PL-15-2128 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone.(305)7952204 Fax:(305)756.8972
inion Number: INSP-251360 Permit Number. PL-8-15-2128
Scheduled Inst Date:January 24 2016 Permit Type: Plumbing-Residential
Inspector: Diaz,Osvaldo Inspection T •ype. Final
P�
Owner Work Classification:Addition/Alteration
,lob Address:1151 NE 99 Street
Miami Shores,FL 33138- Phone Number (786)253-2869
Parcel Number 1132050180070
Project: <NONE>
Contracts: APA PLUMBING CORP Phone:(308}9924614
Building Department Comments
REPLACE EXISiTNG FIXTURES IN 2 BATHS 8 Kb*acw Passed meatsITCHEN INSPECTOR COMMENTS False
NEW FIXTURES FOR NEW MASTER BATH IN GARAGE
CONVERSION I 1 **A
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP 251287.CREATED AS
1Y REINSPECTION FOR INSP 251205.CREATED AS REINSPECTION FOR
i NSP 241897.
Failed NO ONE HOME
Correction a
Needed
Re-Inspection
Fee
No ldddonal Inspedlons can be edheduled until
re4napecdon fN is paid
January22,2016 For Inspection*please calk(305)7622949 Page 31 of 51
t
Miami Shores Village
10050 N.E.2nd Avenue NE F
Miami Shores,FL 33138-0000
Phone: (305)795-2204
EIE, Expiration: 03/16/2016
:E. 3 �h ��a� Ej ,.,,Ar .•p
Project Address Parcel Number Applicant
1161 NE 99 Street 1132050180070
Shima VII LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
Shima VII LLC 1235 NE 100 Street (786)253-2869 (305)796-4922
Miami Shores FL
1235 NE 100 Street
Miami Shores FL
Contractor(s) Phone Cell Phone Valuation: $ 5,000.00
APA PLUMBING CORP (305)992-4614
, ,, _v�.m._�=.._. _._........._......_���.....__._..._ ..�.... Total Sq Feet: 00
Type of Work:REPLACE EXISITNG FIXTURES IN 2 BATH Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Top Out
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# PL-8-15-56796
DBPR Fee $3.38 09/172015 Credit Card $248.76 $0.00
DCA Fee $3.38
Education Surcharge $1.00
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $248.76
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,PL U , ECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I rtify th t all t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fut t orize the above-named contractor to do the work stated.
September 17,2015
Authorized Signature:OWner / Applicant / Contractor / Agent Date
Building Department Copy
September 17,2015 1
a '
Miami Shores Village C , IVFD
�A
o� Building Department 2015
1 050 N.E.2nd Avenue Miami Shores Florida 33138 BY:
0 ,
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 19—'-
BUILDING Master Permit No.FC 2/2A
PERMIT APPLICATION Sub Permit NooPl- 40- 2 J277
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
a / CONTRACTOR DRAWINGS
JOB ADDRESS: // /� �� 71-e-A55 J5 7-
City: Miami Shores County: Miami Dade Zip: a
Folio/Parcel#: is the Building Historically Designated:Yes NO X
Occupancy Type:Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):S.-*V/m /4 V 227 LLC Phone#: �2S YO J--
Address: /o�� S
City: State: Questions/Comments/Concerns?
Please call either
Tenant/Lessee Name: Monique: 786-253-2869 or
Email: Louis: 305-796-4922
CONTRACTOR:Company Name: 2 Phone#: y
Address:
City: l,A,�,� State• Zip:
1.
Qualifier Name: V't e AM"4 Phone# � �r-'Jc L tf-
State Certification or Registration#: � � a. a Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ,Repair/Replace )❑ Demolition
Description of Work: K,F=7 /�L A�C— 13;:�/S T/R ✓aC TIJ�-s B N Gly-
idT�/�S • / el 7G,V-42-etJ J6;X t-5 Tim-�.�" OG 04— /a o._/
Specify color of color thru tile:
Submittal Fee$ `perlit Fce S` ' Z.s°� D ®� CCF CO/CC$
Scanning Fee$ �•®c/ Radon Fee$ DBPR$ Notary$
Technology Fee$ Q Training/Education Fee$ l a ® Double Fee$
Structural Reviews$ Bond$ �•7 p
TOTAL FEE NOW DUE$ G 9?•-I t
(Revised02/24/2014)
P
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 on 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 pection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the
inspection w 11 T1 a approved and a reins5pedei fee will be charged.
9 Signature L4— Signature
WNER or AGENT COQRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 by by day of ,20 1—!f- ,by
0?24`Q�� w� ,who is personally known to i s �G?✓'C��C ,who is personally known to
me or who has produced L as me or who has producedas
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sig S'
rElw
Print:
ary uSeJoanna M Fcommi"eliciano Seal: Ao. Notary Pudic state of RwWa
Eycpires 011 2blic StSW Of I'
12018Commission FF 082753 ,Y canna M Feliciano
My Commission FF 082753
EXOM01/12/2018
************************************************************** * **
----------
APPROVED
********APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
6
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395
1940 NORTH MONROE•STREET
TALLAHASSEE FL 32399-0783
GARCIA, lUIS AlBERTO
APAPLUMBING CORPORATION
8741 SW 49TH STREET
MIAMI FL 33165-6701
Congratulationel With thisliconse you become one of-the'nearly►-.___
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants. DEPARTMENT BUSINESS AND
and they keep Florida's economy strong. ' PROFESSIONAL REGULATION
Every day we work to improve the way are do business in order to CFC1427783 ISSUED: 07/28/2014
serve you better. For information about our services,please log onto
www.myftorldalhmnae.com.orldalhmnae.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR
about our divisions and the'regulations that impact you,subscribe CERT I I LUIS U BI NG
to department r slettersend learn more about the Department's
initiatives. A P A PLUMBING CORPORATION
r mission at the Department is:License Efficiently,Regulate Fairly.
.e constantly strive to serve you better so that you can serve your
customers. Thank youfor doing business in Florida, is CERTIFIED under the provisions of Ch.489 FS.
and oongratulations on your new licensel &028m dere:AUG 31.2MG L140724
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS ARID PROFESSIONAL REGULATION
CONSTRUC71ON INDUSTRY LICENSING BOARD . °�
A..;.
r_ `may
CFC1427783
The PLUMBING CONTRACTOR F
Named below IS CERTIFIED
Under the provislons of Chapter 489 FS.
Expiration date. AUG 31,2016
GARCIA, LUIS ALBERTO ® °
A P A PLUMBING CORPORAnON
8741 SW 49TH STREET ®,
MIAMI FL 33165-6701
m
ISSUED: 07/28/2014 DISPLAY AS RF0111RFn RY 1 AW cin�e vtn�ar+nnnon,
t
0
i .
004M
Local Buss ess Tax Receipt
MI ITIJ-Dade.. County. State of Florida
tUS
i >!$ JNOTABILL - DONOT PAY
6281687
susnv�s n+anat$rt ot:ra ,t RscEpr too.
A P A PUlAABING CORP � �I��ES
7075 sw 6 sr 654
a S5�"S WER.30, 2015
MIAMI K 33155 Must to d**W-at PWW of bW mss
Puum Cwn:y code
Ch8Rt1k8A—Art 9&10
BBC.'r!m OP J3us t3R8
A P A PLt#4W CORP 19 PLUMBING C.ON1RACrOR pA r
Wodmr(s) t C.FC1427783 ear zax cost eerpA
$75-00 08/02/2014
Tbb_ CREDfTCARD--14-031
t+�BdLore � °fit ott lscatB Tax Tinftw to
or �� .Nelder
WWI
7kal�.H�wram+�� oeaq _
" Fera�a� CodeSaoZ�78.
DATE pAmmDmrYY)
ACCRED CERTIFICATE OF LIABILITY INSURANCE
sl11no15
THIS CERTIFICATE 18 ISSUED AS A MATTER OF IiFORMATION 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 DdES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT., N the certificate holder Is an ADDITIONAL INSURED,the policy(Nes)must be endorsed. ft SUBROGATION IS WAIVED,subject to
the tents and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not confer rights to the
ow ifiosts holder In lieu of Such s
PRooucaN SUNZ Insurance Solutions,LLC. ID: (Ally) CONTACT Meffssa Ash
do Ally HR,Inc.. yy 904-739-2722 P 904.2622760
Jacksonville,FIL32256
mashtArnaftwnseource.com
BCI APPORD84G COVERAGE NAIL#
U48WIERA: SUNZ Insurance Company 34762
INSURED owtom B: Aspen Re-London-Best Patim"A"
Ally HR, Inc.
9016 Philips Hwy c: Catlin Syndicate-Lloyds-Best Raft°A"
Jacksonville FL 32256 INS D: Brit Syndicate-Lloyds-Best Rams °Aa
USE:
I INSURER P:
COVERAGES CERTIFICATE NUMBER: 2e&54M REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I HE 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.
am wilm
LTRTYPE OF INSURANCE E10� LOUTS
COMMERCIAL[SAL LUU3UM EACH OCCURRENCE S
DAMAGE TO RENTED
CLAIMS,MADE r-1 OCCUR M n $
W1ED EXP( —p—) $
PERSONAL&ADV NJURY S
GEN'L AGGREGATE UWrAPPUES PER: GENERA.AGGREGATE S
POLICY Q.QCT F-1 LOC PRODUCTS-COMPiOP AGG S
anggt S
AUTONOB.E LUMUM S
ANY AUTO SOMY MUURY(Pet p ) SALL OWNED MIMLED ---
BODILY INJURY(Per aeddmd) $
AUTOS AUTOSNON,OWNED PROPERTY
HiRED AUTOS AUTOS
AGE S
S
Ufa LA LIAR OCCUR EACH OCCURRENCE S
EXCESS UAB SDE AGGREGATE $
DED I I RETENTION S $
A WORKERSCOMPERMNION WCPE00000323 01 1/112015 1/1/2016 1(
AND EBR+LOYERS'LIABILITY ----
ANY � YEL EACH ACC1XW $ 1,000,000
OFF,.P,.EM,.R'EXCLUDEOr NiA
oftndatwy in NN) E.L.DISEASE-EA X10 S 1,000,000
=Am
-OF'"OPERATIONS balm I I E.I.DISEASE-POL1CYLWIT $ 1,000,000
B Workers Compensation This is for informational purposes
C Excess Coverage and nothing shall create any right
D under Such reinsurance.
DESCRIPTION OFOPERATKINs I LOCATKM!VM2CLES(ACORD 101.Ad nal Rewaft Schedule,nw be a H mote,1 -Isre~
Coverage provided for all leased employees but not subcontractors of:A.PA PLUMBING CORPORATION
Effective date:3/10/2015
CERTIFICATE HOLDER CANCELLATION
9109
MIAMI SHORES VILLAGE HALL SHOULD ANY OF THE ABO DESCRIBED POLICIES 13E CANCELLED SWORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Fax: 305 796 8922 ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NW 2 AVE
MIAMI SHORES FL 33138
AUTHOR)a?DNTAflYE
Glen J Distefano
®1988-2014 ACORD CORPORATION. AN rights reserved.
ACORD 25(2014101) The ACORD name and logo arse registered marks of ACORD
28354555 1 Master Certificate 1 Christina Elkins 1 9/11/2015 8:48:15 AN (EDT) I Page 1 of 1
POW NUmbSr CL 1643915A Date Enter: 09/0812015
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
9/8/2013
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(816 AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the cortiflceta holder Is an ADDITIONAL INSURED,the poitry(les)must be endorsed. H SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy.certain poNcies may require an endorsemem. A statement on this certificate does not confer rights to the
Certificate holder in lieu of such endorsement(s).
PRODUCER Your Options lasurance -me"war-ta G. G=Zalez-802A
7171 Coral Way PMO (30S)392-1927 PAx (888)687-1926
info@yonroptituisins.QaNn
Suits 319 12O&W
Miami, FL. 33155 INSURER(s)AFFORDING COVERAGE NAIO s
INSURER A•DNI=D STATS rratarrrmv =NS CO.
INSURED A.P.A Plumbing Corporation INSURER B•
uNSURER C:
7075 SW 46th St INS0:
Niami, FL 33155 ERE:
INSUURPER F.,
COVERAGES CERTIFICATE NUMBER: 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.
am LTRTYPE OF INSURANCE POLICY NUMM POLICY POLICY EXP WHITS
A COMMERCIAL GENERALL"w" EACH OCCURRENCE $1, 00,0000
DA
CLAIMS-MADE Ix OCCUR CL 1643915A 03/25/2013 3/25/2016 P $ 100,000
MED EXP VM one person) $
PERSONAL&ADV INJURY $ 1,00010 Q
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000
POLICY JEtlaf El LOC PRODUCTS-COMPIOP AGO $ 1,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBIIDt SII LIMIT $
i
ANYAUTO BODILY INJURY(Per persm) $
AUTOS OSCHEDULED
ABODILY INJURY(Per aQalderM S
HIREDAUTOS NON-OWNED PRO DAMAtiEAUTOS $
$
UAMORO.LA LIAR OCCUR EACH OCCURRENCE $
EXCESS UAB J CLAIMS-MADE AGGREGATE $
DEO I I RETENTION$ S
WORKERS COMPENSATION I
SPER I TA R-
RS'
AND EMPLOYELIABILITY Y I N
ANY PROPRETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED? M I A
(Mandatory in NN) E.L.DISEASE-EA EMPLOYEE S
II'Ves,desabe under
DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE"p1CORD 101,AddMonal Remarks 8ebedule,may be attaehed I mwe space is required)
PLVNBn=288=2101AL (98483) PLUMBING COMbMRCZAL (98482)
as per information with underwriter policy covers installation LPG equipment
Stater of Florida Plumbing Contractors Lie# CFC1427783
CERTIFICATE HOLDER CANCELLATION
Miami. Shores Village Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 Northeast 2nd Aveane ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, Florida 33138
AUTHORS REPRESENTATIVE
IMSTOAM CAMIWO
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
PM&w8""Forms Boss Pkatsollwarewww.Fom MDQW1977
Miami Shores Village
T Building Department
A�G iF 01015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(30S)79S-2204 Fax:(305)756.8972
BY. INSPECTION UNE PRONE NURABER:(305)762.4949 j!
FBC 2011-1BUILDIWGO'A
RLED Master Permit No.
PERMIT APPLICATION Sub Permit No, � �
[]BUILDING ELECTRIC F1 ROOFING ❑ REVISION EXTENSION RENEWAL
®PLUMBING []MECHANICAL []PUBLIC WORKS 0 CHANGE OF 0 CANCELLATION [3 SHOP
CONTRACTOR DRAWINGS
jos ADDR . 1151 NE 99 ST
City: Miami Shores County: Miami Dade Zia: '3 / X
FollolPa :11-3205-018-0070 is the Butte Historkspy Did:Yes No x J
Occupancy Type: 5)�' Load: Construction Type:0e-S Flood Zone:,�8FE: FFE:
OWNER:Name(Fee Simple Titleholder): J 1 h?—4- y hone#: .f o ' 7�� —f ,v
Address: Io 13 SG 9
City: /J7/i9'�'77 `S'/-/—rte it C State: Zip: -3 .p
Tenant/Lasee Name: Phone#:
Email: S�s!;j %/
COAITRACTOR:company Name; BGL Plumbing Contras w•s, LLC Phone#: 786-367-1932
Address: 2340 Overbrook St
qfi,; Miami . FI gyp; 33133
Qualifier Name: Giancedo Perez Phone#: 786-367-1932
State Cartifkation or Registration#. CFC1429167 Cwtittcete of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Pera t: __Saver__ a L Footage of Woric .
Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Worlc zc' AL 1 sS 77 ti!9
®c/ ,c of_
Spec*color of color thm tile.
Submittal Fee$ Permit Fee$ CCF$ —,CD/CCS.
Seanrdng Fee$ Radon Fee$ DBMt$ Y$
Technology Fee$ TrabdWEducation Fee$ double Fee$
strucuww NNW"$ Boni$
TOTAL FEE NOW DUE$
(R W/24=4)
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 AMDAVR: 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 pasted at the lob 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 oppro spection fee will be charged.
Signature Signature
OW ER or AGENT CO CTO
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledg ore me this
day of (. 1
� - .20 by I day of Vl U S by
rr. .who is personally known to L RM-C 12e.?, .who oral
me or who has produced EQ-4/----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: BR
� No -State o/Florida
Pri Print:
Commission#FF 108587
Seal: ,tom Notary public state of Florida Seal:
Joanna M Feliciano
�P My Commigsfon FF 062753
or w E a 01/12/201
s#####t#
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReWsed02/24/2014)