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RC-13-2871L I 1 �■ � n yr {A 0 \ £» § co (m \ \. ■ .. .. d9) <{ L I 1 �■ � �■ �■ .� .� ■ .. .. BUILDING 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 PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 3 Cl 0 (11C 1 8 S City: Miami Shores County: Folio/Parcel#: C: Ft13 - 0 1 -3 "R 0 Q L FBC 20 Permit No. Master Permit NoAe- /43 — ROOFING - N -- z--- v% 'Lf'Z Is the Building Historically Designated: Yes NO Flood Zone: �,u���J SOS 542( A9146 OWNER: Name (Fee Simple Titleholder): l i� A C6fV('kk1 i '(I K J� Phone#:�S 1 ` b 1 � S Address: 3%) ► V L �11 / City: W Um1 51n0(t) State: 4' 1.. �4 Zip: � 3l L 0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: L'N — C"D N.STVW CVV V h4 1 WCPhone#: ; ® `J I I Address: I`0 38 S�� 38 LY,- City: M1 'P�N State: L' zip: -33t&0 Qualifier Name: E )P -k C- S L-- _ Phone#: 3,uS ' 412Ea) SS State Certification or Registration #: C- S C. 1 SKA1_1 X1"1 Certificate of Compten #: Contact Phone#: Email Address: S ��SSO . 1ri�, DESIGNER: Architect/Engineer: Value of Work for this Permit: $ r Square/Linear Footage of Work: " Type of Work: ❑Addition X161teration ONew ❑Rair/Replace ❑Demolition Description:of Work: 'Two�� . Color thru tile: Submittal Fee $ �J 0 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ 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 r 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. t e a s e of such posted notice, the inspection will not app ved and a reinspection fee will be charged. Signature Signature O r or A t �was actor The foregoing instrument was acknowledged before4�z is The foregoing instrumentowledged before me' �—v day of , 20r, by ►. j':� day o ,7 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: z IMAffiO O OTALORA Sign:0I(A N1Y COMMISSION #FF056301 No /_ I ES September 22. 2017Print: p lr4{,09, d s... �,, ,., .�-- - My Commission Expires: APPROVED BY Plans Examiner Structural Review as identification and who did take an oath. NOTARY PUBLIC: ' "aYP` U O OTALORA Sign: ISSION #FF056301 P! ES 22. ?`i' Print: My C ission Expires: (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Zoning Clerk c t , Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* "YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: S ��` �'- N BUSINESS ADDRESS: 1038 k SW 13'8 GT STATE V'L-- ZIP CODE 3,5 LB CITY Ml P -e -M I BUSINESS PHONE: (b J5) 41263 5 5 FAX NUMBER CELL PHONE 130<,-) %P3 4 < < 5 QUALIFIER'S NAME: G; "-?--I C-- s P.. QUALIFIER'S LIC NUMBER: C-- (;;� C. � So- `1 '7 8 z CF G j +z-1 1 -Mt s Created on 3/19109 BY MLDV 1 RV 3126109 MLDV / RV 6127111 AS STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET .� TALLAHASSEE FL 32399-0783 S.ALAZAR, ERIC F SLAZAR CONSTRUCTION INC 10381 SN 138 COURT MIAMI FL 33186 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. CGC150777 CERTIFi SALAZAR SLAZAR. CO Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. '-18 Thank you for doing business in Florida, and congratulations on your new license! ate, AGS 6243689STATE OF FLORIDA;: DEPARTMENT OF BUSINESS AND PROFESSIOI CONSTRUCTION. INDUSTRY LICENSI3 MIAMI - - - - - -- - -- - -- FL 33186 RICK SCOTT GOVERNOR ,.. ... DISPLAY A5, REQUIRED BY LAW SEWL12080202060 KEN LAWSON SECRETARY SEC. TYPE OF BUSINESS' 196 GENERAL BUILDING CONTRACMR PAYMENT RECEIVED ..... _ . �_ BY TAX COLLECTOR �3`d oam"paymese, sabons requirements which apply to the basiiaess. ra; displayed on ail commercial vehistss NHami=Qade £oda Sec Ba -276 , 'or mere utfarenatioe4 vial# www.miamidadeaeV1lmcsot�cor CERTIFICATE OF LIABILITY INSURANCE DATE(MIIIOWYYYY) 1211.0/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 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 pollcy(les) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polkles may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endommnent(a). PRODUCER OONTACT All Insurance Services PHONE (305) 822-4472 AX (305) 556.4354 1548 W. 37 St. LMNLM,. Fernartdsz@aiSlv.com Hialeah, FL 33012 INSUMLt S AFFORDING COVERAGE NA1C 0 NSURERA: UNITED SPECIALTY INSURANCE COMPANY Phone (305) 822.4472 Fax (305) 556-4354 INSURED INSURER B INSURER G : Slazar Construction Inc. INSURER D: 10381 SW 138 Ct INSURER E; Miami, FL 33186- (305) 412-6355 GEhrL AGGREGATE LIMIT APPLIES PER ❑ POLICY ® PRO- E] LOC PRODUCTS - COMPIOP AGG S 2,01XI 10.00 INSURER P : t-VVr xAtsta GEKTIFN,',ATE NUMBER: REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW, `NSR TYPE OF INSURANCE ADD Y, POLICY NUMBER POLICY EFF MPOIJCY EXP 10118/2014 LIMITS A GENERAL LIABILITY ©COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR ❑ Y 9743 -QT 1011 W013 EACH OCCURRENCE $ 1,000,000.00 PDRAMAG ETO RENTEDSIF a 50,000.00 MED EXP an ons 5,000-00 PERSONAL S ADV INJURY S 1,000,000.00 ❑ GENERAL AGGREGATE s 2 000,000.00 GEhrL AGGREGATE LIMIT APPLIES PER ❑ POLICY ® PRO- E] LOC PRODUCTS - COMPIOP AGG S 2,01XI 10.00 S AUTOMOBILE LIABILITY ❑ ANY AUTO OWNED ALL TOS ❑ ❑ HIRED AUTOS ❑ MON- �D ❑ ❑ COMBINED E LIMIT BODILY INJURY (Per pe,mn) S BODILY INJURY (Per acddenq S PERTY DAMAGE s s A © UMBRELLA LUAB ❑ OCCUR ❑ EXE LIAB ElcLAm-MADE Y Y 13-10189 11/18/2013 11/18/2014 EACH OCCURRENCE $ AGGREGATE s 2,000,000.00 DED ❑ RETENTIONS S 2,000,000.00 WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/ExECUTIVE OFFICERBAEMBER EXCLUDED? (Mandatory in NN) rl eyes, describe under DESCRIPTION OF OPERATIONS below N I A E)TATU- ❑ OTIi E.L. EACH ACCIDENT $ E DISEASE - EA EMPLOYEI S E.L. DISEASE -POLICY LIMIT 8i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Much ACORD 101. Additional Remarks Schedule, K more epan Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 100 50 NE 2 AVE ACORD 26 (2010106) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,�1410TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICYAWVISIONS. A AUTHORIZED REPRESENTATIVE All rlahts rwerved. The ACORD name and logo are registered marks of ACORD 11-19-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers` Compensation law. EFFECTIVE DATE: 1212212012 PERSON: SALAZAR FEIN: 201387305 BUSINESS NAME AND ADDRESS: SLAZAR CONSTRUCTION INC 10381 SW 138 COURT MIAMI FL 33188 EXPIRATION DATE: 1212212014 ERIC F SCOPES OF BUSINESS OR TRADE: 1— ROOFING — ALL KINDS AND DRIVER 2— PLUMBING NOC AND DRIVERS 3- LICENSEE! GENERAL CONTRACTOR IMPORTANT. Pursuant to Chapter 440— 06114), Vs., an officer of a corporation who elects exemption from this chapter by filing a certificate of erection u04or this section may not recover benefits or compensation under this chapter, Pursuant to Chapter 440AS(12), Fs.. Certificates of election to be exempt,._ apply only within the scope of the business or trade listed to the notice of election to be exempt. pursuant to Chapter 440.06f13f, F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation It at any time after be filing of the notice or the issuance of the certificate, the person named an the notice or cattificate no longer meets file requitemeels of this section ter issuance of a certificate The doparteeat shall revoke a certificate at any time for failure of the person named an the certificate to meet the requirements of this miction. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01•-11 PLEASE CUT OUT T"E CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY "` CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 12/22/2012 EXPIRATION DATE: 12/22/2014 PERSON: ERIC F SALAZAR FEIN: 201387305 BUSINESS NAME AND ADDRESS: SLAZAR CONSTRUCTION INC lose( sw 138 COURT MIAMI, FL 33186 SCOPE OF BUSINESS OR TRADE: I- ROOFING - ALL KINDS AND DRIVER 2- PLUMMUG NOG AND DRIVERS 3- LICENSED GENERAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this I) chapter. Pursuant to Chapter 440.05021, F.S., Certificates of election to be H exempt- apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05031. F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. CUT HERE QUESTIONS? 48501 413-1609 * Carry bottom portion on the job, keep upper portion for your records. l3WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISER 01-11 EPiE MIT #:W 13s -TI, t IAMI SHORES VILLAGE t TAPPROED BY DATE ` BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED ZONIrG I 5! RUC RAL s 04, � Z ELECT dAl. Z� I G°/T I Z PLUM ING �r 2,r r';ECHf+�iICAt C=21 Bl W, J L :.ATE TO COMPLIANCE WITH LL EI:13 ID COUNTY RULES AND EGI�I- TK ` L Ivx N nZ Z s ,'! ADD SOKE/CARBON MONOXIDE DETECTORS, Y AND ALL CLOTH AND RUBBER INSU TED CONDUCTORS TO BE REPLA l-< I t•a• I o• -m• I. r-<' �c m C � �NCLG9=D GA�AG-� DGOR � R�M�=RTm CONTREr A8 � I> S .R ' � ° ° CHANGE WINDOW �,,� CIVIL ENGIN��r2, YI L -� s" ALFRED Mc<NjGa 4T i g4.o3 CERTIFICATE P=. 21522 — r B 390 NORTH EAST 98 5TREET 32) N.W. 8l AvE • G-101 z a MIAMI, FL 33138 ( MIAMI, FLORIDA 33112 FNC4�: (305)'IY.-346® PSE: (305) 663- 0543 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230440 Permit Number: RC -12-13-2871 Scheduled Inspection Date: March 18, 2015 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Correction Needed ❑ Inspection Type: Final Building Owner: PATRICK DESBIOLLES & LING Work Classification: Alteration !`ADA\/A IAI DATOWIV r%CCDIY►1 1 CC 4_ Job Address: 390 NE 98 Street No Additional Inspections can be scheduled until Miami Shores, FL 33138-2410 Phone Number (305)527-4748 Parcel Number 1132060135670 Project: <NONE> Contractor: SLAZAR CONSTRUCTION INC Phone: (365)412-6355 Building Department Comments BATHROOM REMODEL 2 03-27-14 Stop work order issued. cotractor fail to reflect the full extend of the work on the permit application and the engineer provided misleading information on the plans. INSPECTOR COMMENTS False March 17, 2015 For Inspections please call: (305)762-4949 Page 25 of 34 Inspector Comments Passed tw_ Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 17, 2015 For Inspections please call: (305)762-4949 Page 25 of 34 Miami Shores Village Building Department BUILDING PERMIT APPLICATION id Avenue, Miami Shores., Florida 33138 05) 795-2204 Fax: (305) 756-8972 LINE PHONE NUMBER: (305) 762-4949 WW_ APR i o IN MY, ` FBC 20 Master Permit No. -D- Ca 13 " 21z4/ Sub Permit No. JOB ADDRESS:�� I ` City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �) O A ' Y �,r Phone#: Address: -3 t90 ,i%G ' S o � City: ( State:Zip: Tenant/Lessee Name: Phone#: Email: �j r CONTRACTOR: Company Name: � 2 ��-��-� � ���N t C, Phone#: ®� 412-6 Jcjs Address: , t+.� i J � CTI City: State: Zip: Qualifier Name: L=-�-�C-- S'l-f�- Phone#: State Certification or Registration #: �- , �'� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: U ! V� City: State: Zip: '`' Y' ` of work for this Prem t: $ Square/Linear Footage of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition Specify color of color thru tile: �j Submittal Fee $ Permit Fee $ ` CCF $ CO/CC $ Scanning Fee $ i, © Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ ILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION [:] SHOP DRAWINGS JOB ADDRESS:�� I ` City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �) O A ' Y �,r Phone#: Address: -3 t90 ,i%G ' S o � City: ( State:Zip: Tenant/Lessee Name: Phone#: Email: �j r CONTRACTOR: Company Name: � 2 ��-��-� � ���N t C, Phone#: ®� 412-6 Jcjs Address: , t+.� i J � CTI City: State: Zip: Qualifier Name: L=-�-�C-- S'l-f�- Phone#: State Certification or Registration #: �- , �'� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: U ! V� City: State: Zip: '`' Y' ` of work for this Prem t: $ Square/Linear Footage of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition Specify color of color thru tile: �j Submittal Fee $ Permit Fee $ ` CCF $ CO/CC $ Scanning Fee $ i, © Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 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 such posted notice, the inspection will not be a oved ITd a reinspection fee will be charged. `�• � �1 Signature_ or The foregoing instrumenYwas acknowledged before me this this4;1 day of 20 Ll�eby who is personally known to me or who has produced NOTARY PUBLIC: Sig Pri My As identification and who did take an oath. Signatu The foregoing instrument was ack Wedged before me day of �`20 �by who is personally known to me or w5o has produced NOTARY as identification and who did take an oath. September 22. 2017 (A66 APPROVED BY C Alans Examiner Zoning Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) BUILDING PERMIT APPLICATION Miami Shores Villa e Building Depart - 10050 N.E.2nd Avenue, Miami Shores, F Tel: (305) 795-2204 Fax: (305) 756 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBrCJ 20 / Master Permit No Ac 1,3 p` � Sub Permit No. , :1/3 ❑BUILDING ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: 3 ,9, n /�- 2 F, �a City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ' +`� ' Phone#: Address: ,f AJ LA � J/� � � 9 F S 4-le774 City: Tenant/Lessee Name: Email CONTRACTOR: Company Name: _ Address: i (0 0 � tj (j ,Z ;z' State: Zip: S�'i­e-4 one#: City: Tt `-'l ti y State: L- Zip: r Z '2 Qualifier Name: yo Phone#: -:;;Y6. L. W A State Certification or Registration #: 25—� 6-� /_? C L�> - Certificate of Competency #: �� /q '7 DESIGNER: Architect/Engineer: Phone#: Address:- - City: State: Zip: Value of Work for this Plermit: $ `-T c_-) Square/Linear Footage of Work: Type of Work:., ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition Description Description of Work: �!y i •� " �"e�- r G C<� 5. �, �/ �� 1 % ( 1"` 1 �lR e144 Specify color of color thru tile: Submittal Fee $ Permit Fee $ C '®' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 Zip Application is hereby madb to obtairka 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 nbe aAproved and yinspection fee will be charged. Signature Owner or The foregoing inWumennt,was acknowledged before me this this day of �--' 20 ( by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature Contractor The foreg!/oiyningJ�'"iyinssttruument was acknowledged Igefore me day of - 20 L _�by who is personally known to me or who has produced E as identification and who did tak'an oath. LColy APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) App 0 4 BUILDING PERMIT APPLICATION Miami Shores Village Building Depart 10050 N.E.2nd Avenue, Miami Shores, F 38 Tel: (305) 795-2204 Fax: (305) 75 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Master Permit No. Ac 13 _aOz J Sub Permit NoT L_ 1:3 _ z 88? '2_ ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL LUMBING ❑ MECHANICAL ❑PUBLICWORKS [:]CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: �✓ 1 1V �� \ City: Miami Shores County: Miami Dade Zip: 113 Folio/Parcel#: Occupancy Type: Load OWNER: Name (Fee Simple Construction Type Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: Q,PVJ4,f .A ` Phone#: City: 4!:4 ! State: Zip: Tenant/Lessee Name: Phone#:_ Email• CONTRACTOR: Company` Name:�`�`–� � "� t R ,� C-71 k10rl IN C- Phone#: c i� _44W) 44 C-dQ ) Address: «�� ` <_'�'W «� City: °M I1N�t State: P-,-- Zip:*s3 11b Qualifier Name: G State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: 16 Certificate of Competency #: hone#: State: Zip: Value af­Work-for this Plermit:,$ '-7- ®4Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ) ❑ Demolition Description of Work: �-\ \ cv\" Specify color of color thru tile: Submittal Fee Scanning Fee $ Notary Permit Fee cam. CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ 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 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 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 rts ust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issuedtheence such posted notice, the inspection will note appie6v�d and a reinspection fee will be charged. Signature nt ctor The foregoing instrument was acknowledged before me this The foregoinginstrumentwas acknowledged before me this 'day of , 20L by r N ' day of W �3 20 �%L by �`-�-�— who is personally known to me or who has produced who is personally known to me or who has produced NOTARY PUBLIC: Sign Prin My As identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: Vw :,,PpYp�-.,. IO O OTALORA Print: Y C ON #FF056301 rS ion E�pr:ot53 FloridallotaryService.com My Co`Lmiss APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)