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RC-06-149Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -6544 Permit Number: RC- 1- 06-149 Scheduled Inspection Date: November 15, 2011 Inspector: Rodriguez, Jorge Owner: GUNN, MARVIN Job Address: 9150 N BAYSHORE Drive Miami Shores, FL 33138- Project: <NONE> Contractor: MF CABRERA INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132050010280 Phone: (305)888 -0046 Building Department Comments EXT.PLASTER, REPLACE KITCHEN CABINETS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /t‘c° / 3-e '' ia,E. AP"- , /vim aezz /j:vs , November 14, 2011 For Inspections please call: (305)762 -4949 Page 34 of 34 r 1 Is% •", • .)c)• • • 77" QiiOi I2C06. -(4q COP rI -1,-4.. • • • • • • • • • • • • • • • • • • • • • • • • • •.--•-ers- x/E.9 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • „A. 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City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 4 (AgeetirZ4 kr.... Address: L OJ®(�. 2. City: 1i►�h,. f' +'_ n.G State: Qualifier Name: ' t,o . ( 2, CA State Certification or Registration #: C'eC. CP 1`\,1O2. Certificate of Competency #: Contact Phone# ) POo 'Ifni Email Address: WCAS C r44 . NW DESIGNER: Archite ct/Engineer: Phone#: Phone#: � % 4 -a2447 Zip: lrreZ, Phone#:C ) 06,0-a,40 YalUeof Work for this Permit: $ Type of Works'' "'C3Adslition DAlteration Description of Work: 1 Ps Squrei,inear Footage of Work: ONaw 4QRepair/Replace p.c o6 -/y1 ODemolition ******+x*+x+x+x*+x+x+ *******a,**************** Fees+ x+ x******+x****+x**n�wn�* ** ** **** ****�x*a�a�a��xn *** Submittal Fee $ Permit Fee $ CCF $ _ 0/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's time (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 FI .RCTRICAL WORK, PLUMBING, SIGNS, WET J ,S, 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 notic ' of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is i ued In the absence of such posted notice, the inspection will not be approved qnd a reinspection fee will be charged. Signature The foreg day of ho is Signature Owner or Agent trument was ackn 1 ledged befoome rsonall to me or who has produced Contractor The foregoi s' ment w acknowl + ' ' day of 20 ,b i�fI ersonally klnlo me or who as produced 64��L ' ����igenuficaU nand who did who is entification an who did take an oath. take oath. e oa . NOTA Sign: Print: My Commission Expires: UBLIC: , • Sign: Print: My Commission Expire ****+ n*******+ s**+ x******* ******** ***************** ********+x***+x****+x*** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) IAMI -DADE COUNTY AX' COLLECTOR W. FLAGLER ST. FLOOR AMI, FL 33130 003440 -5 J M F SGAB EWAIVE 465 MINOLA DR 33166 MIAMI SPRINGS N4EI CABRERA INC 9 elari ERAL BLDG CONTRACTOR 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY SLATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER SA- ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY ONLY A LOCAL S TAX RECEIPT. IT IOT PERMIT THE TO VIOLATE ANY I REGULATORY OR LAWS OF THE OR CITIES. NOR T EXEMPT THE FROM ANY OTHER OR UCENSE D BY LAW. THIS IS :ERTIFICATION OF DER'S OUALIFICA- r RECEIVED *DE COUNTY TAX 'OR: 09/16/2011 60000000193 000045.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 pd�ppii RENEWAL STATE M01.7102 003440 -5 WORKER /S 10 DO NOT FORWARD M F CABRERA INC MARIO CABRERA PRES 465 MINOLA DR MIAMI FL 33166 I,,Ii,,,il,,,,ii,IL „Ii, „111,11 ll „i,l „Ii,,,I,l „i , ►I COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 12/08/2010 EXPIRATION DATE: 12/07/2012 CABRERA 650629906 BUSINESS NAME AND ADDRESS: M F CABRERA INC 465 MINOLA DRIVE MIAMI SPRING FL 33166 MARIO F SCOPES OF BUSINESS OR TRADE: 1- CONSTRUCTION 2- CERTIFIED BUILDING CONTRACTOR CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 4/14/11 PRODUCER Morgan Insurance Group 13155 SW 42nd Street, Suite #107 Miami, FL 33175 Phone (305) 222 -9001 Fax (305) 222 -9008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE OVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED MF CABRERA INC 465 Minola Dr MIAMI SPRINGS, FL 33166 - i(305) 388 -8104 INSURER k. ACCIDENT INS COMPANY INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED 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. AGGREGATE LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM INSRD TYPE OF INSURANCE / POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYYY POLICY EXPIRATION DATE iMMIDD/YYYY) LIMITS A • GENERAL LIABIUTY COMI4ERCIALGENERAL LLABLITY AGL88543 04/14/2011 04/14/2012 EACH OCCURRENCE 1,000,000 PREMISES (Ea occurrence) 50,000 MED EXP (Any one person) EXCLUDED ■ ■ CLAIMS MADE 'J OCCUR PERSONAL &ADVINJURY 1,000,000 . • GENERAL AGGREGATE 2,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG 2,000,000 • POLICY • PROJECT • LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) • ANY AUTO • ALL OWNED AUTOS BODILY INJURY (Per person) • • SCHEDULED AUTOS III HFED AUTOS BODILY INJURY (Per accident) • NON OWNED AUTOS • PROPERTY DAMAGE (Per accident) 0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT • ■ ANY AUTO OTHER THAN EA ACC • AUTO ONLY: AGG • EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE • OCCUR • CLAIMS MADE • DEDUCTIBLE • RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory In NH) P describe under SPECIAL PROVISIONS below • WC STATU- • OTH- TORY LIMITS ER E.L. EACH ACCIDENT EL DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY UMIT OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Building Contractor CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Ave Miami Shores, Fl 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) QF The ACORD name and logo are reglstered marks of ACORD 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 Type (circle): Building) Roofing MCMEWEE I if OCT 0 1 2007 J Permit No. 1t0k14 f Master Permit No. Owner's Name (Fee Simple Titleholder) 1 ! ( _ s Phone # 7 f - g77 - 55?') Owner's Address ?go A) !' 4r)r4 j (. 2 r�J City At % Arek ; S L) o IC) State ,t L Zip 33/ 3 p Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name � . f J eJ Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑ Demolition Describe Work: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side —3 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 not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent ( Contractor The fore to n; instrument was ac owleeged before me this .1 The foregoing instrument was acknowledged before me this day o0 r0 ,20�,by►`�1l�) �� day of ,20,by who is personally known to me or who has produced Ul? Y'S who is personally known to me or who has produced C.PA i' 10-0211Z, As identification and who did take an .� �� as identification and who did take an oath. wo�`�roA�fl.et NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: Sign: Print: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 07/10/07) Miami Shores Village Building Department Owner's Name (Fee Si 1e Titleholder) Owner's Address /67) /U City W ; /4V1. 5 O (z s State Tenant/Lessee Name Change of Contractor nn�� �/�y -- 1 Permit No. F-�l/ lit 0 Phone # 7Z-2177-570 Zp 33)3? Phone # Job Address (of where the work is being done) `--- City County Zip Legal Description Contractor's Company Name 0.0rhe ocunt ✓' Phone # Contractor's Address City State Zip Qualifier Describe Work: I hereby certify that the work has been abandoned and /or the contractor is unable or unwilling to complete the contract. I hold the Building Official and the Village of Miami Shores harmless from all legal involvement. Signature Owner or Agent The foregoing instrument was acknowledged before me this this day of , 20 Go, by Sign The foregoing in Contractor ent was acknowledged before me day of , 20 who is pers na11y klown to me or who has pro ' who is personally known to me or w has produced �• fp G2 )O-ai ti,As identification ar b q l ti an oath. as identification and i o did take an oath. Y PUBL -''� G: "I: & 4- 4' NOTARY PUBLIC: cos �� ,�.l.l�0t�4i ��. >`��`� Sign: �if i IS Mg. j Print: My Commission Expires: • O a�9 My Commission expires: NOT Sign: Print: d Rev. 09/19/03) VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: ADDRESS: Do hereby petition the Village of Miami Sho es to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial / t .g(T- 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial N6- 3. .I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial lue6___ 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code —. only if the structure meets the minimum code. Initial 4_)136- 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate'any contract disputes. Initial ,A/0.- J 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Initial 4/36_ 7. I understand that if any person gets injured on my construction project —they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial 0 -E6- 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this By t4 C, 'e'ot A4 Produced th Initial k J (r St day of 604 a , 20 0 -7 who was personally known to me or who has as identification. OWNER Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305 75 +.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Permit No. 1c C" 4.9 ster Permit No. Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) ( LOS (f,t..)('} Phone # i 7- 1501 Owner's ddress 422 City State. Tenant/Lessee Name Roofing Zip Phone # Job Address (where the work is being done) �( 'o J. e'isi-ort. C City Miami Shores Village County Miami -D de Zip Is Building Historically Designated YES NO Contractor's Company Name Ge [ioc. Contractor's Address ( 1...11N©(A City i �(/ V1tlCTS State Qualifier Phone # ;?),e45-clv Zip State Certificate or Registration No. C-€C. ® f 49'2. Certificate of Competency No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit 1500 ,� Phone # Square Footage Of Work: Type of Work: ['Addition ['Alteration ['New in Repair/Replace ❑Demolition 141 Tc4-J ten ; Describe Work: •Y * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ZOO`' - CCF $ f . Z° CO /CC. Notary $b CO Training/Education Fee $ t. 4 0 Technology Fee $ Z- Scanning $ CI CO Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 2-.m f C) (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip awe .4 410 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 constructi lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded n tice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit i issued /' the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The fore oing instru � ment was acknowledged before me this � day of A lm , 20 C6 byC - P LOS } -1`l), who is ersonally known t e or who has produced As identification and who did take an oath. NOTARY P B .IC: Sign: Print: My Commissio * * * * * * * * * * ** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** -moo los: • 2009 Expires is TheE bEmEa: tick&9,41.1' s4% *114* * * * * * * * * * * ** Signature Contractor The foregoing instrument was acknowledged before me this 1B day of J%� N , 20 by M t-p who is personally known to me or who has produced 1.12) as identification and who did take an oath. OTARY PU : L C: P OF FLORIDA ernandez ai , 76455 li 27' ? tn 9 c. NOTARY Print- My Co APPLICATION APPROVED BY: chc 05/13/03 fission Expires: ********************************* *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 2/7/2006 Expires: 01/18/2007 Owner's Name: CARLOS & MIGDALIA GENO Permit Type: Residential Construction Work Classification: Kitchen Cabinets Job Address: 9150 BAYSHORE Drive N Miami Shores Village, FL Contractor(s) MF CABRERA INC Phone (305)888 -0046 Primary Contractor Yes Comments: EXT.PLASTER, REPLACE KITCHEN CABINETS Additional Information Type of Construction: KITCHEN CABINETS Occupancy: Single Family Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Yes Certificate Status: Certificate Date: 1/18/2006 Additional Info: 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. Fees Due Amount CCF $1.20 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee - Additions /Alterations $100.00 Scanning Fee $6.00 Technology Fee $2.50 Work without Permit Fee $100.00 Total: $215.10 Permit Status: APPROVED Permit Number: RC -1 -06 -149 Phone: (305)887 -1501 Parcel #: 1132050010280 Block: Lot: Section: PB: Total Square Feet: 0 Total Valuation: $ 1,500.00 Required Inspections Framing Insulation Drywall Final Invoice Number RC -2 -06 -23763 Total: Amt Due $215.10 FEB 07 PAID c k 4477 1 Amt Paid C? Building Department File Copy Applicant Signature NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Total Due: $0.00 I Bill To Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 VICTOR MARTINEZ 9333 MIAMI Avenue N MIAMI SHORES, FL 33138- Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Date Fee Name Invoice Number: RC -10 -07 -29940 Invoice Date: October 01, 2007 Permit Number: RC -1 -06 -149 Fee Type Fee Amount 10/01/2007 Change of Contractor Fee Fixed $75.00 Total Fees Due: $75.00 Payments Date Pay Type Check Number Amount Paid Change 10/01/2007 Check 1197 $75.00 $0.00 Total Paid: $ 75.00 OCT 01 PAID Monday, October 1, 2007