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RC-12-2115
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183855 Permit Number: RC -11 -12 -2115 Scheduled Inspection Date: January 09, 2013 Inspector: Bruhn, Norman Owner: MINSKI, JOEL & ANDREA Job Address: 9969 NE 4 Avenue Road Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)510 -0916 Parcel Number 1132060171230 Building Department Comments BATHROOM REMODEL 11/19/2012 - PENDING NOC PENDING INS - LIA AND WC FOR ELECTRIC ALL RECIEVED. 12/06/2012 - MECH PERMIT REQUIRES AS PER NORM. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments 9--/F Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 08, 2013 For Inspections please call: (305)762-4949 Page 33 of 40 Miami Shores Village Building Department 90050 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: BUILDIN JOB ADDRESS: , I ikle "l'E City: FBC 20 1� Permit No. ry Master Permit No. I ROOFING Miami Shores County: Miami Dade Folio/Parcel #: % _ �— .�' ° ] 17,30 Zip: '131 3V Is the Building Historically Designated: Yes 1 OWNER: Name (Fee Simple Titleholder): t) eL /1 r. S t t Phone #: (fj(7 — 3 3 ( y,$ Address: 4610 q pie— Li A-v , City: t7/9-/9 l`- 4,i1499. s. Flood Zone: APD State: zip: "3 5 ( 3 c7 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: r 1 5.A Ci /J f.rS 1-1.t41a-✓ Phone #: 716- (o ) 3 I Address: 30 )3 Ail a. i P s L'.°✓ City: 1i, } State: FL, Zip: 3 f COD Qualifier Name: ie - 4L_ Phone #: 1i 2-S% -13 t ..o State Certification or Registration #: C. i5'oG 1 1(0 Certificate of Competency #: Contact Phone #: Email Address: ()i'0 e 01,5 Ant— 't �� IS'(`/�.ca"" c�J a c-01.1 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $1� Square/Linear Footage of Work: Type of Work: DAddition Alteration UNew ORepair/Replace ODemolition Description of Work: 9 V 12-a t7 /\/E J vet iii h % .rte I it(Egj V:09-$.41-r7 Color thru tile: b2 •'�-r` * *******+ + z****************** ***** *** * **Fees*** **** *************** ******************+ *** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ 0 69 CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1) 2. 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 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 1 rochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notic of com ncement must be posted at the job site for the first inspection ! h '.,h occurs seven (7) days after the building permit is . sued. In t e absence of such posted notice, the inspection will not be a prow. d and a reinspection fee will be charged. Signature Signature O Agent Contractor ?...") The foregoing instrument was . knowledged before me this The The f r going i strume t was ackn° dged befo day of ivlaorOc20 12rby je day oil , 20 , by who is personally known to me or who has produced o s p d rsonally known to me or who has produced V--- As identification and who did take an oath. g .P W f ' `t'. t'3t r e tification and who did take an oath. NOTARY PUBLIC; Sign: Print: My Commission JUUETA PAULA SAAL •: COMMISSION # EE162683 E8 Febti'Ulny 11, 2016 pires: Z ®i I ,,11 Sign: Print: My Commission Ex ** *gyp ************** *+ x****** *************** ***** *** ****w, v******** * *m*+x************* *** ** * * **** * **** **** ** APPROVED BY `ae ,i finI Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) 'STATE OF,FLORIDA AC# . t TMENT OF E R 5 ROFESSIQ BUSINESS AND • N REGULATION 12 120007213 ACTOR I8 ::C} RTZF1�8D Hader the provieictae Of Ch.489 FS �cpirat3oa dater �IUGi:' 31, . ' =2'014 L12871901159 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 05/04/2011 PERSON: DIEGO SAAL FEIN: 030394742 BUSINESS NAME AND ADDRESS: DISAAL LLC DBA DISAAL CONSTRUCTION 3029 N E 183 LN AVENTURA, FL 33160 EXPIRATION DATE: 05/03/2013 SCOPE OF BUSINESS OR TRADE: 1- GENERAL CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05 {141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(121, F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt. E 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. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 507454 -7 THI5' IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT�I0. 530050 -4 STATE CGC1505716 BU4IISAAL CONSTRUCTION X133029 NE 183 LA 33160 CITY OF AVENTURA "AAL LLC THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO; VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT ThE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION - OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAW-DADE COUNTY TAX cOLLECTORil 7 / 2 5 / 2 012 60030000513 000045.00 SEE OTHER SIDE BUILDING-CONTRACTOR FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO.231 WORKER /S 1 DO NOT FORWARD DISAAL CONSTRUCTION DIEGO SAAL PRES 3029 NE 183 LA AVENTURA FL 33160 i, 111, 11111,1111111„111,1, 111111 i11I1,,,,I11,I11J1$1,118 ?11 Miami Shores Viiiage 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. B. C. D. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) 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: /3- 44-A-l_ ((LuC °'( nJ BUSINESS ADDRESS: -3.0-LA (�(.f STATE FL. ZIP CODE 3-3 t l® O BUSINESS PHONE: R8AO ) Co -13 1(6) CELL PHONE (i i ) fo- 13 L to QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: C-4,6_1505-7 1(0 CITY 1)1%E...7t'Lk - FAX NUMBER ova - 0(0(04 br S,09.-AL., E -MAIL ADDRESS (IF APPLICABLE): DI-66..0 �� D t3.A�l _ Co �Si M�l�'�� - con Created on 3119109 BY MLDV I RV 3126109 MLDV Policy Number: Date Entered: 8/ A ° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/2/2012 HOLDER. THIS BY THE POLICIES AUTHORIZED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 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 endorsement(s). PRODUCER KEY KNOWLEDGE INSURANCE, INC. 9101 -C S. W. 19TH. PLACE FORT LAUDERDALE, FL. 33324 CONTACT CON PHONE (Am No, Ext): (954) 382 -5259 Fa ,Nol: (954) 382 -0080 E-MAIL ADD RESS:mryals @keyknowledgeins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: BURLINGTON INSURANCE COMPANY LIABILITY COMMERCIAL GENERAL LIABILITY INSURED DISAAL CONSTRUCTION 3029 N.E. 183RD LANE AVENTURA, FL 33160 INSURER B : 535B020879 INSURER C: 8/11/2013 INSURERD: $ 1 , 000 r 000 INSURER E : $ 100,000 INSURER F : CERTIFICATE NUMBER: • 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. LTR TYPE OF INSURANCE ASR s POUCY NUMBER POUCY EFF (MMIDD/YYYY) POUCY EXP (MMIDD/YYYY) UMITS A _ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 535B020879 8/11/2012 8/11/2013 EACH OCCURRENCE $ 1 , 000 r 000 DAMAGE TO PREMISES (Ea RENTED $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 GEN'L PERSONAL & ADV INJURY $ 1, 000 , 000 GENERAL AGGREGATE $ 2, 000, 000 AGGREGATE POUCY UMIT APPUES jEa PER: LOC PRODUCTS - COMP/OP AGG $1,000,000 $ AUTOMOBILE — LIABILITY ANY AUTO OWNED au HIRED AUTOS _ A(C�H�ULED NON -OWNED AUTOS N/A COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N / A EXEMPT WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POUCY UMIT $ N/A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) GENERAL CONTRACTOR DOING RESIDENTIAL AND COMMERCIAL REMODELING Miami Shores Village Building Department 10050 NE 2 AVE 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 ? ; , MARIA A.RYALS, AGT. yJ- ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Producedusing Forms Boss Pius sof ware. www. FormsBoss .com(mpressivePublishing 800-208-1977 (Y,41(0‘1 NtE 4psv. N141--11 +to (2-&- . -7" ":; NOV 411 la - 1.1EIAJ - 1•\svi vANtn - -TO f4e0 117,'1/4 Np-ocAL- (cet-)64-c-aopv/2-0) r BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.0 PRoTrvED ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED • NDUCTORS TO BE REPLACED. g iKAP24072--- 5-1-1571- 360P-001-1 fC12,--P-t15 PERMIT #: Miami Shores Village APPROVED DATE ZONING DEPT BLDG DEPT 4414 SUBJECT TO =PUMICE WTH ALL FEDERAL STATE AND COUNTY ALES AND REGULATIONS fL 61c 0 C) -ro 26-#41.41'1.i 14Fko 1(1" DVA0C4c. 1.3eop_sooh 3 CIF P .i 9',°o'' NE LOIN . s .tQpe -c f��- �0 Qf nl E 1'i�U S,l- �ol2-6-5 , f L NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF PERMIT NO.—' t 1 S TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 1111111. 11111111111111111111111111111111111111 CFN 2012W:18;38649 OR Bk 28367 Ps 3788i (1) FIRST INSPECTION RECORDED 1.1/21/2012 12:31:19 HARVEY RUVINp CLERK OF COURT MIAMI -DADE COUNTY r FLORIDA LAST PAGE 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 qeq _own of . plop q a treet /address: ', i At S. f &L 313e 2. Description of ' provem t: 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: !P)' Les ,- r"v , "-L, `751&2,0 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address STATE OF KOMIDA, cowry OF DADE I HERM «AI,' ;FY that thfa be copy of the Cat r,� r ar t4,1, A. r 7. Persons within the state of Florida designated by Owner u provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: giVIN 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 -ate of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different ,,at: is specified) Sign. tur Print Owner's of Owner Sworn to and subscribed before me this day of Notary Public: Print Notary's Name My commission expires: Prepared by Pie 60 . i"lau'g-►bese 7L. Address: