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DEMO-12-1622Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 178887 Permit Number: DEMO -8 -12 -1622 Scheduled Inspection Date: September 27, 2012 Inspector: Bruhn, Norman Owner: DEL C NUNEZ, MARIA Job Address: 17 NE 107 Street Miami Shores, FL 33161 -7029 Project: <NONE> Contractor: PROFESSIONAL CONTRACTING AND CONSULTING SERVIC Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1121360070340 Phone: (305)772 -3189 Building Department Comments REMOVE AFFECTED AREAS WALLS AND CEILINGS Infractio Passed Comments INSPECTOR COMMENTS False Passed 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- 177928. No Access. NB September 26, 2012 For Inspections please call: (305)762 -4949 Page 18 of 43 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: City: Miami Shores County: Folio/Parcel#: t -1 NJ � , C:)-1 gt Permit No. MCIEEWMfil AU 2 .2612 ®_.___moo ) 2:- I Master Permit No. ROOFING Miami Dade ( -2 t 3 , -CEO`? -o34 Zip: 3 3 / / Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): M A-re. e �✓# t t L. C. A11 Phone#: 3o -44 C 1 -7rt 3 0 Address: i 7 Aie j 0"7 S°r City: /L1 1 ✓+v i i ' �ff - State: F L- Tenant/Lessee Name: Email: Zip: 33/ b / Phone#: CONTRACTOR: Company Name: r 4 v �ssk ® "lc) 1 ('1 A � ra a 6 ;l S , Phone #: Address: City: Ol.l Qualifier Name: /11/4 -#. i e� TCae- State: h_ State Certification or Registration #: [ f> / / 6 2 Contact Phone #: 30'S-77 2 3 1 S Email Address: DESIGNER: Architect/Engineer: zip: ..)!6 2 Phone#: 307'771-'3 1 S I / Certificate of Competency #: f✓, J Value of Work for this Permit: $ 's t7 Square/Linear Footage of Work: ,��� Type of Work: OAddition UAlteration ONew ORepair/Replace EemolinDtion Description of Work: gra inc.) v� A-r- tied cS £,JQ //S A &de ,& y, S /11ric� proce 1- 74.c.4- aits.;met Phone#: p-�d- Color thru tile: * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * ** ass ***F ***m ************ * * ********* **** **** * ***** *** Submittal Fee $ Permit Fee $■0 Oa CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ ©-3 Double Fee° JSQ Structural Review $ 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, BOIT.ERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S A14FIDAVIT: 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 subje t to attachment. Also, a certified copy of the recorded no c ' of co hce 'tit must be posted at the job site for the first inspecti n w .'ch occurs seven (7) days after the building permit ' iss ''+ d the abience of such posted notice, the inspection will not b - app i ved and a reinspection fee will be charged. Signature � Signatur The foregoing instrument was acknowledged before me this cik day of who is pers Wally known to me or who has produced Fe- 0/41 e- tractor The foregoing instr sent as :..i owledged before me this --- ,201Z,by MAP-44 .lei.. NciNEZ, day of , $2.- ,by )N)W%2IO MAYA , who is personally known to me or who has produced F- L /Li e.. tP who did take an oath. (Vi OD °- 't7 -)i-n as identification and who did take an oath. m N ..•B'% SAMUEL BRYAN Ei NOTARY PUBLIC y f% * MY COMMISSION # DD 886305 NOTARY PUBLIC: o .a s d s :' EXPIRES: September 4, 2013 m o 'F`OOF FL °�\OP Bonded Nu Budget Notary Services ;/ c„ U, m oea z Sign: ' s �; z Print y�viuEc_ vk'N Print: e l�'Y1alGlet/ (3 X % Mwm My Commission Expires: 09/ O(./ 1. N5zo -St £iF- G4.9 -7yf -o As identification My Commission Expires. Cy /. "/3 Sign: *o kHeik*agak ek*** **** *** * * T13 **** *4+*a" vsU ****** ** *******sk*^*f✓ T**** ****sk********* **% k****** ********* ********Tk*******p APPROVED BY U ■174. Plans Examiner Zoning Structural Review Clerk (Revised 3 /122012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) 'O595 5i u Ti pops U T NG AE 2 WORT ' r8':: NgWA FES1ONAL CONTRACT ANO "OM %NM BUILDING POrit RAC T 00'0, PO M T FPNWAHP PROFESSIONAL CONTRACTING AND CONSULTING SERVICES INC MARIO MAYA PRES 1055 NE 179 TERR N MIAMI BEACH FL 33162 I„!h„11 „„1►0i,,,4h1i„yl 0411,1114, 1,1,,1 ?1 fl 09 -16 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO 13E 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: 11/19/2010 EXPIRATION DATE: 11/18/2012 MAYA MARIO G 800245064 BUSINESS NAME AND ADDRESS: PROFESSIONAL CONTRACTING AND CONSULTING SERVICES INC 1055 NE 179 TERRACE NORTH MIAMI BEACH FL 33163 SCOPES OF BUSINESS OR TRADE: 1- CONSTRUCTION 2- CERTIFIED GENERAL CONTRACTOR 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 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 09 -06 QUESTIONS? (850) 413 -1609 CERTIFICATE OF LIABILITY INSURANCE DATE (MMID1 """' 01/02!'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 pollcyltes) must be endorsed. If SUBROGATION IS WANED, subject to the tens 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 Assure -US, Inc. 1880 NE 163rd Street North Miami Beach, FL 33162 Phone (305) 956 -7818 Fax (305) 956 -5946 NAME Jacob Menaker MOTE E,m: (305) 956 -7818 am: (305) 9 -5948 ADDRESS: jacab�g rreus.os INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A : ColonY Insurance Company INSURED Professional Contrast Ig & Consulting Services, INC. 1055 NE 179TH TERRACE North Miami Beach, FL 33162 (305) 772-3189 INSURER B : 12/31/2011 INSURERC : . INSURER D : DAMAGE TO RENTED PREMISES tEe =memo INSURER E : )♦ E CLAIMS -MADE n OCCUR INSURER F : $ 5,000.00 REV'S! O THIS IS TO CERTIFY THAT THE POUCIES 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 REDUUpC�EDDyBEYFPAID CLAIMS. L7TtR TYPE OF INSURANCE 1NAR POLICY NUMBER (IeNIDD11rYYY1 L1t�IwDD11fY1fY) LIMITS A GENERAL UABILITY COMMERCIAL GENERAL LLI TY UIBI 11 -8697 12/31/2011 12/31/2012 EACH OCCURRENCE $ 500,000.00 DAMAGE TO RENTED PREMISES tEe =memo $ 100,000.00 )♦ E CLAIMS -MADE n OCCUR MED EXP (Arty one perms $ 5,000.00 i PERSONAL a ADV NJURY $ 500,000.00 • GENERAL AGGREGATE $ 1,000,000.00 GEM AGGREGATE OMIT APPUES PER ❑ POLICY • , • LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE UABIUTY ANY AUTO El ALL8sWNED AUTOSSCHEDULED COMBINED SINGLE UMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accide t' $ • HIRED AUTOS • AUN D RrWraY(gGE $ II • $ • UMBRELLA UAB • OCCUR EACH OCCURRENCE $ ■ EXCESS UAB • CLAIMS -MADE AGGREGATE $ • DED ❑ RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS LIABILITY Y/N y/ PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MFMRM EXCLUDED? (Mandatory In NH)' NIA • yv UAT($ El 01ll- T Mff$ all- EL EACH ACCENT $ ' EL DISEASE - EA EMPLOYE $ X yyam,, O� DESCRIPf70M OF OPERATIONS below EL DISEASE - POUCY UMR $ DESCRIPTION OF OPERATIONS / LOCATIONS / VBIICLES (Attach ACORD 101, Additional Remarks Schedule,1/ more space Is required) COMMERCIAL GENERAL LIABILfiY POLICY INCLUDING BODILY INJURY & PROPERTY DAMAGE BB P/D. DEDUCTIBLE OF $1,000 CANCELLATION Miami Shores Village Building Dept. 10050 NE 2nd 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 POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) QF 198114W ACORD CORPORATION. AU rights mewed. The ACORD name and logo are registered marks of ACORD O 00 •-N I's- 00 ©1 �� bYwbfi -k5 zsE(1 3t\I Ll �)vhr<s,s� Zavr'N CT TO COMPLIANCE WITH ALL FED[ JD COUNTY RULES AND REGUI A V c19/