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RF-11-2230Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167235 Permit Number: RF -11 -11 -2230 Scheduled Inspection Date: January 12, 2012 Inspector: Bruhn, Norman Owner: KUBAITIS, ELIZABETH Job Address: 37 NE 101 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FM ROOFING SERVICES CORP Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1132060131521 Phone: (786)426 -1736 Building Department Comments REPAIR LEAK ON ROOF VALLEY Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 11, 2012 For Inspections please call: (305)762 -4949 Page 12 of 31 Miami Shores Village Biii 10050 N.E Tel: INSPECT BUILDING PERMIT APPLICATION FBC 20 ding Department 2nd Avenue, Miami Shores, Florida 33138 (305) 795.2204 Fax: (305) 756.8972 ON'S PHONE NUMBER: (305) 762.4949 P `t=om 2 f�lOV30/ 11 v BY: Permit No.RF- 1 - 9ao Master Permit No. Permit Type: BUILDING ROOFING ?f/ ii Name (Fee Simple Titleholder): 4,�/�+tg48E MA, ,447/ T /s' Phone#: ,c3.40,5" 7% ,2i? #' Address: Jr �� AI 6 /t9 ZS J T City: iM,9 / �IQ4C'$ /� State': . FG Tenant/Lessee Name: ^ /O Phone #: Zip: 33/3" Email: 21-/R4Q /T/ „`12®L. a 210 JOB ADDRESS � 1 141 E I () I S T JT City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company N : Address• City:c County: Miami Dade Zip: 33/3 ' NO I/ Flood Zone: Ic2i Cf) Ifp Phone #: l' v v '-l26 - I W r c� State: Qualifier Name: ��`C f g- C� S6- y aft 2i State Certification or Registration #: Cam—[ 3 °2_.S- Contact Phone #: ® Z-6 _1 Email Address: DESIGNER: Architect/Engineer: Zip: Phone #: 1 KO Certificate of Competency #: o Phone #: Value of Work for this Permit: $ TOO. O. 0 0 Type of Work: ❑Addition ❑ Alteraytion Description of Work: &PAir zglaAe Square/Liuear ) potage ofOP: o• L 5 ®` ❑New epair/Replace ❑Demolition + s******+ x**+ s+ x********* **+x***+x*********** Fees** ************** ** *+ x******** **+x+x****+x******* Submittal Fee $ Permit Fee $ 113 a o Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ TOTAL FEE NOW DUE $ 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 accurateanI 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 , � ,L. g _ Signature _ /i �� _ Owner or Agent Contractor The foregoing instrument was acknowledged before me this g3 The foregoi instrument was acknowledged before me this day of NM/ , 2011 , by y 1/ ?? i 0-1- A AUy 1 ,h/ day of t)\% , 20 t / , by i,r�l-�d d4 -2 , who is personally v o to me or who has produced `� who is personall me or who has produc as identification and who did take an oath. As identification and who did take an oath. NOTARY PUBLIC: PABLO A. NAVARRO Comm#DD0626053 Expires 01/02/2013 Florida Notary Assn., Inc. Sign: Print: p iob 1 41UA -r'o My Commission Expires: APPROVED BY NOTARY PUB IC: Sign: ,�° z,�i Print: l e V�Pb My Commission Expires: PABLO A. NAVARRO Comm#DD0626053 Expires 01/02/2013 Florida Not - -- Assn., Inc. //rP6-- l/ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) de. ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edi High - Velocity Hurricane Zone Uniform Perml Sertinn p (General Infnrl PEROT -1 --g).' j Miami Shores Village APPROVED BY DATE ZONING DEPT 1Rft BTPT 4% ��%' �. J //%194.?-4/ Application Form SUBJECT 4'0 COMPLIANCE WITH ALL FEDERAL nfflitAirIND CC.UN N RILES AND REGULATIONS Master Permit No. Process No. Contractor's Name *L o fl fC Job Address 31 t,4 r Lb( �IVi l". re4 -r-(, – ❑ Low Slope ❑ Mechanically Fastened Tile ❑ Mortar /Adhesive Set Tile ❑ Asphaltic ❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes Shingles ❑ Prescriptive BUR -RAS 160 ROOF TYPE 1 ❑ New Roof ❑ Reroofing ❑ Recovering 6 Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) ,Sertinn R (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. o s ��� PeT r 3 • • • ;i • FLORIDA BUILDING CODE — BUILDING • • • • . • • • • • • • • • • • • • • • • • • •• •• • • • •• •. ••• • • • ••• • • •• • SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 1 ac Aesthetics- Workmanship: the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics (appearance) are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. `1`. Renalling wood decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403. (The roof deck is usually concealed prior to removing the existing roof system). 3. ,1\ roofs: Common roofs are those which have no visible delineation between neighboring units (i.e., townhouses, condominiums, etc.) In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing to be performed. 4. Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance; therefore, roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of maintaining the appearance. Ponding water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. Overflow scuppers (wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter /edge wall or other roof extension may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. �Ventilatio or•Mest elf etwe$ sfroLdd'have some ability to vent natural airflow through the interior of e structure►�ss� errAly (thP liltiii fsetft. The existing amount of attic ventilation shall not be reduced. It may be benafltialid c8siideriadciiiti�nalventing which can result in extending the service life of the roof. ••• ••• ••• • • . • • gents Signature• • Dale • :Contactor nature Date Revised on 7/9/2009 LD 46_-0 • • • • ••• • • • • • • • • • • • • • ••• • • • • :•' •• • 1 • :•' •• ••• • • • ••• • • 12/06/2011 14 :36 3055534950 SUNFLOWERS INSURANCE PAGE 01/81 T- pATId (N{1A1DDMf1 12108M 1 - -I �.c� •�' CERTIFICATE OF LIABILITY INSURANCE MATTER OF INFORMATION ei - -- — r PRODUCER 11401 SW 40m st. s droop Inc GMT AND CONFERS NO RIGHTS UPON THE CERTIFICATE OR { 11401 SW fit+ 8t. Ste 311 AVM. HOLDER. S CERTIFICATE O_ NOT I L. .- N-'�!- IC # —�1 I Miami, FL 33168 —1 Phone (305)893.4949 — — F8x (308)553 -�9Q8— — INSURERS COVERAGE =� _ — -- — — — — T! s> CQI,ONY INSURANCE COMPANY �INSUR�D 2M EST 1 'ROOFING SERVICES CORD maim_ — —• — — — —' _ _ — 4 29 WEST 18 ST k 11 — — — - = e HIALEAH, FL 33010 �N IR>3�o:— — -- — — — — l I — nusuRgR E: _ — — — i� I 1 — — — _i 1N$! }RER F: - — I COVERAGES - - - -- — - - -- AN6 REQUIRE OE IT TERM R O LISTED HAVE BEEN ISSUED TRACT OR OTHER DOCumENT W TH RESPECT •TO WHIGGH THIS CERTIFICATE S AND AY ER ISSUED F $UGH ANY REQUIREMENT, TM OR CONDITION OF ANY 40 IJRANGB AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS sUf�JECT TO ALL THE T8Rd1 ®, I NAY PERTAIN. Ttle INS _ 1MMES. ADDREGATE LIMIT@ SHOWN MAY HAVE HEN REDUCED SY PAID G ' TI@N I _ l � POLtGY NUMBER Tarrogra.rietri_ �°'� -' __411-TS--,— 3©a.tit}o.00` I�`�I A T'rPE IpF IP13UfiANCg EACH �►CGU44REICe trIS13Dl.II — — -�— ;ACH Cc — �- 00�o0a.0 GENERAL LJ1lBILm° �� + — RI COWERCk GENERAL LIABILITY 1 Q1913o18429 j 08112111 1 05/121/2 Igig A v 0 L 1_ •00 C i� CLAIMS MADE h� OCCUR 1 I PERSONAL & ADV INJURY - �OOO_001 600,o0o.a0� _ — — I GENERAL ApQREGA 300,000.00 ■ A � I C 1 4 i • PRODUCTS - COMP/OP aaG-t- — j G __ GEN'L AGGREGATE LOT APPLIES PER•' — ----r- -- ---4- �! POLICY I PROJECT Cl LOG — -- — — -- -� COMBINED SINGLE LIMIT — — I 7 — AUTOMOBILE AUTO LIABILITY , .�- -- — —� — (] ANY AUTO 1 I `� DILY INJURY - -L_____ -1 ` I , _} ALL OWNED AUTOS I 1 U SCHEDULED AUTOS BGDII.Y INJURY U ❑ HIRED AUTOS (P�' _ r�} — _ — -a 1 ❑ NON OWNED AUTOS 1 PROPERTY DAMAGE ° _ - -- _ I �. — i — —.I— — � — — — � AUTO �NLY • EA ACCIDENT 4 I�— .------ 4 - -• -- LE TO J A I I 1 OTHER 'THAN .E, CC °— — -1 8 LIABILITY , AUTO ONLY: — —. 1 I U ANY AUTO _— ° ° i _ ° _ _ — — L� - EACH OCCURRENCE — !Fg000CCURSR2LLALIABILITY - I - AGGREBAT@ °- � `� OCCUR L CLAD. I�AAOE ` 1 — — — °- ' — u I —� ❑ DEDL9CTI® �• -- - -- u Wiegla-5t�D - - I AN PROPRIETOR / PARTNER ► EXECUTIVE k i ~ E.L.BACHACCIOgN I yes. desetbe under LSEASEEA E LO- EE - - — - EMPLOYERS' I�ILTY I ILL. DISEASE -POLICY LET — OFFICER 1 MEMBER EXCLUDED? 1 OE3CRIPTION OF OPERATIONS 1 LOCAT1ONB f VEHICLES 1 EXCLUSIONS ADDED BY EWDORSEME T 1 SPECIAL PROVISIONS - - - - -- . _ L — • — — -- - ^ - - - — CANCELLATION _ — — — CERTIPICATEHOLDER — — - — — — —' SHOULD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL r DAYS WRITTEN NOTICE 10 TH8•CERTIPICATE HOLDER Eta 70 10050 SHORES VILLAGE TREAT, BUT FAILURE To 00 so GNALL IMPOSE NO OBLICATION OR LIABILITY 1006E NE 2 AV I OF ANY KIND UPON THE INSURtER, ITS ANTS cue REPRESENTATIVES. — •— — MIAMI SH ©RSS FL 33138 ~AUTIOaID.s �' ' ACO S 0 09o) t1F ` _ _.. . _ ..,._ _ .......... . - -� ORD C©RpaRATIol 58 ' I I f„,,,,_cfnEtT a- DO NOT FORWARD F M ROOFING SERVICES CORP FREDDY JOSE PEREZ PRES 29 W 16 ST HIALEAH FL 33010 lAmihilunAlluudhli 1141.111.12b 03 -25 —2011 JEFF ATWATER STATE OF FLORIDA CHIEF RNANCIPL DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXENNoT FROM SATE LAW CONSTRUCTION INDUSTRY EXEMPTI ON This certifies that the individual listed below has elected to be exempt from Florida mss' Compensation law. EFFECTIVE DATE 03125/ PERSON: PEREZ FEIN: 204478 BUSINESS NAIVE AND ADDRESS: FM RING SERVICES CORP 29 64ST 18TH STREET FRONT HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ROOFING CONTRACTOR EXPIRATION DATE 03/2412013 FREDDY J * IMUOBTAOT Porsaw0 to Chapter 449 - OSHA f.S. on officer of a corporation who elects exemption from Ms chapter by Wino a certificate of election ander is section may ooh wow benefits of componsegon molar Ms chapter. Roma to 44a.ssf21, T.S., Cortilicalos of Elettleri to fie eaeoip9--- aPPIY =IV tiritbia the scope el the business or trade rested on the entice et eledioo to be exempt to Chapter 449.511*, LS.. notices 01 electron to be exempt and certificates of election to be exempt shalt be subject to revncelian R. at any time alter the filing of the notice at the ice of the cn IUu10. the person named en the notice or certificate no loaget meets the tegaireamnts of this section tor issuance et a certificate. The depilated s*an revoke a tattlfirate at any time let isnore of the person named en the cefBicate to meet the tegoifemeats of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEN'T REVISED 01 -11. PLEASE OUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATEOF FLORMIA DEPARIIVIENT OF FINANCIAL SERINCES DIVISION OF WORKERS LOTION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/29/2011 EXPIRATION DATE: 03/24/2013 PERSIA FREDDY d PEREZ FEU* 204478E69 l3USSII ESS NAME AM) ADDRESS FM ROOFING SERVICES CORP 29 WEST 16TH STREET FRONT HIAtEAH, Ft 33010 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED ROOFING conraocToli PAPORTANT F to 44(.0141. E.S., an offit r of a won who O elects exemption filen this chapter by filing a certificate of election - ender this seethes may net recover benefits or compensation under this D chapter. Pursuant to Cher 44ttost12. F.S., Certificates of election to be H exaiipt._ apply only within the sew of the business or trade listed on E the notike of election to be enema R E Pursuant to Chapter 440.05(13) F.S., fdtltiees of election to be exempt and certificates of election to he exempt shall be std+ject to revocation if. at any time after the filing of the notice or the issuance of the certificate. the person named out the nonce er certificate no longer meets the renuirements of this sectan for issuance of At certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the reiquiremients of this serctitm QUESTIONS? (850) 413 -1609 CUT HEM * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 STATE OF FLORIDA DEPARTMENT OF BUSINESS MID pRorzasionza. coasmucTicet ziamsTRY LICENSING BOARD 1940 NO RTH WHIM STREET _ Tp,T.TaxmasEE FL 32399-0783 PEREZ , FREDEM JOSE FM ROOFING SERVICES 29.W 16TH ST HIALEAH EMULATION * * * (850) -48771,395-..1:..- • ..... - _ - • . -.• . • . . • - . ' • • ... ". _ - FL 3.3010-4015%. • •• • - - • - . - • • " - -- • • " • ' Congratulalionsi- With this Nome you bacons orbs of the ready one million Floridians licensed by the Depestment of Business and ProlesskstsdRegtdation,-- Our pitiessiwreis md businesses nage bona architects tuyachttuolpers-;;:kom:"---:: boxers to Wilma° restaurants. and thwireep-ffothist'sjec.OF!!ly-:. Every day we work in byways Bre way ae-do husinessthorderiiairWiloa For informafion about ow services, tdeaselogonby www.mugoddedkieusa:cem: There you can find more bsforrnarion about ourdivistore and the reguktioni that-% impact you, subscrbe to department newsletters and learn was about the Department's kitlafives. Our mission at the Ibpadment im license lEitidenfiy„ Regulate Fairly. We constantly sl,ivetoseiw you beller so tat you can serve purr customers_ Thank you for do big business in Fbrkb, and conwakilatkum on your new ficensel .t. Aak ACE- . • 7.473 .