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RF-12-789Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173052 Permit Number: RF -5 -12 -789 Scheduled Inspection Date: June 21, 2012 Inspector: Rodriguez, Jorge Owner: REICH, WILLIAM & LAURA Job Address: 138 NE 108 Street Miami Shores, FL 33161- Project: <NONE> Contractor: ABC SEAMLESS RAIN GUTTERS Permit Type: Roof Inspection Type: Final Work Classification: Gutters Phone Number (305)216 -1942 Parcel Number 1121360090050 Phone: (305)226 -3995 Building Department Comments REPLACE GUTTERS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 20, 2012 For Inspections please call: (305)762 -4949 Page 7 of 12 ' 6,- CERTIFICATE OF LIABILITY INSURANCE '�►"'° DATE 05/08DJYYYY) 05/012 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), AUTHORRED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(es) must be enthused. 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 endomement(s). PRODUCER Acceptance Insurance Services 6887 S.W. 40th St Miami, FL 33155 Phone (305)740-0515 Fax ( 305) 740 -0518 CONTACT Rene E. Samayoa PHONE ; (305)740 -0515 1 T. Nap (305)740-0518 AD : rene@acceptancelnsseMces.com INSURERS) AFFORDING COVERAGE NAIL # INSURER A: Accident Insurance Company 11573 INSURED ABC Seamless Rain Gutters, Inc 9185 NW 112 Terr Hialeah Gardens, FL 33018- (305) 226 -3995 INSURER B : 03/11/2012 INSURERC: EACH OCCURRENCE INSURER D : Florida Citrus Business & Industry 31259 INSURER E: $ 100,000.00 INSURER F : $ 5,000.00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPE OF INSURANCE ADDLSUBR INSR IWD POUCY NUMBER POLICY EFF (MMIDDJYYYY) POUCY EXP (MMIDD/YYYYt UMnS A GENERAL LIABILITY N N CPP000134700 03/11/2012 03/11/2013 EACH OCCURRENCE $ 1,000,000.00 if COMMERCIAL GENERAL LIABILITY ❑ • CLAMS-MADE "'J OCCUR ❑ PREMGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEM_ AGGREGATE LIMIT APPLIES PER: In POUCY II J LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS AUTOS ❑ HIRED AUTOS ❑ AUTOS NON-OWNED ❑ ■ CO SINGLE UMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PktOPF12TY l?AMAGE (Pera�de�1 $ $ UMBRELLA A LIAB ❑ OCCUR ❑ ❑77 EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ El DED ❑ RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' UABILJTY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) n If yes, describe under ! r I DESCRIPTION OF OPERATIONS below N / A N 10645381 06/23/ 2011 06/23/2012 ❑ WCSTATU- ❑ EAR 100,000.00 E.L EACH ACCIDENT $ 500,000.00 E.L DISEASE - EA EMPLOYE $ 100,000.00 E.L DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) GUTTER CONTRACTOR CER'11FJCATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2nd Ave MIAMI SHORES, FL, 33138 1305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /II/' ACORD 26 (2010105) QF © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 3 t l INSPECTION'S PHONE NUMBER: (305) 762.4949 pp B ILDING Permit No. � --V" ��' 1 2--151 PERMIT APPLICATION Master Permit No. RECEIVED AAY08Z1Z BY: FBC 20 Permit Type: BUILDING ROOFING � OWNER: Name (Fee Simple Titleholder): W t 1 C t�/I/1 ge iC.L1 Phone#: 20 7S s Address: [ 3 8 N a i 0 O --1-- / City: f i x,4 1 31i �'e S State: R R_ Zip: 33 / 6 Tenant/Lessee Name: Phone#: Email: UV 'p `T e lLi-K-0 Ifvtot1.1 JOB ADDRESS: 13 t City: Miami Shores County: Miami Dade Zip. 33 '1 4 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 5 AacutAleSS ire Phone #: S Z 379'.S Address: (g,O 911 ° N 1 , '-�°- Y (1-4. City: 'fit 3 � II State: ®(. Zip: 3 4, j Qualifier Name: ti ®iZ. arJ - /ZBN' Phone #: State Certification or Registration #: Certificate of Competency #: 0? igS� S4 Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 700 Type of Work: Addition OAlteration Description of Work: A1tdMCN bo I Square/Linear Footage of Work: /SO ONew 'i Repair/Replace ODemolition ors e r t c g —57-9/E ***************************************Fees********* 4** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ 56' Permit Fee $ �0 d a" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ g-(1/40,6 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, BOIT .ERS, 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 /��/L�- �i/° Signature DC-- 3 tam i !°L 6,f ' `k_ Owner or Agent Contractor The foregoing instrument was acknowledged before me this d The foregoing instrument was acknowledged before me this day of Mar , 20 2, by LJ i LL i�t-1 , day of 11 , 20K-; `; by reitA r4 CA\R-t`- who is personally known to me or who has produced 1 -10 who is personally known to me or who has produced CC -Cx-0 CA O' As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign:, Print: My Commission Expires: NOTARY PUBLIC: Sign: Print: r h.; 0 ot+� af•` f, j a'4„ My Commission Expires: ooluitilit .1 .1 VOI '�i • ; ,, 8D I. iollognonnpoo- * * * * * * * * ** + x*** * *** *****w * * * * * * ** *�x�x a�*Atvo i tiyA 1� �n�xa�+ x* �x�xx��r+ ��x�xx�x�**** �x**** x�* a�x��:*+ �x�+ x*** * * *** * ***�x *+x+x�x�x�xx��xx�+�� *** jirC-1--rd— Plans Examiner APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk CUSTOMER: A 8 Seamless CRain Gutters Date. Time: — 8040 NW 103 St. Bay #44 • Hialeah FL 33016 Miami Shores Village Ph: (305) 226 -3995 Ci I APPROVED BY Name IA r I(,�..0 Ct Address: 13e NE layst City, State Phone 3 '733 - o ®62 M 1+ SYJvrte 1 f JOB Si i DATE ZONING DEPT !C: BLDG DEPT Address .3/41 SUBJECT TO COMPLIANCE WITH ALL FEDERAL City, Ste NATE AND COUNTY RULES AND REGULATIONS `C C I-evv t'& CC# 09BS00361 f I f ; 1i c ❑ MUSKET BRONZE BROWN ❑ CAMEO ❑ EGGSHELL ❑ SANDTONE ❑ GREEN D CLASSIC SIC S ❑ GRAY • ❑ ALMOND ® BROWN ❑ OTHER DOWNSPOUT COLOR ❑ MUSKET I = •. ZE BROWN D CAMEO I r D EGGSHELL CI SANDTONE I ❑ GREEN ❑ CLASSIC CREAM D GRAY ❑ROYAL CI ALMOND BROWN D 2x3 ❑ 3x4 ❑ 4x5 0 CONDUCTOR HEAD 1 ❑ OTHER TOTAL FOOTAGE TOTAL $ DEPOSIT $ BALANCE $ SALES REP O CHECK '-)t� - 2Vo -61f/ ts-ALUMINUM ❑ COPPER ❑ GALVANIZED O CREDIT CARD ❑ STAINLESS STEEL 5 YEAR GUARANTEE ON LABOR / 20 YEAR GUARANTEE ON MATERIAL EXCEPT: Damage resulting from accident, misuse. abuse, neglect, or from other than normal and ordinary use of the product. TERMS OF PAYMENT Payment in full due upon completion. Contracts which state a draw cut off date and payment release date are the only ex • flans and must be signed by representatives of both parties. FINANCE CHARGE. Finance charge in amount of the lesser of 1.5% per month (18% per nnum), or the maximum allowed by law. will be added to all invoices that are 30 days past due. APPROVAL No alterations or additional work shall be oe unless agreed to by ABC Seamless Rain Gutters, Inc, beforehand, in� mitt .We a not responsible for damage to ref tiles, shingles or fas CLIENT SIGNATURE- DATE: ®/ AUTHORIZED SIGNATURE: E -mail: abcraingutters@msn.com Sea m 1 e