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RC-11-1469Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163204 Permit Number: RC -8 -11 -1469 Scheduled Inspection Date: January 30, 2012 Inspector: Bruhn, Norman Owner: CHARLES, R GREGORY Job Address: 790 NE 91 Street 8 Miami Shores, FL Project: <NONE> Contractor: GILPIN CONSTRUCTION INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132060390080 Phone: (786)709 -8123 Building Department Comments KITCHEN REMODEL Inspector Comments Passed Failed '��✓/ /o'er Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 27, 2012 For Inspections please call: (305)762 -4949 Page 8 of 34 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 OWNER: Name (Fee Simple Titleholder): Address: City: 1 / •r Tenant/Lessee Name: Email: JOB ADDRESS: City: Folio/Parcel #: al NOV OA Nit Permit No. W2 I 1 140 Master Permit No. ROOFING q Aso ! V i 6' ( (7 rr %Phone #: s\n, to. . � � 41/4-e9 fa,. State: Zip:�� Phone#: Miami Shores CountyQcrotk. Miami Dade Zip: 1 8d Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: o\ a 1 iA . l%. - '�� .e4-- City: N ( Cl' � State: = i.� Zip: _����r__ Qualifier Name: @S E-V-1\ � (\N + G- ( 1 e i /N' Phone #: I State Certification or Registration #: C 6 C i 5 Th G $' �' Certificate of Competency #: 1 '\` GA0) ` ( vv\ Phone #:% hone #: d �' Contact Phone #: . G". ® ,' 8 i e9r Email Address: Ci , c= DESIGNER: Architect/Engineer: Value of Work for this Permit: $ ,S� 0 • 6-0 Type of Work: OAddition DAlteration I �s iP 'onp, Work: ' ear Footage of Work: ]Repair/Replace ODemolition * .41104,* * * ** Submittal Fee $ Permit Fee $ /S0 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 177 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, BOIT FRS, 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspe lion wil . t be approved and a re . ee will be charged. Sign Signature wner or Agent The fore o'ng i trument was al. ow day of , 2011 , by 1tt me or Pe has produced NOTAR Sign: Print: identification and who did take an oath. Contractor Al nstrument was - ged efore �, ,2011 ,by 1.i/ - and who did take an oath. PUBLIC: My Commission Expires: APPROVED BY My Commission ;. .t.P , . � Sy o n otary fi 0tb Pobltc V ; CUBeLp O3 205 5 CCootes tmeEot111 1l 1 28I0 04,50 . ********* * * * ***** ******** **** ** ** * *** * ** Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) * * * * * * * * * ** Zoning Clerk Miami -Dade County - Local Business Tax - Payment Process Page 1 of 1 kg" MIAMI-DADE COUNTY - LOCAL BUSINESS TAX Pay Your Local Business Tax 4secum Please print this page for your records. You will receive an e-Mail confirmation containing this payment information within an hour. CONFIRMATION OF PAYMENT. Receipt Amount Due: View Number: Details: 655321 -9 $45.00 550031 -0 $45.00 Payment Date: Payment Time Amount Paid: Authorization Number: Card Holder Name: Credit Card: Confirmation Number: r COI 09/29/2011 23:39:54 EDT $90.00 087084 JOHN GILPIN Visa- 2020 39891 Copyright 2003 Miami -Dade County. Ali rights reserved. Privacy Policy https:// wasexp. miamidade. gov /OCL'Web /OCLRequestController 9/29/2011 11/04/2011 13:20 9549560555 COVER ALL INSURANCE PAGE 01/01 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER COVER ALL INSURANCE 5800 W. ATLANTIC BLVD. MARGATE, FL 33063 PHONE# (954) 956 -0006 FAX# (954) 956.0555 INSURED GILPIN CONSTRUCTION INC. 20109 NW 34 AVENUE MIAMI, FL 33056 COVERAGES DATE (MM/DD/YYYY) 11/04;2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 NAIL # INSURER A; ACCIDENT INSURANCE COMPANY INSURER 6: INSURER C: INSURER D: INSURER 9: 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN R�nl IrCn BY PAID CLAIMS al-SR-Kb-DI POLICY NUMBER PUUCY EFFECT/VE DATE._ (MM(pl2p 1 0542-2011 POLICY EXPIRAq,TION DATE. IMMInfJYY1 05-12-2012 A _GENERAL LIABILITY A01470 LIMITS EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY �r-y- CLAIMS MADE � I OCCUR DAMAGE TO RENTS. ERFMISEktEe_cG/ MED EXP (Any One wean) S 100,000 $ 5,000 I — " " PERSONAL A ADV INJURY $ 1,000,000 GENERA{, AGGREGATE $ 2,000,000 $ 2,000,000 GEN'L AGGREGATE. POI I(r LIMIT APPLIES PRO- PER. PRODUCTS - COMP /OP AGG AUTOIMORIL •,,,._. _ LIABILITY ANY AUTO Al I OWNED AU 1 OS SCI•rFr>I-ILED AUTOS HIRED AUTOS NON -0WNED AUTOS - COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) 9 BODILY INJURY (Per accident) S — PROPERTY DAMAGE (Per accident) S .. GARAGE LIABILITY 7 ANY AUTO AUTO ONLY - EA ACCIDENT 9 OTHER THAN EA & C_,r,$ AUTO ONLY; AGO $ EXC'jjESS/UMBRELLALIABILITY _,.,,I OCCUR f 1 CLAIMS MADE EACH OCCURRENCE 3 AGGREGATE $ DEDUCTIBLE RETENTION 9 r 9 $ 3 wOaBNFIS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP4IF-i OR/PARTNERIEXECUTIVE QFFIC,F-R/MEMBER EXCLUDED? If n, d6,cfrbc undar SPECIAL PROVISIONS btNow T O T 4 O R- E.L. EACH ACCIDENT 3 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ ___J OTHER 1 >E5CRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS 3ENERAL CONTRACTOR :FRTIFICATP unl nee VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES FL 33138 FAX: 305- 756 -8972 %CORD 25 (2001/08) CELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION URER WILL ENDEAV LDER NAMED TO THE DATE THEREOF, THE ISS NOTICE TO THE CERTIFICA IMPOSE NO OBLIGATION REPRESENTATIVES / MAIL 70 DAYS WRITTEN US FAILURE TO DO SO SHALL 4B11.A..a.c0L.ricIND U N THE ( INSURER. ITS AGENTS OR v r S AUTHORIZED REPRE ATIVE ® ACORD CORPORATION 1988 ALEX SINK STATE OF FLORIDA CHEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION a * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual fisted below has elected to be exempt from Florida Workers' Compensatiar law. 03-10-20I0 EFFECTIVE DATE: PERSON: FEIN: 04/19/2010 EXPIRATION DATE: 04/18/2012 GILPIN 043778504 BUSINESS NAME AND ADDRESS: GILPIN CONSTRUCTION INC 20109 NW 34TH AVE MIAMI GARDENS FL 33056 SCOPES OF BUSINESS OR TRADE: 1- ROOFING JOHN M 2- CONSTRUCTION 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 elec'io i under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply eily within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt aid certificates of election t3 be exempt shall be subject to revocation it, at any time after the (fling of the notice or the issuance of the certificate, the person named or the notice sr certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for fa la e of the person named on tie certificate to meet the requirements of this section. Q IE.;TIONS? (550) 413 -1 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMETIT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 04/19/2010 EXPIRATION DATE: 04/18/2012 PERSON: JOHN M GILPIN FEIN: 043778504 BUSINESS NAME AND ADDRESS: GILPIN CONS—RUCTION INC 20105 NW ;4T1-1 AvE MIAMI GAR31'NS, FL 33056 SCOPE OF BUSINESS OR TRADE: 1- ROOFING 2- CONSTRUCTION IMPORTANT ® Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a ce .ti 'icate of election I- under this section may not recover benefits or corn! ensation under -his D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates cf election to be exempt.. apply only within the scope of the busiress or trade lister' en the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exerrpt and certificates of election to be exempt shall be stbject to revocation if, at any time after the filing of the notice or tie issuance of the certificate, the person named on the notice or cettiiicate no longer msel the requirements of this section for issuance of t certificate. The department shall revoke a certificate at any time `ol failure of the person named on the certificate to meet the requ renents of this section. H E R E QUES1I0NIS? (850) 413 -16)9 CUT HERE * Carry bottom portion on ithe job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 °■ —G44'6 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 No. r"" AUG A. 7111 Master Permit No. Permit Type: BUILDING RO OWNER: Name (Fee Simple Titleholder): Address: City: • Tenant/Lessee Name: -� Email: Che5 Phone #: JOB ADDRESS: City: Miami Shores Folio/Parcel #: County: Miami Dade Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: CO /05 5 QC/Q! ell D45/.9 l/t.. Phone #: Address: City: Qualifier Name: State: Phone State Certification or Reg' Contact Phone #: Certificate of Com Email Address: DESIGNER: Arc Value of Work fo \ Type of Work: OA1\ Description of Work: ect/Engine Permit: $ Alteration Square/Linear Footage of ONew ORe.air/Repla•e ODemolition A ��!%` —1/4! ************ ******* : * *****+ +x** ********* Fees******** *****a:+ u***** *********m**********x * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 gecured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILER, HEATERS, TANKS and AIR VONDITIONERS, 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 ;!ECORD 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 fir _ 'ns' ection which occurs seve days after the building permit is issued. In the absence of such posted notice, the inspect on will no be approved and a anspe,� e will be charged. Signature The fore day of known to me or NO Signature The regoing ins has produce s ,11I/ ° is p ssonally jstown to me or w has produced /4'0 L PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) My Commission Expires: 0)0/04 ®fi ,,toty P,,,, EVONE R JONES • My Comm. Expires Aug 22, 2014 Commission # EE 19695 Zo .;'''' Bnn a cn,r,o,V NRti,nal Unta!v Assn * ** Clerk No. 3 Dorchester Walk, Petit Valley, Trinidad, West Indies. Contact: (868) 299 -4734. 5th August, 2011. TO WHOM IT MAY CONCERN This letter is to confirm that I, Randolph Gregory Charles, of the above address, am the owner of Apartment 8,790 North East, 91st Street, Miami, Florida, 33138, United States of America. I hereby authorize my uncle, Reginald Charles Fuller, of No. 10750 North West, 22nd Avenue Road, Miami, Florida, 33167, United States of America, to be my agent for my said Apartment. I also hereby authorize the said Reginald Charles Fuller to carry out all renovations, repairs and/or alterations to my Apartment including changing cupboards; electrical installations, wiring and/or tile works or whatsoever is required. Reginald Charles Fuller is also authorized to sign on my behalf any relevant documentation required for obtaining any permit(s) for the said renovations, repairs and/or alterations to be done to my Apartment. If any further information is required, I can be contacted at my address and/or telephone number in Trinidad. Signed by the above -named Randolph Gregory Charles (Republic of Trinidad and Tobago Driver's Permit No. 153724 E) in my presence at Second Floor, No. 55 Edward Street, Port of Spain, Trinidad, West Indies, this — 5-1`day of August, 2011. Randolph Gregory Charles Pe MUATI-DADECOUNTY TAX COLLECTOR 140W. FLAGL.El 1st FLOOR` MIAMI FL 3 3O 573423 -2 BUSINESS NAME /LOCATION CARLOS QUALITY DESIGN 10670 NW 123 ST RD 33178 < MEDLEY LOCAL BUSINESS TAX :RECEIPT 2011 FIRST -CLASS It -DADE COUNTY -STATE OF FLORIDA U.S. POSTAGE I EXPIRES SEPT. 30,;2011 PAID MUST BE DISPLAYED -AT PLAICE OF BUSINESS MIAMI, FL iStT 3O COUNTY CODE CHAPTER SA - ART. 9 & 10 PERMIT NO. gat THIS IS NOT A BILL - DO NOT PAY OWNER CARLOS`QUALITY DESIGN INC Sec.TypeofBusiT 206 MFG ♦RECYCLINGIPROCESSING IIS sS ONLY A LOT:AL 1SINESS TAX RECEIPT. IT )ES NOT PERMIT THE )LITER TO VIOLATE ANY 1S@U$ REGULATORY OR INING LAWS OF THE CITIES. NOR T T�LpS� ITS EXEMPT THE MAST OR LICENSE :GUMEI BY LAW. THIS LS )T A CERTIROATION OP 15 HOLDER'S OUALIRCA OMENT RECEIVED ADECOUNTYTAX )LLECTOR: RENEWAL RECEIPT NO. 598005-8 07/23/2010 60000000267 000045.00 SEE OTHER SIDE DO NOT FORWARD CARLOS QUALITY DESIGN INC CARLOS CRUZ PRES 10670 NW 123 ST RD 103 • MEDLEY FL 33178 i >)li))) TIT)) T111))) ll) Ti) TTIiT)T)ii)liTT11T)TTTi)ii)Ti�l Miami Shores Viiiage Building Department RECEIPT PERMIT #:C /)I- )4d DATE: I, ri J //s cdzV- Nq Contractor ❑ Owner ❑ Architect Address: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 9x-')210i) +ua1- CCICed0g. TIO From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: C;71-12/69,5 PERMIT CLERK INITIAL: v� RESUBMITTED DATE: 11 \\ PERMIT CLERK INITIAL: Permit No: 11 -1469 Job Name: August 18, 2011 Miami Shores Vivage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Plans must be approved by Miami dade DERM. 2) Provide a plumbing permit application. 3) Provide a detailed scope of work on plans. 4) Provide all license and insurance information for all contractors. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 I #W t! z# NO POINT ALONG COUNYER TO BE MORE THAN 2 FEET FROM G.FI PROTECTED RECEPTACLE. PUT DM RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. 1r"1r°°'�''vii AUG 1 1.2011 11(11\ Miami Shores );TIT' Tr APPROVED BY ZONING DEPT BLDG DEPT DATE SUBJECT TO COMPLIANCE WITH Ai: )Ir flAL STATE AND COUNTY RULES AND RI C'., ! A I IONS GITY SOP 2 1010 lII 0hI 01 11111111u 0hI 01011 u m Derm Number: 2011 - 0831 -1057 -3723 Contact Name: MR CARLOS CRUZ Contact Phone: (786)312 -9759 Folio: 11- 3206 -039 -0080 Protect Name: KITCHEN CABINET Date Received: 08/31/2011 Reviewer Name: PLAN FiNAL. APPOVAL DEPARTMENT OF ENS IRO M gNTAL RESOURCES M AGE , <T CORE REVIEWER (PRINT): SIGNATURE DATE , )1)-- // N .