CC-13-239 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199701 Permit Number: CC-2-13-239
Scheduled Inspection Date: September 24,2013 Permit Type: Commercial Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: Work Classification: Alteration
Job Address:9823 NE 4 Avenue
Miami Shores, FL
Phone Number
Parcel Number 1132060170330
Project: <NONE>
Contractor: IMPACT CONSTRUCTION COMPANY Phone: (954)599-5940
Building Department Comments
SOFFIT&PAINT REPAIR ON THE PERIMETER OF THE Infractio Passed comments
BUILDING INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 23,2013 For Inspections please call: (305)762-4949 Page 28 of 29
CERTIFICATE OF LIABILITY INSURANCE
THIS CEMICATE IS MSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERyg:GATE HOLDER,TUB
CE10 FICATE DOES NOT AFFN MAMMY OR NEGATNELY PAMM,EffM OR ALTER Tim COVFIIAM AFRMM Or THE PMJM
RIELOW. TITS CERTMrATE OF RRMURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE TSSUM AIRTRIORM
RE NTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER.
MORTAUT. I tha eoiflleata bWt-CS m ADOMONAL OGL%W,tha pDftyp*mM be endom,,L I SUBROQAMN 1S WANED,aobJnaT to
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MAX VALUE O ISURAN�RRO1A+ (90l�w1879 ( }l97
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MIAMI FL 99185 5996
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THE EPWRATION DATE TIMMOF NO= WILL BE DEUVERED Or
of ACORD
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s - Miami Shores Village ak � =
Building Department d' U
;! 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 °
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 9e*2 3 N gr
City: Miami Shores County: Miami Dade Zip: -'8
Folio/Parcel#:
Is the Building Historically Designated:Yes NO ✓ Flood Zone:
[> ...
I
OWNER:Name(Fee Simple Titleholder). 1410K 44'er.<--ONnO�'�T Phone#:
Address:
City: e� 15 j A-4: State:
Tenant/Lessee Name: Phone#: 3
Email:
CONTRACTOR:Company Name: � r,V � p � _Phone#: �!
Address:
City: ,// State: � Zip:
Qualifier Name: yoy WW-5V4 V Phone#:
State Certification or Registration#: 4°ie/ /-V/D 7 Certificate of Competency#: /V
Contact Phone#: Email Address: A(0fOX�N G �/ o/1irGpf1/I
DESIGNER:.Architect/Engineer: A46 Phone#:
Value of Work for this Permit: $ e>O S uare/Linear Footage of Work: bo Type of Work: ❑Addition UAlteration ONew .Lkepair/Replace ODemolition
Description of Work: � i SdF' 'Z`Scy� c
Colo"thru tile:
®o
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) /1!/�
Bonding Company's Address /'VA F
City State zip
Mortgage Lender's Name(if applicable) _ JV-A
Mortgage Lender's Address Al '
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the,absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agen
The foregoing instrument was acknowledged before me this S The foregoing instrument was acknowledged before me this
day of d� ,20 ,by r — �lkQay of. 20 r 3 ,by G�� ,
who is personally known to me or who has,produced R,1 d> who is personally known.to me or who has produced GP4YWk
As identification and w �dlitl�t r oath. awa
NOTARY PUBLIC: ���` v�d' %� NOTARY A,`�: T RICHARDS
,• . Notary Public-State of Florida
o�' N,+ J; My Comm.Expires Jul 7,2015
— y o s •o_ %'F�oF��;?:� Commission#EE 110457
Sign: w
Sign:
Print: �� g d ' '��` -n$
My Commission Expires: �' My Commission Expires: b'2
APPROVED BY ^� Plans Examiner Zoning
Structural Review Clerk
(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
STATE OF FLORIDA
DEPART21ENT OF BIISINSSS AND PROFESSIONAL REGULATION
CONSTRIICTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH NONROE STRUT
TALLAHASSEE FL 32399-0783
WATSON, NOEL LBERT
nwACT CONSTRUCTION CONPANr
2613 SW 552'8 AVM
FL 33023
F 8 �1fEOFFLa
Congratuiationst With this license you become one of the nearly one million � D�AlZ " OF BLiS 21r3S;3S
Florldiarts licensed by the
Department of Busyness and Pnofessloraai Regulation. PF!DFS�SIt3 + .REGULATION*
Our professionals and businesses range from architects to yacht bmkers,from
boxers to bus and they keep Fksrlda`s economy strong. CGC3 50183 _ {23f:12 128050332
Every day we work to improve the viray Are do business in order to serve you bete
For information about our services,Please log onto wtvtnt rrtyfiioridaa teerise care. , ; C T1R 3 RFiCT08
There you can find more formation about our c torts and the regulations that
impact you,subscribe to deparlinent newshMers acrd team more about the � ` I�Att�:COBI � comp%'l1fiT
Departments initiatives.
Our mission at the Department ts:Ucense Efficiently,Regulate Fairiy-We =
constantly SYM to serve you better-so that you can serve your customers. Yg.:= ',mccez lie:n s3ons-of:ciL 489 gs
Thank you fior doing business in Florida,and cmtgralulatiotas on your new ikensei; a�earAII 31, 243 i,32asa.�o2a
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STATE-OF FLORIDA
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COIa3 CTION INDUSTRY LICBN 3X.g BOARD 50
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GENERAL Ct3N32AL'T4R:
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Lxpirati= date: At7G•::31, 2014.
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AC'T--CONSTR'.IICTI03ifC}NPANY _
2513 SfnT 652`8 ARTENCIE
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COySOR SECRETARY
D_ PLAY AS REQUIRED MUM
02116/2012 THU 16.29 FAX 3056629666 M VALUE INSURANCE 2001/001
l`'�" CERTIFICATE OF LIABILITY INSURANCE DA'MfMM20 2m
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
OWnFICATE DOES NOT AFFIRMATIVELY OR NWAT1VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
B9LOW. THIS CERTIFICATE OF INSURANCE HOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cerHticate holder Is an ADDITIONAL INSURED,the policy(Ios)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terns and conditions of the poncy,certain policies may require an endorsement. A statement on this Certificate doss not confer dgh*to the
cer0cate holder In 1100 of such endarsome s.
m oomm 001M ACr MARIO W PING
Max Value Insurance Group PHON o SOS-668 787@ (c,�•3Q8.662-8937
14760$W 26TH ST MAIL , marls max"luefns.com
SUITE#203
MIAMI,FL 33185 INsuRPn l AFFORWN 3 cove xye NAIL N
INMIRMA:Burlington Insurance Co.
INSURED IMPACT CONTRUCTION COMPANY _WRERBi
2613 SW 65TH AVE
MIRAMAR,FL 33023 wsnRSRO:
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COVERAGES CERTIFICATE NUMBER: REVISION 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 LSSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED NEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INER TPPM OFMSURANCE DL 8= POLICY WF FQLtGY QQi LIMIT13
Poucy"Meat IMMMOMMM (M 0,A cENERALuAwuTY 76760007093 0210B/20i2 0210=13 maioowmgNoo $1,000,000
✓ GOMMERCdALQRMMLLW[MRy �" S£�roc $100,000
CUMM-MAM M OCCUR $6,000
PERM A_LAAWIWURY S 1,04000
GENMALAGGRE',ATE 3 1000.000
6NLAGG LIMIT AF&W PEIv PRWL=-C0WQPAGG $1,000,000
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COVERAGE FOR HOME INSPECTIONS,RE@lODE UNG,FLOORS,DRYWALL,WINDOWS,DOORS,GENERAL REPAIRS.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DEGGRI13W POLICIES BE CANCELLED BEFORE
CITY OF LAUDERHILL BLDG DEPT THE I MRATION DATE THEREOPr NOTICE VA L, BE DELIVERED IN
081 W.Oakland Park Blvd ACCORDANCE WITH THE POLICY PROVISIONS.
Lauderhill,FL 83313 ,� a
(\ 0217SIM12
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACCORD 25(2010109) The ACORD rime and logo are registered marks of ACORD
Produced uslnp Rnnnt BON iNe6 e6RNeM.wrrw.FmmeBas.wal;4lfnPRetive Pubdshlna 6�20L•14T7
US SS TAX RECER'yr ((954)602-3040
954)602-3470 FAXNE
RESTRICTIONS*
RIC'TIONS*
MAIL t&PHONE ONLY
m NO EMPLOYEES AT HOME
_ = NO WORK ON PREMISES
✓$ .tb' LICENSE NO: 06000097 NO CLIENTS AT HOME
NO(DELIVERIES TO HOME
HOME USED FOR OFFICE ONLY
IMPACT CONSTRUCTION
2613 SW 65TH AVE
MIRAMAR FL 33023
BEGINNING 10/01/2012
ENDING 09/30/2013
NAME & LOCATION OF LICENSEE
IMPACT CONSTRUCTION
2613 SW 65TH AVE
MIRAMAR FL 33023
CONTACT PERSON: PHONE:
NOEL WATSON (954) 599-5940
DESCRIPTION:
CONTRACTORS—GENERAL
PRINT DATE: 10/02/2012
** BUSINESS TAX RECEIPT MUST BE DISPLAYED **
** RESTRICTIONS APPLY TO ALL HOME-BASED BUSINESSES**
-- - ----------------- ----
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