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DS-14-1047Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212840 Permit Number: DS -5-14-1047 Scheduled Inspection Date: September 29, 2014 Inspector: Rodriguez, Jorge Owner: STRAUSS, MICHAEL Job Address: 1251 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: J S L CONSTRUCTION CO sunaing uepartment comments Permit Type: Driveways/Sidewalks/Slabs Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132050100050 Phone: (786)290-4363 REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACEI Infractio Passed Comments WITH CONCRETE INSPECTOR COMMENTS False September 26, 2014 For Inspections please call: (305)762-4949 Page 5 of 29 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection a Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 26, 2014 For Inspections please call: (305)762-4949 Page 5 of 29 Miami Shores Village cV `. Building Department SAY 9� 1 20» 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 iFBC 20 BUILDING Master Permit No.05 I`"l ' 1 0 9 41 PERMIT APPLICATION Sub Permit No. 1 & BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ❑PLUMBING MECHANICAL [_]PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS City: 1 0 C �� 1 & 4/54 JOB ADDRESS: y City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: /� OWNER: Name (Fee Simple Titleholder): I Q q5S Phone#: Address:_�� s City: 1 0 C �� State: �1� Zip: 1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �t s� f *f+104*N Phone#: 7 K- o?9 3_4? Address: S 4 City: State: Zip: -33 J Qualifier Name: vi f n Sq Phone#: —% 0 296 Z?6.3 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ��`% cam- cc Square/Linear Foota a of Work: J36 G Type of Work: ❑ Addition El Alteration r-1New[Repair/Replace ❑ Demolition Specify color of 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 caner or Agent The foregoing instrument was acknowledged before me this day of A 20 & by e/I4,el�- o is personally known to m or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires APPROVED BY 0 s® MARTIN ESPINOSA MY COMMISSION #FF033897 EXPIRES July 15, 2017 �✓1�`'�' Plans Examine Signature 1 - tractor The foregoing instrument was acknowledged before me this/6 day of I 20 by %`�Q 13 i4a C'.� r who is personally known tome or who has producedE' S 577,PY/ 41 ids identification and who did take an oath. ►I911�I1U;111_-1K4A Sign: My �� y`0 x I Ic State of Florida 'g Joanna M Feliciano +� My Commission FF 082753 �ir�ap Expires 01/1212018 r S Zoning Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Clerk 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 caner or Agent The foregoing instrument was acknowledged before me this day of A 20 & by e/I4,el�- o is personally known to m or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires APPROVED BY 0 s® MARTIN ESPINOSA MY COMMISSION #FF033897 EXPIRES July 15, 2017 �✓1�`'�' Plans Examine Signature 1 - tractor The foregoing instrument was acknowledged before me this/6 day of I 20 by %`�Q 13 i4a C'.� r who is personally known tome or who has producedE' S 577,PY/ 41 ids identification and who did take an oath. ►I911�I1U;111_-1K4A Sign: My �� y`0 x I Ic State of Florida 'g Joanna M Feliciano +� My Commission FF 082753 �ir�ap Expires 01/1212018 r S Zoning Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Clerk is p qq��,e u �c� g�-'°"!{fi�gg[(tipp �-w......�,Nnen _..._ — eushwa address Patd 2013-11-26 $86.25 SUB-GENERAL BLDG CONTRACTOR 19 L CONSTRUCTION CO Receipt #0221.14-001928 8019 SW 132 ST "** MIAMI, FL 33156 Account number 1458538 / Recei, number 1458538 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NO T A BILL — DO NO T FAY 1458538 BUSINESS NAME&OCATION J S L CONSTRUCTION CO 8419 SW 132 ST **** M IAM 4 FL 33166 RECEIPT NO, EXPIRES RENEWAL SEPTEMBER 30 2014 1458538 Must be displayed at pia•: a of business Pursuant to County Cade Chapter sA — Art. g & 10 OWNER SEG, TYPE OF BUSINESS PAYMENT RECEIVED J S L CONSTRUCTION CO 196 SU&GENERAL BLDG BY TAX COLLECTOR CONTRACTOR 86.2.5 11/2612013 Worker(s) 3 CBC034266 0221-14-001928 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is nota license, permit, or a certification of the holder's qualifications, to do business. Holder most comply with any governmental or noagovemmeatal regulatory laws and requirements tivbich apply to the business. , T, The RECEIPT N0. above most be displayed on all commercial vehicles —Miami—Dade Code Sec Ba 276. WAM1U,:• For more information, visitw.gw;m amidade.goy(taxcollector ' "'°' CERTIFICATE OF LIABILITY INSURANCE'm" 05116/14 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 cerdf(cate holler is an ADDITIONAL INSURED, the pohcy(les) must be endorsed. H SUBROGATION IS WANED, subject to the texas and conditions of the poUcy, certain Polities may require an endorsement A statement on this certificate doers not confer rights to the cerlIlkate folder In lieu of suede endorsementls► PRODUCER AD American Insumrtt:e 9036 SW 152nd St Miami, FL 33157 Phone (305) 233-0855 Fax (305) 235-8606 CONTACTNAME IGNO MACGREGOR (305) 233-0855 F C No (305) 2358606 CE.COM INSURER(S) A NG COVERAGE NAIC # ItNSURFR A . LLOYDS OF LONDON INSURED JSL ConstrEfion Co 11767 S. Dixe Hwy g 227 Miami, FL 33156- (786)2904363 INSURER B INSURER C: INSURER D: INSURER E: INSURER F WVCRA(aCS 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 REOURM61ENT, 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 CLAM. ILTR TYPE OF INSURANCE A� POLICY NUA�BER POLICY EFF Y ERP LIMITS A GENERAL LIABI.r1Y ® cOMlwatctAL GENERAL uABaTn► ❑ El � ® tx� ElN BUDlfmg Dgmrkneftt JHSXV-E X14 05/08iL015 EACH OCCURRENCE $ 300,000.00 Wim- $ 100,000.00 MED EXP (Any aye pemon $ O.00 PERSONAL & ADV INJURY S 3DD,000.00 ❑ GENERAL AGGREGATE $ 300,000.00 GEWL AGGREGATE LIMIT APPLIES P9t El Pax -f ❑PRO ❑ LOC PRODUCTS - COMPIOP AGG $ 3W,WO.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO UT(� ElPULED ❑Am 0 NSD AUTOS ❑ AAUTNOS SINGLE LIMIT $ BODILY INJURY (Per Person) $ BODILY INJURY(Parawideng $ PR GE $ ❑ UMBRELLA LIAR ❑ OCCUR EXCESS UAB ❑ CLAMADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED RETENTION S $ WORKERS COMPENSATION MID EMPLOYERS' LIABILITY YIN OFYPEREXCLUDED?ER (!r In wo ® Iy�, dem under DESGRTPilOP1OFOPERATIONS bakmr N / A ❑ WC STATU- ❑ OTH- TORY LIMITSEIR — ELL EACH ACCIDENT $ EL DISEASE - EA EMPLOYE $ EL DISEASE -PoICYUMIT S DESCRIPTION OF OPERATMSI LOQATIONS I VEHICLES Mftnh ACORD 111, Atld'Afaral Remar&s Schedule, If more space Is requite* THE PARTY LISTED BELOW IS RECOGNIZED AS CERTIFICATE HOLDER. CONSTRUCTION LICENSE NUMBER: CBC034266 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE MWIRA'TION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUDlfmg Dgmrkneftt ACCORDANCE WITH THE POLICY PROVISIONS 10050 NE 2nd Avenue AUTHORIFED RLSTEMM Miami Shores, FL 33138 Fax: 305756-8972 MARIA MENMwAl Cel A== . C RATION, All rights reserved. ACORD Y6 (241010 QF The ACO ogo ane registered trtarks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,o�}_be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: I /Z! C&A1-:L 4`ii2/tkC4 Signature: State of Florida ) County of Miami -Dade) Sworn to and subscribed before me 0iis Iq day of , MARTIN ESPINOSA By ' •' b �6ddM.SSION *FFo3M7 w big 1R&§ Juiy 15.2017 (SEAL) Tvve of Identification Contractor Print Name: Z11a liW 1iYJ1_4 d% Signature: e� 10"110-11 or //01 State of Florida ) County of Miami -Dade ) 11111111111/0� Sworn to and subscribed befo�,a /®.,, i day of��`T T, Y ' (SEAL) Tv )e of Identification nroducc&.. FE11 A� Report Viewer I . 1 https://apps8.fldfs.com/crreportviewer/reportViewe... 100% z' a JEFF ATwATER '•O 91 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: 4/19/2014 EXPIRATION DATE: 4/18/2016 PERSON: ESPINOSA MARTIN FEIN: 650182648 BUSINESS NAME AND ADDRESS: J S L CONSTRUCTION CO 11767 S DIXIE HWY #227 PINECREST FL 33156 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR ILA m DFSF2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)113160.9 I of 2 5/20/14 I1-19 PM PreparedrBy: • :� EXACTAFL " bbek 1@� 1 Land Sumeyore, Ina worm® It f nppMt4m a Y;, PROPERTY ADDRESS: 1251 NE 94 STREET, MIAMI SHORES, Florida 33138 SURVEY NUMBER: 1005.1372 FIELD WORK DATE: snlrmlo REVISION DATE(S): (re,.o srzsml NBT PART OF TN5 PLAT {sy FL too. 1372 38° E 75.02' (M) - Ifo BOUNDARYSURVEYFir D S 89°46o t FLAT NNO O ID EA5T 75.00'(P) NO ID MAMI-DADECOUNTY 0.7 4' CHAIN LINK P CY COGIC O.G TABLE: L I NORTH 25.00'(P) SHeo N 0°57'00° E 24.73' (M) 19 NORTH 25.00'(P) m N 0°31'24" E 24.89'(M) I. 16.T o�' ��• •;cONc. ,gym ••21.9' ,•� NO .10.3' �N LOT7 N LOT 5 - - RE5lDENCE LU a o 6.3' a W RESIDENCE m LOT 6 m 1 5TY. N 8 Ip Z RE5 S 1251 a? g I' m Z lV b 20.3' VA x341 Y A f 'j 112- Fir FIR NO ID NO ID 5. 5.26' j B. (ASSUMED) _ i a @ W.R4W LINE .... N. 5AY511ORE DR ji 4D - - - N 8 °5 f22 W —52(:T4-8r(-m-)-6. 8 5 I 0 WE5T 520.60' (P) S LAK��A N. E. 94TH STREET (50' R/W) y,w 4512 NQTE5: / k, Of of#w1wB n deq nW LOT APPFAR5 TO BE SERVICED BY CITY WATER AND SEWER ardtoftbastofty FENCE OWNER51'IP NOT DETERMINED IM wd",, ltIsa crxnate repel Ben ofa army NO POINTS OF INTEREST OBSERVED AT THE TIME OF SURVEY I•i Ad the selferlfl by Me F&ft Beard OfP Landsm deeratW17Ckapbr5J-17offt 30 0 19 30 Ronda k, GRAPHIC SCALE (In Feet) N SmQfFkftaftIbWmW&TqpmwMqpr I.lot>rree No.4512 1 Inch = 30' fL i; LIM dThh Smveyfor Purposes odwd=Intended,WithoutWrittenVeffI=Uon,wN beatthe USWS Sole RhkMWWithout Umb ttyto the Swveyw h=.. NaUdn to nshdbeConsbuedto GMANYRI tOwSendbto txhuthmthm Ce Wk& POINTS OF INTEREST Nano VWblo FLOOD INFORMATION: By perforrnin a search at www.fema.gov, it appears to be the properrtlyy to be located in a AE zone with a Base Flood Elevation of 8.0 NGVD1929. This Property was found in VILLAGE OF MIAMI SHORES, and commun' number 12W52, dated 09/11/09. CLIENT NUMBER: DATE: 5/25/2010 C` ExacrsLatbiSusacZma �(( fu®teftim lawslrveyfirm w reg6tAmedaitbths>tGKed'lyda. BUYER MICHAELJ. STRAUSS SELLER: wcc r XACTAFL CERTIFIED TO: MICHAEL J. STRAUSS; SOUTH POINTTITLE COMPANY; Muni Office '..` OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY; CHARLES SCHWAB BANK Land Surveyors Inc P: 305.668.6169 }' Exacta Land Surveyors, Int.: LB # 7337 F: 305.668.6325 This is page 1 of 2 and is not valid without all pages. 1514 San Iggnaso Avenue., Ste.100 Miami FL 33146 WWW,QX8tt3lBrld.tOfliv= r1 /%kt Lor- �Ai K� VJ Nth too MAY 212014 ac P-,Atk w t. ecce lve"0 �e �a. y IN co py �- o� � r Ff �dri ac�� Qy f s pee�c.ce-Tyy,, s${ T i e%.F. i - V D rive fitam► Shores `rooA Of Ro�� czw G U0 C0ro\ VJ ?M.iami 'Sllores Village APPROVED D —By ZONING DEPT j BLDG DEPT r 111JI-C T TO COMPLIANCE WITH ALL FEDERAL IAIE AND COUNTY RULES AND REGULATIONS d4W, V�A pazi Pk set�� banock aie. re .6 4LAQ 7SID"i MAY 2 14 Z� D"Ve'- \AJ Q�( Mori+ �L ts"I tip. Ll 00' 130