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DEMO-11-1294Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1' Inspection Number: INSP- 162171 Permit Number: DEMO -7 -11 -1294 Scheduled Inspection Date: October 20, 2011 Inspector: Bruhn, Norman Owner: RHODES, USA Job Address: 1341 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: STONE & PROPERTIES GROUP LLC Permit Type: Demolition Inspection Type: Final Work Classification: Budding Phone Number Parcel Number 1132050300140 Phone: (305)592 -3376 Building Department Comments DEMOLITION OF KITCHEN, BATHROOMS & FLOORS FOR NEW REMODEL Inspector Comments Passed "0://th,�� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 19, 2011 For Inspections please call: (305)762 -4949 Page 8 of 16 1)9.(ock� Miami Shores Village Building Department 40050 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 No. 11 1- PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: 3UILDIN( ROOFING OWNER: Name (Fee Simple Titleholder): L0 �A 14- 4OD S Address: 1541 E 103 ST City: MV NOV SHOP-ES Phone#: 7lq $32.7555 State: F L Zip: 3 313 e Tenant/Lessee Name: Phone #: Finail JOB ADDRESS: 81=-8 6 NG 6 (23 ST City: Miami Shores County: Miami Dade Zip: s3136 Folio/Parcel #: I O ° 32.05-050-0140 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: STON P 2 Q? J1ES Phone#: 3055923276 Address: ?4 SW 340 mr 1 r¶ City: +a \(M1 State: F. L Qualifier Name: ISNV t E *10 M L Zip: • )31; / Phone#: O55 2 b27 State Certification or Registration #: Certificate of Competency #: Contact Phone#: 76G 5L72G7 Rr nailAddress: jnn®STRXCl 00(1Zarltdpr DESIGNER: Architect/Engineer: P-.09) F l r ch0 Id 4 Phone#: Value of Work for this Permit: $ 6, 000 square/Linear Footage of Work: 000 SF-. Type of Work: ❑Addition ©Alteration New C1Repair/Replace Description of Work: i Pmt , '�,rb®rflS a .f.-4C)00,. � f t 1Af�6� I molition a * * * * * * * * * * * * * * * * * ***e *** * * * * * *a*** **** Fees * ** * ** * **** * ***+ *** * * * * ***** * * *** ******** *** Submittal Fee $ Permit Fee $ /if-0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 1 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 ET 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 o h posted notic he inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 13 day of 20 I, , by Ll.3G4 koD who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: .- 41 r_t; n: • MEZ My Commis i#tn ''P y• tAY COMMISSIQN # DD945290 EXPIRES January 18, 2014 6-0153 FbrldsNafaLcom Signature The foregoing ins day of ontractor was acknowledged before me this 20 l lI , by •c5tRet who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: My Co 00945290 EXPIRES January 18, 2014 40 I04.0103 FWrWallotarySeMoe.com ******* **ckcb+kck +kcbcbck**cP**** CAN+ k+ FcY**** **+ kck**ckchck*cb* ****** *+ k****** rM*ckcM+ R+ kck*+Uck ****** **********dc*rkl +kcP**rkck *********** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15109) Zoning Clerk • fWAIS fiegWris igtt:1112 *art . -1 1 1INwi e+ Il "$208"030'0140 Warranty D Inds - ill Oa • X44. • Loalati S. Loa, �Aa�-,, i�si nglo woman • stun 't 1444 $ Use -*bodes ,.• a gla ten'.. :mama Mani a 1341 WS' 103 .*trs►st, •1iaani Stores J Fii• ' 33130 %tIx h 1 •'. -� 3011 &D.. of Arkansas ens owe .d' )Iiami -Dade , It of Florida ' WIC • nadagdtU ,tli.lomiliti<tootakistoiltaofOw s of . 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SHAUNA WOOD • NOTARY PUaUC- ARKANSAS GARLAND COUNTY MY CAMM1SSION EXPIRES' 09.24.14 . • }: . ✓+. .: :1h:a • • l.•.r m.tWS•+WiPir %+w'aar'iti:s' .•. M'1ars•M:•tK . . r •. • . ' . • ' . • :. a. acearding ea Plat thariato 0. 4~414 alr ilk• 03%,, Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPTI D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Sr0 P P-017 I E-S. 6 BUSINESS ADDRESS: 2-I a I s W 3"464 20 �-c Ty M 1.4.0 STATE Ft— ZIP CODE 33 l a9 BUSINESS PHONE: (305 ) 592327 FAX NUMBER (305) 5‘/2_337G CELL PHONE (75G )5y672 77 QUALIFIER'S NAME: V 1E ... 'IOMf•2 QUALIFIER'S LIC NUMBER: QfJG 1512.230 E -MAIL ADDRESS (IF APPLICABLE): OS Win Created on 3119109 BY MLDV / RY 3128109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 GOMEZ, JAVIER STONE & PROPERTIES GROUP LLC 6020 NW 99TH AVE UNIT 313 DORAL FL 33178 Congratulations! With this license you become one of the nearly one million Ftortdians 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.mAorldancense.com. Them 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 strlve to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487 -1395 DETACH HERE .CH NUMBS! DO NOT FORWARD STONE 8 PROPERTIES GROUP II INC CARLOS LIEVANO 2121 SW 3 AVE 205 MIAMI FL WA% CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 7/6/2011 PRODUCER 305.630.4777, Fax305.279.3022 Gil Garden Avetrani Insurance Group 10689 N. Kendall Dr. Suite 208 Miami FL 33176 INSURED Stone & Properties Group II Inc 2121 SW 3 Avenue Suite 205 Miami FL 33129 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 INSuRERA:BuainessFirMt Ins. Co. INSURER B: INSURER C: INSURER D: INSURER E: NAIC # COVERAGES 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L P CY E pow( :a e' (RATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER PATE DATFn QV L ®lYn.YJ LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR GENT. AGGREGATE LIMIT APPLIES PER POLICY JECT LOC EACH OCCURRENCE $ DAMAGE RENTED PREMISES (Ea occurrence) $ ( MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS (� ��) SINGLE UNIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS /UMBRELLALIABILITY EACH OCCURRENCE $ AGGREGATE $ $ $ $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION A 95057 4056 AND EMPLOYERS' LIABILITY t' I N 08/18/2010 08/18/2011 WC STATU- OTH- Y TORY LIMITS ER E L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ 500, 000 500,000 500,000 ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED( I I (Mandatory In NH) If yyon�,, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg. Dept 10050 NB 2nd Ave Miami Shores, FL 33138 SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED G REPRESENTATIVE Frank Gil/SVC 2r1OdamMe ACORD 25 (2009/01) INS025 /,nnrsv I O 1988 -2009 ACORD CORPORATION. Al rights reserved, TM. A"•nem .S A"nen IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) INS025 poem) ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID YL STONE -1 DATE(MMIDD/YYYY) 07/07/11 TYPE OF INSURANCE PRODUCER Insurance Marketers, Inc. 2600 Douglas Road Suite 712 Coral Gables FL 33134 Phone:305- 442 -9507 Fax :305- 447 -8527 HIS 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Stone & Properties Group LLC. Stone & Properties Group II, Mr. Carlos Lievano 2121 SW�3rrd1Avvenue, #205 INSURER A: Mid- Continent Casualty Company 23418 INSURER B: 04GL000815345 INSURER C: 03/06/12 INSURER D: $1000000 X INSURER E: $100000 COVERAGES THE POUCIES 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 POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. K MK RDD't NSRO TYPE OF INSURANCE POLICY NUMBER �C D T Y(MI IYY) pOL�y DATE (MM1DD/Y� LIMITS A GENERAL LIABILITY COMMERCIALGENERALUABILITY 04GL000815345 03/06/11 03/06/12 EACH OCCURRENCE $1000000 X pREMIgE8(Ea "ooat r�Dm,ca) $100000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ SXCLODED PERSONAL & ACV INJURY $ 10 0 0 0 0 0 GENERAL AGGREGATE $ 2000000 OWL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2 0 0 0 0 0 0 i7 POLICY JEOT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED (Ea accident) SINGLE LIMIT $ BODILY INJURY (Per Pin) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLAUABI.ITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC STATU- 0 H- TORY LIMITS ER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Coverage is subject to terms, conditions, deductibles and exclusions as shown in the policy. 10 days notice of cancellation for non- payment of premium. CERTIFICATE HOLDER CANCELLATION MIAMIS2 Miami Shores Village Building Department 10050 NB 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MM. 3 0 DAYS WRnTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) 07/26/2011 13:17 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES 11001 * * * * ** * * * ** * * * * * * ** ** *** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 1605 RECIPIENT ADDRESS 93055923376 DESTINATION ID ST. TIME 07/26 13:16 TIME USE 00'58 PAGES SENT 1 RESULT OK Permit No: 11 -1294 Job Name: July 22, 2011 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) This property is located in a flood zone (ae.9). No demolition permit will be issued without first having a building permit with all required calculations. Please complete a substantial improvement verification form and attach executed contracts. STOPPED REVIEW 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 FS-5- 3 ?i --112(0111 ui Permit No: 11 -1294 Job Name: July 22, 2011 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) This property is located in a flood zone (ae -9). No demolition permit will be issued without first having a building permit with all required calculations. Please complete a substantial improvement verification form and attach executed contracts. STOPPED REVIEW 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 rk 335 -59 a