RF-18-1264Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
-Issue Date. 6113/2018
Permti NO. RF-5-18-1264
Permit Type: Roof
Work Classification: TitelFlat
Permit Status: APPROVED
Expiration: 12/10/2018
Applicant
425 NE 91 Street
Miami Shores, FL 33138-
1132060140100
Block: Lot:
MIAMI CAPITAL FUND I LLC
Owner Information
Address
Phone
Cell
MIAMI CAPITAL FUND I LLC
425 NE 91 Street
MIAMI SHORES FL 33138-
(561)866-0500
425 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s)
GORO CONSTRUCTION
Phone Cell Phone
(954)554-5837 (954)554-5837
Valuation:
Total Sq Feet:
$ 22,500.00
4200
Type of Work: Re Roof
Additional Info:
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - New Roof
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.00
$175.00
$3.00
$0.00
$178.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # RF-5-18-67513
06/13/2018 Credit Card $ 178.00 $ 0.00
Available Inspections:
Inspection Type:
Up Lift Report
Tin Cap
Final Roof
Tile In Progress
Review Roof
Roof in Progress
Renailing Affidavit
Cap Sheet
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 ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni �� ermore, I authorize the above -named contractor to do the work stated.
June 13, 2018
Authorized . nature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 13, 2018
1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-303939
Scheduled Inspection Date August 16, 2018
Inspector: Naranjo, Ismael
Owner:
Job Address: 425 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor GORO CONSTRUCTION
Permit Number: RF-6-18-12 6 4
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Tile/Flat
Phone Number (561)866-0500
Parcel Number 1132060140100
Phone: (954)554-5837
Building Department Comments
RE -ROOF TILE AND FLAT
RENEWAL OF EXPIRED PERMIT
RF-8-17-2004
AND CHANGE OF CONTRACTOR
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Infractio
Passed Comments
INSPECTOR COMMENTS
Inspector Comments
False
August 15, 2018
For Inspectionsplease call: (305)762-4949
Page 8 of 42
/k/ v Vc7
Miami Shores Village
Building Department RECEI \TED
BUILDING
PERMIT APPLICATION
10050 N.E.2nd Avenue; Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2014
Master Permit No.
t 1 ` 2004
Sub Permit No. 1iC IZ-64'
❑ BUILDING ❑ ELECTRIC Q ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [✓]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: `I L- M15 ' ( $ AJL
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /Iff1,4% /07
Address: ,;o i1 Ne 7sS $5 $(lf r
r-,
/nin l
Phone#: 3c 5- r5l.' a/33
City: Pt i 4t-0^) 5Itd State: PC- Zip: 3-13
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:45 Co#JS,e-,Jc. — ��,
Address: i 000 N ‘;`s. /0 6 tf-4 ✓�
Phone#: 5 4-S54 -5E
City:-PL4#0-/ i a n el A.) State: .44 r Zip: '733 22
Qualifier Name: / GcZ:fi1 (ir7• Phone#: ri'fa—SS¢�5$37
State Certification or Registration #: , 13 2s•c d Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2-21. 0a c)
Type of Work: ❑ Addition ❑ Alteration
Description of Work: /� 1 'AZ
Square/Linear Footage of Work: 44-��+-`,2
❑ New ❑ Repair/Replace ❑ Demolition
() Qnc of Corac4-o., x (-€V1tWa) of k9cccf
•
,.,.�46 ;1 ( t Y.
Specify color of color thru tile: r,� W,ii? t
,„,
Submittal Fee $ Permit Fee $ ri C . CCF $ CO/CC $
Scanning Fee $ 1 Radon Fee $ DBPR $ g Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
t i 0 &O Et 0� (-04(t140
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Comp'an`y's Address
City State Zip
Mortgage Lender's Name (if applicable) Ad'
. JA
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
_.
Signature
The foregoing i
•.._,�
Signature
CONTRACTOR
was acknowledged before me this The foregoing instrument was acknowledged before me this
(%J day of , 20 it , by day of
'ENT
, 20 /g , by
6-4/2R44-1Ochv , who is personally known to /W44.4.40 19who is personally known to
me or who has produced me or who has produced I as
identification and who did take an oath. !
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign•
Print: (y 1I11 pMR1G Print:
Seal: ,,t••••�k+ IM l;Ur�IMiSSI(Yi' f 30 Seal: 1�a �ouec,� pRppptGUQ
w ' ... MY COMMISSION t FF 156456
EXPIRES.Novembe
* * EXPIRES. November 30, 2018
s sAr . BONO It ru Budget Notary Ser„es
rgTf OF F OQ sr �" a�4. Bo.ced Thru Budget Notary Services
qTf OF CV
APPROVED BY
Plans Examiner
Structural Review
( Zoning
Clerk
(Revised02/24/2014)
Goro Construction, Inc.
Residential '\&/ Commerdal
hi it
°412-111aa‘ii
2.4118
CA o
C-n o& T y i t sM-t i
CERTIFIED
GENERAL CONTRACTOR'
*CGC1512960
*QB53276
goroconstruc@hotmail com
000 NW 106'I• !'VE • PLANTATION, FLORIDA 33322
-53 R�o�i'c vw�c 4 1,tis cL )�e�sosi4 (4 q•pPe'sr2 Oyer ' um wia, Eoer' dd1Y
1�
tw o,,•» cto.rel « 9
Not tit W if e -Kte p>h%y pefYsav7 woY���"t�
4-2S e 7 l - SZ':Z� e-r
e�� r e.acTO
5N0C,o ,r -f? [i� (o, 46. ir�w�c cl cs tt.c$ go V. be lif f e IAA e _ t-k:
ct$ , by l'\wO eD OccsSA-i A
.,, 7II e � ec-� (o cc �e c1
Pe-e f.caty u 4-4-41 v — - --
QED.. cl++Ccd Tcicz.v. A. Qi
I
tv° c - C R c!
/t)cw-E. 01 to 04-o,�/
Notice to Owner — Workers' Com
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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.
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this /day of , 20 //
By cCc 7
Nota
SEAL:
who is personallyow1Sn to me or has produced
as identification.� ,,-' 6 i
�,�0 N�em 4
Aft
P.A1E Otis'
Permit N.
018
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
4 Tel: (305) 795.2204
(,✓ Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Owner's Name (Fee Simple Title Holder): vc.t-).• � �` vO l Ur\ Phone #: 31)S- •1S b'3\ 33
Owner's Address: `7-/C) ' C>V- %,\;
City: vc%,"*-k: State : "fir \ Zip Code: -33\3 b
Job Address (Of where work is being done): 4-ZS NE 9 I S-4-4(e4
City: Miami Shores State: Florida Zip Code:
Contractor's Company Name: V •AD...v\\,y Phone #:
Address: \'l-O VC) (%, ‘ k 0 ANC
City: State:
Qualifier's Name : 'Z-v®SZ.
Zip Code: 33\. 1"1
Lic. Number. CZ.�\33 U1 3
Architect/ Engineer of Record Name: Phone #:
Address:
City: State: Zip Code:
Describe Work: o a NCsj
I hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to com Iete the contract. I hold the Building Official and the
Mi ii) es harmless of all legal involvement.
Contractor or Architect
The foregoing inment w s aanowled ed before me The foregoing instrument was aknowledged before me
this A_ day of it`kts ,20rgby za\ this 9 day of , 20/8bybvW4A►LC'�0W2 2
Who is personally known to me or who has produced who is personally known to me or who has produced
as indentification.
Signature
Notary Public:
Sign:
?ot►t+;Pu�
Seal: DENIARODRIGUEZ
MY COMMISSION t FF 156456
EXPIRES: November 30, 2018
/4.0F FioeN Bonded Thnr Budget Notary Services
Signature
as indentification.
Sign ��f
Seal: ��. � 0000
` OON1FF
liovembei 30 $ 01
*
111
5o Bond
Brq�OF c�P
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENSE NUMBER
The ROOFING CONTRACTOR
Named below IS -CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018 -
• . P :ate4.
a 4f-
_GOROSTIAGA, TELMO tiry�,
•
GORO CONSTRUCTION INCH ;� . �.,/y,
1000. NW 1 Q6TH'AVENU ?�� ry, 'F" "' �
PLANTATION:'',,« - E1.33322 -,4, •-
* "e1: `'+,
ISSUED: 06/14/2016
DISPLAY AS REQUIRED BY LAW
SEQ # L1606140001013
STATE OF FLORIDA
DEPARTMENT,OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRYwLICENSING BOARD
The GENERAL CONTRACTOR;„, . ,.
ow Named belIS. CERTIFIED •
Under.the pro visions•of Chapter 489 FS.
GOROSTIAGA,,TELMO ;--»'_
,,GORO CONSTRUCTION LNC,;:
1000 NW 106TH AVER
.'FORT LAUDERDALE,,,, FL 33 0•
..
� .. !.!Y"�i�4�r vi 1� �- b*"'1�� ^ �Mr �} 'til',� LM�' �{�l •�1;,. ..
.. • a.. �.,m..o.�w.+..wr.+.ew.+avc,.� x.., a ._ew.�irv"��: R.
ISSUED: 06/14/2016 DISPLAY AS REQUIRED BY LAW
SEQ # L1606140001240
BROWARD-COUNTY LOCAL " BUSINESS TA
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018
DBA:GORO CONSTRUCTION,
Business Name:
Owner Name: TELMO GOROSTIAGA
Business Location: 100o NW 106 AVE
PLANTATION
Business Phone: 954-554-5837
Rooms
Seats
INC
Employees
'1
Receipt#:ROOF NG/SHEET METAL
Business Type:
Business Opened:06/21/2010
State/County/Cert/Reg:CCCi32 9400
Exemption Code:
Machines Professionals
For Vending Business Only
Number of Machines:
Vending Type:
•
CONTR4
Tax Amount
Transfer Fee
• NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT
WHEN VALIDATED
Mailing Address:
GORO CONSTRUCTION, INC
• 1000 NW 106 AVE
PLANTATION, FL 33322
This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
.20.17__-.._2018._.
Receipt #05C-16-00005863
Paid 07/20/2017 27.00
JIMMY PATRONIS
CHIEF FINANICAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' 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: 3/25/2018 EXPIRATION DATE: 3/24/2020
PERSON: GOROSTIAGA
FEIN: 208276617
BUSINESS NAME AND ADDRESS:
GORO CONSTRUCTION INC
1000 NW 106 AVE
FORT FL 33322
LAUDERDALE
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor Licensed Roofing Contractor
TELMO
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation If, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
AORU®
DATE (MM/DD/YYYY)
10111/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
CERTIFICATE OF LIABILITY INSURANCE
i
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Comegys Insurance Agency
One Beach Drive S. E. Ste. 230
Saint Petersburg
INSURED
FL 33701
NCOONNTACT Jennifer Lynch
PHONE (727)521-2100
A/C, No, Est):
ADDREss: jenniferl@comegys.com
FAX
No): (727)528-0626
INSURER(S) AFFORDING COVERAGE
INSURER A - Covington Specialty Insurance Co
NAIC #
COVERAGES
I
LTR
A
Goro Construction Inc
1000 NW 106th Ave
Plantation
FL 33322-7800
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED REVION NUMB
ABOVE FOR HE POLICCY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
X
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
CERTIFICATE NUMBER: 17/18 GL
GEN'L AGGREGATE LIMIT APPLIES PER:
XI POLICY PRO-
JECT LOC
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
UMBRELLA LIAB
EXCESS LIAB
AUUL
INS°
SUbH
WVD
POLICY NUMBER
VBA57126800
POLICY EFF
(MM/DD/YYYY)
10/13/2017
POLICY EXP
IMM/DD/YYYY)
10/13/2018
EACH OCCURRENCE
UAMAUE Ir.) HEN I EU
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
LIMITS
$ 1,000,000
$ 100,000
$ 5,000
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
SCHEDULED
_ AUTOS
NON -OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per acddent)
PROPERTY DAMAGE
(Per accident)
$
DED J I RETENTION $
OCCUR
CLAIMS -MADE
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y/N
N/A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
#CGC1512960, #CCC1329400
CERTIFICATE HOLDER
EACH OCCURRENCE
$
AGGREGATE
I STATUTE I I ERH
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
Miami Shores Village
10050 NE 2nd Ave
Miami Shores Villag
ACORD 25 (2016/03)
FL 33138
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD