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REV-16-898 Miami Shores Village ,1.� �.,. Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 A Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(3 -4 9 FBC 20 (qc"'-�-(-� BUILDING t Per t No. ' 2-68 PERMIT APPLICATIO Sub Permit No. ❑BUILDING ❑ ELECTRIC REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP l CONTRACTOR DRAWINGS JOB ADDRESS: T ( / N� t od- St ' City: Miami Shores County:{ ,•� Miami Dade Zip: l �l Folio/Parcel#: ( 2i0 � gthe Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): peri r Q oe Phone#: (046' bV-4 M Address: !17 7 (U rs' 10`L"1r2 5�46� r City: I _/�, In l(0- A" �, y lwS State: Zip: j Tenant/Lessee Name: Phone#: Email: /CONTRACTOR:Company Name: C comyacto r� Phone#: WS-46-3 • �6G Address: .1160 Arzw�—Lp&couj Lcad . City Iuolki T'CUII.X, State.. Zip:331 4-0 Qualifier Name: e�M�XI � ic�CJ�C)�� r1 Phone#:. .. 192 . 7k[43 State Certification or Registration#:Cr—r_ t 42-6E309 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ©6 Square/Linear Footage of Work: lad _qtq Type of Work: ❑ Addition ® Alteration ❑ New r ❑ Repair/Replace ❑ Demolition Description of Work: �,U °f���t>w� DSS D Io.tiL`� Specify color of color thru tile: nn," Submittal Fee$ r Permit Fee$ CCF$ 'Gd CO/CC$ Scanning Fee$ �'' Radon Fee$ -aha DBPR$ o�-c� Notary$ Technology Fee$ aZ`y 11 V Training/Education Fee$ ® '�® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ p. �-so (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: 1 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature . 4/ OWNER or iGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this tg day of Y'l;n12 ,20_�_ ,by -t- day of �� 20 6 .by dQP(L'qUQ' 0L Soup' ,anrho is personal i wn to &rrycurl ,who isersonally known o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign•• nj c Sign: -'•�...,dip ptEdplIDAA Print: Print: FF 91221 QUIDA EXPIRES:August 2,2019 Seal: UX MY COMMISSION#FF43855 Seal: .� rdtf 9*dThauBudgstN0Wykft EX IM..August 14,2017 APPROVED BY viz �"' "t��� P Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 9 • 5a ` r _s �. � r"-� - S'4"^'F. _ �,w�R:;,��,�.�-i�,Ara'•�aca�°moi,+�?"' ..�� 4 y"a•r. ,, ,47 Wmi p1Fe 3aa �'d a p d3 P ° r ova _ r %!�""�'�sgtv `. �`� fir-:.. .z„ t s3 '� �' ,, � ' �.> "•. w � � qMI m sli ",wZ* -Sgm w � g S' -. 1" X{ `�v W u In N .: 4f 003303 � ' � .. 01, _ :cl, :11, a Il r�-t o = tat o £ s -1'HISrOusiu.. .. 1 5669�41t _ _ t #NE$S NAMEILtlCAT1OI11 1►_ c cordo fz � r Orr; 3 � asrn �fIA�1 BEACH f�. j40 i'r�i' tafcaurCco x , C1�i4p >, OWNER SEC. TYPE OF Bt1l9ilWE - PAYMENTAECEI'1/E � MANAGEMENT&CONSU LTING 1NC 196 PLUM$1NG 00 NCTOI BY TAX couEcT01 GFC14268-9 Workers ` 1 $45.00 08/25/2015 CHECK21= 15-1171>06 a This 1 Business Tax Receipt oniy ca krms payor of of the -Business tau. The Receipt is not a lit nse, permit>ora certification of° he halder'sr li6catioe to a>bli one.-a Holders ustcon�piY i anq goverpmental or rronggrrerbme�ai regulatory IaWs nquiremsnts wbicir apply to the btutis. lYie AECEIPT,NO.above must be d� a 6n all commercial vesicles—AAiami=0��e� 8a-276 For tpors inoriadon visit miamidadeaoalta © � CERTIFICATE OF LIABILITY INSURANCE °A 11/12/1i°5 PRODUCER Florida Bankers Insurance �'H IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 7278 SW 8 Stmt 92Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)268.6493 Fax (0262-0879 INSURERS AFFORDING COVERAGE NAIL# INSURED MANAGEMENT&CONSULTING INC INSURERk- ESSEX INSURANCE COMPANY D/B/A M&C CONTRACTORS INSURERS- INSURER NSURERB:INSURER C: 960 ARTHUR GODFREY RD.STE.304 INSURER D: MIAMI BEACH,FL.33140 INSURER E: 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 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. ADD'L TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DA SAT) RAW LTR Lam GENERAL LIA1131Lt1Y EACH OCCURRENCE 1000,000.00 © RENTED COMMERCIAL GENERAL LIABILITY 3 DY5751 04/19/15 04/19/16 PEM SEs 100,000•00 ❑❑ CLAIMS MADE © OCCUR MED EXP(Any one person) 5,000.00 A ❑ ® PERSONAL&ADV INJURY 1000,000.00 ❑ GENERAL AGGREGATE 2000,000,0 GENT-AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG 1000,000.00 © POLICY ❑PROJECT ❑ LOC AUT'OMOBI.E LAITY COMBINED SINGLE LIMIT ❑ ANY AUT Q (Ee accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIREDAUTOS 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 EXCESSAMRELLA LIABILITY EACH OCCURRENCE _ ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ WC AT - ❑ OTH- EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER I MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE I yes, E PROVISIONS belowE.deers SPECIAL Pdescribe under DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICL.ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CFC1426809 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CELLED BEFORE THE EXPIRATION DATE THEREOF,THE OWING INSURER WIEL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BLDG DEPT 30 DAYS wm TEN NOTICE TO THE cmmcATE 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 PRESENTATIVES AUTHORRED REPRESENTATIVE ACORD 25(2001/0 OF OACORD CORPORATION 1980 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08)OF +Oldaaiicam�etstw FL 3401 27 l*'L*&-:--_i*i'�hw N. 'FL sool + �trlttao 0�9p9E• otrr�p�in,tt�e�si�aegrit� ►� �etbnns,earatatmxi►PoNt . saw o�tm�e tem, er�n mos; ' Two Of huum= LimbLin: vim jw - ` LlA�LJ7Y ,: MWEV Pata"Adv rclog mgm,rmba1m... 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