RF-11-2004Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 166005
Scheduled Inspection Date: November 17, 2011
Inspector: Bruhn, Norman
Owner: OJALA, JOAN & JOYCE
Job Address: 28 NW 100 Street
Miami Shores, FL 33150-
Permit Number: RF -10 -11 -2004
Project: <NONE>
Contractor: ANCHOR ROOFING COMPANY
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Repair Roof
Phone Number (305)758 -2987
Parcel Number 1131010180440
Building Department Comments
LEAK REPAIR OF ROOF ON BACK SIDE OF THE HOUSE
Passed0
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 16, 2011
For Inspections please call: (305)762 -4949
Page 5 of 17
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH` MONROE STREET
TALLAHASSEE FL 32399 -0783
OND-
ANCHOR ROOFING COMPANY
8531 NW1'ZZNI n-ST=
MIAMI FL 33015 -3749
(850) 487 -1395
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Congratulations!
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Our professional
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For information a
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Thank you for do
280835-1
BUSINESS NAME/ LOCATION
ANCHOR ROOFING COMPANY
1083 E 23... ST
33013 HIALEAH
THIS IS NOT A BILL - DO NOT PAY RENEWAL
RECEIPT NO. 294062- 6
STATE#` CCC1326710
OWNER
ANCFIOR ROOFING COMPANY
Sac. ofBusiness
196 SPECIALTY: CONTRACTOR
THIS IS ONLY A LOCAL -
-EUSINESS TAX REC'EI PTTr -
- ed'O-- VIOLATE =ANY`
EXISTMG;REOULATORY OR-
r LAWS THE', .
COUNTY OR CERES.. NOR
DOES IT EXEMPT_ THE
KOLDER FROM ANY OTHER
PERMIT OR -., LICENSE,.,
REQUIRED BY-LAW.- THISIS-
NOT A CERTIFICATION- OF
THE
HOLDER'S OUALIFICA-
PAYMENT RECEIVED
M1A*DADE COUNTY TAX
COP t perm
07/11/2011
60010000260
000045.00
SEE OTHER SIDE
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, Fl-
PERMIT NO. 231
WORKER /S
2
DO NOT FORWARD
ANCHOR ROOFING COMPANY
RAYMOND RILEY PRES
1083 E 23 ST
HIALEAH FL 33013
!!'tilraindh . 111ift1dhduhAlialrr!iihJardhiNd
DETACH HERE
itT3? CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Coastal Insurance Group, Inc.
150 Westward Drive
Miami Springs FL 33166 -1660
Phone:305- 887 -5999
INSURED
DATE (MM/DD/YYYY)
OP ID MT
ANCHO -1 11(30/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF I FORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
1083oEaRoofing Street
Hialeah FL 33013
INSURER A Century Surety Ins. Co.
INSURER B: Nationwide Insurance Co
25453
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSK
LTR
AuU'L
,INSRC
TYPE OF INSURANCE
POUCY NUMBER
POUCY T�p EFFECTIVE
/YYYY)
POUCY ( M/DDIY EXPIRATION
DATE (MM/DD/YYYY
LIMITS
A
GENERAL
X
LIABILrTY
COMMERCIAL GENERAL LIABILITY
CCP631462
12/03/10
12/03/11
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISES(EaoN rence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
$50,000
$ 5 , 0 0 0
$ 1, 000,000
CLAIMS MADE
X
OCCUR
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X I POLICY n JE a n LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ACPBAPC5923768562
12/03/10
12/03/11
COMBINED SINGLE LIMIT
(Ea accident)
$ $100000
BODILY INJURY
(Per person)
$ INC
BODILY INJURY
(Per accident)
$INC
PROPERTY S r� nt) DAMAGE —
$ TINY:
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESS
/ UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR
CLAIMS MADE
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY OFFICER/MEMBER
OFFICERIMEMBER EXCLUDED? U
(Mandatory In NH)
If yes, describe under
SPECIAL PROVISIONS below
WC STATU-
TORY LIMITS
01 H-
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CANCELLATION
Village of Miami Shores
Building & Zoning Department
10050 NE 2nd Avenue
Miami Shores FL 33138
0000000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED : PRESENTATIVE
ACORD 25 (2009/01)
4(fb :.._ . i s
The ACORD name and logo are registered marks
ACORD CORPORATION. All rights reserved.
ACORD
Issue Date: 12/17/2010
FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC.
ISSUED TO:
1-800-767-3772 • FAX (407) 671 -2520
CERTIFICATE OF INSURANCE
Village Of Miami Shores
Building & Zoning Dept.
10050 Ne 2Nd Ave:
Miami Shores, FL 33138
Attention: To Whom It May Concern
Anchor Roofing Company
This is to Certify that 1083 E. 23Rd Street
Hialeah, FL 33013
COPY PROVIDED TO:
Anchor Roofing Company
1083 E. 23Rd Street
Hialeah, FL 33013
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation
by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS
ASSOCIATION SELF INSURERS FUND, P.O. Box 4907, Winter Park, FL 32793.
COVERAGE NUMBER: 870 - 033159. LIMITS
Workers' Compensation: Statutory - State of Florida
EFFECTIVE DATE: 1/1/2011
Employers' Liability: $100,000.00 Each Accident
EXPIRATION DATE: 1/1/2012 $100,000.00 Disease, Each Employee
$500,000.00 Disease, Policy Limit
REMARKS: Non - cancelable, without 30 days prior written notice, except for non - payment of premium which will be
a 10 day written notice.
This certificate is issued as a matter of information only, is not a policy and of itself does not afford any insurance.
Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown
above or as affording insurance to any insured not named above. This provides coverage for Florida policyholders
and Florida domiciled employees only.
By
Brett Stiegel, Administrator Debra Guidry, CPCU, Un • erwriting Manager
FRSA -SIF FRSA SIF
B
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder)
Owner's Address
City . f,
1 enant/Lessee ame
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
Flood Zone
Phone #
City t . -h. State Zip
Qualifier Name j (i Phone #
State Certificate or Registration No. - _( 2 ., _ Certificate of Competency No.
Contact Phone y % E -mail
Architect /Engineer's Name (if applicable)
Phone #
Value of Work Fo
Type of Work:
Describe Work ,A
r this Permit $
DAddition
eration
Square / Linear Footage Of York l
LNew Repair/ Replace LI Demolition
* *Fee
* ** ** * * **
Submittal Fee $
Notary $
Scanning $
Double Fee $
Structural Review.
Permit Fee $
CCF $ CO /CC'$
Training /Education Fee $ Technology Fee $
Radon
Total Fee Nov Due $
See Reverse side -
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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 a
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."
ork will be done in compliance with all
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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this i The foregoing instrument was acknowledged before me this
day of ( , 20 , by .r t.# , day of , 20 , by
who is personally known to me or who has produced P : ( i I
As identification and who did take an oath.
NOTARY PUBLI(:
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:`* r Sign
Print: Print:
My Commission Expires: My Commas
P4atY tabttc - S #ate n1 Eiorida
My moires ay 12, 2013
Commis ion #� OC 883981
Bonded Through Nalianai N Lary Assr =. =.:
**** * ** * &:F:F::F * ***** ** **** :ti * ** kaF is : Yr :F :F k3r :@ * * * * *�l'"
ans Examiner
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)`
NOTICE OF COMMENCEMENT 1 111111 1 1111 111311111 11111 11111 13111111 1111
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
CFN 2011R0724-4-4-2
OR Bk 27873 Ps 3075; Ups)
RECORDED 10/26/2011 15:08 :00
HARVEY RUVIN, CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
PERMIT NO TAX FOLIO NO. I I' 3 I O I ' 01S. (944C,
STATE OF FIrORIDA:
COUNTY OR MIAMI -DADE:
..UNsIDERSJGNED- hereby gives notice that improvements will be made to certain real
property, am-) in accordance with Chapter 713, Florida Statutes, the following information
is provided itt this Notice of Commencement.
1
1. Legal description of property and street/address: IJ A1/A` (7 S V B F.F. 1 •5 ! L-o —1 13,1-4/-5
.z9 NL) Ina - ST
Fr_ 3 3/50
2. Description of imp , 1 - g- F---PA t DA, L A-C4 -S D P Hat) 6
3. Owner(s1 name and address: 'So JA-1`..1 0 IALoct
• 24 Nw 100 s-r % toi -tit s 1-ko EL�-S i=l_ ,33ts
Interest in Property: ?--E4 (1='
i C_ • -
Name and ddress of fee simple titleholder. N IA--
4. Contractor's name and address:
Name and ddress: �1 A-
5. Surety: (i(ayment bond req red by owner from contractor, if any)
Amount of �ond $
6. LenderTs namey and address:
7. Persons within the state of Florida designated by Owner upc ra
provided b Section 713.13(1)(a)7., Florida Statutes,
Name and Iddress:
8. In addition to himself, Owners designates the following person(s) to
in Section 713.13(1)(b), Florida Statutes.
Name and ddress:
eive a copy of the Lienor's Notice as provided
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
diff fept date is specified)
c=rviiii
Sig r ature 9f Owner
Print Owners Nam4. . C?� r
Sworn to and subscribed before me this
Notary Pu Iic
Print Notary's Name
My commission expires:
123.01 -52 PAGE4 10/04
t \enis St/7
d P_
cn : I'o '4"zof p11 ."3
� . ,e44„ . s pIrsz /C:
, 20
Prepared by E i ‘ ti-'c 1
3O5 be 1 1107
Address: lot& & • .23 S{--
I ---I,a
33ot3
ROOF ASSEMBLIES AND ROOFTOP STRUCTURES
1
()CI \
Master Permit No.
Florida Building Code Edition 2
High - Velocity Hurricane Zone Unlfonm Permit Appli on Form.
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
TATE AND COUNTY RULES AND RFGUI_ATIONS
Process No.
Contractor's Name ique 40 g... go ®i= djk..) G. C
Jab Address / D +it
❑ Low Slope
❑ Asphaltic
Shingles
❑ New Roof
ROOF-CATEGORY
❑ Mechanically Fastened Tile Mortar /Adhesive Set Tile
❑ Metal Panel/Shingles ❑ Wood Shingles /Shakes
❑ Prescriptive BUR -RAS 150
ROOF TYPE
❑ Reroofing ❑ Recovering
ROOF SYSTEM
INFORMATION
XRepair ❑ Maintenance
Steep Sloped Roof Area (SF) /®Q Total (SF) WO
Sketch Roof Plan:
Include dimensio
parapets.
tions, roof drains, scuppers, overflow scuppers and overflow drains.
early identify dimensions of elevated pressure zones and location of
1
FLORIDA BUILDING CODE — BUILDING
Joan Oiala
28 NW 100 St
"1ls�n be pDS,T /2cct, 4300,-
ANCHOR ROOFING COMPANY
1083 Fast 23 ,St Hialeah, FT. 33011
Phalle 305 -691 -7707 Fax 305 -691 -2405
Contract Proposal
September 30, 2011
305 -758 -2987
Job Site: Same
Repairs as follows:
• Remove and dispose of solar panel.
• Remove tile and roofing felts at leak area above back bedroom.
• Replace any rotten wood necessary.
•. Replace eave metal as necessary.
• Replace roofing felts using proper nails, caps, and roofing cement.
• Install replacement tiles in closest possible match using proper tile cement and adhesive.
• Repair cracked and replace broken tiles on remainder of roof.
• Clean valleys of tree debris.
• Clean the grounds of roofing debris.
Price: Time and material not to exceed $2,750.00 1 year company leak guarantee
Note: Roof permit is included in the price
Exclusions: Permits and work by other trades, and any additional work not mentioned above.
Terms: Deposit $300.00 with a signed contract and balance due upon completion.
NOTE: All rotted wood to be replaced on a time and material basis or as noted in contract. Additional concealed roofs will need to be
removed and hauled away; this additional work if necessary will be an extra to the contract price. It is agreed that the owner will pay additional
costs to perform this work. Due precaution will be taken when working around roof gutters; however we will not be responsible for any damage
to the gutters. It is recommended that they be taken down prior to re-roof work commencement This proposal when accepted shall constitute the
entire agreement the parties hereto. We will use precaution when re- roofing; however, we shall not be held responsible for any interior damage to
building, including plaster, fumishings and personal belongings during progress of work. We shall not be responsible for any damages or delays
due to strikes, fire, accidents, or other causes beyond our control, nor for inherent defects in the premises or structure in which work is to be
preformed on. Due precaution will be taken but contractor must be allowed access to buildings and will not be responsible for any damage to
lawns, Landscaping, sidewalks, driveways, sprinkler systems, water lines septic tanks or lines, screen enclosures, pools and patio decks. Please be
advised that in the areas where you have open beam ceilings there will be light debris and dust sifting through the sheathing boards. Failure to
notify us of open beam ceilings could result in nails penetrating sheathing boards in which we will not be responsible for. Please take precaution
in these areas to cover any carpet, or furnishing that you do not want to get soiled, as we cannot be responsible for any damage. Any loose objects
should be taken down as vibrations from work could cause damage. This agreement constitutes the entire understanding of the parties and no
other understanding shall be binding unless in writing signed by both parties. Any unpaid balance shall bear interest at 18% per annum, -and all
cost incurred in collection including attomey's fees and court cost shall be paid by the Contractee. This quotation is subject to revision if not
accepted in 15 days. When this proposal is accepted please sign and return one copy, which will be our order to proceed 'with the work. All
invoices are due upon receipt.
Accepted By
wner or Authorized Agen
1.o /1, %dl
Anchor Roofing Company
CC -C 1326710