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WS-16-2652 3i ' Miami Shores Village LMH 7-ypM�Fttlttr4 11!hig :° 10050 N.E.2nd Avenue NES �iwn�rrlovr Miami Shores,FL 33138-0000 , Phone: (305)795-2204 a E "' L Sta�.'Al1 ► AM ffim a I „e F 72t11t Expiration: 03/26/2017 Project Address Parcel Number Applicant 358 NE 101 Street 1132060135280 PATRICE AND SCOTT SMITH Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell PATRICE AND SCOTT SMITH 358 101 Street MIAMI SHORES FL 33138- 358 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 20,600.00 PRESTIGE WINDOWS&DOORS (305)820-5999 Total Sq Feet: 0 Type of Work:REPLACING 13 WINDOWS AND 4 DOORS TO Available Inspections: No of Openings:17 Inspection Type: Additional Info: Window Door Attachment Classification:Residential Final Scanning:7 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $12.60 Invoice# WS-9-16-61481 DBPR Fee $4.05 DCA Fee $4.05 09/27/2016 Credit Card $332.70 $0.00 Education Surcharge $4.20 Permit Fee $270.00 Scanning Fee $21.00 Technology Fee $16.80 Total: $332.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECH ICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all t e f egoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh re,I ze the bove-named contractor to do the work stated. September 27,2016 Authorized Signa Owner ! li n ! r o / Agent Date Building Department opy September 27,2016 1 Miami Shores Villager�r � Building DepartmentSEP 27 2016 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 20N S 4-4 BUILDING Master Permit No.kD�E(p PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION MJENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP i� s \ CONTRACTOR DRAWINGS JOB ADDRESS: ✓'5� IV E t®� s'+ City: Miami Shores � .� pCounty: Miami Dade Zip: Folio/Parcel#: �� 3 20(4pol� S'-- � Is the Building Historically Designated:Yes NO Occupancy Type:10 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �(�QJI"� �" �� ( $, i') hone#: 1 Dom' -3 q Address: M City: S�AOC2S State: Zip: 3-3� Tenant/Lessee Name: Phone#: Email: �/� /' qCONTRACTOR:Company Name: er,pS�V,�. U"�n� ®6�S Phone#: �Sa0 S-99 / Address: L � SJVo Iv �D /� �✓1 City: i'�1 01n are,&I/' State: -7Zip: Qualifier Name: ) 5 �q �0 yu ti-�p Phone#: 010519 40-3& State Certification or Registration#: 0-t c l (49& Certificate of Competency#: DESIGNER:Architect/Engineer: f , �Y1cl) Y12Qf1 r i'JX/TSS �Phone#: LIN 35-q� Address: J(00 SW ) 2- 'q,,,0 City: 41ap, Imo"- `State:ft-Zip: 3z el Value of Work for this Permit:$ Alf r, `� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 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 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 bep roved and a reinspec on ee willpe charged. .r Signature Signature OWNER or AGENT CONTR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ai2l 020 6 by �+� day of 20 Q by who is personally known to 119 J_T who is personally known to me or who has produced as me or who has produced 1-3" °�� as m fication and who did take an oath. identification and who did take an oath. m MOT kRY PUBLIC: NOTARY PUBLIC: \'A �,*IIIIIIIII�� : e. 0 4Q g Sign: y •� •r— i Print: : ti��m= fA Y�TOR44 i9J• \•� U �% iw;` .s*)1*a�uft Seal: %i,/Alk O� B�•....5''� R` W Eke� �.i0q ///1/r�0RiD 111*��\�\� Vq ..� PROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) From: 06/26/2015 15:36 #383 P.001 /001 �C R CERTIFICATE OF LIABILITY INSURANCE o 6/20D1S 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. N SUBROGATION IS WAIVED,subject to the terns 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 endorsements. PRODUCER 1-239-935-5069 Staci Merchant Merchant Insurance Solutions PNE 305-804-2989 q/C me): 1-866-406-4983 12326 Isabella Drive ADDRESB• amerchantBmerchantinsurancesolutions.c INSURER 8 AFFORDINO COVERAeE NA1C8 Bonita Spring&, FL 33015 INSURERA: Interaational Insurance Company of Hano sr INSURED INSURERS.Association Insurance Company RJS Consultants Inc. INSURERC: dba Prestige Windows a Doors 5500 NBT 161st Street INSURERD: INSURER E: Miami, BL 33014 INSURER F: COVERAGES CERTIFICATE NUMBER:44384656 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. 1 M TYPE OF INSURANCEPOLI POLIC EXP POLICY NUMBER IMMIDD1YYYYV QRS A 8I COMMERCIAL GENERAL LIABILITY IG06CO03370-00 06/03/15 06/03/16 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE O OCCUR PREMISM lEs mwtmnew $ 100,000 MED EXP one raen $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L.AGGREGATE UMITAPPUESPER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JM Q LOC PRODUCTS-COMP/OPAGG $ 2,000,000 S AUTOMOBILE LIABILITYK.MBIWt?IN0LE11M1T $ ANY AUTO BODILY INJURY(Per parson) Is ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED P A G AUTOS $ $ (Per N=kwal UMBRELLA LAO HCLAJMS-MADE OCCUR EACH OCCURRENCE $ E"BRE LA L AGGREGATE $ PED N $ H WORKERSCOMPENSATION AND EMPLOYERS*LIABILITY WCV016309800 10/16 VEOCEIEAORCLU� � YIN X ER FIWMBFEXLUDED? NIA EL.EACH ACCIDENT $ 1.000,000 (Mandatory in NH) NYes�aaaribaunder EL.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OFOPERATIONBbelow ELOISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addtional Remerke Schedule,may be agaahed if more apace Is requbmd) CERTIFICATE HOLDER CANCELLATION CDC12SX687 MIAMI SHORES VILLAGB BIIILDING DEPARTMENT THE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NB 2nd Avenue AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 USA - - ©1868-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and I090 are registered marks of ACORD RJSCon 44384856