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RC-13-2216Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 200178 Permit Number: RC -10 -13 -2216 Scheduled Inspection Date: November 14, 2013 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Owner: , Job Address: 186 NE 109 Street Miami Shores, FL 33161- Project: <NONE> Contractor: LCN GROUP INC comments NEW KITCHEN CABINETS inspection Type. Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360090090 INSPECTOR COMMENTS False Phone: (305)318 -2686 November 13, 2013 For Inspections please call: (305)762 -4949 Page 13 of 31 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 13, 2013 For Inspections please call: (305)762 -4949 Page 13 of 31 6 Miami Shores Village CMM Buildin g Department artment . 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Z�' OCT Tel: (305) 795.2204 Fax: (305) 756.8972 �e INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING Permit No. n n it) PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 1K;6 Ale, 1061 9-1(-4 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: f' —Jt?- T� oe / q —©1>70 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Y, N)' /-1 o,,w City: State: %G'r Zip: Tenant/Lessee Name: Phone #: Email: Ie:,0( 3o = 7Liq) CONTRACTOR: Company Name: Phone #: y&J". &i t4 Address: 5�# Xt City: State: lG 1 Zip: Qualifier Name: Le t f 4 Phone #: State Certification or Registration #: c& a 7 /& Al Certificate of Competency #: 1�' Contact Phone #: 105 pr :10 d't° Email Address: I Gw 64W a e-. DESIGNER: Architect/Engineer: 4,11h— Phone #: ' Value of Work for this Permit: $ rt b b 0 Square/Linear Footage of Work: Type of Work: OAddition DAlteration ONew *epair/Replace ❑Demolition Description of Work: &Ac h/ t cl yr 4 Q Color thru tile: Submittal Fee Scanning Fee $ Permit Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ 11 q 0 6L-- Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 ,RECORDQ+ 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 Owner or Agent The foregoing instrument was acknowledged before me this cam' "' day 6QIr;201,5,by�j5� who is personally known to me or who has produced ' As identification and who did take an oath. `Iallfiv 112\2 U Sign: Print: My Commissi APPROVED BY Signature Contractor The foregoinginstrument was acknowledged before me this day of 20 / 7, by "X"/ ty" nu( who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: JANICE AIMEE MATOS My Commission MY COMMISSION #FF011193 EXPIRES Aoril�3, 2017 Plans Examiner Structural Review (Revised 5 /2 /2012)(Revised 3/12/2012) )(Revised 06/10 /2009 )(Revised 3/15/09 )(Revised 7/10/2007) Golding DWIRES:JUNE21,2015 WWW.AARONNOTARY.00m Zoning Clerk Miami shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. � OPY 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. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS 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 ■■ rrrrrrrrrr�rrrrrrrrrrrrr�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: L C-lioU R :7;,17 a BUSINESS ADDRESS: S Sw 4-,/'7 f -CITY STATE ZIP CODE J BUSINESS PHONE: (3 y5 ) 3 J t FAX NUMBER) 0Z1`01 4 CELL PHONE QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: c /.5-) 1 t -� E -MAIL ADDRESS (IF APPLICABLE): "/t/ 6-11 Ot"' 1-fell tyto k-��° Created on 3119109 BY MLDV 1 RV 3126109 MLDV 1 RV 6127111 AS FIRST -CLASS U.S. POSTAGE MIAMI, FL PERMIT NO. 231 585319 -8 THIS IS NOT BILL - DO NOT PA's RENEWAL BUftlff`dffloLIWON STATEV IR19854610365 -9 201 S BISCAYNE BLVD 2800 33131 MIAMI ' GROUP INC 'a`l dfI ` BUILDING CONTRACTOR WORKE2 /5 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY OR ZONING LAWS REGULATORY HE THE C DO NOT FORWARD cow on Es COUNTY OR EXEMPT NHE HOES tT EXEMPT TER t=•ROR ANY OTHER LCN GROUP INC PERMIT PERMIT OR LtCRS IS RRDtnRED R�r LAW. THIS Isf LEIGWtO'N BROWN FIRES NOT A CERTIPICATIDN OF H THE atoER -s GlIAL9PICA. 201 S BISCAYNE BLVD 2800 THE MIAMI FL 33131 PAYMENT RECEWaD MIAPAI.DADH COUNTY TAX COLLECTO10 /10/2012 09010045001 000049.50 76 SEE OTHER SIDE CERTIFICATE OF LIABILITY INSURANCE DATE `1W13 '' TYPE OF INSURANCE 073 THIS C R IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OERTIFICATE 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: lithe certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAVED, 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 endomementls). PRODUCER J.V. Insurance Agency 17690 S. Dude Hwy. Suite A CO E! CT VetbertAndersort PHONE Ext (305) 253 -7555 a No : (305) 254 -1461 E4WL Pantmrn@belisouftnet INSURERS) AFFORDING COVERAGE NAIC# Miami, FL 33157 INSURER A: LLOYDS OF LONDON $ 100,000.00 Phone (305) 253 -7555 Fax (305) 2541461 INSURED INSURER 13: PROGRESSIVE EXPRESS INS $ 1,000,000.00 INSURER C : ILLOINOIS NATIONAL INSURANCE COMPANY GENERAL AGGREGATE LCN Group, Inc. INSURER D: PRODUCTS - COMPIOPAGG 201 S Biscayne Blvd. #2800 POURER E: $ Miami, FL 33131 AUTOMOBILE LABJTY ❑ ANY AUTO ❑ AA OWNED w A�8 ULED HIREDAIJTOS ®AUiOSWNED ❑ ❑ INSURER F: 12/13/2012 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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. ILTR TYPE OF INSURANCE R UBR POLICY NUMBER MMIDD EFF POLICY EXP LIMITS A GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY F-1 F1 CLANS-MADE ❑ OCCUR ❑ HUWT1 -13 08/28/2013 06/28/2014 EACH OCCURRENCE $ 1,000,000.00 PREEMMISES(Ea RENTED $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL BAOVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLES PER: ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOPAGG $ 1,000,000.00 $ B AUTOMOBILE LABJTY ❑ ANY AUTO ❑ AA OWNED w A�8 ULED HIREDAIJTOS ®AUiOSWNED ❑ ❑ 01979342-0 12/13/2012 12/13/2013 BND INGLE LIMIT C(12! ad $ 500,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ P OP�ERdYAMAGE Uninsured motorist 19 UMBRELLA LIAB 90CCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE ❑ DIED ❑ RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERtMEMBER EXCLUDED? (Mamiatory In NH) El If yes, describe under DESCRIPTION OF OPERATIONS below NIA N 03138483 3/5/2013 3/15/2014 WC STATU- OTH- ❑ TORY IMITS ❑ ER E.L. EACH ACCIDENT $1,1300,000.00 EL DISEASE - EA EMPLOYE $1,Img000.00 E.L. DISEASE- POLICY LINT $1,ODO,000.00 A BUILDERS RISK HUWT1 -14 06128/2013 06128/2014 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Rem Schedule, ff more space is requhed) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT 10050 N.E. 2ND AVE MIAMI SHORES, FL 33138 ACORD 26 (2010105) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVE IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1888 -2010 ACORD CORPORATION. All rights reserve!. The ACORD name and logo are registered marks of ACORD 9 -�-W S Qe U� �Q �o �104r V#, r' �� e b APPROVED ZONING BLDG. SUBJECT CT 1 STATE AND r 7o WITH ALL FED L i AND RE(,0LAT .., N S R s V F/ e C-tn; el ( C out je fs NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.E I EPTAGLE UNDEfl SINK. TCLE. POT DM1 REG ALL FIXED APPLIANCES ON DEDICATED CKTS. ml