DEMO-16-2678Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
o(4- 22 32-
Inspection
Z
Inspection Number: INSP-268179
Permit Number: DEMO -9-16-2678
Scheduled Inspection Date: December 21, 2016
Inspector: Hernandez, Rafael
Owner.
Job Address: 800 NE 91 Terrace
Miami Shores, FL
Project: <NONE>
Contractor: CONWELL & ASSOCIATES CONSULTING COMPANY (GC)
Permit Type: Demolition
Inspection Type: Final
Work Classification: Plumbing
Phone Number (786)241-6627
Parcel Number 1132060050390
Phone: (305)962-5673
Building Department Comments
DEMO OF GARAGE IT WAS BEDROOM & BATHROOM >
RETURN TO ORIGINAL
Inf actio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
Inspector Comments
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC20(���n
Master Permit No:DErItt Z
Sub Permit No.D C Vk
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 470 )t q7 7C
City: Miami Shores County: Miami Dade Zip: S ��
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):/dl��%�7 Y C%S r � or ef`#:C ,2 ' 74/ (K27
Address: ytfo 104 BA /Lo �! /27/
State:
City: ,af irk/
Zip:
Tenant/Lessee Name: Phone#:
Email: TX -4M- ' 4-i � =jXi
CONTRACTOR: Company Name: 7C 0 e/ -)d, /// If& /Lz 1 S Phone#: N ?D 5— 2�5‘ 7 ,3
Address // 7 7 / ,524-')/37 10 2e 4i)/24 ,, R-33/ l� 6
(0 / State: \ / C o Zip: 13 31 & C7
City: -.
Qualifier Name: P Phone#:,
State Certification or Registration #: CG ' +'Le047 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ io c5 -62v Square/Linear Footage of Work: 9 iY13 4-, ter -
Type of Work: ❑ Addition ❑ Alteratio n New /Repair/Replace ,❑ De olit' n
Description of Work: , ;g/vt !) • 0 C/riI e �1,.' .ild / f-f-YZ &�(%1/dv
�� 0r'
r� y
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ %a `' CCF $ l • Z® CO/CC $
Scanning Fee $ 3 Radon Fee $ Z. DBPR $ Z Notary $
Technology Fee $ 1 . (0 (J Training/Education Fee $ • (-( ® Double Fee $
Structural Reviews $ Bo
TOTAL FEE NOW DUE $ /10 • 10
(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_c_ansirtc ion lig lnw hrnrbura vyPL� b san
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
OWNER or AGENT
Theforegoing instrument was acknowledged , before/me this
day of Se A 20 / by
n
y
i PDQ J , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of S-12 ,20 th. ,by
/c �4 e.., a
.4,_ ,who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
*******
OS, ,4
;OW':N. ra /i9SITA N. SIMM,�gJ
+ r CC;' ISSION#FF3t2.q
��oRdYb.F B ,N Jut), 14, 20X,,e
Q Print:
Seal:
SIMMONS
/AY CC Ya;.ONxFF972243
y -n�ro'r
Ei<PiRES, Jc'ry 14, 2020
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*****************
APPROVED BY
(Revised02/24(2014)
Plans Examiner
Structural Review
***********
Zoning
Clerk
DATE:
CACC GENERAL
CONTRACTORS
wa y s #':F o r va
CONWELL & ASSOCIATES CONSULTING COMPANY
)4-14,
Before me this day personally appeared Kenneth F. Conwell who, being duly authorzied and says:
That he or she will be the only person working on the project located at:
Sworn to (or affirmed) and subscribed before me this
q2 9
(Date)
1 (eh tve t(
(Print name),`c" ............. 4),
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
a ti CefF 204 .
e
The regoing in rument as acknowle ged before me this , yday o 20 by
ISeHN
e ` F
), ,,ttPtl on behalf of (.0 rP who is
personally known to me or [ ] has produced
Notary Signature:
Type or Print Name:
vuf
as identification.
I�/,���Carolyn M. Comm
4 Commies # G6001091
'r= Expires: October 7, 2020
�
''•,, ;� . ` Bonded thN A8r011 NOW
II DO
11771 SW 137 PLACE Miami, FL 33186 Tel: 305-926-5673 Fax: 305-385-7827 Email: info@caconsultingc.com
Miami Shores Viiiage
Building Department
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 ,
Owner
State of Flom
County of Miami -Dade PP
The foregoing was acknowledge before me this day of SRS,`' , 20 /4.
By / k '' z.s who is personally known to me or has produced
as identification.
Notary:
SEAL:
1144
ROSRA N. SIMMONS
f COMMISSION N FF 97220
&MIRO& July 14, 2030
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