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RC-11-2024Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 168414 Permit Number: RC -11 -11 -2024 Scheduled Inspection Date: January 05, 2012 Inspector: Rodriguez, Jorge Owner: LLC, MACAII Job Address: 9545 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: DENIS CONSTRUCTION INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060143040 Phone: (786)390 -9264 Building Department Comments REPLACE KITCHEN CABINETS Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 04, 2012 For Inspections please call: (305)762.4949 Page 18 of 21 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON TIM JOB SITE AT TIME OF FIRST:INSP)CTION PERMIT NO.J �C I j2b29 TAX FOLIO NO. 32a— Gjy 7 /C STATE OF-FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that Improvements wM be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information Is provided in this Notice of Commencement. -•,al description of property and street/address: 9r'�/S: _ 4% - J sir 72- d- •. Description of provemerth _, .41111291/. �1 • 43.Owner(s) name and address: rev /.V tl Interest in property: �l/l Sri F/ Name and address of fee simple titleholder. 40. Contracto = name, addre s and i LU fi 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 whom notices or other documents may be served as provided by Section 713.13(1Xa)7., Florida Statutes, Name, address and phone number IIN111111111111110111111111111111 CFFN 2011R0837864 OR Bk 27927 Ps 1524E (fps) RECORDED 12/14/2011 11:41:52 HARVEY RUVINr CLERK OF COURT f1IAMI —DADE COUNTYr FLORIDA LAST PAGE Space above reserved for use of recording office 0 o c .ecczt 8..In addition to himself, Owners designates the following person(s) to receive a copy.of the Uenor's.Notice as provided. in Section 713.13(1)0), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement (he dare to 1 year from fire dare of recordi g uniMM a dirt date Is spedfed) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THEEXPIRATION 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 JMPROVEMENTS 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 BEFORECOMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. lOgRatEMIEMEMI or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By Print Name 3) e , (3--°3•31C , Print Name - ' iUe/Office �✓i,C>r,� . j,�( /�rh', 4e.- Title/Office STATE OFFLORIDA 0 O COUNTY 1 -DADE The for By LI I dually, or O as Inowledged before me this %1 day of a kp f '.r • -.47/ for Personally (mown, or 0 produced the following type of Identification: Signature of Notary Public: G Print Name: • bVyr Arnow - (SEAL,) 4VERIFICATTON.PURSUANI .TO S C11ON 82625. FL( RIDA STABS 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 By 1n.01.52 PAGE 3 ma CU ;o�pgrn�, , Sunilda E. 'Casilla �_ .q CDMMISSfON #DD99Qa413 a� ;.4 ofi°. D(PIRES: MAY 10, 2014 er(s) or Owner(s)'s Authorized Offloer /DIrector/Partrler/Manager who signed above: inn% %% N'►`1W.AARONNOTARYccm By 7.7/6t BU L IN 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 Yn+iz1tJeu- at - PERMIT APPLIatION FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): A' 1- 6. 6 a e " �® G�' _ ' ' Phone #: e j5 2-'` ' 9 d7-C BY: NOV 0 1 2011 Permit No. (2 i---( 1 Master Permit No. s• Address: n` 5 it/C0 � y.a (64.4 City: /1) :a.492 e State: i L Zip: 5/ Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: 6/2/ Miami Dade Zip: r Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: dPrj '771" c1 i Phone #: 71C, 3 90Y2‘ Address: 1) g c:.' d City: / 12e' ; State: Zip: /± Qualifier Name: 2a Phone #: 71 3 ,9' State Certification or Registration #: ° /.50 Certificate of Competency #: Contact Phone#: 743 �'O Email Address: DESIGNER: Architect/Engineer: Phone #: (/ Value of Work for this Permit: $ (" t)(') Type of Work: Addition ❑Alteration Description of Work: /� -_ // c/< Square/Linear Footage of Work: New epTir/Replace ❑Demolition *** * *** * * ** ** **** ** ****+x***m********* Fees ****** **** ******* ***** ************* * ***** ** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 1 9.3",-.47 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 { i i a: o.. -,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) days after the building permit is issued In the absen h posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 1 sF day of PJOV , 20 ill , by JOU F - 7arii.e Z , who is personally known to me or who has produced GifVet ,s 1 l L n Sir As identification and who did take an oath. NOTARY PUBLIC: Sign: ,.aliti'./4- (/�ll44_4_, Signatu rt Contractor The foregoing instrument was acknowledged before me this day of 20 i, by ' We-NO who is personally known to me or who has produced fa.A40 as identification and who did take an oath. NOTARY PUBL C: \`\`\0u1 `urr Sign: - tP''s Print: 4� 6'7 fri,ute iQ Print: cp ?QU�`::u��r� MAMA VINO LA < My Commission Expires: * �y cA MISSION # EE 014044 My Commission Expires: ` o i °; ; ;1 : EXPIRES: August 3, 2014 °� \1 l ed Budget NOY genies <1.*. ° y°- /rrilmll%■"' APPROVED BY `� ./ 4// Plans Examiner Zoning f. Structural Review Clerk (Revised 07 /10 /07)(Revised 06110 /2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 DENIS, JORGE LUIS DENIS CONSTRUCTION INC 8530 SW 133RD AVENUE MIAMI FL 33183 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's 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 �.._ RTIYrIED wader the provi&ioae o8 Cb.4 tdcina dates Atf 4 "+ -33;,-'4!.4 2 4,)46090]. BATCH NUMBER GOTkiig `ate below 13 CI =Undr3 'at RTIF e isions Cb p' Expiration 'date: AUG "a 'f 31, 201. QU!RE From:Beverly Haisley FaxID:Roemer Insurance Page 1 of 1 Date:10/24/2011 09:36 AM Page:1 of 1 OP ID: BH AC PR©" 4,..,._- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDPtYYY) 10124!11 THIS CERTIFICATE 1S 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(ies) 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 954- 731 -5566 W.F Roemer Insurance Agency 954_731 -0438 William F. Dowd P.O. Box 190669 Fort Lauderdale FL 33319 William F. Dowd III CONTACT PHONE FAX (Jc. No. ExB: (A/C, No : E-MAIL ADDRESS: PRODUCER MB,BDE -1 CUSTOMER ID m: INSURERS) AFFORDING COVERAGE NAIC f INSURED Denis Construction Inc 8530 SW 133 Avenue Miami, FL 33183 INSURER A:VInings Insurance Company 16632 INSURER B : GLP006007202 INSURER C: 12/2W11 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : CLAIMS -MADE 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 CONTRACT OR 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 ADOL INSR SUER— WVD POLICY NUMBER POLICY EFF (MMIDDM'YY) POLICY EXP (MMIDD(YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR GLP006007202 12128/10 12/2W11 EACH OCCURRENCE $ 1,000,000 DRMAGETO Ro cur, PREMISES(Eeoccurrence) $ 100,000 CLAIMS -MADE MED EXP (Any one person) $ 6,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' POLICY JEC7 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE — _ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA L1AB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ — DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V 1 N ANY PROPRIETORIPARTNERJEXECU11VE OFFICERJMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) MIAMIS2 Village of Miami Shores 10050 NE 2 Ave. Miami Shores, FL 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EPPRRESENTATT VE Q AUTHO,RRIIZEEEDDrR• TA . AGORD 26 (2009109) O 1988 -2009 ACORD CORPORATION. All rig The ACORD name and logo are registered marks of ACORD ALEX SINK STATE OF FLORIDA CKIEPFINANCIALOFFiCER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BI 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: 02124/2011 EXPIRATION DATE: 02/2312013 DENIS JORGE L 205914442 BUSINESS NAME AND ADDRESS: DENIS CONSTRUCTION INC 8530 Sw 133 AVE MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CONSTRUCTION 2- CERTIFIED GENERAL CONTRACTOR i1 IMPORTANT: Pursuant to chapter 440. Of414 F.S., on otficor of a torporetion who elects exemption trine this chapter by nog o certificate of autism under this section may not receve! beeellts or compensation under this chapter. Persoeot to Cbepter 440.0ef121, F.5., Certificates of election to be exempt... apply only within the asepe et the bocinee er rode iieted an he ooslee of %ioctien to be exempt. Perauset to Chapter 44105113% R.S.. Notices of election to h 01001 and certificates of election to be exempt shall be subject to revocation if, of any time eater the thine of the notice or the lasuence of the certificate. the person named on the notice or eeltaieele no lender moots the requirements of Me section for lasagne of 0 tertilic9(9. The department obeli revoke a certificate et any time for tenure Of the person named on the certificate to meet the requirements of this section. OWC-252 CEPTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -C6 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OP FINANCIAL SERVICES DIVISION OP WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO RE EXEMPT FROM•FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 02/24/2011 EXPIRATION DATE! 02/23/2013 PERSON: JORGE L DENIS FEII1t 205814442 BusiN :7:s NA:1hc AND ADDRESS: MNIS CONSTRUCTION INC 8530 $W I,s7 Ave, MIAMI, FL 091913, SCOPE OF BUSINESS OR TRADE: 1- CONSTRUCTION e- CERTIFIED GENERAL CONTRACTOR IMPORTANT Pursuant to CI+epter 440.05':14), F.S., an olficer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to chapter 440.05(12?, F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E: the notice of election to be exempt Futsumr, to Chapter 440.05(13), F,5., Notices of election to be exempt erd certificates of election to be exempt shell be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificete, the person named on the rotice or Certificate no longer meats the requirements of this section for issuance of c 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? 18501 413-1609 CUT HERE • ::'eery bottom portion on the job, keep uppe' portion ft.r you( rfia sorria. DWC ^252 CERTIFIC}JL 01 ELE(7T'0N 1) BE C.'EM,`T R.:VI EEJ 09 -06 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. lst FLOOR MIAMI, FL 33130 648425 -7 BUSINESS NAME / LOCATION DENIS CONSTRUCTION INC 8530 SW 133 AVE 33183 UNIN DADE COUNTY 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA SEPT. MUST BE DISPPLAYED AT PLACEOOF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 675405-6 STATE* CGC1514635 OWNER DENIS CONSTRUCTION INC Sec. Type of Business 196 GENERAL BUILDING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09010128001 000075.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD DENIS CONSTRUCTION INC JORGE DENIS PRES 8530 SW 133 AVE MIAMI FL 33183 1 II 111111111IIitII 111111 1111,11 11111111 },1!l11t}11IIt 1114911 C 14 hore APPROVED 1 DY ZONING DEPT BLDG DEPT !: /f—Z— ( asr,c1 // SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS fl /1-"a NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F.I PROTECTED RECEPTACLE. PUT DM/ RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. Peti u),‘IA ot,<J v tit Ck S-C3'i, k M( Cvca)6,-v.e._ U es Gu OR/ c-P--(AlLeekif- b-e 5(11 S e,1 ita 1 ADD SMOKE/CARBON MONOXIDOETECTORS. ANY AND ALL CLOTH AND tJBBER INSULATED CONDUCTORS TO BE REPLACED. x I L x r .7ea 3,0 SWIM In NIG p 20,1 k 131 isv 81' SR