RC-09-1775 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 127990 Permit Number: RC -10 -09 -1775
Scheduled Inspection Date: March 17, 2010 Permit Type: Residential Construction
Inspector: Bruhn, Norman Inspection Type: Final
Owner: GOMEZ, JORGE Work Classification: Addition /Alteration
Job Address: 9969 NE 4 Avenue
Miami Shores, FL Phone Number (305)510 -0916
Parcel Number 113206017123
Project: <NONE>
Contractor: ARTEK CONSTRUCTION MANAGEME CO Phone: (786)255 -6124
Building Department Comments
DEMOLITION OF A PATION ON THE FRONT OF THE
HOUSE AND REPAIR EXISTING STEPS ON FRONT
DOOR
Inspector Comments
Passe
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 16, 2010 For Inspections please call: (305)762 -4949 Page 8 of 19
����1/�9. • � • �� f4�� � !rat 1
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d , Miami Shores Vill age OCT 2 8 2009
Building Department
*Vp W c*e( C �, W , 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No.J
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle): Buildin Roofing
Owner's Name (Fee Simple Titleholder) J 0 6 Phone It
Owner's Address `146 KJ E Lf 412 2 ,� Pq_m� Q
City Nl GR^A I State Zip
Tenant /Lessee Name Phone #
Job Address (where the work is being done) 1 69 N C- Lf- 2✓t� l�ao�
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # (� �jZ060
Is Building Historically Designated YES NO
Contractor's Company Name ArZW- (ZC*1 JS7yZ Phone # -7 B6 -
Contractor's Address Z33 SW L9 AVE
City__ H1 &1i State Ft— Zip 33 1 -T
Qualifier Name RI G11,46Q -0 _ P G MM Phone # `j $6 " ZSS'` & 124
State Certificate or Registration No. CGC 1506"137 Certificate of Competency No.
Architect /Engineer's Name (if applicable) �� Phone # /A.
Value of Work For this Permit $ $,000 Square / Linear Footage Of Work:
Type of Work: ❑Addition Alteration ❑New ❑ Repair /Replace Demolition
Describe Work: D_9 ,0 / t • o - 1 .a r ay? c( r'.e /111� O r
p G
QC-r C%
/, q � ^ * ** r * * ** r
Subm%ttal Fee $ - � Permit Fee $ CCF $ 5' 0 CO /CC
Notary $ Training/Education $ Technology Fee $
Scanning $� _ Radon $ O,. DPBR $ Zoning $
Bond $ Code Enforcement $ Q!ee uble Fee $
Structural Review. $ Now Due $
See Reverse side -�
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 commeitcement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
O ner or Agent A20by rac r
The instrument was acknowledged before me this The fore Witrum no ed ed before m this day of C 20 i1t' , by day of
who is personal known tto e or who has produced who is per onally kno t e or who has produced
As identification and who did take an oath. 4 ication and who did take an oath.
NOTARY PUBLIC: v OAR PUBLIC:
% DORA FA
Notary Pok - 6to of FNS 6-k Si n: 'My Comm. Farms Aup 10, 2043 n: 1623 f
Print: " TA h Nd AS g t:
My Commission Expires tf l i y Commission Expires: 0 1am ��•
G� �1 P an
APPLICATION APPROVED BY: Pans Examiner
Engineer
Zoning
(Revised 07/10/07)
ORF
t xc. Tsai G1l
Miami shores Village
L� Building Department
P� ORI"vA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: +�1�I DATE: �c lc
❑ Contractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other) d i
Address:
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL.
RESUBMITTED DATE: IL C7
PERMIT CLERK INITIAL:
Pla
Miami Shores Village Permit NOR - 1 0 -09 - 1 7 J75
10050 N.E. 2nd Avenue t
PeM* T,�, Miami Shores, FL 33138 -0000 it1#IfttlQfA�r
`' Phone: (305)795 -2204 Fax: (305)75 6-8972 -'
TES +
Issue Date Not Issued
Expires:
Folio Number :1132060171230
...
Owner's Name: JORGE GOMEZ Owner's Phone: (305)510 -0916
Job Address: 9969 4 Avenue Total Square Feet: 400
Miami Shores, FL
Total Job Valuation: $ 5,000.00
Contractor(s) Phone Primary Contractor
ARTEK CONSTRUCTION MANAGEMENT CO (786)255 -6124 Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 11/2/2009
Comments: PLEASE PROVIDE MORE DETAILED PLANS AND DESCRIPTION OF PROJECT
11 -9 -09
WHAT IS THE WIDTH AND LENGTH OF THE PROPOSED SIDEWALK. CLEARLY IDENTIFY ALL HARD SURFACES AND
DIMENTION.
S NoREs
Miami shores Village
moll Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
fi A, rm to Tel: (305) 795.2204
OR Fax: (305) 756.8972
Permit No: 09-
Job Name:
2009 Page 1 of 1
Building Critique Sheet
/ h
f/`'
r yy
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 795 -2204
Planning and Zoning Criteria
Miami Shores Village Permit NO RC 0 - 0 9 -17 7 5
10050 N.E. 2nd Avenue
-� - Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 - 8972° , ��1.
+rtion
F t4RT��
Issue Date: Not Issued
Expires:
Folio Number 132060171230
Owner's Name: JORGE GOMEZ Owner's Phone: (305)510 -0916
Job Address: 9969 4 Avenue Total Square Feet: 400
i
Miami Shores, FL Total Job Valuation: $ 5,000.00
Contractor(s) Phone Primary Contractor
ARTEK CONSTRUCTION MANAGEMENT CO (786)255 -6124 Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 11/2/2009
Comments: PLEASE PROVIDE MORE DETAILED PLANS AND DESCRIPTION OF PROJECT
i
SURVEY
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Client JORf� GOMEZ ANIFf, � � ��+► �rr • s
9969 NE 4 AVENIX ROAR Unit P#o. •
'Qs h MIAMI SHORES MIAMI -DADE
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Planning and Zoning Criteria
Miami Shores Village Permit No. RC 0 - 09 - 1775
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000 . `
Phone: (305)795 -2204 Fax: (305)756 -8972 �fSS�
Issue Date Not Issued pp��
Explres:l�l ®t Iss
S'
Folio Number: 1132060171230
Owner's Name: JORGE GOMEZ Owner's Phone: (305)510 -0916
Job Address: 9969 4 Avenue Total Square Feet: 400
Miami Shores, FL Total Job Valuation: $ 5,000.00
Contractor(s) Phone Primary Cont
ARTEK CONSTRUCTION MANAGEMENT CO (786)255 -6124 Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 11/25/2009: Yes
Comments: PLEASE PROVIDE MORE DETAILED PLANS AND DESCRIPTION OF PROJECT
11 -9 -09
WHAT IS THE WIDTH AND LENGTH OF THE PROPOSED SIDEWALK. CLEARLY IDENTIFY ALL HARD SURFACES AND
DIMENTION.
11 -25 -09
NEW PLAN OK, SIGNIFICANT REDUCTION IN EXISTING PAVEMENT IN THE FRONT YARD.
g Miami Shores Village
10050 N.E. 2nd Avenue x x
Miami Shores, FL 33138-0000 '3
Phone: (305)795 -2204
MI N I M
oR "
Ago
Explratlon: 0610712010
Project Address Parcel Number Applicant
9969 4 Avenue 1132060171230 JORGE GOMEZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
JORGE GOMEZ 9969 4 Avenue Road (305)510 -0916
MIAMI SHORES FL 33138 -2439
Contractor(s) Phone Cell Phone
ARTEK CONSTRUCTION MANAGEME 86 255 -6124 Valuation: $ 5,000.00
n ) (305)443 -5778
...__ Total Sq Feet: 400
Approved: Yes For Inspections please call:
Comments: PLEASE PROVIDE MORE DETAILED PLANS AND DESCRIPTION OF PROJECT (305)762 -4949
Date Approved: 11/25/2009: Yes Available Inspections:
Date Denied: 11/2/2009 Inspection Type:
Type of Construction: DEMOLITION & REPAIR Occupancy: Final PE Certification
Stories: Exterior. Drywall
Front Setback: Rear Setback: Miscellaneous
Left Setback: Right Setback: Window Door Attachment
Bedrooms: Bathrooms: Tie Beam
Plans Submitted: Certificate Status: Final
Certificate Date: Additional Info: Framing
Bond Return: Classification: Residential Insulation
Truss Inca
Fees Due Amount Invoice # Total Amt Paid Amt Due Columns
CCF $3.00 RC- 10-09 -36250 $ 368.00 $ 318.00 Foundation
DBPR Surcharge $2.00 .. ,w Window and Door Buck
Education Surcharge $1.00 RC- 10-09 -36250 $ 368.00 $ 368.00 $ 0,00 Fill Cells Columns
Permit Fee - Additions/Alterations $150.00 Wire Lathe
Permit Technology Fee $0.00 F. Termite Letter
Radon Surcharge $2.00 F. Elevation Certificate
Scanning Fee $6.00
Submittal Fee $50.00
Technology Fee $4.00
Work without Permit Fee $150.00
Total: $368.00
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.
December 09, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 09, 2009 _ 1
, This Instr
C3 Name
Address
_j GfGI f a A , /
- L6 Permit No. L 1 3Z O�D (�'I Zia
.�.
j
STATE OF NOTICE OF COMMENCEMENT Tax Folio No. --
_L
COUNTY OF _DOG
C7
TH•E UNDERSIGNED hereby gives notice that Improvement will be made to certain real pro
S perly, and In accordance with
Uj Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement.
Q
1. Description of ro ert le ption of property, and street address H a t able)
property: Y�( al descri
9
. 2. General description of improvement: 641&A_ -t jvk%ie.5
..°°"� rs, v� ov �-�cx� s�CY
CA' rx: 3. Owner information
'y ,e
C �tS a-r�e tl uvr,P,rs
r`
=C-4 C3 a. Name and address: Mel
���
M
C3 c. C- 4 ` b. Interest in property:
Name and address of fee simple titleholder Qf other than owner):
a: 4. Contractor: A��
,-
M Ca_J a. Name and addr�ss: rz` *- Tc-;v— C OVISTYLL�}fby{�C r ,
� b. Phone number
r.
00 ^4 5. Surety
C%, a. Name and address:
W f-
b. Amount of bond a
C W 4t: c. Phone number.
+� z 3— w
r-a ce W
0 3 t 6. Lender
s„ Lj ce- 0'3
rz Uj S C a. Name and address:
ej oz b. Phone number:
7. Persons within the State of Florida designated by Owner upon whom notices at other documents may be served as
provided by Section 713.13(1 ua)7., Florida Statutes:
a. Name add address:
b. Phone number:
a. In addition to himself, Owner designates the following person(s) to retmnre a copy of the Llano Notice as provided In
Section
7.13.13(i)(b), Florida Statutes:
a. Name and address:
b. Phone number.
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording Unless a different date is
specified)
WARNING T OWNER.
COMMENCEMENT ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
ENT ARE ANY
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713 13,
FLORIDA FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION IF YOU INTEND TO OBTAIN FINANCING, CONSULT WiTH YOUR LENDER OR AN ATTORNEY BEFORE
r v - - , r , a, } 4 COMMENCING W..O �R RECORDING YOUR NOTICE OF COMMENCEMENT.
a� rf,�1. ' :�� o�
a °lla� dv 4 p� Signature� arorO er'sA ruedOfiiceNOtrector -
_ ;B. ; ; t �� n t •
, Crr e, PattnerlNl(ins, er �O O11
Signatory's Till Office
w._.'
The foregoing instrument was acknowledged before me this1 day of
(name of person) as• Y {year)by
authority, ...e.g. officer, trustee, attorney In fact) for (type of
behalf of whom Instrument was executed). (name of party on
NtlMY AM -- ft" Of �Slgnatqu eta u bli - Slate of Florida dtt41'�l, AW 10, 2018 int, T, or Stamp C missioned Name of Notary Public c amain t+R 0 901828 ommission Number
Personally Kn or Produced Identification
V tion Pursuant to Sect on 82.626. FIo da S(atules '_
Under' � ,y
penaltles qt ry, �r e� thy! t � ; lho foregoing arid. that (he facts stated in it are true to the best of.my
knowledge and belt = i
"'" Signatur f Nalur ers gning Above
*�— - 20 -2009
ALEX SINK STATE OF FLORIDA
CHIEF FINANCIAL OFFICER 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: 08/20/2009 EXPIRATION DATE. 08/20/2011
PERSON: SPRINGER RICHARD
FEIN: 113679186
BUSINESS NAME AND ADDRESS:
ARTEK CONSTRUCTION MANAGEMENT CORP
2330 SW 29 AVENUE
MIAMI FL 33145
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED GENERAL CONTRACTOR
IMPO sectio n array not recover to er b ene 440 . 0 nsati F.S., on under officer of this chapter. Pursuant to corporation who elects exemption from this chapter by filing a certificate of election under this
sectio may t ecovenfits t compensation . Chapter 440.05t)2), 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 it, at any time after the filing of the notice or the issuance at 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
en the certificate to meet the requirements of this section.
'TIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413 -160!
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
FEBUS INESS OF FLORIDA MENT OF FINANCIAL SERVICES
N OF WO RKERS, COMPENSATION F IMPORTANT TRUCTION INDUSTRY O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
ICATE OF ELECTION TO BE EXEMPT F elects exemption from. this c RS' COMPENSATION LAW , _ `° under this section may not reco l f l o er benefits or t ompensati o oder this
IVE 08/20/2009 EXPIRATION DATE: 08/20/2011 ROM FLORIDA D chapter.
N: RICHARD SPRINGER H Pursuant to Chapter 440.05 F.S., Certificates of election to be
113879188 exempt.. apply only within the scope of the business or trade listed on
SS NAME AND ADDRESS R the notice of election to be exempt
ONSTRUCTION MANAGEMENT CORP E Pursu to Chapter 440.05(13), F.S., Notices of election to be exempt
2330 SW 29 AVENUE and certificates of election to be exempt shalt be subject to revocation
MIAMI, FL 33145 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
SCOPE OF BUSINESS OR TRADE: department shall revoke a certificate at any time for failure of the
1- CERTIFIED GENERAL CONTRACTOR person reamed on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06