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RC-16-285 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253717 Permit Number: RC-2-16-285 Scheduled Inspection Date: March 01,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: PALACIOS NOVAS, REBECA Work Classification: Alteration Job Address:1700 NE 105 Street 412 Miami Shores, FL Phone Number (786)547-2572 Parcel Number 1122300500690 Project: <NONE> Contractor: VINWARD CONSTRUCTION CORP Phone: (786)251-2398 Building Department Comments REMOVE CARPETING IN TWO BEDROOMS, INSTALL Infractio Passed Comments SOUNDPROOFING AND INSTALL LAMINATE FLOORING. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 29,2016 For Inspections please call: (305)762-4949 Page 22 of 22 Miami Shores Village Building Department 2 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 <�k4 ABC 20 BUILDING Master Permit No. - � PERMIT APPLICATION Sub Permit No. QBUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF . ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1700 NE 105th Street Apt.412 c� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_11 - 3432 -0so ` Db9 o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):REBECA PALACIOS Phone#:786-547-2572 Address:1700 NE 105th Street Apt.412 City. Miami State: Florida Zip. 33138 Tenant/Lessee Name: Phone#: Email: rebecaroddguezmanor@gmaii.com CONTRACTOR:Company Name: 1/���✓/►i c]L 6CWS%r&e_ `i a� e�tQ. Phone#: ;t-" Address: I dze AI&vl Zo 2t--- -yr CityState: ore—/6r. 904C Zip: _1.3/4 S Qualifier Name: (,d��/� �L�= Phone#: $�--ZS��3j� State Certification or Registration#: CAAAA�GisOVepltls Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$1000.00 Square/Linear Footage of Work: 450 Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: - � 11�) ��OYL Specify color pf color thru tile: jnr-_to Submittal Fee$ Permit Fee$ Tc r� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ 1P Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 6 (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 approved and a reinspection fee will be charged. Signature Signature ` OWNER or AGENT CONTRACTOR The foregoing instrum t was acknowledged before me this The foregoing instrument was acknowledged before me this L day f 20 _, by day of ;�rt,A0 y .20 by A C ho is personally known to who is personally known to 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: Sign: P e:;•,, HEINRICH C.HUECK Sign: 9 tr A oary Public aeo or a Print: N` M Comm.Expires Sep 30,tots print: /-��i� R.MACHIN Commission#FF 164339 Cvo � J�17,201s �Illlit\\\ YID ••'�'� Seal: Seal: °orw0 APPROVED BY �/ l�( ki Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Jk- WORK REQUEST APPLICATION Owner's Name -- .�� �C�il C���Cj Unit L I hereby request approval from the Board of Directors for the following modification or alteration to my unit that will be performed by a licensed contractor. Electrical work Plumbing work Carpet installation "Windows :l Tile installation Other work Description of the work Before you decide to upgrade your apartment (other than paint or carpet)you must obtain'permission from the Board of Directors and/or Miami Shores Village. A copy\of the plans, specifications and permits, and a description of the licensed work to be performed must be submitted for consideration and approval by the Miami Shores Village Building Department (305-795-2204). It is the owner's responsibility to ensure that the contractor removes all excess construction material or building debris. It cannot be placed in the dumpsters. *Window frames must be gray in color to look like aluminum. Windows must be Two (2) panels over Two (2) panels. Glass must be clear color. 1, as the unit owner acknowledge responsibility for any damage to the building or personal injuries that may occur during the project. The Shores Condominium Inc. its officers and employees are in no way responsible for damage or theft to my apartment or my belongings. (A $200.00 deposit is required and will be refunded if no damage to the property is reported.) I fully under tand and agree to the statements made above. Unit asvner s signature Date i .f - `r- App roved by: (;. _� Date: s L al Business Tax Recei-p Miam- County, State of Florida OTA BILL — DO NOT PAY 6299358 BUSINESS 14"E/I.00ATION REC EXPIRES VINWARD CONSTRUCTION CORP REN 1011 NW 207 STlace of business MIAMI G40 9 Pursue to Chapter 8A—ArL 9&1 OWNER EC.TYPE OF BUSINESS PAYMENT RECEI 196 GENERAL BUILDING CONTRA 0 VED ����WNSTRUt:IION CORP CGC1504408 BY TAX COLLECTOR Worker(s) 3 $45.00 09/15/2014 CREDITCARD-14-037210 Tbls Local Tax Receipt only confirms paymow of the Local Business Tae.The Is eat a license, pemdt,or cation of the holder'egualificatiaas.to do business.Holder most comply any www memal or mo I regulatory taws and requirements wblob apply to the business. K-CM NO.atuve must he displayed an all commetcfei vehicles—salami-nada a sac ea zee. For more Inimmedoe.vle1twwwideaddedeaembmilwar RICK SCOTT,GOVERNOR A KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The GENERAL CONTRACTOR �= g Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Pym° Expiration date: AUG 31,2016 � `. ROMER, CALVIN EDWARD VINWARD CONSTRUCTION CORP t 1011 NW 207TH STREET _ MIAMI GARDENS FL 33169 - ua ._.D_.-._-..._._--_- ISSUED: 08/21/2014 DISPLAY AS REQUIREBY LAW SEQ L1408210001693 Miami-Dade f,Qun Y► Mata of. 'Fiol IS ss, orA"WLc: - no NOT PAY 6299358 B tB E S NAPAWL*cA'tION R I Elo VIM, o'cdNl hook cof?p I f1i 1'PIW2o7 5F; 6ltusc be dispred ac piece a#riigirtess tt4{U11 GMPIS64-1--.,M 165_ Pursuarrtlo Covrrty CQiie" Chanter AA-Arr.,9'&.�a" OWNER - SEC.TYPE OF BiISINBS8; PAYMENT RECEIVt D ViN4NARD CONSfRUCT10N CARP 186 GENERAL BUWNQ 6Q11 RAGTOR BY TAX COLLECTOR 41Vorker(s) 3 CGC1504408 $45.00 09/09/2015 FPPPU05-15-017020 rlt�taealBnsiaass7ac RerWptmi�co Payrtam���t1Bns�ffisTaa The rtacaiya�oat a lirg�, timet ora cerdfieationtd era holAers tode •t ddw_a i r w�8q gmmme�el ;or ragatatarq bras u�ich �the 6 Ttte Rftgn NO.obmm mast he dfsPiayed oa all am aerciaf ve5iriles-�lia�nE-llathr is Seo Ba-27fi For rmfre iaao,aseiCs .miamidada eiroharReoKaatair _ng'y 4 Maw" ,4 ,h�3- `z^3.r i�.. 4` Ni I'M, Y;7� - ��"y. ) 'Aye'irj+. gy a�H � � y S'-� F� >•„ +.exa -�� ,^ ,,3� � x� s;, r 3,. I„,� '3"'`r';t. 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'�.�� A MBEL CERTIFICATE ®F LIABILITY INSURANCE D D/-28 Z2 YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A&b ALL-LINES INS ASSOC INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5600 SW 135 Ave Ste 106 ALTER THE COVERAGE AFFORDED BY THE POLI IES BELOW. Miami, FL 33183 (305) 463-6781 INSURERSAFFORDING COVERAGE NAIC# INSURED VINWARD CONSTRUCTION, CORP. INSURERA UNITED SPECIALTY INS CO. 1011 N.W. 207 ST, INSURER a MIAMI, FL. 33169 INSURER C: INSURER D: 1786-251-2398 INSURER E COVERAGE 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 SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Imm LTR NERD POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 PCOM MERCIAL GENERAL LIABILITY PREMI ,re ce $ 100 000 ^CLAIMSMADE o,OCCUR MED EXP(Anyone person) $ 5 000 A NPP8134507 10/29/15 10/29/16 PERSONAL&ADV INJURY $ 1 000 0 0 GENERAL AGGREGATE $ 2, 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1 O O O 0 O 0 POLICY M PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WCSTATU- OTH- WORKERS COMPENSATION ANDFR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If ,describeunder E IAL ROVISI NS Wow E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS GENERAL CONTRACTOR CERTIFICATE LDECANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN BUILDING DEPARTMENT 10050 NE 2ND AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ON T NSURER,ITS AGENTS OR MIAMI SHORES, FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENT A A RD CORPORATION 1988 ACORD25(2001/08) 7111,28/2016 (MM/DDNYYY)A�" CERTIFICATE OF LIABILITY INSURANCE 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 Claudia Reutlinger Keen Battle Mead & Company PHONE (305)558-1101 No:(305)822-4722 7850 Northwest 146th Street E-MAIL ,creutlinger@kbmco.com Suite 200 INSURERS AFFORDING COVERAGE NAIC @ Miami Lakes FL 33016 INSURER A$rid afield Employers Ins Co INSURED INSURER 9: Vinward Construction Corp INSURER C: c/o EMS 235 E Commercial Blvd Suite 201 INSURER D: INSURER E: Lauderdale by the FL 33308 INSURER F: COVERAGES CERTIFICATE NUMBER-CL15121005572 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 SUER POLICY NUMBER MMM/UDDY� MM%DD� LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO R CLAIMS-MADE 17 OCCUR PREMISES EaENTED occur encs $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICYPRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ PDEXCESS UAB CLAIMS-MADE AGGREGATE $ ED I I RETENTION $ WORKERS COMPENSATION PER OT AND EMPLOYERS' YIN LIABILITY STATUTE ER H ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) 083054908 11/16/2015 11/16/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more apace is required) Carpentry/Construction of residential dwellings CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NL 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Alex Perez/CLAUDI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 ontanit v IL mi FEB 0 2 2016 � ------ 3y DATT TO(,0IMPLIANOE WITH ALL FEDERAL Cly i nPJ[)COI)?dTY 17ULES AND REGULATION v 00 go 00: (05 9.0 P .. . CA �►� �8c2�S2 . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . 4�9li qh r� Cl( t 0000 0000.. 0000 0000.. . 0000.. 0000.. 0000.. .. 0000 0000. .. . 0000 0000.. . .. .. .. , 0000.. 0.00.0 0 0 • • 0000• • • . • . • • • 0000 • •• . • PROFLEX T11 90 MIL MEGA SOUND CONTROL MEMBRANE State-of-the-Art Crack isolation, Waterproofing, and Sound Reduction Membrane PROFLEXI 90MSC Is a self-bonding, reinforced 90 mil-thick elastomeric membrane that provides superior sound reduction, crack isolation, and waterproofing. The mem- brane forms a permanent bond to most substrates, Including (but not limited to) con- crete,steel, wood, tile, stone, and cementitious and epoxy terrmo. It Is compatible with most urethane adhesives. PROFLEXTM 90MSC bridges cracks and controls joints up to 3/8"wide, eliminating .... the transfer of cracks to the finished flooring. PROFLEKI is specially designed to be used under thinset and mudset mortal g4 •••:• adhesives for interior and exterior applications of ceramic tile, stone, and bid . for interior applications of wood flooring. Other applications also may be sulWk. .. . Contact Technical Support for additional Information. • PROFLEK�°' 90MSC sound reduction properties are for floors requiring a nophxfit • Impact Insulation Class (IIC) of 68 and Sound Transmission Class (STC) o4,72,.* •••,•• tested In accordance with ,American Society for Testing and Materials (AS'CM)' Standards E90-02, E989-89, and E492-90. Testing for PROFLEX- 9OMSC was con-:••"• `---' ducted on So concrete slab with a suspended gypsum board ceiling. Test canducded •••• on 81 concrete slab with suspended gypsum board ceiling. Field sound tests were con- ••• ducted on 8" concrete slab without suspended ceiling PROFLEX' 90MSC warranty terms are up to ten (1 O) years, based on the system of materials used to i NWI the finished flooring products. PROFLEX- 90MSC Summary of Features and Benefits ► Easy to install r Exterior or interior conditions ► Wet or dry conditions ► Crack and point Isolation up to 3/8" ■ Sound reduction (ASTM E90-02, E989-89, and E492-90; IIC rating 68 with suspended gypsum cefiing, one layer 5/8"; IIC rating 8"concrete slab no ceiling RIC 49-54, depending on concrete type; STC rating 72) r No waiting time for the installation of floor covering materials PROPLQC" 90MSC Recommended Substrates May be applied over properly prepared substrates Including (but not limited to): con- crete slabs; precast panels; lightweight toppings; patching, leveling, and repair com- pounds; cement backer boards; terrazzo; ceramic tile; plywood; OSB board; particle board; steel; radiant-heated substrates; or masonry block. Profiex Products, Inc. Member o -� 3406 Dean Street Naples, FL 34104 ,,.. ALW (877)5PROFLEX Fax: (677)283-1511 For additional Technical Support, ` contact (877)538-3437 ; IYtlMBBH www.profiex.ua Proudly made In the U.S.A. LO/TO 39dd OhVcMd OOSIO BOTOLT6096 ZZ:6T OTOZ/Z0/EO 9999 6666•• 6l99 • f 6699.• •66!99 • 6669!• • • { • 966.9• !0000! • • 9.:0• •• • 6666 6!R!• • •• 99••66 : . • • ! :•9!• ! •! • .• .• • • 0 .0.006 ..6..6 .0666. • • • • • 9669 • •. Permit No.`RC-2-16-284 �sH°` s Lei Miami Shores Village Permit Type;Resident( CC311St lCt) tt 10050 N.E.2nd Avenue NE Waal Class l00n:Alterit)t t11 Miami Shores,FL 33138-0000 Phone: (305)795 2204 >�e►rrri�;��t�:'AP`PROVED Rm�' 2111/2M Expiration: /2016 Project Address Parcel Number Applicant 1700 NE 105 Street Number: 412 1122300500690 REBECA PALACIOS NOVAS Miami Shores, FL Block: Lot: Owner Information Address Phone Cell REBECA PALACIOS NOVAS 1700 NE 105 Street (786)547-2572 MIAMI SHORES FL 33138-2145 1700 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone VINWARD CONSTRUCTION CORP Valuation: $ 1,000.00 (786)251-2398 Total Sq Feet: 450 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Framing Type of Construction:REMOVE CARPETING IN TWO BEC Occupancy: Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Planning Bond Return: Classification:Residential Review ElectricalReview Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural CCF $0.60 Review Mechanical DBPR Fee Invoice# RC-2-16-58533 $2.00 02/02/2016 Credit Card $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 02/11/2016 Credit Card $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 info on is accurate and that all work will be done in compliance with all applicable laws regulating cons fU tion and zone . Futhermore,I e a ve-named c ctor to do the work stated. February 11, 2016 Auth rized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 11, 2016 1