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ELC-15-529 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 I Q - C� Inspection Number: INSP-229900 Permit Number: ELC-3-15-529 Scheduled Inspection Date: August 26,2016 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address:11300 NE 2 Avenue Weber Hall Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-13 Project: <NONE> Contractor: AGC ELECTRIC, INC Phone: (305)823-2280 Building Department Comments WEBER HALL RENOVATIONS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 2 Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 25,2016 For Inspections please call: (305)762-4949 Page 3 of 36 Miami Shores Village MAR 1 x ,zoa5 Building Department _ s 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 BUILDING Master Permit No. ��o�f PERMIT APPLICATION Sub Permit No.& F-IBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING F-] MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP /✓�� CONTRACTOR DRAWINGS JOB ADDRESS: GO ®® �Iy� C-2 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): RcIrr—f f' 4 Ue1 Phone#: Address: �1.3 0® ye,. City: State L-• Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C� Phone#: Address: 2G G® W4264 2'=f City: 10 -0 State: Zip: Qualifier Name: -F n 12 1ttkR Z 6"Z P-7a/-7 Phone#: State Certification or Registration#: 9-L 0000 7& Ll Certificate of Competency#: DESIGNER:Arrpdchitect/Engineer: �� — Phone#: 7 a'- %1— ®6 Address: 1�J®® e/tr• S ® City: �K� ti�State: Zip: Value of Work for this Permit:$ � � � �'`L� Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: k6ew' 4LZ( 0( 'eV el 1-,'/7®-2-5 Specifycolor of color tfiru tale: `# Submittal Fee$ Permit Fee$ $ -41®®° e' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 121 ro - (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 sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued.�l a absence 0fovch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature. Signature OWNER or AGENT O TRACTOR The fo agoing instrument was acknowledged before me this The foregoing y'fistrumIt was acknowledged before me this hi day of f,� 20. 15 by day of J:�(, - - ,20 /J , by S(ASAW USGKAL ,who is personally known to 3-�' re 14--e —7 is personally known to me or who has produced as me or who has produced —& , C.- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:NIJ - ary Public-State of Florida P ' Print: a*Q:00i tary ies Feb 24.26210 Putil Smte of Florida -;;F�,�.o;�� Commission#FF 095275 ffry J Yeo Seal: �,,,, ..• Commbsfon FF 188481 pk'e l l/1?r2018 0% '74pa-, APPROVED BY � i� / �//L- �/ st9,4-17- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION g ELECTRICAL CONTRACTORS LICENSING 130ARD Et�764 The ELECTRICAL CONTRACTOR Nerved below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date. AUG 31,2016 J GUZMAN, ENRIQUE 1 AGC ELECTRIC, INC. 14780 SW 98 AVENUE MIAMI FL 33176 >� '''• •• Ar ISSUED: 06(t82014 DISPLAY AS REQUIRED BY LAW sEa a L14081eo�tsas �..•.•'�� ,, City of Hialeah Business 014-15 Business Tax Receipt Mayor Carlos Hernandez No: 238210-S4 (OLD-1731-807) Amount: $ 130.00 The person,firm or corp.listed dere has paid the business talc required to engage in or operate the business specified subject to the regulations and restrictions of the City of Hialeah,Florida Owner.TOMAS CURBELO Type ojBusuress:Electrical Contractors and Other Wiring Installation Contractors AGC ELECTRIC INC 2660 W 79 ST Business location HIAT.EAH t RL 33016 2660 w 79 ST Validating No.: 0000 Expires September 30,2015 THMHNOTA BILL Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS Nor A BILL -111)NOT PAY [LB 4528783 giUSiNESS"AmMorM" N Rel mar no. EXPIRES aCt 1c"bc REVEWa- SEPTEMBER 30, 2015 :.:.0 W:3' 4727740 Must be displayed a t place or business HKEAH RL 33016 Pursuant to County Code Chapter 8A-Art.8&10 OVOIRR SEC.TVP!OF BUSINESS PAYPAOff RECEIVED AGC ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Vilodcer(s) to Et2O000764 469.00 08/07/2014 CHECX21-14-045407 Thb local B Tar Base' =0 only coa8rms 1011 8168 Local Busiam Tab.The eeealo b am a lieaase, laroir or acoaftedoaofft otdnsgoeli ieedom to dobusha .NaldarawstComplyWhaay9armimav al at onvoinummewregula w laws am railubameata"hick apply to am bo kmm The RECEIPT NO.ob ve ar=t be fisphiml an all commercial ratdclas-Viami-Bate Coda Sec to-M For am laton"doo,vbi1 Wo-w AGCEL-2 OP ID:LK ATE CERTIFICATE OF LIABILITY INSURANCE F D03/09/20912/Y015 035 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 policy(les) 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 of such endorsement(s). PRODUCER CONTACT Brown&Brown of Florida,Inc. NAME: 1201 W Cypress Creek Rd#130 ac°NN E,,:954-776-2222 AIC No):964-776-4"6 P.O.BOX 6727 E-MAIL Ft.Lauderdale,FL 33310-5727 ADDRESS: Christopher M.Moore,CPCU INSURERS AFFORDING COVERAGE NAIC# INSURER A-*Amerisure Insurance Com any+ 19488 INSURED A G C Electric Inc. INSURERB:Amerisure Mutual Ins.Co.+ 23396 2660 West 79th Street Hialeah,FL 33016 INSURER C: INSURER D: 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. 1LTR TYPE OF INSURANCE 1M WVD D L B POLICY NUMBER MOM/UDDY/YYYY MMfDD1Y YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY CPP2057297060014 10/01/2014 10/01/2015 PREMISES Es occurrence $ 300,000 X1 CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ 10,000 X XCU PERSONAL&ADV INJURY $ 1,000,000 X Contractual Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRCT 7O- LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY Ea BINEDSINGLE LIMIT $ 1,000,000 accideA JX ANY AUTO CA20572960606 10/01/2014 10/01/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ( )BODILY INJURY Per accident $ HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT Com $500 Coll$500 $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS LIAR CLAIMS-MADE CU20724380402 10/01/2014 10/01/2015 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OTH AND EMPLOYERS'LIABILI Y YIN Y M TER A ANY PROPRIETOR/PARTNER/EXECUTIVE WC2084183 10/01/2014 10/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Equipment Floater CPP2057297060014 10/01/2014 10/01/2015 Scheduled 66,000 Leased/Re 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) RE: Project Barry University - Weber Hall Renovation Ph1, Qualifier: Enrique I Guzman License Number: EC0000764. CERTIFICATE HOLDER CANCELLATION MIAMI-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Det THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD q a ALL STATE ENGINEERING AND TESTING CONSULTANTS, INC.�� "� TESTING LABORATORIES-ENGINEERS-INSPECTION SERVICES-CHEMIST-DRILLING-ENVIROMENI'AL SERVICES ENGEWEERING 12949 West Okeechobee Road.Unit C-4,Hialeah Gardens,Florida 33018=Phone: 305-888-3373 Fax:305-888-7443 PROCTOR (',oMPACTION TEST ASTM D-1557 15-294 Date August 17r',2015 Order Number _ Client V.En ineerin & Consultin Address 2138 SW 23 Street,Miami,Florida 33]45 Pro'ect "SFR" Address 874 NE 99t' Street,Miami Shores,Florida Sam le Location Stock He at the 'ob site Soil Descr' tion Base Rock:Lime Rock with Lime Sand Mix Re orted to Sam led b TEST RESULTS GI Laborato Number: 15-294 Sample Number: to lb.Hammer and 18" rop The following compaction test was conducted in accordance wi AthAe F�ITO designation T-Moist80-C.ure/pensity relations of soil using a %Moisture Drybensiq 6 pay pensi�vs °lo Moisture 10 11 6.S. 124.4 5 7 130.9 8.1 132.1 10.3 123.3 Optimum Moisture 8.1 1001/oMag.Dry Density 132.1 981/6 Dry Density 129.5 95%Dry Density 125.5 N Gradation test passing 314"Siev 59.50% z W 0 Sampled By Tested By Asad Checked By SS 0 % MOISTURE Typed By we — --- Respectfully submitted by, AUG 2 0 2015 Gil erto G r t P.E. #F513T1 ALL S TE ENGIN EERJN G & TESTING CONSIJLTANTTS,INC. Should any subsoil conditiog do ns in the property(area)testo be held rs different from those encountered on the tested locations reported on our Density Test All State Engineerintesting Consultants Inc.is not t e As a mutual protection to client,the public and ourselves,all reports are submitted as the confidential properly of chants,and authorization for publication o statements,conclusions or extracts from our reports is reserved. 6 � ALL STATE ENGINEERING AND TESTING CONSULTANTS, INC � Tlw' TESTING LABORATORIES-ENGINEERS-INSPECTION SERVICES-CIC-MIST-DRILLING-ENVIROMCNTAL SERVICES A fL-L S ERIIE�a 12949 West Okeechobee Road,Unit U4,Hialeah Gardens,Florida 33018-Phone: 305-888-3373 Fax:305-888-7443 ENGField Density Test of CoMpacted Soils ASTM D-5195 Order# 15-294 Client: Y.En ineerin & Consultin Date: 08-17-IS Address: 2138 SW 23 Street,Miami,Florida 33145 Gauge# 23599 17-15 Pro'ect. "SFR" Address: 874 NE 99"Street,Miami Shores,Florida r .Location Building Addition Wall Footer South Side Building Addition Wall Footer East SideBuilding Addition Wall Footer West Side Description o Material Lime Rock with Lime Sand Mix Back Fill Sub rade �Blaasef1& x Sampled By: Tested B Laboratory Identification Number 15-1611 15-1612 15-1613 Test Number 1 2 3 Depth in Inches 12" 12" 12" Field Density LB/Cu Ft. (Dry Density) 131.1 130.7 131.8 Moisture Contents 7.9 7'5 7.9 Maximum Density In tale Field(%) 99.3 99.0 99.8 Compaction Requirement by Specs %of 98% 98% 98% Maximum Densi 100%Maximum Density(Lab) 132.1 132.1 132.1 Proctor T-180 AASHTO Method C 15-294 15-294 15-294 Optimum Moisture(%) 8.1 Reported By Asad Checked By SS Typed By we Respectfully submitted by, ` UG 2 0 2015 GiL ava re 14,a P.F. #51371 ALL STATE ENGINEERING & TESTING CONSULTANTS, INC. Should any subsoil conditions in the property(area)tested be found different from those encountered on the tested locations reported on our Density Test,All State Engin rin &testin&Consultants,Inc.is not to be held responsible. As a mutual protection to client,the public and ourselves,all reports are submitted as the confidential property of clients,and authorization for publication of statements,conclusions or extracts from our reports is reserved. ? ami Shores Village , .-. VF ,a' TVF ding Department 10 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JUN 205 Tel:(305)795-2204 Fax:(305)756-8972 a: . INSPECTION LINE PHONE NUMBER:(305)762-4949 - FB 2010 BUILDING Master Permit No. rC11_/— vw30 PERMIT APPLICATION Sub Permit No. )K BUILDING ❑ ELECTRIC ❑ ROOFING rtj REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ++ I nn CONTRACTOR DRAWINGS JOB ADDRESS: I 1600 UE 2oa Rm anue - W&e_f- �AGi+I I City: Miami Shores County: Miami Dade Zip: 331(10 1 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: 11 Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Eo i� U M e Cb i-61 Phone#: Address: 1\ 3G® r Zna �t�rn uC-_ \ City:_M1 cAi�► Shotes State: 21 OY1ACA Zip: Tenant/Lessee Name: Phone#: /� 1 Email: -2 J 1 r � � • CONTRACTOR:Company Name: S-0b -fi , 1!�C5 c6Y15-1s r.:c�ni) Phone#: ��J�� -� Z Address: g2n6 City:Win. an 1n\ f 1�re5 ^-' _State: �L Zip: 3 13 Qualifier Name: • aCl'—L 1t Phone#: ��5 ��G9 State Certification or Registration#: C C I \WDSS Certificate of Competency#: DESIGNER:Architect/Engineer: S� 'OMCA Ste\ ��r�MQ� O1 el _j LLC. Phone#: 9Sy �T�c Address: 150D F--kOz=Y Drqc . . Sl A,_- SCS city:VA.I n0bfJCL1e_State: FL Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration ElNew E] Repair/Replace ❑ Demolition Description of Work: we_�)r>_Y' t�C�� a-e-'r o Q-\ tIoy1S — Specify co 3rrvfrohir. ru tile: Submittal FeeP,� t Fee.,$ ®0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ 0 P Bond$ TOTAL FEE NOW DUE$ r (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 and a reinspection fee will be charged. 1A Aga JM44Signature V�& I4/ Signatur OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this Theforegoinginstrument was acknowledged before me this day of Vvne— 20 /X ,by C, �VN day of J\) 20 1S by who is personally known to e (+ who is personally known to me or who has produced as me or who has produced A) A as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: \�\\\\t111111111111/j/// � •�R1S TARP/,,•./� ' NOTARY PUBLIC: SSIOp � ycP�xa.?0��9 Sig Sign: - 1 • � = Print: i? Ff 22o337 Print: Seal: '9/-'; d� N �� Seal: ,"y°e�•,, MILDRED Y.GOMEZ l 111 1111 \\\\` My C mmu Expires Aug 24,2017 Commission#FF 40660 ** *w*w*x*x *x ******** xx****** + x ** x *** x** ** ** * ******* * APPROVED BY 4Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 201s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 - -- FBC20 (4s� BUILDING Master Permit No. e 0_1K --�203 D PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING 'REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING &21MECHANICAL r-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ��"I CONTRACTOR DRAWINGS JOB ADDRESS: �/3o0 /IC ?ILID 14 yr W� �/� 11:ILL City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: !� OWNER:Name(Fee Simple Titleholder): p�40/�k tl'17w*c!SiJr v Phone#: Address: 1110 4— City: State: PL Zip: 31 1 Tenant/Lessee Name: Phone#: Email: r- CONTRACTOR:Company Name: f-�C C��4P• Phone#: 0S- 6-7-1/ S Address: 7 /(7D s�/ o t M j�1�, S P F l©� City: N11 Lq I State: Zip: 33/ Qualifier Name: &'A h C (Sc--0 ' "�614- Phone#: 3®-5- State Certification or Registration#: (_q 7,5- r7©7 P Certificate of Competency#: DESIGNER:Architect/Engineer: \ yL Phone#: Address: 19do o '!�L Lele S l T �y City: �� u�, State: -o'-7L Zip: Value of Work for this Permit:$ ( Lbfoo Square/Linear Footage of Work: Type of Work: ❑ Addition ['Alteration ❑ New ❑ Repair/Replace El Demolition Description of Work: AIL-134K /-114LL �:C/l�(�//' 7761L.S. Pl/� Z A Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ rJ (Revisedo2/24/2014) 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 1 be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencem t ust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 10 the a se ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 141 Signature " r r� r Signature OWNER or AGENT CO TR OR The foregoing instrument was acknowledged before me this The foregoing instrum w acknowledged before me this day of,,,,�,�Ut�,,�nnV�S , ,20 J� ,by day of ( 20 « ,by SUSAN i1wSy1Y6�� ( who is personally known to rcanaWho is personally known to me or who has produced as me or who has produced A1/ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: Toi Jeffry J Yeo "" " MILDZ GO My Comms FF 180401 Sea ,��aoB�,, Expires11H212o1e ?ate°�4°.= Notary Pubf Florida N: :Q?My Comm. 24,2017 ffCommis0660 APPROVED BY s Examiner Zoning Ll Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 SEP 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �� FBC 20dc� BUILDING Master Permit No. P C-04-,203(2 PERMIT APPLICATION Sub Permit No. -EL — l5 — 52!. ❑BUILDING ERELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /1300 N 2/Vj f�y�< — ��/�d°E� AI City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): B/I 14tC/ /�I/j�i ir'�r%l/ Phone#: Address://3©0 'A'a- i� UE. City: I'+Y01 S d State: _ L Zip: 3jl(o l Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: A CSC'_ Phone#: 3 v5— -_10 Address: g ag w � 17t/tµ City: d 1,4 L cm j:- State: F-L Zip: 3 -9 01(� Qualifier Name: Z-M/Qlje3. t�lel /V Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: 1090 PLLL< lSU/TL - yV City: t • ill e te: Zip: 331 Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition [2-Alteration El New ElRepair/Replace El Demolition Description of Work: �.t/��/� 11, lL L !�'D✓� `7�l d / Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ 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) ! /� 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 plicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be del• red o the person whose property is subject to attachment. Also,a certified copy of the recorded notice of comm enc t must a postgd at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in e a sence f such osted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 1 , r Signature OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoing strument was acknowledged before me this 2D day of u ,20 �S , by 'r� day of 20 1,C , by Su who is personally known to �u, � •��Z —,who is personally known to me or who has produced as me or who has produced e/a�� /��wv� as 7' identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: — Print: Print: 3r° r `;` s, ESPERANZA CHIRINO Seal: JAY�Yuia Seal: .,,� �•=My Comm.Expires Feb 24.2018 Mir Cans W"RF 1!!481 '•.,Fa ��'� Commission N FF 095275 w Exon 11111IZ01, '�auuS�• AO APPROVED BY /�� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)