT1019 BOOM ON"PROPOMT arA awrea to Y* bmt of my kvmwi go. 1q *nnW" else tow as refer W 61fwwod amt PIS rmar nW dtrccttan, also OW thine M not o "e=mm m wM Oftw tits„ ft" shwa -P, UXIT" "lads sumW mmu Nee mWmum t'echntral smrz:�s set WINDY ft Plarftla 9MM of LOW &Ov"Ws Iramam to Chow 61097.8. fWW AdmlvdMadhv Cods, Saaftn 472.027. Ptoti0o SWas a. N SURVEYING, INC AA� L.B. NO. 33 3 -" At4•rao aw NN 11371W $met HS m�f 7 rid S 'f1b, SH" tAIAAfI, FLORMA 33i7I8 S! er trtorl�a 3L'sl'5t2�l940 THIS IS_A SOU14DAI3Y SURVEY __ - •- - ._ ..... _ �_ DKwU 4 Ll KAW OF SURVEY SCALE 1v = 2ot y rc,&yt 'f... Je6 t� • eg65' .moo, � n %01 AL � �S 1_S9` lbi area a S.o.f>+c� ff-33139 � rj DKwU 4 Cl � '�.eJ. 1� e•�' 41MTE IAL EIeC.,,EpS:ftgA6t1 B,Pr 9!/I...foLo•.140P WAV,.. %„ tt21a'tRtt Ift Pipe *0-.t1"tfEdD Yfr�d.:�vr0.T�@.kEt`�'J � &D vn . pgrmr s#ec, cQacxete rr IS FM HYiaNO up-4rd"aoUt R, AN" u&.-llTtMe^S"wM R.;.aA>SElC&_PtNffBR r._T.t9[IIH1T C.B.....LATClf edrYf vK..."WMA t:LP.,,R:PIJY L`VK FU= rj 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: BUILDING N<-- A® S ST P19111018 FBC 20 2 Permit No. Master Permit ROOFING City: Miami Shores County: Miami Dade Zip: (� Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): n t ? Phone#: ---+ �!? 6 L 9 o? z 2 Address: A D A t-) Iff- \ 0 S S� City: .Alm �; State: Zip: 1 ,3 R Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: S cy z� �I�-723 Address: "1 19 (AJ P s° 2 3 I Ck A '{ City: WState: Zip: 330)% _ Qualifier Name: Yt' 'e 'Z Phone#: State Certification or Registration #: CVOQ G 1'� S -I S M Certificate of Competency #: 1 Contact Phone#: 90.;'.35-4q3 Email Address: z-g� S® U ne geyrod °_ I1 rQ DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ n Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ONew ❑Repair/Replace ODemolition Description of Work: (i. I S (B -- \/ UL, Jo LU Cf.(I (Pe fPnk rarraA aft Color thru tile: a�a:a�M�a���a����axa�aaxa:x•Ma�aaa��a����x����a�a�a�rax�a�X�a�FeeS����::k%�x��aaMxa���na��a�a��:�a�s�a��sa�x'•��a����a���a���a�a�a��a�aa Submittal Fee $, Scanning Fee $ Notary $ Permit Fee $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ _ Technology Fee $ TOTAL FEE NOW DUE $ . 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 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this I2- The foregoing instrument was acknowledged before me this 1 2 - day of --a 20 ]?, by C K ( 15 � j e\ W CVn'111CrNayofL-A! 20, � by , who i ersonall know o 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: % auh11�// +........ Sign.a-uct�Sign: `,``>>+��+•tu "•• Print: C 1rI's -t-ice cin Z 1Ito Y -On Print: 'eye • .-. CRST!"'CLULLERA My Commission Ex ire My Commission Expires: 4 LL- NOTARYSTATE OF SDA qc�b e, au., O v Goml OE219343 APPROVED BY 14 Plans Examiner Zoning "Al ""i 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 12-1q-13 Permit No: R e-, 3 -) 9 J Structural Critique Sheet Page 1 of 1 -k1e w(AS®,'oR!i f�Er"w��'�e� 'JE -t ;L .g -L� 84f i���C (3RD X9 1 pi -T ?oP &V-r-Zog, C®®F'D t,M 9P( --c; Fy 1*6 til® &f' -our `p-voalwiaDOW -To 66 AEPCA-CeD ?044 ►'cc- czpfe7s &f til w i fijo ►A] To 36 f-EPLAcc, V STOPPED REVIEW 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. Mehdi Asraf