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RC-15-1680 (2) MM *s�!°Re Miami Shores Village 10050 N.E.2nd Avenue NE , aF Miami Shores,FL 33138-0000 r xtu�emP Phone: (305)795-2204 3� � Exp' t' n• 2f1712 1 Project Address Parcel Number Applicant 420 NE 92 Street 1132060140079 LOUIS LEZAMA Miami Shores, FL Block: Lot: Owner Information Address Phone Cell I LOUIS LEZAMA 420 NE 92 ST MIAMI SHORES FL 33138-3155 Contractor(s) Phone Cell Phone Valuation: $ 12,000.00 QUIRINO CONSTRUCTION CO (305)892-1987 Total Sq Feet: 82 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:BATHROOM RENOVATION Occupancy:Duplex Window Door Attachment Stories: Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review StructuralReview Mechanical Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $7.20 Review Building DBPR FeeInvoice# RC-7-15-56232 Review Building $5.40 08/21/2015 Credit Card $349.00 $50.00 DCA Fee $5 qp Review Building Education Surcharge $2.40 07/06/2015 Credit Card $50.00 $0.00 Review Plumbing Permit Fee $360.00 Review Plumbing Scanning Fee $9.00 Review Plumbing Technology Fee $9.60 Total: $399.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the abov - e ractor to do the work stated. August 21, 2015 Authorized Signature:Owner / Applicant / Contr for / Agent Date Building Department Copy August 21,2015 1 Miami Shores Village crij Building Department AUG 12 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel:(305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 l BUILDING Master Permit No.,90-6--Myn PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS [CHANGE OF ❑ CANCELLATION ❑ SHOP pCONTRACTOR DRAWINGS JOB ADDRESS: K' . I 5hrGPT City: Miami Shores County: Miami Dade Zip: ...3313 Folio/Parcel#: 11 3200 OJ 4 ptb`1 q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 3 75 r OWNER: Name(Fee Simple Titleholder):k4AAZ4 CW - Phone#: 3 06"'.4{i4 52 3 C Address:. - �f 20 106 ghidl- Sbr"t- City:M1� -51►0re5 State: Zip: -3.3 13 Tenant/Lessee Name: — Phone#: Email: o CONTRACTOR:Company Name: td1 s by �_9i7�t iul ,t13r+J Phone#: 3 d7 � �-17 D Address: City: KO- M t 047LA-1 State: V. Zip: Qualifier Name: J014$° A,, Q u i 12- Ll Phone#:.3 i.1 N ':� tS 1 State Certification or Registration#: C(5 C 031 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Y--- Address: City: State: Zip: WO Value of Work for this Permit:$ Square/Linear Footage of Work: �� t Type of Work: ElAddition Jj Alteration F-1NewE] Repair/Replace ❑ Demolition Description of Work: IZrmoo EI 9/4 ru goo Specify color of color thru the Submittal Fee$ Permit PEe$- CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ a49 (Revised02/24/2014) �I Z i 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 approved and a reinspection fee will be charged. �j Signature 7 Signature OWNER or AGENT ONTRACTOR The fore oing instrument was acknowledged before me this The f regoing in t was acknowledged before me this day of l� /bj 20�s by )V�day of 201,-S f by �je , Ci I-.e-za,rl?t4 who is personally known to '5 L,? hos pj�na y knTf-o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: ' NOTARY PUBLIC: j Sign: Sign: /� Print: L y/Al k) >g (t' J Print: 1:�'/07,�X-t �" Gi'-9--^' o SARRY CkARLES CERRATO Seal: LYN E M. 0' AL IN Seal: WTARYPUBUC Commission#FF 234178 STATE OF FLORIDA MY Commission Expires Caiitm#FF121241 Ma 25 2tn APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) QUIRT-1 OP ID:SG ACURL� DATE(MM/DD)YYYY) `,..� CERTIFICATE OF LIABILITY INSURANCE 05/20/2015 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(iss)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 CONTAC'rNAME: William F.Dowd W.F.Roemer Insurance Agency 3775 NW 124 Avenue PHONE FAX;954-731-5566 ac No):954-731-8438 Coral Springs,FL 33065 E-MAIL William F.Dowd ADDRESS:bdowd@roemer-ins.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Mid-Continent Casual Co 23418 INSURED Quirino Construction-Co 1987 NE 119 Road INSURERB: North Miami,FL 33181 INSURERC: INSURER 0: 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 ADDLSUBR EFF PO LTR TYPE OF INSURANCE POLICY NUMBER (MA YYY MM/LICY P LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR 04-GL-000928768 05/11/2015 05/11/2016 DAMAGE TO RENTED-- PREMISES Ea occurrence $ _ 100,00 MED EXP(Any one person) $ Exclud PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0 RO POLICY a CT LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY OM IN IN LE LIMA $ Ea acadent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON SWNED PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSA71ON AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached H more space Is required) Subject to policyy terms and conditions. John Anthony Quirino#CGC031466 JohnPaul Quirino#CGC1519472 Fax:305-756-8972 CERTIFICATE HOLDER CANCELLATION MIAMIS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD