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FW-11-1708Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165172 Permit Number: FW -9 -11 -1708 Scheduled Inspection Date: February 13, 2012 Inspector: Bruhn, Norman Owner: BROOKS, GARY & FRANCES Job Address: 10502 NE 4 Avenue Miami Shores, FL 33138 -2014 Project: <NONE> Contractor: MARSTAN CONSTRUCTION INC Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number Parcel Number 1122310130180 Phone: (954)709 -8756 Building Department Comments 2' TRELLIS FENCE ON TOP OF 3' BLOCKWALL ABOUT 24' rassea:*Jr�3 <,� 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- 165147. CREATED AS REINSPECTION FOR INSP - 164986. CREATED AS REINSPECTION FOR I NSP- 164580. 10/05/2011 - FENCE IS TOO TALL AND EXTENDS INTO FRONT YARD. SEE COMMENT ON PERMIT. NB February 10, 2012 For Inspections please call: (305)762 -4949 Page 3 of 19 te*\ -1)1 BUILDING Permit No. h W I l 477 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): t0 A ey f $7O 4724.14C¢S Phone #: 3o, jam 7S/ 70 7 Address: 4 :25.0 Z /t9 yi4 vP City: IW1il7?4/ J`tche.e." State: Zip: 33 /3? Tenant/Lessee Name: /oot Phone #: Email: 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 JOB ADDRESS: / ©,S'O Z • F G/4- City: Miami Shores County f% ;% .0 Miami Dade Zip: 3 .3 / Folio/Parcel #: Is the Building Historically Designated: Yes NO Hood Zone: CONTRACTOR: Company Name: i/V1Ck et H v S+ %.4 o-- vtLPhone # Address: (17 fV t ZcPI Z 3 ?Ai (,..9 7 JL.�- City: c a��, 44? AV./ State: �" % Zip: 3 3L? p Qualifier Name: lTQu/ a v i 47/71-2- Phone #: •f %l ^ /.J a Z3 State Certification or Registration #: ` C ®,S''f, AZ Certificate of Competency #: Contact Phone #: F, S` / 70 f 22.1-4 Email Address: tJ Gam' S pox _ ' 4oL. • Cet^'1 DESIGNER: Architect/Engineer: .ti ,/r4 Phone #: Value of Work for this Permit: $ 11000 Square/Linear Footage of Work: Z Y X 2. 17')? ti Type of Work: ❑Addition UAlteration New ❑Repair/Replace ❑Demolition Description of Work: 7,8' . ►'WELLS 1 JC O/J 70? of 3 : %� C t� -' ctfi 29 I ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *M* Fees' **** ****** * * * ******** ** *** * *************** Submittal Fee $ Permit Fee $ e/.® 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ' Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) (-)t 7f 0414g- f 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 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) day %a er building permit is issued. In the absence of such posted notice, the inspection will not e approved a reins s ection e' i be .c arged. Owner or Agent The foregoing instrument was acknowledged before me this %6 day of , 20 ./L, by who is personally known to me or who has produced_ As identification and who did take an oath. NOTARY PUBLIC: Sign: J 'Le r Print: Lt 54 l. /� Clt/id1C} "Ot'D1D THRU ATLANTIC BONDING CO., ING, My Commission Expires: Feb l 01 2 012 Y ^TART PUBLIC -STATE OF FLORIDA Lisa Covington ,, Commission #DD757129 ,ires. FEB. 10.2012 Signature {' Contractor The foregoing instrument was acknowledged before� / this day of k i� ,20// , by i/ e who is pexjQnally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: .il/M1 ` , Print: A ro � .aeaau° My C s, 'ssion e. Sieee®aoaeeemee3otan : aeu 22g4Er°°'° Y :. ri`s wroa J• t oi 0111n a: Del770K0 5 ti ' EiA ii Aivi 2011 , e4= swie ********************************************* ******o****** ************* ***** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) **** *ten ** Zoning Clerk STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, France C.c; ku , does hereby attest that (Property owner) The attached survey, performed by (Name of surveyor's company) For address: Performed on (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey Tess than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect F .I(, Affiant say e, /1.....41L1// // inspec 'ons as applicable to this or other permits. Property Owner Signature SWORN TO AND SUBSCRIBED before me this /611' day of /-tt,lC9t- tst- ,21u // . Affiant is ✓personally known to me, produced as identification. Property Owner Print ame Revised on 5/22/2009/ Revised on 6/12/09 NOTARY PUBELCIlliNfE OF FLORIDA Laura J. Turk Commission #DD972211 ••;,,, Expires: SEP. 27, 2012 BONDED THRU ATLANTIC BONDING CO., INC. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICEN'SIN'G BOARD (850) 487 -1395 1940 NORTE MONROE STREET TALLAHASSEE FL 32399-0783 ITZ„ HOWARD JOHN TAN CONSTRUCTION INC 4 38 NW 78 LN RAL SPRINGS FL 33067 Congratulatio Floridians 1 Our profess! boxers to bar Every day we For informatic There you cal impact you, si Department's Our mission constantly str Thank you f si With this license you become one of the nearly one million by the Department of Business and Professional Regulation. als and businesses range from architects to yacht brokers, from aqua restaurants, and they keep Florida's economy strong. work to improve the way we do business in order to serve you better. n about our services, please log onto www.rnyfioridalicense.com. find more information about our divisions and the regulations that ibscribe to department newsletters and learn more about the nitiatives. the Department is: License Efficiently, Regulate Fairly. We to serve you better so that you can serve your customers. doing business In Florida, and congratulations on your new license! DETACH HERE AC Date: 8/22/2011 Time: 1:01 PM To: 9,9547520061 Page: 002 - 772 -6464 Client #: STCON 954 ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD /YYYY) 8/22/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Cypress Insurance Group BO-CL P.O. Drawer 9328 Fort Lauderdale, FL 33310 -9328 954 771 -0300 OZEACT Joyce Simpson NPHONE 954 771 -0300 FAX 954 772 9424 (�') (' N�) E-MAIL ADDRESS: JoyceSQCypresslnsurance.Com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Old Dominion Ins Co COMMERCIAL GENERAL LIABILITY INSURED Marstan Construction, Inc. 4138 NW 78 Lane Coral Springs, FL 33065 INSURER B : MPG65078 INSURER C 08/26/2012 INSURER D : $1,000,000 INSURER E: $500,00 $10,000 $1,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONTRACTOR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INER wVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERALUABILITY X COMMERCIAL GENERAL LIABILITY MPG65078 /26/2011 08/26/2012 $1,000,000 EEAACCHHOECTCpURRENCE PREMISES (EaocalRence) $500,00 $10,000 $1,000,000 CLAIMS-MADE I X OCCUR MEDEXP(Anyoneperson) PERSONAL & ADV INJURY GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 GENII AGGREGATE LIMIT APPLIES —1 POLICY PRO- F-1 JECT PER LOC $ A AUTOMOBILE — _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS MPG65078 /26/2011 08/26/2012 CEa OMaccident) BINED SINGLE LIMIT ( $ Included BODILY INJURY (Perperson) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per acddent) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WCSTATLI- I I TORY LIMITS ER WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEVIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) dyes, describe under DESCRIPTION OF OPERATIONS below N / A _ E . EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule,11 more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 -2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE eeezt . 6 ACORD 25 (2010/05) 1 of 1 #S120037/M119495 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CAT Broward County 3/30/2011 1:09:12 PM PAGE 2/002 Fax Server BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100. Ft. Lauderdale, FL 33301 -1895— 954 -831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name:MARSTAN CONSTRUCTION INC Owner Name: JOHN HEITZ HOWARD Business Location: 3630 NW 118 AVE M CORAL SPRINGS Business Phone: 954- 752 -0061 Rooms Seats Employees 2 Receipt #:18C'-8365 Business Type: c-0— CONTRACTOR {GENERAL CONTRACTOR) Business Opened:o9 /11/1998 State /County /Cert /Reg :CGC 0 5 5 8 5 6 Exemption Code:NONEJtEMPT Machines Processionals For Vending Business Only Number of Machines: Vending hype: Tax Amount Transfer Fee NSF Fee Penally Prior Years Collection Cost Total Paid 27.001 27.00 0.00 0.00 0.00 0.00 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES ATAX RECEIPT WHEN VALIDATED Melling Address: JOHN HEITZ HOWARD 4138 NW 78 LANE CORAL SPRINGS, FL 33065 This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2010 - 2011 Receipt #04A -09- 00014204 Paid 08/26/2010 27.00 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Receipt #:180-8365 Business Name: MARSTAN CONSTRUCTION INC Business Type: GENERAL CONTRACTOR (GENERAL CONTRACTOR) Business Opened: 09/11 /1998 State/County/Cert/Reg: CGC 0 5.5 8 56 Exemption Code:NONEXEMPT Owner Name: JOHN HEITZ HOWARD Business Location: 3630 NW 118 AVE B4 CORAL SPRINGS Business Phone: 954- 752 -0061 Rooms Seals Employees 2 Machines Professionals Signature Number of Machines: For Vending Business Only Tax Antolini Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 Receipt 004A -09- 00014204 Paid 08/26/2010 27.00 LOCAL BUSINESS TAX RECEIPT City of Coral Springs Business Tax Office 9551 West Sample Road Coral Springs, FL 33065-3800 Phone (954)344-5958/(954)344-5963 2011 MARSTAN CONSTRUCTION 4238 NW 78 LANE CORAL SPRINGS FL 33065 Other information: Payment Date : 20/04/10 Amount Paid : 132.00 Business Tax#: 11-00056827 Expires on : 94/30/11 ***.* vAraDATED*.*.* CITY OF CORAL SPRINGS EUSXRESS TAX OFFICE 2.0/11/1 ** DETACH AND POST THIS BUSINESS TAX RECEIPT IN A CONSPICUOUS PLACE ** ALL WINDOW STaNS SHALL COMPLY TO LAND DEVELOPMENT CODE CHAPTER 18 MIWIM12000 02 -24 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS" COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION 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: 02/24/2010 EXPIRATION DATE: 02/24/2012 ESPOSITO DAVID S 650587151 BUSINESS NAME AND ADDRESS: MARSTAN CONSTRUCTION INC 4138 NW 78TH LANE CORAL SPRINGS FL 33065 SCOPES Or BUSINESS OR TRADE: 1- REMODELING 2— CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursaanl to Chapter 444. 06114), F.S., on officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section may not rticover benefits or compensation under this chapter. Pursuant le Chapter 440.0(1112), I',S., Certificates of election to he exempt... app y only within the scope of the business or trade listed on the notice of election to he exempt. Pursuant to Chapter 44(1.00(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it, at any lime after the tiling ul the meticn ar the issuance of the certificate. the person named on the notice or certificate no loop.- meets the requirements if this section for issuance of a certificate.. The department shall revoke a certificate at any time for iaifure of the person named on the certificate to meet the requirements of this section. IIUESTIONS? (850) 413-960! OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCH STATE OF FLORIDA DEPARTMENT OF I °INANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION cONSTRUCTIOIM INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 02/24/2010 EXPIRATION DATE: 02/24/2012 PERSON: DA'h►ID S ESPOSITO FEIN: 650587151 BUSINESS NAME AND ADDRESS: MARSTAN cons- mU(I1ON INC 4138 NW 78TH LANE CORM SPRINGS, FL :33065 SCOPE OF BUSINESS OR TRADE: 1- REMODELING 2 CERTIFIED GENERAL CONTRACTOR 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 L under this section may riot recover benefits or i:;ompensation under this D chapter. 1 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 on E the notice of election to be exempt E Pursuant to Chapter 440.06(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall he 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? (860) 413 -1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 OR 12 2001 6:0QPM RLAYON AND ASSOCIATES, P. 3052215321 B O UNPARY ST IR Y EY n r�► ✓ ✓✓ SCE: 1" =201 ._.J 75.E - u1T 1_0 r d'' ,N&.. ALL tR " F. 14017A 4, Ft_ 10 cep' o • 75.00' ,,.50' Parka& etio #0' vLr! Lam► l // `BLDG DEPT' SUBJECT Te COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS O'R/W ACCORDING TO Tag ai mss . p. Tim maser FALLS Trrns�r noon ZONE - X+`— 041341-120652 C,,r) ?-.1 74" 6 gr cFAoic ceitm-r) v 2 t t I 54 t I fhl " v\4.t(c.,- cy,erv?A-R 11. 7', z ) 1 . 5 ° Z.)04 " 2- 1/4,1' TA-roo45 -to / TjAz.,icc:) _ 211'y 1 ? T TOF 4 efilD011ziti 1-(-N —C,Pos.S lep c 4. 011011:0•1.40614.11 e,eueeer.f,..e• 111 1 if , • e•-■eel... „ s „sss s,s2, 1