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RC-11-1105Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162822 Permit Number: RC -6 -11 -1105 Scheduled Inspection Date: December 15, 2011 Inspector: Bruhn, Norman Owner: KULICK, BARRY Job Address: 940 NE 95 Street Miami Shores, FL Project <NONE> Contractor: GOUD CONSTRUCTION CORP. Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132050070121 Phone: (786)845 -7074 Building Department Comments REPAIR WATER DAMAGE WALL & CEILING AND WOOD FLOORING - HISTORIC HOUSE Passed Failed Zz Sit Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 161049. No access. NB December 14, 2011 For Inspections please call: (305)762 -4949 Page 3 of 29 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFIINNG OWNER: Name (Fee Simple Titleholder): Address: 90%' 9—rr<4 City: '/.i _„;i‘� State: it� Zip ` 7r/-0° Tenant/Lessee Name: Phone #: Miami Shores Village JUN 1. C REcv 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 Permit No.1? H k o� Email: /��/G'.e®'41v/ [9 JOB ADDRESS: %/ ✓ "14 City: Miami Shores Folio/Parcel #: 11 - 0 5 --O 0 % Is the Building Historically Designated: Yes County: Miami Dade —01A,1 NO Flood Zone: CONTRACTOR: Company Name: e®/.r,r/U -'e zrcdJ �PoZ P, Phone #: �6 -d /S- 707 y Address: i4 ! to / ".11. • S i/Z Fir City: NIA-nit State: 1 L Zip: /‘ Qualifier Name: //eve,,,/ 6 ®V 1.) Phone#: State Certification or Registration #: G e C. O 3-15 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 9 '500 ~ Square/Linear Footage of Work: Type of Work: DAddition DAlteration ONew ORepair/Replace DDemolition Description °Mork., _ R-dePa In - �k kt- D d w L L 1 & i>v6, 12 s :#14 0,v3i MJ O (-Lice) 0 coors, \6 (50 •- m),. , Rv. P619t • 1i409 OW *+x** **** * * ****Feeeess** **+x** *.m*"** ********* ** * *** *****+x*+ *** Submittal Fee $ SE . Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 1a.5 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, BOILF.RS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and thatall 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 The foregoing instrument was acknowledged before me this day of e .?su 6 , 20 / , by / /6'," [9 ®v D who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: MAXIMILIANO PECINA MY COMMISSION #EE046460 EXPIRES: DEC 05, 2014 Bonded ttuouph 1st State Insurance The foregoing instrument was acknow edged before me this day of , 20 ,L, by ' oe- 1,16X- , who is person 11y known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis ***m+x********** **+x*********/ x�x�x�+ x+ x�x* x�+ x�x�x/ �x�* �u�xx�**** �x* *** **** *�x+x****x:a��x****** * ** . ** ** . ,.. ,,.�,::.,�,,,.,�...,�... *, APPROVED BY t'V 6Jif Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk MANN-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. it €LOrOR- MlAMI, fL 33130 2010. LOCAL -BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY- STATE OF FLORIDA MIMES SEPT. 30, 2411 MUST SE SPLAYED AT PLACE DP BUSINESS PURSUANT TO COUNTY CODE CHAPTER SA - ART, 9 & FIRST -CLASS U.S. POSTAGE I PAID LOAM, , FL 10 PERMIT NO. 231 656659 - i THIS iS NOT ABILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION nECE1PT NO. 420392 -3 GOUD CONSTRUCTION CORP STATEO-CBC058124 8101 NW 60 ST 33166 UNIN DADE COUNTY OWNER GOUD CONSTRUCTT D4 CORP Seo. Type of Business 196AS,UB- GENERAL BLDG CONTRACTOR THIS le Y BUSINESS TAX RECHPT. IT DOES NOT MEET THE HOLDER TO VIOLATE ANY EEISSTURO REGULATORY OR me Laws eF THE =MT!' en =cr. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERICT OR LICENSE RECKONED BY LAW. THUS is NOT A DEITIVICATION OF THE HON.DERB OUAUFICA• TIONS. REQEIVED MAM4 -DALE 1:13UNTY TAX 09/08/2010 60000000397 000075.00 SEE OTHER SIDE WOER/S 1 DO NOT FORWARD GOUD CONSTRUCTION CORP KEVIN GOUD PRES 8101 NW 60 ST MIAMI FL 33166 �cti�ttt�{ ttssl�ttlttrlltttsiSttlttlttfiit�tflt�ttttts��t� STATE OF FLORW • DEPARTMENT OF BUSINESS AND PRO ESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 GOUD, KEVIN SCOTT GOUD CONSTRUCTION CORP 20535 LEEWARD LANE MIAMI FL 33189 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.rnyfforida€ €cense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE DATE (MMlDWYYYV) ew®iI2011 IMkT FO7AnF.CAoT±4 NOT AMEND EXTEND O BY THE POLICIES BELOW. ACORD CERTIFICATE OF LIABlurr INSURANCE THZ CERTIFICATE _Z AS ONLY AND CO N E'°z 3 3 2 HOLDER. THIS CERTIFICATE DOES ALTER TIME COVERAGE AFF'?`,'F'ED P ODUCEF COVER ALL INSURANCE 5800 W. ATLANTIC BLVD. MARGATE, FL 33063 NONE6 (95� 956.0008 FAX #1 95 NaORED GOOD CONSTRUCTION CORP. 8101 NW 60TH STREET MIAMI, FL 33186 LINSURERS AFFORDING COVERAGE RIAIC # ;NSURER , : BRIDOrr I C INSURER e: INSURER C: INSURER D: INSURER E INsurAms C . COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING VI/HICH THIS CERTIFICATE MAY BE ISSUED OR ANY MAY PPEERTAIN, THE INSURANCE AFFORDED BY THE CONTRACT OLICIES DDESCRIBED HEREINUIS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 13VICY EFFECTIVR POLICY EXPIRATION i °49 3 iaL° ?EP. 4 itts _ Isrs r fl OCCURRENCE AUTOMOBILE LIABILITY AWY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS _ a HON- O71INED AUTOS EXCESS/UMBRELLA UABIL TY 1 -- OCCUR ID CLAIMS MADE I DEDUCTIBLE RETENTION WORI®i8 COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETORIPARTNEWEXECUTWE OFFICERIAE M8ER EXCLUDED? `1g39, dome under 4PEC;11-L Pry 4I JONS t cbu OTHER 8 0.41723 APR 21,2012 EL. DISEASE - POLICY MIT DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES 1 INICLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2ND AVE NAN StiffS FL 3313S ACORD 25 (20011138) SHOULD ANYOFTHEABOVE DECREED POLICIESI3ECAROELLEDBEFORE THEEXPIiATION DATE THEREOF, THE LSSULNG ENDEAVOR TO MAR. 10 DAYS WRITTEN LEFT, BUT FAILURE TO DO SOMALI. UPON THE II18UR L ITS Amens CR NOTICE TOTHETEHOLDER WI?�€ NO cATAMATIOM 9P LL —crY R(1TTA ACORD CORPORATION 1988 1..".....„_(:)REP CERTIFICATE OF LIABILITY INSURANCE PRODUCER (954) 724-7000 FAX! (954) 794-7024 r Tri1 3 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Keyes. Cover age, Inc. ONLY AND CONFERS NO 1-118 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5900 Hiatus Road ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. DATE (MMIDINYYTY) 6/7/2011 Tamarac INSURED Goud Construction Corp 8101 NW 60 St. Miami, FL 33166 'ET 33321 INSURERS AFFORDING COVERAGE 1 1NSU kktici-Coht-theut. Casualty Co INSURER B: INSURER C: INSURER D: INsurto7 E: N= # 2341/3 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT wrni 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 OISUCH POUCIES. AC-SSEGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. vas AD= _ . vOLICY F - i6tiity -4° FP-110/4 LTR NMI TYPE OF INSURANCE POLICY NUMBER DATE GENERAL mature X I COMMERCIAL GENERAL LIABILITY _ CLAIMS MADE I X_ I OCCUR ',14tXD0 00771907 1_1 • GEN% AGGREGATE UMIT APPLIES PER X POLICY I PRO- ET LOC AuTomodiLEuABILITY H ANY AUTO A j ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occisrende) uMIiS $ 1,000,000 10/19/2010 10/19/2011 MED EXP (Any one person) pEfisoNAL A ADV INAJRY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 100,000 EXCLUDED 043L000771907 10/19/2010 10/19/2011 (*MINED SINGLE LIMIT (Es EiWasit) 311P0,0100 2,000,000 2,000,000 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per or.,-Idost) PROPERTY DAMAGE (Per acddent) GARAGE LIABIUTY ANY Am() AUTO ONLY - EA ACCIDENT $ 011-EP, THAN AUTQ EA ACC , $ A(Mi $ EXCESS/ UMBRELLA UABILITY X j OCCUR , DEDUCTIBLE RETENTION $ CLAIMS MADE FED 10,0001 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMEER EXCLUDED? pleandstory /r/ I if yes, describe under SPECIAL PROVISIONS below OTHER °ESC YIN EACH OCCURRENCE i $ 2,000,000 AGGREGATE $ 2,000,000 $ 11/16/2010 11/16/2011 WC STATU- I I 0114 TORY LIMITS ER EL EACH ACCIDENT $ $ EL DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ WNW opENATIONSi Loc,AHONS VE-ULJ EXCLUSiaNS ADDED BY /AL CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Mimi Sores, FL 331-4B ACORD 25 (2009101) INS025 (200901) SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE MEREOF, THE ISSUING INSURER WILL TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 10 D0 SO SHALL. PAPOSE NO odUC.-ATION OR LIABILITY OF ANY KIND tYPEIN THE iNstmeH, ITS AGO:as GO REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Carey Keyes/KB 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks ot ACORD 10' L A DING Living Room (OS A. • CITY OPY 0.4rOvA. Repair or replace 50 square feet of flooring on LANDING Repair aprox. 8 !thing room, are Repair 2'X3' hole in the wa the east side of landing, ar 4214 - Barry Kulick 940 NE 95th St. North Nliami Shores, FL 33138 (305) 757-8714 Miami Shores Village BY DATE A ROVED 2 '1-NG DEPT B DEPT 4rd „rvi,ir. WITH ALL TY RU1 FS AND REGULATIONS FEDERAL still 'IP CT TO COMPLIANCE AND COI IN CITY OPY 0.4rOvA. Repair or replace 50 square feet of flooring on LANDING Repair aprox. 8 !thing room, are Repair 2'X3' hole in the wa the east side of landing, ar 4214 - Barry Kulick 940 NE 95th St. North Nliami Shores, FL 33138 (305) 757-8714 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 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. 11111 111111111111111111111111111111 11111111 CFH 201 1 80422427 OR lilt 27736 Ps 3881; (fps) RECORDED 06/28/20111 12218:09 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUHTYs FLORIDA LAST PAGE tt-�, Space above reserved for use of recording office 1. Legal description of proper y and street/address: ' L4 C) J L �s \-1 l i1 k ,ciCZ.CC.. 7 t 3 rY 11 -- 3 2- v5 — Uc3-7 — 0 ( 2. Description of improvement: N.N' -C}/.4-11N%-‘,17-Z_ p YZ(i_2A -At r2. 3. Owner(s) name and address: r2- Interest in property: Cam;. ,tit Name and address of fee simple titleholder: Lam. LA Cie_ 4. Contractor's name, address and phone number 551 C)1 iA) (e t 1`L_ 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 Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 33 )c 8. In addition to himself, Owners designates the following person o r cop • - • _ • • ce'as • ro •-in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) 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 RECORD G YOU , ►.' • COMMENCEMENT. Pre wner(s)' Authorized Officer/Director/Partner /Manager By Prepared By Print Name Title /Office P `t Name Trtle/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The fo o1n� �in"st"rument was ac_kkr��owledged before me this day of C___. ❑ Individually, or ❑ as for �, CI Personally known, or (1 produced the following type of identification: r Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES 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 belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who <1 signed aboverm IID11��`\ 1�IIt`\`\`\\ By By