DS-14-7240)//1/4.0./n4c- Nil j ~ Miami Shores village
a *' Building Department
e
40050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972''
I �" p INSPECTION'S PHONE NUMBER: 30 762.4949
BUILDING rli) ,if-/s=1
,roW
PERMIT APPLICATIO 311a%y
Permit Type: BUILDING
JOB ADDRESS:
Z ✓)E%
� C20Ic
Permit Ne--) I if —
Master Permit No.
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): o�^ � 4�t rrG, Phone#: 305 !; _s !� 5
Address: 2 z:
City: 400r444 r State: T C zip: 3 '/
Tenant/Lessee Name: Phone#:
Finait:
CONTRACTOR: Company Name: Pelican Home Builders Inc.
Address: 5037 Hansard Avenue
City: North Port State: FL
Qualifier Name: James H. Gomez
State Certification or Registration #: CGC 047399 Certificate of Competency #:
Phone#: 305 - 992 -6959
Zip: 34291
Phone#: 305 - 992 -6959
Contact Phone#: 305 - 992 -6959 Email Address: pelicanbuilder @aol.com
DESIGNER: Architect/Engineer: Phone#:
`4
Value of Work for this Permit: $2000.00 Square/Linear Footage of Work:
Type of Work: OAddition OAlteration ONew ORepair/Replacp ODemolition
Description of Work: Deck 0 () r �?a'1STZ. c1 L r - f "{oe(L c /- c' Xi1 VQ rs
cric focg, sed
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ (r 6-
R
TOTAL FEE NOW DUE $ 6
Bonding Company's'Name (if applicable) NA
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) NA
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 will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of April . 20 _, by o c. "act .r1 who is personally known to me or who has produced T2 L
NOTARY PUBLIC:
Sign: _
Print: -, J <- - U fl%
My Commission Expires:
Signature
Contractor)
The foregoing instrument was acknowledged before me this 1
day of April , 20 _, by James H. Gomez
who is personally known to me or who has produced FL Drty Uc
HARRISON-- as identification and who did take aaoath.
Notary Public. State of Flom
Commission # EE 198163
My comm. expires May 14, 2018
a •�ht� #Q�N�A�b4 , kd�d�t �MQ,N�ri�Et *+R�F�R,l,kt�WB&�Mfl�B *Sri[
APPROVED BY 0 r Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
* * * * * * * * * * *** * * * * * * * * * **
Zoning
Clerk
A t ' CERTIFICATE OF LIABILITY INSURANCE '
DATE "")
Q4/07/2014
THIS CERTIFICATE 15 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 POUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HO DER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, die potIcy (ies) must be endorsed. If SUBROGATION IS WAIVED, 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 endorsement(s).
PRODUCER
Per Project Insurance Agency
3065 ROSECRANS PL STE 208
SAN DIEGO CA 92110-4822
CONTACT
NAME:
Nor () 269 -0992 I Fat Not (888) 969-0247
Mos, austanerserviCe@glquote.txmT
INSURER(S) AFFORDING COVERAGE
NAM #
mums A: Preferred Contractors Insurance Company RRG
12497
INSURED
PELICAN HOME BUILDERS, INC.
PELICAN HOME BUILDERS, INC.
5037 HANSARD AVE
NORTH PORT FL 34291 -5622
INSURER B :
INSURERC:
INS D :
INSURER E :
INSURERF:
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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OMR
LTR
A
TYPE OF INSURANCE
ADDL
0I
SUBR
WVD
POLICY NUMBER
POLICY OFF
POLICY EIIP
LIMNS
GENERAL UAWUIY
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE ® OCCUR
GE N'L AGGREGATE LIMIT APPLIES PFD
1 IouCY n
IECT n LOC
AUTOMOBILE UAWUTY
ANY AUTO
ALL OWNS)
AUTOS
HIRED AUTOS
PC105026- PCA514446
02/07/2014
02107/2015
EACH CXCURRHNCE
DAMAGE TO RENTED
PREMISES (Ea ocnm e)
$ 1,000,000
$ 50,000
HIED EXP (Any one per)
$ 5,000
PERSONAL ADV INJURY
$ 1,000,00
GERSRAL AGGRB3ATE
$ 2,000,000
PRODUCTS - COVEHOP AGO
$ 2,000,000
SCHEDULE)
AUTOS
NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
Rat)
$
$
BODILY INJURY (Per person)
$
BODILY INJURY end)
PROPERTY DAMAGE
(Pe' stmt)
UMBRM.LA UAB SIR
MESS LUAB CLAIMS -MADE
DN0 1 1 RETENTION
WORKERS COMPENSATION
AND EMPLOYINEW LIABILITY Y 1N
ANY PROPRETOR/PARTNEREXECUTIVE
OFFICERIMEMBER (Mandatory in OCCLUDED? DF IPTION OF OPERATIONS below
EACHtNCE
AGGREGATE
NIA
$
EL EACH ACCIDENT
$
El. DISEASE - EA EMPLOYEE
$
EL DISEASE - POLICY LMOT
DESCRIPTION OF OPERNRONS LOCATIONS I VEHICLES (Attach Ate 101, Addittonai Remarks Schedu1, if more space Is requited)
Miami Shore Village Building Department is named as a certiftcate holder.
X7399==
CPC-455644=
CELLATION
Miami Shore Village Building Department
10050 NE 2ND AVE
Miami Shores, Florida 33138
I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WIl BE DELIVERED IN
ACCORDANCE YUWH THE POUCY MORMONS.
AUTH Ni'ATIBtE
j� aoldril
ACORD 25 (2010/05)
2090 ACORD CORPORATION. AI rights resew
The ACORD name and logo are registered marks of ACORD
.'Jv„U:. p..0 ^.CE� G?C.l!' L� WkozR i `,:�`C Ncf' R i s EiJic^
A STATE OF FLORIDA: •
DEP cNStX1N 5 I1$ N1 TRRLIFEEESS1 13REGULATION
SEC* L12080901651
LICENSE NBR._
t ff 08/2033x= 128035092:. G056369
'1'li�e_ ROO
FING °p
i}R
cE'1'IFED:
er the' iov$.sions of - Chapter FS
Expiration date: AUG ::31.. 2014'
DATE
BATCH NUMBER
Goract (lutes
'PELICAN- ROME BUXLDSRS , INc
5037 HANSARD AVENUE
7 ?9RT FL :3:4291
RIt > OTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
KEN LAWSON
SECRETARY
s,o,G 2 O[EDiggc^c i6 t1 D.
DISPLAY AS REQUIRED BY LAW.
'Z OjaapcitTi ? r CC C 4-16 2), M !J ;Vf.C5 ;'6ti.iP +G f E MAR' T D ;v E
DATE BATCH NUMBER
0 9J2O 2:: 128034092 C04047399
Gam. CONTRACTOR
d > ow C$R'TIFIED
Vaster the Iztrovisibres oi� Chagt
Expiration date: AUG 31, 2014 ,; a
DISPLAY AS REQUIRED BY LAW
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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: 3/27/2014 EXPIRATION DATE: 3/26/2016
PERSON: GOMEZ JAMES H
FEIN: 650049995
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DMSION 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 Taw.
EFFECTIVE DATE:. 3/27/2014 EXPIRATION DATE: 3/26/2016 .
PERSON: GOMEZ JAMES H
FEIN: 65004$995
BUSINESS NAME AND ADDRESS:
PEUCAN HOME BUILDERS INl
5037 HANSARD AVENUE
NORTH PORT FL 34291
SCOPES OF BUSINESS OR TRADE:
UCENSED GENERAL UCENSED POOL
CONTRACTOR CONTRACTOR
LICENSED ROOFING
CONTRACTOR
Pursuant to 440.1 (14), F.S.. an officer da who elects exemption !nun this chapter by filing e certificate of es under ads section may
not recover bed or oonmensation under this dmp e r . Pend t o Chapter 4401Z(12). F.S., C e t i defection to be exempt... apply only Whin the sc ope
d t h e busbress or trade Bated on die nat or el ction to be exempt. Pursuant to Chapter 440.05(13), F.S., Not oes or e>eouon to be exempt and oe of
election to be exempt shad be subject to revocatbnit at any time &e0xa flan tithe notice or the iSSUM103 of the oertiHmte, the person named on the notice or
osttiticate no longer meets the requimmeMs of MIS seer for a of certificate. The department stud revoto3 awe at any time for faeraeof the
persm named on the certificate to meet the requharnenis of ads section.
DFS- F2 -Db252 CERTIFICATE OF ELECTION TO RE EXEMPT REVISED 07-12 QUESTIONS? (850)413 -1609
April 9"', 2014
To whom it may concern:
This letter is to inform the City of Miami Shores Villages that our Company Pelican Home Builders, Inc is
not going to use any day workers or any other employee at this location 225 NE 96 Street Miami Shores
Fl 33138.
Thank you for the opportunity to work with you.
Best Regards,
!tibd and acorn to (a�� ` TI
of
Praia* Imam _. produced lda Gan_
rem 9 51
YREM PAIONp
MY Cwt # FF036616
EXPIRES: July 16, 2017
BowedTlao Nobly Public Und a
' NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOUO NO.
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
1. Legal description of property and street / address:
2. Description of improvement:
3. Owner(s) name and address:
Pe $231- v , 4 L i _ 3 i h 3s_%'
Interest in property:
Name and address of fee simple titleholder.
4. Contractor's name and address:
5. Surety: (Payment bond required by owner from contractor, if any)
Name and Address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes.
Name and Address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's 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)
9
Sign ' re of Owner
Print Owner's Name
re-rzit, Prepared by
Swom to and subscribed before me this :,,,,, ialyoof 2 ` �— , 20
prlenis''''
Notary Public: _ 0�'�'° %�Gld��°
Print Notary's Name: }..1r+e ice
My commission expires: _ =+ : `' ft, • F.
%.,,11/ 1
OR1®00
Address:
2013 -14
Business Type:
Businesas Addrass:
GOMEZJAMES H
Sarasota County Business Tax Receipt
THIS TAX DOES NOT ASSURE QUALITY OF WORK OR CONFIRM THAT REGULATORY OR Account No.
ZONING REQUIREMENTS HAVE BEEN MET, IT IS THE OWNER'S RESPONSIBILITY TO 990010107637
ENSURE COMPLIANCE.
5037 HANSARD AVE
NORTH PORT FL 34291
CONTRACTOR - LICENSED
PELICAN HOME BUILDERS, INC.
5037 HANSARD AVE
NORTH PORT FL 34291
All businesses in Sarasota County are responsible for complying
with the Sarasota County mandatory recycling ordinance.
Valid until 9/3012014
PAID: 5007353.0009 112412014 $0.00
Sarasota County Tax Coltecbaa.
Barbara Ford - Coates
101 S. Wasidngton Blvd., Sarasota, FL 34236
(941) 861.9300, option 3
www.SarasolaTaxColler.tor.com
Info@SarasotaTaxCellector.com
Mission:
To protect, promote & improve the health
of all people in Florida through Integrated
state, county & community efforts.
HEALTH
Vision : To be the Healthiest State in the Nation
Rick Scott
Govemor
John H. Armstrong, MD, FAGS
State Surgeon General & Secretary
September 17, 2013
Marilyn Schwitzer
13250 SW 131 Street
Miami, FL 33186
RE: Contingency Letter
Application Document No: API 119306
Centrax Permit Number: 13 -SC- 1493301
OSTDS Number:
225 NE 96 St
Miami, FL 33138
Lot:15 Block: 30 Subdivision:
Dear Applicant:
This will acknowledge receipt of an application dated 09/05/2013 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
Proposed pool at the back of the property, septic system is at front.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use.
If you have any questions on this matter, please call our office at (786) 315 -4444.
Sincerely,
Carlos Icaza
Enclosures
cc: \aaHea \t
F \o 05,05.
Florida Department of Health
In DADE COUNTY
1725 NW 167 St, Opa Locke, FL 33056
PHONE: (305) 623 -3500. FAX: (305) 623 -3645
www.FloridasHealth.com
TWITTER:HealthyFLA
FACEBOOK: FLDepartmentofHealth
YOUTUBE: fldoh
FAD.
010
cL.
LOT -17
BLOCK -1
l.i'. 7S P/44
68 ASPHALT
ROST.
hores Village
APPROVED
DATS
NO RE
Florida He
O.S.T.
Application N
Date:
Signature
so' TOTAL ,raiiihASUPT
N. E. 9Gtth5
rNO
SUBJECT TO COMPLIANCE WITH ALL FEDERAL.
STATE AND COI INTY RULES AND REGULATIONS
NO;a
N Sri* OT ,ASPHAU
REC
APR 1 2014
LEGAL
LOT15AteTt iQOF LOT Ia. BLOCK X. MENDED FIAT OF WPM SAS
SECTION ONE. ACCORDING TO THE PIAT THEREOF AS RED 84 MAT GOOK
10. PACE 70, OF THE PUBLIC RECORDS OF OMATI042ASE COUNTY, H.0R A
SMTriga
RODRIGO tilERAANDADRIANAMENA
IMAM SAIZAISSTOR1A. ESQ., PA
OLO REPUBLIC NATIONAL TITLE INSISTANCE COMPANY, ATFS
NAVY FEDERAL Ci T MON
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 212457
Permit Number: DS -4 -14 -724
Scheduled Inspection Date: May 23, 2014
Inspector: Rodriguez, Jorge
Owner: MERA, RODRIGO & ADRIANA
Job Address: 225 NE 96 Street
Miami Shores, FL 33138 -2715
Project <NONE>
Contractor: PELICAN HOME BUILDERS
Permit Type: Driveways /Sidewalks/Slabs
Inspection Type: Foundation
Work Classification: New
Phone Number
Parcel Number 1132060134091
Phone: 305 -892 -9077
Building Department Comments
INSTALL INTERLOCKING PAVERS LIME ROCK BASED
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP - 210684. Pavers already
installed, provide letter from Arch. / Eng
r
May 22, 2014
For Inspections please call: (305)762 -4949
Page 11 of 21
NELCO
TESTING AND ENGINEERING SERVICES
FIELD DENSITY TEST REPORT
Client: Pelican Homebuilders
5037 Hansard Avenue
North Port, Florida 34291
Date: May 15, 2014
Job: D- 140589
105764
io.
Residence (Brick Pavers)
225 N.E. 96th Street, North Miami, FL.
PROCTOR DATA
Lime Sand l Lime Rock
95 %
Test
FIELD DENSITY TEST RESULTS
126.9
7.4
12"
2
3
105764
105764
105764
Comments:
Northeast Area of Pool Brick Pavers
Southeast Area of Pool Brick Pavers
Southwest Area of Pool Brick Pavers
Top
Top
Top
123.9 8.0
97.6
Pass
123.0 7.6 96.9 Pass
122.1 7.4 i 96.2 1 Pass
—VinayagaribEiltdattrishnan
Professional Engineer No. 63107
State of Florida
13370 S.W. 131 Street, Suite 105, Miami, FL. 33186 (305) 2.59 -9779