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
.