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RC-14-621Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 212402 Permit Number: RC -3 -14 -621 Scheduled Inspection Date: May 15, 2014 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Inspection Type: Final Owner: MEDINA, ANA MARIA Work Classification: Repair Job Address: 1081 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132060143620 Project: <NONE> Contractor: ROBBINS GUNITE CO INC Phone: 305 - 756 -6101 tsunal comments GUNITE REPAIR TO APPROX 150 LF OF RIB -JOIST I ---� - - " " " - "� INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 209856. Print photos for next f inspection Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 14, 2014 For Inspections please call: (305)762 -4949 Page 20 of 30 q •. 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 Z01 tco� Permit No. q Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: / c9 4r t tO . e 4 s Sr. City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: I/- 3 a o t. - ci r f- 3 (a A Is the Building Historically Designated: Yes NO k:f' Flood Zone: OWNER: Name (Fee Simple Titleholder): Phone #: Address: 4,of*U 4 114c C) ► m 4 City: !/�, rs / ey , :; ? S "irati :f, .n z % Zip. Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: e ra 73! na 5 (S k XN4 e re-, ec, Lei. C Phone #: 3a j - 7.r6-61&( Address: to Z 6! Al r sq v c City: /W® State: Zip: Qualifier Name: _ S. r2 a 8 , ,,, s Phone #: State Certification or Registration #: Certificate of Competency #: r {Y 60 0_1 2ia a:j Contact Phone #: Email Address: DESIGNER: Architec ngineer 3 r k J , s * r_ rvrd o `v + v4 c o Phone #: "_i a -3 Z Fr i! Value of Work for this Permit: $ Cvd 06 • o o Squar Footage of Work: / .sa r Type of Work: ❑Addition ❑Alteration ❑New [BRepair/Replace ❑Demolition Description of Work: &u At i ► E K e e y rd -n �9 ��a x < I S-� L r j2 .. Xi r s 7 - Color thru d1e: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 Owner or Agent The foregoing instrument was acknowledged before me this .1 9' day of 34 cus/T , 20 L 1, by k 1A ti rfe P r,4 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: rA. Print: L2.1 c ef�nkta My APPROVED BY ERIi✓"" my coY✓MIISS1014 Zg 14 F-XPIIZF� -. FLlsota�Ya°w° °a Signature_ Contractor The foregoing instrument was acknowledged before me this day of A14-CA . 2011 K , by $ &L lce-t y C , who is personally known to me or who has produced Plans Examiner "14 Structural Review identification and who did take an oath. NOTARY PUBLIC: Sign: Z4-9!� Print: 4 e (Revised 5/2/2012XRevised 3/12/2012) XReviser106 /10 /2009XRevised 3 /15 /09)(Revised 7/10/2007) �BVIREr, A Co. Zoning Clerk C 1 ° °� CERTIFICATE OF LIABILITY INSURANCE iiioi2o 2 PRODUCER THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION Robert Bernstein Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR DBA Royal Brokerage ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 561 450 5544 1 INSURERS AFFORDING COVERAGE NAIL # INSURED Robins Enterprises, Inc INSURER A: Colony Insurance Co 6701 NE 3rd Ave ~INSURER B:.,. 44/ INSURER C Miami, FL 33138 '_s-1— -. __ INSURER E rnwr-0Arecc 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. — r(Pff OF INSURANCE tlliiR i I POLICY NUMBER - — POLICY EFFECTIVE ( POLICY EXPIRATION Uh11TS GENERAL IJASRM EACH OCCURRENCE S1,000,000 =� MMERCIAL GENERAL LIABILITY ; CO PREMISES IEa RENTED w=) 4 S 100, 000 CLAIMS MADE X OCCUR MP 3 9 6 5112 04/14/13 04/14/14 ` MED ExP (Any ona tom+) $5,000 . X. j l PERSC#dAL 6 ADV INJURY 151,000,000 GENERAL AGGREGATE $1,000,000 I GENT. AGGREGATE LIMIT APPLIESPER:1 PRODUCTS- COMPIOPAGG i S INCLUDED ~— POLICY ^ 7 PRO- LOC FC AUTOIIIDBiLE tSAeiLRTY i COMBINED SINGLE LIMIT S ANY AUTO (Ea acaaent) L J ALL �A NEO AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) ~• HIRED AUTOS BODILY INJURY S NON-OWNEO AUTOS (Pet a=dent) . PROPERTY DAMAGE S (PeratdtJent) GARAGELWBILITY AUTO ONLY- EAA CIDeNT i S _ I ANY AUTO OTHER THAN EA ACC S AUTO ONLY: EXCESSIUMBRELLALIABILiTY —: i EACH OCCURRENCE S OCCUR CLAIMS MAD'e AGGREGATE _ __ S .__ . — S DEDUCTIBLE - S — I RETENTION S - S WORKERS COMPENSATION WC STATU- OTH- ER AND EMPLOYERS' LIABILITY YIN ; T.DBY LIMITS = ANY PROPRIETOAIPARTNERSnCUTWE E.L. EACH ACCIDENT S_ � - OFFIC£RIMEMSER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S =F-208=6 palmy - E.L. DISEASE - POLICY LIMIT i S OTHER 15,000 Scheduled Equipment x Inland Marine MP3965112 04/14/13 04/14/14 19,88 scheduled Equipment 1,000 Deductible S I VEWLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ResideMia( Ccmcr xcluding Earthquake, FIDDd, Theft and Wind or Hail ACV: 100% Co-Ins r1RR2T V1f1AT'F t4nt nr-Rt r`AMr_R:1 1 ATIfIM Miami Shores Bldg. Dept. SHOULDANYOFTHEAMNEDESCRtREOPOLMMBECANCEL LEDBEFORETMEWMTIOM 10050 NE 2 Ave. DATE THEREOF, THE I SUNG INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTW4CATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 $O SHALT. Miami Shores, Fl 33138 IMPOSE No OBLIGATKxN OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Fax: 305 -756 -8 972 REPRESENTATNES. AUTHORIZED REPRESENTATIVE ACORD 25 (201 MI) ®1988 -2009 ACORD GORPORATION. All rignts reservea. The ACORD name and logo are registered marks of ACORD Municipal- Contractor's Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT BILL —DO NOT PAY CC NO: 000018307 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES ROBBINS GUNITE CO INC NEW BUSINESS SEPTEMBER 309 2044 6701 NE 3 AVE 7436047 MIAMI, FL 33138 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 OWNER ROBBINS GUNITE CO INC TYPE OF BUSINESS PAYMENT RECEIVED SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR 175.00 08/20/2013 022413- 000827 For more information, visit www miamidade gn d=oljflctnr Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 2165181 LBT BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES ROBBINS GUNITE CO INC RENEWAL SEPTEMBER 30 2014 6701 NE 3 AVE 2277762 MIAMI, FL 33138 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED BOBBINS GUNITE CO INC 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 08/20/2013 Worker(s) 3 000018307 022413 -000827 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder mum comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles— Miami —Dade Code Sec Ba -276. MIaMtOAUE For more information, visit www.miamidade.govhexcollestor mm • CERTIRCATE OF ELECTION TO BE EXEMPT FROM FLORIDA WONOW COMPENSATION LAW "' CONSTRUCTION INDUSTRY EXEMP71ON This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE 8/3/2013 EXPIRATION DATE 8!3/2015 STEPHEN FEIN: 6501 ROBBINS GUNITE CO INC 6701 N.E. 3 AVENUE MM FL 33138 SCOPES OF BUSINESS OR TRADE.- CONCRETE WORK INCIDENTAL TO TH seam DFS- F2-DWC -252 CERTIFICATE OF ELECTION TO BE E)EWT REVISED 07 -12 QUESTIONS? (850)4131 608 40AIDADE COUNTY 2011 LOCAL BUS TAX APT 2012 FIRST-C' COLLECTOR MIAW-DAOE COUNTY - STATE OF FLORIDA U.S. POSTAGE W. FLAGLER ST. EXPIRES Ski. 80, 2012 PAID MUST BE OMPLAYED AT ftAft OIL /DOSS MIAMI, FL PURSUANT TO COUNTY 00106 .SA 4M. Y i 10 PERMIT NO. 231 216518-1 THIS IS NOT A BILL - DO NOT PAY BUSINESS NAME! LOCATION- ROBBINS GUNITE CO' INC. 6701 NE 3 AVE 33138 MIAMI OWNER ROBBINS GUNITE CO INC TY BUILDING CONTRACTOR PAVAIM rJECOM WAM•DADE COMY TAX 000MM 09/22/2011 02250010001 000045.00 SEE OTHER SIDE RENEWAL CC >1RECEIPT 018307 227776 -2 WORKER /S DO NOT FORWARD ROBBINS GUNITE CO INC STEVE ROBBINS PRES 6701 NE 3 AVE MIAMI FL 33138 11111./ 111111111, dill$ 1I, 1 ,1i11i11,1i„iliiiill►,,,,i11441 T E I'OCOUNTY 2011 MUNICIPAL CONTRACTOR'S ;2012 FIRST -CLASS 14 �� LER ST. TAX RECEIPT U.S. POSTAGE MIAMI -DADE COUNTY -STATE OF FLORIDA PAID FL 33130 PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI, FL EXPIRES SEPT. 30, 2012 PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY RECEIPT NO. 30- 2277762 CC NO: 000018307 BUSINESS NAME / LOCATION ­RECEIPT RECEIPT HOLDER MAY DO BOBBINS GUNITE CO' INC BUSINESS AS A CONTRACTOR 6701 NE 3 AVE AS SPECIFIED HEREON. OWNER : ROBBINS GUNITE CO INC SEE BACK OF RECEIPT FOR SPECIALTY BUILDING CONTRACTOR A LIST OF NON— PARTICIPATING MUNICIPALITIES Receipt holder must DO NOT FORWARD register in the city ROBBINS GUNITE CO INC where work tst°be done. STEVE ROBBINS PRES do 6701 NE 3 AVE MIAMI FL 33138 PAYMENT RECEIVED ='"n 1 02290011001 000175.00 1 1I CTQB Construction Trades Qualn9 Board i BUSINESS CERTIFICATE OF COMPETENCY] 000018307 r 'ROBBINS GUNITE CO INC D.B.A.: ROBBINS STEPHEN WAYNE Is certified under the provisions of Chapter 10 of Miami -Dade County 14 SV(od Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 I (We) have been retained by !./�i< G�., 4 ' in the Flo a Building Code at the o &/ �. °is' . °� special r under 9 / �9' projact on the below listed Structures as of (date). I am a registered architect or professional engineer licensed in the State of Florida PROCESS NUMBERS: o SPECIAL INSPECTOR FOR PILING, FBC 1822.1.20 (84404.6.1.20) • SPECIAL INSPECTOR FOR TRUSSES >35 LONG OR W HIGH 2319.1714.2 (84409.6.1724.2) • SPECIAL INSPECTOR FOR REINFORCED MASONRY, FBC 2122.4 (84407.5.4) ❑ SPECIAL INSPECTOR FOR STEEL CONNECTIONS, FBC 2218.2 (84408.5.2) ❑ SPECIAL INSPECTOR FOR $OIL COMPACTION, FBC 182011(R4404.4.3.1) ❑ SPECIAL INSPECTOR FOR PRECAST UNITS & ATTACHMENTS, FBC 1927.12 (R4405.9.12) ,IT' SPECIAL INSPECTOR FOR !Q� -M& IQ Abb?: Only the marked boxes apply. The folio 2representatives 2. tndMdual(s) employed by this firm or me are authorized to perform 1. " 3. 4. *Special Inspectors utilizing authorized representatives shall insure the authorized representative Is qualified by education or licensors to Wrforrn the duties assigned by the Special Inspector. The qualifications shall include lcensore as a professional engineer or amhltect; graduation from an engineering education program In civil or structural engineering; graduation from an architectural education program; successful completion of the NCEES Fundamental Examination; or registration as building Inspector or general contractor. inspection * I, (we) will no* Miami Shores VDlege Building Department of any changes regarding authorized personnel performing inspection services. I, (we) understand that a Special Inspector inspection log for each building must be displayed to a convenient location on the site for reference by the Miami Shores Village Building Department Inspector. All mandatory Inspections, as required by the Fiprida Building Code, must be performed by the County. The Village building Inspections must be called for on all mandatory Inspections. Inspections performed by th e Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the Deparhnent Further, upon completion of the work under each Building Permit I will submit to the Building Inspector at the time of final inspection the completed inspection log form and a sealed statement indicating that to the best of my knowl�ge, belief and professional judgment those portions of the project outlined above meet the Intent of the Florida Building,: Code and are In substantial accordance with the approved plans. . • • • '• • • . . . . . . Signed -and Sealed Engineer /Archite •' . .. . . . . ... . Name �% — ,mss✓ .... MW Address_ /Z¢u'� �.:F✓. " ... . . :0: .. . . .. .. . .... . . .. Phone No. �g�- ►�7LZ�, 0 • .... ..... .... . Created on 6110009 .. . .. .. . . . .. .. .... . . .... . AMERICAN SOCIETY NATIONAL SOCIETY OF OF CIVIL ENGINEERS PROFESSIONAL ENGINEERE NATIONAL ACADEMY•• FLORIDA ENGINEERING OF BUILDING INSPECTION CONSULTING ENGINEER SOCIETY ENGINEERS PROFESSIONAL BUILDING INSPECTION 12420 S.W. 76th AVE.,1 MIAMI, FLORIDA 33156 TELEPHONE: (305) 37 8-1244 Established 1876 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 Att: Building Official 4 March, 2014 Ref: 1081 N.E. 95th Street Miami Shores, Florida I, J.N. Sheingold, P.E. have prepared the concrete restoration plans and specifications to correct the structural deficiency at the above referenced single family residence. Please be advised that the work as described will not reduce the structural strength or the stability of the building structure, or any individual member, thereof as per FBC 2010 edition. If you have any questions or require additional information, please do not hesitate to call this office. P.E. 21181 .• ..• • . . .. •. . • . . . . .. . . .. ... .. . .... . .•. . ••• . • ... . .. . .. . .... . . . . . .. . . . .... . ... • . . ••• . • • • • • • • :00.: ••• • • • ••• • 0 AMERICAN SOCIETY NATIONAL SOCIETY OF OF- CIVIL. ENGINEERS PROFESSIONAL ENGINEER; NATIONAL ACADEMY` `��• FLORIDA ENGINEERING OPSUILDING INSPECTION CONSULTING ENGINEER SOCIETY ENGINEERS PROFESSIONAL BUILDING INSPECTION 12420 &W 76th AVE., / MIAMI, FLORIDA 33166 TELEPHONE: (305) 373 -1244 Established 1976 4 March, 2014 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 Att: Building Official Dear Sir: We have been retained by the owners of 1081 N.E. 95th St, Miami Shores, to provide special inspector services as defined in section 105 of the F.B.C. The repairs are to be performed by Robbins Gunite under contract to the owner. The repairs will consist of the following: 1. Structural repair to approximately 150 lineal feet of reinforced concrete rib joists under the existing living area. 1. Remove all loose and spalling concrete using a light chipping hammer. Note: no additional chipping without approval of Engineer. 2. Inspect exposed interior reinforcing steel and replace any steel damaged in excess of 10 %. Should laps be required, at least 48 bar diameters or 30 inch minimum is required as per ACI 318 -11. Steel is to be 60 KSI. Concrete cover for steel rebar is to be a minimum of 1.5 inches. Concrete strength to be 5000 psi. 3. Should steel replacement be required, embedment of rebar into existing concrete structures is to be a minimum of 9 inches and Sika 31 Gel epoxy is to be used. No areas are to be concealed without Engineer's approval. 4. Sandblast existing exposed rebar and coat with Armatec 110 or equivalent. 5. Restore to original dimension using Gunite. Engineer's inspection required to verify removal of all loose debris and adequate coating of rebar. 6. Remove all construction debris from job site. All work to be in accordance with ICRI 03730 and ACI 318 -905. In progress inspections will be performed and a final inspection report will be forwarded uponwrople0op. •.::... . . .. ••• .. . • • •• .... . . .... . AMERICAN SOCIETY OF CIVIL ENGINEERS. NATIONAL ACADEMY OF BUILDING INSPECTION ENGINEERS Page 2 NATIONAL SOCIETY OF PROFESSIONAL ENGINEER: /• ' FLORIDA ENGINEERING CONSULTING ENGINEER SOCIETY PROFESSIONAL BUILDING INSPECTION 12420 S.W. 75th AVE., / MIAMI, FLORIDA 33158 TELEPHONE: (305) 378.1244 Established 1978 1081 N.E. 95th St Note: no work to be concealed without inspection by the Engineer -of- record. The engineer's inspections are in addition to those required by the Building Department. The work is to be in accordance with the FBC 2010 - Existing Bldg Manual Section 506. Concrete batch mix must comply with ACI Table 4.2.2 for locations subject to salt spray. Rebar cover must comply with FBC 1926.5. No work to be concealed without inspection by the Engineer -of- record. A. B. Preliminary Inspection showed the structure to have less than substantial structural damage The areas defined above will be inspected after all areas exposed to determine if the extent of damage exceeds expectatjon. .. ... . . . . . .. • ....... 000 ... .. 000 .... ... . . . . , • • . .. .... . • • • • .. ... • ... . . . . ... . . . ...... .... 0,0 . ... . ... . 21181 'AMERICAN SOCIETY '....� .. • ��' -' • .._.. '• i OF-CIVIL ENGINE RS �- �.:- -. _ 3 NATIONAL SOCIETY: F , --�- ' PROFSSSIONALIEN I S -Ti , NATIONAL •ACA4EM - I �'. - FLORI N�JN OF BUILDING INS EC 10 _ OMSULTING ,ENGINgER R G ENGIN ER ROFE$SIQNA L BUILDING INSPECTION - --- � .�. -...:. __.__ U420 S• rath AVE. ,'.JMIAMI, FLORIDA 33156 TELEPHONE: (305) 3781244 - +- _ - ••�_- Established 1976 jj evil • i • r •• •�� s .-.• :ham � • .. ��+Q �Q��/�.C!� '" '• . • • • •i ,•,�f _ •••i. .:...•...• . f i• • • • • • •• i•• 0. w J ! IffiHISINEIMHEMEN C F H 201480207744 [lit ilk =77 Pas 2738 - 27691 Mss? 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