RF-13-351Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 186189 Permit Number: RF -2 -13 -351
Scheduled Inspection Date: March 26, 2013
Inspector: Bruhn, Norman
Owner: DAGNERY, MICHAEL
Job Address: 75 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MURPHY ROOFS
Permit Type: Roof
Inspection Type: Roof Repair
Work Classification: Repair Roof
Phone Number (305)318 -3180
Parcel Number 1132060130270
Phone: (305) 892 -1700
Building Department Comments
ROOF REPAIR
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
FJ7(e7
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 25, 2013
For Inspections please call: (305)762 -4949
Page 8 of 19
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
9j'91I)1 GPIAJ L3(z
UI IN
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: 7s ift)e 7A sr
FBC 20 10
Permit No. ��^^
Master Permit No..O 3 '` 3 Si
ROOFING
City: Miami Shores County:
Folio/Parcel #: 11-20i9 -b/3 -OA'?
Miami Dade
zip: 33/57'
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): r` �t;lA LhQln Phone #:3f�� 75 (."III
Address: 75- /i1 5 /
1 p
City: , 4 I Al / %iA C State: p zip: 3 3( 3
Tenant/Lesjee Name:
Phone #:
Email: e ')de 11 Cat 40144 2
ti
CONTRACTOR: Company Name:
I.6 6'3
Address.
City: Q . c � c � • � State: Zip: / ta
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: Q_ 7 0
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
i Phone #: `
I_ Value of Work for this Permit: $
Type of Work: DAddition
t - _,Dese iption of Work:
Square/Linear Foo
UNew
Sal Prkk 7o
Oe 12.06F: Qi for thru le:
*** * * *** * *** * * * * * *** aa****** . * Fees*** ***+ x******** *lx***** ******x:******** ** *****
Submittal Fee $ S-0 J1 "4 10 Permit Fee $ CCF $ CO /CC $
Scanning Fee $ � Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
p-p: v L...E,:y 9�
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 attach rnt. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ins p ec t ion which o c rs sev / 7) days after the building permit is issued. In the absence of uc p s ed notice, the
inspection wil t /.e app % d a rei ction fee will be charged.
Owne or Agent
The foregoin instrument was acknowled • -' befor- me
day of d` , 20 /6 , by 1, /'
Contractor
The for _2:' ins ment was acknowledg
day of ' . 2013 by
who is\personally known to m5lor who has produced who iscer.simaajgmat or who has prod
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
/, /1D�l /5
My Commission Expires:
APPROVED BY /A �/ /J 5, Plans Examiner
• w 3 r s. - 7 -wr-r
Notary Public State of Florida
Max A Goldfarb
oe My eormtssion EE 197923
ow' Expires 08 /01/2015
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
milli 3
:a�s . Z 80 i7aOa anl
y•
S
0
Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
CITY
COPS
OOf•00gO
E � .
FEB 21 2 13
Florida Building Code Edition 2010
H g h Velocity Hine a Zane Uniform Permit AINAcagon Farm
Section A (General Information)
Master Permit No. Process No.
Contractor's
Job Address 7 r A-1-- 1
❑ Low Slope
❑ Asphaltic
Shingles
ROOF CATEGORY
2
❑ Mechanically Fastened Tile !t'' r= Adhesive Set Tile
❑ Metal Panel/Shingles ❑ Wood Shingles/Shakes
❑ Prescriptive BUR -RAS 150
ROOF TYPE
❑ New Roof ❑ Reroofing ❑ Recovering ❑ Repair , ❑ Maintenance
ROOF SYSTEM INFORMATION
Low Slope Roof Area (S9 Steep Sloped Roof Area (S9 Total (59
Section B (Roof Plan)
Sketch Roof Plan: Illustrate aii Levels and sections, rookdrains, scuppers, overflow
scuppers and overflow drains. Include dimensions of seNons and levels, clearly
identify dimensions of elevated pressure zones and location of parapets.
TONING DEP
DG DEPT
J .!ECT i 0 C(.MPI NCE WTPd ALL FEDERAL
^ Nu _:C LiN, (RULES AND REGULATIONS -
# 2/8/2013 15:56 Southeast Personnel
Lion Insurance Company+JRPHY ROOFS 1/1
CERTIFICATE OF LIABILITY INSURANCE
crew
2/812013
producer: Lion Insurance Company
2739 U.S. Highway 19 N.
Holiday, FL 34691
(727) 938 -5562
This Cani/icate is hued as a natter of Information **and confers no fights
upon the Certificate Holder. This CerUficabe does not amend, extend or alter
the coverage afforded by the policies below.
Insurers Aforing Coverage
NAIC #
Insured: South East Personnel Leasing, Inc. & Subsidiaries
2739 U.S. Highway 19 N.
Holiday, FL 34691
Insurer A. ion Ina,ratroe Company
framers.
Insurer C:
Its D:
Insroetr E
11075
Coverages
lla Won eCrrnusmrnt d b e l o w a r e been ImedLe the msued named aboretor die ado owed intthated m a r rammed. tetra t y C01111,1411 +fayy writ= ox a reseec1to
which Mt certificate maybe i„rted m may pertain. the insurance attaded by the policies described heroin i milled to Si temm entutorm. and cow.igotw sf ch policies. Agg efate;mils /tom trey have been
reduced by paid claims
PSC
Lm
ADDL
Type of insurance
Policy Number
PEE
Date
(MWO)
Poky Bmhtdkm Data
(MWDDJYY)
GENERAL UABIUTY
Camuerciai General Liability
Glalna Maas C1a
General aggregate limit applies per
Pokey El Project LOC
Each hOccurrence
Damage to rented premises (EA
occurrence)
1
MedFxp
Postural Adv Injury
canard Aggrega
Products - Comp/OP
AUTOMOBILE LABILITY
Any Auto
At Owned Aides
Scheduled Autos
Hoed Autos
tOrxred Autos
Cwnbited Single Luce
(EA Accident)
(Per Person)
Botlitit iy
(Per Acdd )
Propeey Damage
(Per Accident)
EK LIABILITY
°car Claims Made
Deductble
EachOcaanenee
Aggregate
A
Workers Compensafion and
Employers' Liability
Any propnetonpartnerloxecuove otnceun a mber
oxcludod? No
if Yes. describe under spacislprovisions below.
WC 71949
01/01/2013
01/0112014
XItonL s I IER
•t?tti, Each Acddo
11.800000
C.L. Diaease- Ca Cmptoyee
VI nt UUu
E.L. Disease- Poky thrift
$1.000.000
Other
Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12516
Descriptions of OperationsilocatIonsiVehideslExcluslons added by Provisions:
Coverage only apples to active employee(s) of South Est ranpbyee teasing Services, Inc. that are wed to the following °Clienit Germany ":
Murphy Roots, Ini9
Coverage only apple to Injuries Incurred by South East Personnel Leasing, Inc. & Subsidiaries active empbyee(s) , Wt narking In Noida.
Coverage does not apply to statutory ems) m irulependent contractor(s) of the GiientCompany many other ently.
A list of the active empbyee(s) leased to the Client Company can be obtained by faxing a recpostto ( 727)937 -2A3B or by caing (727) 938-5562.
Project Nimes
FAX & 3055- 75&9972! ISSUE 0208 -13 (.90
CEIVIIPICATE HOLDER CA: .LA
VILLAGE OF MUM SHORES
10050 NE 2140 AVENUE
MIAMI, FL 33138
CkntIo 92- 57-1.20
Bert's Date: 1/81 /2013
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endemerto mad 30 dayswrirtennoticet ote certdicateholdernemedwthebatbuttai6ae todososhellimposeno
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