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RF-12-1855dir Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 179491 Scheduled Inspection Date: October 23, 2012 Inspector: Bruhn, Norman Permit Number: RF -10 -12 -1855 Owner: BORREGO, THEODORE & THOMAS Job Address: 87 NW 100 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ALLIED ROOFING AND SHEET METAL, INC. Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1131010180380 Phone: 954 -485 -5922 Building Department Comments REPAIR 5 LEAK ON SLOPE ROOF REUSING SAME TILES Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed/ }-3711-- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 23, 2012 For Inspections please call: (305)762 -4949 Page 13 of 18 111111111111111111111111111 111111111111111111 NOTICE OF COMMENCEMENT CFN 2O1 `RO7253:15 O" 8k 28309 f'es 1556 - 1557; (2'ss) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 10/11/2012 13 :52:37 HARVEY RUVIN CLERK OF COURT (1.-- l MIAMI-DADE COUNTYv FLORIDA PERMIT NO. TAX FOLIO NO. 11-3101-018-0380 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: 87 NW 100th Street Miami Shores, FI.33150 2. Description of improvement: Repair Sidle4ky &Mown Chase Bank, National Association Interest in property: 87 NW 100th Street Miami Shores Fl 33150 Name and address of fee simple titleholder: 4. Contractor's name and address: Allied Roofing and Sheet Metal, Inc. 2801 NW 55th Court Bay 5W Fort Lauderdale, FI. 33309 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of reco ess a different date is specified) iP Signature ofO km Actium vice President Swom to and subscribed before me this IN GOD Prepared by �� day of , 20 2v3i OR BK 28309 PG 1557 LAST PAGE CALIFORNIA JURAT WITH AFFIANT STATEMENT See Attached Document (Notary to cross out lines 1 -6 below) ❑ See Statement Below (Lines 1 -5 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 State of California County of i V\ 1t l4JC3 K. MURPHY Commission # 1820487 Notary Public - California San Diego County My Comm. Expires Oct 28, 2012 t (2) Signature of Document Signer No. 2 (8 any) 6re u. oW o› Subscribed and swom to (or affirmed) before meal fr 1.-21+"' day of grMem 'per , 20 -. y Year Date Month (1) -C,∎∎ CI 'Pea ee -r v\ Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and iJ i ►�- Place Notary Seal Above Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me.) Signature OPTIONAL Signature of Notary Public Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document Title or Type of Document: 1054-1 Ce Document Date: I i 2� k 2- Signer(s) Other Than Named Above: p� Ctj vIAvNA'nteuvPvA- Number of Pages: Pr 1 RIGHT THUMBPRINT OF SIGNER #1 Top of thumb here RIGHTTHUMBPRINT OF SIGNER #2 Top of thumb here ©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 *Chatsworth, CA 91313.2402 • www.NationalNotary.org Item #5910 Reorder. Cali Toll -Free 1-800-876-6827 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: 87 NW 100th Street Miami Shores FI 33150 M @METE` OCT u Lu12 L) BY: _m__o__vaomoomo a o F�B}C 20 kr Permit No. rZ- 1(1.— Master Permit No. ROOFING City: Miami Shores Folio/Parcel #: 11- 3101- 018 -0380 Is the Building Historically Designated: Yes County: Miami Dade Zip: 33150 q NO t� Flood Zone: 944)ig Mars. OW Ilmok Nana'AeweiaBee OW' E *? r W i tic 1der) - 'UsAttormapil-fact Ati 1111 Po I it-r-i- Park LAIA-Ai City Col ova 5, tat D l4 ?'e vLLe t\l — vike, i.)°t rl CONTRACTOR: Company Name: Allied Roofing and Sheet Metal, Inc Address: 2801 NW 55th Court Bay 5W City: Fort Lauderdale Qualifier Name: Robert Borowski State Certification or Registration #: CCC 1325516 Certificate of Competency #: Contact Phone #: 954- 485 -5922 Email Address: info@alliedroofing.cc DESIGNER: Architect/Engineer: N/A Phone #: 954- 485 -5922 State: FI Zip: 33309 Phone #: 954- 485 -5922 Value of Work for this Permit: $ Type of Work: DAddition Description of Work: , R00 ❑Alteration tiTte ';k-- IA"p Phone #: Square/Linear Footage of Work: ❑New 5 eels. fraM eepair/Replllace 4 / Q c (R [C9C2 Ski Fit– ODemolition d® (!/g.. Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ 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, 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 b' •.sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absen . posted notice, the inspection will not be approved and a reinspection fee will be charged. Astons vice Presides Signature The foregoing instrument was acknowledged before me this The foregoing in day of , 20 _, by day of O C., who is personally known to me or who has produced who is As identification and who did take an oath. ;NOM LAC -« — i t See PI-W..0-06— V x Igg. see oc■icz�6 ontractor as acknowledged before me this ti 011 -,by R013e(1 '04'ows,Kl own to me or who has produced as identification and who did take an oath. th NO ARY PUBLIC: Sign: Print: S a n ��;dBa SANDRAAC� t°l- My Commission Exp* : yylj * MY COMMISSION! # EE 0081182 EXPIRtS: September 4, 2014 .c ,ce Bonded Thru Budget Nata�y Services �OF F�� ***************** ;it ***** 4e**********************************+ k****************** * * * * * * * * * ** * * * * * * * * * * * * * * **** ** APPROVED BY \/ Z J9 , Z • Plans Examiner Structural Review (Revised 3112 /2012)(Revised 07 /10 /07)(Revised 06110 /2009)(Revised 3/15/09) Sdkr,6ly MOW' CAllo 110414 *timid Asociation ibAtifiatrilpilat Zoning Clerk State of California County of SAN DIEGO ACKNOWLEDGMENT ) On SEPTEMBER 12, 2012 before me, K. MURPHY - NOTARY PUBLIC (insert name and title of the officer) personally appeared ICgrrn ePe )ers -ev\ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their authorized capacity(ies), and that by his /her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) K. MURPHY Commission # 1820487 Notary Public - California I San Diego County M ry Comm. Expires Oct 28, 2012 ' 3'f y , tia'..��won Report �.� - �a • 0 64. • n `lade. go;. http: / /gisims2. miamidade .gov /myhome /proptext print.asp ?folio= 1131... My Home Property Information Report Summary Details: Folio No.: 11- 3101 - 018-0380 Property: 87 NW 100 ST Mailing Address: HSBC BANK USA NATL ASSN TRS 10790 RANCHO BERNARDO RD SAN DIEGO CA 92127- Property Information: 'Primary Zone: 0800 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 4/2 Floors: 1 Living Units: 1 Adl Sq Footage: 2,661 Lot Size: 22,140 SQ FT Year Built: 1936 Legal Description: NAVARRO SUB PB 12 -59 LOTS 9 10 11 & 12 BLK 4 LOT SIZE 205.000 X 108 OR 20580 -4132 09 2001 4 COC 23951 -1526 04 2003 5 OR 28149 -3150 0512 12 Assessment Information: Year: 2011 2010 Land Value: $122,467 $122,467 Building Value: $226,238 $226,614 Market Value: $348,705 $349,081 Assessed Value: $348,705 $349,081 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 '2nd Homestead: YES YES Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $50,000/$298,705 $50,000/$299,081 County: $50,000/$298,705 $50,000/$299,081 City: $50,000/$298,705 $50,000/$299,081 School Board: $25,100/$323,705 $25,0004324,081 Sale Information: Sale Date: 5/2012 ° Sale Amount • $258,900 Sale O/R: 28149 -3150 Sales Qualification Description: Deeds to or from financial institutions View Additional Sales [Close windows [Click here to Printl This report was created on 8/14/2012 7:01:09 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. 1 of 1 8/14/2012 7:00 PM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/20/2011 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 policy(Ies) 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 in lieu of such en dorsement(s). PRODUCER Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. 0. Box 1927 Pompano Beach FL 33061 CONTACT Denise Page la(c° Nn._EXU (954) 943 -5050 (FVC.No►: (954)942 -6310 ADDREE -MAIL SS: denise@furmaninsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURERA:First Mercury Insurance Co (1r) 10657 INSURED Allied Roofing & Sheet Metal, Inc. 2801 N W 55th Court Ft Lauderdale FL 33309 INSUREREt:Travelers Indemnity Co of 25666 INsuRERcBridgefield Employers Ins Co 10701 INSURER D:American Cas Co Of Reading PA 20427 INSURER E : MEDEXP(Anyoneperson) INSURERF: GEN'L • w,v,• fLJnIucr•• THIS IS TO CERTIFY THAT 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 MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR X SUBR WVD X POLICY NUMBER NJCGL000000062301 POLICY EFF (MM/DD/YYYY) 10/20/201110/20 POLICY EXP (MM/DDIYYYY) /2012 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50 , 000 CLAIMS -MADE X OCCUR MEDEXP(Anyoneperson) $ Excluded GEN'L PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE POLICY X LIMIT APPLIES PRO- PER: LOC PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X x SA7880R676 10/20/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ c WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NN N / A 083043296 10/20/2011 10/20 /2012 WC STATU- OTH- X TORY LIMITS (ER E.L. EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEE $ 500 000 E.L DISEASE - POLICY LIMIT $ 500,000 D Installation Floater 4026295647 10/20/201110/20 /2012 $100,000perLoss $2,500 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CANCELLATION (305)756 -8972 City of Miami Shores Buidling Division 10050 N.E. 2nd Avenue Miami Shores, FL 33138 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 Frank Furman, Jr /DP ACORD 25 (2010/05) INS025 (2mnn5101 ©1988 -2010 ACORD CORPORATION. All rights reserved. -rho A(Y1Rtl name anti Inn,. aro roniatororl marke of Amon STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 BOROWSKI, ROBERT ALLIED ROOFING & SHEET METAL INC 2801 N.W. 55TH COURT UNIT #5 -W FORT LAUDERDALE FL 33309 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 wuwv.myfioridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam 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! (850) 487 -1395 AC# 6 q' O S BUSINESS AND ULATION 120022128 DETACH HERE A 'Q t 6197015 STATE OF FLORIDA DEPARTMENT OF BUSINESS PR FE CONSTRUCTION INDUSTRY ;LAC LICENSE NBR:, IS :CERTIFIED under the provisions of -Ch. 489 FS. xp xatioa dater AUO. 31r ''2014 L+12b71.103.280 GULATION BO GU SEQ# L12071101280 07 11 2012 120022128 The ROOFING ° CONTRACTOR Named below IS CERTIFIED , Under the provisions of Chapte Expiration dates AUG 31, 2014 CCC13255 BOROWSKI, ROBERT ALLIED ROOFING & SHEET METAL 2801 N.W. 55TH COURT UNIT #5 -W FORT LAUDERDALE FL 33309 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY Florida Building Code Edition 2010 High Velocity Hurricane Zone Uniform Permit Application Form Master Permit No. Section A (General Information) Process No. Contractor's Name _Allied Roofing & Sheet Metal Job Address 87 NW 100 street Miami fl 33150 ❑ Low Slope ❑ Asphaltic Shingles ROOF CATEGORY ❑ Mechanically Fastened Tile ©Morta dhesive Set T le ❑ Metal Panel /Shingles ❑ Wood Shingles /Shakes ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ New Roof Re- Roofing ❑ Recovering ® Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 0 100 100 Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. 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