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RF-16-110 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250942 Permit Number: RF-1-16-110 Scheduled Inspection Date:January 15,2016 Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Owner: SAXON,GLORIA Work Classification: Gutters Job Address:9941 NE 4 Avenue Road Miami Shores, FL Phone Number Parcel Number 1132060171260 Project: <NONE> Contractor: SHEET METAL AND ROOFING TECHNOLOGY Phone: (786)2935802 Building Department Comments RENEWAL OF EXPIRED PERMIT BP03-405 GUTTERS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 14,2016 For Inspections please call: (305)762-4949 Page 16 of 23 11/25/2015 10:58AM 7862938803 SMART INC PAGE 02/03 Miami Shores Village 16 Building Department 10050 2 Q. JAN 14 2016 N.E.2nd Avenue,Miami Shores,Florida 3338 Tel:(305)795-2204 Fax:(305)756-897 INSPECTION LINE PHONE NUMBER:(US)762-4949 FBC 201j . .BUILDING Master Permit No. ' ,L _Jho . PERMIT APPLICATION Sub Permit No. KRUILDING . ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9941 NE 4th AVENUE ROAD City: Miami Shores County. MiPmi wade Zb: Folio/Parcel#:11-3206-017-1260 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee simple Titleholder):Gloria Saxon Phone#:305-710-7584 Address:9941 NE 4th Avenue Road City: Miami Shores State: Fl. Zip; 33138 Tenant/Lessee Name: N/A Phone#. Email. CONTRACTOR:Company Name: Sheet Metal and Roofing Technology, Inc Phone#: 786.293-8802 Address: 10330 SW 187th Street CKY. Miami. state: FL Zip;33957 Qualifier Name: Bruce Popowski Phone#., 786402-6901 State Certification or Registration t!: CCC1329042 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address". City: State: Zip: Value of Work for this Permit:$. ��� � Share/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of work: Replace Expired permit#BP2003-405 Specify color of color thru tile: -Submittal Fee$ Permit Fee$ • CCF 10 619 CO/CC$ Scanning Fee$ 00. Radon Fee DSPR$ Notary S `J Technology Fee$ n Training/Education Fee$ ® Double Fee$ Structural Reviews$ Bond S i e TOTAL FEE NOW DUE$ (Revisad02/24/207.4) 11/25/2015 10:58AM 7862938803 SMART INC PAGE 03/03 qunding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 W 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 ey _ Signature OWNER or AGENT CO OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this C� day of�CEN3�� .20 ,by 25th day of November .20 15 by �.T X\ ON who Is personally known to Bruce Popowski ,wh personally k_nZWr>to me or who has producekL,_��f'2_33�Ks me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: . Sign: 'dodz_—go Print: Q is Print: Deanna M. Gra b"Y^a�•.,• DEANNA M.GRAFF Seal: Seal: `as v •r Notary Public-Stale of Florida }�1PRq P4e�?+ Notary Public State of Florida 01.0 '•= ray comm.Expires Jan 8.2015 Sindia Alvarez ; �;= Commission A EE 130345 a M Commi ion FF 156750 �.�oc Q°r° ° y '��.,,,,.k• apntisd Throu h Nation 1 Notary Assn. Ya#sssst+xk+>ts#s s +tzc gss# ### ss#sssss#ssssssss s9slyM9*## APPROVED BY Plans Examiner Zoning Structural Review Clerk (RevisedW24/2014) 11/2512015 11:59AM 7862938803 SMART INC PAGE 01/05 shores, VilIgge B In, , Department 1.0050::N.E..2r�d Avenue ..t iamv,5hores:,.Florida X33138 Tel:'(30.5)795,220 Fax (305)756.8972 CORTI RACTQ.R'T RSC ST ;• TION IF::CONTRRACTIO.IS:A FLORIDA STATE CERTIFIED CONTRACTOR: A. !/ COPYOr QUALIFIER'S STATE LICENCES COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF-LIASILITIlNSURANf;E* D• COPY-OF IIIORKE RS CAMP NSATION INSURANCE (1Alor eis Compens tion'EXI;MPTI4N must have NOTICE-TO OWNER'form arid:Con.fractorAffid.avit): IF CONTRACTOR.IiAS A.MIAIVII:RADE COUNTY 511TIFICATE-OF.COMPETENCY; :A. CQPY Off'-CERTIFICATE OF COMPETENCY OF:QUALIFIER B. COPY OF LOCAL BUSINESS TAC:RECEIPT' C. C6I'Y OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI 'DADE COUNTYMUNItIPA- L ' CONTRACTOR'S TAX RECEIPT, D . 'CO'PY OF LtABILITYINSURACE* E. .COPY.OMORKERS COMP.EN$-ATION'IIIISURAMCE* Morkers.Cod ensaY 4n EXEMPT ION must.have NOTICE T(}OWNER:form and Cor dtactor:A.fdavit) 'YOUR INSl1RANCE.:COMRAItIY MUSS`fSSEl<E.A CERTIFICATE.A'S FOLL01�1: Certificate.Wde,•r. MIAMI•SMD l S'VILLAGE SLOG DEPT 100 'NF.2NO-AVE MIAMI SHOM. S, Certificate rbust.600ify-tfioldescriptfon of apera#(ons or contractor l�erisQ numb�c; *R.ir�arr■'■.•�YYY'■r■:��sa.e.r■K•llaas■■•�sarrl.■NNW MMaaNapM.Mft:raaaaw�>frr•.■Rrr'r.■rs�'r��a:gr•a.r•a■■.wlr,r-Marra BUSINESS NAME. pI yt BUSINESS ADDRESS:Ja 3 4 S11� l i_ Crry .STATE.. BUSINESS.:POONE:. FAX Noma=R C ?- -CELL PHONE QUALIFIER'S NAME: QUALIFIEWS•:LiC NUMBER: �Q � 11/25/2015 11:59AM 7862938803 SMART INC PAGE 02/05 TATS 6r- FLp0jDA MmENT OF 131.JMNI SS AND PROFESSIONAL REGU,ATION N17"yyi. ��y1y,ICTI©N.�N{��.-S+. •i L�+I ENSI Y1 O'41�./T�iaR.f 1:'��": �4 •.: '.:,:`:;,`•• % MON T H sY i'I SSEE R 3239:9-07$3 POP.OWSIU,:P.RU.Ce WAYId Sk1 4''fi 't ##;;AI O; t ClFIN FIN'-TECHNOLOGY INC103 _ Yr MPAlf9 �}�`�.I�r/��g��p.� s�.n� 1��,wq2��}y, ✓.4°;�"' �+'+•,IwY�'w,�l/�'Q•L7�yW,,r,i a''.l..a R-thl4.,Qc8(7 s ou is-c Lo *e],�y '�,4,�1.,'•ei oft.r i ;iT,9�1PFi .H + .: °.�'. i�1 ',�A'1�!•'•'.}••:.°i.re•. •:I•: :.. i "may Rml as : 3Ac'3 ;0 MVA ' Rsi,: :• . ,yard ,ar�Dc�s,'4rt�is'8` s to:bairosque re0dura�nts ,:..... tSAO, • . trtb barnc�ss an it :. . ser++a� , For 6nta - ,,x.•:., ;":` :,;' r. 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Tk"",Cfit�-0 1t�Y<a„aS7+,�r.. 1,k ���rRC��,.. - KI 1, Fv n\ v' r � ' r+ � 4 a 3rd• h §�w �`\ '>`l\ �ti�,� " ��+,�`�i„k sF^`.' •�'_ 1 rs,.'�nm''�w�t�ts'y�'s`d�7 i{�r F i 1 ACCO CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 16.�1 1 12/8/2015 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. PO the certificate holder Is an ADDITIONAL INSURED,the policy(les)mustbe endorsed. If SUBROGATION ,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). GONIACT PRODUCER NAME: Amanda Harvin PGI of West Central Florida,LLC UwCNNo Ext): 941-479-7215 (Arc,No): 941-845-4722 515 9th St E.,Ste 211 ADDRESS: amandah.pgiogmall.com INSURER(S)AFFORDING COVERAGE NAIL 0 Bradenton FL 34208 INSURER A: AXIS Surplus Insurance Company 26620 INSURED INSURER 8: Evanston Insurance Company 35378 Sheet Metal and Roofing Techology,Inc.dba SMART-INC INSURER C: 10330 SW 187th Street INSURER D: INSURER E: Miami FL 33157 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. LTR TYPE OF INSURANCE INSD pryD POLICY NUMBER MMIDD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one parson) $ 5,000 A FLGLN02141AX 11/20/2015 11/20/2016 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 B X EXCESS LIAS CLAIMS-MADE MKLV20LE104913 11/20/2015 11/20/2016 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION Ulm- AND EMPLOYERS'LIABILITY YIN STATUTE ER - ANY PROPRIETOWPARTNER0MCUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Ifes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) Description:CCC11329042 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DNYYY AieO CERTIFICATE OF LIABILITY INSURANCE DA01(/13/20 6 ) 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(les)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 NAME: Bouchard Insurance for WBS PHONE FAX P.O.Box 6090 ac No Ext): 866 293-3600 ext.623 A/c No): Clearwater,FL 33758-6090 E-MAIL DRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Zurich Insurance Company 40142 INSURED INSURER B Workforce Business Services,Inc.Alt.Emp:Sheet Metal and Roofing INSURER C: Technology Inc dba:Smart Inc 1401 Manatee Ave.West Ste 600 INSURER D: Bradenton,FL 34205-6708 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15FL079857413 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. rNSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I D POLICY NUMBER MM/DD MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED FRCP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY FIJECT PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY Ea accOMBINEident D SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE Pcc $ AUTOS era UMBRELLA L OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I R I $ WORKERS COMPENSATION X PER TH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUE NIA WC90-00-818-05 12/31/2015 12/31/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Location Coverage Period: 12/31/2015 12/31/2016 Client# 054125 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached K more space Is required) Coverage is provided for Sheet Metal and Roofing Technology Inc dba:Smart Inc only those caempioyees 10330 SW 187 Street of,but not subcontractors Miami,FL 33157 to: CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD r Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 Tel: (305)795-2204 9 Fax; (305)756-8972 11/20/2015 To: Current Owner 9941 NE 4 Avenue Road Miami Shores, FL 33138 Permit: BP2003-405 Address: 9941 NE 4 Avenue Road Miami Shores FL 33138 Date Expired: 9/8/2003 Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to refinance or sell this property Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, (� I I I o �r Ismael Naranjo (CBO) Building Director HoRI2 is P2. Miami Shores Village Building Permit % � 10050 NE 2nd Avenue ••" Phone: 305-795-2204 Permit Number. BP2003-405 �CORl>� Printed:3/12/2003 Page 1 of 1 Applicant: CARTER SAXON Owner: SAXON CARTER JOB ADDRESS: 9941 NE 4 AVENUE RD Contractor Contractor's Address: Local Phone: Parcel# 1132060171260 Legal Description: MIAMI SHORES SEC 4 AMD PB 15-14 LOT 7&8&E1/2 OF LOT 9 BLK Fees: Description Amount FEE2003-1522 Building Permit Application Fee $60.00 Total Fees: $65.60 FEE2003-1523 CCF $0.60 FEE2003-1524 Notary Fee $5.00 Total Receipts: $0.00 Total Fees: $65.60 Permit Status: Approved Permit Expiration: 9/8/2003 Construction Value: $440.00 Work: GUTTERS If there is no permit package accessible on the job-site for inspectors to verify,there will be no inspections. Re-inspection fee is$50.00,which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,drawings,statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents,servants or employees. Signed: . (INSPECTOR) BY: In consideration of the Issuance to mef 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 responisibility for all work done by either myself,my agent,se nts or employes. v Signed: (Contractor or Builder) BY: RE Gal J 1J.i C�'filn - a`.o �� v . . . ... . . . ... .. .. . . . .. .. . . . . . . . . . . . . . . . . . 0. . . . . . . ... ... 00 0.0 . . . . . . . . .. . . . . ... .. CARTER T.SAXON GLORIA J.SAXON 9941 N.E 4TH AVE RD. L MIAMI SHORES,FL 33138-2439 Date ! —6.7 994 tol Aa.wder of a9:44W2 "4�94!k Dollars BankofAmerica � m+wro,ow7 So Mo � (Sheet Metal And, Roofing :Echnology, Inc.) , PO BOX 841438/PEMBROKE PINES,FLORIDA 33084 TEL:(305)822-2747 (954)322-2253 Fax �� Ora 10- V9• Proposal DATE: �• I • d 3 PROPOSAL :SUBhUr=TO: JOB NAME: PHONE: ( C A+-tEo- 5p.KoAj ADDRESS: CM 1 4 + NC C f-&Y a 90QDREss. JoB PHONE:(So S) 00-75-f/ We propose to complete the job in ac=tiance with specifications below,for the sum of� + PAYMENT TO BE MADE AS FOLLOWS: 1/9-D o a a7RU=s :YATL`RE Nhis may be withdrawn by us if accepted u Po r4CO, Lo_ ICA w as days SPECIFICATIONS AND ESTIMATES: /{ A ® .7-7�3 {✓,/�eflcu�j ����_ �`� srr '3J' 5 - / ACCEPTANCE OF PROPOSAL—The above prices,ap-M ations and SIGN,DATE AND ONE PY ffi and are hereby aooepted You an awhorized bodowarkagmcifiA Payment will be made as outlined above. 9th DateofAooeptance—o Sipanue 3 Y—moo 3 275-a-e E RES y��► •;. ;•; .:. PERMIT APPLICATION use His ... Master Permit No. "�:" ��` •• 4sidi*6 Pat nit ORiDQ' • i i • • • • • The folloNsing Steps 111tist he takell to obtain 11 perillit from tile Miami Shores X'illage:t t Step 1. Complete the attached permit application which mdstbdsibedU j1g%LQ 'ray owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processiftoCM apljic:tjp%.:f roofing work will be done,a roofing application must be submit- ted along with this permit application. ••• : : 0.0 : : :•• ••• . Step 2. Submit the completed application with all necessary documents to the Building,Planning and Zoning Department for processing. During the processing of your application,you may be asked to submit additional information. APPLICATION 1> ob Address: y� / N� /�''yl r c� S 3 3/ 3 Address Apt. City State Zip Folio Number Nescription of Work �� -.,'Ie- -s Lot Block ' Subdivision PB PG Zoning Linear Feet I Current Use of PropertySquare Feet Units Floors Proposed Use of Property ) alue of Work ` OG Bldg Value Tenant Information Tax Assessed/Appraised Value i Flood Zone Base Floor Elev. PERMIT TYPE (✓) PERMIT CHANGE (✓) TYPE OF MANAGEMENT ( ./) Building Chg.Contractor New Construction Enclosure h Electrical Renewal Alteration Exterior Repair Mechanical Revision Alteration Interior Demolish Plumbing Extension Relocation of Structure Shell Only LPGX Supplement Foundation Only Add'l Attachment Roofing Reinspection Other Add'1 Detachment Fence Oth Other ARCHITECT ENGI Name Name License No. License No. Address Address Telephone Telephone Fax Fax ROP Y OWNER CONTRACTOR Name Address _ �`7 License No. Address Home Telephone 6��7 i_cam S U( -x =...► .., ,,s� Business Telephone Telephone Fax Fax Qualifier Name i Paget . . . . . . . . • PERMIT APPLICATION 1. DO NOT BEGIN ANY WORK WITHOUT HAVIN4 RFdI�ED YOUR VA�11) T1QD PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are lifiNd W Mondaylthrough Friday from 7:30 a.m.to 6:00 p.m.,and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN NE AT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE Mir FR1iiE i 6MbIIT A D DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAJAGEI5:3-?F4U11'4&dR AHICLES,AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. •.. ..; ; ; 0.0 ; ; '.. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building,Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services(HRS)approval is required for applications involving septic tanks. Department of Environmental Resources Management(DERM)and/or Miami-Dade Water and Sewer Department(MDWASD)approval is required for applications involving sewers. AFFIDAVITPlease Application is hereby made to obtain a permit to do work and installation as indicated. I,the OWNER of the property,certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50%) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50%) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1"Floor,(305)679-1078. Once recorded,the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713-35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA,COUNTY OF MIAMI-DADE STATE OF FLORIDA,COUNTY OF MIAMI-DADE Nfnature of Owner / Signature of Contractor/Qualifier XPrint Name Print Name nd subscribed before me this�__�_ day of Sworn to and subscribed before me this day of D ignature of p tary Public State of horida Signature of Notary Public-State of Florida SEAL: f- j Angea M Beeker SEAL: My Commission DD150048 Expires November 15,2008 Personally known OR,Produced Identification C/ Pe rally known OR,Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 :-•-: : : : :-•-: • PERMIT APPLICATION 4 2i INSTRUCTIONS: Please indicate the type of work 12eing perfcgined'PO' qu4itity(ies) in the space provided below. M1311&�MMM 1 Minimum Fee Dryer • . • • OuM A,ppliancZ Service Repair A/C Central 1-3 Ton Fan Ou e Waff Service,Temporary A/C Central 4-7 Ton Fire Pump Outlet,Switch Signs A/C Central 8-15 Ton Fixture-Fluorescent Oven Space Heater(kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights I Spas/Hot Tubs A/C Central 20+Ton Flood Lights Plugmold/Strip Subfeeds,No.of Amps A/C Window FPL-Load Central Posts Swim Pool,Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool,Residential Chiller Generators,etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator,Comm.(p/PH) Temp Serv.,Construction Compactor Low-volt,Burglar Refrigerator,Domestic Temp for Test-30 days Deep Freezer Low-volt,Fire Renew-Temp Service Demolition Low-volt,Intereom/Teleph. Repair Circuits Dishwasher Low-volt,Television Service,Number of Amps ECHAMCAL Minimum Fee Condensate Drain Generator Refrigeration,Tons A/C Central,Tons Cooling Tower Heating Strips,each Vent Hood,Cost A/C Wall/Win.Tons Dryer Vents,Number of Paint Booth Ventilation,Cost Air Handler,Tons Ductwork,Cost of Piping,Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan-Vented,# Fireplaces,Number of Pressure Vessel A/C Condensate Drains,Roof Miscellaneous Fixture Soakage Pit Bath nb Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap-Fixture Fountain Pump and Abandon Sprinkler System Cap-Water Gas-Appliance Pump,Domestic Supply,AC Well Cap-Sewer Gas-Natural Pump,Fire Stand Temporary Toilet Catch Basin Gas-Propane Pump,Re-circulate Temporary Water Closet Clothes Washer Gas Piping Pump,Replace-Pool Urinal Dental Chair Grease Trap Pump,Sprinkler Utility-Sewer Discharge Well Ice Maker Pump,Sump Utility-Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield,4"Tile/Res. Lavatory Septic Tank Water Heater New Drains,Area Meter Set(Gas) Sewer Connection Water Re-pipe Drains,Floor Minimum Fee Shower Water Service Drains,French Miscellaneous Equipment Sink Well,Supply RECEIVED AND REVIEWED BY: DATE: Page 4 ; • • • • PERMIT APPLICATION ... . . . . ... . . OFFICE USE ONLY ❑ OWNER-BUILDER FORM ❑PROOF OAW&SHI13 ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT ❑ HRS/ISERM:k2P1CtVAL.• ❑ BPR APPROVAL(Restaurants) APPROVAL(Commercial/ 0(6eptie;A-4erS•• 0•• multi-family) ❑ CONCURRENCY ❑ IMPACT FEE ❑ CONTRACTOR REGISTRATION (New Construction) (New Construction) (On File) ❑ OTHER ❑ OTHER (Specify&Attach) (Specify&Attach) $3.00 per page(Scanning Fee) $ Miami Shores Village $ 6o f Bond $ Metropolitan Dade County (C.C.R) $ (sq.ft.=x/1000 x¢.60) Inspector State Educational Fund $ (¢.005/sq.ft.) State DCA(Radon) $ (¢.01/sq.ft.) Code Enforcement Fine $ Zoning Review $ Notary $ < ' 0 l7 TOTAL REVIEWED AND PREPARED BY: DATE: SECTION BY DATE CONDITION OF A PPRONA 1, Zoning Electrical Mechanical Plumbingi Fire II Public Works Structural 42 Building Official i Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES,FL• (305) 795-2207 •FAX (305) 756-8972 • http://www.miamishoresvillage.com Pere �"� .,, Miami Shores Village r Pl3ll??Itat Rtf, 10050 N.E.2nd Avenue NE Wt�rk C ss;iCahtm G et}5 .... Miami Shores,FL 33138-0000 ' ;,�'e►artit Status:AF?!l�'���. Phone: (305)795-2204 F@COR Expiration: 07/12/2016 Project Address Parcel Number Applicant 9941 NE 4 Avenue Road 1132060171260 Miami Shores, FL Block: Lot: GLORIA SAXON Owner Information Address Phone Cell GLORIA SAXON 9941 NE 4 AVE RD MIAMI SHORES FL 33138-2439 Contractor(s) Phone Cell Phone Valuation: $ 440.00 SHEET METAL AND ROOFING TECHN (786)293-8802 (786)402-6901 M..._ Total Sq Feet: 00 Type of Work:Gutters Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Review Building Fees Due Amo]$2.00 Pay Date Pay Type Amt Paid Amt Due CCF DBPR Fee Invoice# RF-1-16-58338 01/14/2016 Credit Card $ 114.60 $0.00 DCA Fee Education Surcharge Permit Fee-Repairs $Scanning Fee Technology Fee Total: $11 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 ning. Futhermore,I authorize the above-named contractor to do the work stated. January 14, 2016 horized Signa re:Owner / Applicant / Contractor / Agent Date Building Department Copy January 14,2016 1