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RF-07-878
s 4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -47828 Permit Number: RF -5 -07 -878 Scheduled Inspection Date: March 21, 2012 Inspector: Bruhn, Norman Owner: OR OWNERS, CURRENT OCCUPANT Job Address: 490 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: JOHN BUSTA ROOFING INC Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1132060170550 Phone: (305)757 -7620 Building Department Comments REMOVE AND REPLACE FACIA BOARD SOFFIT Passed % / Failed R2/61 Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 20, 2012 For Inspections please call: (305)762 -4949 Page 23 of 23 BUILDING PE FBC 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. — C7 r Master Permit No. \.,MAR $0Z01Z Permit : UILDING ROOFING OWNER: Name (Fee Simple Titleholder): #6EXUSE TOWS Phone#: &7.5' 7g9 ° g0 Address: 1,90. /az c5�a City: 4 /A kt/ Sd6 2 State: AZOR MA Zip: 53/3 Tenant/Lessee Name: A%4,I Phone #: /VA Email: /M JOB ADDRESS: 4/90 A/Eta Z (S -gt'Er City: Miami Shores County: Folio/Parcel #: l/° 9.0 0/1-4.550 Is the Building Historically Designated: Yes NO Miami Dade Zip: 33 /39 Flood !Zone: CONTRACTOR: Company Namef 3/:-/ / /t. 4 0/C Address: :3OC NE q/ - City: h/44/ State: FL- J/g Qualifier Name: C /,W 1 � iz 4 State Certification or Registration #: ece. ° 62.5V e2 4 42, Certificate of Competency #: phone: C 2 5 -757-762.0 Zip: 33/38 Phone #: 305-V9- 96 97 Contact Ph 'one*: 75'7 ° 7 Email Address- " 0C) a-si "VL + cf,Af DESIGNER: Architect/Engineer: /1/,A Phone #: NA Value of Work for this Permit: $ / 000, Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New e ®Re�air/Replace ODemolition Description of Work: geE AOd& V i€604,4e, Fits e/A /3oMR AetJ,6 SO F,7 A7 FRONT . 'OMR_ AREA * *********+x********DI:* *+ x+ x** *************Fees********+x*+ + a+ x***** *************+x*** ********* Submittal Fee $ Permit Fee $ t 00 • W Scanning Fee $ • Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ O 0 m Bonding Company's Name (if applicable) ,/VA Bonding Company's Address NA City ,4J4 State /t% A Zip //A Mortgage Lender's Name (if applicable) Mortgage Lender's Address A/A City l A State NA zip /t/A Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work r 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 t be approved and a reinspection fee will be charged. .t Signature c � 24 r / ' — Signature 1PffriPik Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was ac wledged before me this SZ tea. day of 20 . by avfqn ®Zre ,Sday of , 20 , by who is personally known to me or who has produced who is or who has produced As identification and Atwaialittilft.iiyikoath. NOTARY PUBLIC: o` ••• •••=9ri4'�.% Ikk_O v cs "41111 NI It°° Sign: Print: My Commission Expires: as identification and who dic} �t�ittnanty��h `N,, i' NOTARY PUBLIC: �dLS Au. p i h ! ep. _Na ,1'111 tll1iiiittt '' ��`` Sign: Print: My Commission Expires: *************************** ***** ******* *m ****+ x*+ x*+ x* ***** ************* ************* *** * ********************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) `° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 03/20/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES 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(tes) 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 Southeast Insurance Agency 5001 S University Drive Suite K Davie, FL 33328 Phone (954) 680 -2255 Fax (954) 680 -3208 CONTACT MASSIMO PULCINI NAME: ((a/c°. No. Extl: (954) 680 -2255 1 a , No): (954) 680 -3208 E-MAIL ASS: southeastinsuran@belisouth.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : NORTH POINTE INSURANCE COMPANY INSURED JOHN BUSTA ROOFING INC. 300 NE 91 Street Miami Shores, FL 33138 954 INSURER B : 12/09/2011 INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person INSURER F : ❑ Fl ATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP ( MM/DD/YYYY) LIMBS A GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY ❑ • CLAIMS -MADE n OCCUR CPP10497 12/09/2011 12/09/2012 EACH OCCURRENCE $ 300,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person $ ❑ PERSONAL & ADV NJURY $ ❑ GENERAL AGGREGATE $ 600,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO • LOC JErT PRODUCTS - COMP /OP AGG $ 300,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS NED ❑ AUTOS SCHEDULED ❑ HIRED AUTOS ❑ AUTOS ■ ■ C�OaMBI NDISINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB • CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A = TOSS LIMITS = OT E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE ATTN: BUILDING DEPT 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) OF ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Parcel Number Expiration: 10/29/2007 Applicant 490 NE 102 Street Miami Shores, FL 1132060170550 Block: Lot WILLIAM CATE 941 NE 91 TERR MIAMI SHORES FL 33138 -3219 Contractor(s) JOHN BUSTA ROOFING INC Phone Cell Phone (305)757 -7620 Type of Work: Repairs Additional Info: SOFFIT AREA Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Repairs Scanning Fee Technology Fee Total: Amount $0.80 $0.20 $100.00 $3.00 $2.50 $106.30 Total Amt Paid I Amt Due $ 0.00 $ 0.00 Payment Type: $ 0.00 ,CLI1 41.13JUL 1 1PAID Available Inspections : Inspection Type: Final Roof Roof in Progress 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 02, 2007 Date Wednesday, May 2, 2007 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 754;8972 BUILDING OD103102 UX PERMIT APPLICATION JOl^`t, FBC 2004 Permit Type (circle): Building ?fin? BY: Permit No. —WI Master Permit No. Electrical Plumbing Mechanical Owner's Name (Fee i ple Titleholder) Phone # `, - -75gLD Owner's Address 0 (VZ City IQ(') 1 a )re.) State 1 Tenant/Lessee Name Nf/1 Zip Phone # A Job Address (where the work is being done) 4/9O ,v,E. i O 67 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # /1 3 - 0/ 7 — Is Building Historically Designated YES Zip 3 +/ 3g Contractor's Company Nam ' 4( %/ 6)64,57A / C Contractor's Address 300 4(/ 6 9/0-7. S7, r City %1%'C ji;" State Qualifier Name N ,..0/9250- l&4 Phone # 305- - SS% . 74, Zip 33/?‘ . 3/3P Phone # 3 a -7/7- 96 9f State Certificate or Registration No. e T e' Certificate of Competency No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $ y�� Phone # /V/74 Square / Linear Footage Of Work: of Work: DAddition ❑ eration EiNew 20 Repair/Replace ❑ Demolition Describe W o r k : z . F A e z i l sA R E A or `,; Ae 7j /7- y' tw es Ci :.f<l+s ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *Fe Permit Fee $ / b O Submittal Fee $ Notary $ Scanning $ •00 * ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Training/Education Fee $ 'aio Radon $ DPBR $ CCF $ 0(00 CO/CC Technology Fee $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ j See Reverse side —* Bonding Company's Name (if applicable) Bonding Company's Address City Sta " f Zip Mortgage Lender's Name (if applicable Mortgage Lender's Address City tate Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify commenced prior to the issuance of a permit and that all work will be performed to meet the construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICA WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC that no work or installation has tandards of all laws regulating WORK, PLUMBING, SIGNS, OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wi 1 be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEM NT 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 RECORD NG YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exc promise in good faith that a copy of the notice of commencement and construction lien law brochur whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem for the first inspection which occurs seven (7) days after the building permit is issued. In the ab inspection will not be approved ara reinspection fee will be charged. Signature(y Signature eding $2500, the applicant must will be delivered to the person nt must be posted at the job site ence of such posted notice, the Owner or Agent Co tractor The foregoing instrument was acknowledged before me this The foregoing instrument was adknowl dged before me this day of J� " 2Q('?, by C�_Q , day of , 24�� y s nersonaiiv known to me or w o has produced who personally known to e r who as produced entific tion and who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: IND V C A.1 •Q, My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) LORRAINE ELL Notary Public -titittitbt Florida I - OV-LA • duly Commission Ex Tres pr 16, 2010 �;= commission lt n� ft-1 � Expires: o 510 7 Plans Examiner Engineer Zoning • • • •• Process No. Roddseidlding Code Edition !# r eZone Uniform Permit Section A (General informattonl Master PIrmit None JobAdthess 17470 NF-ift9.4 ° ROOF CATEGORY ❑ Low Slope ❑ Medundcally Fastened Tile ModadAdiesIve Set ]� Asphanic ❑ Metal PanelfShin9les ❑ Wood Shiny Shingles Are th 0 Prescriptive BUR -RAS 150 Gas *ent Yes'❑ ROOF TYPE type: Natural PGX D B Y: ° ❑..1 Roof ❑ Re- Roofing ❑ Recovering 1 Repair 0 Menance ROOF SYSTEM INFORMATION Low Stops Roof Area (59 Steep Sloped Roof Area (59 Total (59 p() Section B (Roof Plan) Sketch Roof Pare Illustrate all levels and sections, roof drains, sus, ov i scuppers and overflow drains. dknensions of sections and. 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