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DS-11-5284 Inspection Number: INSP - 157631 Permit Number: DS -3 -11 -528 Scheduled Inspection Date: April 27, 2011 Inspector: Bruhn, Norman Owner: MATZ, BETTY Job Address: 10090 NE 12 Avenue Project: <NONE> Miami Shores, FL 33138- Contractor: FIGUEROA & DAUGHTERS BUILDERS INC Building Department Comments INSTALLATION OF CONCRETE SLAB BERING HOUSE Passe j' Failed Correction Needed Re- Inspection Fee April 26, 2011 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments ere- For Inspections please call: (305)762 -4949 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132050190380 Phone: (786)344 -4996 Page 16 of 36 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOOFI OWNER: Name (Fee Simple Titleholder): �I f I Address: Ong D N E , ?. Q LU 1SL City: \ QIAA Tenant/Lessee Name: 11 __ r 9 Phone #: Email: b M c b � �� C.ow State: JOB ADDRESS: \O° N E I z Qa.+cuuis1- 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 VI— REUT3eWZR LIAR 2 5 2011 g Permit No. 05 f Master Permit No. /Sb Phone#: / t I W .72a , 638 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: I I Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: . 1 1 \ u e ro Ct. 4 Do.0 td Cr clJw 6 Phone#: ' 1 LJ / 3 ' ► ( Address: s (O \A.J �C 7 Pile • City: \AA VtAt. ( 1 State: ) (-- Zip: . 1 3 Qualifier Name:1 x>e,(�7r1.C1Y`do F 1 v P roG. Phone#: '34'6 .`? 4 q - V 9 Y State Certification or Registration #: C 6C ! 5 1 ,26 4? Certificate of Competency #: Contact Phone#: 3 OS 975- ©7 6C Email Address: t ,j /// emew-d z-a- @ Co w'-«.S"/ n DESIGNER: Architect/Engineer: NO e 5 q 47 U/ / /Qi1(i elf a.- Phone #: 7g 6 -..2.1/- ..2 // - r‘( Value of Work for this Permit: $ 1, S 0 0 Square/Linear Footage of Work: 3 9 0 5 F4 • Type of Work: ❑Addition / � ❑ Alte New ❑Repair/Replace ❑Demolition Description of Work: 1,:,, ' SV l'1, b') t (d `'1, 1 r ************** ****** * * ****** *** ***** ** �***F e o **** x• x***a:**** **** ** **** *a:*****x•** **** * *** Submittal Fee 5Oc0 Permit Fee $ '-mot./ CCF $ CO /CC $ Scanning Fee $ ' Radon Fee $ DBPR $ Bond $ Notate fk Training/Education Fee $ Technology Fee $ /J Q Structural Review $ TOTAL FEE NOW DUE $ d � —ICJ 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. ;1 the absence of such posted notice, the inspection will not be approved and a re Q spection fee will be charged. Signature Owner or •_ The fore o instrument was acknooIec ed before me this 1J , day of Ai e6 20 , by I 4` I.Qr l.° , who me or who has produced As identification and whwilditilialooth. NOTARY PUBLIC: Sign: Print: My Commission Ex (Revised 07 /10 /07)(Revised 06!10 /2009)(Revised 3/15/09) \ � \ e� ,s( t Bops o/4, �� �; ��NtISS1pNF�y �� C ;; j • � N T. Sign: ires: ,y° ..�aB cie, ,,. �- of ® � 0 oi � ` t, STKM sj k Structural Review Signature Contractor The foregoing instrument was acknowledged before me this L` day of pliQ • , 2011, by Lion. a Pd0 FizV ;e ,. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: o`?"'' % Nolary Pubiio Siete of Floif'da 'i EiissonTaussaint ie M Commisakin ODD eoc fo% Expires 03/3O012 **** ******* * * * * * * * * * * * * ** * * * * * * * * * * ** * * * ** * * * * ** * * * * *�x�x** **** * * * **** :** ** * ** * ***** ** ****' * ** * **** APPROVED BY Plans Examiner Clerk MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI FL 33138 I SHOUL THE ACCO A Y b F 1 N DA C WI E ATE TH P E DESCRIBED POLICIES BE CANCELLED BEFORE REOF, NOTICE WILL BE DELIVERED IN LILY PROVISIONS. AUTHO Am. N (305) 264 -5382 A INSURER(S) AFFORDING COVERAGE NAIC # Ate` CERTIFICATE OF LIABILITY INSURANCE . °°' DATE(MM/DDIYYYY) 03/22/11 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. 0 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 Jimenez & Co., Inc. 8000 Coral Way Miami, FL 33155 Phone (305) 264-9900 Fax (305) 264-5382 CONTACT NAME: P HOO N Est)* (305) 264-9900 Am. N (305) 264 -5382 - MAIL Julio @jimenezandcompany.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : BURLINGTON INSURANCE COMPANY INSURED FIGUEROA & DAUGTHERS BUILDERS INC 5800 SW 127 AVE APT 2403 Miami, FL 33183 (786) 344 -4996 INSURER B INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION 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. 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. INSRR T TYPE OF INSURANCE IN WVD POLICY NUMBER FEZEDO -Y (MOIL POLICY M 03/05/2011 (MAD ) 03/05/2012 OMITS EACH OCCURRENCE $ 1,000,000.00 A GENERAL n ❑ • ❑ GEN'L • LIABILITY COMMERCIAL GENERAL LIABILITY U CLAIMS -MADE ' OCCUR PREMISES S (Ea PREMISES (Ea ocxurrence) $ 50,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP /OP AGG $ 1,000,000.00 AGGREGATE LIMIT APPLIES PER POLICY ❑ PRO ❑ LOC JFS:T $ AUTOMOBILE LIABILITY • ANY AUTO ❑ AUTOS OS OWNED • AUTOSU ❑ HIRED AUTOS ❑ AUTOS ❑ • COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident; $ PROPERTY DAMAGE (Per accident) $ $ III UMBRELLA LIAB 1 OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ ❑ DED ❑ RETENTIONS 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 ❑ WC ST LIMITS ❑ OT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ • DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 7Y1 CERTIFICATE HOLDER ACORD 25 (2010/05) QF CANCEL 9 .s2010 ACORD CORPORATION. All rights reserved. ORD name and logo are registered marks of ACORD 1'on JEFF ATWATER 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 Iavv. EFFECTIVE DATE: PERSON: FEIN: FIGUEROA 263167712 BUSINESS NAME AND ADDRESS: FIGUEROA & DAUGHTERS BUILDERS INC 5800 SW 127 AVE APT#2403 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05(141, 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 440.05113), 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 an the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 01/04/2011 EXPIRATION DATE: 01/03/2013 I MIAMI-DADE COUNTY TAX COLLECTOR . 140 W. FLAGLER ST, 1st FLOOR MIAMI, FL 33130 LEONARDO 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY 636315 -4 RENEWAL BUSINESS NAME / LOCATION. RECEIPT NO. FIGUEROA & DAUGHTERS BUILDERS INC STATE# CGC1512609 5800 SW 127 AVE 2403 33183 UNIN DADE COUNTY OWNER FIGUEROA & DAUGHTERS BUILDERS IN Sec. Type of Business THISISONCY OERAL BUILDING BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CtIIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/27/2010 60060000361 000075.00 SEE OTHER SIDE CONTRACTOR DO NOT FORWARD FIGUEROA & DAUGHTERS BUILDERS INC LEONARDO FIGUEROA PRES 5800 SW 127 AVE 2403 MIAMI FL 33183 IiitLI,I UOIt I lil6AOlALL33A[1M)r!{Yilrl 01 =04 -2011 663067 -8 * FIRST -CLASS U.S POSTAGE I PAID MIAMI, FL PERMIT NO. 231 d • ' ` 3L � n i ? nc k s)". op : ` `T' h - a1,ot'^ i iL BLOCK 177 fib \gaa x b blv • • • • •••• • • • • • • ••, 000000 • • • •• • rag • LOT 16 BLOCK 177 • .LN VU IVd3a 1-1.1.1113H AlNnoc bava- aSInoaadn = SURVEY ©RS & ASSOCIATES, INC, • • • 3921 SW 47TH AVENUE, SUITE 1011 DAVIE, FLORIDA 33314 CERTIFICATE OF AUTHORIZATION : LB $ 6448 PHONE (954)680 -9885 FAX (954)680 -0213 ( PROJECT NUMBER : 6243 -09 CLIENT : FACADE CLAUDIO RODRIGUEZ FtP (1 /2 ") Guillermo Mendoza 10090 NE 12 Ave Miami, FL 33138 RE: Contingency Letter Application Document No: AP999862 Centrax Permit Number: 13 -SC- 1310159 OSTDS Number: 10090 NE 12 Ave Miami, FL 33138 Enclosures cc: 727g 1 PR 0 0 2011 April 05, 2011 Lot :17 Block:177 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 03/30/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use (new concrete slab). If you have any questions on this matter, please call our office at (305) 623 -3500. Sincerely, Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 Joseph P er• r , r Specialist II Rick Scott Governor