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EL-09-1730 a Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 144070 Permit Number: EL-10 -09 -1730 Scheduled Inspection Date: May 24, 2010 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HURTAK, DONNA Work Classification: Alteration Job Address: 533 GRAND CONCOURSE Miami Shores, FL 33138 -2464 Phone Number Parcel Number 1132060171350 Project: <NONE> Contractor: ELOHIM ELECTRIC Phone: 305 -635 -7999 Building Department Comments electrical work for bathroom remodel Inspector Comments Passed [Ef f� Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 21, 2010 For Inspections please call: (305)762 -4949 Page 28 of 39 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 6 Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 133216 Permit Number: PL -1 -10-47 Scheduled Inspection Date: May 24, 2010 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: HURTAK, JEROME Work Classification: Addition /Alteration Job Address: 533 GRAND CONCOURSE Miami Shores, FL 33138 -2464 Phone Number Parcel Number 1132060171350 Project: <NONE> Contractor: Building Department Comments REPLACE GAlvanized pipe with copper pipe for the upstairs bathroom. re -route sanitary line to connect to septic tank, rough set, 1 water closet, 1 lavatory and 1 shower Inspector Comments Passed tom/ Failed C Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 21, 2010 For Inspections please call: (305)762 -4949 Page 7 of 39 Z Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 127237 Permit Number: RC -10 -09 -1709 Scheduled Inspection Date: May 27, 2010 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Final Owner: HURTAK, DONNA Work Classification: Addition /Alteration Job Address: 533 GRAND CONCOURSE Miami Shores, FL 33138 -2464 Phone Number Parcel Number 1132060171350 Project: <NONE> Contractor: DOWER CONSTRUCTION INC Phone: (305)986 -4999 Building Department Comments bathroom renovation Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 26, 2010 For Inspections please call: (305)762 -4949 Page 1 of 15 / �.�� aft' _�'�- 3 m L . d � NWPR, Y Miami Shores Village 10050 N.E. 2nd Avenue�� Miami Shores, FL 33138 -0000 g E Phone. (305)795 -2204 „jam Explratton: 08/16/201 Project Address Parcel Numbe Applicant 533 GRAND CONCOURSE 1132060171350 Miami Shores, FL 33138 -2464 Block: Lot: DONNA HURTAK Owner Information Address Phone Cell DONNA HURTAK 533 GRAND CONCOURSE MIAMI SHORES FL 33138 -2464 Contractor(s) Phone Cell Phone Valuati=F MANCO AIR INC. 305/409 -7719 Total S Tons: For Inspections please call: Additional Info: (305)762 -4949 Classification: Residential Available Inspections: Approved: In Review Inspection Type: Comments: Date Approved:: In Review Ventilation Date Denied: Type of Work: Final Hood Rough Duct Underground Fees Due Amount Invoice # Invoice Total Amt Paid Amt Due CCF $ MC -10-09 -36176 Education Surcharge $0.20 $157.55 $157.55 $0.00 Permit Fee - Additions✓Alterations $150.00 Permit Technology Fee $3.75 Scanning Fee $3.00 Total: $157.55 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 17, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date February 17, 2010 1 z y` f 'nom r� 3s n fl' Miami Shores Village EM 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0004 r „ Phone: (305)795 -2204 YM u Expiration: 08/16f2010 Project Address Parcel Number Applicant 533 GRAND CONCOURSE 11320601.71350 Miami Shores, FL 33138 -2464 Block: Lot: DONNA HURTAK Owner Information Address Phone Cell DONNA HURTAK 533 GRAND CONCOURSE MIAMI SHORES FL 33138 -2464 Contractor(s) Phone Cell Phone Valuation: $ 2 50.00 MANCO AIR INC. 305/409 -7719 Total Sq Feet: 150 Tons: For Inspections please call: Additional Info: (305)762 -0949 Classification: Residential Available Inspections: Approved: In Review Ins p e ction T ype: Ype: Comments: Date Approved:: In Review Ventilation Date Denied: Type of Work: Final Hood Rough Duct Underground Fees Due Amount Invoice # Invoice Total Amt Paid Amt Due CCF $0.60 MC -10 -09 -36176 Education Surcharge $0.20 Permit Fee - Additions/Alterations $150.00 $157.55 $157.55 $0.00 Permit Technology Fee $3.75 Scanning Fee $3.00 Total: $157.55 Building Department Copy February 17, 2010 2 1 3 oar) Miami Shores Village Building Department 10050 E.2nd Avenue, Miami Shores, Florida 33138 e1: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. —J PERMIT APPLICATIO I Master Permit No ��-' ���� FBC 2004 (, Permit Type Mechanical Owner's Name (Fee Simple Titleholder) Phone # �J • C 44 Owner's Address City State Zip Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Villaize County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES < NO /Contractor's Company Name Phone Contractor's Address /Vzo ` lIt Ci State Zip 0 Qualifier Name f Phone # �., State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: I Type of Work: ❑Addition Iteration ❑New ❑ Repair /Replace El Demolition Describe Work: at atat' at9ratae atat�ocat at &atxxatxxat arx at deda at at eY 9r ArdeunY aY nY aY aYxee eYxxarxoc�sexslrxaY o: �e4�xi: xtYx�xxxaY aY aYxx Submittal Fee Permit Fee 6 V ©V CCF $ _ (p 0 CO /CC Notary $' Training /Education ee $ 20 Technology Fee $ J Scannin $ - C�0 Radon /� g $ DPBR $ g Zonin $ Bond $ Code Enforceme t $. Double Fee $ Structural Review. $ Total Fee Now Due $. See Reverse side -4 V W 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 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 wil of a ap d a r ection ee will be charged. i Signature Signature Agent Contractor Owner or A The foregoing instrument was acknowledged before me this � The foregoing instrument was acknowledged before me this day of �� 20 � by �L��� Q! —�I� day of ®� , 20, by who is ersonally known to ' oe who has produced who is ersonally known to me who has produced As ide "I,- did as i ti nand who did take an oath. DANIEL P. DOWER NOTARY P DANIEL P. DOWER NOTARY PUBLIC MY COMMISSION # DD917231 r ••e MY COMMISSION # DD917231 EXPIRES August 21, 2013 EXPIRES August 21, 2013 Sign: Sign: �y Print: � ✓ � / �j� Print: My Commission Expires: My Commission Expires: xx4rxeY &uk oY•a°xYxxa4 e'e tY et dexxxxeYY 4exx{¢ xu* xaYdexxxxeYYxa4xx .&xa:xxxxxxxxxi:' '9axxicxxxuxaYxxx• xxxoY dexxeYxx9exx dcxdex,: de d: ,tixxxaYxx xsYx APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revise&02/08 /06) gill h M i4 m i , Shores .' Ita e it ing ve art e nt I j' 1005 1V.,2nd Awentre, Miami Shoces, larida 33138 e1j� (JQ5)I795.2204 Fax: (305); / $972 I� U I IJIG ECEI D ermit No. Y -71 1 E N I`I"f APP T10 rini N `' C + ti Oq O CT OOT`'1 te Per z o: L' ' BC 2004 I y� P um` -� errx�'if T e Jt I. r s wner s Nam ��� .. Name Fee Simple le T t! eh p � aM±d r P p. h one # ;►weer "S Act re� a (> j J5 1.7g i t ty I� s Z ip t , I nant/LessEe Name hone # h Addr� II ess w re � , e the work is be ( done ) �p g ..rr hh 1, �1, �ZAO lkliami S ore i!i .I L ou Zi i i- Da e: pty / PA RG I Building (fist ricaliy Designated YES 4 outractor's Company Name �b ', � M.. , Phone # 32 ` ntractor's jAdd' es9 t5 II c c �, gln fier Name � one # � ali am l '. Ph to Cetttcater Registratrarl Nt�� Certificate o Competency;�. ALi k. I chitect/Engmeer's Name (rf, tr Ie t?k� ) Phone # h diue of V��`Glc ar this Perm t. i � o �I ��pe [:]4dd i Square !Linea Footage Of Work r. , of Wok iti q f I, 9 � u � t i 4 l l [New Rep�n,r /��eplace, ! Demolition Iescrl�e Wbrk's ? i I L li I� fl I' , Fees** * ** ***two bmttall� $ iP rmit h $� CAF$ CO /�C to �' I $ i Trainin '/ u t is ry. . ca Feo $ ,T � echnol Fee I i p � e �a anning $ �b D>PB $' Zoning $ ,� f nd $ Co d l forcem 'ntr$ Double I i ruc � ra v I to e �v: `I $ , . i 't'otat'Fee IYQw Due $ : t ; See Reverse side I I�� is r I G += - �, f . Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage L ' en Lender's s Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a eimit to do the work ork 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, FURNACf;S, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify hat all the foregoing fY g g information is accurate and that all work will be done in compliance with all ' iI applicable laws regulatin construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 1 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND „TO OBTAIN FINANCING, I 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 5 g $ D0, the applicant must promise.in gobd faith tha 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 l he absence of such posted notice, the inspection wil a . p oved a d eins ctio ee will be charged Si natur ;III g e Signature Oyri�er or Agent Contractor The foregoing ournent was acknowledged before me this The foregoing I�r instrument was acknowledged before me this {�I day of 20 , by , day of , 20 ,b k i Iwh personal n to me or ho has produced P who ' personally own to me who has pro uced l who did take an oath. as Vol 194" 1W NOTARY - tea: DANIEL L PUBLIC: P. DOWER :.: NOTARY P MY . _ My COMMISSIOM # OMMISS ION # pD817231 p0817231 EXPIR IRES S „ ' , Augaet 21, 2013. )3ae -ot August 2 1 .2013 89 t sa Sign: F 4 r Sign: Print: 'Print: G d � My Commission Expires: My Commission Expires: �PPCICATION: APPROV D BY: � l �✓ Plans Examiner Engineer er _ g . Zoning (Revised ised 02/0 8/06 it sue,° Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 4&R Phone: (305)795- 2204 R +I VIIu,.,.:< tOAli�'' z cm v r , Expiration: 0711212010 Project Address Parcel Number Applicant 533 GRAND CONCOURSE 1132060171350 Miami Shores, FL 33138 -2464 Block: Lot: JEROME HURTAK I Owner Information Address Phone cell JEROME HURTAK 533 GRAND CONCOURSE MIAMI SHORES FL 33138 -2464 Contractor(s) Phone Cell Phone Valuation: $ 7,000.00 DOUGLAS ORR PLUMBING INC 305/887 -1687 _• _,. _ m_ _.... Total Sq Feet: 0 Type of Work: PLUMBING For Inspections please call: Type of Piping: PIPE REPLACEMENT (305)762.4949 Additional Info: RE ROUTE A SANITARY LINE Available Inspections: Bond Return : Inspection Type: Classification: Residential Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $4.20 PL - 1 - 10 - 36805 $ 289:20 $ 50.00 }r Education Surcharge $1.40 - -"--�- — – -- PermitFee - Additions/Alterations $225.00 PL -1 -10 -36805 $ 289.20 $ 289.20 $ 0,00 Scanning Fee $3.00 Check #: 59486 Submittal Fee $50.00 Technology Fee $5.60 Total: $289.20 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. January 14, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy January 14, 2010 1 !. Miami Shores Village 10050 N.E. 2nd Avenue �z Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 M �� Expiration: f Project Address Parcel Number Applicant 533 GRAND CONCOURSE 1132060171350 DONNA HURTAK Miami Shores, FL 33138 -2464 Block: Lot: Owner Information Address Phone Cell DONNA HURTAK 533 GRAND CONCOURSE MIAMI SHORES FL 33138 -2464 Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 DOWER CONSTRUCTION INC (305)986 -4999 (305)986 -4999 Total Sq Feet: 150 Approved: In Review For Inspections please call: Comments: (305)762 -4949 Date Approved:: In Review Available Inspections: Date Denied: Inspection Type: Type of Construction: Occupancy: Final PE Certification Stories: Exterior: Drywall Front Setback: Rear Setback: Miscellaneous Left Setback: Right Setback: Window Door Attachment Bedrooms: Bathrooms: Tie Beam Plans Submitted: Certificate Status: Final Certificate Date: Additional Info: Framing Bond Retum : Classification: Residential Insulation Truss Insp Fees Due Amount Invoice # Total Amt Paid Amt Due Columns CCF $2 Foundation RC- 10-09 -36174 $ 166.45 $ 166.45 $ 0.00 Window and Door Buck DBPR Surcharge $0.75 Education Surcharge $0.80 Fill Cells Columns Notary Fee $5.00 Wire Lathe Permit Fee - Additions/Alterations $150.00 F. T Le Permit Technology Fee $3.75 F. Elevation Certificate Radon Surcharge $0.75 Scanning Fee $3.00 Total: $166.45 g In considi6tion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertainingVereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting is permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required LECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNER$FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating constructs and zoning. Futhermore, I authorize the above -named contractor to do the work stated. November 06, 2009 A,Vdi orized Signature: Owner / Applicant / Contractor / Agent Date mamm Build ng Department Copy NovemlW 06, 2009 1 �� :; " I ' i I ; i i i Z oe ---- - - - - -- il III PER7_ 11 iv' am S o res ViHag- APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS Miami Shores Village Building Department 10050 N. .2nd Avenue, Miami Shores,. Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING R( (' ({VED Permit N . C` tO q—f PERMIT APPLICATION ter Permit . FBC 2004 L " T 1 UQ Permit Type (circle): uilding oofmg _ _ _ Owner's Name (Fee Simple Titleholder) In Owner's Address Phone # �� Lax ��'��:— CityH114 State Zip TenangUssee Name Phone # Job Address (where the work is being done) City Miami Shores VillagLe County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES �5 V / Contractor's Company Name , Phone # Contractor's Address AV r City l 4_ S to Zip / Qualifier Name / Phone # State Certificate or Registration No. Certificate of Competency No. ArchiteeVEngineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition YVAltera n [-]New E] Repair/Replace [],Demolition Describe Work• Submittal Fee $ Permit Fee $ ® tea CCF $ Notary $ •a Training/Education F $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -4 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 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 app ved and a ei ect'on fee ill be charged Signature Signature Owner or Agent Contractor The foregoing ins ment was. acknowledged before me this' The foregoing instrument was acknowledged before me thikcr_ day of b day of 20da, by DaA�QJ wh is personally known to me o ho has produced who is personally known to me or who has produced�� As identification and who did take an oath. as idei ion and who did take an oath. .�`� NOTARY' PUBLIC: - ►' DANIEL. P. DOVER NOTARY P " -°: •": MY COMMISSION 0 DD917231 EXPIRES August 21, 2013 Sign: Sig n•l GL I— Print: Print: , My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: /a �P Plans Examiner Engineer Zoning (Revised 07 /10/07) _ 81ajE OF F`WRIDA. COUNTY uF0AKNE dy 0��/ that 0,4 is tn 10 �43y of Ow VV VV>TMESS rrj hand 3pd[ffidmSedl / couft 06 cft t% NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. OR Ok 27074 Ps 0573; Qp9) _jAX FOLIO NO. RECORDED 11105/2009 13:11:06 HARVEY RUVINr CLERK OF COURT STATE OF FLORIDA: MIANI-DADE COUNTY? FLORIDA COUNTY OF MIAMI-DADE: LAST PAGE THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. Space above reserved for use of recording office 1. Legal description Df ropwty and s: g&5� 4110 e—J5 �r/ 0 4. Tr`94k x0clau"a- HlOwt C91MAI-14 P-21 _>-3011.66 2. Description of Improvement: /zoom !�� ow 3. Owner(s) name and address: M'Je-6RE� XU 641FVV W Hw--SVPE-3;� 1;,.) Interest in property.. 0WA4X_ x ' / Name and address of fee simple titleholder: 4. Contractor's name address an I pho number ?V6 qM 5. Surety: (Payment bond required by owner from contractor, if any) Name, nddr»moand phone number: Amount mfbond G' Lender's name and address: 7.PenmonnwithintheQtoteofF|ohdadaaignotedbyOwneruponwhomnoUceaorotherdooumsmtemay. be served oo provided oy Section 713'13(l)(a)7, Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice ofCommencement: (the expiration date Is 1 year from the date of recording unless a dtfferent date Is specified) WARNING TO OWNER� ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713. PART |. SECTION 71uJ3.FLORIDA STATUTES, AND CAN REGVLT|N YOUR PAYING TWICE FOR IMPROVEMENTS nJ YOUR PROPEFUY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. |P YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s &ofner44r 0 orized Officer/Director/Partner/Manager Prepared -'- ^ rL Print Nam r-ft Print Name, 3 _ C7 ND C Trtle/Office. Title/Office "q STATE OFFLORIDA OOUNTYOFNikAM|CADE The for:erp ristrumesit wAs a4, no IeLged before me this 1 6.- day Of- OC By ersonally known, or Q produced the following type of identificat! EAPIRES AUQUst 21, 2013 Signature of Notary Public: 01 Print Name: (SEAL) 13 RA j— Under penalties. of perjury� I declare that I have read the foregoing and that the fact at in' t e, (s) 2! — B a e L BY . _*~4' -7 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 � 333 " Phone: (305)795 -2204 Expiration: 05102J201 Project Address Parcel Number Applicant 533 GRAND CONCOURSE 1132060171350 Miami Shores, FL 33138 -2464 Block: Lot: DONNA HURTAK Owner Information Address Phone Cell DONNA HURTAK 533 GRAND CONCOURSE MIAMI SHORES FL 33138 -2464 Contractor(s) Phone Cell Phone Valuation: $ 500.00 ELOHIM ELECTRIC 305 - 635 -7999 _... - Total Sq Feet: 75 Y Type of Work: ELECTRICAL For Inspections please calk Additional Info: INT. REMODEL (305)762 -4949 Classification: Residential Available Inspections: Inspection Type: Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 EL -10-09 -36198 $ 188.30 $ 188.30 $ 0.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $180.00 Permit Technology Fee $4.50 Scanning Fee $3.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Total: $188.30 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. January 06, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy January 06, 2010 1 Dun Miami Shores Village g , [ OCT ®CT 2 l 200 i Building Department 10050 1 I.E.2nd Avenue, Miami Shores, Florida 33138 T,,1: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit N o. ' f! PERMIT APPLICATION Master Permit N o. 4 —/ FBC 2004 Permit Type Electrical - Owner's Name (Fee Simple T Phone # k�! a 1?4P A ?f Owner's Address City State �� Zip Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City Miami Shores Villase County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name C(1 V t lo o Cj jvi Phone # 00 - 766 Contractor's A dress G 6 j /V O i 6 thu City P 1-n I (State Zip 3 3 P7 Qualifier Name a 0V 4R Phon #_ 0: State Certificate or Registration No. Certificate of Competency No. C Dom® Zl�t� E -MAIL: Architect/Engineer's Name (if applicable) Phone # r �S - Value of Work For this Permit $ too Square / Linear Footage Of Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair /Replace ❑ Demolition Describe Work: ., ( J/� a4x�Y�xoY vYalr do w°oY oY Yxx�etY 9Y is oYxYudexxYx eY &9t &xxoYoYxde Fees'��e oYY��ex�oY Yxxxxx9exxxeY i:xxYxxx�c aY oYY s4 kteY d: Y ek dtY Y droY �e Submittal Fee J20 Permit Fee S CCF $ . (PO CO / Notary $ Training /Education Fee $ 1- O Technology Fee $ . w Scanning $ 0 Radon $ DPBR $ ning $ Bond $ Code Enforceme t $ / Double Fee $ / Structural Review. $ 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 Zi 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: 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will approv or ei pection ee will be charged Signature Signature g Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 0 - �i�N7/� -r day of 0 20 61� by who is rsonally known to who has produced who is OEsonally known or who has produced A n oath. S Jcatio ® �r�iopd �igljoat -. NOTARY PUBLIC: " DANIEL P. CIOWER # NOTARY P MY COMMISSION # DD917231 MY COMMISSION DDg17231 EXPIRES August 21, 2013 EXPIRES August 21, 2013 Fw�rwa oa „ AIL Sign: Sign: Print: �� Print: My Commission Expires: My Commission Expires: dz ac dr 4eaxxxaYxx4exok$ xoY& Yx4 :xxzxx •uxxxxxxx xxxdcxaexx rxxx xutrx$exacx a:xzx xx3r is icxicxx4cx9:a:xx�z xuxxu4: 9: sic cx�cxxx�exxs: 9cxoYz APPLICATION APPROVED BY: ®�G��'! Plans Examiner Engineer Zoning (Revised 02 /08/06) Miami Shores V illag e g J 1 1 2 10 I k ' f V. I i I I ldin D Bu E.Florida } .... �/.......... . 10050 �n ��' d Av nue Miami Shores, R I el: ( Q 35 I ' ) 7915.2204,0 ax: (30$) 75.8972 , UILDING Permit No. I ERIVI;IT A'PC A�IZ'IO 1V�1�aster Permit' No. C 200± , . I I p II I ' rmit Tyke: ! Piu�nb Ild f i ner °s Na a (Fee Simple 'I i(l 'ohdici r) Phone # I' �, , I C} ri Address II ii A Ci Y r S . � P T' 'nant/Lesse6, Na a ��; p hone MAIL: JbAd t a the � Flo n wh edr w r ess ' o k `5 e i � be' t I C y iami hores it[ Qbunty ivliami�Dade Zip 3 ` F LIO /PARC G# 02 — '7 -' 3 Is Building Histo ically Desig S'/ nated L YES NO a ntractor's Company Name deli l ; �- _ ; � t`23 �✓ hone # �_ �'8(� C ntractor's Address '1. j� r Ci Stalte L Zip 3 3d G f� 9, alifierName 4� Phone # 11 r I S a Certific4te off• Registration No. ' (� Certificate of Competency No. E IU 4 ' AY l ill chitect/Engineer's Name (if applicable) -�- Phone # f I ;, ,� • II I '1/ liue of Wo�*k For this Permit $ tl . �� Q Square / Linea Footage Of Work: Ad fi "J "'*� il' ]Alt iQkt l I, oNew { � Repair /Replace [ Demolition I N y C/ r II D S fa T Q u do dcYikaex& • �r l S mittal Fee $ #et�tnit Fee �CF S CO /C � I I /F �ucation ;eel$ �'' Technology Fe� S �J i t I S nning $ ' Radon' DPBR S Zoning S I B' nd S Code 19 r4forceme t $ Double Fee S St actural.Revie*4 $ � � Total Pee Now Due S � `Z Lill I I See Reverse side H i I r I Bonding Company's N me (if applicable) 'Bonding Coin `An s Adress p Y i i City State Zip Mortgage Lender's Name (if applicable) �I �es Mortgage Le' rider s Add s , City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify i that no work Y or install commenced prior to th ' installation has, p Issuance of a permit and er that all p work wi ll be performed to meet the standards of all laws regulating on ►n t his jurisdiction. I understand construction a separate to ermit m p p must be secured for ELECTRICAL WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AI WORK, PLUMBING, SIGNS, l RC�N�[TIONERS, ETC ..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance wi applicable laws regulating construction and zoning. p th all "WARNING TO OWN ER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN Y PAYING OUR WIC F �`. E O IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND , TO OBTAIN FINANCING, CONSULT', WITH OUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE o f COMMENCEMENT. "'i Notice to Applicant: As 4r condition to the issuance o a building permit with h an estimated l • g P aed vaue exceeding 2500 $ t promise. S' he applicant must p n good aith th 't a co PP g o the notice .f of ce PY .� of and construction lien law brochure will be delivered to the person p whose property is subject) to attachment. Also, a certified copy of the recorded'notice of commencement must be posted at the job site I , for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil p' an re i pec 'on ee will be charged Signature Signature II Owner or Agent Contractor The foregoin ''nstrument', as acknowledged before m this T he foregoing instrument -was acknowledged before me this day of 20 �I , by T r �% r �'�� day of an , 2 01G . , b I*U.x� '� Y r � 7 who s i rsonally o has r oduced -Vlff is ens a ovally known tom r who has produced cati��e oa . ftl as iden tification ntlfication and who did take an oath. NOT ' LI - MY COMMISMON # X817231 plI =s,q,� NOTARY PUBLIC: r gust 21, 2013 ''Sign: Si tdARIA V. LLANE6 I V Pant: Print: lul EspmFeb�,201Z comnuft My Commission Expires: My Commission 0 OD 73Qm �., , ►, B*ndedTlsouB N tlowMftyAes L APPLICATION APPROV D BY: /' �2 � y Plan Examiner Plans miner Engineer I, I c � I a Z m n �I . 9. g i (Revised 02/08/06) , �f. . � i t � , �•. i I I I �; II