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WS-15-1202 ones Miami Shores Village Building Department IORiDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ` COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. �OPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: BUSINESS ADDRESS: �® �� Z �� CITY STATE 4'-( ZIP -330/0 BUSINESS PHONE. O __ FAX NUMBER CELL PHONE(161 �0 Wo�' QUALIFIER'S NAME: fn fi e2,60 Ine-12o QUALIFIER'S LIC NUMBER: C) 0l6 RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD qn y f. CCC044016SI� The ROOFING CONTRACTOR 1{ Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ROMERO, MARCOS W 4 M ROMERO'S ROOFING&-INSPECTIONS INC 50 W. 22ND STREET HIALEAH FL 33010 _ MYk 1 ISSUED: 07/14/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407140000446 003212 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 3618171 �LBT ) BUSINESS NAME&OCATION RECEIPT NO. EXPIRES M ROMEROS ROORNG&INSPECTIONS INC RENEWAL SEPTEMBER 30, 2015 50 W 22 ST 3780368 Must be displayed at place of business HIALEAH Fl.33010 Pursuant to County Code Chapter 8A-Art 9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED M ROMEROS ROOHNG&INSP INC 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CCC044016 $45.00 07/17/2014 CHECK21-14-022450 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, penult or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. Thb RECEIPT N0.above must be displayed on all commercial vehicles-Mland-Dads Code Sac ga-276. For more information,vishwww.miamidade.govkaxcolleotor DATE(MMIDD/YYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE 5/1/2015 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(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 Ileu of such endorsement(s). PRODUCER CONTACT Amanda Nogues Eastern Insurance Group, Inc. PHONE (305)595-3323 FAX No:(305)595-7135 9570 SW 107 Avenue E-MAIL :amanda@easterninsurance.net ADDRESS Suite 104 INSURERS AFFORDING COVERAGE NAIC Miami FL 33176 INSURERA:Kinsale Insurance Company INSURED INSURERB Ma fre Insurance Co. of Florida M. Romero's Roofing & Inspections, Inc. INSURER C:Brid efield Employers Insuranc 50 West 22 Street INSURER D: INSURER E: Hialeah FL 33010 INSURER COVERAGES CERTIFICATE NUMBER:Master 15-16 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 ADOLSTYPE OF INSURANCE UB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS MADE a DAMAGE TO RENTED OCCUR PREMISES(Ea occurrence) $ 100,000 0100023162-0 9/14/2014 9/14/2015 MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 17 PRO- JECT El LOC PRODUCTS-COMP/OPAGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE Ea accident IT $ 100,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS 4150130009430 12/23/2014 12/23/2015 BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED Par .Ids DAMAGE $ PIP-Basic $ 10,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION it AND EMPLOYERS'LIABILITY STAT TE ER ANY PROPRIETOR/PARTNERIEXECUTIVE Y"N/A C E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 830-48047 5/1/2015 5/1/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additiomal Remarks Schedule,may be attached H more space Is required) Roofing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building and Zoning Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE David Lopez/ANA m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD lht¢n9A roman„ �►� Miami Shores Village Building Department MAY 19 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Lc-=) BUILDING Master Permit No. L--`' S I PERMIT APPLICATION Sub Permit No. 0 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 1270 NE 100 Street City Miami Shores County: Miami Dade Zig): Folio/Parcel#:11-3205-009-0030 Is the Building Historically Designated:Yes NO X Occupancy Type: Res Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Lois De Oliveira Phone#:786-942-5382 Address:1270 NE 100 Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: Ibdeoliveira@hellsouth.net CONTRACTOR:Company Name: WindowM Phone#: 954-946-1553 Address: 3076 NE 12th Terrace City: Ft Lauderdale State: FL zip: 33334 Qualifier Name: James Von Wyl Phone#: 954-946-1553 State Certification or Registration#: SCC131151341 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State Zip: Value of Work for this Permit:$ 02 �i y 17• d Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of Work: Install 1 French door and 1 French door w/2 Sidelites into existing openings. No alteration of openings. &',j iy y--/s,a/owa. Specify color of color thru We: nM� Submittal Fee$ ' Permit Fee$ • c� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) t , a ' s 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 V— OWNERorAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 5 ,by day of Wat20 5 ,by 1-bis It 611v&&& ,who is personally known to S� M nauVnn W11 .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: aw Sign: 4 Print: I• '`..•°AY�"!,�� DONNA A LEAVELL Print89- . "', 'o . EXPIRES September 4,2017 •......: Seal: •a�••° p Seal: .� a*.••° EXPIRES September 4.2017 (407)3980153 FloridalloteryService.com 'y°�°" (407)398-0153 FloridallotaryService.com APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 3 05/18/2015 12:43 PM ET Windowman SFL 4 13057568972 03 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD {850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 It VON WYL,JAMES A WINDOW MAN OF SOUTH FLORIDA 2388 NE 13TH ST FORT LAUDERDALE FL 333041538 cOngratulational with this kense you become one of#*nearly one mw+uwn Fnndxwans uuce�__--__JJ ,ppm Buss end id:>�•c.'rrtrd}'s�S�'d::,r:>.e jru..�ita.w�'�: :»..w..r...,v...::.'.::": �f�by ��o!'w W,w,•t oWJo1nem mW •,: .: .^ ..:•^_'... -' .. ,.. Professional Remotion. Our professionals and businesses range Iran architects to yacht brokers,from boxers to barbeque restaurants. and they keep Florida's economy sarong. p,��P �StlS1E3S.AND Every day we work to serve irrprove the way we do business in to SCCt31151. _ 19!2014 you better. For information about our services,alease log onto ,''IE www.rr+y I%wi ucense.mn. There you can find more Information OF_R7"IFIEO P R about our divisions and the regulations that impact you,subecrlbe 'g�' to newsletters and team more about the Depwbnant's �; f ltlllNi�D ' . • e�Lass. . Our mission at the Department is:License Efficiently,Regulate Fater. , .. We Constantly strive to serve you better so that you can serve your ` customers. Thank you for doing business in Florida, �, .... and congratulations on your now license! j3 ¢£fiFrl�tEfl upi}es-lha prods}ions of'flh.4'B'fi.fl$. E> daosa-Allv87,34ie L1408490002r84 -_...._.__ _ _ DETACH HERE RtCKSCOTT,_GOVERNO__R _ _.__..._.._.......__ _..._ _. _„_. ..___...._..._...._.._.... _ _ .... _._ .. ........ 7�- w_. .- _,,_ _,......___�._., .._ _____, KEN LAWSON,SECRETARY r • Hf€RAi1IlAN �16 •~ AND t�$'Al1I' 74C-TGR ISSUED: 08/19 14 DISPLAY AS REQUIRED BY LAW gt tt a L14osv9oaf27e4 CD 05/18/2015 12:43 PM El' Windowman SFL ->13057568972 02 B�AEp COUNTY LOCAL BUSINESS TAX E FL 33301-1895—eEsa s3�-a000 115 S.Andirew$Ave., RM. A-100, Ft. Lawaerda VALID OCTOBER 1�2©i4 R�CA THROUGH SEPTEif�BER�3gt_�Lg.2tgg1p15 ik�ft#'ALOT�IER TYPF58 CONTRACTOR N A:nw.WZNDOW MAN OF SOUTH BLOR11 $tisinem Type:(GLASS AND GLAZING CONTRACTORBusume } Business Opened:a 7/12/2 0 0 0 Owner JAMES A VON WYL q Cpsnty/C*rWReg:SCC131151341 BliE0j,64g 1. ;3476 NE 12 TER ExeMPUM Code: OAKLAND PARK 9Ugjr,4Wp[tpt{e:954-946-155 3 � Machlnsa Ppb RoosmI VwAnqT pe: Tax Amount Trsr4fer Fee NSF Fes Penalty Prior Years CoNec�lon Codi Paid 27.00 0.00 0.00 2.701 0.00 0.00 29.70 g RECEIPT MUST BE POSTED CONSPIpUOUSLI IN YOUR PLACE OF BUSINESS THIS ttX�ME:i A TAX RECBiPT This tax is levied fob the privilege of dog business w(th[n Broward County and is nms..regulat"in hire.You must meet au County and/or Municipal planning and zoning req=ants.This Business Tax Receipt must be traferred when WHM YAUDATED the business is d. business name has changed or you have moved the busIt Is in ssosr1000��S receipt does not indicate r local laws and �t the business is legal o'that in# Receipt #049-14-00000005 JAMW A VON WYL paid 10/01/2014 29.70 P O SOX 7518 FORT LAQDERDALL, TL 33338 2o14 - 2015 .<., {\i:<.:.............J:�s..w..:f..r..:;i'....k.....t ...:.tAis+�•SL'?N:;Cw.t:;'-..+/n'Ri..t`:�Mi!....n.!.....n....:::::C.i?l:.'.+..:�r.+. ...r �R�fi4:+�rJ1" .?Ati• CERTIFICATE OF LIABILITY INSURANCE °A 5/119155"' PRODUCER Alexander and Greep Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 2727 E.Oakland Park Blvd.Ste 200 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Ft.Lauderdale,FL 33306 ALTER THE COVERAGE AFFORDED BY THE POLIC1ES BELOW, Phone (954)561-9496 Fax (954)561-1350 INSURERS AFFORDING COVERAGE NAIC 9 INSURED Intracoastal Fuel Services INSURER A: Cypress Property&Casual ty INSURER B: DBA Windowman of South Florida INSURER C: 3076 NE 12th Ter INSURER D: Oakland Park,FL.33334 INSURER E: Associated Industries COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF 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 CLAIMS. INSR ADD1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE D DATE GENERAL LIABILITY EACH OCCURRENCE 1,000,000 ©COMMERCIAL GENERAL LIABILITY 20P0053936-2 07/03/14 07/03/15 PREM SES Ea oc curTO RENTEence 100,000 ❑❑ CLAIMS MADE © OCCUR MED EXP(Any one person) 5,000 A ® ❑ PERSONAL&ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 2,000,000 ❑ POLICY ©PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS Perperson) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ STATI- ® OTH- EMPLOYERS'LIABILITY AWC1034322 07/14/14 07/14/15 E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? No E.L.DISEASE-EA EMPLOYEE 1,000,000 N yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Glazing license#SM 31151341 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village Bldg Dept 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Ave THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Miami Shores, FL 33138 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)OF 0 ACORD CORPORATION 1988 i MW F SOUTH FLORIDA rS 1 �V ' Customer: Zd! O l r r a L z g Job Site Address: i� G Nl i a�.� �Iry}e S Z N" a 1 a. 6 TERMS&CONDITIONS: 1) All work to be completed in a workman like manner according to standard practices and within requirements of local building codes and scope of work listed on attachment. 2) Any deviation or alteration for the above specifications require written approval of all parties and may involve additional costs to the customer. 3) We shall remove and replace windows and/or doors and cart away all debris.Any Major interior drywall damage and/or exterior stucco damage shall be repaired by the customer. Small repairs to be provided by WM after installation. 4) All Interior and Exterior caulking will be provided as per proper window installation. 5) Window sills that are damaged during the removal of the windows shall be replaced as long as sills were previously installed correctly and have not had any water damage. 6) Wood bucks that are damaged due to water intrusion and beyond repair shall be replaced with new.Additional wood framing to be paid by the customer at$50.00/per opening. Wood frame homes may have an addition cost to repair any major wood damage. 7) Actual Permit Amount from designated local Gov. will be collected in full upon completion of work.Receipt will be provided. WARRANTY: Installation and labor for one(1)year for the date of completion. Pricing break down as follows: Windows$_16,572.09_(CGI Estate See Attachment) Installation$ 3,365.00 Permit Processing Fee$ - 0.00 Total Price$ 19,937.09 t31 50%down $ _9;968.55 date Y-/K-fr initial payment �� aeo,vo/#as3?S8 35%down_$ _6,479.55 date upon delivery 15%down—$ 3,488:99 date upon completion Customer Signature ` 02 date Jq J5 Salesperson Signature date4/- 3076 NE 12`h Terrace Fort Lauderdale,FL 33334 Office#:(954)946-1553 Fax#:(954)941-9804 Glazing Contractor SCC 131151431 r Miami Shores Village 4'-� � ,y Building Department F E 3 , 2m 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FHC 20 10 BUILDING Pert No. 3�S PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS:—Li 4 b N E 'TL $) City: Miami Shores County: Miami Dade Zip: 33 1 3 _ Folio/Parcel#: U- 32-0 6--0 L!'-000 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): d LZ YA$. Phone#: Address: 1'x'1' o X0 q l -_:T City: ttuwo 51I91t5 State: - Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: "At�vt % Phone#: 305 2-572- Address: 11001 MUIva S 1W1 3 2 � City: . 0 State: Zip: �'�1 '7 67 Qualifier Name: A Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: a Phone#: Value of Work for this Permit:$Z L_(50 Square/Linear Footage of Work: -5�0 Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 57"A�:T ifIrd G®Yb4 FTC� A J IQ/L.O Color thru tile: 2, Submittal Fee$ Permit Fee$ � CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ + TOTAL FEE NOW DUE$ \ • 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 b delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement m be posted at the job site IV for the first inspection which oc rs sever (7) days after the building permit is issued. In a absence f such posted notice, the inspection will n oved d a reit'Opction fee will be charged. Signature Signature " Owner or Agent Contractor 06 The fore oipg Instrument was ac owledged befo m s The foe g instr��um t was c ledged befo�this day, ,20�,by tZ u of V'n' 20 I by r h produced o is ersonal kno to a or who has produced w �-perso ly kno to me o who has p p y identification and who did take an oath. entification and who did take an oath. NOT P LIC: - NOTARY PUBLIC: - .i Sign: Sign: Print: Ct.PUDIA V.CUBI of Florida pmt. cl aUala v state of Florida 15 _ nota Y ues Sep 23.2 =..y�••.,• ota(Y s e My Commission Expir (; .� y My Cot*, , FxP #EE 128810 My COmmissi any o15 ion#EE 128g1 Assn. Commission Assn. ' Comm 1 NotatY o; nal Notary `.o, ou h Natrona ",;e Bonded lhtough Natio :,� 'f��F o Bonded tht 4 4esFaks4ieir4nt&skFr4ro4dr4esY4r4esk ak alr�evrdesY�e�Y�r�eaY�raYaYv`rxY�e�e�r�rdaaY�a3tak�tsYtk�rtkdt�Y�ededearda�asY�rakalr�r�takaYa�e�rhe&�r�r�Y �k sv-- —r—Zrk9rrdedt—a—r�YsYskaFs&�r�e�e�rdasY�a APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 5/2t2012XR'evised 3/12/2012)XRevised 06/10/2009XRevised 3/15/09XRevised 7/10/2007)