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PT-17-390 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-276739 Permit Number: PT-2-17-390 Scheduled Inspection Date: August 28, 2017 Permit Type: Paint Inspector: Naranjo, Ismael Inspection Type: Final Owner: SOLUTIONS,LLC,CK PROPERTY Work Classification: Addition/Alteration Job Address: 186 NE 106 Street Miami Shores, FL 33138- Phone Number (305)758-3133 Project: <NONE> Parcel Number 1121360050010 Contractor: CLEMDEL CONSTRUCTION CORP Phone: (305)856-4715 Building Department Comments PAINT Infractio Passed Comments INSPECTOR COMMENTS False i Ins Comments Passed Ej� V) Failed Correction l� Needed l� Re-Inspection ❑ Fee I No Additional Inspections can be scheduled until re-inspection fee is paid. r August 25,2017 For Inspections please call: (305)762-4949 Page 7 of 35 Miami Shores Village X\ Building Department FEB 1,5 201 ~ , \ 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 No. PT- I-q - 3��1n PERMIT APPLICATION Master Permit FBC 20 Permit Type:PAINT OWNER:Name(Fee Simple Titleholder): Address: 2 d /�/�� S i S</i i is 7 State: L Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 7�/i ^� Folio/Parcel#: Is the Building Historically Designated:Yes NO e Flood Zone: CONTRACTOR:Company Name: �� 1"1 — e_p Phone#: Address: City: 1 State: �--� Zip: X31�3 Qualifier Name: Phone#: -_4t)_,C)5""g 4- `1 j State Certification or Registration#: Certificate of Competency#: Contact Phone#: 3a S'l t e- 'S'—+ ►k Email Address: e�A-4,L--• 6V Value of Work for this Permit:$ l 7 c, Square/Linear Footage of Work: Description of Work: ter/rA/aA 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 r understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS and 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a'certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged. f Permit Fee$ CCF$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$ t 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: ( :� 2 3 4 Fascia: 1 CQ 3 4 Attach color sample with name and number Drip edge: 1 2 3 4 Soffit: 1 2 3 4 Roof: 1 2 3 4 Flower Bins: 1 2 3 4 Shutters: 1 2 3 4 2. Awnings: 1 2 3 4 � Z ;7Chimney: (Q2 3 4 �62r Doors&Jambs:l 2 3 4 / L U Garage Doors: 1 2 3 4 3. SW 6272 Railings: 1 2 3 4 Ilun t • Fences: 1 2 3 4 All Brick: 1 2 3 4 Stucco Bands: 1 2 3 4 Other Stucco r 4. Feature: 1 2 3 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 regulating construction and zoning. Signature: Signature: —C, Z,7,4�< Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before the thi day of ,20 Z1,bye-44- ?�"o lt4 yr Ac;- day of 7"P ,20 a,,by h is nally er onally known to me or who has produced G who i persoknown to me or who has produced I N y As identification and who did take an oath. as identification and who did take a = (+ N D. 14D PUBLIC: NOTARY PUBLIC: 's► ' 0�` Zo C °r•'.tooN,., � o v c sign- Sign: o�rr1F % Print: is iso o v �o� ssion Expires: /� ? X?d Z My Commission Expires: > Ze 7-1 `"uiupq, :. D BY: Z Code Official o n Preservation o r I ` � I SW 6183 275-Cl Conservative Gray © /\ 4J � ` ® t7 '.3 / _ § « � �§a �A J/ /\ � � ^ �2/, 2 CLEMDEL CONSTRUCTION CORP. February 28, 2017 State of Florida County of Miami-Dade Before me this day personally appeared Clemente Gonzalez who,being sworn,deposes and says That he or she will be the only person working on the project located at 186 Northeast 106 St Sworn to(or affirmed)and subscribed before me this "� day of 20a BY personally know or Produce Identifications y Type or Identification Print,FY-pe or Stamp name of Notary JIM'G PAMPUN ``p1�K o M•. ?+ �+ Notary Public.State o1 Florida > 'a Commission N GG 041934 f �1, •`' My Comm.Expires Jan t3,2021 80nde0 through National Notary Assn.1 `$gOC.REs rrrC Miami shores Village Building Department ORIDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption _ � �: a.: ,�°• .s y t`r •:fin;: �' Via. � � .; 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 fisted 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: l O ner State of Florida County of Miami-Dade The foregoing was acknowledge before me this �S day of '1��-�� ,20_(3 F By V 1 r ,w+�U who is personally known to me or has produced as identification. -Vtprld Not • SEAL: :; ► ,, MAH ARAI K GONIALEZ MY COMMISSION#GG 044602 EXPIRES:November 2,2020 s o: '/��FQ•R F`aP.` Bonded Thru Notary Public underwriters