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CC-11-766Scheduled Inspection Date: May 17, 2011 Inspector: Bruhn, Norman Owner: MIAMI, ARCHDIOCESE OF Job Address: 10690 NE 5 Avenue Project: <NONE> Contractor: GANTT BUILDERS LLC Building Department Comments May 16, 2011 Miami Shores, FL Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159002 Permit Number: CC -5 -11 -766 For Inspections please call: (305)762 -4949 Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)762 -1033 Parcel Number 1122310430010 Phone: (954)639 -1259 REMOVE EXISTING QUARRY TILE AND MAIN ENTRY TO CHURCH Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 14 of 33 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): Address: L_:Lx7/ n — City: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: JQ City: Folio/Parcel#: Miami Shores Is the Building Historically Designated: Yes - - V City: State: Qualifier Name: iw State Certification or Registration #: rC, CT Type of Work: DAddress Description of Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 CIAlteration State: CL kw 0 County: Miami Dade CINew Permit No. CC I 1(00 Master Permit No. NO Flood Zone: CONTRACTOR: Company Name 6 .)cao, t L Phone: , Address: Certificate of Competency #: Contact Phone#: 1 9‘,Ri U Email Address: a DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ (,) Square/Linear Footage of Work: glRepair/Replace Zip: 4z Phone#: C2 r,0 ‘25 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ***************************************F Submittal Fee $S3 ir Permit Fee $ /00 dPg' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ pAy 0 2 2011 bl Zip: .1 Zip: Demolition 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 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 The foregoing instrument was acknowledged before me this day of � �y , 20 11 , by 44( W'' Q.c (s' 1. , who is personally known to me or who has produced CU- !J -�ys • u Cert5c NOTARY PUBLIC: Sign:, Print: My Commission Expires: cLui, cc4JA as �P Contractor The foregoing instrument was acknowledged before me this o2- day of x A , 20U ( , by .74 0 n . 1 O who is persona ly known to me or who has produced as identification and who did take oath. NOTARY PUBLIC: Sign: Print: My Com :° . `• I Not Publ - States o oria i3s ' Qy y mci1pires v 1, 21112 �.- Commission # OD 807066 '04 a ° • Bonded Through National Notary Assn. • .. ************************ * * * * * * * * * * * * * * * * * * * ** * *** * * * * *, +**** t *t *+ * * * * * * * * ******** * * * *re *Me ter **Me Alin air ** APPROVED BY s % '2 % _f Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) COVERAGES MISR LIR A 9.LIABILITY TYPE CIF DISURANCE X COMPIERCIAI GENERAL L MIRY I CLASAS4AADE E3 OCCUR evil. AGGREGATE LIMIT APPLIES PER: — I POLICY X Fl LOC wrozi3 E L 9Y AM AUTO _ ALL OWNED AUTCG _ Sc IEDULED AUTOS PORED AJTOS 1f 044-O AUTOS USISRELLA LIAE EXCESS LJAO DEDUCTIRIE R ETENTION $ OCCUR WORKERS COMPBOATION AND EMPLOYERS' LIABILITY Y TN OFFICEPMENEER EICUICEISI plandatary In mg Rye� d�oite amdsr OESL'R0'TOOC� OF OPERATEOUSI:Orta ERTIFICATE HOLDER ACORD 25 (2009109) CERTIFICATE NUMBER: ADM ) te e POLICY NUMBER r N/A GL0011355 01/18/11 OF OPERATIONS I LOCATIONS ISEMLER Mash AC 9e0, Addrffanad Remadls Scateaula, IT men spars Bar ) to 305- 7584972 CANCELLATION I t 4W CERTIFICATE OF LIABILITY INSURANCE I DATE 05104111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ARID 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. IMPORTANT: If Use certificate holder is an ADDITIONAL IN MIRED, the pe ) must be endorse. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, chin policies may require an endorsement. A statement on the certificate does not confer rights to the entilioete holder in lieu of Duch endoisemeldisi. PRODUCER Brown A Brown of Florida, Inc. 1201 W C Creek 0 110 P.O. Box FL Lauderdale, FL 33310-5727 Shawn A Burton, MC 859 -773 -2222 INSURED Gantt Builders, LLC 8825 Marina Blvd. Suite 100 Boca Raton, FL 33428 ecorrAcr RARE FAX PHONE Na, E I IAre, Ha TTERIEER CUSTOMER ID 0: GANT-al pp INSURE! S AFFORD5JG COVERAGE NRIO sisuRER A: FCCI Commercial Ins Co MUTTER C: POURER D : RED: WEIMER E USURER F REVIION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOWT THSTANDA4G ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WPH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR I5AY 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 CLAMS. EASE OCCURRENCE VETO RENTED PREMISES (Ea eesreaaer e) MED EXP (Any ota D +a) PERSONAL 8 ADY rils7Y GENERAL AGGREGATE PRODUCTS- COMPA'PA6G COQ SINGLE L WIT (Ea acradanN MUILY INJURY (Par psrasn) EOM. ABJJRY (Pea'ate) PROPERTY DAMAGE (Pe r =Word) eacm OCCURRENCE A.� sREGsATE OTIB- T Lt7ITS l 1 IER E.L EACH ACCIDENT E.L. DI - EA EliIPLO E.L. DISEASE - POLICY LIMIT OP ID: E2 1,000,000 100,000 5,009 1,000,000 2,000,000 2,009,090 Miami Shores Village Ann: Ades 10050 NE 2nd Parenue Idlami Shores, FL 33138 MIAMISH SHOULD MW OF THE ABLE DESCRIBED POLICIES BE CAft' ELL EO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PATH THE POLICY PROVISIONS. - 1/4 1 4-44 741 ,44 - TIVE ® 1988 - 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mars of ACORD STATE OF FLORIDA, COUNTY OF DADE 1 HEREBY CERTIFY that this is a true copy of the o R g n ( this offi y 0 1 20 i1 day of A020 Seal. By STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 129.0142 PAGE 9 9110 It d Co ttW+ Courts D.0 9. Expiration date of this Notice of Commencement: NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TiME OF FIRST INSPECTION PERMIT NO. C e , ' 14 TAX FOLIO NO THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1 1111111111111111111111111111111 11111 11111111 CFN 20 a 1 1 80290098 DR Bk 27675 Ps 48381 Ups) RECORDED 05/04/2011 10:26:30 i HARVEY RUV'INI CLERK. OF COURT MIAMI-DADE COUNTY? FLORIDA LAST PAGE r - � Space above reserved for use of recording office a Legal description of property and street/address: 5 1 . L..4" 465 Nr.. IbS S`.org - s, FL 1313e. O . Description of improvement: i2e..rw .. ' .,s {pc ,.. e i a. rr. •r i it Owner(s) name and address: - At_ 14rci, i c ces 0f /YI.:►.r.." Interest in property: ct 46 ` f3: s tpirw, e, 1 J, /hr % tl -mss FL- /7 I s ame and address of fee simple titleholder. Contractor's name, address and phone number. &A 8,,0: le ae-s _ L L "MS Sy.4 160 Rgac.a. FL 314 154 q iel SL &o 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. (the expiration dates 1 year from the date of recordIng unless a different date is spec! ied) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. SIgnature(s) of • .. _r(s) r r(s) ed Officer/Director/Partner/Manager Prepared By f' i �� f 2 Prepared By Print Name Print Name Title/Office le STATE OF FLORIDA COUNTY OF DE �/� The foregoing instrument was acknowledged before me this 3 day of / 1' By U Individually, or U as for Personally known, or ❑ produced the following type of identlfi r.n: Signature of Notary Public: Print Name: (SEAL) IgRIEILMLON ANT TO SECTION 92.52 - F namA STATUTES perjury, Under penalties of I declare that I have read the foregoing and that the facts stated in It are true, to the best of my knowledge and belief. Signature(s Owner(s) or Own : )'s Authorized Officer/Director/Partner/Manager who signed above: c AACCPICE7 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER. THIS CERTIFICATE DOES NOT AFRRMATIVELY OR NEGATTiIELY AM END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polleyjieri) must be eaulorsed. If SUBROGATION IS WAIVED, subs 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 Geu of such endorsement(s). 954-776-2222 Ax 954-M-4449 v PRODUCER Brown A Bro s, of Florida, Inc 1201 W Cress Creek Rd # 130 P.O Box UV Cs�7 Ft. Lauderdale, FL 33310 5f 2! Sham A. Burton, ac Gantt Builders, LLC 9823 !Marina Blvd. Suite 100 Boca Raton, FL 33428 GENERAL LIABILITY A X CA: ANEW:3AL DEV°7EPfL LIQHILIl CLAILVAIADE rrLCliR GEM_ AGC REOA TE Lear APRA& PEP' 1 FOLIC^f IJlI PI AurOA5OBILE LAWN MY F1L ■eYwaaEe SCHEDULED ALIT OS HEED AMC'S NON-DYAI N.ITOS CERTIFICATE HOLDER CERTIFICATE OF LIABILITY INSURANCE CUSTOMER IAA : FCCI Commercial Ins Co Ott: WARM C: INSURER D: INSURER E: IMF OESCROMONOF OPERATIONS LOCATIONS /VET rCLES (A *CORD 01. AdsNional Renaults it more Apace Is reciAre®I CANCELLATION INSUREfils) AFFORDING COVERAGE REVISION NUMBER: OP ID: E2 I DATE RENOMYYTYI 03f1 5111 33472 MC • COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POKY PERIOD INDICATED. NO1W RISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO mini THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR ;: ED HEREIN IS SUBJECT TO ALL THE TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED P CLAMS. POLICY EXP NtSR TYPE OF I'14i POLI YRAI9II ,ri�l LOINS E4CH OCCURRENCE Pr,GREGATE TciF Y rITS I I rjE El. EACH ICCI ERIT E L DISEASE - EA EMPLOYEE E D5EPa - POLETLILLIT UMBRELLA L.IAB EXCESS UAB CEDItCTrELE PETEFITIC+H f EE.CH COI IB' £ pp- COW r.Gi,SB IEO STOGIE LLIT ac ED L'if It s (Per rAfT I $ BON. ( AMY (Far ar-aakrA FROPEPTY DAKROE IPer atc.tSer$ j 1,000,000 2,000, 2,009, 1,000,000 5,000 / 1 4 r 1i 1.0A i 54are.z V I Ase reiyof Averiture Atm Ins 10200W Coup Club Drlye FL30:'18t1 AVENTUR SH0ULD ANY OF THE ABOVE DESCRIBED POLICIES BE BERNIE THE EXPIRATION DATE THEREOF, N BE DELIVERED A mil THE POLIO ATrr4 ATNE (51999-2099 ACORD CORPORATION. A0 rights reserved. Project Address 10690 NE 5 Avenue Miami Shores, FL 1122310430010 Block: Lot: ARCHDIOCESE OF MIAMI 1 Owner Information ARCHDIOCESE OF MIAMI 415 NE 105 ST MIAMI SHORES FL (305)762 -1033 1 Contractor(s) GANTT BUILDERS LLC Phone CeII Phone (954)639 -1259 Approved: In Review • Comments: Date Approved:: In Review Date Denied: Type of Construction: INTALL NEW TILE TO ENTRY Stories: Front Setback: Left Setback: Plans Submitted: Yes Certification Date: Bond Retum : Scanning: 2 Occupancy Load: Exterior: Rear Setback: Right Setback: Certification Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $5.40 $2.00 $2.00 $1.80 $100.00 $6.00 $7.20 $124.40 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 04, 2011 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number Phone Pay Date Pay Type Invoice # CC -5-11 -40765 05/02/2011 Credit Card 05/04/2011 Credit Card Amt Paid Amt Due $ 50.00 $ 74.40 $ 74.40 $ 0.00 Applicant Valuation: Total Sq Feet: $ 9,000.00 1500 1 Available Inspections: Inspection Type: Final PE Certification Slab Window Door Attachment Tie Beam Termite Letter Framing Store Front Attachment Insulation Drywall Screw Window and Door Buck Ceiling Grid Fill Cells Columns May 04, 2011 Date Cell 1 1 JEFF ATWATER STATE OF FLORIDA CHEF FROVICIAL OFFICER DEPA1 TMOVF OF FINIA! CIAL SERV1 DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO SE EXEMPT FROM TWN LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation IDYL EFFECTIVE DATE PERSOkk FEIN BUSINESS NAME AND , OANTT BUILDERS LLC 12204 GLEAWORE SOME CORAL SPRINGS PL 33071 SCOPES OF BUSINESS OR TRADE 1- SAL CONTRACTOR ITVrC -252 CERTIFICATE OF ELECTION TO BE £O 1 RV= O1 -11 OWC -25Z CERTIFICATE OF ELECTION TO DE EXEMPT REVISED 01 -11 03/00/2011 EXPIRATION DATE 03109812013 TIO SERGIO CUT HERE 03 -09 -2011 1166P=T401: Follow W to Moot 940. OM14I. F.S., as MMOelo eR mews** w49 elms exteeess too DO tiostoa 0, Yr0 s ttatdi421, A 99940099 ®9w Ois maw too ant 4400000 9sse l§ 04 t £4a otter Om mow. ammo to Moo 44945102*, 04. Coa0irsl#o If doubt to ter - POO 9144 agar* Oa mote of 449 ttntrass er otos hood to Or mitre A ttloolot to is esteto, Parmar * as goer 443461$0, F.E., % uet of ~R. to ao 839.340 314 rte Roo A chotiss to to moot stag 944 tobit8o to tetotootto f0 11 air Om 14099 Os Woo A Ob tofito or Os wawa. A Co ostltt4ra, Ot Parses 33949 so Os mitt of selt0uete 39 tow mats 049 towiree4A4r A Ms storm Rot Fassooso A a tertaitsle. 14* 49430441al sal mote s 39!0&349 91 0W Ow Om 00044 A acs *groat 9.1084 oa 44 tettairaas to meat Oe te$Otootots of Ott mate. Ms09 412 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE Carry bottom portion on the job, key upper portion for your records. STATEOF FLOM% DEPARrMERTOF RISIND2AL SERVICES S OS WORKERS' COMPERDATIDD • TEOF PTO SEE FROM FLORIDA LAW EFFECTIVE 03/09/2011 EXPIRATION DATE: 03/02/2013 FERSOnt SEEOSO TSO FEOt B1SXY.RESS MAE M4D AIXVIESE 44001 4444441448 Lae !4209 oLotototte MOT COA1 SP &S, Ft =9t SCOPE OF BUSINESS OR TRADE 07 MAMMA IMPORTANT F Pemaire to Chapter 44011504i, F.S., eat officer of a cmp�rafl i v410 O e1o00 exemlltioo from t1t*5 edema by firing a cerfifitate of elect1Lw I - under MOM $000 net reamer tre<mlits or compensotien under ties D otter. Par0rot to Chapter 440.551121, F.S., CerfrIbrodes of election to be exempt.. apply of tote business or trade rid o* E election E Emma' to Chapter 440.051131 F.S., litfiw1 of election to to exempt and cerlificeles of election to be exempt gall be scaliest to remotion if, et any time after the fir i of The actor or Om issueless of The eertifitatee, am pen tamed on Ote 001 a to certificate no lour meets RIM repirements of fitis section for ire of a certificate, The deportment sten revoke a 40tifimae es ow time for Ware of ifi4 prom named on 4ite certificate 19 meet the re1Inbunenlf Of 13* section. 11 0 413 -1