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DEMO-13-2737Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 213832 Permit Number: DEMO -12 -13 -2737 Scheduled Inspection Date: June 10, 2014 Inspector: Naranjo, Ismael Owner: ROSS, IAN Job Address: 640 NE 98 Street Miami Shores, FL 33138- Project <NONE> Contractor: GILNIK ENTERPRISES INC Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number (305)979 -3879 Parcel Number 1132060171820 Phone: (305)283 -9793 Building Department Comments KTICHEN & BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False Passed ,7",,,,Inspector Comments d Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 09, 2014 For Inspections please call: (305)762 -4949 Page 38 of 45 PERMIT # 9-l._,‘ ?7 -' l J CONTRACTOR: C 7 L- \) I CAC-. ■4f`) 6E3 SUBMITTAL DATE: 1 2,--- ` � I ADDRESS: !7L u Lx(— crc3 5I NAME: .S S RESUBMITAL DATES: PROJECT TYPE: 1/ik 0--'--3 -t-- <i-1 r1/4MA-1D __ ZONING .w FIRE STRUCTURAL IMPACT FEES ,4/ #1 PIV,1 00/0 4 ELECTRICAL HRSIDERM 2 -fs) NOC A MI.SHMID, ;,, _ PLUMBING- MECHANICAL BLS i3[of -693 oa 101- 112.4/0 671-g- ilF,10 X23 20 t Miami Shores Village Building Department EEC, o . 20i3 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 Type: BUILDING JOB ADDRESS: /B Ito NE 8 . FBC20it' Permit No. �1 Master Permit Noi2C-) 1 ROOFING City: Miami Shores County: Miami Dade Zip: 33 Cap Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: t Phone#: ? 7f ) 7 / OWNER: Name (Fee Simple Title�hojl�der)p� Address: G ctO %V E' 8 S. City: r (02,141 S‘N-O r'e5 state: ` r L zip: 33 13 AD Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: A 1('�f.- 'T . ?izl SSE S � Phone#: 436 112- 91' Address: —2® - —_ City: t-tD State: -11c.- Qualifier Name:( A< '` _ Phone#; ^2.r — t 9.9 State Certification or Registration #: C- ®1 O Cam'. i ® Certificate of Competency #: Contact Phone#: q.EC l [ 9 Email Address: - DESIGNER Architect/Engineer: Phone#: Value of Work for this Permit; $ Type of Work: UAddition Alteration Description of Work: • At 4- irte Square/Linear Footage. of Work: ONew o,\ URepair/Replace ((/4 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 $ 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 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 FT.RCTRICAL 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 promise in good faith that a copy of the notice of commencement and construction lien law br whose property is subject to attachment. Also, a certified copy of the recorded notice of co for the first inspection which occurs seven (7) days after the building permit is issued inspection will not be approved and a reinspection fee will be charged. g $2500, the applicant must I be delivered to the person t be posted at the job site e of such posted notice, the Owner or Agent The foregoing instrument was acknowledged be ore me this O day of , 20M., by who is personall known to me or who has produced My Commission Expir s-,/, /7 APPROVED BY The fore oing instrument was acknowled ed before day of I t , 20 .i, by % r3 who is personally known to me or who has produced Plans Examiner Structural Review (Revised 3 /1212012)(Revised 07 /10/07)(Revised 06/10/2009XRevised 3/15/09) My Commission pires: Zoning Clerk Thies Document Prepared By and Return to: SEAGULL TITLE COMPANY 20801 Biscayne Blvd Suite 304 Aventura, FL 33180 Parcel ID Number: 11-3206-017-1820 Warranty Deed 1111111 11111 111111111111111 1111111111 1 1111111 CFN 2013R0911933 OR Bk 28915 Pss 4693 - 4694; (Ins) RECORDED 11/18/2013 14:37:45 DEED DOC TAX 4,422.00 HARVEY RUVIH, CLERK OF COURT NIAHI -DADE COUNTY: FLORIDA Ind 1 Made this 1 ±day ofd, ,,,,yam./ , 2013 AD., Between Kenneth Ray and Jennifer Ray, husband and wife of the county of Palm Beach, State of Florida, grantors, and Ian Ross & Cory Ross, Husband and Wife w rose address is: 640 =% 98 Street, Shores, FL 33138 of the County of Miami -Dade, State of Florida, grantees. esseth that the GRANTOOR.% for and in consideration either sum of DOLLARS ($10) DOLLARS, and other good and valuable consideradon to GRANTORS in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEES and GRANTEES' heirs, successors and assigns forever, the following described situate, lying belag is County of M3. - —Dade State of Florida to wit: Lot (s) 7 and 8, Block 101, Amended Plat of w Shores Section No. 4, according to the map or plat ,. =sof, as racer in Plat = .k 15, Page(s) 14, of the Public Records of Miami -Dade County, Florida. Subject to restrictions, reservations and easements of record, if any, and taxes subsequent to December 31, 2012. and the grantors do hereby tally warren the title to said land, and will chard the same spins lawful clahns ofatl persona whomsoever. AC# 6205386 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK ' PATENTED PAPER - p� g STATE OF FLORIDA DBP,AR STRD'CTIoN INDUSTRY �I ENUNG BOARD TION SECI# L1207170089 DATE BATCH NUMBER LICENSE" NBR 07/17/2012. 120030700 , CBC010630 4, The BUILDING CONTRACTOR Named below IS CERTIFIED , Under the provisions of 'Chapt Expiration date: AUG 31, 2014s1, FERNANDEZ, GZXBER O s� GILNICK �RPRISES, INC. 17320 SW 278TH STREET HOMESTEAD FL 33031 RICK <;SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW S CR TAi N AC# 4O 0' THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK'" PATENTED PAPER STATE OF FLt R I* OST It; Ri: DEPAR DATE BATCH NUMBER 09:.25 201 ■ w n The ROOFING-CONTRACT . Named. below , IS CERTIFIED Under the proviaRona of p Expiration date: AUG 31, 2014 r ERNANDEZ GU TO': S , r GILNICKC ETER''RISEr, 17320 SW 278TH STREET 33031{ HOMESTEAD GOVEOOR re DISPLAY AS REQUIRED BY LAW art— I r #J I i IILt�G itELATION !8F L120925 75. us LAWSON SECRETARY AR °® CERTIFICATE OF LIABILITY INSURANCE 1ATE( 20 3 Y) 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 POUCIES 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 poiicy(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 The Contractors Choice Agency PO Box 13645 Chandler AZ 85248 CONTACT Jon Rook Ida. (800) 918 -3584 I inic. Not•. (877) 684 -9951 A Es$ :Jon @nginsuranaeonline. cam INSURER(S) AFFORDING COVERAGE NAIL I INSURER A preferred Contractors Insurance 2497 INSURED Gilnick Enterprises Inc. 17320 SW 278th Street Homestead EZ 33031 INSURER B: PC9O806 -1R INSURER C : 9/28/2014 INSURER 0: $ 1,000,000 INSURER E : $ 50 , 000 INSURER F: I CLAIMS -MADE i l OCCUR COVERAGES CERTIFICATE NUMBERCL0962304266 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 POUCIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MISR LTR TYPE OF INSURANCE WA a PO POLICY NUMBER 1" ITAMID atilI LIMITS A _ GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PC9O806 -1R 9/28/2013 9/28/2014 EACH OCCURRENCE $ 1,000,000 IE DAMAGE m___marrel MED EXP (Any one meson) $ 50 , 000 I CLAIMS -MADE i l OCCUR $ 5 , 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGO $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY El a El LOC $ AUTOMOBILE `-- _ — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - SCHEDULED ON-OWNED AUTOS ICEOM D ISINGLE LIMIT 3 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acmsdmmt) $ $ UMBRELLA LIAR EXCESS LIAR _ OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ $ OE0 I I RETENTIONS WORKERS COMPENSATION ANO EMPLOYERS' LIABILITY ANY PROPRIETOR!PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? C (Mandatory In NH) it yy�� d under DESCRIPTION OF OPERATIONS below N i A _ I TORY UATU- I I ER EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sehedu e, U more space is required) (305) 756 -8972 Miami Shores Village 10050 NE 2nd Ave Miami Shores , PL 33138 SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIS IONS. AUTHORIZED REPRESENTATIVE �' Robert Rock /JDA ACORD 26 (2010106) IN ROPE mmUMxr nr ©1988 -2010 ACORD CORPORATION. All rights reserved. Tha ArAR11 nano anti Inn" era roe leteeari market "1 APApr1 JEFF FINATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIMSION 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: 11/29/2013 EXPIRATION DATE: 11/29/2015 PERSON: FERNANDEZ GILBERTO S FEIN: 550854028 BUSINESS NAME AND ADDRESS: GILNICK ENTERPRISES INC k�. 17320 SW 278TH STREET MIAMI FL 33031 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING LICENSED ROOFING CONTRACTOR CONTRACTOR Pursuant to Chapter 440.08(14), F.S., an officer of a corporation who abets exemption from Ns cheeks' by tiles a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Cher 440.05(12), F.S., Cerinkates of electtn to be exempt... apply only +ate the scope of the business or trade listed on the notke of elecemi to be a 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 0, at any time after the tiling of the notice or flw issuance of the pert e, the perm 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 ire for faNwe of the person named on the certificate to meet the requirements of this section. DFS- F2- DWC-252 CERTIFICATE OF ELECTION TO SE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609