RC-11-1699Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 164941 Permit Number: RC -9 -11 -1699
Scheduled Inspection Date: October 05, 2011
Inspector: Bruhn, Norman
Owner: HOLT, JAMES
Job Address: 112 NE 93 Street
Miami Shores, FL
Project: <NONE>
Contractor: CATALYST CONSTRUCTION CORP
Permit Type: Residential Construction
Inspection Type: Final Building
Work Classification: Alteration
Phone Number (828)944 -2112
Parcel Number 1132060133140
Phone: (305)323 -9496
Building Department Comments
SISTER 2X8 OR 2X10 BEAMS TO EXISTING UNDER
HOUSE UNDER BATHROOM
Passed
Z/(1),,r/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 164522. CANCELLED OVER
INSP. LINE
Cc-
October 04, 2011
For Inspections please call: (305)762 -4949
Page 32 of 49
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
122/2
Applicant
112 NE 93 Street
Miami Shores, FL
1132060133140
Block: Lot:
JAMES HOLT
1
Owner Information
Address
Phone
Cell
JAMES HOLT
112NE93ST
MIAMI SHORES FL 33138 -2818
Contractor(s) Phone Cell Phone
CATALYST CONSTRUCTION CORP (305)323 -9496
(828)944 -2112
Valuation:
Total Sq Feet:
$ 3,200.00
120
1
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction:
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted:
Certificate Date:
Bond Return :
Occupancy: Single Family
Exterior.
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$2.40
$2.00
$2.00
$0.80
$100.00
$9.00
$3.20
$119.40
Pay Date
Invoice #
09/28/2011
09/16/2011
Pay Type
RC -9 -11 -42040
Check #: 11157 $ 69.40 $ 50.00
Check #: 111109 $ 50.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
1
Inspection Type:
Final PE Certification
Shutter Final
Window Door Attachment
Tie Beam
Slab
Termite Letter
Framing
Insulation
Drywall Screw
Shutter Attachment
Window and Door Buck
Ceiling Grid
Fill Cells Columns
Declaration of Use
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.
September 28, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 28, 2011
1
Miami Shores Village
Building Department
10050 N.F nci Avenue Miami Shares, Honda 33138
Tel: (305) 7952244 Fez: (305) 756.8972
INSPECPION'S PHONE NUMBER: (305 ) '762A949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Typ= BUILDING ROOFING
OWNER: Name (Fee ample Tileholdat J- 3 L 7--
d
SEP 1 6 2011
...y0)-)vtor
Master Permit No.
Addle= //2. ,"ye' 93 . 5t. 07(1-;%-- A/ C'en 1f.
air /i'° 3( d hQateS Steam a - ®t)/2! P•1
Tame Nam rS)AV k P Ce4. d=
ry c1►f e 1 r
Email: C 1. coM
JOB ADDRESS: /1 a rd S ,
►: hicami Shoves County: Mani Dade Ep: 33 13g
Foy:
Is the Building Historically Yes NO Flood Zone:
are 330
7,_ -_7443
CONTRACTOR: Company Nam CAn C.04191Pd EVA J CAA°. phone #3 05 =-32:3- 7 44 t'
Addresx (2- 32-1 2 6620-4a 444-
ow: 1, HLMAT" star= Ft... - zip: 551 S(.
Qualifier Name: (A1mtD./D . K I t�RI 4L Pione -3'5°' 323 `t 5�9.c
Stare Cron or Registration IICO.C. ad 3384- Catiticate of Competency d:
Contact Pt : -3Z'1 9 Lit g4 Email Addle= 9411/4y id-- i'i 44 CR 6 WAIL, e..
DESIGNER: Arc»ta/Pagioocr. 3.---'"-- Phonett:
Value of Work for this Berndt $3200 ° SquawaiLinear Footage of 40 L. P .
Type of W *: I -xi ni r r", . CiDemolition
Deserrg afwo i /67,.2 a"te DR aX/o °X, FiWSW
DMA lisfogIs4 /,WI---- - ,
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Trohdn cafon Fee $
Double Fee $ Structural Review $
/no
CCF $ CO/CC $
DB�R $ Bond $
Tedmotogy Fee $
Bonding Company's Address
City
Mortgage Leash's Name (if
Mortgage Leader's A+ddnas
Coy
Application is heeby made to obtain a permit to do the work and installations as iced. 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
this • . I that a separate permit must be secured for ELECTRICAL WORK, PL,UMBINO, SIGNS,
WELLS, IS, FURNACES, BORERS, HEATERS, TANKS and AIR CONDITIONERS, ETC —
OWNER'S ORIATEit'S AF1tiDAVIT: I certify that all the foregoing
information is accurate and that all work will be done in with all
applicable laws regulating construction and zoning.
WARNING TO OWN Ri YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO Y BEFORE
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
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 are good faith that a copy of the notice of commencement and construction lien law brochure will be delivered at the job
whose property is subject to attachment Also, a certified copy of the recorded notice of commencement be posted
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
erection will not approved and a r • ection fee will be charged , ��� ►Z 20C)
'43 t�
rip
state TAP
r1: Wit 11.1 1 1 m
owe or Agent 1Jt..F�t� 3 -' C 3 t 1 Cry
instrument was wledAed before this l) The foregoing instrument was acknowledged before me this
211 t�, by all 0C1 , day of - -i -� 20 _IL by C-C�.2 ►`'camrrr� i Pa`si 1e J
who is personally known to me or who has produced DCtV who is personally known to me or who has produced '-.r"
Lu r - v'-SE. As identification and who did take an oath. LA Ca- v` as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
. *1
11,
Pain
My Commission Exp•
APPROVED BY
`111° "'' SYLVIA PAGAN
? e�; Notary Public - State of Florida
My Comm. Expires Oct 20, 201
Sm Ily v
gIP
°111F °`N , Bonded Through National Notary Assn. 0
•••••**
aPhulaiinouner
Structural Review
•
(Revised 07nO107)( Rev ised06 /102009XRevised3/15l09)
11
. SYLVI GAN
- , ^" "`° • Notary Public - State of Florida
.,i .
1, ac My Comm. Expires Oct 20, 2012
' , �p4O` Commission # D0 832547•
o ary ssn.
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMIT ED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIERS STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION?
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:
BUSINESS ADDRESS: (2 3 Z CR oC,lt G kitrAPI `N- CITY A!6 %u40-cT
STATE JR.- . ZIP CODE 33 /g.
BUSINESS PHONE: (3 oS ) 23 14 9 FAX NUMBER (30 ) G 46 1-7 7 7
CELL PHONE (30 s a 323 f fd QUALIFIER'S NAME: C' k O1' j - K l LFI i (--?
QUALIFIER'S LIC NUMBER: C & c. 06 3 3 �y
E -MAIL ADDRESS (IF APPLICABLE): RAY K 1/4C (i (Mk L (, ' LiP41"
Created on 3119109 BY MLDVI RV 3120 09) MLDV
NOTICE OF COMMENCEMENT
A RIMMED CiWY POST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. I/ y 16415' TAX FOLIO NO.
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
THE UNDERSIGNED hereby gives notice that improvements will
property, and in accordance with Chapter 713, Florida Statutes,
Is provided in this Notice of
STATE
AHERENY
be made to certain real
the following'
111111111111111111111111111111111111111111111
CFN 2011RO652694
OR Bk 27841 Ps 2574; (113s)
RECORDED 09/28/2011 11:30:13
HARVEY RUVIHr CLERK OF COURT
MIAMI -DADE { :pi_1HT`f r FLORIDA
LAST PAGE
/HARVEY
By
am, County Corns
D.C.
Space above reserved for use of recording office
1. Legal deception of property and street/addr /%Z 93 S( 1 n9/ 6i% shwa
/�- 33i�
2. Description of improvement: el04 j (2. $6 .yS
3. Owner(s) name and address:
Interest in property:
Name and address of fee simple titleholdeer.
4. Contractor's address and phone number.
G
AA/tic 0/kslli
5. Surety: (Payment bond required by owner from
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 Lieror's Notice as provided in Section
713.13(1Xb), Florida Statutes.
Name, address and phone number.
__ r
it any
of 3'!'�.
33/s7-
9. Expiration date of this Notice of Commencement
(the expiration date Is 1 year from the date of recording unless a Meant date Is specified)
WARNING TO OWNE#t ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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
Prepared Print Name
r James /4. t Print Name
Title/Office V Cl Title/Office
s) or Owr (s)' r¢ed Officer/Director/Partner/Manager
I/I.�e ti -�(A Prepared By
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The fo instrument wap 'o wf� ged before me this day of
By - 1/144r /E !% I
Individua1l or ❑ as for
?Personally known, or Q produced the following type of iden
Signature of Notary Public:
Print Name:
(S
ion
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, to the best of my knowledge and bel
Signature) of Owner(s) or s ; prized Officer/Director/P
By 1'L~ N�>
7730182 P 8'113
Notary Public State at Florida
Jahn Valium Crouch I11
My Commission EE01147S41
Expires 05/2412015
By
v.,
• 1,
•
18 tOT A Rai — NOT PAY
144in -1 RENEWAL
gPIPIMIMI NAME iLOCAZION NuMWTMIX 166415-1
CATALYST CONSTRUCTION CORP STATER CGC003384
12321 ROCK GARDEN LA
33156 PINECREST
MOM
CATALYST CONSTRUCTION CORP
soo, Typo or Businemi
FIRST-CLASS
U.& POSTAGE I
PAID
MAIM R.
pentar No. 231
NORKER/S
cuptra DUILD/NO CONTRACTOR 10
w.nr
Tax
001110/2010
43010000333
Lr OBSO45.60
SEE ODER EWE
DOIMITIORWARD
CATALYST CONSTRUCTION CORP
KILPATRICK RAYMOND PRES
12321 ROCK GARDEN LA
MIAMI FL 33156
lAh.H..111JJMUJJ.J.A.Jhulthulls411
BUSINESS & PROFESSIONAL SERVICES - SOLE PROPRIETOR
CATALYST CONSTRUCTION CORP.
12321 ROCK GARDEN LN
PINECREST FL 33156
$97.50
SEP 08 2011 9:54RM HP LASERJET 3200
AWRO®
CERTIFICATE OF LIABILITY INSURANCE
p. 1
CATAL -1 OP ID: KC
• DATE IMMIDM1YYY►
09 08111
PRODUCER
InSource. Inc.
9500 South Dadeland Blad.,#400
P.O. Box 691687
Miami, FL 332584687
J. Hayes Worley, Jr., CIC, AA1
3064704111 THIS CERTIFICATE 18 ISSUED AS A MATTER bF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE ClERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSMO Cataly*ConstnictIon Corp.
12321 Rock Garden Lane
Miami, FL 33166
CAA 305 (dote 4Yrn
COVERAGES
INISURERA Colony Insurance Company
NAIC #
39993
DER a
INSURER C:
INSURER 0;
INSURER E
THE POUCIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING
ANY ,REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RVBR
J T1.44
ADOL
BR.
1YEP i nus a mrs
-
POLICY mum
DA7s r" u
Pa
E91P�
UNIT$
A
GENERAL
X
UABILOY
COMMERCIAL GENERAL IJABRJTY
GL321137U -D
•
11113/10
11/13111
EACH OCCURRENCE
8
1,000,000
PREMISES (Ea samaaucal
$
50,090
mums MADe 1 X OCCUR
LIED EXP (Any one perms)
$
5,000
PERSONAL & ADV INJURY
$
1,000,090
GENERAL AGGREGATE
$
11000,000
GEN L AGGREGATE LIMIT APPLIES PER;
X POLICY n %V In Lou
PRODUCTS - COMP/OP AGG
$
1,000,000
AUTOMOBS.E
—
UABLRY
ANY AUTO
ALL OWNED AUTOS
ScHEOUI EDAUTO$
HIRED AUTOS
WON - OWNED AUTOS
COMBINED SINGLE LRAM
$
BODILY INJ)1RLY
$
BODILY INJURY
(Parades
$
(Par ��)DAMAGE
$
GARAGE
UABILRY
ANY AUTO
AUTO ONLY - EA ACCIDENT
8
OTHER THAN EAAOC
8
AUTO ONLY AGG
$
EXS
1 UMBRELLA UA@RJITY
OCCUR n CLAIMS MADE
DEDUCTIBLE
RETENTION 6
EACH OCCURRENCE
$
AGGREGATE
6'
$
$
6
•
WORKERS
ANO EIIFI
ANY PRDPRETDRIPIFAATNE
OF FER
(r
Wm describe
$ AL,PROVISIQN$beMa
COSiPENSATION
QYYEILS LIABILITY
Yis
I WC BTATU- I CTH-
TORY LIMITS 1 ER
E.L EACH ACCIDENT
$
RIEXECIMVE
EMBEEXCLUEXCLUDED',
E.L DISEASE -EA EMPLOYEE
6
In
wider
E.L DISEASE - POLICY UMIT
$
OTHER
DESCRIPTION OP OPERATIONS f LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
10 days notice lesturd cancellation for non payment of premium:
-_ -- -.._- -- - _ . _ � M AMSH3
Miami Shores Village Building
10II60Nl:SeoondA�
10950 NE Second
p . Miami Shores, FL 33138
cay �30s - /sto -19r12°
SHDULDONY OP THoABOVE Descemterouctes EECANOEI.LW EEPORE mecamwrion
DATE TMEREOP. TIN 68UDIG Neuman WILL ENDEAVOR TO MAL *30 DAYS rRtn-IBII
NOTICE TO THE CERTIFICATE HOLDER NAN@0 TO THE LEFT, NWT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR UABUJTT OF ANY RIND UPON THE INSURER, ITS AGENTS DR
REPR SENTATnreS.
'/ wry_ �,y�/
AUTHORIZED REPRESENTATIVE d / Lf
ACORD 25 42009101)
(81988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
02 -04 -2011
JEFF ATWATER STATE OF FLORIDA
CHIEF FRdANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
e * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA COMPENSATWN LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE
PERSON:
FEIN:
02/04/2011 EXPIRATION DATE 02/03/2013
KILPATRICK RAYMOND E
592750190
BUSINESS NAME AND ADDRESS:
CATALYST CONSTRUCTION CORPORATION
12321 ROCK GARDEN LN
MIAMI FL 33156
SCOPES OF BUSINESS OR TRADE:
1- CONSTRUCTION
e
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 ender this chapter. Pursuant to Chapter 440.06(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed an the notice of election to be exempt. Pursuant to Chapter 440.06(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.
WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
QUESTIONS? (850) 413 -1609
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCML SERVICES
DIVISION OF WORKERS COMPENSATION
ONSTRi1CTI0N INDUSTRY
CERTWiLATE OF ELECTION TO SE EXEMPT FROM FLORIDA
WORKERS COMPENSATION LAW
EFFECTIVE 02/04/2011 EXPIRATION DATE: 02/03/2013
PERSOIt RAYMOND E KILPATRICK
FEIN 592750190
BUSINESS NAME AND ADDRESS:
CATALYST CONSTRUCTION CORPORATION
12321 ROC GARDEN LN
MIAMI, PL 33156
SCOPE OF BUSINESS OR TRADE
1- CONSTRUCTION
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
O 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.
Pursuant to Cllr 440.05(12), F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt
E 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.
QUESTIONS? (850) 413 -1609
•
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
Miami Shores village
Miarn�
AReitsr o4 GJO Rt
PZ4c�.. Si t- _ t 0.' C1741TfOr5 04-Y1
ric.ISC7 (46. Ad 4,05
i1/41144a NUOtSCZ0A "TO 440 IFettZtAiks. 4. .
3S cq
•