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RF-12-1637Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 178008 Permit Number: RF -9 -12 -1637 Scheduled Inspection Date: October 01, 2012 Inspector: Bruhn, Norman Owner: INC, NICAMERICAN Job Address: 1360 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A -1 GUTTERS TECH INC Permit Type: Roof Inspection Type: Final Work Classification: Gutters Phone Number Parcel Number 1132050300070 Phone: (305)457 -0863 Building Department Comments INSTALL GUTTERS Inspector Comments Passed J/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 28, 2012 For Inspections please call: (305)762 -4949 Page 11 of 36 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 Permit Type: BUILDING JOB ADDRESS: 1 t it 0 3 S r City: Miami Shores County: RECEIVED SEP 0 4 2012 r C20(( Permit No. F4 2_ 1 (z3 Master Permit No. ROOFING Miami Dade Zip: � ► 3 � Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1 1 ��P,[ � ) �"� _ Phone#: kc° 6 ST 0867 Address: A 3 Co N c_- Ao � S Zip: 3 3 Y -e�gc� Tenant/Lessee Name: Bo f-�,fts-tit k` 1 t c Phone #: 1-8,G SL13 TES G,1 City: 14 14/61-14 S t,.4,0 s State: FL- Email: ( RI .1A-QC (D fro L'1 /MA_ ° C011 CONTRACTOR: Company Name: A-.1 &I1/Q5 71j\ INC Phone#: Address: Z V O /01i, Ave City: i /Q. 4t. L State: _ Qualifier Name: f d d g y c / O , d, eV l"� Phone # 3 0.5-° 3 d —"EP Zip: State Certification or Registration #: Certificate of Comf ten cy #: og 0 ' 73 Contact Phone #: Email Address: ed L 0 YI o e Ai b u Q r v e, (a L) r C t) ►tee DESIGNER: Architect/Engineer: Phone #: 305 - 31 ? -2fIi Value of Work for this Permit: $ 6 ®6 Square/Linear Footage of Work: Type of Work: ❑Addition D Alteration New ORepair/Replace 1 t Description of Work: 5 il / ei E o � u tie v_3 ODemolition Color thru tile: ** ************* *******:x**** *******+x****Feeo* �x�x�x�x****** * *xx�x� *�xx�a� *�x�x�x **** ****** ** * * *** Submittal Fee $ O ar) Permit Fee $ / 'C CCF $ CO /CC $ Scanning Fee $ .S �' Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ i , _ TOTAL FEE NOW DUE $ L 'R Bonding Company's Name (if applicable) 3onding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip pplication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has ommenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating onstruction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, LLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all pplicable laws regulating construction and zoning. `WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF OMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR MPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN INANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." otice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must romise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person hose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site or the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the nspection will not be approved < inspection fee will be charged. ignature Owner or Agent e foregoing instrument was acknowledged before me this ay of � � s I� , 20 d �,- by till 1 � r ) 9 J u, ho is p lly k. o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ',®ou bopiAi =;moo ti 1. •O My Commission Eime..1... d�� y ..k : o :d .� ▪ v °�4� ."4- ....= PROVED BY rtF `•`4_ Plans Examiner Structural Review Signature (923.4A°1— Contractor The foregoing instrument was acknowledged before me this day of� C , 20 CZ; by e��- 1�dC� who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: _ ,W t. • p 4 i O� • o'.a'cC= My Commission Expires: *********************************************V44;11..;;;‘ Akt Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 08 -09 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE 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: 08/09/2012 EXPIRATION DATE: Of ALBUERNE EDUARDO 204997312 BUSINESS NAME AND ADDRESS: A 1 GUTTERS TECH INC 2740 EAST 10 AVE HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: 1- GUTTER CLEANING CT ?B Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09BS00673 A -1 GUTTERS TECH INC D.B.A.: A ERNE EDUARDO Is certified under the provisions of Chapter 10 of Miami -Dade County 2- GUTTER INSTALLATION VALID FOR CONTRACTING UNTIL 09/30/2012 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 440.05(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 parson 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 parson 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 A -1 Gutters Tech In Tel: 305.512.5158 - Fax: 305.691.36 PROPOSAL SUBMITTED TO:. Narn,3 , PE 103 3 Address: PIA a;. t3 j-- dity, Starts 33/ Phone Date: LIC# 09BS00673 WORK TO BE PERFORMED AT: Address: City, State GU. •ER COtOR ITE O CREAM D IVORY D BROWN ■ BRONZE DGRAY © L. GRAY 0 D. GRAY D EGGSHELL 0 ALMOND D GREEN D RED 0 GOLD 0 OTHER -POUT COLOR D IVORY 0 BRONZE 0 L GRAY 0 EGGSHE D GREEN 0 GOLD 03X4 D CONDUCTOR HEAD © OTHER D CREAM D BROWN 0 GRAY O D. GRAY O ALMOND E3 RED 0 2X3 O 4X5 FOOTAGE TOTAL DOWNSPOUT SALES REP WTEE ON. LABOR 120 YEAR GUARANTEE ON MATERIAL acc dent. rrasuse, abuse, neglect, or from other than normal and ordinary use of the oduot TOTAL $ 0 CASH •. 0 ALUMINUM 0 CHECK 0 COPPER 0 L .V ilZ D' 0 STAINLESS S'T'E FROM (TUE) SEP 4 2012 1O: 23IST. 1O: 22 !No. 9901832661 P 1 vriu:LA. '`� -'`"' CERTIFICATE OF LIABILITY INSURANCE DA�`"04/12"'Y' 09/04/12 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 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 pollay(les) 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 to lieu of such endorsement(s). insurance Network Center Luis De Gongora 7735 NW 146 ST., SUITE 204 MIamI Lakes, FL 33016 Luis De Gongora 305 -362 -0052 305- 362 -0080 POLICY NUMBER PHON o. �: I FAX No): �: PRODUCER CUSTOMER ID N: Al GUT -1 INSURERS) AFFORDING COVERAGE INSURERA :GRANADA INSURANCE CO. NAIC II INSURED Al GUTTERS TECH INC 2740 E 10 Ave HIALEAH, FL 33013 PlrnleaA P►ea ��____ I INSURER a INSURER C : 0185FL00035046 INSURER D : 03/29/13 INSURER E : $ 500,000 INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) • THIS INDICATED. CERTIFICATE EXCLUSIONS GAR REVISION NUMBER: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL !NM SUER H -u POLICY NUMBER MIDDIYYTY) OMEDDIYYYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL I LIABILITY OCCUR 0185FL00035046 03/29/12 03/29/13 EACH OCCURRENCE $ 500,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 J CLAIMS-MADE MED EXP (Any one person) $ 5,000 PERSONAL 5 ADV INJURY $ 5O0,000 GENERAL AGGREGATE $ 500,000 `GEN'L AGGREGATE LIMIT I POLICY 7 JPER - APPLIES PER: PRODUCTS - COMP/OP AGG $ 500,000 -I LOC $ 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 accldant) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA 1.148 EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER MEAXCLUDED (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N NIA I TORY L MITS I OER I ECUTNE E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE •POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sohedul. It more space h requital) CERTIFICATE 1-Ini n=o - - _ _ - - VILLAG4 VILLAGE OF MIAMI SHORES 305 -756 -8972 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE ELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL — DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Luis De Gongora © 1988-2009 ACORD CORPORAT • N. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD