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RC15-513 Miami Shores Village Building Department MAR Q9 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 , je Tel:(305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BUILDING Master Permit No i-`-_—S, J PERMIT APPLICATION Sub Permit No. ,BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP y CONTRACTOR , DRAWINGS v JOB ADDRESS: J I , ( t)L- City: Miami Shores County: Miami Dade Zip: 33 )35S Folio/Parcel#: -3;-(a,i Q3 `�C-LVO Is the Building Historically Designated:Yes NO t/ Occupancy Type:� � Load: Construction Type: Flood Zone: F BFE: FFE: OWNER: Name(Fee Simple Titleholder): i ii Lid T' 1� �C� Phone#: Address: r� NC C ) 0 1111 34R ECT State: � } � + ' 33i3 City: �vl t i�F�-1� ��'-'�CS � L Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 1'.>AV y, •)� � �NC - Phone#: rjc�cf Address: 42—C, t,�,C j i 15'tk t City: ( l 00-i State: �-' Zip: Dt CC Qualifier Name: f Phoneo(�u ;A u 1L42-9 State Certification or Registration#: �/� 7 I I � La Certificate of Competency #: DESIGNER:Architect/Engineer: Phone#: Address: „OO City: State: Zip: Value of Work for this Permit:$ �7_�� + Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace 1:1 Demolition Description of Work: Q 0 �rC 'k ” ' It U Specify color of color thru tile: C Submittal Fee$ 5L Permit�' Permit Fee$ CCF$ �� 0 CO/CC$ Scanning Fee$ ( ' Radon Fee$ J' DBPR$ Notary$ � Technology Fee$ Training/Education Fee$ 1 Double Fee$ Structural Reviews$ — Bond$ TOTAL FEE NOW DUE$ (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 su osted notice, the inspection will not be approved and a reinspection fee will be charged. SignatureSignature OWNER or AG ImCONTRACTOR The foreg ing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day ofY3� 20 0by J day of 20 1.� by ZmarvN who is personally known to IbAy id- wh ' personally know me o who has produced as me or who has produced as identification and wh id take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1�nro� �'.....�`� FRANK WOLLAND �t * MY COMMISSION A FF 128362 EXPIRES:June 2,2018 Sign: Sign: �' aFcoa`O' 8"W1bE,8lW0N0Ft6irk=--- Print: Print: Seal: VEN L.JONES Seal: 1% Notary Public-State of Florida �,,,• R'•' •c My Comm Expires Dec 5 2016 •' Commis on #EE 850621 7 7 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 3/10/2015 5 : 30 AM FROM: 7276667636 TO : +13057568972 P. 2 r Date CERTIFICATE OF LIABILITY INSURANCE F 3/10/2015 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages he po icies of insurance listed below ave been issue to the insured named a ove or the policy icy period indicated. Notwithstanding any requirement,term or condition o any contract or other ocumert 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. Aggregate limits shown may have been reduced by paid cla'.ms. INSR ADDL Policy Effective Policy Expiration LTR INSRD Type of Insurance Policy Number Date Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises(EA Claims Made Occur occurrence) Med Exp $ General aggregate limit applies per: Personal Adv Injury Policy ❑Project ❑ LOC General Aggregate Products-Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Camage (Per Accident) $ EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X wC Statu- OTH- Employers'Liability tory Limits ER An proprietor/partner/executive riet Ary p p or/partnerlexecutive officer/member E.L.Each Accident $1,000,000 excluded? NO If Yes,describe under special provisions below. E.L.Disease-Ea Employee $1,000,000 E.L.Disease-Policy Limits $1.000.000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB# 12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company":Client ID: 84-65-534 David Hester,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: DAVID P HESTER LICENSE#CRC1330537 AS QUALIFIER/FAX:305-766-8972/ISSUE 11-20-14(TLD);REISSUE 03-10-15(TLD) CERTIFICATE HOLDER Begin Date 10 19 2o11 CANCELLATION VILLAGE OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof.the issuing BUILDING DEPARTMENT insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to 10050 NE 2N0 AVE do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. MIAMI SHORES, FL 33138 �� r Miami hores Village Building Department sman N MINIX" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �F+uTee Tel: (305) 795.2204 ltJR1DA Fax: (305)756.8972 March 18, 2015 Permit No: RC15-513 PLUMBING —OSVALDO DIAZ 1. F 107.2 Provide in legend • eferenced code year • Occupancy type /2. Level of alteration FBC 107.2 Provide floor plan indicating existing conditions of kitchen and laundry l�C,r A� 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. ♦S�on f s D from mutual" Miami shores Village RID Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel!: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT DAT C/ ----- _ E. I, �J 4 >Contractor (NAME) a Owner o Architect Picked up 2 sets of plans and (other) Address.- From ddress:From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Departm nt to continue rmitting process. Acknowledged by: j (Signature) PERMIT CLERK INITIAL: � � RESUBMITTED DATE: ,ac PERMIT CLERK INITIAL: SNORES G Miami shores Village ` Building Department Boom 11111M 10050 N.E.2nd Avenue Miami Shores, Florida 33138 L�Ftiroy� Tel: (305) 795.2204 �L0R1Dp` Fax: (305) 756.8972 March 18, 2015 Permit No: RC15-513 PLUMBING — OSVALDO DIAZ 1 . FBC 107.2 Provide in legend • Referenced code year • Occupancy type • Level of alteration 2. FBC 107.2 Provide floor plan indicating existing conditions of kitchen and laundry 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. Re: Village's Additonal Requirements of Plans, 317 Northeast 102 Stree t Page 1 of 1 From: miamicampbell<miamicampbell@juno.com> To: attykavloff<attykavloff@aol.com> Subject: Re:Village's Additonal Requirements of Plans,317 Northeast 102 Stree t Date: Wed, Mar 18,2015 4:42 pm Please leave them at the Village. I can just make the changes there. So please return them as soon as you can. mark Fast, Secure, NetZero 4G Mobile Broadband. Try it. https:/imail.aol.com/webmail-std/en-us/PrintMessage 3/19/2015 Miami Shores Village ,S�oREs Building Department sem„ 10050 N.E.2nd Avenue Miami Shores, Florida 33138 L"Ftir �y� Tel: (305) 795.2204 �IORiDP' Fax: (305) 756.8972 March 18, 2015 Permit No: RC15-513 PLUMBING — OSVALDO DIAZ Q)��J2 f---7 1 . FBC 107.2 Provide in legend G,AJ • Referenced code year • Occupancy type Level of alteration 2. FBC 107.2 Provide floor plan indicating existing conditions of kitchen and laundry 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. 'ern?it NO. RC-3-15-513 Rcr r,, Miami Shores Village Pen nit' oe: Residential 'Construction 10050 N.E. 2nd Avenue N- roermit Avorrk Ctassification:Alteration tll1 Miami Shores, FL 33138-0,)00 ' Phone: (305)795-2204 Permit Status:APPROVED- Phone: — a Date 3/23/2015 i-Xpiration.' 9W "'2015 I Project Address Parcel Number Applicant 317 NE 102 Street 113206.135060 Miami Shores, FL Block: i...t��. Owne-' nasion �'ress Ph,a; ::ell STEPHEN !_JFFREDO 317 NE 1 +2 ,-r 1M.,1AM1 S , 1:'--i Contractor(s) Pho;te Celi Pnorre $ 8,500.00 -- Valuat rt: DAVID HESTER INC (7&t,294-09 <- —_--- Total °: F— ApprO-ad Ir, ^-view Comments: i ,� E Certificat+cn t Date Denied- Type enied Type of Constriction: RFMODFL KITCHEN AMID' c,',1NDR (- y_--- -- _-- Stories Exterior. _ .':aJon Front Setback Left Setback F <-k Bedrooms: r - �k r Plans "Iubrr Yes Certificate Date- �In= Bond :eI it rur uu 1. Fees Due ,A.mo!.;nt Pay 'i ?; _ - —�.. --- Piumbina CCF $5.40 Y P Invo _. r itrr r+u 31 DBPR=ee $3.83 - DCA ee t 03/23, r 248 )6 $ 50.00 e , C'i $3.83 Edaca ic,.Surcharge $180 03l1C, t ;arc: O C $ 0.00 Pei"T) Gee X755-0" i S r, i Fae $21-00 Te -,,,v Fe- $T20 I Tots. $298.06 In Cur "deratign of the. !SSU?_nCe t0 mP. Oi ?rr a7rC P es and regulations perain rry ;.reto ana In strict comorrni,, w!u e r:_ sdr vi s ViiIage. In accepti g ',h;E permit I assume respons, I'it/ f.r all r _o , r _ mits are required for ELECTRICAL PLUMBING MECr^.t;� WINC�r OWNERS AFFIDAVIT: I certify that all the fo goin,, iprc tr,� ' ,Ie Jcr r -;i _ :,!ic able laws regulating construction and zoning. Futhermore, I authorize e: ave na I' Fla Authorized Signature: Owner / \pptca t / Building Department f'nr M _ 1