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BPP-13-673'm Miami Shores village Building Department 10M 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 FBC 20 Permit No. AfasWr Permit No. 340173 0173 Permit Type: BUILDING ROOFING JOB ADDRESS: 1 3 S ( 1--1 , 1 C) () t City: Miami Shores County. Miami Dade Zip: 1 Folio/Parcel# 1 Z -Ci - Q-13" 00 b 0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): T 0-2 o — 7-ez� -R�t7� Phone#: 11� 54- S Zf1T - S!' Z Address: 1351 ?--k c City: I& L a1.N, I Tenandi essee Nam: Email: v Cel CONTRACTOR: Company N Address: --790 q 11A City: 1A9 e -r- N Qualifier Name: State: TZ— Zip: ) 3 46 9 1 q - S Zit-- "t'SS-C- CS (::-"--s 5-. S(::-"--s -'f:E-- Zip: 1�5 acD Phone#: g 'S "( - 5 Z9 - "'A 5SZ State Certification or Registration #: 1 q S &61 bertificate of Competency#. Contact Phone#. DESIGNER: Architect/Engineer: 'Ur I Address: V� V -f,0 Phone#: Value of Work for this Permit: $ Footage of Work: J Type of Work: OAddition OAlteration ,New Dl)emolition Description of Work: Color thru life: Submittal Fee $ Permit Fee Scanning Fee $ Radon Fee $ CCF $ CO/CC $ DBPR $ Bond $ 151) Notary $ Traini MpAucation Fee $ — Technology Fee $ Double Fee $ Structural Review $ ' TOTAL FEE NOW D -JUA Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State Tap 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 er Agent Co The foregooiingl instrument was ackn-o�wlle�d_ge�d bef me this �� The foregoing instrument was acknowledged befo me this ZS day of , .L� 20 �bY �.yL �x ' 2c v �`-�G� day of �—, 20 by who is personally kn� to m�e or who has produced who is personally known to me or who has produced, NOT Sign: Print: my As identification and who did take an oath as identification and who did take an oath. APPROVED BY Plans Examiner Ae<It Structural Review (Revised 3/1=012XRevised 07/11107)(Revised o6JlWM)(Revised 3/15/09) NOTARY Print: Yf�iludsr�' "o °4 Notary Public State of Florida My( sion�� Roberto Sanchez cny Commission EE04399ti ora Expires 12/OE3/2014 36(") Zoning Clerk I + 1 0 APR Ob213 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Miami Shores Village Building & Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as 1 � . located at Y'-C� In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a Dermit and erecting and approved barrier prior to final inspection and use of the Legal Note: This cerdfication is to be submitted with a swimming pool pemdt application in dupiicatt. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned Ware the fee simple owner(s) of the following described property alluded and bung in Miami Shotes Vfte, Florida: Address: 7'a)5 ) 1-k %—=1 10 k 5 Whereas, the undersigned owner(s) ayy �:j 2-491. desire to utilize said Lot(s) as a single building site, and the undersigned owner(s) do(es) hereby dune and a" as follons: I. That the property will not be used In violation of any ordinances of Miami Shaer Vilthge or Miami -Dade County now in effect or hereinafter enacted. IL That the purpose of the covenant Is to induce Had Shores Village to issue a permit for a pool where the required enure Is not an the subject property where the pod Is located. Ill. That If any of our adjoining neighbors remove any portion of their farm or wall, or If our/my property shall fail to meet code requirements for pod barriers, we, as owners will immediately mall a protective enclosure to meet code raluirements and will obtain a permit for such fence. IV. That, fte, as owner(s) hold Had Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property, I agree to maintain & or replace said enclosure in the evert that Is damaged or removed by any cam. NOW, THEREOF, for good and valuable consideration, the undersigned do(es) hereby declare that helshe will not convey or rause to be conveyed the title to the above property without requiring the successor in title to abbe by all terms and cations setforth herein. FURTHER, the undersigned dedere(s) that this covenant Is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above property and shall constitute a covenant nrmig with the lend and shall be binding upon the undersigned, his/her sucoessors and assigns and may only be released by Miami Shores Village, or its Village (then In effect. Jvs� iia-��v 0 & PRINT OWNNERf SING & PRINT 1H� y Certify that on this day appeared before me C3 z `I �u �"� and has produced ID #�I Zd� - 3 v - to?- i catlon and heMe Wmawledge that he/she owc uted to foregoing, fray and voluntarily, for purposes fere in mpessed. /11 SWORN TO AND SUBSCRIBED before me on this 2 day of OF FLORIDA f 00 y PU State W FIOidB oberto $ $ a nchez zMytsOMMM&W SE043996 o► n EXPM 12/69/2014 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new sWnpWng pool, spa or hot tub will be constructed or Installed at 13 S 1 9-1 ;z! \a) Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues and the Florida Building Cale R4101.17. Please initial the method(s) to be used: The pool will be equipped with an approved safety pool cover that comp lies with ASTM F1346-91. (Submit Manufacturer's Specifications). A continuous, one-piece (child) barrier meeting the requirements of Florida Building Code R4101.17.1.15 will protect the {mol perimeter. The plans shall show the fence location and method of attachment, including one end that shall not be removable without the aid of tools. (Submit Manufacturer's Specifications). A combination of non -dwelling walls and fences (ten enclosure, child fence, masonry fence walls, chain link or wood fence, etc.) will protect t he pool perimeter. The plans must specify t he type and loclon of all non dwelling walls. Florida Building Code, R4101.17.1 Any combination of protection which incorporates dwelling wags with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code, R4101.17.1.9 (Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling wags with openings directly into the pool perimeter and all doors will be equipped with a self -latching device with positive mechanical latc hinglloddng installed a min. 54° above the threshold. If this option is selected, submit plans showing all types and location of all perimeter protection. The plans must also show the location and type of all openings, and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Cade, the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements, and upon expiration of the permit, the pool shall be presumed to be unsafe. I understand that not having one of the above Inst will constitute a violation of Chapter 515, F.S ., an d will be considered as committing a misdemeanor of the second degree, hable as provided In Section 775.082 or Section 775.083 RS . This form must be signed by th wne ag�f2,5 me ntractor. i i S SIGNA UREA DATE OWNE ' NATU AND ATE CO NAME (P SE PRINT) OWNER'S SNE (%EASE PRINT) "- POBUC Roberto SanCit 043995 th �E X512014 a�,00 n�(4� Notary Public State of Florida Roberto Sanchez o` My commsion isEE043995 qo`F E.Pires 12!0512014 (Southern Septic) 1421 SW 153 Path Miami, OL 33194 RE: Contingency Letter Application Document No: AP1099017 Centrax Permit Number: 13 -SC -1458138 OSTDS Number: 1351 NE 101 St Miami, FL 33138 Lot:3 Block:2 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated.02/27/2013 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use (certification fora proposed pool in the NW side of property). If you have any questions on this matter, please call our office at (305) 623-3500. Sincerely, Joseph Piverger, Engineer Enclosures cc: Florida Department of Health www.FlorldasHealth.com in DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locka, FL 33056 FACEBOOKFLDepartmentotHealth PHONE: (305) 623-3500. FAX: (305) 623-3645 YOUTUBE: fidoh Miami Shores Village Building Department W50 NY -2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30S) 762.4949 FBC 20 BUILDING Permit No.�1 PERMIT APPLICATION Master Permit No.I Permit Type: PLUMBING JOB ADDRESS: I as 1 %L t-, 1 ® l 54 City: Miami Shores County: Miami Dade Zip: FOlio/Parcel#: 1 --a2 < )S- 0 3-- 0 �Q Is the Building Histork ally Designated: Yes NO K Flood Zone: OWNER: Name (Fee Simple Titleholder):. Z05, -Z, i n — , . c \ — % 1 City: a 1 A 1AA ( YL -r State: �— Zip: -3�3- `772 ?) Tenant1essee Name: Phone#: Email: CONTRACTOR: Company Address: -:30 14 City:�TU� Qualifier Name: �C>'-AA ,z1 S,,A- iy3 -,-I ss z. 9ig- -;y_,4—>S r— State Certification or Registration (,;s� 1 Certificate of Competency#: Contact Phone#: �' S'L - Email Address: C +� c-�-�-- 3 DESIGNER: Architect/Engineer: 1 U ';7-a1ako Phone#: Value of Work for this Permit: $ 1 '50D Sgaa maJaear Footage of Work: Type of Work: OAddress ` OAlteration Din of Work: )ISNew ORgmidReplace ODemolition ssssssssssssssssss sass sF�s Submittal Fee $ Permit Fee $ 2- CCF $ MCC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ TraininglEducation Fee $ Tahnology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I .N 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 permat is issued In the absence of such posted notice, the inspection will not be approved and a rekWecdon fee will be charged Signature ----�P `�§lor Agent The foregoing inst<vment was acknowledged Irfore me this 2-5 dayof_,33kA,_, Signature ntractor The foregoing instrument acknowledged before me this 7-45 day of 20 n by who is p fatty moxm to me or who has produced who is perWWJYJmam to me or who has produced As identification and who did take an oath. Print: - - - - - - - - - Print: M Co ion Roberto Sanchez M C y�T My Commission EE043995 y os w� Expires 12105=14 APPROVED BY is (ice —1 -Mans Examiner Structural Review (Revised311112012xRevised 07/10W)(Revised 06J111MM)GtrAsed 3115109) identification and who did take an oath. tics' Pik Notary Public State of Fioride berto Sanchez V1G �" My Commission EED43995 of po Expires 12/05/2014 Zoning Clerk 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) 7624949 BUILDING PERMIT APPLICATION Permit Type: Electrical iS v FBC 20 10 Permit No. UU ? l S Master, permit No.Br� `® (cq 3 JOB ADDRESS: 1351 '1_4 t=1 1 o 1 � City: Miami Shores County: Miami Dade Zip: �� 113 Folio/Pazcel#. 1 r— 5— U Z j— v t"➢?3 Is the Building Historically : Yes NO Flood Zone: OWNER: Name (Fee Simple G'i s, 4- 2,,;� -1''S S Z City: 9 kaw � L o:=, lAWX-1-61► zip: Tenant/Lessee Name: Phone#. CONTRACTOR: Company Name: _ Address: , S'� 1-5 City: M kc Qualifier Name: -TL-- Zip: ,'31 q-5 State Certification or Registration#: c��k�l �, Certificate of Competency #: Contact Phone#: -1 S& 33 "1- S 00'71 Email Address: DESIGNER: Architect/Enginew.. u.c-o Value of Work for this Permit: $ ) Sm 1 SgnareaJamr Footage of Work: Type of Work: DAddress Description of Work: _ 3e 5--3US- S( ) 4&New ORepairlReplac:e ODemofition �ss��eseee�ees�esseesssee�F��s�s��s+sss*��essss�� ase Submittal Fee $ Permit Fee $. Y�0'O' 0a 0 CCF $. CO/CC $ Seaming Fee $ Radon Fee $ DBPR $ Bond $ Notary $ TrabdugW ncetion Fm $ Tedowkwv Fee $ Double Fm $ Structural Review $ TOTAL FEE NOW D � 4 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 DIPROVEMENTS 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 encs of such pasted notice, the inspection will not be approved and a reinspection fee will be charged Signature //'� Signature or Agent Contractor ft. - The foregoinginstrument was acknowledged be ore me this -Z5 The foregoing instrument was acknowledged before ,me this 1 s day of.20 ]5F by _. a G -)A- t -&u x. day of ^ 20 3 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 as identification and who did take an oath. NOTARY MBLIQ NOTARY PUM40 Sign. - Sign: Print' of Florida pmt; o1P e� My Commi ion RobeRo Sanchez My CoN My Gnmmissfon FE043995 Notary Public state Of Florida ExP res 121o5/2014 Roberto Sanchez My f oil EXPVe81EE043985 APPROVED BY /'%L Plans Examiner Structural Review (Revised 3/12/2012XRevised 07/1MIXRevised 06✓loP M)Mevised 3/15/09) zoning Clerk r _T M -Ami Shores Village ® n�� Building Department `Q 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 A P R O 5 2 13 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 l� BUIL ING Permit No. PERMIT APPLICATION Master Permit Permit Type: PULLJMG ROOFING JOB ADDRESS: 1 S51 TA E City: Miami shores CoW11Y. Zip: 1 �� Folio/ParceW Is the Building Historically DesigoaW: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): �� z`. �'� � Phone#: C15q- 7 Zei-4955_ Address: 3 1 tJ City: State.• I L_ Zip: 3 a Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Address: GLI I City: v\/`.s_W Qualifier Name: t9Zk-S I I�u ��^ Phone#. ��1-�2.� ^�5�•,, q54-SZO1-14-55Z State Certification or Registration #: �a L Q (0 10 ® 4 Certificate of C?mpetency #: Contact Phone#: 415q- "l2 � 455 Z Email • O► v 0CAYv,-> P a ";D • C_ o-,-> DESIGNER: Architect/Engineer. 1n Phora0#: Value of Work for this Permit: $ Footage of Work: Type of Work: OAddition DAlteration t ON w =V— /Replace Description of Work: �� Lk,.,,o `V, l M _0LLk Submittal Fee Scanning Fee $ Color thm iik: Permit Fee $ CCF $ CO/CC $ Radon Fee $ Notary $ Training/EdueaBon Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ .w y11 IF -11 M P- 1k 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, BOIL ERS, 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. 14WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR DIPROVEMENTS 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 buildbtg 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 approve,¢ and a reingection fee will be charged Signarine Signature Own or Agent The fore g instrument was acknowledged be ore me this The foreg ' g ' io=eodged be me this day of 0 �,, by .--- �- day of r �— )by u� who is X11 known to me or who has produced who is v known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY a # EE091055 MAY 05, 2015 Ba�9L;G Co ,1NC Plans Examiner Structural Review (Revised 3/1=012)(Revised 07/1MIXRevised 06=2009XRmised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: pTARY PUBLI My Commission Zeida An&eu commission # EE091055 Expires: MAY 05, 2015 nrwilkll THRB ATLkynC Bo*,D0;G M 1NC. Zonmg Clerk V Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226142 Scheduled Inspection Date: January 22, 2015 Inspector: Diaz, Osvaldo Owner: KING, JOHN & CONCHITA Job Address: 1300 NE 103 Street Miami Shores, FL Project: <NONE> Permit Number: PL -12-14-2652 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050300010 Contractor: THE NEW MIAMI SHORES PLUMBING Phone: (305)751-2446 tiunamg uepartment comments REPLACE GAS LINE FROM METER TO WATER HEATER, Infractio Passed Comments WASHING MACHINE AND BARBECUE I INSPECTOR COMMENTS False nspector Comments Passed I CREATED AS REINSPECTION FOR INSP-224559. Failed •I� Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 21, 2015 For Inspections please call: (305)762-4949 Page 13 of 29 Lmsv job Name: John King Address: 1300 NE 103rd St. 24 HOURS MIAMI SHORES PLUMBIN TELEPHONE: 900 N.W. 144th Street (305) 751-2446 ifflaird. F1 33168 FAX: CC# CFC019205 (305) 754-5402 Licensed and Insured DROP TEST Permit # PL -12-14-2652 City: Miami Shores Operating Pressure Lock-up Pressure Test Pressure Minutes Performed By , b �' � v George Rackl Miami Shores Village Building Department artment 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 FBC 20 Permit Type: PLUMBING I DEC 0 6 ?014 Permit No. —R -A 4 r `kcS 2' Master Permit No. Owner's Name (Fee Simple Titleholder) J D ti 4iA11 Phone # Owner's Address 1300 VE 10 3& S1- City (,{ m i %a t$ State EL Zip 3 3 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 1-3t)() k) E 103 rd S � City Miami Shores Village County Miami -Dade Zip I S FOLIO / PARCEL # 1 — 37,05- - D 3 0 - 0010 Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 141 Contractor's Address 0 N U) City N_ PW 4fhrn� %Hej ?kl4 Phone# �05- �F/- 2yy& I Lfq R S'l State EL Zip 33/( Qualifier Name JjjnYRJ 4dt1AaQA( L w Phone # 305-- 3Si- JL/%4 State Certificate or Registration No. (' % 14 () 10 00 Certificate of Competency No. / Contact Phone E-mail M S P / am 4iY4 A GOC - 9 0yr) Architect/Engineer's Name (if applicable) a0 Value of Work For this Permit $ 2 0 Type of Work: �DAddition DAlteration Describe Work: ALp/'ut Q qs (/�(,(, t 1. 1 1 — . 14 l /7 Phone # Square / Linear Footage Of Work: '70 ]New Repair/Replace ❑ Demolition Notary $_ Scanning $_ Double Fee Structural Review. $ Rlireie b /�� d CCF $ CO/CC Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Violation date: Bond $ Total Fee Now Due $ 11 (0 - 0 See Reverse side -> '� �'%r• ILI a a .i� �. Notary $_ Scanning $_ Double Fee Structural Review. $ Rlireie b /�� d CCF $ CO/CC Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Violation date: Bond $ Total Fee Now Due $ 11 (0 - 0 See Reverse side -> 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. s 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 IlgPROVEMENTS 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 theSence of such posted notice, the inspection will notfie-&poved grrdja reinspefsi!�; will be charged. Signature Owner or Agent The fore g instrument was acknowledged before me this day of 20-1—' by , who is personally known tome or who has produced - and who did take an oath. Signature v The foregoing instrument was acknowledged before me this day of�QLCt'1'I�Oa ! , 20, by , who is personally knoum to me or who has produced as identifica ' an ho did take an oath. MARY PUBLIC N Y PUBLIC: ' Si S gn: N ary Public - State of Fforida Print : r Priv „. . •= y comm. p +.pct B�:•s My xpiEmission #► EE 154840 Public -State of Florida ''':. „R• `O 8o�ed Through National Nary Aaaa My • •m. Expires Mar 18, 2018 Commission SEE 154840 •,'� �° `'�� Bonded Tbrogb National Nay Assn. APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07)(Revised 06110/2009) RICK SCOTT, GOVERNOR LAWSON. SECRETARY ISSUED. 0710112014 DISPLAY AS REQUIRED BY LAW SEQ# L140701WO1239 AAKM Dec 05 14 10:41a MSP 3056887382 p.1 MIAMSHO-03 SSIMEON FWDINY CERTIFICATE OF LIABILITY INSURANCE °A�O8/2014 12/0 Y' THIS CERTIFICATE IS ISSUED J S A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIR 4ATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE 01 INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCE t, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate I older is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the p olicy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such er dorsement(s). PRODUCER CONTACTON Collinsworth, Atter, Fowler & French LLC PHONE 3O 822.7800 F 8000 Governors Square Blvd N t c No 305 362-244$ Suite 301 noDss: Miami Lakes, FL 33016 INSURERA:MasSachUSettS Ba Ins Co 22306 INSURED,wsuRER B : Hanover American Ins Co 36064 The New Miami Shores Numbing, Inc INSURER c: Hanover Insurance Company 22292 900 NW 144th Street INsuRER D :ASSOCiated Industries Ins CO 23140 Miami, FL 33168 INSURER E: INSURER F: COVERAGER CO"IC a-A'r•e NI/IN-02s_ THIS IS TO CERTIFY THAT THE PC INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF S RGYIWVI\ 114UMIMCM; LICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS WAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, JCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OP INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I I POLICY NUMBER I MPMIDDDY EMP NYM MM1DO EXP LIMITS A GENERAL LtaaanY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR RDJ3841050 8123/2014 SM12015 CURRENCE $11000,00 EACH OCPRE I EaoccurD $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY S 1,000,00 GENERALAGGREGATE $ 2,000,00 i GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY '.PRO JEC• LOC PRODUCTS -COMPlOPAGG S 2,000,000 S AUTOMOBILE 8 X LIABILITY ALL ANYAUTOD SCHEDULED AUTOS AUTOS HIRED AUTOS _WNEC _ AUTOSE AZJA042149 ! 8/2312014 8/23/2015 , 1 aM& nt IN IdrT 1,000,00 BODILY INJURY (Per parson) S BODILY INJURY (Per accIdent) S dent AM1 AG S $ EACH OCCURRENCE S 5,000,000 X C UMBRELLAtJAB %C OCCUR ExcEss LIAa CLgIM3 > I I ! N I A _ UHJ3841053 WCIOU991 612312014 ! 8/2312015 I 8/23/2014 8/23/2015 I 1 AGGREGATE S DED I X RETENTIONS AM EMPLO WORKERS OYMW UABIUTY D ; ANY PROPRIETORIPARTNER/EXEcurivE OFFICBRlMEMBER EXCLUDED? I (Mandataryin NH) Ify� =0h ON DESCRIPTION OF OPERATIONS below g regate $ 5,000,00 I OTH- X I WC STATU- ORY LIMITS E L EACH ACCIDENT $ 1,000,000 ELDISEASE -Ea EMPLOYE $ 11000100 E L DISEASE • POUCY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS! V CFC019205 EHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space is regt/Ired) Plumbing Contractor t�Clrrlcrr•ere Ir�r ncr, I Ct/rAOZu I u/1VVRU VVr(rVKj% I ium. All rlgnts reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 Northeast 2nd Avenue Miami Shores, Florida 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. I I AUTHORIZED REPRESENTATIVE Ct/rAOZu I u/1VVRU VVr(rVKj% I ium. All rlgnts reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD WATER HEATER 38,000 BTU WA MA 20,( BBQ (2 BURNERS) 10,000 BTU j pnniJ f l J ,��1►p� �,,,� CARMEN A. RIVERA Notary Putfiic - State of Florida . =My Comm. Expires Mai 16.2016 Mc Commission #r EE 154640 z' MMM Itoup Natio al y Assn. A p,Rqq ZONSNG DEPT FRE, I "' DEC 4 5 2014 I DAT it -4-f 't gU[3JECT TO CO PM LIANCE WITH ALL FEDERAL STATE AND COUNT`S RULES AND REGULATIONS Of Wk, v- Nl 000 :::*a: 00 .. r.... • • • _• a • 0 • • • • • • •• • • 00 •• a )IPE TYPE "L" RUN ) FEED (1) WATER SHING MACHINE AND LOM THE METER • ••• • • ••• ••• • • • • •• • • • • • • •• • • • • • DRIP LEG •• • • ••• • • S ••• • • • . •.. • • • • • • • . • • . • ••• • • • ••• • • F00 �afn M Ha z�w H O x�o 0 ul O H CD, � H -.. Seaga% • •••••4 • 4 a He OW to .--I N In • • M ��••• •• "a Log Ln ' fA [Mr14 �•teg• •N NSA • H O O H Fq o. P4 F4 W a% z w x H 4 . 4 0000 • • • • 0000 • • •0000• 0000•• • • 0000•• • • • • •• • • •• • 0000•• • ••• 0000• ••goo• 0000 0000• ••• 0000 • • 0000•• • •• •0000• • • 0000•• •0000• •• • • • • • ••• •• • ••• • • • • •• • • • ••goo• 00 ••• ••• ••• • •0••• • • • •000• • W NE 103rd STREET TABLE USED FBCFG 402.4 (6) TYPE "L" COPPER TUBING N W a� a w H U W zcl) H '0 M O o x x r -I U1 zH O H O', M r -I C7 z H X ::) Ei i PI W 00 aw/ N CDca p H lw cn LO aM 1n•�� •o w: Vb... • E-1 T Ln 11w Lnso •• oe RW -M 1 to •.• •s• •.. .1.1 • .--I . ! 0 Ind �• ••i •• • O s • date