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MC-14-1609Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216574 Permit Number: MC -7-14-1609 Scheduled Inspection Date: October 08, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: ECHT, GUSTAVO Work Classification: A/C Replacement Job Address: 1190 NE 100 Street Miami Shores, FL 33138 - Phone Number Parcel Number 1132050180020 Project: <NONE> Contractor: SERVICE AMERICA ENTERPRISE INC Phone: (954)979-1100 Building Department Comments AC CHANGE OUT OF A 2 TON 16 SEER UNIT AHU Infractio Passed Comments INSPECTOR COMMENTS False October 07, 2014 For Inspections please call: (305)762-4949 Page 8 of 25 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 07, 2014 For Inspections please call: (305)762-4949 Page 8 of 25 Miahii shores Village 3531536 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING JUL 2 5 2014 FBC 20 ID Master Permit No. C-, II' I LOCDI� Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 7 MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1190 NE 100 ST City Miami Shores County Miami Dade Zip: Folio/Parcel#:11-3205-018-0020 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): SHALOM 1190 LLC Phone#: 305-389-7129 Add es 1190 NE 100 ST r s. City: MIAMI SHORES Tenant/Lessee Name: _ Email: State: FL Zip: 33138 ne#: CONTRACTOR: Company Name: SERVICE AMERICA Phone#: 954-979-1100 Address 2755 NW 63 CT City: FT LAUDERDALE State: FL Zip: 33309 Qualifier Name: RICHARD LEVINSON Phone#: 954-979-1100 State Certification or Registration #: CAC014619 DESIGNER: Architect/Engineer: Certificate of Competency #: hone#: Address: City: State Zip: Value of Work for this Permit: $ 3723.00 Square/Linear Footage of Work: 1915 Type of Work: ❑ Addition ❑ Alteration ❑ New K Repair/Replace ❑ Demolition Description of Work: A/C CHANGE OUT OF A 2TON 16SEER UNIT AHU RHLLHM1724 AND CDU# 14AJM25A01 Specify color roojf�color thru tile: �Y Submittal Fee $ s-`" ' Permit Fee $ V i CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ qci ° 0 (Rev1sed02/24/2014) —7 �'71 (6 qA a• r Briding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVrr: 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 $25110, 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 nspection fee will be charged. r Signature Signature OWNER or AG NT CONTRACTOR The foregoing instrumentwasacknowledged before me this Z i day of --- V 20 17/ , by 1 V &'1 a 0 G C /7 —,who is personally known to me or who has produced identification and who did take an oath. :NOTARY PUBLIC; Print: Seal: �,, vein N-BERTOF. QIJIROS MY COMMISSION # Munn EXPIRES: October 21, 2016 A'FOF pt`Oc &rMTkUBWWWM8WM APPROVED BY as The fordio-ing instrument was acknowledged before me this --�-- day of by Richard Levinson , w o is personally know o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ***************** Examiner MY COMMISSION #FF1 25SW, EXPIRES May 21, 2018 ******************************* Zoning Structural Review - Clerk Miami Shores Village ry ` Building Department 10050 N.E.2nd Avenue 25 2014 d Miami Shores, Florida 33138 Tel: (305) 795.2204 P y .: Fax:(305) 756.8972 A R CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 11 CM gaSlEA)r aha Sfi City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMIT AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ N 4<A -RHI Sheet Attached: YES NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER Zl AHU or PKG. UNIT MODEL # T 11 1� 19 COND. UNIT MODEL # LIJ fsm 9-51461 KW HEAT NOM TONS 2— AHU CUA 0 PKG 1) M.C.A AHU CUED PKG AHU R* CU _ PKG 2) M.O.P AHU CU3aPKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / /.77::. EER/SEER % / • • &seYES REPLACING DUCTS YES . � • 0 YES REPLACING THERMOSTAT YES •• • YES NEW 4"CONCRETE SLAB YES • .' YES N NEW ROOF STAND YES YES NEW RETURN PLENUM BOX YES • •••••' 1. Minimum Circuit Ampacity (Wire Size): /0 • 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3 •..' •••• 3. Voltage of Circuit (208/240/480): r?, F6 4. Size Disconnecting Means: Contractor's Company Name: - �° (V r C� Ame I^f eg=, a Phone: �� AA L� State Certificate or Registration No. �!T O / f0_ Certificate of Competency No. Signature Date: C 4 jl� (Qualifier's signature) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2013. AHRI Certified Reference Number: 5550388 Date: 7/24/2014 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 14AJM25 Indoor Unit Model Number: RHLL-HM2417+RCSL-H*2417 Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM, RUUD, WEATHERKING Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. .• 666 6 0 ...... 66 •6.64 .•••4 • 00000: 9969* 60:91 • • • 6666 6666•• • ' Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicate: an igAlyntary rerate. • • • 6 DISCLAIMER • • • • AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridlrectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING,EFRIGEATNINSTITUTE CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahridIrectory.org, click on "Verify Certificate° link we make life betrei- and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which Is listed above, and the Certificate No., which is listed at bottom right. 130506900166636118 ©=4 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1 tb M P ntiernatj' onal 2010 Florida Building Code State Approved,, PL 14239 -RS EQUIPMENT T18 DOWNS 0000 . . fees ...... BMP International, Inc... 4710 28th St N, St. Petersburg,, 33714r�•7•'7-4006 ..Z• *j§4 ...... Note: This file contains approval Information from www.floridab000:Lllding.oig-Ar :*so BMP tie down clips. Information required by building departmenI&CORI vary. "e"' from listing the approval number, FL14239-111, on your permit application to submitting copies of the drawings. Consult with the individual building departments for their requirements. This file can be downloaded in PDF format for use. Drawings 1-4 contain the installation Instructions. Natlda kgdhq Code (NJ" r a s £ yq6 41`:5 N v i p `t'n - 1/21111 12:44 AM 5: ..pearri., stt -4 1 '} trb`'�i'-fr� !, "�1 Sq�3 �+ '.,. F{ r r RirS, $j r 1. r l aatrewe tqb IhreyWreea Marra aweaewra.ge etesaner pwftdm l raeatdf t„P td Busne' Pro ess al'd gid, q FU4239•R1 3 w Codentlon Typo +L c ,, Cods Verden mat APPlkttlan St" Iolarr4d Comment ArpdY•d Preuss Meffukcu w Add+tWPhandamea 8MP tnbarngtlenal Inn 471018th Sb i t N SL Pet mkwo, FL 33714 (727) 40•-0544 ur"."I yehta etrN Authorized s4naWrt JOenbin Mens benmmg8tlYahea.aom Teehnfal Rapmpntotly. 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ASTM 017a1 -I6 zoos Ra of dua abndards �� 1060 • • Av Horld• Umneed Pmfadon•I Qngfne•r w Areha•d • • : • • See94m hem the Cade et14o3e At F—ry Ee, lu edf .::00. .. • A . • g . • . • • • • • . • . • • ease • • • • • • • • PradYdApprool McWad • • • • • • • • • .:.. • Method l Optlon 0 asses• • • • • . • • OatSubmltd 09/29/2011 0 •.a•.�••••• ••••�• Oat ValmeW 044 Pendln0 FOGAppravol W13/1011 • • •. • • • • Oct Apprtyed 12/18/2011 • • • • • ease•• 01!71/3012 •••�•• aummu+erPevdL� � .•. • •....• Fir d• MeIr Nunrk.► or Name De•aeiptlaq • • • • • awpe----- 14239.1Sletlad ;W— , 9tee1 TU 0oww Cop ayoaam (Fw Use With Modrs"I 2• Models . a1 units Limlb M Yet Rent ar Orode) at APpmvW f" un In NVIW yea - tnettllalleN Lu uedont ApProtnrd ftp we outlde NVIW yes 911110414 R•alstMt N/A i Vertled ay$ Frank L 0ennarda, P.B. 0040549 Oeefgn PFaWUm N/A hubld by Indepand=tThlyd PaRyt yea dulp puede• e001abf• apadtla far thereQuIred eyalem, The H 14Z7e agapb 1 edr `ehal Co olalaaad by gehat kr uodai y,� tdepmdent Thlyd Partys yes hnP:lf waw neridatedldbq,prglm/prrPp_dd.a,p.:parem.,,04V7ttlynp�yoElUeOtCutoplHvlCarolrotglerDQeepNfyWy,A>a,agd page 1 of 1 BMP INTERNATIONAL, INC. 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Tnr_ I M03VAM LLwrwlroUg3tLALLAMBa1 XDUSM Lams swot RE eoo-ie mn awmoirsuL� r.arn ar-m XS , aus•Lmt .�Luxs�+cuamsswruue ���,�aiauomr. o �3 waerrrmrwtsa�y � 0 w� �. aam v �urTo.araaG•nfi: �� 1. outs Q_i" CLIP ISOMETRIC DETAIL 4 +crs rsaw:rwc aur ,lm= 00 0 � go i •• • ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • ursz s� woe s s+�r w:rx. SCW-Td"uAimL-TQ J=XuumLmxmauwlw Sam" c*Ausj -= 1" TIE DOWN CLIP ANCHOR DETAIL ML �MmL DE aagoPbeca �sLwarwtu� tb sL>+t�asuaou�amm +alba—musmomw arm �Foa6ig1 rmL �Tn ayoa;Lagw ter saw mmarmo try, :/ ,, / ' / iss�wue�e•mma i • i �. tw�s7 24TFE-DOWN CLIP 4 OR DETAIL aatsa�Lanwni �warnTfiEe+tgoyr�eL • L.WIR.IYP. sa�o.strm.ay may BELMM FM .ttv I9 M CDETJ .. • • • ••• .•• ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • ursz s� woe s s+�r w:rx. SCW-Td"uAimL-TQ J=XuumLmxmauwlw Sam" c*Ausj -= 1" TIE DOWN CLIP ANCHOR DETAIL ML �MmL DE aagoPbeca �sLwarwtu� tb sL>+t�asuaou�amm +alba—musmomw arm �Foa6ig1 rmL �Tn ayoa;Lagw ter saw mmarmo try, :/ ,, / ' / iss�wue�e•mma i • i �. tw�s7 24TFE-DOWN CLIP 4 OR DETAIL aatsa�Lanwni �warnTfiEe+tgoyr�eL • L.WIR.IYP. Detail by Entity Name I , Detail by Entity Name Florida Limited Liability Comnan SHALOM 1190, LLC Filing Information Document Number L08000005506 FEI/EIN Number 261944883 Date Filed 01/15/2008 State FL Status ACTIVE Principal Address 1190 NE 100 STREET MIAMI SHORE, FL 33138 Mailing Address 1190 NE 100 STREET MIAMI SHORE, FL 33138 Registered Agent Name & Address ANTONACCI INCORPORATION SERVICES, LLC 1075 NE 99TH STREET MIAMI SHORES, FL 33138 Name Changed: 02/24/2014 Authorized Person(s) Detail Name & Address Title MGRM ECHT, GUSTAVO F 1190 NE 100 STREET MIAMI SHORE, FL 33138 Title PTS ECHT, GUSTAVO F 1190 NE 100 STREET MIAMI SHORE, FL 33138 Title MGRM EIDELSTEIN, ROBERTO MR. Page 1 of 2 http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetaillEntityName/flal-10... 7/24/2014 Detail by Entity Name PANAMA 729 CAP. FEDERAL, BUENOS AIRES, BA ARGEN-TINA AR Title MGRM ECHT, SILVIA MRS. PANAMA 729 CAP. FEDERAL, BUENOS AIRES, BA ARGEN-TINA AR Annual Rworts Report Year Filed Date 2012 04/27/2012 2013 05/01/2013 2014 02/24/2014 Document Images 02/24/2014 -- ANNUAL REPORT view *image in PDF format 05/01/2013 -- ANNUAL REPORT View image in PDF format 04/27/2012 -- ANNUAL REPORT View image in PDF format 03/03/2011 --ANNUAL REPORT View image in PDF format 04/07/2010 -- ANNUAL REPORT View image in PDF format 03/17/2009 -- ANNUAL REPORT View image in PDF format 01/15/2008 -- Florida Limited Liability View image in PDF format Copyriah © and Privacy Policies State of Florida, Department of State Page 2 of 2 http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetaillEntityNameIflal-10... 7/24/2014 eggs • • egg• eg•geg • • •cess• •• ••gees • sows* g :sees: gee•• • • • ♦ g • • • •cess• • • e�g•s • • gsgg•• 00 geese• ••see• • • • • g•••g♦ isgsee e • • •gees• •• • gee• • • http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetaillEntityNameIflal-10... 7/24/2014 SERVICE Corporate office 2755 NW 63rd Court t< F,-. Lauderdale. FL 33309 a a www.serviceamerica.com ww..a ]C.I .««.e. SALES AGREEMENT 1-888-201-5759 0••9# vv r..ro.,y.....". p,. ..•. ...y.:. 'e&�,l4 �, r,q a .. Thermostat Type: Replace Circuit Breaker: WDigital Condensate Drain Hookup: J Primary J Secondary R Customer Name V LL A,:y,,,•t�: r ntrJtr a S 9 Date r r0' :.J Auxiliary drain pan Horizontal citain pan Tons Z SEER / Wiring: J Condenser (XAuxilary float safety switch Erna.IAddress Utht+r })hone J Refrigerant copper liquid line size. SOaAdr•rtn Fef` J Disconnect Box J Heater me I Model A/H _ ._ _--_ Installation Aodtess li7 90 A46 ?4707h aidg Apt r-Ity 11 �3�' System Type: b4pLt J Package J Water Source tnrght (_r,.,I J Heat Pur.+p Condenser Location: xGround J Roof J Crane Needed M of Stories Air Handler Location: J Garago KAttir J Cioset Price %4i] Z _ . I 0••9# vv r..ro.,y.....". p,. ..•. ...y.:. 'e&�,l4 �, r,q a .. Thermostat Type: Replace Circuit Breaker: WDigital Condensate Drain Hookup: J Primary J Secondary R J Air Handier J Programmable J New Condensate Pump J Slab Make _ Size __-_"„_Type :.J Auxiliary drain pan Horizontal citain pan Tons Z SEER / Wiring: J Condenser (XAuxilary float safety switch Tons SEER J Thermostat Size Type J Refrigerant copper liquid line size. J Disconnect Box J Heater J Refrigerant copper suction line size Model A/H _ ._ _--_ J Smoke Detector Size •- J Gas pipe from J Refrigerant line cover 4I dl Flush Model Cond LY-44�5 f'i d / //--- Installation Information: � �t' roe' N e 14, ­„ gfLKtC r,__,f euw _ _2d a 44ev�e_ Installation Date:77"Z - CGH9P.vi ��/ �QYL.ZON i 24 l7v.v/ Price %4i] Z _ . J��2z"etJ r. .rt .1. e•')'tJ"P.' 1. -.rl •Y .NlnurttJ.,.:`hC1Ptn :hila Cr. r_me1..;:r Uf,. •e?i: ••'I..fe ♦111 .•r ... I. f>!.. .. �.. 0•dn .. , �.•tr tilt". 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Service America Other Expiration Date: �.! CSV# Replacement Credit Re(:o►!�+ enend;132ns; Insulation Signature:. Duct Cleaning per..G/ ,`. ..".-... .- '.•a 9 _. .... SAES Labor Warranty A/H �._ Yrs. J/SAES Labor Warranty Cond. - - Yrs. • • • • • {Mfg.'s Warranty on Compressor ._-3 go 0 0 Yrs. • • • «{Mfg.'s Warranty on Outdoor Coil 19.• • • t Yrs. • • XW9 's Warranty on Indoor Coil ! Yrs. • ,J/Mfg 's Warranty Parts Nom• o-•, Yrs. •• • i 0000 ioo 00 • • - " — -- -- - UV Light Method of Payment: Cash F'"%Qkig — ._ .._ '�t;Credit Card Check # • • • • Other Administrative Fee �r /71! CC Type f ,Visa MC _-. Disccwer • r Credit Card #_ _ ___ .__.— _. Total Investment - --- Down Payment -- i ® ------ Expiration Date: �.! CSV# Dug fila tc _;_ ._ Signature:. y Installation Date:77"Z - Financing Company: r 1 •1 I j .C.P i .I fIN`..{v`•'•)•i Tf a lin{ !f rn ai` .• )n:r.i1—rrtrth' •'. •,11r•r• Yt lJ { 41py l lc ,ralPy,1 •Iftd CJ_ d yfl nr• c l•, r. .rt .1. e•')'tJ"P.' 1. -.rl •Y .NlnurttJ.,.:`hC1Ptn :hila Cr. r_me1..;:r Uf,. •e?i: ••'I..fe .:r •,rrl � far{.: r+ri [r trll.r rn.rfit :•. tlrll •t rr-r 1. rtad Br ` iv"s _7h: I.l ,�^.•i Y.r.,rr:r'8,�•.rn;.r farv't'Ir'i'•.rr.)'t.l't•nn Vnrh•tJr CPn )lf��r Ohir,)JI•nn.)l ..nil!Illr•t`I ."'ti+rl«C)n«)Ill,v r{rr•r!:,• ilr, _cl lk,<r r«,S :13v.111e'r. 7it2.}t •hr•trdet;.l�':n::la'n,'+n.•r rv+o[• ;,r. �r• Payment doe to installers in full upon complehan of installation. My signature acknowledges acceptance of the terms above. I have read and understand all information on the front and back of this Sales Aereement_ Customer Signature: Date: Comfort Consultant: A16,"l—a t9y, r Ladder required for inspection. 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Pink -r, 4tnJr,.r.ln,Wtrgn Pdt lay!tit l • • ,C .' --f—a 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 B IL I[NG Permit No. � 1 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOMI OWNER: Name (Fee Simple Titleholder)O YMICA Phonek City: State: Tenant/Lessee Name: Phone#: Email: JOB City: Folio] Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone#: Address: City: State Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition OAlteration ONew ORepair/Replace ODemolition Description of Work: �?A)blf�m ju 4Y "Z< 1 Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 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 The foregoing instrument was acknowledged before me this day of , 20 _, by day of , 20 _, by , who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: My Commission Expires: L c5 Ce a, y APPROVED BY / Plans Examiner Zoning 00 le 17 Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) A 1 Property Information Map Page 1 of 1 My Home Miami -Dade County, Florida MIAMr- E a�a. ail Property Information Map t � i�� a @l'�✓ t tai �.j* r, HEATH ST.;' I a jI 4W �C 4*0 oz, 414 Aerial Photography - 2009 0 - 58 ft This map was created on 12/23/20119:07:57 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Summary Details: Folio No.: 11-3206-011-0140 Property: 8945 BISCAYNE BLVD Mailing JOHN MILITANA &W Address: DRIENNE Floors: 8801 BISCAYNE BLVD Living Units: MIAMI FL d' Sq Footage: 3138-3381 Prooertv Information: Primary Zone: 6200 ARTERIAL $252,816 BUSINESS CLUC: 0011 RETAIL OUTLET Beds/Baths: 010 Floors: 1 Living Units: 0 d' Sq Footage: 5,693 Lot Size: 10,534 SQ FT Year Built: 1952 SBURY PARK PB 4- 110 LOT 16 E OF FED Legal HWY LOT SIZE 108.600 Description: 97 OR 21081-2017 96 4 OR 21081-2017 1700-.9601 Assessment Information: Year: 2011 2010 Land Value: $252,816 252,816 Building Value: $189,981 190,056 Market Value: $442,797 442,872 Assessed Value: $442,797 442,872 Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Applied Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $0/$442,797 $0/$442,872 Cour $0/$442,797 $0/$442,872 Ci $01$442,797 $0/$442,872 chool Board: $0/$442,797 $0/$442,872 Sale Information: ale Date: 7/1996 ale Amount: 0 ale O/R: 1081-2017 ales Qualification Descrition: ales which are isqualified as a result of xamination of the deed View Additional Sales http://gisims2.miamidade.gov/myhome/Printmap. asp?mapurl=http://gisims2.miamidade.g... 12/23/2011 Miami Shores Village Structural Critique Sheet `eke Ar�.- Page 1 of 1 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 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 September 23, 2014 Permit No: RCRT-12-11-2359 Building Critique Review list REVIEW 8/15/14 Pending statement of compliance from the architect of record 2ND REVIEW 09-23-14 Pending structural approval 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. Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ITY September 09, 2014 Permit No: RCRT-11-2359 Building Critique Pending statement of compliance from the architect of record. 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. 06/14/2012 15:27 FAX 1 800 685 7530 DATA SCAN FIELD SF.RVTCF.S TRANSMISSION OK T%/R% NO RECIPIENT ADDRESS DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT Permit No: 11-2359 Job Name: June 13, 2012 �xeXs�&xe��kKeXSxcsk�k��xexc�&skXs�sk x�x�m T% REPORTx� xexexexe�kxesk�kxe�NS��k�Rxs�k�kskXs��k 2652 93057577833 06/14 15:27 00'21 1 OK Onni Miami shores' illage Building Critique Sheet 1) Provide parking lot lighting certification. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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. Norman Bruhn CBO 305-762-4859 FAX , 159-1 3-'7 3 Permit No: 11-2359 Job Name: June 13, 2012 Miami shores Village Building Department Building Critique Sheet 1) Provide parking lot lighting certification. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 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. Norman Bruhn CBO 305-762-4859 PA)t ' 305 4 MIAMI SHORES VILLAGE Building Department 10050 NE 2 Ave, Miami Shores Fl, 33138 Tel: 305-795-2204- Fax: 305-756-8972 12/23/2011 Certified Mail # 70110470 0000 8985 5447 Property located at: Address: 8945 BISCAYNE Boulevard Miami Shores, Florida, Permit Number: RCRT-12-11-2359 Folio # 11-3206-011-0140 Notice of Required Inspection/Certification Dear Owner: The Village has been notified by Metro -Dade Building & Zoning Department that the above referenced property has a building or structure that is forty (40) years old or older. In accordance with Miami -Dade County Chapter 8 Section 8-11, the subject property must be inspected by a Florida Registered Architect or Engineer and a report furnished to this office. A report and a fee of two -hundred fifty dollars must be submitted to this office within ninety (90) days of receiving this Notice of Required Inspection/Certification. If you would like a copy of Minimum Inspection Procedural Guiddines for Structural and Electrical Recertification, or if you have any questions, please call my office at 305-795-2204. Sincerely, Norman Bruhn, LuildingOfficial 305-795-2204 • RAMON F. CAMAYD, R.A. ARCHITECT. ROOF DESIGN. INSPECTOR 8030 S.W. 99TH AVE. MIAMI, FL 33173 TEL: (305) 598-5399 NCami> Re: Forty years recertification Address:C7 S -CJ 11S `> i Folio # f t -- 3a c) & 611 - 0 110 Dear Building Official: A.- The above property in your jurisdiction. I have found it to be structurally safe, for its intended use and occupancy. In accordance with is Chapter 61615-23 of Florida Administrative Code ". SEP 16 2014 B.- I found the above property, to be electrically safe for its use and occupancy, as per the "Florida Building Code " and "Miami Dade County Chapter 8 it Sincerely yours, F ME w t , fI AM 15 2014 MIAMI•L DE _ BUILDING & NEIGHBORHOOD •7 COMPLIANCE DEPARTMENT INSPECTION COMMENCED Date: Acpat I 'Lo/tz INSPECTION COMPLETED Date: INSPECTION MADE BY: n�aNL+aM� d rz Ac - SIGNATURE: PRINT NAME: TZd 1�1101dCa,,r • TITLE: RM2E, i ►t2GL1 1 TEGT ADDRESS: $030 5 W as TO Ay a bA us M. I 1` L 3317 3 1. DESCRIPTION `OF"STRUCTURE A. Name on Title ....J a H_N _-i <<tA14^ .._.._._... _.... _... ._---.--.---._._...-____—_.__-_..--.---_ b e Street Addrss: _ 4rz_- MsAwll 5ltolz s� LoM4PA P. Legal Description: _ � 100 _._._-------. d. Owner's Name: _.J NH_-.AnaN_N_ e. Owner's Mailing Address: I ' S`TF- 1 d e 1. Folio Number of Property on which Building is Located: j. Building Code Occupancy Classification: h. Present Use: A �F-^-G •1.! a it �i L E ji. General Description, Type of Construction, Size, Number of Stories, and Special Features Additional Comments: 1X ..1_s_.__t_l�L=..o b1 AL1Vr 'Tw.. r.i♦1 a.ei I�..,���..s �,. r,r, r9�_�. �..�� ..z al�. .�� K L METER AND ELECTRIC ROOM 1. Clearances: Good ( X ) Fair Requires Correction ( ) ELECTRICAL PANELS Location: Good ( X ) Needs Repair ( ) 1.Panel#( '1 ) %40USE PAuS .. (tdaA) Good ( X ) Needs Repair ( ) �2. Panel #( 'j, ) p 4} R M A. C r -too A� Good ( X ) Needs Repair ( ) Panel#( 3 ) 446Ia FLOWECL5 ({ooA) Good ( X ) Needs Repair Panel #( 4 Good ( X ) Needs Repair ( ) Panel #( S ) h d+c N E 54* P ( t oo b.) Good ( X ) Needs Repair ( ) Comments: ' I- VJ M E? S R 5 l ti 5( OE E. L E G. 2 0 aM AT MF -AM Z T(4,0 TENIN of &tZoJND w(R.Is To at4D Ron,4, Oc�Nt-% i f f BRANCH CIRCUITS. 1. Identified: Yes ( X ) Must be identified ( ) 2. Conductors: Good Deteriorated ( ) Must be replaced ( ) k _ Comments: GROUNDING OF EQUIPMENT: Good ( X ) Repairs Required ( ) ....... ...... Comments �� W a �G K o� (7,,� or ..... . _ ... _ _ _ _ __. SERVICE CONDUITSIRACEWAYS: Good ( x ) Repairs Required Comments: I rjEr�.VIGIr Its the7e�L- tn u, T SERVICE CONDUCTOR AND CABLES TYPES OF WIRING METHODS; Conduit Raceways: Good Repairs Required ( ) Conduit PVC: Good ( ) Repairs Required ( ) NM Cable: Good ( ) Repairs Required ( ) BX Cable: Good ( ) Repairs Required ( ) FEEDER CONDUCTORS: Good ( k ) Repairs Required ( ) Comments:, M P��2 ✓ S ; o Doi. 2a va N C2 5 `1 a -o ` Civ d ti oK S EMERGENCY LIGHTING: Good ( X ) Repairs Required ( ) Comments: � 13046 E, Co 2 12 S n D O TZ- -c To P-6 I BUILDING EGRESS ILLUMINATION: Good ( X Repairs Required ( ) Comments: N_ // I ��� `_L % Lou,) o G G v h a u G N AAP, u f� A -kA l .e . In u - SMOKE DETECTORS: Good ( ) Repairs Required ( ) Comments: EXIT LIGHTS: Good ( X ) Repairs Required ( ) Comments: Comments: WIRING TO MECHANICAL EQUIPMENT: FComments: -C-# r f Good ( X ) Repairs Required ( ) U ADDITIONAL COMMENTS: L M a g Y eu , i BUILDING & NEIGHBORHOOD COMPLIANCE DEPARTMENT 1. DESCRIPTION OI= :STRUCTUURI± a. Name on Title: €b. Street Address: C. Legal Description: t- 1 b G. o —"T i- - ---- , kS 6v 4&L Id. Owner's Name: � is �L_� A 1 i2.i� AA, . �r-1 n a`. -- _ Vie. Owner's Mailing Address: b_.o_L s cmc_ ( i�r �o! /j2�f►� jF. Folio Number of Property on which Building is Located: �1_ ���� b it 4b j 9 Building Code Occupancy Classification: .Present Ilse: mlm Ic- 1. General Description, Type of Construction, Size, Number of Stories, and Special Features Additional Comments: ux. Ve w r_. 0 L ILDI NL. . � tya.taE-t�si_,_aK 33/Wk "ago Z"�Nc Zs .. I'M L GG►L, J kt 15 -20% - AUG , 4t= - BUILDING & NEIGHBORHOOD COMPLIANCE DEPARTMENT 1. DESCRIPTION OI= :STRUCTUURI± a. Name on Title: €b. Street Address: C. Legal Description: t- 1 b G. o —"T i- - ---- , kS 6v 4&L Id. Owner's Name: � is �L_� A 1 i2.i� AA, . �r-1 n a`. -- _ Vie. Owner's Mailing Address: b_.o_L s cmc_ ( i�r �o! /j2�f►� jF. Folio Number of Property on which Building is Located: �1_ ���� b it 4b j 9 Building Code Occupancy Classification: .Present Ilse: mlm Ic- 1. General Description, Type of Construction, Size, Number of Stories, and Special Features Additional Comments: ux. Ve w r_. 0 L ILDI NL. . � tya.taE-t�si_,_aK 33/Wk "ago Z"�Nc Zs .. I'M L GG►L, J kt 2. PRESENT CONDITION OF STRUCTURE 'a. General alignment (not good, fair, poor, explain if significant) 1. Bulging f LJ. �� dr$_. oN L __ �v i S(bG k}AS t ll LDM.PLEZL 2. Settlement 3. Defections 4. Expansion I 5. Contraction N € =b. Portion showing distress (Note, beams, columns, structural walls, floors, roofs, other) .__......_. _..__....-._.._____....... _... ._. Nod_wtc t c. Surface conditions — describe general conditions of finishes, noting cracking, spalling, peeling, signs of moisture penetration & stains. a►t�._t�lr_. A&_ ci. o oK ?A 2P1?�T �p�cN4 �e aired r Cracks - note location in significant members. Identify crack size as HAIRLINE if barely discernible; FINE if less than 1 imm in width: MEDIUM if between 1 and 2 mm in width; WIDE if over 2 mm. ---G✓�AGltS c✓N. 17L.b 6'►'2,. i.r> G VL 5 t'c7� [� v .� __fin• <<. rz rt et._�._ Q _�a__Y -S -r t1 G t.p . P L & S TV r— i . General extent of deterioration - cracking or spalling of concrete or masonry; oxidation of metals; rot or borer attack in Nwood. u.rt�o d ►.! U L � vt, c. , w I N CA u� Z05 6 u c i i f. Previous patching or repairs . Nature of present loading indicate residential, commercial, other estimate magnitude. �a64 ��__ Z tF 1 11=.M �_t'�aI I T1,40- SA -PAF- As 3. INSPECTIONS i. Date of notice of required inspection I b. Date(s) of actual inspection _�__. __.._� +?►_ �... 1�7/ t 2 . __ _.. F t tz� Vt s ta' • I�I.art,�I ic;/t z ;c. Name and qualifications of individual submitting inspection report: .......__..... _...... _.. _ _ ...._... lilii/ g% %5N.1760 4 fid. Description of any laboratory or other formal testing, if required, rather than manual or visual procedures 1 4 j . Structural repair -note appropriate line: 1. None required N o N �� t2E17 2. Required (describe and indicate acceptance) 4. SUPPORTING DATA a.N hn�- sheet written data b. N/A photographs C. N/A drawings or sketches: 5. MASONRY BEARING WALL = Indicategood, fair, poor on appropriate lines; a. Concrete masonry units �ppp jb. Clay tile or terra cote units N,P4 , Y c. Reinforced concrete tie columns -----_______..._.......___.....__..._.._._........___.._._.._.._._....-----__......_......__..............._...._.._...___...... ... _ ....... ....._--._.._-------.._._—._---- d. Reinforced concrete be beams e. Lintel fi. Other type bond beams . Masonry finishes - exterior __._ .............. --------- _. 1. Stucco J Lc� (??,,,,�N TL.Y 12�P�►t tZ.EP 2. Veneer N �, 3. Paint only pp D 4.Other(describe) ........ ,h. Masonry finishes - interior 1. Vapor barrier 1�p T aK 2. Purring and plaster mop fl .... 3. Paneling �A 4. Paint only 6 43© G' , 1 i 5. Other (describe) J. Cracks: ....... ...... -_-_-.-_---.___-- 1. Location - note beams, columns, other n N Le N A% M L t N U<LA CAC S. 2. Description jj��•p r.A y i N t6 G �, Ar 5 S . Spalling: 1. Location - note beams, columns, other Nb GAN e_"Tjjs� I I t N 2. Description `:k. Rebar corrosion -check appropriate line: �INoa visible _ 2. Minor -patching will suffice �— ✓ — i 3. Significant -but patching will suffice 4. Significant -structural repairs required 1. Samples -chipped out for examination in spall areas: s - describe color, texture, aggregate, general quality 6. FLOOR AND ROOF SYSTEM ,a. Roof: 1. Describe (flat, slope, type roofing, type roof deck, condition. �-At 4pm A 4e. jvreGevi+-44 -trsf v t S t T .... ......... . .......... . .. . ...... . ..... ... .................... . . . . . . . .... . .... ...... . .... ... ............. .......... -T A. 0 ti Vo 4 CiP 2. Note water tanks, cooling towers, air conditioning equipment, signs, other heavy equipment and condition of ;support: Pwt--r, 3. Note types of drains and scuppers and condition: . ___. � a�._�_-._. � � � N` L-. E .D. b E.,�R. S � ,zs � o t� c. �� etc. w .4 l l . � A ST s t t�El b. Floor system(s) 1. Describe (type of system framing, material, spans, condition) 4�00yl dL� e V- V r - to r -t 4 J. e. '"I CO [AIM 11 0; 1:— fc Inspection - note exposed areas available for inspection, and where it was found necessary to open ceilings, etc. for inspection of typical framing members. . ... .... .......... — - ----- - -------- t $e 01 9C 3 0 CA I'P'A h ir-e "O v'4 taeei Ed 7. STEEL FRAMING SYSTEM i 2. Description I 0, (" 0 vtkaptr roD jo te,- r e? ( -Z.- X t �L % -ell a VIU b, 6.0-C0 [ 0 M Pt C u,^ loa V fl %4 + 'A4 I L el I 1 . 1 0 b. Exposed Steel - describe condition of paint & degree of corrosion: 0 f4? 413� tt e. t i Ic. Concrete or other fireproofing - note any cracking or spalling, and note where any covering was removed for Inspection 11 �l1AA el co I d.Elevator sheave beams & connections, and machine floor beams - note condition: i Pile Vr4-fo-r O-Vt f 8. CONCRETE FRAMING SYSTEM C..11 d.......L.iO. -IF ..4......4-1 ✓i L � i rim er '_ fl ...._..... _ r..�__. (b. Cracking 1 1. Not significant WoVte 2. Location and description of members affected and -e p type cracking v1,cv► Ij cGeneral condition y a o ...._ ........ ........ ... .... ._..... _......... ..__..._._......... _..... ..._.--- --- _._-------._.__.______._._._._...._..._____�_..__-.__-_ d. Rebar corrosion -check appropriate line: 1. None visible 2. Location and description of members affected and type cracking %0%,D Ke . 3. Significant but patching will suffice K 4L . 4. Significant - structural repairs required (describe) K c K e., a. Samples chipped out in spall areas: ...... _._..._.._.... _..---- ..................... .__..... _..... - - --.-.••-Gg-C+ �1� .. 2. Yes, describe color, texture, aggregate, general quality: V a f 11 9. WINDOWS 6. Type (Wood steal, aluminum, jalous' , single hung, double h ng, casement, awning, oted, fixed, other I lX.e �la.h�t ._S.alt��. .� fiQr�._ r2 ��Qti!!l C21.e44ae---. ?b. Anchorage - type & condition of fasteners and latcheq: '- -' 44_12M.___....r`�! .Ed Liz 1. C_-•- - �._... _ 1� �_1 n ei jkt� & D D H ic. Sealant - ty a of ondition A perimeter sealant & at mullions: ./ E...__._ ...... _'�&- r3.C�.1�,?..L!�._.... `? _ a._ ��1.................... .............. _....... __.__....__._._.._..._.__...__...__.._______..__....___..__----___._.._........_._.._.....__...._......._.._-_._ d. Interiors seals - type & condition at operable vents: N 1%ev%t- e. General condition: 10, WOOD FRAMING a. Type - full describe if mill construction, li ht construction, major spans, trusses; - t� ►� F. 1b. 'b. Note metal fitting i.e., angles, plates, bolts, split pl tles, pintles, other, and note condition: P. Joints - note if well fitted and still closed: d. Drainage - note accumulations of moisture: 6 ci. uji U hE I'dDIH a. Ventilation -note any concealed spaces not ventilated _ o r _ . _... _. _ __ .._........ - .. _._......- _...._.. _...... _.... _..._- — f. s Note any concealed paces opened for inspection: Aem # vtot Ce, t It h 01 i n 6 I i of mofcl5, SD:rs:vc:mb.js:rtcl :2/11 /2010:40yrtrackingsystem cwnFICATION OF COMPLIANCE VM PARKING: LOT LLUMINATMM STANDAFM IN CHAPTER SC OF THE CODE OF NIAND-DA—DE QWM DATE: Re- . Cme No. PropMyAddreid $4A re m- e�"JCL Building Desw%Won: N43 , — The urdwoWW sI I the tftwhW. cm &A Ce -lama-Florida regWered Icew- - Af4t 2 On 7 t 2D 4 1 mPal wed On ft" of Murrdnation in tfs3pm" bKs) serving the abowe mfterxed bL"V- occuparal ckmsffcamm 3. The level of MmbmMm pumided in fm Wking kgs) MeM fm ff**Mm SWKW& for the afthe bWWft as esW*dmd in Secdon CC -3 of the Code of MWW4)aft CMV - �ffl •vfIU,FJif_.- MA r.. p: tG C' � - A ��r F' �'� a. `z S� - i %. � P —aa-,a� ',����„� � �{�`` •� c � � � I � k*.,,,,. wr ( z �'`,.� F 1 c'�• V f ? r'��g`: rir r d T �- } d a qjI t r e k` IN 7 �11 No 9 w- rti i� a p: tG C' � - A ��r F' �'� a. `z S� - i %. � P —aa-,a� ',����„� � �{�`` •� c � � � I � k*.,,,,. wr ( z �'`,.� F 1 c'�• V f ? r'��g`: rir r d T �- } d a qjI t r e k` IN 7 �11 No 9 M� boost boost O r r' ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery Is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed ttoo:/A� /j �' ��•A1111 A. Signyntu� ❑ Aga A. J/ ---rte B. Received by ( kited N-64 C. Date of I D. Is delivery address different from item 1? ❑ Ye: If YES, enter delivery address below: ❑ No /`�,► 1 �! Y 3. Serve Type I,YO.J ❑Certified Mail ❑Express Mail Me0 Registered ❑ Return Receipt for Merc ❑Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Ye 2. Article Number 7011 0470 0000 8985 5447 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-t Postal CERTIFIED MAILM RECEIPT Domestic Mail, Insurance Coverage Provided) Ln L • OFFICIAL cc Er CO Postage $ 4 0 Certified Fee Postmark E:3 C3 Return Receipt Fee (Endorsement Required) Here ® Restricted Delivery Fee ® (Endorsement Required) [` � Total Postage &Fees r-q Sent To _�-- ---------------- ave------- - -------- -- [� [` Street, alp[. No.; or PO Box No. ---- VIP 1 T-r"Ir ------ city sieie, ziP+4 t A i . 1 ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery Is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed ttoo:/A� /j �' ��•A1111 A. Signyntu� ❑ Aga A. J/ ---rte B. Received by ( kited N-64 C. Date of I D. Is delivery address different from item 1? ❑ Ye: If YES, enter delivery address below: ❑ No /`�,► 1 �! Y 3. Serve Type I,YO.J ❑Certified Mail ❑Express Mail Me0 Registered ❑ Return Receipt for Merc ❑Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Ye 2. Article Number 7011 0470 0000 8985 5447 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-t Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mair or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". ■ if a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT. Save this receipt and present it when making an inquiry. PS Form 3800, August 2006 (Reverse) PSN 7530-02-000.9047 UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • MIAMI SHORES VILLAGE 110050 N. E. 2nd AVENUE MMMT SHORES, Fl 33138