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RF-13-649 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-188414 Permit Number: RF-4-13-649 Scheduled Inspection Date: September 20,2013 Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Roof Owner: JEROME, MACULESE Work Classification: Repair Roof Job Address: 10728 NW 2 Avenue Miami Shores, FL 33150- Phone Number (305)335-4106 Parcel Number 1121360020110 Project: <NONE> Contractor: BESSARD ROOFING LLC Phone: (786)419-1876 Building Department Comments REPAIR 1 SQ TILE AND PAINT ROOF 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. September 20,2013 For Inspections please call: (305)762-4949 Page 2 of 36 P Miami Shores Village- Building � 4 ' Department o p, Z 1 1 ® 10050 N.E.2nd Avenue,Miami Shores,Florida 33138; I i� Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 P BUILDING Permit No. �� (O' -�11 PERMIT APPLICATION ~ Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 10 7,Z sS PV LO Z 4ye nur- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): - C.L e�`�° J �ON&- Phone#: Address: 1 7 �. iA� ,+j .M l 4/tf) City: State: 1-- Zip: 2,3 l(Q g Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 8 Phone#:7L6_(4 0 08 X Address: 17-6 City: �—� State: F ( D 4 Zip: 62�1 �7 Qualifier Name: _,�S& Wit ► Phone#: �(Sb L4 D 074 State Certification or Registration#: ® � Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ U Square/Linear Footage of Work: Type of Work: ❑Addition OAlteration ONew Repair/Replace ODe •olition Description of Work: a . 6ioe thru tile: Submittal Fee$ Permit Fee$ 00 a CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ TraininglEducation Fee$ Technology Fee$ _ Double Fee$ Structural Review$ av, A p 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 i 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. a Signature ,t& Ie /Ye Signature �� S Owner or Agent Contractor The foregoing instrument was acknowledged before me this / The foregoing instrument was acknowledged before me this-a7f f day of �(A l�C ,20 ,by "(A It �a ron�l day of f•Y�l�RC�F ,20 a,by T�(rl//!0 jej�,' ag who is personally known to me or who has produced who is rsonally known m r who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: ®� p o l`-'1 My Commiss t `�nI Y P a"� JOSEPH t PIERRE aJap B�. d «`�M, Notary public-State of Florida � ,�" P, My Comm.Expires Jul 5,2015 lle'��@oP blonde�C� �'t�t�Y��FsY Y�:aY�Y�Y ,h,,i3`„i�e��` ��St��i��$'apq Jose Urena Bonded Through National Notary Assn APPROVED BY MY it l ' � to lbn g � Structural Review Clerk p., (Revised 5/2/20 (R�QVI/f2/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) �4 10-05-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 06/03/2012 EXPIRATION DATE: 06/03/2014 PERSON: BESSARD JASMIN t- �� FEIN: 270884518 Construction Trades Qualifying Board BUSINESS NAME AND ADDRESS: BUSINESS CERTIFICATE OF COMPETENC BESSARD ROOFING LLC 275 NE 48 STREET OBSoO1 8,0 MIAMI FL 33137 Illlrwz BESSARD ROOFING LLC SCOPES OF BUSINESS OR TRADE: D.B.A.: 1- REGISTERED ROOFING CONTRACTOR BESSARD JASMIN IMPORTANT: Pursuant to Chapter 440 . 0504), F.S., an officer of a corporation who elects exemption fro Is certified under the provisions of Chapter 10 of Miami-Dade(Yount section may not recover benefits or combensation under this chapter. Pursuant to Chapter 440.05(12), F.S., scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.056, --- 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) 413-160E DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW 0 D chapter. EFFECTIVE: 06/03/2012 EXPIRATION DATE: 06/03/2014 Pursuant to Chapter 440.0502►, F.S., Certificates of election to be PERSON: JASMIN BESSARD H exempt.. apply only within the scope of the business or trade listed on FEIN: 270884518 E the notice of election to be exempt BUSINESS NAME AND ADDRESS: R BESSARD ROOFING LLC 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 275 NE 48 STREET if, at any time after the filing of the notice or the issuance of the ' MIAMI, FL 33137 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 SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this I- REGISTERED ROOFING CONTRACTOR 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 MIAMI-DADE COUNTY TAX COLLECTOR 140 W. Flagler Street • • Miami, Florida 33130 Please keep , , p your receipt for I future reference. Thank you and have a nice day. I' 4/2/2013 1300/222/OOIMDM 0016-0001 Last Seq.#:0001 WI LBT#:00 693230-6 Local Business Tax $156.25 i!LOCAL BUSINESS NESS TAX I CA CHANGE $170.25 ' $14.00 Or in business,please notify us in writing. CASf erect any information shown on this application. operating MIAMI-DADE COUNTY TAX COLLECTOR ssed to anyone found o p ng without a aid local business tax, 'LOCAL BUSINESS TAX SECTION iher penalty provided bylaw or ordinance (Sec 8A -176(2)) 140 W. Flagler St. - 1st Floor Miami , Florida 33130 a and/or City Business Tax Receipt may also be required. TEMPORARY RECEIPT o to www.miamidade-gov/taxcollector online g ww.miamidade.gov/taxcollector LOCAL BUSINESS TAX To Pay by mail make check payable to: lami-Dade County T Local Y ax Collector al Business Tax#: - 0069323 0 6 140 W Fla e r S# 14 Floor State/CC#:lOBSO S 0180 Issued to: Miami FL 33130 BESSARD ROOFING LLC (305) 270-4949 fax (305) 372-6368 Type of Business: I' SPECIALTY BUILDING CONTRACTOR bring the bottom ortio p n of this bill for proper validation. 25.00 up to a minimum of 5%will be charged for all returned checks. THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX ' OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami-Dade County Tax Collector I I 0312212013 09:361 P.0011001 ' CERTIFICATE OF'LIABILITY INSURANCE DATE(MMIDDNYYY) +�... 1 03/22/13 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 certiflcate holder Is an ADDITIONAL INSURED,the policy(les)must he endorsed. H SUBROGATION IS WANED,Subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer lights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Patricia Fernandez Assure-US,Inc. PHONE (30 )956-7818- , No: (305)956-5946 1880 NE 163rd Street M L patriciadiassureus.us North Miami Beach,FL 33162 PRODUCER CUSTOMER ID 49 Phone (305)956-7818 Fax (305)956-5946 INSURER(S) AFFORDING COVERAGE NAIC d INSURED INSURER A: Atlantic Specialty A- Bessard Roofing,LLC INSURER B: 275 ne 48th Street INSURER C: Miami,FL 33147 INSURER 0: INSURER E: INSURER F! 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 ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, N EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY EFF P LI Y IX S POLICY NUMBER MM/D MID LIMITS GENERAL LIABILITY EACH OCCURRENCE S $300,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED— PREMISES Es occurrence)$ 50,000.00 CLAIMS-MADE �/I OCCUR Policy#1174000463-1 MED EXP(Arty one person) $ 1,000.00 A 02/08/2013 02/08/2014 PERSONAL&ADV INJURY S $300,000.00 GENERAL AGGREGATE $ $300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S $300,000.00 A t/ POLICY — PRO- Ej Loa $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ SCHEDULED AUTOS ALL OWNED A NA BODILY INJURY(Per accident; $ — i — PROPERTY DAMAGE 4 — HIRED AUTOS (Peracoident) $ NON-OWNED AUTOS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR _ CLAIMS MADE NA AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION Y/ WC STATU- I OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIE)aECUTNE NA E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED/ NIA (Mandatory in NH) describe urWer E.L.DISEASE-EA EMPLOYE $ M s, DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romance Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES,FL 33138 AUTHORI7ED REPRESENTATIVE �- Fax:(305)756-8972 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09)OF The ACORD name and logo are registered marks of ACORD _ Miami Sit®resihlla HIGH-VELOCITY HURRICANE ZONES FFi=.O rED BY r NG DEIP APR -1 � : C DEPT F ade di19on2010 - --- • High Vet H RA"" Form. Section A (General Information) Master Permit No. Process No. Contractor's Name SA Job Address-10 r � A C4/ �I f. (/45 /n / M I L 331 Q' ROOF CATEGORY • ❑ Low Slope ❑ Mechanically Fastened Tile J50 Mortar/Adhesiv et Tile ❑ Asphaltic ❑ Metal Panel/Shingles ❑ Wood Shin a Shingles • ❑ Prescriptive BUR-RAS 150 ■ ROOF TYPE r Q New Roof ❑ Reroofing ❑ Recovering Repair Ma,Inte ROOF SYSTEM INFORMATION Low Slope Roof Area(SF) Steep Sloped Roof Area(SF) Total(SF) r Section B (Roof Plan) C Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identrfy dimensions of elevated pressure zones and location of parapets. L7 .a i • • ■ • 2010 FLORIDA BUILDING CODE—RESIDENTIAL „w 04 a.. SECTION R4402.13 HIGH VELOCITY HURRICANE ZONES-REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS R4402.13.1 Scope.As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit,and to explain to the owner the content of the section.The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations. Additionally,the following items should be addressed as part of the agreement between the owner ant the contractor.The owner's initial in the designated space indicates that the item has been explained. 1. AJ— Aesthetics-Workmanship:the workmanship provisions of Section R4402 are for the purpose of providing that the roof system meets the wind resistance and water instruction performance standards. Aesthetics(appearance)are not a consideration with respect to workmanship provisions.Aesthetic issues such as color or architectural appearance,that are not part of a zoning code,should be addressed as part of the agreement between the owner and the contractor. 2. H J- Renalling wood decks:When replacing roofing,the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403.(The roof deck is usually concealed prior to removing the existing roof system). 3. Common roofs:Common roofs are those which have no visible delineation between neighboring units(i.e.,townhouses,condominiums,etc.) In buildings with common roofs,the roofing contractor and/or owner should notify the occupants of adjacent units of roofing to be performed. 4. lY cl� Exposed Ceiling: Exposed,open beam ceilings are where the underside of the roof decking can be viewed from below.The owner may wish to maintain the architectural appearance;therefore, roofing nail penetration of the underside of the decking may not be acceptable.This provides the option of maintaining the appearance. v. Ponding water:The current roof system and/or deck of the building may not drain well and may cause water to pond(accumulate)in low-lying areas of the roof. Pounding can be an indication of structural distress and may require the review of a professional structural engineer. Pounding may shorten the life expectancy and performance of the new roofing system. Pounding conditions may not be evident until the original roofing system is removed. Pounding conditions should be corrected. 6. Overflow scuppers(wall outlets): It is required that rainwater flows off so that the roof is not overloaded from a buildup of water. Perimeter/edge wall or other roof extension may block this discharge if overflow scuppers(wall outlets)are not provided. It may be necessary to install overflow scuppers in accordance with the requirements of Sections R4402, R4403 and R4413. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structure assembly(the building itself).The existing amount of attic ventilation shall not be reduced.It may be beneficial to consider additional venting which can result in extending the service life of the roof. �� t�� LEI&4-L kw1;e. je_r-a'-we 0 J Owner/Agent's Signature Date Contftlbtor Signature Date Revised on 7/9/2009 LD