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EL-14-1554 (2) Miami Shores Village C-EIVED �� . Building Department JUL 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ��e Tel:(305)795-2204 Fax:(305)756-8972 �\9� _ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC Z 6 G BUILDING Master Permit No. Q L 2/q 3Z4 PERMIT APPLICATION Sub Permit No. E-- 114 - I SEM ❑BUILDING -ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL TifilotP. Pork. Fob AI"S-r lrow/ 05c- ❑PLUMBING r--] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �� 91, City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): F_PJG + /AJ6(Z.l r p,44-4416,/f,4 0 Phone#: 1305 771�r ;9� Address: 1031 &1 13 City: [A41,4m1 S 0AQ&; State• Zi p: 3 O 3 Tenant/Lessee Name: Phone#: Email: ;Z7 (35A4 14W/ l.'11A)T �A�•® CONTRACTOR:Company Name: `L41 k-oi!5 Gc15 c gnoo a r�f Ci Phone#: Address:_W'K "7( 51./ /218 57 l°l City: M I A 411 State: Zip: 33/ 15- C2ualifier Name: A41 glA 6- (d,90V 5 Phone#:�i 3/,K- I" State Certification or Registration#: ft- Q01,'If�3 Certificate of Competency#: /g f 01010X75-- DESIGNER: DDX75-- DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ M • Oh Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 4?5--New ❑ Repair/Replace ❑ Demolition Description of Work: t`GM? tot)W V 6-T f-od (A Specify color of/hcolor thru tile:.: Submittal Fee$ .. Permit FeeCCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) _ Bonding Company's Name(if applicable) 0 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 eX �x Signature "Z11 OWNER or ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 46 day of 3&L Y ,20 I q ,by 114 day of �ul- ,20 by Q63 E 1%-T MviWAV ,who is personally known to M fic tA EL S who is person y known to 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: Sign: Print: i Gu Bt` Print: ►Z7 my(ZP/gp Seal: %p{tY A1" DAVID W.HAMEL Seal: ?aMO.. Notary Public-State of Florida Notary Notary Public State of Florida My Comm.Expires Apr 24,2015 Robert Murphy ; "< Commission#EE 87157 MyCommissionEE201088 �1YOF r,q•% E7fp1f08 esmr2o1e 7k$7k7kkkikN#k4i9 ;i141�akka�A(l111QI{9j141QIS 1R 1krx***wwr*tM+k *B** ws.xa*aixaw re-%l APPROVED BY /29 V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 07!18!2014 03:12 7862067066 STATEWIDE INSURANCE PAGE 01 DATE(MMIDDNY) CERTIFICATE OF L.IABIL,IW INSURANCE � 07/17/14 _PRODUCERTHIS GERTWIGATE IS ISSUED AS A MATTER OF INFORMATION Galloway Insurance , 17354 South Dbcie Highway ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Miami.FL 33157 HOLDER.THIS CERETIRCATDOSS NOT AMEND,EXTEND OR ALTER COVERAGE AFFORDED BY THE POLICIES BELOW. Phone(305)255-1661 _ Fax (788)2064086 INSURERS AFFORDING COVERAGE _ N_AIC 0 INSURED Mikes GUslom Electric Service,Inc, INSURER A: Federated National InsuranCB 10871 SW 188th Street,#19 INSURER B:INs<IRER c'... M— N------ _ - Miami, Florida 33157 INsuR6R • INSURER E• COVERAGES _ rHe POLICIES OF INSURANCE LISTED HAVE BEEN 3 T THE IPISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ----' ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDI'T'IONS OF SUCH i POLICIES.AGGREGATE LWIMG SHOWN MAY HAVE BEEN RCDUOCD DY PAID riLAIMO, y R ADD'L XTR TYPE OF INSURANCE _ POLICY NUMNER POWOY EFFECTIVE POLICY MUnPAMON ----- - _ LT ... DAT$FAME=AAT11 EAlAIDQIYYYY LIMITS GENERAL LIAmLrry EACH OCCURRENCE $1,000,000! ©COMMERCIAL GENERAL LIABILITY GL-17436-01 08128!2014 06/28/2015 PREMIUM- _ __$10010001 ❑❑ CLAIMS MADE ® OCCUR MED EXP(Any one person) —.$g�QQpi A PD:Dad:$500 PERSONAL 8 ADV INJURY .._--- •- $1,000,000; ❑ _ GENERAL AGGREGATE $2,00,0001 0MVLAGaRmaATELIMITAPPURSPER: PRQDUCTs.CORAP/OPAGG $2,o_QOQ, ® POLICY ❑PROJECT C1 LOC El ANOB UTo� - --'-- -ZJTY COMBINED SINGLE LIMIT (re acdde ❑ ALL OWNED AUTOS J ❑ QED AUTOS�� (Per1LY�)URY NR ❑ NON OWNED AUTOS BODILY INJURY (Per amiderd) ❑ _—'� — PRQPFRTY nAMAGE i —.. _ --••-• _ -__-_ _ (PeraooideM GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT ❑ � "—""'"'-•"N"' OTHER TWAN FA AQC —... — AUTO ONLY: A EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE u f❑ OCCUR C I CLAVAS MADE AGGREGATE --'~ ❑ DEDUCTIBLE ED -d RETENTION S WOR COMPEN&iTI0W AND ... '--- ••- . • p - EMIn-OYER3 LIAmLI?Y T .LI1AR S ❑ RH- ANY PROPRIETOR I PARTNER I hxLt-II I r q-YM OFFICER I MEMBER EXCLUDED? E L EACH ACCIDENT (la►andatory dawAIn and ELL_DISEASE-EA EMPLOYEE M— .eeaodae under D��"I NB flow B.L.DLSFJII;F.PA1 i"1 @AIT' OTHER DESCRIPTION OF OPERATIONS/LOCAW Ns 1 tI6 CLM J 6xCLUSIDNa aDA6D BY ENDORSEMENT!sPCCIA!pRaVt910N8 ;Electrical Contractor/Work..... ("Columbus Properties,Inc.and Colonnade Management are named as an Additional Insured" ... CERTIFICATE HOLDER -• CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E CELLED BEFORE THE � EXPIRATION DATE THEREOF,THE ISSUING IN L WdD VOR TO MAIL Miami Shores Village 30 DAYS WRITTEN NOTICE TO THE CERTIPI MOLD D TO I 10050 NE 2nd Avenue THE L&T,BUT FAILURE TO DO 80 SHAW_ImposE UVA NOR LIABILITY Miami Ehoroo, Florida 33138 r OF ANY FIND UPON THE LNSURER,IIs AGENTS OR PRE _ Attn:Building Dept T AUTHORIZED REPRESENTATIVE Fax#305-758.8972 I Jose H Romero,Licensed Agent-A225234 Ii AGORD 25(260sro1)QF —_.—_ — _ I a Talcs-2009 AGORD cv T1vN.All 69tits'r+ewserved. The ACORD name End I0.90 ardjugletared marks of ACORD