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DGT-11-542Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 168826 Scheduled Inspection Date: March 06, 2012 Inspector: Bruhn, Norman Owner: WENSJOE, THOMAS Job Address: 1135 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Number: DGT -3 -11 -542 Permit Type: Decks /Gazebos/Trellises Inspection Type: Final Work Classification: Trellise Phone Number Parcel Number 1132050340050 Building Department Comments 2 CONCRETE FOOTERS AND WOOD TRELLIS Passed fJ61L 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- 168747. Provide an electrical permit for the electrical work. NB March 05, 2012 For Inspections please call: (305)762 -4949 Page 5 of 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1 Tel: (305) 795.2204 Fax: (305) 756.8972 (P I � V� INSPECTION'S PHONE NUMBER: (305) 762.4949 IV BUI DINE G 1�1-, Permit No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): ROOFING Address: rl&S Aid°' (C() ST- City: ,Lfc., Y 11 2 helve__ Phone #:._305 °?5 -`' State: Zip: 3 .3L ge Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: f" 3.S 4-' £ /C(3 s City: Miami Shores County: Miami Dade Zip: 53t 3 Folio/Parcel #: `�'' 34)0S:031( ),�°c) Is the Building Historically Designated: Yes NO Flood Zone: n CONTRACTOR: Company Name: 0 B hOilf4 L )e4 pC''e Phone #: 786 2S- l ]' (9, Address: 03 S Axe 5'f City: fi1itAl < S Love e t State: . Zip: 33(-Se Qualifier Name: 7710 COC,i .) `( & f Phone #: `7 –4 74-i� S3:S' State Certification or Registration #: ,1 Certificate of Competency #: Contact Phone #: -7K–re 7 Email Address: DESIGNER: Architect/Engineer: t/ C `t-c- g CL) Phone #:,3—°,3/ 5C23 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Adddtion ❑Alteration ❑New ❑Repair/Replace Description of Work: /a4.X 3 17 6 el ❑Demolition ******** ******+ x***+ xx: x:***+x *********** * ** Fees** ******* ********+ x**** ********:x*.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 $ 41,C 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reins, 'ction fee will be charged. Signature The f day o who ignature Owner or Ag mew was ac` ,20� ,by own to nie or who has produced The for day of 14-identification and who did take an oath. NOT.i. RY PUBLIC: Sign: Print: s.J ment w ackno„ - .:ed/beto , 2011 , by r'kn. / r o me or who has produced. I� ✓ • • ratification and who did take an oath. NO AR ' U • LIC: v JVg \\.\�� \o<1da �`P'��` . S \ate ° 23.20' My Commission Expires: 9,0� fr:" SE \78 P55i, Myr %S‘ * * * * * * * * * * * * * * * * * * ** **t$******** , * ************************************************************** APPROVED BY f "53-IJIans Examiner Zoning Sign: Print: My Commission Exp. Structural Review (Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09) Clerk 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 Permit No. D 6 /f- k Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): / AC V1`1si ` /1k7/1. f UThone #: 3C5 S / /6 0 Address: /KS- 1U f /00 S l City: �%l /WI l S'k✓°e -s State: Zip: 33 (-3(S" Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: //35 )S / / /CO City: Miami Shores County: Miami Dade Zip: 3-73k s %33 Folio/Parcel #: / /- 3:96S-Gk 54- o C Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 7/10/04=-C 0/04=C ( )C41 C " tit Phone #: —�/l� ` (1-* 01 &(C' Address: / (3,S AJ II: /r)(5 s ( J City: /1t/1Y? i , t1�-c State: /2::-( , Zip: .3 3 (=3c? Qualifier Name: / iiO ✓ i Q U e J S 1G rt Phone #: / - (-f & / & State Certification or Registration #: p J Certificate of Competency #: Contact Phone #:�86 `Li ?(‘-'---1 C'o Email Address: DESIGNER: Architect/Engineer: t.1 i C- rtC`C i) o ',.1 C_ e Phone #: r -3! ' <2 C∎ Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration New URepair/Replace ❑Demolition Description of Work: � In Ji�v* CCU r '��'6Q Submittal Fee $ Permit Fee $ / J 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 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 absence of such posted notice, the inspection will no be approved and a reinspection fee will be charged. 1 1L4 Signature /'Owner or Agent Contractor The fo- _oing ins im men was ac <'owllje',,�dgedi�.ef2r , �e this 0 The foregoing instrument was acknowledged before me this day of , I1 , 20 \ I , by MAC 1, d a day of , 20 _, by IREo is per ,1 nallx kno n to me or who has produced IR ho is personally known to me or who has produced fication and who did take an oath. as identification and who did take an oath. NOTAR PUBLIC: _ _ NOTARY PUBLIC: Sign: Print: My Commission Expires: ommission Expires: **** ** ***** ** * *****+x********�x ,. ..; ... :.********* *+ x*: x+ x***+ x+ x******** ** *a: **+ x ***** *** * ******m********** APPROVED BY Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT �i NAME: -% 1 t » Sr �✓ DATE: "i/ e/ ) `) ADDRESS: l ) 3 6 /d �- / 0 i !7l ,»rvt i A 7J/3 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial _ v 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial Li 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial \ -Lk). - 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 1 L 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial W 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial t `CO` 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbor/oro/cilb/index.html Initial 1 t 60° 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner- builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this By Produced there License or who was personally known to me or who has fl�l 0S5t ) 5' identifi ation. OWN % R NOTARY - --- CLAUDIA V. CUBILLOS A Notary Public - State of Florida 4 = k', "- mm E spires Sep 23, 2015 ` G,amrnrssron # EE 128810 3onai , rhrougb National Notary Assn. 1 4 • Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. 1 _ - owner's Name (Fee Simple Title Holder): ' l 0=1 ``,c;. % e cePhone #: 305 -i5 Owner's Address: (13 f -5c; G �1 City: "4/LelYn i e_ State : ( . Zip Code: 3 3i3j / Job Address (Of where work is being done): /13 Ad /oo City: Miami Shores State: Florida Zip Code: 33/ :cc:--- Contractor's Company Name: . h gins C.Je- Ju f (gy 0cote) Phone #: 78G --(47S: `f FM Address: %3 5 A. /00 E f City: '-lA✓1y0 / l..c.�e State: F?1 • Qualifier's Name : Lic. Number: Zip Code:.3< Architect/ Engineer of Record Name: IV CTO Address: `70 AU 5 Phone #: -- 5030 City: AlCoivi t) 3 tto Describe Work: 0 o door- Q Q State: F(- Zip Code: 3 (3- 1 hereby certify that the work has been abandoned andlor the contractor /architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvement. Signature er or Agent Contractor or Architect th' day of going nt was akno dged befo a The foregoing instrument was aknowledged before me The fo �� ( ,2011 ,by 6 1./l r VJ I " ` this day of J Who is son Ily k own t me or ho h s produced 1'. U��- -0 2--'* Notary Sign: Seal: s-indentification. , 20 by who is personally known to me or who has produced as indentification. e; ili .• t;* *.:1',/tilt3 aligWa 19N" • • -4 01814g7 )1 i fliqarkftlailg) =.? , qui rilfski 1411014mM IM lia -^'."47.;, September 19th, 2011 Robert Anastasi European Sculptured Stone 10001 NW 50th Street Sunrise, Fl. 33351 Reference permit # DGT -11 -542 Dear Mr. Anastasi: This letter is to inform you that we have decided to change contractor for the completion of the job related to the permit number mentioned above. If you have any questions please do not hesitate to contact me. 7010 2780 0001 1826 8483 0 SC ' •1,Cn N m p cn r rn n rn m 10• m Order stamps at usps.com /shop or call 1- 800- Stamp24. Go to usps.com /clicknship to print shipping labels with postage. For other information call 1- 800 - ASK -USPS. ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com /poboxes. ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** 811 1#: 1000402719388 Clerk: 06 All sales final on stamps and postage Refunds For guaranteed services only Thank you for your business ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** HELP US SERVE YOU BETTER Go to: https : / /postalexperience.com /Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Customer Copy a • =P'< .�_ gprle���ttbbbbb _54 'c —8 aFa kg IF IF 7010 2780 0001 1826 8483 m z m 0 0 r- r U) 0 0 Order stamps at usps.com /shop or call 1- 800- Stamp24. Go to usps.com /clicknship to print shipping labels with postage. For other information call 1- 800 - ASK -USPS. ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********** * * *,'- * * * * * * * * * * * * * * * * * * * * * * * ** Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com /poboxes. ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Bi11 #: 1000402719388 Clerk: 06 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** HELP US SERVE YOU BETTER Go to: https : / /postalexperience.com /Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Customer Copy EA: m ru 00 w w .1 C00-01 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. Master Permit No. 1)61 31/ 54A Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): ThOrr►AS ♦ MONICA WEJJSTDE Phone #: QS 4- 9:14 -g4B3 Address: i i 3 S /V & Ide smear City: fruam, S K1RES State: FL Zip: 33(3g Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: (I 35 N E room viz e ET City: Miami Shores County: Miami Dade Zip: 331 3 2 Folio/Parcel#: r 1 — 3 205 - b3 4 - 006 0 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: auiti..prow CCULR,U D 3ib Phone#: q4 ` 4 -QQ Address: 10001 N4) $ o'M sr Of City: S tJ N it tS X, State: FL- Zip: 3335 Qualifier Name: RD ERr pr✓,qAT.ts i Phone #: State Certification or Registration #: C&(. 0444 665 Certificate of Competency #: Contact Phone#: gs4 -2 l4,- c3g83 Email Address: R.813ER1 007bAl4.tJ % 41 6'b+J 'CO`t. DESIGNER: Architect/Engineer: ?BL&R ti Phone#: in+ -23%- 2544 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 2e t) r$i Co N Fek. f rze. 2_ 3 i K, fa I �`•i!It—, r Y ^Ffl b ******** *******x ******** * ***w**+xw**** ** Fees* * **+x*** ********** ** * *** * ******** * **+x**** ** Submittal Fee $ Permit Fee $g:t,ed CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 secured for FT FCTRICAL 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature t v — 11,A. Owner or Agent The foregoing instrumen was acknowledged bef me thisL'> The fore day of I .1u , 201) , by , day of who is pe on. y . own to me or who b. s o u .�_ who is personal Signature Contractor g instrument w acknowledged before me this) ,2C7,by y known to me or who has produced Atcation andsi8Ydidltake an o r °w�►�'�`'•- Notary Public - State of Florida .a" My Commission Expires Mar 19, 2012 NOTARY PUBLI S Print My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3115/09) as i cation and + chke an oa irR�e4''•. NOTARY �M ° Notary Public - State of Florida Commission Expires Mar 19, 2012 Commission # DD 761538 J Sign: Print: My Commission Expires: Zoning Clerk GERALD BELGRAVE ARCHITECT a- 4823 N.W. 66TH AVE FORT LAUDERDALE, FLORIDA, 33319 May 19, 2011 To: City of Miami Shores Re: 1135 NE 100t Street Permit # DGT311542 To Whom It May Concern: Please be advised of the following revisions in the field. The hanger for the 2x8 rafter to the 2 -2x12 wood ledger is a USP LS50 in lieu of the JUS28TZ as per plan and, in lieu of the galvanized strap welded to the top of the 4x4 steel post, a 3/8" dia. threaded rod was welded to the top of the post. A hole was than drilled thru the 4x12 wood beam and a bolt placed atop to secure it. If you have any other questions, please feel free to call me. Thank you, Gerald Belgrave, Architect Reg. No. 15,085 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.OT ) 1—r-2- Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder):TT-IQWtAS $ MOAICA WEN-5s0 Phone#:(305) 'IS S3`II5(0 Address: 1 IQ € 1004' ST 1.FET City: MIAMI S1-10firS State: F1_ Zip: 331353 Tenant/Lessee Name: Phone#: Email JOB ADDRESS: 1 13B NE, 10 014` 5 to p -r City: Miami Shores County: Miami Dade Zip: 33131 Foli o/Parcel #: 11-3 Q05 - ©31-4 -6050 Is the Building Historically Yes NO Flood Zone: CONTRACTOR: Company Name: EU RO'P€.P ■S C.0 L PT STO Phone#: (ciTiL-1)a { --lig8 3 Address: [ 00 1 AIW CAP" SIRFF,T City: SU ft S State: FL Zip: 33351 Qualifier Name: 'ROBFIiT AMAS TAS1 Phone#: (Ci ;Lt) -1-Lt H 83 State Certification or Registration #: C, CIE (9`i `1(g535 Certificate of Competency #: Contact Phone#: (95.'1) -61617- Email Address: DESIGNER: Architect/Engineer: CrL&A1, 1;) Az L Er AV E. Phone#: Valve of Work for this Permit: $ $14 00 . 00 Square/Linear Footage of Work: 14 li Type of Work: OAddition OAlteration []New ORepair/Replace ODemolition Description of Work: a (0,)11 CRE"[F. FoDTE 1 F LW.IS ***************************************F *+k********** * ** *Slid **ASR ***** ** ***** ******** Submittal Fee $ l'.:>1,0 Permit Fee $ p%SQ? Oa CCF $ COICC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Trsdning%Edncation Fee $ Technology Fee $ Double Fee $ Structural Review $6a - TOTAL FEE NOW DUE $ /!ti ICJ • Bonding Company's Name (if applicable) Bonding Company's Address (:\ City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address \k)\ 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 FJ ECTRICAL 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 properly 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. r.. Signature Owner or Agent (/ Contractor The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this day of 20 Ll , by who is y known to me or who has produced who is personally known to me or who has produced NOTARY P Sign: Print: As identification and who did take an oath. as identification and who did take an oath. My Commission Expires: APPROVED BY 49 1 •c : Notary Public - State of Florida • s My Commission Expires Mar 19, 2012 " Ot�� a c� htini Commission # DD 761538 47, C11.24( Plans Examiner NOTARY ' -' = LIC: I Sign: k. I ,a ,,,v ,, SHERYL GIL Print: `et ; v a V, My Commission Expir ° r \` �1 Notary Public - State of Florida t+ j My Commission Expires Mar 19, 2012 ,ti g `l`;� Commission # DD 761538 ,s£i �hi+�hh�N k�b +k+6ab�H#�Uk+Y�P�h4+k�hK��h�FMi Zoning Alt J (lf Structural Review Clerk (Revised 07 /10/07)(Revised 06/10t2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSED ON THE JOB SITE AT TIME OF FIRST INSPECT ION PERMIT NO. (T31I5 /, TAX FOUO NO. I- 3d05_03y`0050 STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, a ftidldvVirii(dfiRrl°atidriU is provided in this Notice of Commencement. 1 HErra y ri Y or ininai fi this .ficc on 1. Legal description of property and street/address: 1 / 3 111111111111111111111111111111111111111111111 CFI,' 201 1 80227019 OR Bk 27646 Ps 2199; (ips) RECORDED 04/08/2011 11:03:34 HARVEY RUVIFI, CLERK OF COURT MIAMI -DADE COUHTYr FLORIDA LAST PAGE !TV OF DAr_ E a fray y of °4's 11a, Of 0 11 w; nJ Ulf"; •) Soal. L`ci ;{, of above served fait* , re tgj office i6/14 ta ,14; 33 38 2. Description of improvement: %A/CRP1F_ l 'DO LiQ51 TREWS 1 P1 xaTe as Q 3. Owner(s) name and address: `1'64 /LJt -f ri o r14 .U¢. LJC N 577)x, Interest In property Name and address of fee simple titleholder. 4. Contractor's name, address and phone number. E IA ROPEAA) 59AL.PTG RED VOA/6 ) 0001 AFW S0' SOW?, SUNRISE FL 33331 5. Surety. (Payment bond required by 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 by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates following person(s) to receive a copy of the Uenor% Notice as provided in Section /1 9. Expiration date of this Notice of Commencement: 713.13(1)(b), Florida Statutes. Name, address and phone number. (the expiration date is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION 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 IMPROVEMENTS 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 BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of • er(s) or Owner(s)' Authorized Offlcer/Director/Partner/Manager Prepared B - Prepared By Print Name e , (�(aj r� ti i Print Name Title/Office STATE OF FLO ' : 4 • `r go, SHERYL lilt 4 "w` COUNTY • ' ` � I -DADE (� � Notary Public - State of Florida The foregoi a was acknowledged before me this E I Cortur sloe Expires Mar 19, 2012 By '0 c .. Commission DO /51539 ❑ Indivfdu . ,► 4 r f ❑ Personally known, or produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that 1 have read the foregoing and that the facts stated In it are true, to the best of my knowledge and belief. Sig s) of Owner(s) or • s)'s Authorized Officer/Director/Partner/Manager who signed above: By 173.0142 PAGER 3/10 By 01 -25 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO HE 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: 01/25/2011 EXPIRATION DATE: 01/24/2013 ANASTASI FEIN: 030513090 BUSINESS NAME AND ADDRESS: EUROPEAN SCULPTURED STONE CORP 10001 NORTHWEST 60TH STREET STE 104 SUNRISE FL 33351 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR ROBERT L * * 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 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 only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF RNANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 01/25/2011 EXPIRATION DATE: 01/24/2013 PERSON: ROBERT L ANASTASI FEIN: 030513090 BUSINESS NAME AND ADDRESS: EUROPEAN SCULPTURED STONE CORP 10001 NORTHWEST 50TH STREET STE 104 SUNRISE, FL 33351 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT F 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 not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.06(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 R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be 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? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. MC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO DGT -3 -11 -542 Issue Date: Not Issued Expires:NOt Issued Folio Number:1132050340050 Owner's Name: THOMAS WENSJOE Job Address: 1135 100 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: Total Job Valuation: 48 $ 8,400.00 Contractor(s) Phone Primary Contractor EUROPEAN SCULPTURED STONE CORP (954)742 -6832 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 4/4/2011: Yes Comments: PERMIT #: 1 I, r Contractor o Owner o Arch' Miami Shores Viiiage Building Department RECEIPT DATE: 6-,/,‘(//c cked up 2 sets of plans and (otherz' f' r —I'F 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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 Dep m: t to tinue permitting process. Acknowledged by. PERMIT CLER NITIA RESUBMITTED DATE: 11 Z 1 2,0 t PERMIT CLERK INITIAL: Rick Scott Governor H. Frank Farmer, Jr., M.D., Ph.D. State Surgeon General April 19, 2011 (Anna Gil) 1135 NE 100 St Miami, FL 33138 RE: Contingency Letter Application Document No: API000954 Centrax Permit Number: 13 -SC- 1311969 OSTDS Number: 1135 NE 100 St Miami, FL 33138 Lot:3 Block:71 -91 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 04/08/2011 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. This permit is granted for the construction of a trellis. There will be no increase in sewage flow or characteristics and no impact on the unobstructed area. * * * * * * * * * * * * * * * * * * ** *APPROVED * * * * * * * * * * * * * * * * * * * ** If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Since, ly Astrid Edwards, Engineer Specialist II Miami -Dade County Health Department 1725 NW 167 St, Opa Locka, FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YY) 3/16/2011 PRODUCER Phone - 954 583 -5444 Fax - 954-583 -2820 Pelican Insurance Agency 6950 Cypress Rd Ste 208/7 Plantation, Fl 33317 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ALTER THE COVERAGE AFFORDED BY THEE POLICIES BELOW INSURERS AFFORDING COVERAGE N,AI C # INSURER A: Burlington HMI tocn Concrete By Design Inc. dba European Sculptured Stone,Corp _ 10001 NW 50 St #104 Sunrise, FL 33351 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSI ED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWITHSTANDING ANYREQUIREMENT ,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONt OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A TYPE OFINSURANCE POLICY NUMBER POLICY EFFECTIVE OATE(11MI0Ef'Y) POLICE EXPIRATION CATE(61MtDDUW) LIMITS GENE R%LUABILITY 3508003600 5/13/2011 5/13/2012 EACH OCCURENCE $ 1,000,000.00 X COMMERCIAL GENERAL UABWTY (CLAIMS MADE OCCUR I MADE TO RENTED PREtDIISFS /Ea OOCUnenncel $ 100,000.00 MED EKP (Anyone person) $ $5,000 PERSONAL &AD'INIURY $ 1,000,000.GO GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMITAPPUES PER: —1POLICY FECT VlLOC PRODUCTS - COMP/OP AGG $ $2,000,000 AUTOMOTIVELLABLIY —ANV AUTO ALL OWNED ALTOS SCHEDULED AUTOS HIRED AUTOS NON•O WNED AUTOS COMBINED SINGLE WIT (Ea accident) $ BODILY INJURY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY- EAACCIDENT $ OTHER THAN EAACC $ AUTO ONLY: AGO + SS LKBLITY !OCCUR rICLAMSMADE EACH OCCURENCE $ AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COPS PENSATIONAND EMPLOYERS' UABILITY MYPROPRIETOR/PARTNERMECU1'P E OFFICER/MEMBER EXCLUDED? If l�ess.� desaibe under SPECIALPROVISIONSbetow II I TORY LMTS 1 IIER EL ACCIDENT $ EL DISEASE- EAEMPLOYEE $ EL DISEASE- POUCYLIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUS IONS AWED BY ENDORSEMENT/SPECIA L PROVISIONS CERTIFICATE HOLDER I 15.0DTIONAL INSURED: INSURER LETTER A CANCELLATION (See Below) - Village of Miami Shores 1005 ®NE 2nd AWe Miami Shores Florida 33138 CORD 25 (2801 tr z1 1 464 9 SHOULD ANY OF THE ABOVE DESCRIBED PO UCIES BE CANCELLED BEFORE THE 10 CLAYS WRITTENNOTTI CETOTHECERTIFICAOTEHOLDERNA MED TOO THE LEFT. —MT FAILURE TO MAIL SUCH NOTICE SHA LL IMP OSE NO OBLIGATION OR LIA BILITY OFANY KINDUPONTHE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORl2EDREPRESENTATIVE ='` Samuel Jacks _ _ - ACORD 25 (2401 /08) 1 of 2 CACORD CORPORATION 1988 CCORD CORPORATION 19 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1135 NE 100 Street Miami Shores, FL 33138- 1132050340050 Block: Lot: THOMAS WENSJOE THOMAS WENSJOE Address 1135 NE 100 Street MIAMI SHORES FL 33138 Contractor(s) Phone EUROPEAN SCULPTURED STONE CC (954)742 -6832 CeII Phone Approved: Yes Comments: Date Approved: 4/4/2011: Yes Date Denied: Type Const: Trellise Classification: Residential Scanning: 5_ Additional Info: Scanning: 5 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Amount $5.40 $3.78 $3.78 $1.80 $252.00 $80.00 $3.00 $7.20 $336.96 Pay Date Pay Type Amt Paid Amt Due Invoice # DGT -3 -11 -40469 04/26/2011 Credit Card $ 286.96 $ 50.00 03/29/2011 Check #: 3766 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Slab Final Framing Footing In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. April 26, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 26, 2011 1