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PT-15-1789 4• Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239302 Permit Number: PT-7-15-1789 Scheduled Inspection Date: March 21,2016 Permit Type: Paint Inspector: Rodriguez,Jorge Inspection Type: Final Owner: , Work Classification: Addition/Alteration Job Address: 161 NE 106 Street Miami Shores, FL 33138-2036 Phone Number (786)408-3661 Parcel Number 1121360060380 Project: <NONE> Contractor: FAM CONSTRUCTION Phone: (305)298-3216 Building Department Comments PAINT EXTERIOR OF PROPERTY Infractio Passed Comments INSPECTOR COMMENTS False Inspector Com is Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 18,2016 For Inspections please call: (305)762-4949 Page 8 of 34 Permit Nth. PT-7-15-1789 `SgoREs yam! Miami Shores Village Permit Type: Paint Perlill't 10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 �'�ORtDp Issue Date:7/17/2015 17Expiration: 01/13/2016 Project Address Parcel Number Applicant 161 NE 106 Street 1121360060380 SECTION M INC Miami Shores, FL 33138-2036 Block: Lot: Owner Information Address Phone Cell SECTION M INC 3821 EL PRADO Boulevard (786)408-3661 MIAMI FL 33133- 3821 EL PRADO Boulevard MIAMI FL 33133- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 FAM CONSTRUCTION (305)298-3216 (305)335-7823 ..,.._.. _ ___._ ..__ Total Sq Feet: 1200 Type of Work:Exterior Available Inspections: Color:WHITE Inspection Type: Additional Info:PAINT EXTERIOR OF PROPERTY Final Classification:Residential Color:WHITE_Approved Code Comments: Color:WHITE_Approved_ Color:WHITE—Denied Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PT-7-15-56376 Education Surcharge $0.40 07/17/2015 Check#:909 $63.20 $0.00 Permit Fee $60.00 Technology Fee $1.60 Total: $63.20 11 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING PO work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work ill be don '! compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to e w rk st ' 2015 Authorized Signature:Owner / Applicant / Contractor ; Agent Date Building Department Copy July 17, 2015 1 Miami Shores Village JUL 1Z His Building Department 4 Y - 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 SIt, FBC 20 �q PAINT Master Permit No.lz I PERMIT APPLICATION Sub Permit No. FIT15- (�U JOB ADDRESS: 161 1 /"E City: Miami Shores County: Miami Dade Zip: 2:313d' Folio/Parcel#: l/-Z 136`©0� O 3t:>0 Is the Building Historically Designated:Yes NO OWNER: Name(Fee Simple Titleholder):-5'c:,P—y 'S4-04 1�cnoN M 14.JC ! Phone#: Address: >92- 1 Ll P,ed6L, BLycl !"'141Lf1 F- -- 2,3133 City: M/' I I State: FL zip: 3.3133 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: % �'/ �D/U� r(�� Phone#:3�+ Z�� 3 b Address: ?,3 y0 City: M14 A41 State: FL zip:331V3 Qualifier Name: 2�iRFA1/N p-- A A&,FIA)e - Phone#:-� -2 qs 3 Z(L/ State Certification or Registration#:CCC �1 ��t Certificate of Competency#: Value of Work for this Permit:$ Square/Linear Footage of Work: Description of Work: 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,PLUMBING,SIGNS,WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS,ETC..... "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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. in the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged. Permit Fee$ CCF Fee$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ TOTAL FEE NOW DUE$ �� PAINT COLOR APPROVAL AND AGREEMENT ' All elements on the site must be listed and indicate the color to be painted DIRECTIONS: Please circle corresponding number to appropriate color sample. Walls: (1 J 2 3 4 Attach color sample with name and number Fascia: 1 2 3 4 Drip edge: 1 2 3 4 1. TCShuSoffit: 1 2 3 4 / . l Flower Bins: 1 2 3 4 W t4 (TC— Shutters: tters: 1 2 3 4 Awnings: 1 2 3 4 2. Chimney: 1 2 3 4 Doors&Jambs: 1 2 3 4 Garage Doors: 1 2 3 4 Railings: 1 2 3 4 3. Fences: 1 2 3 4 All Brick: 1 2 3 4 Stucco Bands: 1 2 3 4 Other Stucco Feature: 1 2 3 4 4• Accessory Bldg: 1 2 3 4 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 regul uction and zoning. Signature Signature1� ER AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 0(, 20 , by 1 y day of 1(lL/ 20 /J by 224r-'*7A .k who is personally known to -2r6A9'WA) 4• MAie/70` who is personally known to me or who has produced as me or who has produced as identification and who did take an oat identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: MARYD.CAMARGO Seal: MY COMMISSION#FF242221 MARY D.CAMARGO EXPIRES:JUN 21,2019 "'r ��n MY COMMISSION#FF242221 Bonded through 1St State Insurance EXPIRES:JUN 21,2019 APPROVED BY: Bonded through 1st State Insurance Code Official ------------ Historic Preservation Board FAA CessluuCTICS CCUU0 8340 SW 65 Ave#3 Miami FL 33145 PHONE (305) 298-3216 C.G.C. 019440 ----------------------------------------------------------------------------------------------------------- Date : 07/13/2015 State Of Florida Miami DadeCounty Before me this day personally appeared FERMIN A. MARTINEZ who, being duly sworn, deposes and says : That he will be the only person working on the project located at 161 NE 106 Street Miami Shores FL Sworn to and subscribed before me this day of uW&V 2015, by FERMIN A. MARTINEZ ----------- ------- - C.G.C. 01440 Personally Know QI I TJ � ( ISSION#FF242221 PI' JUN 21,2019 8 ded through 1st State Insurance Print,Type r tar /� ♦SNOREsell S Miami shores Village VN� 9a�6 Building Department LORIpP► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: wner State of Florid County of Miami-Dade The foregoing was acknowledge before me this to day of jUl Y 2016— By 5fAgwho is personally known to me or has produced as identification. Notary: SEAL: MARY D.C GO Y w� MY COMMISSION#FF242221 EVIRES:JUN 21,2019 ands Bonded through 1st Slate Insurance