RF-10-49Protect Address
Owner Information
SUZAN HARDWICKE
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
240 97 Street
Miami Shores, FL 33138-
1132060134020
Block: Lot:
SUZAN HARDWICKE
240NE97ST
MIAMI SHORES FL 33138 -2404
: :;
Contractor(s)
DALEY ROOFING INC
Phone Cell Phone
(305)754 -9892
Type of Work: Repair
Additional Info:
Classification: Residential
Fees Due Amount
CCF $1.80
Education Surcharge $0.60
Permit Fee - Repairs $100.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $107.80
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
ROI
Expiration: 07/1412010
Phone
Invoice # Total Amt Paid Amt Due
RF -1 -10 -36807 $ 107.80 $ 50.00
RF -1 -10 -36807 $ 107.80 $ 107.80 $ 0.00
Check #: 7996
Applicant
Valuation:
Total Sq Feet:
$ 2,375.00
0
Date
Cell
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
Roof Repair
Final Roof
Roof Review
1
In consideration of the issuance to me of this permit, P 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 one by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL d.11Nl3OWS, 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.
February 09, 2010
February 09, 2010 1
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE: 07/24/2009 EXPIRATION DATE: 07/24/2011
PERSON: DANIEL P DALEY
FEIN: 650491667
BUSINESS NAME AND ADDRESS:
DALEY ROOFING INC
738 NW 107TH STREET
MIAMI, FL 33188
SCOPE OF BUSINESS OR TRADE:
1- CERTIFIED ROOFING CONTRACTOR
IMPORTANT
0 F 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
L under this section may not recover benefits or compensation under this
D chapter.
H Pursuant to Chapter 440.05112), F.S., Certificates of election to be
exempt.. apply only within the scope of the business or trade listed on
R the notice of election to be exempt
E 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 on the certificate to meet the requirements of this
section.
QUESTIONS? 1850) 413-1609
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -
CUT HERE
INS
ANY
MA"
POLICIES.
S
A
POLICIES
REDU
PERTAIN,
y
I_
IREMeNT,
AGGREGATE
GENERAL
OP INSURANCE LISTED BELOW HAVE
TERM OR O0RDITION OF ANY
THIS INSURANCE AFFORDED SY THE
LIMIT SHOWN MAY HAVE
_
i
LIABILITY
COMMERCIAL GENERALLIABILIIY
Seel ISSUED TO THE INSURED NAMED
OONTPADT OR OTHER DOCUMENT WITH
POLICIES DESCRIBED HEREIN IS SUBJECT
BEEN REDUCED BY PAID CLAW
POLICY NUMBER
n00 02.1-1
MOVE FOR THE POLICY
R EBPEDT TD WHIG l
TO ALL THE TERDffi,
r �.:�. !,, r
fiVillr ff , .L
06/19/09
PERIOD IN09CATED,
THIl C'ER70 MAY
EXCLUSIONS AND CONDITIONS
:: ,
} 1 � 1 ,.. ,4
NOTWITHSTANDING
De lee= OR
OF SUCH
lam
EACH OCCURRENCE 4 500 000
•
06/19/10
X!
PROM! 450,000
CLANS MADE L OCCUR
MEb ReP era - -roan) 1 Estalidod
PERSONAL aADYINJURY 1500 • 000
DENBRALAGGREGATE S 1 000 000
GEN'LACCREOATE
LIMITAPPLIEle PER;
POLICY : 1 04, • Loa
PRODUCTS • COMP/DP A33 1900 000
COMBINED SINGLE LIMIT
(Ea maw*
a
ALROIAOSILS
LWEILITY
ANY AUTO
ALL OWNED AUTOS
DOHEDULED AUTOS
HIRED AIJTO8
NON (lWNE AUTOS
[
OL )UR`/
(Par
a
BODILY NOT
(Pa SU 7
PROPERT'Y>] MINE
(P'sr aaaiarAT
S
OARAO!
LIASEdTY
i ANY A pTO
AUTO ONLY • EA ACCIDENT
1
SA
1
AUTO ONLi
juTp � o.Y
a
!ANN
0 MBRELL O LAM M'
O UR f i� CLAWS MADE
EACH OCCURRENCE
a
J
AGGREGATE
a
osoUGTae
RETENTION $
4
S
4
AND
ANY
=wry
RB ',_, F ION
EMPLOYERS' LIABILITY
PR TO�R/PARTNER/E%ECUTIM
IN I N) EXCW�� (—�
essalbi u •• r
PROM '. N$ Wow
•
T LIMITS
E.L, BACHACCIDENT
a
$
ILL DISBARS • EA EMPLOYEE
EL, DISEASE • POLICY LIMIT
1
GTNNIE
DESORIFVON OF OPeRATI NS I =MONO ! ICI. ECM , ;.. AD ED : ' EN . - I IA I SPECIAL PROVEN
ROOFING CORTRRCTO11, STAIR OT FLORIDA. DANIBL DALEY LICENSE S CCCO57190
Feb 08 2010 3:40PM
CERTIFICATE OF LIABILITY INSURANCE rrl9 PATe(Mr4 '
Y -s a� e
Brown Insurance Inc.
1672 Tamiami Trail S. Suite d
Vaniaa FL 34293
POsoaraa •41 -493 -1586 M1;941-457-6329
INffiIAED
COVERAGES
CERTIPICATI HOLDER
NigimiTili
MANI EMUS Eld 41.38
941-487-6325
p.1
E CE . MCA ` •- 11 INSUED _ OF ORMAT10 N
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE 0OVMlRAi'iE BYTHE POLICIES BELOW,
INSURERS AFFORDING COVERAGE HWC i
IM PAR, 1/1RiT NIIR IY ZEBU 0L CO.
NEAR R Er
INSURER Ce
INffi,RER
1, =1 RA e:
CANC9LLATION
E 4 ILO MIY OP TM WYE DESOAEI6D POWER DE CAN0 L4.ED URALTNE BAFIR, -nh+
ATE THUMP, THE ISSLBNG INSURER WILL ENDEAVOR TO NAIL EL_ DAYS worm
NOTIC1 TO THE CENTHNCATE HOLDER NAMED TOTH; LOT, NUT FAILURE TO DO EA ENAL.
IMPOM NO LIEU ATIN OE LIACBRY OF ANY MECUM E INSURED, ITO AGENTS ON
Miami Shores Village Building REPRIDIeNTATrvEa
10050 ICS 2 Awlnue A*YM E0 IO REPILIONINTAIN1
Mel 092583
Miami Shares E'L 33139
ACORD 96 (200041) ®115.2009 AOORD CORPORATION. All rIghim r rvad,
The ACORD !Tame and logo ars registered marks of ADORED
BUILDING
PERMIT APPLICATION
FBC 2004
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
ECEOVE
JAN Al 2010
MO
m O w
Permit No. _1 e 10 ° 9 ct
Master Permit No.
Permit Type (circle): Building 3 Owner's Name (Fee Simple Titleholder) 3 �1 � �W i Gk.t Phone # 3 US 7 a) /A Zg j
Owner's Address '10 X 7 S 1
Cit N l 1Fl 1 S ilv ia State "r Zip �3 ? J ) 3
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 2-4° h1 S 1
City Miami Shores Village County Miami -Dade Zip 33 l
FOLIO / PARCEL #
Is Building Historically Designated YES NO 1.
Contractor's Company Name 'b. 200 ( i 6 N Phone # 36N"
t 761-1q o / 2 —
Contractor's Address 1g f c) to 1-5;
Cit N119714 I _SOVILES State i� Zip 3 ) 3 1
Qualifier Name T.)74 0 Di÷tAitti Phone # 3t 7 9e
State Certificate or Registration No. OA-0X 571 Certificate of Competency No.
Type of Work: ['Addition
Describe Work:
Value of Work For this Permit $ ,23 -S ' b 6
Architect/Engineer's Name (if applicable) Phone #
['Alteration
a CA
c• t ',
c 1
L A
• i e s;•
tde WH ze: '_
m Milk tJ p11219c.
Vric
1—n
0 FsQPQ.p) 1
fir / -,1
EAcT P 2 ,oin . PAW 1
et 10 d
['New
tJ
`1 X01 - �/ * *' * ***
� t Submittal Fee T50 EO .W Permit Fee $
Notary $ Training/Education Fee $
Scanning $ tJ ` Radon $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
* * * * * * * * * * * * * * * ** ees * * * * **
d
/D O
Square / Linear Footage Of Work:
DPBR $
Dt Repair/Replace
['Demolition
r
4, •
* * * * * * ** * * * * * * * * ** * * * * * * * * * * * * * * **
CCF $ 1 ''SO CO /CC
Technology Fee $ 9.40
Zoning $
Total Fee Now Due $
See Reverse side -
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 FT.RCTRICAL 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 1n4 .
Contractor
th
The for oing instrument was aq ►owledged befor The foregoing instrument was acknowledged before me this ?I
day of ,20 ,by
who is pers nally known to me or who has producedT 1. �� who is person) oo (bane or who has produced Pk_ D
...• � .04 glez�`t iution and who did take an oath.
NOTAR P
Sign:
Print:
LIC:
Owner or Agent
� � ' Print •, F O F F L0 •\`
„ y c (Si "ill/111W"
,, �,f':s• `off ° � My Commission Expires:
�k+ kd��k�k�kA��k+ k+ k�k+ N�k�k�k�k�k+ k�k�k�k�k�k�k�k +k�k:k�k�kek�kd�Aa�k� *re*+ *
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 07/10/07)
State
me this 11
CIAO t 6`-. , day of `SQV,.�a.✓ , 20 110, by 'A ,
AiItiflfcation and who did take an oath.
2 1
' p C.: _
1 ti
ok8: ********* **********& **+ k***& ******d: ***** ****M*sN*darle**:k*****
V�
01111111/1
k
i
Plans Examiner
Engineer
Zoning
Zip
overt!
with
SECTION
HIGH vELoc§Ty HURRICANE ZONES REQUIR
C SI PE
verriteY SC1,1 rs (wall outlets): It is
dad from 2 build up of water, Perimeter/edge
scuppers (wall outlets) are not provided. It m
Florida Building Code, Plumbing.
SUBJECT
T. Ventitation: Most roaf structures should h
th atria:nivel ea:semi:ay (the building itself). The existie
ne,neficial to consider aciditional venting which can result in
•
Ownero/Agenrs Signature
0 /Le qi 4 )1 -
Property Address Permit Number
Rev."1/20fd005.Camputer Services, Building Dap
• a.
walls or ot
TC
JAN 1 1 2C13
APPROVED
1 7 6 94ING DEPT
Mam Shore ViUaje
t,4 FOR ROOFING
1524.1 As it pertains to this section, it is the responsibility of the roofing cont to provioe the owner wit the
s re oce TO COMPL WITH LL FEDERAL
required roofing permit, and to explain to the owner the cdritertrbtilltsere. ea 3 Tres paresibienaletTeleepter 5 of
the Florida Building Code, Building govern the minimum requirernents andsitintrardrorlhe industry for •tfing
syste installations. Additionally, the following items should be addressed as part of the.agreement between the
ill
r and the contractor. The owner's initial in the adjacent box indicates that the Kern has been explained.
\V t Aesthetics-Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone)
ae for the purpose of providing that the roofing system meets the wind resistance and water intrusion
performance standards. Aesthetics (appearance) issues are not a consideration with respect tc workmanship
provisions. Aesthetic issues such as color or architectural appearance, that are not pail 4 a zoning code, should
ressed as part of the a sement between the owner and the contractor.
5. Ponding Water: The current roof system and/or deck
ca se water to pond (accumulate) in low-lying areas of the roof
distres and may require the revies of a professional structur
rctoli'g Eflry and performance of the new roofing system. Ponding
system is removed. Ponding conditions should '4:- s ealitatet:s
BY
2, RenallIng d : ks: When replacing roofing, the existing wet t. roof deck may have to be renailed
orrience with the current provisions of Chepter 1 (High Velocity Hurd ne Zones) of the Florida Building
WO (The roof deck is usua_lly concealed prior to removing the existing roof aystern).
3. common Roefs: Common roofs are those ihich have no visible delineation between neighboring
UtifeD (i.e. townhouses, coridominiurns, etc.). In buildings with common roofs, the rooting C011tr8Ciar and/or owner
d notify the clecupants of adjacent units of roofing work to be perfoneed.
s
4. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be
vit• ed from below. The owner may wish to maintain the archilectufal appearance, therefore, roofing nail
perietredons of the underside of the decking may not be acceptable. The Florida Building Code provides the
maintaining this appearance.
ot drain well! and may
structural
the life
e original
TO COMPLIANCE WITH ALL FEDERAL
N.$ terventelattoarar Ith
etticesettite'dowsliall hdriNiFfFT
tending the service life of the roof.
Contractor% gigukte , •
• •
• • •
• •
•
•
• •
• •
• •
• •
•
• • • • • • • •
• • •
•
•
•
• •
•
• • •
•
•
• •
• •
•
•
• •
• • • • •
• • •
•
•
• •
••
•
• • •
•
•
DATE
•
• •
•
of
the
• •
• • • • • • • • • • • •
• • • • • • • •
• • • • • • • • •
• • • • • • • • • •
• • • • • • • • • • ••
• • • • • • • • • • •
•
• •
• •
• •
• •
•
f is not
harge if
orciance
interior of
It may be
High Velocity Hurricane Zone Uniform Roofing Permit Application Form
Masted ermit No.
Contractor's Nsma:
• Roof Category
Low Slope .�- Mechanically Fastened Tile
_Asphaltic Shingles _.Metal PaneUShin Ies
_PresciipUve BUR-RAS 150
Section A (General Information)
Proees No.
Dstk.
Job Address:
Roof System Information
Section B Roof Plan
N .
diei
^ 'MorlBdAdheslve Set Tile
=Wood Shingles/Shakes
Roof Type
.._ New twin •.._ Re- Roofing _,_Recovering Repair . ` Maintenance
Are there Gas Yen! Stacks located on the roof? . • :Yes = No It yes, what type ?LiNatural _LPDX
Ldw slope roof area (fl.'y ' Steep Sloped area (ft.') Total (R.')
• Weil Rgaf Plan: tgushata all Wale and saattrna. ron/ ditto. aolppara, overflow acuppare and overflow drains. hedude dimensions
'seeUons and Wets, dearly identify dimensions of elevated pressure zoned and location of parapets.
Perimeter Width (at size (a' a a'I; •
■lit■ illi■ 1111 ililURN1111iuii ■ ■lillllaliii11i1111111i11UUi11
Iii ■ ■iii■■ 1111 ■ 111111111 11i■ 111■ ■i1111111111■11i11111111i 11
■■ i ■1 ■111■lilliil•
aliiiiliitmminerniililill1i111i111iii1 ■11■111i1111liiiliiit
■ iiiiiiiiliili 111 111iiiii1111 1i1iiilililinimmiliiimmi
■■ iii■ i 111111111 1111 111V11111111 ■1lliliui1111i111 ■111111■ ■■.
C ■ 11 ii ■■ii ■■ 1111111 ■■liiiii■iliilliiii■ii1UI
1 ■iiiiiiili 111111111 1 ■■ 1 1i11111111111111ii11 111111111i1■11i
■ 11111111 111111111111 111111111111 ■■1i11111111111111■1• 11111
■ 1111 1111111111111111111•11111111111h ill11i1111111■111ii11l1 ■1
liiiillialIIIII - «- ��.�..mmmm>r _- 7iiiiil
■u iiiii ■■! iii 11 i 71 ii 1 1iliiiiiiilllillil ■11 ■iii ■MON jii11 ■
�Riiliiiilliiililiiiiiiiiiiiiii ■■1i■iliOMMOMMiiilill�lACEMiiil
liliiiillliili1111111ii1111i111111i ■111iliiililll■ 4N".w`"i Mliil7
IIIMI ■ INIMUIii11ii11iliiMIIIIiiiiiiiiiiiiilaiiiiI AJrliliiMI
11111iiiaii11 iii■ 111i111111111iiii11111111111111111■ilallllli111iiiiii111i
■!iii■ ■i ■iii.■! 111i■■■ RlUUUI iiiiiiliil ■■liliiliiliiliiiiiii+ytii
1111111111111111111MMII ii li111iilililiiili ■1■lilil",lltAINII
l•iiiiifiiilii 1 iilillil■ llli11i1ilIiiiifii ■ill■i.i ■Al['1AIrliU
■i■ iii■ iiit iii ifil•Il la■ lliilliliiilillliii111ii1 11ii■l.fi11■
!•Uiiiiliiliili 1l' aiiiiaiiiUIh lIIli ■ililial■liliilliiiialiiiii
■iiiiiliiiiiii 1i' lli■ iliiillliiiiiiiiil ■illliiiiiiiiiiliiiiil
liiiiiMOMMUMi! ■IIMEMEMEmmomU>ummommr ii •111111
liiiliiiiliiiiii■ iiiii11111Iit fiiliililiiiiiii■ ■iii1111MM IMI
■ iiliili■■ iliila iiiili>liaiiiiiiiai■
i■■ iiiiiliiilliiiii ■iiiiiiiiiiiirR:ANNI iiiliiiiiiiiilliiii■
iiii iliiiiiii! ■It1Nsiiliiii■■iiiii �i`+ 4111iililliiiiiiii■■ ■iiiii
■ ■iiimiiiiiii■ Ia/ A:11iiii iiiii/ i ■ii&iuiiiiiiiliiliiiiiiiiiliil
iii ■iiiiiiiiii111Ui,1 -iililiumm ..i.Uiiii
• iiiiililiil■iii'iii■■$UU$ hint ■iiiiiiiiiiiliilii■ /1liiiii1111
iiiiiliiiiiii i■iiliililiiiii11P1111IPir� 3Erareliiiiiiiiuu
iliiiillilii■liliiiiitiliil■iii III.11V'illLit l` lIle2kjiiiiitiiiii■
■iiiiiiiiiiii■1hh /iii ■iii■UIiitl,C "!' ,41iiI iiiiiliiii■iiiiiiii ■ iri
■iii ■iiiilii iiiiii lltiiiiiiiii ■iii■iiii■iiiii.Rw
■■ INNERillvl■IIII■MlM lull\li)1INUMMENEURIM MPAI1kLt INN
•• •. •
•
•
• • • • • • • ••• •
• •
•. • •.. •• • • • ••
• • ••
• • •
• • •
• • • •
• • ••
F•. c b. Ya4 . • :•
••• • •
• • •
•
• • • • •
• • • • • • •
•• •• • • • •
• • • • •
•
• • • • • • • • • • • •
• • • • • • • •
• • • • • • • • •
• • • • • • • • •
• •• • • • • • • • .
• • • • ••• • •
k
Scheduled Inspection Date: February 11, 2010
Inspector: Bruhn, Norman
Owner: HARDWICKE, SUZAN
Job Address: 240 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: DALEY ROOFING INC
Building Department Comments
February 10, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 133232 Permit Number: RF -1 -10-49
For Inspections please call: (305)762 -4949
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Repair Roof
Phone Number
Parcel Number 1132060134020
Phone: (305)754 -9892
Peuad —,
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 9 of 29