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DEMO-10-158Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \ -(hav Inspection Number: INSP- 163871 Permit Number: DEMO -2 -10 -158 Scheduled Inspection Date: August 30, 2011 Inspector: Devaney, Michael Owner: KOTALIK, KENNY Job Address: 950 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FIVE STAR ELECTRIC SERVICE Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1132060340200 Phone: (786)356 -0162 Building Department Comments AS PER CONVERSATION WITH PL CONTRACTOR, OK TO EXTEND THEM 60 DAYS. NB Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments c 69 August 29, 2011 For Inspections please call: (305)762 -4949 Page 21 of 22 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Venn Address. F LOQ City: M karn'1 State: MAR 2 4 2011 Permit No9fI O I 0 1% Master Permit N vo40 Phone :305 7c51 244-6 goo Nw (44 5+ PI zip: 331G78 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: q 50 NE 100 54- City: Miami Shores County: Folio/Parcel #: (1— 320G- O34 -020° Is the Building Historically Designated: Yes Miami Dade Zip: 333 8 NO Flood Zone: CONTRACTOR: Com any Name: friOe `J y?. r d€L4T1'._ Set UtZe - T�Phone #C 3- Sg.-ag2_ Address: ♦ 9pL,. octo(I' ' Glen Ce {. e- City: = �. State: Zip: .51-/-7 3 /��� Qualifier Name: 2tv2 n '1 von Actre t ex-% Phone #: State Certification r���Registration #: E 1300 a��3 Certificate of Com. -tency #: Contact Phone #: '?ilOa. st -0147Z Email Address: 4 12'122 �' P i . earn DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ t S 00 c" Square/Linear Footage of Work: Type of Work: Address ❑Alteration ❑New ❑Repair/Replace Description of Work: Q fled. eC. tY 1 C 0.1 Demo ll a n £2rn,o -2- 10- 158 U emolition Pere►t+ s kxk*ak*aks 4sk: ksk%ksk*:ksF-Ba:>::kka::i::d:4 $r.. *>k>dsazkkeR*pis :k***Fees *=R.k8asF8s$s *sk****. *r..::kxok>aokskek****K * : >;:ekxa;:aasksF*A'sak*** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 lo the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature w Signature Owner or Agent Contractor The for 14UC1'22� oing itrument was ac wledged before me this / The for going i strument was acknowledged before this / day of V I , by to Yl 14D 'i {� • , day of , 20 ! f , by �Iej 1( who is personally knot to me or who has prod ced 4 -C`! i - As identification and who did take an oath. —* 412as identification and who did take an oath. NOT Y1 UBLIC: v�ho is personally known. to me or who has produced • Si // / / %il Print: ,e Y� % et I II4 .. V A. WERA My Commissi a `� MY COMMISSION # DD753565 , 9 EXPIRES March 16, 2012 • Fh-1r.'_ ,1otaryS ^rm o.com (407)398-01'3 NOT Y !' UBLIC: Sign: Print: My Comi Rriio (407) 339.0955 F.1 ^.1_7 :1;AeryScr ice.com MY COMMISSI ° )res:I=XPIRE . March 16, 2012 • 1 " I D q't$aHei)efje*****t}tj, ; ( eP. t* tjt*> 6ifI ****TA *Mi)t* SC:<MY,.i<M.i>. . . 6* *iji ** * * * * * ** ****** * * **%k *9<ylNi, tNT¢iAi D4iQijtY,t*>6*D;6'Sytt@, ** •RM^LMY 1M %9$ . ***ill*ill*litfitf t**** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /I0/2009)(Revised 3/15/09) Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 08/09/2010 Applicant 950 100 Street Miami Shores, FL 33138- Owner Information Address 1132060340200 Block: Lot: KENNY KOTALIK Phone Cell KENNY KOTALIK 950 100 Street MIAMI SHORES FL 33138 -2513 Contractor(s) Phone Cell Phone FIVE STAR ELECTRIC SERVICE (786)356 -0162 (786)356 -0162 Type of Demo: Electric Additional Info: DEMOLITION Classification: Residential Fees Due CCF CCF Education Surcharge Education Surcharge Permit Fee Scanning Fee Submittal Fee Submittal Fee Submittal Reversal Fee Technology Fee Technology Fee Total: Amount $0.00 $1.20 $0.40 $0.00 $150.00 $3.00 $0.00 $50.00 ($50.00) $0.00 $1.60 $156.20 Invoice # Total Amt Paid Amt Due EL -2 -10 -36942 $ 156.20 $ 10820 Et 0 01) EL -2 -10 -36942 $ 156.20 $ 156.20 $ 0.00 Check #: 4917 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: 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, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. February 11, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date February 11, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit No. @mamg7311 FEB 0 2 2010 gli BY:..` Master Permit No.DEiM0 `O -/0 Permit Type: Electrical { Owner's Name (Fee Simple Titleholder) V-er1iN' VCr3'Cc i \ 1 Owner's Address 6) 00 N tll) 144- 54 Phone # P Si `l -1 C City M OM l State Zip 3316 Tenant/Lessee Name Phone # E -MAIL: I Job Address (where the work is being done) GI 50 NE 100 S T • City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # AI- 320G-o 4- °ZOO Is Building Historically Designated YES NO Contractor's Company Name Y tj'2.- e612_ I L �e J'cc 3-r7C_ Phone # Contractor's Address b !fl 1`1t3e.L J City I ct agY\ Read-, State Qualifier Name` an )h' n ALA c-e_(i'` State Certificate,or Registration No. - �� �iQ Certificate of Competency No. E -MAIL: C2 12 31n o(. r Architect/Engineer's Name (if applicable) Phone # 7P-4J 35'6 1 1 t2 zip 33 q-7A Phone # 7 76:)'3 -- z 1 Value of Work For this Permit $ 15 Cy(/ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alte`ratiion 1_ ['New ❑ Repair /Replace Demolition escribe Work: Demo. (-Lc:tS-fe r pe (r+- if 01-10 - fo 0 ee.d -�t1 * * * * * ** * * * * * * * * *xxxxx x xx x xxxxxx *x * * * * ** Fees * * * * *x *x *xxxxxxxxxxxxxxxxxx xxxrxxxxxxxx * ** ** Submittal Fee $ ""(:)4 " Permit Fee $ j -re, 4°,%;') CCF $ - (20 CO CC Notary $ Training/Education Fee $ '40 Technology Fee $ 1- Scanning $V' o Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ Double Fee $ Zoning $ Total Fee Now Due $ See Reverse side -* 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 PAVING 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 S2500, 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 he posted at the job site for the first inspection Which occurs seven I7) 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 wner or Agent The foregoing instrument was acknowledged before me this day of , 20 ��', by k—itNef 1A who is personally known to me or who has produced FL. L 1? As identification and who did take an oath. NOTARY PUBLIC: sign: . :;, .... . S -; .1.- Print: cam:• y0, �,i~' m My Commission Expires; p °• 4��1 : sou ° * *pest ******** * ******** ". nVe „,4e txx ***** * *,� *:�,� *see *,tee,��e, , * xxxxxx�e*x*x �te, xx* �exxxxx�: xxx ,r,�e * *a�,��aar�r *�e�c *,� * *�a iVASA: •••. ....... `. APPLICATION APPROVED BY' �.,.`/`.�' 9 Plans Examiner Engineer Zoning Contract The foregoing instrument was acknowledged before me this 1 i 11PT day of 're , 20 0 , by J ceer) who is perso I kr own to me or who has produced NOTARY P an WINN itd BERNAAn `= MY COMMISSION # DD753565 EXPIR - "` arch 16,2012 (407)388 -0153 ;;: <_ rvice.com Sign:4(o' Print: C r r+9,2fl My Commission Expires: .r , (Revised 02/08/06)