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RC-15-1607 .. ........ -CC, -Alf F v ............. t nl -I log 1:4 v Ic za v=10 lorij I Ic 17" Iz, pT om.,W, Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-253518 Permit Number: RC-6-15-1607 Scheduled Inspection Date: February 25,2016 Permit Type: Residential Construction Inspector Rodriguez,Jorge Inspection Type: Final Owner , Work Classification: Alteration Job Address:70 NW 105 Street MIAMI SHORES, FL 331504242 Phone Number (305)793-0002 Parcel Number 1121360131210 Project <NONE> Contractor. PRIME MASTER DESIGN INC Phone:(786)3442336 Building Department Comments REMODEL KITCHEN AND 2 BATHROOM,CONVERT Infractlo Passed Comments GARAGE TO STUDIO OFFICE WITH BATHROOM 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 24,2016 For Inspections please call: (305)762-4948 Page 21 of 29 INSPECTION RECORDg POST ON SITE Pennit No. RC-6-15-1607 Miami Shores Village t - ;r 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)785-2204 Fax (305)758-8872 Issuee Date:9/14/2015 `' .... . � 5 Expires.03/02/2016 INSPECTION REQUESTS: (305)762-4948 or Log on at https://bldg.miamishoresvillage.comfcap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel#:1121360131210 Owner's Name: Owner's Phone: (305)793-0002 Job Address: 70 NW 105 Street Total Square Feet: 1700 MIAMI SHQRES, FL 33150-1242 Bond Number. Total Job Valuation: $ 11,500.00 WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM-6:00PM.NO WORK IS ALLOWED ON Contractors) Phone Primary Contractor SUNDAY OR HOLIDAYS. PRIME MASTER DESIGN INC (786)344-2336 Yes BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. AL CT OAMAMMft All am � ybftl _ THIS mu�'; --@I WMIN I I OB ARAM MUG kqMMwxlbWCMbe torr+ ;� �ily�rd�fc rrn�t r��►rr�lt , NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Q .F t INSPECTION RECORD41 -. INSPECTION DATE INSP INSPEC11ON DATE INSP 1 CnONf NSp_ Foundation Zoning Final O Z ZONING COMMENTS c.l� Slab Water Service Columns(1st Uft) t « ! V-- 2"d Rough ,Columns(2nd Lift) Top Out Tle Beam Jr"�f/L tt j '� Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors,L4Gas Interior Framing INSPECTitt DATE iNSP LP Tank Insulation Temporary Pole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall s«f•,," �' Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence, Wall Rough Z,411A W0,10/ HRS Final Screen Enclosure Ceiling Rou Driveway Rough PLUMBING COMMENTS Driveway Base Telephone Rough A/ Tin Cap Telephone Final Roof in Progress TV Rough Mop In Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails . Intercorn Final mini Ate corr►'liance Alarm Rou h INSPEt7((SN A DA[E NSP Alarm Final UndergroundPipe DOCuMENTS Fire Alarm Rough A. Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert Service Work With Floor Elevation Survey X&>S ! Ventilation R h Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURALCOMMENTS Final Vacuum j #N�CHAN COMMEf�,TS. INSP CTIONpg1 E INS 21 Final:$ rinkier- Final Alarrrt. ee Oct 08/-RV&31109 Fermin A. Martinez, P. E Professional Engineer. Ns: 19363 8340 SW 65 Avenue, Unit 3 Miami, Florida 33143 Ph.: (305) 298-3216 FINAL MASONRY REINFORCEMENT AFFIDAVIT February 26,2016 Miami Shores Village Building&Zoning Department 10050 NE 2nd AVE Miami Shores,Fl. 33138 Re: Remodeling to residence of Trusted Home Buyers LLC 70 NW 105 ST. Miami Shores ,F133150 Permit# Rc 15-1607 Dear Building Official: I Fermin A.Martinez,P. E.Ns: 19363,hereby certify that I inspected the reinforced masonry; 1#5 vertical tie downs in concrete poured cells at the sides of the wall openings as per the approved plans. This document is being prepared in accordance with section 2122.4 of the Florida Building Code and is being submitted to the City of Hallandale Beach Building and Zoning Department at the time of the final inspection for the above referenced structure. Should you have any questions or need additional information,please do not hesi�tatI p contact me. 0000 r�sl f••o a `. �:•�e,G NSA 4 19363 ° LAO i O pp d iI • �. O ye+1 0,®q0�0®0 F1YU /1111110/ INSULATION CERTIFICATE Building Permit No:RC_G-15-/60-7 Project Name Project Address: 70 lw 10 5 �'T STa MENT OF COMPUAM We,the undersigned,hereby certify that the THERMAL INSULATION Installed in the above referenced project Is In compliance with the latest edition of the FLORIDA BUILDING CODE,the APPROVED ENERGY CALCULATIONS and Pians, and is in accordance with good construction practice. The Insulation furnished and installed has the characteristics shown below:(Circle the applicable Items). 'TWSUWG 13 % "J— Extedor CBS k!Insulation: R-5,,,,,,(MIn.) Material: ��OM U fa .•e 0 - Thickness: inches) Density: Ib/ft Mfr: G W IF $2)Exterior Frame/Metal Stud Walls: R- (Min.) Material: Thickness:_ inch(es) Density: Ib/ft Mfr: 3)Exterior solid concrete watts: R- (Min.) Material: Thickness: Inch(es) / Density: Ib/ft Mfr ,._ lrrt dw web separating'A/C frog C C'a')I SMa. ins��' non A/C sees insuiatlon: ` R-_ 1 _(Min.) Material. Thickness: inch(es) Density: Ib/ft Mfr S)MULTI-FAMILY RES1004 IAL CONSTRUCTION ONLY:The COMMON(Party)walls to two separate conditioned tenancies shall be insulated to a minimum of R-11 for frame walls, and to R-3 on both sides of common masonry wails.See FLORIDA BUILDING CODE 2010—Energy Conservation,Section 402.2.12.These"minimum levels of Insulation",are not Induced In the Energy Calculations,but shall be Installed In the field. r^ G Ceding Insutatlon: /i R, _ (Min.); Material: Ei &< Thickness:&�5 Inch(es): Density:�+$q Ib/ft: Mfr: W—_Com "ote:Do not use this form for lighbvelght insulating concrete. Installed by(select one): Insulation Contractor General Contractor/Builder �s S� cit CGC 15--o'SISD (company name) (CC number) (company name) (CC number) ?4" A44Dxkt)nque7 CGS (contractor's name} plcense number) (co s } (license number) JO ® /6 ma (contractor's signature) (date certified) 11" co ttgnaKre) ( e certified) SWORN AND SUBSCRIBED before me by e dr-o A rri I n 5 V, � .beim personally known to me( )or having produced as Identification EL.PL bSS'AO 73 W /V ,� ,and who being fully sworn and cautioned, statestV fpregOng Is true and correct to the best of his/her knowledge and belief. Signature of Notary f Print Name BENSON I! Notary Public-State of Florida My Comm.Expires Dec 10,2016 Votary Public: NOTARY PUBLIC STAMP BELOW My Com � es:Commission a EE 857464 .n ` Bonded Tft qh National Notary Assn. INSPECTION RECORD POST ON SITE Permit NO. RC-6-15-1607 % Miami Shores Village un 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 AftratiOn ®o`$ Phone: (305)785-2204 Fax: (305)758-8872 �e>Ft10� Issue Date:9/412015 03/0212016 Expires: INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.cofWcap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day Inspections. Residential Construction Parcel #A 121360131210 i Owner's Name: Owner's Phone: (305)793-0002 Job Address: 70 NW 105 Street Total Square Feet: 1700 MIAMI SHOR S F R. 1 0-1 4 Bond Number: Total Job Valuation: $ 11,500.00 WORK IS ALLOWED MONDAY THROUGH SATURDAY,s Contractor(s) Phone Primary Contractor 7:30AM-6:0012M.NO WORK IS ALLOWED ON (786)344-2336 Yes PRIME MASTER DESIGN INC SUNDAY OR HOLIDAYS. BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. 3 ? r MMU h�.. . . SHORES VI,AGE Fbr Driveways and/or SidwaNcs, final Inspeclion,and bond can be appoWforftnd;all sod and yard work . m�ict ha�mm�lrt�, NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD INSPECTION DATE INSP INSPECTION DATE INSP M77 INSP ZONING Foundation Zoning Final ZONING COMMENTS �„c S. Slab Water Service Columns(1st Lift) t L $t 1 '" 2"d Rough Columns(2nd Lift) I Top Out t' �V Tie Beam $ t1 .I Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors Gas Interior Framing INSPECTION DATE INSP LP Tank Insulation Temporary Pole Well CeilingGrid 30 Da TemporaryLawn Sprinklers Drywall Z-f g,'- 1.4 Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rou h �1HRS Final Screen Enclosure Ceiling Rou ., PLUMBING COMMENTS Driveway Rough Driveway Base Telephone Rough 1 /Y e— Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final ADA com liance Alarm Rough INSPECTION DATE INSP op Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert Service Work With QS R Floor Elevation Survey dOVentilation R h Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum ® MECHANICAL COMMEIM INSPECTION DATE INSP Final Sprinkler vita viv Final Alarm Oct.08/RV 8/31/09 Miami Shores Village Ruil epartment DEC 092015 n, , iami Shores,Florida 33138 BY,� REVI :(3�{ ) Fax:(305)756-8972 N NUMBER:(30S)762-4949 FBC 20(p BUILDING Master Permit No.RC 6 15 1607 PERMIT APPLICATION Sub Permit No. ®BUILDING ❑ELECTRIC ❑ ROOFING ® REVISION ❑EXTENSION ❑RENEWAL I []PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS; 70 NW 105 SST city, Mlaml Shores C-0u0_t)C- Miami Dade zip: 3 fs� Folio/Parcel#:11-21-36-013-1210 is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: SFE: FFE: OWNER:Name(Fee Simple Titleholder):Trusted Home Buyer, LLC Phone#.305-793-0002 ,,ddress- ;12864 Biscayne BL,#271 qty; North Miami State: FL gyp; 33181 Tenant/Lessee Name: N/A Phone#: Email: DonBaumann7@gmaii.com CONTRACTOR:Company Name: Prime Master Design, Inc Phone#: 786-344-2336 Address: 5954 SW 4 ST CRY; Miami State. FL ap; 33144 Pedro Dominguez Ph786-344-2336 Qualifier Name: g one#: State Certification or Registration#: Certificate of Competency#: CGC1508150 DESIGNER:Architect/Engineer: Fermin Martinez Phone#: 305-298-3216 Addres8340 SW 65 AVE,#3 Miami FL 33143 s: City: State• Zip: value of Work for this Permit:$Same/window change Square/unear Footage of Worts Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Wo&. Change window size at West side of garage enclosure to 60"x 36" Specify color of color thru NO.. Submittal Fee$ Permit In$ C CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ - Technology Fee$ Tralnrng/Education Fee$ Double Fee$ Structural Reviews$. C) Bond$ TOTAL FEE NOW DUE$ (ReW"d02/24/2014) ` 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. 1 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$2SOD,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 inspecdon will rat be roved and a reinspection fee will be charged Signature Signature , c OWNER or AGENT ONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of T=C .201 ',by A? day of ,20 /1- .by XIC.4 &,.(d ~A"Ns personally known to ra who is personally known to me or who has produced t as me or who has produced F01- -0 55,7-673-40-173"0 as Identification and who did take an oath. Identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Seal: Seal: �, Cem� 10.2018 ' +w Notary Public State of Florida C 0 EE 857484 Joanna M Feliciano sm" �g My Comminim FF 082753 **essssss**asst s 8lrr tlssssrsrr sr*s*s•srsrssr ss *s*sass*tsar*asst****sssssssssrssrsssrrrss APPROVED BY I+ Y Plans Examiner Zoning Structural Review Clerk (ReAwd02/24/Z14) r } c r Miami Shores Village y. 10050 N.E.2nd Avenue NW ., Miami Shores,FL 33138-0000 i' '' • "'f !� Phone' (305)795-2204 '£ Expiration:0310212016 Project Addres Parcel Number Applicant 70 NW 105 Street 1121360131210 TRUSTED HOME BUYERS LLC MIAMI SHORES, FL 33150-1242 Block: Lot: Owner Information Address Phone Cell TRUSTED HOME BUYERS LLC 12864 BISCAYNE Boulevard (305)793-0002 NORTH MIAMI FL 33181- Contractor(s) Phone Cell Phone $ 11,500.00 PRIME MASTER DESIGN INC (786)344-2336 Valuation: �- Total Sq Feet: 1700 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:REMODEL KITCHEN AND 2 BATHR Occupancy:Single Family Framing Stories: Exterior. Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Electrical Certificate Date: Additional Info: Review Electrical lBond Retum: Classification:Residential Review Planning Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building Bond Type-Owners Bond $500.00 Review Building CCF $7.20 Invoice# RC-6-15-56142 Review Structural DBPR Fee $5.18 06/26/2015 Check#:1216 $200.00 $963.56 Review Mechanical DCA Fee $5.18 09/04/2015 Check#:1226 $963.56 $0.00 Review Mechanical Education Surcharge $2.40 Bond#:2829 Review Plumbing Permit Fee $345.00 Review Plumbing Plan Review Fee(Engineer) $120.00 Review Plumbing Plan Review Fee(Engineer) $160.00 Review Structural Scanning Fee $9.00 Review Structural Technology Fee $9.60 Total: $1,163.56 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 AFFIDAVI 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con cti nd in Futhermore,Zrize the above-named contractor to do the work stated. September 04,2015 ortz nature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 04,2015 1 b Miami Shores Village Building Department 1 JUN 26 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY. Tel:(305)795-2204 Fay(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)7624949 FBC 20 LQ BUILDING Master Permit No. 'CZC.1 -- (40-4- PERMIT APPLICATION Sub Permit No. ®BUILDING M ELECTRIC M ROOFING ❑ REVISION []EXTENSION ❑RENEWAL []PLUMBING ❑MECHANICAL []PUBLIC WORKS [] CHANGE OF CANCELLATION M SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 70 NW 105 ST City Miami Shores Coun • Miami Dade 7.io: — Folio/pa e;11-21-36s013-1210 U theBui�ing HistoriwHy Designated:Yes No Occupancy Type: Load: Construction Type: Flood Zone: X SFE: ' FFE: OWNER:Name(Fee Simple Titleholder):Trusted Home Buyers, LLC Phone#:305-793-0002 Address:12864 Biscayne BL,#271 City: North Miami State: FL zip: 33150 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: Prime Master Design, Inc. Phone#; 786-344-2336 Address: 5954 SW 4 ST City: Miami state. FL yip: 33144 Qualifier Name: Pedro Manuel Dominguez Phone#: 788`344-2336 State Certification or RegWratlon t CGC1508150 Certificate of Competency#: DESIGNER:Architect/Engineer: Fermin A. Martinez Phone#: 305-298-3216 Address:8340 SW 65 AVE, Unit 3 qty: Miami She: FL ZIP: 33143 Value of Work for this Permit:$11500 Square/LMear Footage of work: Type of Work: ❑ Addition N Alteration ❑ New N Repair/Repiace ❑ Demolition Description of work: Remodel kitchen and bathroom, Convert garage to Studio/office with bathroom. Specify color of color thru We: Submittal In$ Uy✓ Permit Fee$ CCF S _. CO/CC$ Scanning Fee$ 1ffRadon Fes$ DBPR$ ,Notary$ Technology Fes$ Training/EducrMon Fee$ U Double Fee$ Structural Reviews$ d Bond$ 0 a TOTAL FEE NOW (Revised02/24/2M4) q�3 -5;� f s w t 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 constriction 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$2504 the appikont must promise In good faith that a copy of the notice of commencement and construction lien low 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. Signatu� Signature OWNER or AGENT ONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20/ by _day of V)/! r/ .20 ZJ ,by &A ,L who/is personally known to M re who Is personally known to me or who has produced��- 174 ' as me or who has produced L,D532-673-go-173-D as identif c o id take an oath. Identification and who did take an oath. TARY PUB NOTARY PUBLIC: Si Sign: Prin e---lfrint. Seal: .a�" 'r d'•'., rlda CHARLOTTE ANTI tiFFMlO Seal: ,y`�� Notary P�tic'State of Fi 201 lAy comm.�as Dec 10,2016 Notary Pubis-St a of Florida z �p Comnrisslon•EE 887464 Je P=My Comm.Expires Feb 28 2018 '�., r` Booed rnra* Notary Assn. -•., �`, Commission M FF 068163 , •:, ,�,,,�:.. rte. APPROVED BY j J tans Examiner �!< Zoning Structural Review Clerk (Revised02/24/2M4) Detail by Entity Name Page 1 of 2 Detail by Entity Florida Limited Liability Company TRUSTED HOME BUYERS, LLC Filing Information Document Number L12000034482 FEI/EIN Number 30-0762710 Date Filed 03/12/2012 Effective Date 03/12/2012 State FL Status ACTIVE Princioal Address 12864 BISCAYNE BLVD 271 NORTH MIAMI, FL 33181 Mallina Address 12864 BISCAYNE BLVD 271 NORTH MIAMI, FL 33181 Registered Agent Name&Address BAUMANN, DONALD AJR. 12864 BISCAYNE BLVD 271 NORTH MIAMI, FL 33181 Authorized Personas} Detail Name&Address Title MGR BAUMANN, DONALD AJR. 12864 BISCAYNE BLVD,#271 NORTH MIAMI, FL 33181 Annual Reaorts Report Year Filed Date 2013 05/01/2013 2014 04/30/2014 2015 04/30/2015 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/26/2015 05/20/2015 12:04 3059640889 PGI<ENTERPRISES°> PAGE 01/05 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD AMMMMMt- CGC4508150 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS_ .Exp€ration date: AUG 31,2016 M. •• M'•` ■ ❑ ❑ .. OMlNGUEZ, PF�RO MANt��L..: •: :'..:.: . ,.' . . ':'4,;,;:'.:.:::• '.,:.:.: t�RlME MASTER DE${GN;€NAL:' ... ... .. .. ::,°.r:::n�''+.::?:"�'»r�•`'.`•ti<:5a��;::rJ4:;:yM1r' � ...5954 SW 4 STREET..:.,:::..::,::... _.'..':':.-.y.w •�: ,.•,ti:: x:� '4:,•` :.;: :.:.:.. :.MIAMI ••FC:3:�'I��i4'=3325 F ISSUED: 07/01/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407010001377 RICK SCOTT, GOVERNOR KEN LAWSON.SECRETARY 'STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1428121 The PLUMBING CONTRACTOR -Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 DOMINGUEZ•PtDRO•MANUt;L�::.-..: . PRIME MASTER..DESIGN,1I4C"-'--,.;,,..:: 5954•SW 4 STREET.. :'.::':•:•� .. '��:�' -MIAMI. •''FL 33144`3325 .. ■ ISSUED: 06/23/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406230000541 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CMC1249324 The MECHANICAL CONTRACTOR -Named below IS CERTIFIED .Under the provisions of Chapter 489 FS. : Expiration date: AUG 31,'2016 : DOMINGUEZ, PEDRO IVIANlIEl PRIME MASTER DESIGN PI�f+�::, -6954.SW 4 S7RE1*I' > ... .. F..�...._ :..,:;'•::,` `.. MIAMI "I"L:33'f4�4-3325. :. ❑. iaa�:cn• na»ar�nt.t niGPi AY AR RFOIIIRED BY LAW SEQ# L1406230000682 05/20/2015 12:04 3059640889 PGI<ENTERPRISES°> PAGE 03/05 oosaae c .3 •t�'. l tir '•�•::�� :1. �"�":��'i; ��•Y•.ci`v::�,'1X:. .tu;: '^!3J3 •E»:vtSYd:ti:: :{•:: ?:?.iS:Y':« •p'}<:Y :iY,'`!5 M1'' i?>.. s}Fi 't}'?:'.:' ..9 wyyF:(. ;:�t<':.5 :'i ht• •:}: SI:"J: ,�•+ft r'�j"Za:•'.e n ::t:'` :•lr 'N� :•'d1L1.i;:..;D�b:".: `.i`iai�,•.:.s:::i.r:';''�:``i<"`•�' .o.•a J-r.tii :i?': �!5 i ,i:.r_ `".?;'> r•r:tsJk« -•3 tAt; yy, ��.^ '��;•'.:�>'.-P'j-.-t7'"a_ .:.':`;::;i y,'..a n•(r::q.r::�. .r. i:'!."•. ..3 `:G i" - '.:3.. r' �'. •� v�'r s?....v.Ji!•"`.`.'i.1:�. :PR' R'{� •�;�+.p'b } ]{�L{�u� i:i:^::••�:i:;il;^�' ,��y�], r'.Ss_ .,� .�3i r",•.....,.t 'IM I.WV%M�{ '•NAV,' .•f.• .::.i Wrli� C, r"h' `554>• +�" `:�' � .<>• :h .•l1nN'Utlll:• '•9J Y.. ��y ::d�ryry �,.�•� .};. �r. •BZ781NBSffi�'��-�=�';." PAYAA@N7' ..::.•• ..• :: 1� GEN R14 'B1JitbING C Nr r QR tkecs�v�&t►:;r.;:`:;c::::::: PRIME ii NSTER DESIGN INC.`: • •.•. BY TAX cisce„fcroti-:-- : :Wtitite�i(sj 1 :.CGC1606ibtf' r" • ::;::. :'. :•:.�•: ... �• x.00 08jii/20TH .. ..". ?bistoEaE'BusinessTefx:tfecaiptatifijt w+Hrn9spapga tofttie'[at BodfiessTax.Thea ::;:`` netelir.�i ;:: ';•'`?•`: pMM%---*4 4 os mt:of the hohh3r.s oodaft m do badness.Hohtern}9nst• or ni'tdtata�Yiau .aitesvnhlaha�Wq�tl�ebu�iteF:=': • •7de�AECEFPTD@Orabovenu�'t3edF�rfayedoaidlb�iriiaiwialvohloia9i�`IbAi8N�8de,'CtideSoctie,�78, Fataliq diamden.9}isif'Y 'i'i"I lift I *fm 05/20/2015 12:04 3059640889 PGI<ENTERPRISES"> PAGE 02/05 Ot3�ta Coen!-BuMnetx•: ipt S T1" Ma1T1i--Dade•County; ..-Siiie .: of.:::Florida ..• 7)RS IS !NOTA BILL- DO NOTPAY • . 6599053 ... .. LB, T -BiNtNa$stt: PRIME MASTER DESIGN INC, REMIEWAi: EMER-30, 0; S• 5954 5W 4 ST 158 9821 MusCiie displ4vad at olaco of business MIAMI Fk 33144 .: Pursuant to County COcta Chapter 8A-Art.B&10 OWNER SEC.TYPE OF SUSINS96 PRIME MASTER DESIGN INC .198 PWMBING CONTRACTOR .. PAYMlsNr IMCEN10 . BY TAX COLLECTOR CFC1428121 Worker(s) 1 :$45.00 07/15/2014 CHECK21-14-021395 This Local Business Tax Receipt wayc"mas paymeat td the Local Bulness Tax.The Reasiptis sot a Itceam..• patmit,of a aertiRtsUat►olusa tw i squsiNkations,to da basiaass,Holder am zompiywith any gw aram"m or aaagovemmaMal regulatory tabes and requirements which apply to the iarshmm Ilia RECEIPT No.above mm be displayed on all cemnwnial vabioias-Mised-Uada'Codo sot$a-= Forman irstannation.visit CERTIFICATE OF LIABILITY INSURANCE . _ � t,s THIS c9nFICATE IS SUED/e8 A MATTUt OF INFORM/ITIOt�1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TNS CERTIA"TR DOE>?i NOT A FFIRMA11VELY OR NE"TIVEI tY AA-6i$ND,PJ(T�IQ OR ALTER TiiE E AFFORDED BY THE POUCIES BELOW, THIN CERTIFICATE OF INSURANCE DOi�NOT t 111 UTE A CONTRACT BE7WL°EN THFB ltaSWNO iNSURERM),AUTHOR= REPRIgffiIENTATIVE OR PRODUCER,AND THE CEMFICAI IL'HOLDER. _ E ®APOR'CANT: ifim etolosm holder is an AD�97�AL 911SURED,'ha poiMAW�!bs endorsed.1f M A7"181NANED,m&O to the teens aid of the poft,ewn pow MR require M wMmmn A on This�Ttl doss not infer �the oerfNh�elmi�rMueu,s4�emeTtt{s). .. _ . , ._.� . south Paoft Profee WW In. 1400 K W.48th Street _ _... Hialeah.FL 33012 Phom (308Wt8-3636 (3 Fox OP25.88fIa nett 51 e _ +�aa s _ UNITED SPECIALTY INSURANCE COMPANY R 0931ON INC PR1ME MA3TE . am SW 4 STREET MIAMI,FLORIDA 33144 LLAXt30B)a!!!! mhhgu yah0o.*cm COVERAGES CER"MIGATE NUMBERI� REVISION NUMBER:' THIS i8 TO CERTp'THAT THE POLICIES OF OMRANCE Lwko ELOW BEEN=UFO TO THE NtatlliED NAMED ABOVE FOR CFiB PQLtCY PERIOD INDICATED. NOM MOTANDM ANY REQUIRENBNT,TERMOR MM OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERwiCATE MAY sE ISSUED OR MAY PERTAIN,THE INWRANC AppORDW BY THE MMIE8 OEWRIORD HUM 15 SMECT TO ALL THC TERMS. EXCLUSIONS AND ODNornoNB OF SUCH POUCiES.LIM01'8$H0% MAY HAVE BEEN REDUCED BY PAID CLAMS, TYPE IRNNOB �N M _. LMMTB aTUtAi Lu►sslryOA014OrXIMUDICEkvgvs„ 1,0OO,Oa cnL LlAiil mr 8• ' F3 L � W1 0=111 GQD0 =1336.01 A�DIsr— �yaTmmon) $ S,OC A t — _ _ 061 tZ016 6 p anovIJAw i _ 1000 Ot�I r-1 - caaaYE p 2,000`01 11 GEWLAI9 ATN'_LMTAT MR t?RODUCTS.T' A09 63 2,0OO,Ot I III AWT Umm Sa I ea:r p mymm Sw Lr Mwuar Xpw1 1 [j ALLOYMM AIxim OILY Mw(ar F83 ❑ SCh1EDtAED AUf08 } $ l—f iso euros $ Cl Nc,I�-ow�teo�tt+a� a Lj -. "Nou"acummTM TM —EH' AnownumwUABLITY yIj ELMQHA� ANY NIA 04 --awavy 04 z.L,01 w=-ePOI.IC UwT 8 _„ phi Qp QpNptp'Ti�tT.OQAT10N9tV 1A�D tc i, l BoAed�gs,nRlmaapa�e is n ..�. ..—_. GENERAL GONTRACTOR U'GENSE S CI3 iMIG0 PLUMl191NQ G0NTRAa0 R UCENsE#OSC1428121 CAN?iM.LATiON __ —.. — --.• L4OU 0 ANY Ota IN NO TFG EXPIRATIX3N TE MIAMI SHORES VLLAGE T dE suiLDINCa DEPARTMEN nuzft — AtThht 100 NE 2 AVE MIAMI FL 38198 _ 36-Y5S•BUDT2 Olen2 ACO CORPORATION. All ftMa U pd. The ACORD fruNWO WV0 are regWomd marks of ACC 110 ACORD 26 MM")QF Td WcET:ZT SZOZ 9Z ''-n r V69 : 'ISI XHd 331 1I dcIS: WMW 05120/2015 12:04 3059640889 PGI<ENTERPRISES°> PAGE 04105 Jul.111403:06P pdmgMaster Design.4nc. ,SPF ATWATM STA,mor-FWMDA CWW MASiCAL OFMER WPARTMENT OF FINANCIAL SER+1ttCES 0WOM OF WORM W'COMPMATM •"CERTIFICATE OF ELEC'�t11g0pN TO IE EXEMPT FROM FLORIDA'Yi�RiWW COWERS'iATIESN LAW.. CONSTRUCTION M�i R r I./�.}+i w��i■\/itl n le - 'this c9�rti��te�+s�tthAat the indWiiduat Isted below has�ted'to bAe e�x+e�r{nlP11 Fland�a}�W(o�rlcer�Casten EFFECTI TI PERSM: DOMINGUEZ PEDRO M .FEK 320280898 13USINM NAM AND ADDRESS: PRIME MASTER DESIGN INC 6A54 S.W.4TH.STREET MIAMI FL 33144 SCOpSS OF BuSIt1 MS OR TRAi9E: LICENSED GENERAL LICENSED PLUMBING LICENSED ROOFING HEATING,yENTIIATION. CONTRACTOR CONTRACTOR CONTRACTOR AIR-GOND p wauact4e Chapter 440.09141 F.B.,an etRaer tt<a CCVW t M Who deMeXaMp 'fam htie chopwby MM a cKmbumbefSWJM Un M"Oft"t not recover bents or0mrOWAeNon tatdw"S do$W.?ntwaM to ChMW 44WW12).F.S..Cis of 0 b0 exec VL-aAp1Y oily"*/A 00 80*0 etitaebu64e�ortradOHsionttfantdictr slet�tmttoIreat�ntptFlasva%10Chep'4wost�3)P.s..Nottaasots +tobw•eWM*ltditsOf elWS0n 10bee> sham bw stn mmeolm K at OW t t7Rarlh�l p the AC86e tD1'Gt0 iesaaftca of tC Ito X19 Q81SG4t tt fled CIt Ott3ltt tCa OT' cergicee no lonmetmeeta me mgAm" mD*f Ws**coon for tesuoum of m oma.The dopmW OM WO W-10a ooh atmW yptOiDrfattWe 6f tlt6 penton nem on the awaa ate=meat awe f"Wmm0fftcf C+k sr n: DFS+-2Awc,=CER7lmwe or awTu N TO IE ExEmO T MOM 07.12 4tlf+$T10NS?(8�131�9 r NINE BMW Miami Shores Village Building Department xtiR1AA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWL1K*E THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. ✓ Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this � day of ai1 lJ'�- 20 lS Byj U NP&3 4 ` pvu M Q NN who is personally known to me or has produced Vl–'Dl2t V — � N �as identification. Notary: SEAL: Notary Public Stairs of Fiodda $India Alvares +� My Commill w FF 158730 �dop Expires 00972018 r Prime Master Design,Inc Pedro Manuel Dominguez 5954 SW 4 ST Miami,FL 33144 May 21,2015 State of Florida County of Miami-Dade II Before me this day personally appeared,Pedro Manuel Dominguez,who,being duly sworn,deposes and says: The he will be the only person working on the building and plumbing project located at 70 NW 105 ST, Miami Shores,FL 33150. Affirmed and subscribed before me this 21s day of May,2015,by fro.�Pp'_a & /. 'OP141wk-z /11 PA Ago � � Personally know OR Produced Indentification �- �C Type of Identification Produced b X27 &73-wo--/73-0 Print,Type or Stamp Name of Notary BWON CtUlR1.ES r' �S Notary pow-swe of PWW8 '=My Conon.Expo Dec 10,2016 Comn*SW#E EE 657484 BMW ►W"-"Assn. 05/20/2015 12: 04 3059640889 PGI<ENTERPRISES"> PAGE 05/05 {�`ri`}-�3#y ;gyri f'y(4�Ly�F y�g�'S 3,.�� 3�'W'Y�y�f�+?.� r s• �. �� V.{�1`,fi>t��- � µ.ti rlL'"dlr �'� � d�� t✓' Oaam�adk"stiri'sri et.�r:nirr� .eakN�6 t'!C C'GYiC+F7'M1�?A'�'i�•,C44Y?�'9$+'S�PMCS; i.i$i>�i:36;..