DS-14-1833Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 OLMIEU
Inspection Number: INSP-223342
Scheduled Inspection Date: November 18, 2014
Inspector: Rodriguez, Jorge
Owner: DENA & DENNIS HELING 81 WILLIAM
1112117 r1CAlA 4 r%CNIK110 UCI IAI01- Q
Job Address: 9636 NE 5 Avenue Road
Miami Shores, FL 33138-2443
Project: <NONE>
Contractor: WILCON CO
Building Department Comments
Permit Number: DS -8-14-1833
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
DRIVEWAY REMOVAL OF ASPHALT TO CHICAGO BRICK I Infractio
INSPECTOR COMMENTS
09/30/2014 - Bond paid by owner. Energov did not print a
Bond certificate to issue. As.
Phone Number
Parcel Number 1132060170150
False
Phone: (786)399-8855
Inspector Comments
Passed V9 CREATED AS REINSPECTION FOR INSP-218304. Restore sod
Failed
Correction ❑
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 17, 2014 For Inspections please call: (305)762-4949 Page 29 of 45
1" t `° t
RIM Miami Shores Village
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
BUILDING
PERMIT APPLICATION
jflBUILDING ❑ ELECTRIC ❑ ROOFING
FBC 20 QC)
Master Permit No. Ds
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
r_1 PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: J
City: A _� Miami Shores County: _D/ Miami Dade zip:
Folio/Parcel#:TJ 3 2 0 4 t9l2j�2Z 50 Is the Building Historically Designated: Yes ✓ NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): K 1114711 �� Phone#: �9 f
Address:
City: �� State: Zip:
Tenant/Lessee
Email
CONTRACTOR: Company Name:
Address: 5'ADzd
hone#:
hone#: G7Y� 3 95
City: y , , State: Zip:
Qualifier Name: _ /,1,// / / fj/�71 Phone#:
State Certification or Registration #:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: LJ Addition .❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description -of Work:
Specify color of color thru tile: m
Submittal Fee $ Permit Fee $ � ° CCF $ , CO/CC $ (( )
Scanning Fee $ Radon Fee $ QDBPPR $ 2_Notary$
Technology Fee $ . Training/Education Fee $ 0) - ' P 0 Double Fee $
Structural Reviews $ Bond $ Sn `oo
TOTAL FEE NOW DUE $ 9 t °
(Revised02/24/2014) Scl d ° 2-0
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
16
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 eins 'on fee will be charged.
1
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 . by
who is personally known to
me h1 1 pr u e0-r"'WL as
identification and who did take an oath.
NOTARY PUBLIC:
i ENA LYNN CRUZ
* * WCOMMISSION # EE N1682
Sign:
Print:
4 a
Seal:
The foregoing instrument was acknowledged before me this
day of 20 /11�— . by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
MYCOMMISSION # EE 0111882
EXPIRES: April 7, 2015
Sign: 'r�o,eo�`O �ndTlruBu�,g
Print: e.
Seal:
as
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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, ou a 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:
o�
Signature:
moots :=��o DEKA LYw CRuZ
MY COMMISSION II EE 081892
State of Florida) *A14,V
* EXPIRES: April 7, 2015
County of Miami -Dade) ple ea Wft &W Sr
swomtoapd subscribed before me this
day of ' , 20.
B
Type of Identification produced
Print Name:
Signature:
State of Florida ) L $°
County of Miami -Dade)
Sworn to and subscribed before me T�lf
day of �� , 20�.
Lo
(SEAL)
Type of Identification produced
DENA LYNN CRUZ
* MY COMMISSION 8 EE 0818
EXPIRES: Apra 7, 2015
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