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ACT-12-1902Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 179798 Permit Number: ACT -10 -12 -1902 Scheduled Inspection Date: November 01, 2012 Inspector: Rodriguez, Jorge Owner: Job Address: 9820 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: JMR CONSTRUCTION CO INC. Permit Type: Awnings /Canopies/Tents Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1132060132240 Phone: 305 - 672 -8055 Building Department Comments RECOVER AWNING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 01, 2012 For Inspections please call: (305)762 -4949 Page 8 of 15 PERMIT # CONTRACTOR: G AcW - t r aS E SUBMITTAL DATE: I O I l l I (I-- ADDRESS: \' ' 2-e-D NE- 2 /1(-- NAME: RESUBMITAL DATES: PROJECT TYPE: ZONING e `� .. 1 - / o / /// /2. 6. lam- f ta. +�iti FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLDG r�/ vv 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 PO lU e Oahvi FBC201O Permit No. 112-7- Master Permit No. P 1 1G 0 ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Aftarkh% 5hOre5 Cevii'er Phone#: 3Q g of . g Ub r Address: oaf ® 7151- ie3o 9 City: fire' Beach State: zip: 33lLtI Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: -Sisik R. Co t& setT u. c.f O G , Phone#: �D S • � % � • Li L 3 Address: pO (3 ©X 0 g 7/ City: Cora y imps Name: State: Zip: �-� f l e'?Y Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: OAddition OAlteration CINew • air/Replace Description of Work: Alew canvois ®F eX ISf L °, ono 5f ODemolition Color thru tile: ********* **+ x+ x*******.x**+x•x****** * * * *** * Fees+ x********. x. x**• x**+ x** ** ****** * ***•x****a• ***+x*** Submittal Fee $ Permit Fee $ �tD• 6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ( S 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, 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 co 'ncement must be po ed at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 1 ' th absence o : ,ch posted notice, the inspection will not be approved and a r inspect' n fee will be charged Signature GIMAAAA- Owner or A t t, The foregoing instrument was acknowledged before me this ,� "I day of , 20 _ii,by 4� ; eh?V: e , who islerso� ally known to me or who has roduced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 04. 0 LL ' My Co .e,, ORIT MIMOUN * Commission # DD 946625 F.* L. My Commission Expires Signature Contractor The foregoing instrument was acknow ed ed bef e e this�� day of ®d- . , 20 / by c f e rho vi wh a na y known to me or who has produced as identification and who did take an oath. NOTARY P Sign: Print: My Commission E ** * * * * * ** * * * * *** *ear * * ** * *** * ** APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ' ""t,; ORIT MIMOUN ° os a Commission # DD 946625 ' . My Commission Expires Zoning Clerk � R � CERTIFICATE OF LIABILITY INSURANCE OP IC DATE (1a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CCOONTTRRACC BE WE COVERAGE NG INSURERS), BY THE POLICE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE MOLDER BETWEEN THE ISSUING INSURER(S), AUTIiOR(ZI IMPORTANT: H the certificate holder Is an ADOmONAL INSURED, the polIcyges) mu certificate st the terms and �e"�d� SUBR�� o�holder n such conditions of the Fades may require an endorsement. A aemnt certificate not rights to t Peon 409 SE 7th St Insurance Fort Dou A. Levy glas Lauderdale, FL 33301 INSURED JMR Construction Co. 11890 NW 19th Drive Coral Springs, FL 33071 COVERA ES CERTIFICATE NU r• = ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION NUMBER: CERTIFICATE MAY STANDI OR ANY ARY THE ' � OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH FOR ECT TO Ima THI1 EI(CLUStONS AND INSURANCE AFFORDED BY THE POLICIES DESCRIBED RESPECT TO TO THE THE CONDITIONS OF SUCH POLICIES. LIMITS SHOW MAY HAVE BEEN REDUCED BY PAID CLAIMS. HERGN � TO ALL THE TTRM9 TYPE OPMUM= Phone: 954.487 Fax 954 -944 -1881 Atl;t COVERAGE A :Accident Ins. Co. e• INSURERC D; INSURER B; Nara • GENERAL LIABILITY ® CLAIMGDADE a OCCUR GENL AGGREGATE UNIT APPLIES Pet POLICY LOC ANY AUTO AALtuirED NIREDAUTOS UREMIA Una OCCUR EXCESS uAe CIAIMS4IAOE RETENTION WORKERS C a AND ANY ��� T Ej /N �((1�1apndaoenyMC, Ll f1ON OF OPERATIONS beto n N/A 1677731 0615112 MS/4 �Occ a 1,000,1 s 001 eiED (any EXP cs epNlcr1 $ PERSONAL aADVINJURY $ 1,000,1 GERERa6AGGREGATE $ 2,000,C PRODUCTS •CO/ADP At3t3 $ 2,000,0 a BODILY INJURY LIMNT 1'cri0*c1» $ BODILY INJURY (Parnell:W) $ a 1 EACH O0 URREN( AGGREGATE EL FAIN mama EL DISEASE •EA EMPLOYEE, $ DESCRIPTION OP General OPERATIONS UICAT{ONS 1 VEHICLES Ugh ACORD 101, AQdatl Ramsdn BeAdcNp npm numb r ) = CERTIFICATE HOLDER ILL DISEASE • POLICY LIMIT $ VILLAGE Village of Miami 10050 NE 2nd Ave Miami Shores, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELUID BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED f)V ACCORDANCE WITH THE POLICY PRDVSIONS. AUDI PAPRESENTATIVE (01100M, (81988"2010 ACORD CORPORATION. All rights reserved. ace MU l0nth* te marts otACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954-831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA:J M R CONSTUCTION CO INC Business Name: Owner Name: SIDNEY L ROBERTSON Business Location: 11690 NW 19 DR CORAL SPRINGS Business Phone: 305-672-8055 Rooms Seats Employees 10 Receipt #:GENER L7 CONTRACTOR Business Type:coNTR) Business Opened :03 /28/1991 StatelCountylCert!Reg :CBC125263 0 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Typo: (G Tax Amount Transfer Fee NSF Fee Penalty Prior Yeats Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and Is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it Is in compliance with State or local laws and regulations. Malting Address: SIDNEY L ROBERTSON P 0 BOX 770871 CORAL SPRINGS, FL 33077 Receipt 803A -11- 00006629 Paid 09/05/2012 27.00 2012 - 2013 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ROBERTSON, SIDNEY LYLE JMR CONSTRUCTION CO INC 11690 NORTHWEST 19TH DRIVE CORAL SPRINGS FL 33077 Congratulations! With this license you become one of the nearly one million Floridians 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.myfloridaticense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! AC# 6247479 DETACH HERE STATE of FLORIDA AC# 6247479 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CBC1252630:' 08/04/12 128028752 CERTIFIED BUILDING_ CONTRACTOR ROBERTSON, SIDNEY LYLE JMR CONSTRUCTION CO INC I8 CERTIFIED under the provisions et ch.489 Ps Expiration Hater AUG 31, 2014 L12080400456 'THIS DOCUMENT HAS `A COLORED 5BACKGRoallo MICROPRINTING •'..INEMARkw PATENTED'PAPER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFEEggS ONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SOW L1208040t)456 LICENSE NBR CBC1252630 . The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 Expiration date: AUG 31, 2014 SIDNEY LYLE JMR CONSTRUCTION CO INC 11690 NORTHWEST 19TH DRIVE CORAL SPRINGS FL 33077 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW REN LAWSON SECRETARY A '� CERTIFICATE OF LIABILITY INSURANCE DATE ottaYYYI 10/23/12 1165 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND =FIFERS NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS CER71RCA1EDOES NOT AFFIRMATIVELY OR mamma, AMEND, EXTENDORA.TER IRE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(Sj. AUTHORIZED REPRESENTATIVE OR PRODUCER. Ala THE CERTIFICATE HOLDER. IMPORTANT: !Ike content holder Is in ADCIITIONALOYdARED, the panties) NM be massed. ti5UERODATIDN LS WANED. =Sled to the tonne nude:million Otto pony,certain policies way require an endue :saner. A INESMINLE ontldscereflea1edoes nal confer rights boar celtabeda bolder In Ike al such mss). PEOR Oneaaaee Of Florida Ins Sew boo 184955 Diode Hwy#110 taunt FL 33157 Pitons (305)7448478 Fax ()7406951 INSURED .IMR Censbodlon Co. p1° P.O.8oa 770871 Core) SpsIngs. FL 33077 COVERAGES -' CERTIFICATE NUMBEFb REVISION NUMBER THIS 13 TO CERTIFY 'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE I1IAMED MANED OMAR FORTH@ POLICY PERK WED. NONATIGTAPRING ANY REOURSAINT. TERROR COMMON O+ANY CONTRACT CROTHER COMMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR (WAY PERTAIN. THE INBURANCEAFFORDED BY THE POLICIES CESCRIBED HEREIN ISSUBJEOT TO ALL THE YEWS. ECCWEIOPIS AND CONDITIONS OF SUCH POLICIES. LASTS SHOWN MAY HAVE BEEN REDUCED BY PAID CUM. . rECP nisuiunli Andaman 061areALIBLrY _ . B 6 OatN6RCCW6OesleitALw ury 0 El GUNS/MN U °noun ❑ MEWL ANNUM LIVE AMMO PEN: ❑ POLICY ❑ .tea ❑ LOC ALT OIANILE LMalLRY ❑ ANYAt11D 8 a L., arc= C I,UiEDAUTO9 C :0 UMBRELLA LIM EXCESS U E C3 AUTOS e�•reDYtev ❑ AMIN 0 E OCCUR CLANSMAN ❑ DRD..»a TBiiig s WONIU SBCOINENBATON AN BEPLOYnRIT LY.WUTV Y!N ANY MROPMERsumARTNERIERECUTAN 11/0 OPFICERNEMBER mums? r---1 YrA PTIOi+ OF smovo wow i.�J eCCNRRONCe _PjffattgareLveinevaal YEA CIPoOneoersgn PERSONAL ACV RUM/ CENERALAGGREGATE PROCYCTe. COMP G I �sr�IA wnr $ B ossy WUURY(Perp ) s UMW OUNRY(POtaaagmq s•�. a WCF781174100 0BO$12012 0910513013 EACH OCCURRENCE ACERBATE r WAvs<At s ❑ ER. e t. EACH ACCIDENT s 100000.00 e t. Dew. EA EMPLOYE s 100.000.00 eI.odesse.DOL1¢YLI4l1T s 500.000.00 R OP DPERATe 1 LOCATIOTIBIV 33L33 (AID ACORO ICI. MOWN Ibmub ate. a �ws space Y Nawne) CERTIRCATEHOLDER VI1 ge Of lend Stoles 103S0 NE 2nd Ave Miami. FL 33198 i AC)ORD25 poem* GP 1d I969'OPLSO£ CANCELLATION SECLULCI ANY OP THE ABOVE DESCRIBED ROM= ISM CRO .,E, I = BERM us EXPIRATION CATETHEREOF, NOTICE WU. BEGRASSED Of ACCORDANCEWITH THE POLBZYPRDV . AUSIONEDRi ENTATWE ID 1988.2010 ACCRD CORPORATION. NI d9Ms r'eservad. The ACORD name saes logo are rsgtstered mks OIACORD BPPoId JO eanoseu0 e9L :LO ZL £ZOO 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: q City: Miami Shores Folio/Parcel #: Ne 2hot Akre FBC 20 tp Permit No. Master Permit No. ALT 1 1 � 0 Z ROOFING County: Miami Dade Zip: 3g Is the Building Historically Designated: Yes NO Flood Zone: p Titleholder): Mi'ctAM i- Sors Cer r A C OWNER: Name ee Sim le Titleholder : Phone #•, `.30�' "349%— '80 Address: lo Sfi 4 re 4- a City: / am i Shores State: �' � Zip: 3 14 1 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: /620 Name: Address: /620 bJ 33 City: H i 1,e ct LI Qualifier Name: lV "dL or vel State Certification or Registration #: Certificat Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: —716 6 31 D. Cb11? Phone# Zip: 0 Q, Phone #: e�f Comaetency #: ors e;tS to Zi Value ofWork for this Permit: $ Type of Work: Addition ❑Alteration CO ck" V, (30 —° Description of Work: Square/Linear Footage of Work: ❑New ❑Repair/Replace ❑Demolition Color thru tile: ***** * *** ** **** * * * * * *x * * * * * * **** * * ** Fees * *, x *x, * *x * * * * * * *, **** * * * * * * ****x *x *xw * * * * ** Submittal Fee $ ; , Permit Fee $ /feOd • Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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, 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 issu In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this Signature AV talk l ,orrel)Contractor The foregoing instrument was acknowledged before me this 3 day of j'r _ 1 by iiejLitiA 1 , day of , 20 2 by pay a 1` p . who i NOTARY PUBLIC: Sign: Print: e or who has produced identification and who did take an oath. ?_( t A- un My Commission Expires: >> •;•;�l ,,,, ORIT MIMOUN ? Commission 4 DD 946625 *******************00S ':i ; zive*MaYegaWiThifatigtikkitilikoaskie December 14. 2013 APPROVED BY who is personally known to me or who has produced C-'Qs7 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Structural Review (Revised 5/2J2012)(Revised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007) `aO�'0.ti 4B1i VstirGeon****Potielitegelit 625 ORIT MIMOUN S44o ac My Commission Expires ,;ia,° Decembe .013 Clerk -T1.7-1902_ (90Z ri Shrug D Pr Y DATE !ANCE Vt! rN A,I_I_ FEDERAL C E i T„ T OCT 112012 r6"-- PI' /6 (l4 W- 98'c' 9ho ` Ave YwetrM: Shores tT44r, L.L� ,re'o i•+— ttirtiftratr of Mame ?&uiztana REGIS'T'ERED APPLICATION CONCERN NO. F -06901 ISSUED BY HERCULITE PRODUCTS, INC PO BOX 435 EMIGSVILLE PA 17318 Date Work Performed 10/08/2012 This is to certify that the materials described below have been flame- retardant treated (or are inherently nonflammable). FOR TRI VANTAGE LLC CITY GLEN RAVEN X AT 1831 NORTH PARK AVENUE STATE NORTH CAROLINA 27217 -1100 Certification is hereby made that: (Check "a" or "b ") (a) The articles described at the bottom of this Certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the law of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used Chem. Reg. No. Method of application (b) The articles described at the bottom hereof are made from a flame - resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade name of flame - resistant fabric or material used REINFRCD VINYL Reg, No, F -06901 The Flame- Retardant Process Used WILL NOT Be Removed By Washing PETER COHEN Name ofApplicator or Production Superintendent By STEPHANIE MUMMERT, Q C MANAGER TYtle We hereby certify this to be a true copy of the original "CERTIFICATE OF FLAME RESISTANCE" Issued to us, "original copy" of which has been flied with the California State Fire Marshal. Customer PO# AMAURY Invoice Number 40466172 Quantity Description Product Code 12.000 YD WEBLON CP2746 -62 OCEAN BLUE 857246 TRI VANTAGE, LLC FAST AWNINGS.COM 2930 BISCAYNE BLVD. MIAMI FL 33137 ControULot # Control/Lot # 49351C9388