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RC-14-1284Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223936 Scheduled Inspection Date: November 26, 2014 Inspector: Rodriguez, Jorge Owner: , Job Address: 11225 NW 5 Avenue Miami Shores, FL 33168-3329 Project: <NONE> Contractor: JOSEPH A. MARCELIN CONSTRUCTION Isunaing uepanment comments KITCHEN RENOVATION Permit Number: RC -6-14-1284 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)759-1111 Parcel Number 1121360010170 INSPECTOR COMMENTS False Phone: (305)562-7926 November 25, 2014 For Inspections please call: (305)762-4949 Page 34 of 48 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 25, 2014 For Inspections please call: (305)762-4949 Page 34 of 48 PERMIT APPLICATION C Miami Shores Village 2014 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2016 Master Permit No. Sub Permit No. BUILDING l ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: City: Miami Shores II County: Miami Dade Zip: is e` Folio/Parcel#: 1 �, ®L .. Is the Building Historically Designated: Yes NO ✓lam Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): J 1 W 1W0 Address: �.SP� / S tom% Sq 47_1- � City: t11 P-12 yrtta,%, State: Zip: 330-- 7 Tenant/Lessee Name: Email: CONTRACTOR: -Company Name: �0 iLr 1 \ r F < , Phone#: �4S • to'� • -1 Q7,C. Address: 15� all City: bN 119 State: Zip: Qualifier Name:®, 'Sl (°St��1Y� Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 2)00' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Rep place E] Demolition Description of Work: r -c ;.' rr�c-�G A�exy Specify color of color thru tile: Submittal Fee $ 11;j 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 $ 70 . 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the inspection will not be appro inspection fee wi a char d. Signatur Signature e Owner o Age tContractor The foregoing instrument was ackno d ed before me this day o:l�•+°201by �_ who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission i •-, SILLIEN A DERIUS _ • ''' MY COMMISSION !f EE177498 EXPIRES Mann 3o.2916 APPROVED BY Plans Examiner The foregoing instrument was acknowledged before me this day of 20L�,, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: SILLIEN A DERIUS My Co • is ri+%c1'r MISSION # EE177498 EXPIRES Merdt 30.2016 Zoning Structural Review Clerk Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) STATE Q�.Ff (?RIDA A(�°# �y..` DRPAR � � S. 8 ®�s OF RtTSIN.z S AND 1'R(3I�ESSI©NAL RAGULATION CGC1514109 E7°J( '12 128002434 CRRTIFIij CRACTOR MARCi$LIN, SAPt4' :A� JOSEPIR A. CONSTRUCTION IS CBRTIFIEp under the provisions of ch.489 Fs Expiration este:' AUG31, 2014 L12070500965 " �° O CERTIFICATE OF LIABILITY INSURANCE ° 06/117/1a PRODUCER Annette Willis Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 18401 N.W. 27 Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33056 Phone (305) 625-2403 Fax (305) 62-5.6472 INSURED JOSEPH A MARCELIN, CONSTRUCTION, INC 16561 SW 144 Ct MIAMI, FL 33177 - COVERAGES INSURERS AFFORDING COVERAGE I NAIC # INSURERA: ACCIDENT INSURANCE COMPANY INSURER E: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYYYY POLICY EXPIRATION DATE MM/DD LIMITS A ❑ GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY El L1 CLAIMS MADE OCCUR ElPERSONAL ❑ GEN'L AGGREGATE LIMIT APPLIES PER IV POLICY ❑ PROJECT ❑ LOC CPP0003248 06/03/2014 06/03/2015 EACH OCCURRENCE 1,000,000 GE TO RENTED PREM SES Ea occurrence 100,000 MED EXP (Anyone person) 5,000 &ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 PRODUCTS - COMP/OP AGG 1,000,000 ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yes describe under SPECIAL PROVISIONS below ❑ W C STATU- ❑ OTH- LER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS LICENSE # CGC1514109 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2009/01) QF ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BLDG DEPT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2ND AVE THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) QF ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 00317$ — - Local Business TAX Miami -Dade County, State f F10 a t -THIS IS NOTA BILL _ of Florida DO NOT PAY 6549563 BUSINESS NAME/LOCATION MARCELIN JOSEPH A 16561 SW 144 CT MIAMI FL 33177 OWNER MARCELIN JOSEPH A Worker(s) I RECEI ,r NO. RENEWAL. 6820261 EXPIRES SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter SA Art, 9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED CGC1514109 BY TAX COLLECTOR $75.00 09/11/2013 This Local Busing To, Receipt only FPPU08-13— pormit ora certification of the p Y cmNirmqualifs 001979 nongovernmental regulatoryholder's quiro'cat""M to d business. the Local Business Holder me . cTax c a RBLOW is not a license, laws and requirements which apply to the business; nY govsmme The RECEIPT N0. be most he displayed on all commercial vehicles -� � �� mal or For more information, visa Mlam�'Bade Code Sec Ba -27g W W W-minmidada 6ovhw - STATE OF FLORIDA CES DEPARTMENWOKERSCOMPENSATION FINANCIAL SERVI OMPENSATION DIVISION OF CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERV COMPENS6�o SLAW EXPIRATION DATE: B 02015 ` EFFECTIVE DATE. A MARCELIN PERSON- JOSEPH FEIN: 300274630 BUSINESS NAME AND ADD CONSTRUCTION INC JOSEPH A MARCEUN 16561 SW 144 COURT FL W77 MIAMI SCOPES OF BUSINESS OR TRADE. 2 CERTIF iED PLUMBING CONTRACTOR 7- CER-JFIED AC CONTRACTOR 4- CERTIF'ED GENERAL CONTRACTOR 3- CERTIFIE'' siOOFING CONTRACTOR PIFDetail by Registered Agent Name INVESTMENT GROUP II LLC ment Number L13000096114 IN Number APPLIED FOR Filed 07/08/2013 FL s ACTIVE tive Date 07/05/2013 5214 SW 52 STREET AIRAMAR, FL 33027 ,hanged: 05/01/2014 flailing Address 5214 SW52 STREET A[RAMAR 33027 AF :hanged: 05/01/2014 legistered Agent Name & A4 )ORVAL, HERBY 5214 SW 52 STREET A 1 RAMAR, FL 33027 ►ddress Changed: 05/01/2014 wthorized Person(g) Detail lame & Address 'itle MGR )ORVAL, HERBY 5214 SW 52 STREET I I RAMAR, FL 33027 'itle MGRM IELIN, ALNES 260 SW 131 TER I I RAMAR, FL 33027 Page 1 of 2 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetaillRegisteredAgentN... 6/16/2014 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, you may be personally liable for the worker compensation injuries of anv 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. State of Florida) County of Miami -Dade ) Sworn to and subscribed before me this I day of+ , 20 By Contractor 11N MY 00MM SSION # EE1774 EXPIRES Mangy 30, 2818 State of Florida) +o )30 0153 County of Miami -Dade ) Sworn to and subscribed before me this day of r� LIM (SEAL) (SEAL) Type of Identffication produced Type of Identification .3N GENERAL STRUCTURAL NOTES L CONCRETE: A. ALL C4W'r cTE WOW SHALL GONFOW TO ALL IE QUIRSMENTS OF: ACI 501-05 AND AGI -318-08. '8t-0',C.ATIONS 10R STF3=RAL G NCRETS FOR P• UILE)iNG36'. B. A'-4- CONCRETE SWALL ATTAIN 3000 PaJ MINIMUM C4MI~FIESSIVE ST•feNGTH AT 28 DAYS G. r1IX DESIdbNS $HALL BEE SUBMITTED TO THE ENGINEER FOR APPROVAL MOR TO CO!'v1ENCEMENT OFIE W .Olrq%. D. NO WATER SWALL BE ADDED TO T14E CONCRETE AT THE JOTS SITE. E. TRANWORTIWz, FLAC040, CURWs AND DEPOSITWx of =)NORETE SHALL COMPLY WITH �P E RM IT A0I-301-ft. �.- 2. CC FeM COVER: TO W AS FOLLC USs BOTTC m TOP SIDES FOOTINCYS 3' 2' 3' SEAMS l COLUMNS --- - I INTERIOR SLAB'S 3/4' 3/4 a 1 EXTMOR SLAAIS 1' I 3. STRUCTURAL STEEL: V_ I 14 SMALL CO*OW TO ASTM A-36 DF-TAILEDWA13R1CATED AND ERECTED IN AC.CORDANGE WITH THE LATEST AUK SPEVA ATIC7I�lS. ALL STEEL COLUMNS TU se ASTM AFILL L WITH Pr.,J-.I. commom 6l4Bh'IIT SHOP` DRAWINGS FGR A FiwvAL PRIOR TG 1=A®RICATION. 4. REWORCHS STEEL: 4 e" TO BE NEW H101-1 STSENGTH BILLE=T STEEL I7W-OWW AS PER ASTM A -aft AND C iNFOI4I"iI" TO AS?M A-615, GrRADE 60. LAIC' C-ONTa LX* 5A163b SARS 01"TRIMS. HOC>IC. PISGC?AfFp+IUGS ENDS OF ALL TCP SARS. ALL REINFORWNCi ST9EL TO BE DETAILED AND FABRICATED IN ACC4fMANCE WITH MANUAL OF STANDARD PR ACMCE OF DISTAILII& REINFORCE CONCRETE 87MJCTURES AND THE AGI BUILDWa 0=3 3113-05. SUBMIT SHOP DRAiIJINGS FOR APF IWVAL f"OR TO FAB%IGAT]OK to r� DINT s ROOM All KITCHEN ozat's oa Sol � xlatien9 t3 O 9 paW9 etttscture UTILITY RDOM NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F.I PROTECTED RECEPTACLE PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. pro i►r.,w PLAN FOIL* �2E=M e:3J� Er L 11'►EC� CI{fCKED., EP 10 01 Jm etruatuures MIAMI SHORES VILE APPROVED BY � DA fE ZONING IICTURAL i ELECTRICAL. vele PLUMBING `r`' MECHANICAL BLDG. G" SUBJECT TO COMPLIANCE WITH ALL FE ERA STATE AND COUNTY RULES AND REG U ct OWFE OF WORK L romve arta replaces extatkg wtck"i cabs ats. 2. remove and replace kitchen ah* - 3. all Sirs at kitchen area Misting. KJ® fir...,•.; -}•-• � ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. Iii: ZL\ OATS: , UAY 15, 31114 som i /r = 1'--I}" Fu wwF: 14.30