Loading...
PL-14-2642 Miami Shores Village 10050 N.E.2nd Avenue NW ri Miami Shores,FL 33138-0000 3 " Phone: (305)795-2204 a z•• Expiration: 03/27/2016 PS e Project Address Parcel Number Applicant 102 NW 108 Street 1121360100010 DOUBLE TT LLC Miami Shores, FL 33168-4313 Block: Lot: Owner Informadon Address Phone cell DOUBLE TT LLC P.O.BOX 90393 KEY BISCAYNE FL 33149- P.O.BOX 90393 KEY BISCAYNE FL 33149- Contractor(s) Phone Cell Phone Valuation: $ 3,200.00 EF DESIGN&CONSTRUCTION (305)409-4581 Total Sq Feet: 0 Type of Work:NEW TOILET,NEW VANITY,NEW TUB AND Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# PL-12-14-53772 DBPR Fee $3.38 12/04/2014 Credit Card $50.00 $191.16 DCA Fee $3.38 Education Surcharge $0.80 09/29/2015 Credit Card $191.16 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $241.15 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, DOWS,D ORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoi informati ate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize th above-na or to do the work stated. September 29,2015 Authorized Signature:Owner / Appli t / Con / A ent ME— Building eBuilding Department Cop September 29,2015 1 Miami Shores Village CE vfv Building Department SEP 2 3 2n 5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No. PC I L-1 — 2 6 I® PERMIT APPLICATION Sub Permit No.VC ` 2(o- 42.- F-IBUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP r CONTRACTOR DRAWINGS JOB ADDRESS: ` O L N e W L 0 0 -ST— City: S T- City Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:2 FFE: OWNER:Name(Fee Simple Titleholder): ` � �� Phone#: cJ®S� � � N� Address:��.0 z®)< �_CA9A73 'KL�^S`` ►11XIE City: State: Zip: Tenant/Lessee Name: Phone#: Email: o C,, (�/ CONTRACTOR:Company Name: �nl A 44 OVIfe cr , Phone#: Si9J - [ Address/:�2,67") N'w !S l- 14)/ ` City: k-G 0 L�I�^-�°D-, -State: !�{� �- Zip: 02 Qualifier Name: C—D 6rr.1' r.�T✓2�0 0 Phone#: State Certification or Registration#: c& — 1 c 2 e22,1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ o�- '� Square/Unear Footage of Work: Type of Work: F-1Addition F Alteration ❑ New �❑ Repair/Replace F-1 Demolition Description of Work: L N4�r1-G /w u ry D A tia !'") �,Ti1 r -f Specify color of color thru tile: t Submittal Fee$ Permit Fee$ �Z-�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Ir (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 bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. i Signature Signature bVVAR or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Flo`day of .SEf rGM-6 eVZ- ,20 (S ,by 2 Z day iof � T" ,20 l �r ,by yLby4NIJR &110'e—MA ,who is personally known to C' 6112 !'pl/a Pjoo ,who is personally known to me or who has produced �as me or who has produced �L �2�3 -Z(3'6)-26 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ` `YP°ems:, S oOL HIDALGO Si Si = O ISSION#FF023893 �AA ?•••' EX IRE Print: ":b kiA Pr a N=r4 Seal: NaWy Public state of Florida S MUdiayC M Fuentes My Commission EE 841144 Expires 10009/2018 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND.PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD.. CFC1428221 .4p PLUMBING CONTRACTOR Named b6low IS CERTIFIED Under the provisions of Chapter 489 FS.- Expiration.date: AUG 31,2016 . ■ R. .�' FAJARDO, EDGAR MANUE EF DESIGN&CONSTRUE 297 NW 152 AVE HOLLYWOOD_ - : of 33028 w ISSUED: 07x3=014 DISPLAY AS REQUIRED BY LAW SEQ# L1407300001686 ren -must r . Aursuant tb CPU !� Chapter 8A-Art owner sec.TYPO etss. aPErRUCt18N.N11C 1� P1.E31 GGtONTRAC sYT f) t CFC74 BW v5.00 09/10/2014 CREWCAW-14-.T3 61 T t 1Bo Tse@�t �1�lacal6 Ta:,Tie Isada ofd 1Bdo I�I�re1' � eay .q► ©° CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDIYYYY) 09/08{2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY MDW INSURANCE GROUP AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 362 MINORCA AVENUE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE CORAL GABLES,FL 33134 COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER ACCIDENT INSURANCE COMPANY EF DESIGN&CONSTRUCTION INC. INSURER B. 297 NW 152 AVENUE INSURER C: PEMBROKE PINES,FL 333028 INSURER D: INSURER E. COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADDIA TYPE OF INSURANCE POLICY NUMBER OLICEFFECTIVE LTR INSR4 DATE(MK4XVM ��EMl AT10N LIMITS GENERAL LIABILITY EACH OCCURENCE $1,000,000 A ® CPPP000511102 08!25!2015 08/25/2016 ®COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 PREMISES Ea commence ❑❑CLAIMS MADE ®OCCUR MED EXP(Arri am ) s5,O0 ❑ PERSONAL BADV INJURY $1,000,000 a'L AGGREGATE LIMBAPPLIES PER. GENERAL AGGREGATE $1,000,000 ®POLICY❑PROJECT❑LOC PRODUCTS-COMP/OP AGG $2,000,000 $ ❑ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ANY AUTO (Each ) $ ❑ALL OWNED AUTOS BODILY INJURY $ ❑SCHEDULED AUTOS (Per ) ❑HIRED AUTOS BODILY INJURY ❑ NON-OWNED AUTOS (Peraccident) $ ❑ PROPERTY DAMAGE10— $ (Per accident) ❑ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ❑ANY AUTO OTHER THAN EA ACC $ ❑ AUTO ONLY: AGG $ ❑ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ ❑OCCUR [—]CLAIMS MADE AGGREGATE $ ❑DEDUCTIBLE $ $ ❑RETENTION $ $ B ® EEM COMPAND ❑TORY LIMITSAT - El ER ANY PROPRIETORIPARTNERIEXECU- E.L.EACH ACCIDENT $1,000,000.000 THE OFFICERIMEMBER EXCLUDED? If yea,describe under E.L DISEASE-EA EMPLOYEE $1,000,000.000 SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $1,000,000.000 ❑ OTHER GENERAL PLUMBING SERVICES AND INSTALLATIONS. CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORE VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDING DEPARTMENT EXPIRATION DATE THEREOF,THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO 10050 N E 2 AVENUE MAn.30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE MIAMI,FL 33138 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE ACORD 25(2001108) 0 ACORD CORPORATION 1988 Report Viewer ' 100% ....... �._.t�,..� - r.�- ;i JEFF ATWATER CMEF FINANCIAL_OFFICER STATE OF FLORIDA i DEPARTMENT OF F94AINCIAL SERVICES DIVISION!OF WORKERS COMPENSATION = F **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLEA WORKERS'COMPENSATION LAW** I CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. { .`" EFFECTIVE DATE: 4/2412015 EXPIRATION DATE: 4/23/2017 PERSON: FAJARDO EDGAR M FEIN: 270946010 BUSINESS NAME AND ADDRESS: EF DESIGN&CONSTRUCTION INC Y { 'fit. E 297 NW 152 AVE .1 PEMBROKE PINES FL 33028 i SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING 3 * CONTRACTOR CONTRACTOR ;+ Rast®d6ot9ar44M'ffii.FAQ,roafterdefmwtnelecWesa0an4om Ude�t�m' ffidtafids seR[a" n: rtasy� ben cr( IM der Oft A � KnumttoC? 440WIM.F.SL oafdoclmbba .-appSYordywfUdn i v. � U�acopaafUiatraeW9atelonU�roUwdden8�baezern ttaat�4ffiCI�r4�.0,13j.F.S.,N��t6ffibeasammpteM v. ceUUca?ae�elegimffihemcenPt efmll bew�ffirevamdm iG�mNrUie®§g�BtamUoaarUretsauencedUe9taperaon - &1�,=:. mon thend6roWamffi6ea8erotangarma�S Ure re�ert�sdUds aed�n car iast�caorao�iHcffis.Tt�Ue�r4rtmUshdl rawokeaoee; OFS-F2-0WC-252 CERTIFICATE OF ELECTION TO BE EXB&trr REVISED 08-13 QUESTIONS?(850)413.1GN I " a _ t i ky` r` rcr" {wz 9 �4 u dt, . u . "`, ,s £"A >Y,rn`:sry f. u�:' u .S._:. * 'k, .b`-� .'-.«... '::t+-`,R'_.u"�+7.' s.' 1.::_�• - ht4mJ/apps8.fidfs.can/crrepo t ewer/repWiewer.aspx?data=kdvpgjnC9D7Q3gH6TER61P1KMZO/o2fSz5b)G YfBxkrekeESOPVv1v4NPOPN42XeirDRGXVW... 112 DATE ; SEPTEMBER 22,2015 STATE OF FLORIDA COUNTY OF MIAMI BEFORE ME,THIS DAY PERSONALLY APPEARED , EDGAR FAJARDO, WHO BEING DULY SWORN,DEPOSES AND SAY; THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT ; 102 NW 108 ST MIAIVII SHORE. SWORN TO(OR AFFIRMED) AND SUSCRIBED BEFORE ME THIS 22 DAYS OF SEPTEMBER 2015. PERSONALLY KNOW-------- ------------------ OR PRODUCED IDENTIFICATION----------------- w-------_-------_-----___ TYPE OF IDENTIFICATION PRODUCED-2M- --- -2-63 ^ 213 '(? 2 6V e --------------------------- =3-98-0153FlarldaN=sGwlccc' HIDALGO N#FF023893ne 4,2017 Service.com logo Miami shores Village Building Department �OR1C� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exem tion s , t 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:.® ner State of Florida County of Miami-Dade -N7 The foregoing was acknowledge before me this (to day of Se?T9Ak6E* ,20 By R WA N N A B :t't'.4 who is personally known to me or has produced OM as identification. Notary: SEAL: Notary Public stat.of RoAda - LkHeC n Fuentes My +� My ommiseton EE 841144 '?pr E 10/09/Z018 L- - 2040 Miami Shores village Building Department R 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. COPY OF LIABILITY INSURANCE* 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: CC AVS7'(2ye7j f? V BUSINESS ADDRESS: 2 7 W CITYat,�,->Oltefy P STATE ZIP 0 2F _ BUSINESS PHONE: ( p� 1 r FAX NUMBER y 8)S r) �I CELL PHONE 3( N ) f 2 Z'57 2! o QUALIFIER'S NAME: P,3&A fl- F/4j 14 R,�O QUALIFIER'S LIC NUMBER: GSC- 1 y 2 f 22/ Miami Shores Village Building Department DEC 14 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 -- -- -- -- J Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 L6 BUILDING Master Permit No. P-*'2& 0 PERMIT APPLICATION Sub Permit No.TL-L= t q - 2Gq 2- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ®,PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I Co 2 ) 1 08;� ZS1 City Miami Shores County: Miami Dade Zip: c33166 Folio/Parcel#:_1O 2,1 3G U i L—)A i n Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): D C,fa2 AL2 -T7 LLC Phone#: 33 2AS Address: `,o I' ox, 4,5/ q G rR City: 1t-4 i IN to i State: Zip: Tenant/Lessee Name: Phone#: Email: 1 f� CONTRACTOR:Company Name: /I) JA Phone#: 0 �� 6��` Address: Z `j 'SWao'etallan AU 17\ City: State: Fc Zip: 3 Qualifier Name: Iq ep Phone#: State Certification or Registration#: 16 k _Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ . 2�� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: /�,� r° %700 To T L.D %b Lko —M i Lac-. 1-4A0 0 ate" 0�_w ts.7 �__O, 5 Specify color—of color thru tile: Fc Submittal Fee$ 00 Permit Fee$ 25® ' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Doe hie Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 W qorANT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Dck--t�e2 ,20 N .by 16 day of O L V hWo ,20 by -2,tzr--J. 3:±s'4A ,who is personally known to '44.4w ',who is personally known to me or who has produced /�`/h as me or who has produced as identification and who did take an oath. identification and wlM . NOTARY PUBLIC: NOTARY PUBLIC: ' ►� omm.EXp v #EE 157 Sig Sign: L Print: Ai& Print: �rIANaKAMBE Seal: '': ,�*"c MY COMMISSION#EE136658 Seal: ", EXPIRES October 09.2015 (407)399-0153 Fbr1dallos c0M ############################################################################################################ APPROVED BY A: y�t�!-S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) #. , ] . . Miami Shores Village -- Building Department OCT 2015 10050 N.E.2nd Avenue,fAwni Shores,Florida 33138 Tel:(305)79S-2204 Fac(30S)756-8972 INSPECTION UNE PHONE NUMBER:(305)7624949 FBC 20 t BUILDING Master Penna No's-�-IY- PERMIT APPLICATION Sub Pemtit No. (14" BUILDING ❑ELECTRIC ROOFING REVISION ❑EXTENSION (RENEWAL ,PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION -VHOP .IVCONTRACTOR DRAWINGS JOB ADDRESS: f O 2° LL) I&S �S T me- Miami Stores County Miami Dade Z)o: - F /Parcet6: kr the BtNdUm History/mated:Yes NO Occupancy Type: Load: Construction Type. Flood Zone: BFE: FFE• OWNER:Name(Fee Simple Titleholder): Do0ALc 1 LL C- Phone#_3D-e- �&S-q ' Address: State: DP� Tenant/Lessee Name: Phone#: Email: a ' CONTRACTOR:Company Name: L G'' 10,FSI6.v° �fk�•, �0,°.s?✓vc 1oy Phone*: .':fvJ'rEf®� o-tiy tt�t Address: S State: Zip: 3 O L Qualifier Name• f C- � I'"1A /ry o Phone#: State Certification or Registration Z 2-1 Certificate of Competency#: DMNER:Architect/EngIneer. Phone*: Address• City: State: ZIP: Value of Work for this Permit:$ SgmWLinew Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replece ❑ Demolition DenAption of Worlu �' kbc�u i t- l 0 7 (-�D�� A�� b I \ � G L� SPAY mor of Color thm tile: Subndftal Fee$�� Pelt Fee$ '-� CCF$ CO/CC$ Scou „g Fee$ Radon Fee$ DBPR$ Jnr$ T y Fee$ TrabgrdifEducalion Fee$ Double Fee$ Suucbnvl Reviews S 11011d$ TOTAL FEE NOW DUE$ ' (Itv J24rM4) 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 COMMENCEMENTS Notice to Applicant. As a condition to the issuance of a bugding permit with an estimated value exceeding$250,the applicant must promise In good faith that a copy of the notice of commencement and construction Men law brochure will be delivered to the person whose property Is subject to attachment. Aba,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 bullding permit&Issued. in the absence of such posted notice, the inspection w1M not be approved and a reinspection fee will be charged. � I r Signature Signature or CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument C was rracknowledged before me this 9-4-.12— e day of C7'0Q grZ g0 LC by Z.3 day of COC to �wI 10 by who is personally known tofl� r� ,�+a7zvJ'� ,who is personally known to me or who has produced —as me or who has produced 0•'- ' as Identification and who did take an oath. identification and who di s°� o WWON I FO *�? IqN @ fl`9221 NOTARY PU NOTARY PUBLIC: * EXPIRES:lleptertber ZT,2019 '?r .'r 8=WT= l�Nawy Sign: Sign: ' Prinr. ZPrint: Seat: . Loa M Fuentes �°j0f a Seat: My COMW*01M EE a4»aa JJa APPROVED BY Plans Examiner Zoning Structural Review perk (P"Iseaos/24/2014) i. 002M VIA F��r�j .'3•'��� 17� � Y�� i C Y*-R '�S ,� ��f I[���f�'�����l��t �. t� ' BEC.T OF EF Ate'&col, fRUCitI "Imc 06 PLBING W PAYMEPdj''REC $� FC142 1 TAX 4 L ACT. . air � . tEDITC�NtD-15--D45401 . ( tAs e1� A R i�R Bnsie Tax The Re bade l►r ,