RF-14-1966Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-220607
Scheduled Inspection Date: October 06, 2014
Inspector: Rodriguez, Jorge
Owner: ALEXANDER, DAVID
Job Address: 1640 NE 104 Street
Miami Shores, FL
Project: <NONE>
Contractor: CITY ROOFING AND CONSTRUCTION INC
suuamg ueparltment comments
TILE/FLAT TRANSITION
Passed 17M
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Permit Number: RF -9-14-1966
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Repair Roof
Phone Number (646)675-3489
Parcel Number 1122320320430
INSPECTOR COMMENTS False
Inspector Comments
CREATED AS REINSPECTION FOR INSP-219255. Provide uplift test
t2
October 03, 2014 For Inspections please call: (305)762-4949 Page 8 of 17
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7066 SW 44- SbvW Nerni, fl. 33165
Tel-, 78&398-9179 Fax 786-800-2627
LAS CERTIFICATION #10-0542-01
SITE SPECIFIC INFORMATION
UPLIFT TEST — TAS #106
Roofir.- Contractor
CITY RING
JIM
.i,5OAdnlrl�i) �i�40,N',FWST RES, fL. 33138
Owner's Name DAVID ALEXANDE
FLAT 13'C"'NCRETE
ApproxiryLl - Roof Height 12' feet Roof Pitch 3/12
Approxi mate Souare Fcota,of Roof 1 fe
Ditel*es�e(! 1ow0A NUM64,,of Tests 12
Permit # RF -9-141932
Date Installed
Type of Access to Roof LADDER
Required Testing Force 35 Lbs
Testing Equipment F.G.E.100
Phone # WM-7W
F LG
# OF TEST
PASS
0 OF TEST
FAIL
0 Tests
0 Pass
Test
Fail
2 Tests
2 Pass
Test
Fall
He'd
10 'Tests
10 Pass
Test
Fail
0 Tests
0 Pass
Test
Fail
QIA
12 ,Te
I 2 Pass
Test
Fail
Ah
A-1 Engineerin'E Inspection Services, Inc
7066 SW 44 Street Miami, FL 33155
Tel: 786-398-9179 Fax: 786-800-2627
alroofinspection ,gmailxom
LAB CERTIFICATION # 10-0512.01
10/02/14
PERMIT. # RF -9-14-1932
1640 NE 104 ST
MIAMI SHORES, FL. 33138
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T T T T T T
T T T T
FIAT
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7066 SW 44t` Street Miami, FL 33155 Tel: 786-398-9179 Fax: 786-800-2627
-y I Miami ShoresVillage
agc
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33136
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: 04 0 1 -E O `1 Vk
City: Miami Shores Cour
Folio/Parcel#: I `- 93 Q - ^ o'A
Is the Building Historically Designated: Yes NO
OWNER: Name (Fee Simple
SEP 9 214
BC20€Q
Perrtiit Nc,FF_ (�.4 - �
Master Perinit No.
Miami Dade Zip: —3` 138
i":vuc. Zuiw.
City: _ W CkM 1 )n We ..�— State: F I13 1
Tenant/Lessee Name 1'; uuerr
Email:
CONTRACTOR: Company Name: (TV (�;(-i(I
Address: 2a-1 00 i) 1, O( a -
City: State:
Qualifier Name: AO
1'Iw,u ttr�-a�1g' aqa u
State Certification or Registration #: =15@ 1 �Fj 1 Certificate of Competruc w
Contact Phone#: �7)05-2qqC y Email Address: (l
DESIGNER: Architect/Engineer: 111iuue#:
Value of Work for this Permit: $-9,1250'00 Square/Linear Footage ul' W,)rk:
Type of Work: ❑Addition OAlteration ❑New Repair/Replace D�cmoii;iu:7
Description of Work: 1=I n- frnnq Lao,(?
Color thru tile:
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Submittal Fee $ ( � Permit Fee $ (2)0 CCF $ � � CO/CC $
Scanning Fee Radon Fee $SA DBPR $ —Bond $_
Notary $ Training/Education Fee $ (3 3 Technology Fee $
Double Fee $ Structural Review $ 21
TOTAL FEE N! MVV L'UE k o
-44 . E
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 installat un has
commenced prior to the issuance of a permit and that all work will be performed to mee; the i,,anuards o1' ail laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECfiaCAL WURK, PLUMB; NC, S'CNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, c',,C.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that ai; vvun< w „ oo uune ,u CunipLt nce with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO R!?CO .D A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P/� Y [ \ (: ' i' Z -Y ►_ C1-: FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU ! v ` i' .1 _►1 'FO O � � T AIN
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 valae e.,c•eeairjg $2500, rhe appiic•aru must
promise in good faith that a copy of the notice of commencement and construction lien law urooiale pl"I, be deliv,,red to rhe ;Verson
whose property is subject to attachment. Also, a ' ed copy of the recorded notice of rotnr,;• is e even; ; , Isi be; -sled a; ;he job site
for the first inspection whit c rs sev ) days er the building permit is issued. in ,ue aoset,c, +iGVlea, nolic•e, the
inspection wi of be ap oved a einspection fee ill be charged.
`/ Owner or Agent
The foregoing instrument was acknowled ed before me this
day ofaombgO A, by J ad l 19X r
,
who is personally known to me or who has produced
As identification and who did take t
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
1---13-1'7
FAPMOR
F.apires: Nov 13, 2017
wwW,AAg0KN0TA"=X
The foregoing instrument wsk efore me this
day o r20 14, by� 1✓111�YlQdQ
who is personally known; ,o me or wn,j haS p:uduced
as idenultcatiou au(A Will,) aid truce tin oath.
NOTARY PUBLIC.- A;.•
�• • =Columissiaat#YFO700
r Expires: Nov 13, 2017
Sign:
Print: -Th r10 Uop _ r,-,,nin n.4.'A
My Commission Expires: 1 k _ 1 `3. 1
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APPROVED BY C 17
Plans Examiner ;.o;, rig
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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