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RC-13-1294Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220545 Scheduled Inspection Date: October 02, 2014 Inspector: Rodriguez, Jorge Owner: PEARSON, LEONARD Job Address: 246 NE 103 Street Miami Shores, FL 33138-2431 Project: <NONE> Contractor: BUILDING CONCEPTS OF FLORIDA Building Department Comments Permit Number: RC -6-13-1294 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060134880 Phone: (305)796-0096 REPAIR BACK ROOM AND BATHROOM WATER DAMAGE Infractio Passed Comments DRYWALL REMOVE AND REPLACE VANITY I INSPECTOR COMMENTS False Expiration date 1/5/2015 - based on last approved inspection Inspector Comments Passed 41 CREATED AS REINSPECTION FOR INSP-220160. No access Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 01, 2014 For Inspections please call: (305)762-4949 Page 17 of 32 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 Permit Type: JOB ADDRESS: BUILDIN lc) 2-2 Permit No. JON 10 2013 FBC 20 (® Master Permit No •, C- I S —12-11 ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: Tenant/Lessee Name: Email: 7-;�' `T em "I - cxwr,- a Calm%. e--SiO49oAai I a tom ( wie.1 CONTRACTOR: Company Name: mil 104�`�' ®� Phone#: *aE 7 %1- o o Gl Address: 92VE 47 City: State: Zip: 5 7-> A Qualifier Name: State Certification or Registration #: ObCD: i � 4:1 Certi\fic, of Competency #: Q Contact Phonek 7f& /)0 qL Email Address: YI i C=- !Mb I � -C- � DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ! ��� Square/Linear Footage of Work: `J2-� Type of Work: DAdditionw OAlteration ONew )!Repair/Replace ODemolition Description of Work: VVWM:02— Submittal Fee $ 50 Scanning Fee $ Color thrd ile: tl Permit Fee $ ea)_ CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ L 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 inspectio w' l not be app oved and a reinspection fee will be charged. I Signature Signature Owne or Agent Contractor The foregoing instrumentwasacknowledged before me thi9 day of , 20 L, by L�'A T �eetc, who i ersona me or who has produced As identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission Expires: 1*: 's MY COMMISSM # EE 157534 EXPIRES: February 5,2D16 Rf„1 BM1&d TMu Notwy Nft Urt Wafters The foregoing instrument was acknowledged before me this 2'Z' day of OCT—, 20 I Zby VICADC- who is personally known to me or who has produced NOTARY My identification and who did take an oath. # DD 978958 $a Hs Ha sk ik =k 9k =k s$ ga sg 9k ak.k $a $a $a 9k $a si: s:a $s nk ak �k a$ $a a$ sk z:e sk a$ ag Ha 8: +k 9k ak�ak sk �a �: s� sk sk Hs sk �k �k �F �k �k �k �S �k sk �a sk a� sk �k sk sk ds sk sk sk sR *k sk sk sk sk sk �S Hs Ha sk � �k sk na.k sk H� zk ik ak xs pis sk �k �k �k sk sk �a fia sk ak sla sk sk nk H� �k �k APPROVED BY ��lU '� Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk JUN 10 2013 r , S *.tje) en 'D&maq4�c> Dt�u-,4u- 4 [�,pLac, c- . L A ILIi�GS I(� ADD ITI br-1 �EpLxe endo 1Zccw\ 4, �Ats, qA � f tW -rlLt 5U IhJLO 6DO �p f , �co Wt> ADD SMOKE/CARBON MONOXIDE DETECTOR BATHROOM RECEPTACLE ON 20 AMP CKT ANY AND ALL CLOTH AND RUBBER AND G.FI PROTECTED INSULATED CONDUCTORS TO BE REPLACED. �2�� �� � �� -�r�- _ �r-�-_ NOTICE OF COMMENCEMENT A RECORDED COPY MEI' BE POSTED ON THE JOB SITE AT TIME OF FIRST Nff= PERW NO. -6- 14 W 44x FOLIO NO. STATE OF FLORIDA. COUNTY OF MIAIV>I-DADS TME UNDEFOGNEO hereby gives noticethat impromments will be maw to certain real property, and in aomdarrce with Cfrapter713, FIS Statutes, the following Urformation Ls provided in this Notice of Commenoa rent. OR Ek 28715 Ps 1973i< (Ips) RECORDED 07/11/2013 10348:28 HARVEY RUVIN► CLERK, OF COURT MIAMI-DADE COUNTYP FLORIDA 1. Legal description of property and str ttaddress: ^t 2. Description of improvement: _ wk "10 i�'j 'ro H i _'�; c.,t f ~nv- 3.Owner(s) name and address:y 94L sem- -- 4l ---- Interest in property, Name and address of fee simple titleholder. --------------- 4. Contractor's name and address:t t 11R� 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)(x)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. E.xpiraft date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different V4e is spe Signatdffi of Owner Print Owner's Name Sworn to and Notary Public Print Notary's My commissic TfkM-36 W" PAGE subscribed before me this day of JW 20 Prepared by '4� CERTIFICATE OF LIABILITY INSURANCE 4/2 ; 0°x'3 "' 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 certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 certlticate does not confbr rights to the certificate holder in Ileu of such endon3em s PRODUCER Heritage insurance Services PO Bou 1508 Palmetto FL 34220 aaf Tiffanie Ellis PHONE , (941)723-1400 FAX Mal.(941)723-1440 L.tiffanie@heritagefla.aom AFFORDING COVERAGE NAIL MI INSURERA00rth Pointe Insurance Co 27740 INSURED Building Concepts of Florida 8089 NW 67th ST Miami FL 33166 INSURER 0; c; SURERD: ►N SURER9: INSURER F: [d4*1�:7d�3a..3�c��i3t.T�f�321i1�`,T?�h���g'���L����i�� k� r � I . • , ,�: �: 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. IADM - TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUOR POUCYNUKKR ARM &M LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE XI OCCUR ^� David Clements/TIFF 8090020943 /22/2013 /22/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE 1 T $ 100,000 MED EXP (ft ate $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY MPRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LUUMM ANY AUTO ALL AUTOS ED AUTT)SU� HIRED AUTOS AUTOSVVNEO COMBINEDtSINGLE LIMIT BODILY INJURY (Per person) S BODILY INJURY (Peraoddent) $ PROPDAMAGE $ IpAwacdderdl III UMBRELLA LIAR EXCESS LW9 OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ wo I I RownoN WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIET,OWPARTNERMEXECUTIVE YIN N OFFICERIMEM13ER EXCLUDED? D (Myaene WM In NH) DESCUrKIW RIPTION OF OPERATIONS below N/A ATU O ELL EACH ACCIDENT $ EL DISEASE - EA EMPLOY $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, AddMonal Rem Schedule, Ir more space is required) Certificate Holder is added as an additional insured on a blanket basis with respects to the General Liability policy. CERTIFICATE HALER CANCELLA11nid ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN.R09R ignimm M The Arew t norm& enol Inn^ are ronniefenal medre of Ar'rion SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NN 2nd Ave AUTHORIZED REPRESEWAM Miami Shores, FL 33138-2207 ^� David Clements/TIFF ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN.R09R ignimm M The Arew t norm& enol Inn^ are ronniefenal medre of Ar'rion