The URL can be used to link to this page

REV-16-942 \kn Miami Shores Village Building Departmentfl ` ' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 APR 0 8 Z 6 Tel:(305)795-2204 Fax:(305)756-8972 . I INSPECTION LINE PHONE NUMBER:(305)762-4949 IBY:- FBC 201H '5 BUILDING Master Permit No.7Vq/,,' F-15 PERMIT APPLICATION Sub Permit No. l L—Ql BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING F-1 MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS I®20 JOB ADDRESS: ! ®2®�o_ 4 � ' 171-yCl ` City: Miami Shores Countv: Miami Dade Zip: Folio/Parcel#: 1132-0601 3S/c/ Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �i OWNER:Name(Fee Simple Titleholder): 6 fl Phone#: —?L)5 '7S7 Ll9 vj Address:_ q-ll q � 1C 2" Aire "',210! City: N(&gfl JL� State: FL Zip: Tenant/Lessee Name: Phone#: � Email: C UPds-&➢� ` 9 / 74cc m-YK c,,' CONTRACTOR:Company Name: I ` Phone#: Address: 41434 /VF_ City: jA State: A k Zip: Qualifier Name: `, Cf2V z' Phone#: (( ``�'7 State Certification or Registration#: Certificate of Competency M c 6 c h 5 1 L., k-A DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 000. V Square/Linear Footage of Work: ® 0 $ (� - Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: P-& 11 p—J��`e'l!'t`d✓� 0 d ry II L JA&e Specify color of color thru tile: Submittal Fee$ X--) Permit Fee$_3 . 03 CCF$ CO/CC$ Scanning Fee$ W Radon Fee$ `'� y DBPR$ `4 Notary 6 Technology Fee$_ �� Training/Education Fee$ Double Fee$ 10 Structural Reviews$ 2-0 Q) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved a d a reinspection fee will be charged. Signature Signature WNER or AGENT Vtas TRACTOR The foregoing instrume was acknowledged before me this The foregoing instrum (acknowledged before me this day of 20 (', by day of �y^�,� A ,20 J(m by Cv�V �(�m� ,who ispersonallyknown to who is ersonally known t me or who has produced (�(U�Z"� as me or who has produced as identification and who did take an oath. identification and who di t, 9qath. nFr+� cRUZ :r° .`•.' Not_,, F..- "a NOTARY PUBLIC: ��\\O��INIIIt11/l�j�i NOTARY PUBLIC: Commission#Fi . ap� �Yc'q,91��/� My Comm.Explr�s r.p; 2019. through National Notary Assn. Sign: °�%• cn_Sign: _ * � Print: ��': ? ® 1��°mPrint: nal � Seal: b'� Seal: `/,ffj4tl.riv6l4`" k+k k k k k k k$k k k k k ek k#*k k k k k k k k k k k ak k ek k ak k k k k k &k8k�k ak Me k k k k+k k k4***k k k tk k k k+k k k k k k k k k+k k k k k k k k k k k k k k&k k k k k k k k k Ie k k k k k fie* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) C� e 2 / CERTIFICATE OF LIABILITY INSURANCE DATE 5I01m 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the term and conditions of the policy,certain policies may require an endomemerlt A statement on this certificate does not confer rights to the certificate holder in lieu of such endoremnt(s). PRODUCER CONTACTNAME FRANK FERNANDEZ Equiinsurence PHOM No. . (305)557-5578 No, (305)557-5197 6839 Main Street ADORm ffemandez@equnnsurance.com AFFORDING COVERAGE NAIC# Miami Lakes,FL 33014 INSURER A: Federated National INSURED INSURER e Wilcon Co. INSURERC. 9636 NE 5th Ave Road INSURER D: INSURER E: Miami FL 33138 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. LDiSTRR I AWL SUM TYPE OF INSURANCE POLICY NUN(eER POLICY EFF EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea amarenee $ 100,000.00 MED EXP(Any one person) $ 5,000.00 A N N GL-0000029598 07/23/2015 07/23/2016 PERSONAL BADV INJURY $ 1,000,000.00 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X POLICY❑JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE- Me U T $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per amident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS PROPERTY $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORWARTNER/EXECUTNE EL EACH ACCIDENT $ O mandatory In N R EXCWDED? N/A EL DISEASE-EA EMPLOYEE $ (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DE PTION OF OPERATIONS/LOCATIONS/VENICLES(ACORD 101,Additional Rammlm Soule.maybe attached 8 more a1 Is requIred) Unit#3303 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd.Ave. ALITNORt�REPRESEnIrATIVE Miami Shores F1.33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD