RC-13-0822Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 189721 Permit Number: RC -4 -13 -822
Scheduled Inspection Date: July 25, 2013 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge
Inspection Type: Final
Owner: GOMEZ, JOAQUIN Work Classification: Addition /Alteration
Job Address: 1560 NE 105 Street B -2
Miami Shores, FL
Phone Number
Parcel Number 1122300530140
Project: <NONE>
Contractor: . RAUSA BUILDERS INC Phone: (305)554 -5711
Building Department Comments
KITCHEN REMODEL
Infractio Passed Comments
INSPECTOR COMMENTS False
i
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 25, 2013 For Inspections please call: (305)762 -4949 Page 6 of 33
07/25/2013 08:43 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES
TRANSMISSION OK
TX/RX NO
RECIPIENT ADDRESS
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT
RESULT
AU Or
TX REPORT
3034
97885587290
07/25 08:43
00'19
OK
BUILDERS CORP
7111 SW 42nd ST Miami, FL 33155
Ofr'CC; 305-554•.5711 1 raX: 786-558-7290
. ED CfV-%VErK% SFIEET
. .......... . . ..... .
TO: villagc----: of Miami or
� I.,
1� es
DePQrtMent: fnspc?cfion�
Tel: 305,762.4'49
Fax: 305.756,8972
FROM, Martha GL.JerrO. Coordinator
Fmail-- marthOEu(IrriC6jrLlLi5,c)btjildLrs.con)
DATE: July 24, 20 '13
RE: FINAL BUILDING INSPFCTION RFQUEST
FOR THURSDAY, JI-AY226, 2012
9:00 am - 1:00 pm
Michelle and Joaquin Gomez
1560 N.E. 705th Street
M'Omi Shores, FlOnida 33141
Permit No.: RC,473822
IA 001
W(.-*: have Irn--ft rr�cwssc�clo Via telo-,phone, re.c.ordinc
I g rt�,quesfing, the abow*�---
r1ced
- r 15111, 13
confirm 4hat on ThUr$ciay, j�:, V 2� 20
CFN: 20130359249 BOOK 28617 PAGE 3693
DATE:05/07/2013 01:02:25 PM
NOTICE OF COMMENCEMENT HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. - 13 TAX FOLIO NO. t�-
STATE OF FLORIDA:
COUNTY OF MIAMI- ,DADE:
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.
2.
Legal description of property and street / address:
' F. j vl In1F1UYCrrlClll.
3. Owner(s) name and address:
3 �u c-soft2z•1 ""Cycke. eo mjm ; IS&C N 05 c5. -#�,2 �tty4�; S)IcrU'C_j 33,39_
Interest in property:
Name and address of fee simple titleholder.
4. Contractor's name and address:
RotusA Q'Vj'k&_NrS 144 5tO �K C. AA Qft,Vl '231.55
5. Surety: (Payment bond required by owner from contractor, if any)
Name and Address.
Amount of bond $
S. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents maybe served as
provided by Section 713.13(1)(x)7., Florida Statutes_
Name and Address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienoes Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and Address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
rWM�km
Print Owners lame Jp++EB'tl?) J &o'AAa 2x
Sworn to a /b's�cri before me this day of � -�,r " r' em' laex
i \ J lidv My � ion EE 188275
ExpirEaU',107ni ala
Print NotaryTs`id2rf"e:
My commission expires:
HARVEY RUVIN, CLE7 , irkitAi1A0AnV CCU
Deputy
n
\'SIN° <)
Miami Shores Village
Building Department
10050 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 No.
F !
APR 2 Y 2013
c --
FBC 20 l6
Master Permit No. 13 ° ac-;kq)
Permit Type: BUILDING ROOFING
JOB ADDRESS: %5(4 QZ 10K 54
City: Miami Shores County: Miami Dade
Folio/Parcel #: It— VLSO — —01LA C)
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Sod Hwy\ D Z Phone #:
Address: MU ® N1 V-- X05 S
City: & \Q Wlo '�) VIC/`t-9 State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: Phone #: SOS _15-s-L4 ° 15 31 i
Address: . L4 R o . _ _ Rte.
City: AX\ 01 ft i State: ` Zip: �� _S7
Qualifier Name: N e-1 '1\c \ daa- Phone#: q ' -iLZY3
State Certification or Registration #: 00 70 Certificate of Competency #:
Contact Phone #: SOS " '(-0° � `2 � 3 Email Address: (lam td-9:®iC*,l tide\rs . COM
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ t 0J 00 Q Square/Linear Footage of Work: 1 k—Z—
Type of Work: ❑Addition giAlteration ONew ORepair/Replace ODemolition
Description of Work:
Color thru tile:
Submittal Fee $ J(D Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
*_ 0^
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
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 q I approved and a re' spection fee will be charged
r.
Signature Signature
Owner or Agent Contractor
The fore oin instrument was acknowledged before me this
g
day of , 20 I � , by �D (A LL2' y' (j a,4A- ,
who is personally known to me or who has produced
As identification and
NOT PUBL C: $�v P� Notary Public State of Florida
Marta Hernandez
° a My Commission EE
166275
Expires 0710212016
Si
Print: r
My Commission Expires t 2-1 to
The foregoing instrument was acknowled ed before e this
day of J• , 20 _T, by i B ,
who is personallftnown to me or who has produced
I' identification and who did take an oath.
Public State of Florida
Hernandez
"mission EE 186275
Print: 0EftWiW�kWNMLW_M1LW;
My Commission Expires*
i
APPROVED BY �� Plans Examiner zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
ox-ers to - bar6eque iestauratft and tKey keep Flo dda's economy song.
Every day we work to improve the we a do business in order to serve you betty
For infbrihabon about our services, pt se log onto vAmmy.florldalleensecom,
There you can fired more information about our divisions and t-h6 regulatfoits that
impact you, subscribe to department newsletters and seam more about the
Depari nt's Initiatives,
iFAri�'r the tioST� a. M.S. 0 chap
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C,O DrA, CERTIFICATE F LIABILITY INSURANCE
04/17/2013'
PRODUCER 305 - 227 -0082
CAROLINA INSURANCE CONSULTANTS
$250 W FLAGLER STREET, STE 916
MIAMI, FL 33144
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED A
RAUSA BUILDERS INC
7111 SW 42 ST
MIAMI, FL 33155
INSURER A ACCIDENT INSURANCE. COMPANY
INSURER B:
INSURER C.
RE D
FINSU�RERRWE:
I:n'II=*AGE -S
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I�
QJT AT M! D !DRAY
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION !EMITS
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
GENERAL LIABILITY
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT F ILURE TO DO. SO SHALL
MIAMI SHORES VILLAGE
IMPOSE NO OBLIGATION OR LIABILITY OF ANY fN UPOI THE SURER, ITS AGENTS OR
EACH OCCURRENCE
S 1,000,000
FIRE DAMAGE (Any one EEra)
S 100 000
A
X COMMERCIAL GENERAL LIABILITY
2012010002
10107/2012
10/07/2013
MEO EXP(Any one person)
S 000
CLAIMS MADE ® OCCUR
PERSONAL &ADV INJURY
S 1,000,000
GENERALAGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGO
S 2,000,000
JE a LOC
POLICY f7 F
i
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
S
BODILY INJURY
(Per person)
S
ALLOWNED AUTOS
SCHEDULED AUTOS
I
BODILY INJURY
(Paraccident)
S
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Par accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
R
S
AUTO ONLY: AGO
EXCESS LIABILITY
EACH OCCURRENCE
S
AGGREGATE
Sw
OCCUR F CLAIMS MADE
S
S
DEDUCTIBLE
S
RETENTION S
WORKERS COMPENSATION AND
7ORYTAIvtITS �OER
E.L. EACH ACCIDENT
S
I EMPLOYERS' LIABILITY
111
E.L. DISEASE - EA EMPLOYEE
S
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONSILOCATION SNEHICLESIEXCLUSIDNS ADDED BY P-NOORSEMENTISPECIAL PROVISIONS
PC0-rl C7r`ATI- un! DPQ I X I nnnrnn�n, INSURED INSURER 9-rm=. CANCELLATION
».�,.... .. ................. .......... -.., ......... -.. - ........
SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT F ILURE TO DO. SO SHALL
MIAMI SHORES VILLAGE
IMPOSE NO OBLIGATION OR LIABILITY OF ANY fN UPOI THE SURER, ITS AGENTS OR
1006'60 NORTHEAST 2ND AVENUE.
MIAMI SHORES, FLORIDA 33138 FLORIDA 33138
REPRESENTATIVES.
✓
AUTHORIZED REPRESENTATIVE .a�� ��
ACORD 25-S (7187) -�'Kty u 1�.vmrlurtR I tvay I woo
DATE (MMIDD7MM
CERTIFICATE OF LIABILITY INSURANCE I 4118!2013
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 certificate holder Is an ADDITIONAL INSURED, the po[Wies) must be endorsed. If 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 rights to the
rAmflcate holder in lieu of such endorsement(s).
PRODUCER
QUINTANA & ASSOCIATES OF MIAMI INC.
5200 S W 8 ST SUITE 250
MIAMI FLA 33134
INSURED
RAUSA BUILDERS CORPORATION
7111 SW 42 ST
MIAMI, FL 33155
305 -445 -8153
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
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.
- — ccs I ant ir_v Fxn I ...�
GENERAL LIABILITY
MERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
LIMIT APPLES PER:
AUTOMOBILE LIABILITY
ANY AUTO
ALL QWNED SCHEDULED
AUTOS NON-OWNED
HIRED AUTOS AUTOS
UMBRE , A LIAR OCCUR
EXCESS, I" CLAIMS -MADE
DED I I RETENTION 3
WORKERS COMPENSATION 10645162
AND EMPLOYERS LIABILITY YIN 5113!2012 5/13/201
ANY PROPRIErOtuPARTNERIEXECUTlVE N I A
OFFICERtMIa1IBER FJ(CLUDED?
DESCRIPTION OF OPERATIONS 1 LOCATIONS t VEHICLES (Attach ACORD 101, Addidonat Remarks Schedule, H more space is ragtdred)
GENERAL CONTRACTOR—HOME INSPECTOR
POLICY SUBJECT TO POLICY TERMS AND CONDITIONS.
MIAMI SHORES VILLAGE
10050 NORTHEAST 2ND AVE
MIAMI SHORES, FL 33138
BODILY INJURY (Per pen=) $
909ILY INJURY O'waWd0-0 $
PROPERTY DAMA E 3
3
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
(r
Q 1 0 AC RP ION: All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registeredmarks of ACORD
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NO POINT ALONG COUNTER TO BE MORE THAN �
2 FEET FROM G.F..I PROTECTED RECEPTACLE. ADD, SMOKE/CARBON MONOXIDE DETECTORS.
PUT D/W RECEPTACLE UNDER SINK. ANY AND ALL CLOTH AND RUBBER
ALL FIXED APPLIANCES ON DEDICATED CKTR, INSULATED CONDUCTORS TO BE REPLACED. _
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