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RC-15-816 (2) Miami Shores Village A01 � APR >� Building Department �Q�►,>� I 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC t20 d0 BUILDING Master Permit No�,r�, S 'E ` 6 PERMIT APPLICATION Sub Permit No. QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F–]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [—] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 171 NE 102nd Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-013-1840 Is the Building Historically Designated:Yes NO X Occupancy Type: Res Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):STEPHEN C MUMBY&ALBERT V CATTERTON JTRS Phone#:786 464 9360 Address:SAB City: State: Zip: Tenant/Lessee Name: Phone#: Email: 430steve@gmail.com CONTRACTOR:Company Name: Jorge E Hernandez ly 1�L�� Phone#: 954.678.7580 Address: 9090 Southern Orchard Road South City: Davie State: FL Zip: 33328 Qualifier Name: Jorge E Hernandez Phone#: 954.678.7580 State Certification or Registration#: CGC 061029 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2q�27� Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Kitchen Cabinet Replacement Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$�)22 (Revised02/24/2014) 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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 ap roved and a reinspection fee will be charged. ti Signature _ Signature �— OWNER T CONTRACTOR :,! .Y��� G'NU(✓�Z The foregoing instrument was acknowledged before me this The foreii g' strument was acknowledged before me.this day of �� 20 by _-day of 1L\ 1 20 by IT ,, e-e`?M /I'!V/17-,who is personally known to ..) L Y� >y_ 1` I '20 who is personally known to me or who has produced M W 78,.3.<22-22,0/A3as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r Sign: In . "" Print: y'/►SAN y! �. o,,JXy At,, Notary Publir.State of Florida ,-- w % Notary FuDwc, Seal: ;� Joanna M Feliciano Seal: Commission I)EE 198163 w9` My Commission FF 082753 M comm.expires May 14,2016 '��ovnye Expires 01/12/2018 y ***************************** ********* ******************************************************************* APPROVED BY ZZ / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGCO61028 The,GENERAL CONTRACTOR " Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 HERNANDEZ, JORGE EU , fC INDIVIDUAL 9090 SOUTHE fie l " 4< DAVIE al ` ISSUED: 06119(2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406190000920 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA; eceipt#:GFBNERAIL 62 CONTRACTOR (GENERAL'\•` Business Name:JORGE.sE H> RrtAwDEz Business Type y CUNfiRALTOR) Owner Name:JORGE EUGENIO HERNANDEZ Business Opened:01 J03/2006 Business Location:9090 SOUTHERN ORCHARD RD State/County/Cert/Reg:CGC061029 DAVIE Exemption Code: Business Phone:954-678-7580 Rooms Seats Employees Machines Professionals 3 For Vending Business Only Number of Machines: Vending Type: =a. Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 TOWN OF DAVIE BUSINESS TAX RECEIPT First-PRSRTSRT al U S Postage Paid 5591 SW 45m St PDS Davie,FL 33314 Name and Location of Business Tax Receipt JORGE E HERNANDEZ 9090 SOUTHERN ORCHARD RD DAVIE, FL 33328 License Type: Contractors General Residential Licensed For& Quantity: Contractors General Residential .................... _............. _ _.. . ._......._.... License#: 22524 Phone#: 9546787580 Effective Date: 10111120114 Expiration Date: 9/3012015 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 0 410 812 0 1 5 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hilton Insurance Services,Inc. PHONE 954 341-5252 Fax 954 341-5678 10211 West Sample Road AE,,,RE. admin hiltoninsuranceservices.com Suite 208 INS RER S AFFORDING COVERAGE MAIC Coral Springs FL 33065 INSURER A; Western World Insurance Company INSURED NSURER : Florida Citrus,Business&Industries Fund Jorge Hernandez INSURERC: 9090 Southern Orchard Road INSURERD: Davie FL 33328 INSURER E, INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UB POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1.000,000 ACLAIMSMADE I OCCUR DAMAGE TO RENTED 100,000 NPP8106874 10/16/2014 10/16/2015 MED EXP one on 5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X JECT ❑LOC PRODUCTS-COMP/OPAGG $2,000,000 POLICY❑PRO- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ $ UMBRELLALIABOCCUREACH OCCURRENCE $ I1 EXCESS L8 HCLAIMS-MADE AGGREGATE DED I I RETEN N WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N ER B OFFIANY CER/MEMBER PPAR NERf ECUTIVE❑ N/A El.EACH ACCIDENT $1,000,000 (Mandatory In NH 10650724 10/11/2014 10/11/2015 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlBonal Renaults Schedule,may be attached If more space Is requhed) State of Florida License#CGC 061029 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores,FL 33129 AUTHORIZED REPRESENTATIVE <LH> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Otto r-s - ®N f-)( ST +I�J909 t, iT 1343147 APR 0 9 2015 Q" 35314" 4$" OPY 21" 44 314" 21" 24" 24" 3" 24" 33" 45" to I WCL 4-W W2142R !y� Y ir ��� N LV (((( p • N • • • W 71I�r t goo •••:•• •••• ...... ...... 1 N _ N • • u • • • • fir'/ � � � • • • • • f I- \ •••• 71 16" 24" 15" 331/4" 7NQ PAINT ALONG CO TSR TO BE MORE THAN \,,:'' >\` i OTHiM RECEPTACLE. ' 2 FEET FROM G.F. '� � � / .� /'rf �',� ���.� Vit► � PUT DINT RECE ACCE UNDER SINK. i ALL FIXED APPLIA S ON DEDICATED CKTS.`� ,s' /� 171 N 102 Stre ti ��GAJ i i S e illage,. 33138 ti� f h \ C/ a � All dimensions and size desig ion: U sign drawings are provided Designed:02.04.1: must be verified on the site to fit jo 6ti a'G for the fair use by the client or Printed:02.04.15 Client accepts these drawings a s; his agent in completing the ` x`'f ; can use them on its own risk. r �J project as listed within this contract P�r�e_�`c—"` Design:Mumby,Steve and Vernon', wing#:1 Display settings 5/16"=V r m _ { r r' T 5 _ { } i RFG-6EF-S i 0000 I • • � _ ,- - I ••• 0000 0000+• N ` { i •L • 0000 • • • { # 0?•0•0 0000 000000 0000•• --^-^----_---a • •• 0000 • • .... ...,_._. •�•• 0000 00.00 0000•• • •• 0000• 23" 24" 36" 7/8" 48" 1WWO•• •000••0 •••••• • 7!6" 000000 • • 47' 36" 1/8" 27" 24" • • • • • • •• 00000000• • • • • 135" • 000 0000•• •• • 0000 • • 0000• NO POINT ALONG COUNTER TO BE MORE THAN 2 FEETFROM G.Ej PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. 19� ADD SMOKE/CARBON MONOXIDE DETECTORS. �/ b ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED, All dimensions and size designation, _ Design drawings are provided Designed:02.04.1; must be verified on the site to fit job :, for the fair use by the client or Printed:02.04.15 Client accepts these drawings as is,. his agent in completing the can use them on its own risk. ! project as listed within this contract cnea:er.:r.�r Design:Mumby,Steve and Vemon Drawing#:2 Display settings 3/8"=1. N i i WCt24-W t � 1 o I i DHW-2-S i •••• • •••• •••••• � � � 3 • i 24" 3" 24" 33" 45" ••••:;14" ••�••• •••••• 24" 21" 44 314" 21" 24"• • • • 000000 • • • • • 50" 35314" 49" • • • •••••• • 134 314" lb I lJ All dimensions and size designation: Design drawings are providedTDed:02.04.1: must be verified on the site to fit job for the fair use by the client or 02.04.15 Client accepts these drawings as is: f his agent in completing thecan use them on its own risk. project as listed within this con Desigm Mumby,Steve and Vernon Drawing#:3 Display settings 318"=1' . Y F -i I HD-WCKT-30-S � 4 N : i m o RGF-FSRS �� 3 •••••• - • S • • • 24" 4" 21" 30" 33„ 56 •••••• • •••••• 24" 1" 21" 122" •••• •••• ••••• •• •• •••• •••••• • • • • • • 90 0 •0•• V � r^ � � r � All dimensions and size designations _ Design drawings are provided Designed:02.04-1: must be verified on the site to fit job for the fair use by the client or Printed:02.04.15 Client accepts these drawings as is; = his agent in completing the can use them on its own risk. project as listed within this contract Design:Mumby,Steve and Vernon Drawing#:4 Display settings 5116"=1' ...... .... ...... .... .... . . .... .... ..... • . 0 0 00 Oe 000 • . .. . 0 0 0 "00 a •• � 0000 • • f • 0000 e � l 331/411 15" 24" 1 15/16" 74 3/16" f � V All dimen$ ions and size designation: Design drawings are provided Designed:02.04.1: must be verified on the site to it job ` s for the fair use by the client or Printed:02.04.15 Client accepts these drawings as is his agent in completing the can use them on its own risk. {-, project as listed within this contract Design:Mumby,Steve and Vernon Drawing#:5 Display settings 3F4"=1' � �- c dip 67'-8" • APR 2 1 015 ,...., REAR • • NOT PART OF ••••• , • • • THIS PERMIT • • •i•••• ••••• NOT PART OF *•o c•: • •• NOT PART OF THIS PERMIT THIS PERMIT • • •• • t f„f, NOT PART OF • • • • f THIS PERMIT •• • i KITCHEN DINING FAMILY ROOM LEFT ^ BATH BEDROOM NOTPART OCL THIS PERMIT = LIVING CL CS O ® d BATH NOT PART OF GARAGE RIGHT THIS PERMIT (VENTILATION) CL NOT PART OF THIS PERMIT BEDROOM CL BEDROOM NOT PART OF v THIS PERMIT FRONT NOT PART OF NOT PART OF THIS PERMIT THIS PERMIT NOTE: MEAN ROOF HEIGHT : 14'-6" ROOF TYPE : 5 : 12 �e ANY AND AL;_ OTH AND RUBBER SUI.AYC ceiNUUCTO --c, BE PI RCEL GROUND FLOOR PLAN asR,L: u NWt-D �,�''�¢�7 Ram ����io� Q►'R� • ��' ,