EL-14-1524Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-222908
Scheduled Inspection Date: November 06, 2014
Inspector: Devaney, Michael
Owner: ALEXANDER, DAVID
Job Address: 1640 NE 104 Street
Miami Shores, FL
Project: <NONE>
Contractor: AMERICAN STAR CONSTRUCTION INC
Building Department Comments
U
Permit Number: EL -7-14-1524
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (646)675-3489
Parcel Number 1122320320430
Phone: (954)367-5168
2 BATHROOMS AND MASTER BED ROOM REPAIRING Infractio Passed Comments
AND RELOCATING EXISTING WALL OUTLETS AND INSPECTOR COMMENTS False
LIGHTING
Inspector Comments
Passed _M
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 05, 2014 For Inspections please call: (305)762-4949 Page 33 of 35
Miami Shores Village i JUL is 2014
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (30S) 762-4949
FBC201
BUILDING Master Permit No.?a0- I pp Il `
PERMIT APPLIC ION Sub Permit No.
[:]BUILDINGCTRIC ❑ ROOFING ❑ REVISION [:]EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1640 NE 104 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-032-0430 Is the Building Historically Designated: Yes NO X
SF IIB AE 10.0 8.19
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): D. ALEXANDERN. AGUIRREBEITIA Phone#: 646-675-3489
Address: 1640 NE 104 ST
City. MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR: Cmpar►ny Na e: AfYt I x"161 &V- 6*0tJ f4OV4 "Phone#
Address: "t 0 P4
J r State: ict Zi 0 d
City: � �� I � p:
Qualifier Name: Phone#:f/—,367—�6�
State Certification or Registration #: &L t 3 OC T Certificate of Competency #:
DESIGNER: Architect/Engineer: DEN ARCHITECTURE LLC Phone#: 305-335-6085
Address:
1477 SW 14 TERRACE City: MIAMI State: FL Zip: 33145
Value of Work for this Permit: $ SBO Square/Unear Fof Work:
Type of Work: F1 Addition Alteration ElNew Repair/Replace ❑ Demolition
Description of Work: °Z &&gj6g V 44-S % � 47SIQ. 19&i-D4eW*1 �/RIIVC�
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ Z 7.:� i CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Rev1sed02/24/2014)
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ IN ^-7 0
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) CITIBANK NA
Mortgage Len der'sAdd1000 TECHNOLOGY DR
ress
city O'FALLON
State MD
Zip
63368-2240
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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.
Signatur ® � Signature
OWNER or AGENTONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 114 by
11,-4Ate-IlLw�-Jer who is personally known to
me or who has produced 1=1— OL as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: °`
MARIO CABRERA
:°. Notary PuW lc - Stato of Florida
. • • _ My Comm. Expims Aug 11, 201",
Commission M FF 044SU
APPROVED BY
(Revised02/24/2014)
The foregoing instrument was acknowledged before me this
---7— day of , u C t/ 20 1 !J by
, L`~ A 1,614_.. who is personally known to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
4, --
an, 4JOSE CESPEDES
Sign:PrintExpiresJW7.2018
8
Seal:
Plans Examiner Zoning
Structural Review
Clerk
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 Sled 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 any person allowed to work under this permit Please check with your
insurance tamer 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%
Signature:
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me this 2 7
day of„ / L,,,, g, , 20.1 `
MARIO CABRERA
Commission #F FF 044363
Bided Thm* N JWW NCWY ASK
Contract
Print Name:
1
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me this
day of. �— .20 �.
By a le,�ri2. -- I i -
AtEJ "WC -1111614010
Id JId
of IdentrScatto r$' 'f+_e.� �'
A
( "Tils C914TIFIC
,E TIFICATE OF LIABILITY INSURANCE _ ' DATE
AT 0717�i11 1
��.
S A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TEAS
WATI ELY OR NEGATIV � LY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i
INS DICE DOES ILIO CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
ER, D THE CERTIFIC+,, BOLDER.
IMPORTANT. if the certificate holder is an 4DDITIONAL INSURE .., the poilcypes) must be endorsed. If SUBROGATION IS WAIVED, subject to I
the terms and Conditions of thepogc}r, cortqn poll
Cies may reqw an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endo s). t
r PRODUCER; CONTACT
PHONE _ IFAX
305) $98-8828 �a�, may, {305} 698-8789
5360 W. 12th Ave. IiMLO
� sdinsure@Wlsouth;net -
--_ _.._._.__. .....
Hialeah, FL 33692 � � INSURER(S) AFFORDING COVERAGE NaiC a
Phone 3{ 05j 598-8828 Fix (305) 698-8789 INsuR A : _ UNITED SPECIALTY INSURANCE COMPANY
.................
!INSURED INSURER S. l
American Star Construction a IN U C:
409 Phippe Rd INSURER
: Dania FL 33€ 04 (954) 367 ` 168
..- ^" INSURER F.,
COVERAGES CETIFICATE NUMBE s REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 14AMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RE UIREMENT, TERM O � CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wirth RESPECT TO WHICH THIS
( CERTIFICATE MAY BE ISSUED OR MAY P ' TAIN. THE INSU E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH OLICIES. LIMITS SH E. MAY HAVE BEEN REDUCED BY PAID CLAIMS
IINSR: ADDLSUBR1 i POLICY i POLICY I" €
TYPE OF INSURANCE IINSR ? VJVD ; CY NUMBER 1IMMIlm 13 (MM LIMITS
GENERALLIstSiLITY ; EACH OCCURRENCE s 1,000,000.00
COMMERCIAL GENERAL LIABILITY j � � pAMAGE TII NiE13 $ $0,000.00
> ❑ ❑ CLAIMS-AMDE ® OCCUR MED ExP l one sas $ 5,000 00
A ! Y ' 1' CC30-ti0S202072 €12)261 2013 112/2&20`14 _ —
PERSONAL & ADV INJURY S 1,000,00000
GENE 4L AGGREGATE S 2,000.000-00 �___
GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGG $ 1,000,000.00
3 ® POLICY.._ t_t�M ❑ LOC � g, $ .. 3
AUTOMOBILE LIAMUTY v n ; EflsMBiAt D SINGLE LIMIT
rl
ANY AUTO ; BODILY INJURY (Per person) $
r--�1I ALL OWNED SCHEDULED j
is ❑L❑.I s l aI 4 io �BODILY INU
AUTOS AUTOS
MON-OWNEDPi RY IP-a�a
HIRED AUTOS UTO5
UABRELLAIIAB OCCUR at–
aderd i
—S$
._—
i ;ICH OCCURRENCE $
E3 ......-«_..._.....:_
❑ EXCESS LIQ ®CLRhAS•IdA9E ' _ _ . __
I AGGREGATE
o DED o ITS _----
I WORKERS COMPENSATION
10M
STATU- OTH
AND EMPLOYERS' L149HJTY YIN I
0 213R`._LIl16CCS _.._❑ _._._._..-_-....
ANY PROPRMTORIPARTNERIEXECUn vE 6 I E L EACH ACCIDENT e-
IIFFIRER EXCLUDED? N I A a { #
(Mandatary In NHI ; E.L. DISEASE -EA EMPLOYE& S ?
hyas, dasmft under
DESCRIPTION OF OPERATIONS batow_ ; E.L DISEASE POLICY LIMrI . S
DESCRIPTION OF OPERATIONS I LOCATIONS I V ICLES (Attach ACORD 1, AddManai Remarks Sahedede, if more space Is requ md)
LICENSE NUMBER: EC13005448
i
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE
MIAMI SHORE VILLAGE � THE EXPIRATION DATE THEREOF, NATICE WILL BE DELIVERED IN
+ r,
ACCORDANCE NTH THE POLIO
10050 NE 2 AVE O SIONS.
G MIAMI SHORES VILLAGE; Fi.. 33138 AUTHORIZED REPRESENTATIVE
f
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 2612014105) OF The ACORD name and logo are registered marks of ACORD
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