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REV-16-326 Miami Shores Village r -�:=: - ��� � Bu i id i ng Dep a rtm a nt FEB o 4 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ( -- Tei:(305)795-2204 Fax:(305)756-8972 - INSPECTION UNE PHONE NUMBER:(305)762-4949 FBc 2014'TIL, BUILDING Master Permit No. M-15 -06 (e PERMIT APPLICATION Sub Permit No. VT--q i to r-jBUILDING ELECTRIC ❑ ROOFING REVISION EXTENSION E]RENEWAL ❑PLUMBING MECHANICAL []PUBLIC WORKS ❑ CHANGE OF []CANCELLATION [] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �Z -L� st- City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type:Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): jd tom• WCL Phone#: L96- 3!/'g'10-7 Address: Z C ity: �S State: p( zip:. 3l 3G Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: &&14/—q-tf fir-(0/i:�C Phone#: .3 o -%x x4 -7S Oq Address: �' S l/� S`•� 3 2. City: AA j it i (� State: Zip: .� � � 1 y Qualifier Name• Phone#: 30.S- 2-©2-:3 8"7 3 State Certification or Registration#: CAC 19 t ju q q 2_ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 3 60 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: R6 L d r&-f a A 114 A& D R e Q I A C e ALL Specify color of color thru tile: Submittal Fee$ Permit Fee$ a CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ '9 J� (RwhedMA4/2014) S w � F 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 herby 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 Signatur OWNER or AGENT CT The foregoing instrument was acknowledged before me this The foregoing instrument s acknowledged before rme this 2,day of && .20 /-/& ,by 2) day of 20 by a who is sopa *flown to YO r(j" e f`�who is personally known to me or who has produce as me or who has produced ir(_ f as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY P1.181,10 Sign: Sign: 4101A M.Pr /�R" ` e� a ►may PuaB[•5 r Myy�m.Mi lid of Flea � IA�r WmT.yeyea t. "TAIS"#FF 107443 aaasmaa�r.ff Bret �,� �+ o t �%�+. �• M1►COM.Expires Fab 9,2018 ofa° glup,gtaarccKcray ,_ ' :";� BsMxkd01rau0hppg rs s s �s sssss �ns ssssess**sssesssa�stss+stsssMe+►sesassssrsseessssssasss�ss APPROVED BY PExaminer Zoning Structural Review Clerk (Rftls z4=4) b To: Miami Shores Page 2 of 3 2016-02-04 20 23:35(GMT) 13055039646 From: CRISTIAN FERNANDEZ {.�.�3?. ¢, 't ��'�;t^ �5»q ,ktrM:.F.a- r°:•`+,r ��k,:' "'2• �,�,�t z`'yv, e�.� ,���'''!vt _ sisi+g�. �.. �' w � ��i ,��"��`� �svr�"�ni�� .'�'* t ! �w.s`E' ti � �'i'i,�r�. s3. .��� yk• ,,' ".aa.!i�+ �4 `� t. � }s-.�v�ti�� ,t,�' ✓ .�a w�-�,�..�Afv^i �f tics--. �Y"�'��°^�3�1�'� Y'. j1 t`��a�\ To: Miami Shores Page 3 of 3 2016-02-04 20:23:35(GMT) 13055039646 From: CRISTIAN FERNANDEZ CERTIFICATE OF L ILITY INSU NICE DATE(KW2016 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: N the certificate holier Is an ADDITIONAL INSURED,the poiloy(les)must be endorsed. H SUBROGATION 18 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 _..._ _.....____..._ Best Option Insurance Brokers,Inc (305)859-7303 866 910-EL483 3400 Coral Way Suite 500 i x"Cbestoptianinsurenoextet Cored Gebles,FL 33145 INSURER(S)AFFORMG COVERAGE NAIC 0 Phone (305)859-7303 Fax (866)910-0983 IN SURER A: Grenada Insurance INSURED INSURER a: INFINITY New Service Company I SURERC: 501 SW Ist ST#302 INSURER o: NORMANDY HARBOR INSURANCE COMPANY _ MIAMI,FL 33130 pVSURER E:I COVERAGES CERTIFICATE NUMBER: NSURER F, 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. DISR AWL UB _....._.. ._ ..___.. -------- L TYPE OF INSURANCEISM POLICY NUINBER CY EFF PCd ICY ExP tJBtiTB MV COMMERCIAL WNEI AL LIABILITY EACH OCCURRENCE S 1,000,000.00 ❑ ❑ CLAIMIs.MAOE © OCCUR PREMISES(Ea ona,rregsg}— s 100,000.00 AN N 0185FL00073289 0810412015 08/0412016 MED EXP one mc" S 5_000.00 ❑ PERSONAL S ADV Ir-1 URY S 1.000,000.00 GENT AGGREGATE LIMIT APPL ES PER: I GENERAL AGGREGATE S 1 0000 .00 ❑ POLICY F-1PRO-T ❑ LOC I PRODUCTS•coMlProP AGO s1,000,000.00 ❑ OTHER $ ........_......_._...._.._...._._ AUTOMOBILE LIABILITY I BINEUN BUGLE LIMIT rr,e ❑ ANY AUTO ( BODILY INJURY(Per Pmm) S 25.000.00 AUT ALL OW NED Auros BODILY INJURY(Per aockferd S SCHEDULED B ❑ O ® N N 509800014081001 12103(2015 12/03!2018 _ $0.000.00 NOKOWNED ❑ HIRED AUTOS ❑ AUTOS .R ! S 25,000.00PI NIRR DED-$1,000 s 10,000.00 r-1UMBRELLAt.u►B FJ OCCUR EACHOCCURRENCE s El EXCESS UAB CLAIMS-MADE i AGGREGATE $ DED 0 RETENTION S S YORKERS COMPENSATION PER OTNa AND EMPLOYERS'LIABILITY Y r N { o ANY PROPRIETOR+PARTNMVME.E.EACH ACCIDENT S 1,000,000.00 D OFFiCERrMEMrBEREXCLUDEEP CUTIS—�NIA N NHFL0032152015 101/08/2016 01/ 017 (Mandatory U YYes,desalbe under E.L.DISEASE-EA EMPLOYE S 1,000,000.00 DESCRIPTION OF OPERATIONS balor E.L.DISEASE POLICY UNIT S 1,000,000.00 I i DESCRIPTION OF OPERATIoN81 LOCATIONS I VE14CLE3 Otlsah ACORD 141,AddNtonat Remarks Schedule,6 more apace is required) License#CAC 1814442 CERTIFICATE HOLDER CANCELLATION ................... .._............._.....------......---.............................. j SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE Miami Shores THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WTTN THE POLICY PROVISIONS. Miami shores fl 33138 _— AUTHORtzED REPRESENTATIVE E i , ACORD 2S(2014101)OF ®1OW2014 ACORD CORPORATION. All rights reserved. The ACORD Llano and logo are registered marks of ACORD