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RCFV-16-896 (2) � I � Miami Shores Village kill Building Department I APR 01 talo 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Li BUILDING 1 aster Permit No. PERMIT APP Sub Permit No. ecv k (o (''BUILDING ❑ ELECTRIC ❑ ROOFING j4jREVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ® CONTRACTOR DRAWINGS / JOB ADDRESS: ® /oo / 1 V City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: //- 2-1' 3r. oO-? ` 03k q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 0 ® �/W✓ Phone#: 74/0- aS/- Address: ?(a �O Or • 33173 City: k ( o'\ f State: Zip: Tenant/Lessee Name: /�l�i Phone#: Email:NLJ4C S/-L 4 (/w-iQa (;0- q ►��• til CONTRACTOR:Company Name: /A?*(36-0- z07 e#: Address: 6t" 4-5 S City: State: Zip: 3 ?® i Qualifier Name: A-7'g Phone#: ?g a 5' 6--031 State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: r p'� City: State: Zip: Value of Work for this Permit:$ 1�^'• Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ID New Repair/Replace F-1Demolition Description of Work: /�'l�' /N STi9�! + 0 Cr -U0 2k- 7-0 Specify color of colo hru tile: LZ Submittal Fee$ Permit Fee$ W GO CCF$ L✓ CO/CC$ �- Scanning Fee$ Radon Fee$ CC) DBP��RIl$ G CO Notary$ Technology Fee$� Training/Education Fee$ U Double 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 app `and a reinspects ee will be charged. G Sign ture Signature qN ER or AGENT CONT CTO The foregoing instrument 4was acknowledged before,me this The foregoing instrument was acknowledged beforemethis day of 1 20 Vi .by �a day of ) 20 I Y� by who is ersonally known to 12C�Cdf� �UW1�+�1��;�`�" who is personally known to me or who has produced -- as me or who has produced ��� 1��•�(� ,1 C Sl as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 7 Ie d_` i... Sign: - _ Sign: Print: 1 IIS a a � i1�1 Print: T lkS gin\ i 11 ,��'14 .�:, Alyssa Hemandez >b�• .• ���',, A Hernandez Seal: �z• •o= Seal: .`a ,�;� COMMISSION #FF916795 = COMMISSION IFF916796 EXPIRES: September 9,2019 +`a EXPIRES: September 9,2019 www.AARoNNoTARY.coM �••.,,��I 1 ,��.��'� www.AaRONNoraRr.COM APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 31/03/2016 11:10 Page 1/1 8-111 Acl` ' CERTIFICATE OF LIABILITY INSURANCE DATE rYYY1� 033!31//31/16 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcypes)must be endorsed. 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 ofsuch endorsement(s). PRODUCER CONTACT NAME: SONIA RODRIGUEZ Red Road Insurance&Services PHONE FAX Arc No, o Ext): (305)557-2323 (AIC,No): (305)820.2038 10103 W Okeechobee Road E-MAIL redroadinsuranceoQbellsouth.net Hialeah Gardens,FL 33016 INSURER(S)AFFORDING COVERAGE NAIC Phone (305)557-2323 Fax (305)820-2038 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B: Rader Appliances Corp INSURER C: 1728 W 65 St INSURER D: Hialeah,FL 33012- (786)546-4331 INSURER E: INSURER 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. -LTR TYPE OF INSURANCE IANDSRL WUVBDR POLICY NUMBER POLICY EFF PMOM/LIDCDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 AMAE TO RENTED G COMMERCIAL GENERAL LIABILITY PDREMISES Ea occurrence $ 100,000.00 A ❑ CLAIMS-MADE © OCCUR 0185FL00057389-2 MED EXP(Any one person) $ 5,000.00 F-103/06/2016 03/062017 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000.00 0 POLICY ❑ JPERO-CT El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accident) $ NON❑ WN HIRED AUTOS ❑ OSED R pp Pl OPEcder<AMAGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATIONWC STA TU OTH- AND EMPLOYERS'LIABILITY Y r N ❑TRY LIMITS ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El r A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe unde DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (Attach ACORD 101,Additional Remarks Schedule,11 more space Is required) AC CONTRACTOR LIC CAC1817949 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORI2ED REPRESENTATIVE FAX:305-756-8972 SONIA RODRIGUEZ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD Miami hores Village ♦S, T3 j'I Building Department lam, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 LORIpA Fax: (305) 756.8972 April 5, 2016 Permit No: REV16-896 Mechanical Critique —Jan Pierre Perez Missing returns Pian review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings.