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RC-14-2490BUILDING PERMIT APPLICATION 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 ❑ ELECTRIC ❑ ROOFING F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS NOV I a 2014 FBC 2010 Master Permit No. &I 7 CNlyG�9 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 2 7 5 Al,64!J S ti u 2z c P A City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: / / 3 a n S- ® -A 'L — ® 9'7 6 Is the Building Historically Designated: Yes NO - Occupancy Type: R F-5 Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): :S tc F P= (7iq ✓ , S Phone#: 30i - F q 3- �(7 a Address: 9 ;L 7 1- A). RA -1 City: A4 1.4 n-1 o 5' "1 aX-z S State: r— r.04 Zip: Tenant/Lessee Name: Phone#: Email; CONTRACTOR: Company Name: Rei A /3 i n. S C 14 A, i ? r- r 7- A- c- Phone#: 3cS-75' 4- 4 /C Address: In 7o i /w C- c City: s%4 1"y M r State: F a Zip: ? 3 r 3 S Qualifier Name: s• PN 2 b 3 9 i w 5 Phone#: State Certification or Registration #: Certificate of Competency #: Cc b4 o (> p 0 / f5r3 a 7 DESIGNER: Architect gineer ' w. sh E �.v Bosh d s<P a Phone#: 3a� - 3?5r- l a 4L/ Address: I a +-( A u ,i� . Z -I .g o City: 174 ,4 t3 C State: r, c.4 Zip: Value of Work for this Permit: $ S000 • ac.) Square/Linear Footage of Work: `/ Sl .1 , l - Type of Work: ❑ Addition ❑ Alteration ❑ New ®Reps /Replace ❑ Demolition Description of Work: Cr tow 9 r -g kg_ Pia.( R -t v G".e 4 v, to R E,4 •yC of 2 9 f3•--sG,.17 Specify c e Submittal Fee $ Permit F Scanning Fee $ Radon Fee Technology Fee$ L ' . ra�inin Structural Reviews $ o' W (Revised02/24/2014) Nucation Fee $ `I Notary Double Fee $ 5� Bond $ 0) TOTAL FEE NOW DUE $ <./ I ` �� 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 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)lays after the building permit is issued. In the absence of such posted notice, the inspection will not lie approved and a reinspe9flon fee will be charged. ER or AGENT The foregoing instrumerif was acknowledged before me this — — day of amu• 20 /-J . by a -c' 1Z Z/1 S , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: r= 4 Vw6 ,.e.o Rat Seal: ' "�, ERIC R00RIG— 0�0Rb9% Notary Pnplln - State of Florida yy o,; My Comm. Expires Apr 25. 2018 Commission N FF 10971 APPROVED BY (Revised02/24/2014) Signature �� z ' 1 CONTRACTOR The foregoing instrument was acknowledged before me this ! e, day of ti n . , _ , 20 i L( , by 4-, 1 _ 14 who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ec, Print: 4 A 1L -c- Z o Ot 16 ti cr as Seal: •a�' a, ERIC RODRIGUEZ •s 'g Notary Public - Stale of Florida J. Commission #� FF 100971 Plans Examiner BondedlbroupNationalNotaryAssti Zoning L9� Structural Review Clerk a k CERTIFICATE OF LIABILITY INSURANCE Daft 11/12/2014 Producer: Lion Insurance Company This certificate Is Issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. Holiday, FL 34691 rights upon the certificate Holder• This certificate does not amend, ercbend or alter the coverage afforded by the policies below. 1 Insurers Affording Coverage NAIC # (727) 938-5562 insured: South East Personnel Leasing, inc. 8r Subsidiaries Insurer A. Lion Insurance Company 11075 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer B: Insurer C: Insurer D: Insurer E: Coverages The polies of Insurance Rated 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 reaped to which this cert8c ale, may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, fusions, and condtlons of such pdides. Aggregate limits shown may have been reduced by paid daims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Eifechve Date Policy Expiration pate Limits (MM/DD/YY) (MM/DD/YY) GENERAL UABILITY Each Occurrence Commercial General Liability Claims Made 13 Occur Damage, to rj promises rance Med EV Personal Adv Injury enerai aggregate limit applies per. Padicy 13Rojed ❑ LOC General Aggregate Products - Cuxnp/Op A9g MOBILE LIABILITY Combined Single Limn Ami All Owned Aufos Scheduled Autos (EAAcddent) 5 Bodily Injury (Per Perm) Bodily Injury Hired Autos Non -Owned Autos (Per Aociderd) Property Damage (Per Accident) 3 EXCESSIUMBRELLA LIABILITY Each Occurrence Ouxar ❑Claims made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2014 01/01/2015 X WC Statu- OTH- Employers' Liability to Limits ER EL Each Accident $1.0m.0m Any propdatodpartner/mcecutive officx;dmamber E.L Disease - Ea Employee $1.000.000 excluded? No If Yes, describe under spectral provisions below. E.L. Disease -Policy Limits $1.000.000 OUter Lion insurance Company is A.M. Best Company rated A- Excellent). AMB # 12616 Descriptions of Operations!Locations/Vehicice/Exclusions added by Endorsement/Special Provisions: Client ID: 19-45-009 Coverage only applies to active employee(s) of South Fast Personnel Leasing, Inc. & Subsidiaries that are tv the following "Gent Comparry": Robbins Gunite co•, furc. Coverage only applies to Injuries Incurred by South East Personnel Leasing, Inc. & Subsidiaries acute employee(s), while woridfrg in: Fl- LCoverage Coveragedoes not apply to statutory employee(s) or independent coniractor(s) of the Gtent Company or any other entity. A list of the alive employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: COUNTY COMP CODE: STEPHEN ROBBINS #WW18W / ISSUE 06-03-14 (rD) REISSUE 11-1214 (AF) (MT) Begin Da" 13 2014 CERTIFICATE HOLDER CANCELLATION CRY OF MIAMI SHORES should any of the above deed policies be cancelled before the expiration data thereot, the issuing BUILDING DEPARTMENT Insurer will endeavor to mag 30 days written notice to the cartficale holder named to the I&L but failure to do so shag Impose no obligation or Ilebiity of any Idnd upon tire insurw, Its agents or vepresentatvas. 10050 NE 2 AVE MIAMI SHORES, FL 33177/ Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL- DO NOT PAY 2165181 ROSINESS tNAAAEJ=ATION ROBBINS GUNITE CO INC 6701 NE 3 AVE MIAMI, FL 33138 OWNER ROBBINS GUNITE CO INC Worker(s) RECEIPT NO. EXPIRES RENEWAL SEPTEMBERS©, 2015 2277762 Mus: be displayed at place of business Pursuant t0 County Code Chapter BA - Art: 9 & 10 BEC. TYPE O= PUSINESS 196 SPECIALTY BUILDING CONTRACTOR 00001&307 - PAYMENT RECEIVED BY iAXCCLLECTOR 45.00 09111/2014 0225-14-005547 This Local Basi sass Tax Receipt only confirms payment of the local Business Tax. Tire Reeaipt is net a license. permit, or a cortificatioe of the holder's qualficatiom, to do business. Roldernest comply with any governmental or megarermnental regulatory laws and re"iremmeats which apply to the business. The RECEIPT NO. above must be displayed an a!I commercial vehicles - Mimm i-Oade Code Sec Ba -276. MIAMS For more information, vi3itwww.miamidadnamt taxceltecmr BUSINESS NAME6LOCATiON RECEIPT NO EX PiRaES SEPTEMBER 30, 2015 � �� 7454479 33138 Must bedisptayed at pliceaf business Pwwamt to County Code Chapter 8A - Art. 9 & 10 OW hER ROBBINS GUNITE 00WC TPE 0- BUS V ESS PA Yt.. �'YT RECEIVED SPEMTPBuILDINGCXJA17WaOR BY'.I . COLLECTOR 175.Ot 09111/2014 K25- 4-00:547 MAS IAM For moreirdorr115 cm%isitw wwmarnldK*gadwcCalledor AMERICAN SOCIETY OF CIVIL ENGINEERS NATIONAL ACADEMY OF BUILDING INSPECTION ENGINEERS -gc-- \ (-A- D-�-4 q 0 NATIONAL SOCIETY OF PROFESSIONAL ENGINEER CONSULTING ENGINEER FLORIDA ENGINEERING PROFESSIONAL BUILDING INSPECTION SOCIETY 12420 S.W. 75th AVE., / MIAMI, FLORIDA 33156 TELEPHONE: (305) 378-1244 Established 1976 Village of Miami Shore Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 Dear Building Official 1 December, 2014 RC -11-14-24;0 9275 N. Bayshore Drive Robbins Gunite I, J.N. Sheingold, P.E., having performed and approved the required inspections, hereby attest that to the best of my knowledge and belief, the repairs to the reinforced concrete rib joists complies with the permitted documents. I also attest to the best of my knowledge and belief, the approved permit plans represent the as -built condition of the structural and envelope components of said structure". This document is being prepared in accordance with Section 105 of the 2010 Florida Building Code and is being submitted to the Village of Miami Shores building department at the time of final inspection for the above referenced structure. Should you have any further questions or need any additional information, please do not hesitate to contact me. P.E. 21181 9275 North Bayshore Drive Permit RC -11-14-2490 Date of Inspection Time of Inspection Location By Unit # 12/1/2014 Repair of Reinforced Concrete Rib Joists e of work inspected FINAL ✓ Demolition 1 ✓ Rebar Prep V ✓ Rebar/Concrete Epoxy Coating Other (Specify) Comments Rebar Splice LJ Dowel/core drilling Concrete Pour—Finish Plaster QApproved ❑ Rejected 11/25/14 Setup and chip loose concrete from rib joists (tension section only) Joists are precast, not post tensioned. Sandblast rebar and coat with Epochem 110A 11/28/14 Gunite areas of repair. 12/1/14 Final Inspection J.N. SHEINGOLD >r Name J.N. SHEINGOLD, P.E. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 MIAMI SHORES VILLAGE NOTICE TO BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE I (We) have been retained by Jeffrey Davis to perform special inspector services under the Florida Building Code at the 9275N. Bayshore Drive project on the below listed structures as of 11/10/2014 (date). I am a registered architect or professional engineer licensed in the State of Florida. PROCESS NUMBERS: ❑ SPECIAL INSPECTOR FOR PILING, FBC 1822.1.20 (R4404.6.1.20) ❑ SPECIAL INSPECTOR FOR TRUSSES >35' LONG OR 6' HIGH 2319.17.2.4.2 (R4409.6.17.2.4.2) ❑ SPECIAL INSPECTOR FOR REINFORCED MASONRY, FBC 2122.4 (R4407.5.4) ❑ SPECIAL INSPECTOR FOR STEEL CONNECTIONS, FBC 2218.2 (R4408.5.2) ❑ SPECIAL INSPECTOR FOR SOIL COMPACTION, FBC 1820.3.1(R4404.4.3.1) ❑ SPECIAL INSPECTOR FOR PRECAST UNITS & ATTACHMENTS, FBC 1927.12 (R4405.9.12) 0 SPECIAL INSPECTOR FOR srRucR'w PI'AR of REINFORCED coN—m Note. Only the marked boxes apply. The following individual(s) employed by this firm or me are authorized representatives to perform inspection 1, JOSEPH N. SHEINGOLD, P.E. 2. 3. 4. *Special Inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or licensure to perform the duties assigned by the Special Inspector. The qualifications shall include licensure as a professional engineer or architect; graduation from an engineering education program in civil or structural engineering; graduation from an architectural education program; successful completion of the NCEES Fundamental Examination; or registration as building inspector or general contractor. I, (we) will notify Miami Shores Village Building Department of any changes regarding authorized personnel performing inspection services. I, (we) understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Village Building Department Inspector. All mandatory inspections, as required by the Florida Building Code, must be performed by the County. The Village building inspections must be called for on all mandatory inspections. Inspections performed by the Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the Department Further, upon completion of the work under each Building Permit I will submit to the Building Inspector at the time of final inspection the completed inspection log form and a sealed statement indicating that, to the best of my knowledge, belief and professional judgment those portions of the project outlined above meet the intent of the Florida Building Code and are in substantial accordance with the approved plans. Signed and Sealed Engineer/Architect 11 , Name JOSEPH N. SHEINGOLD, P.E. (PST) Address 12420 S.W. 75 AVENUE, MIAMI, FLORIDA 33156 Phone No. 305-9867002 on 6/10/2009 AMERICAN SOCIETY NATIONAL SOCIETY OF OF CIVIL ENGINEERS•Imo, ' , PROFESSIONAL ENGINEER: NATIONAL ACADEMY FLORIDA ENGINEERING OF BUILDING INSPECTION CONSULTING ENGINEER SOCIETY ENGINEERS PROFESSIONAL BUILDING INSPECTION 12420 S.W. 75th AVE., / MIAMI, FLORIDA 33156 TELEPHONE: (305) 378-1244 Established 1976 10 November, 2014 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 Att: Building Official Ref 9275 N. Bayshore Drive Miami Shores, Florida I, J.N. Sheingold, P.E. have prepared the repair plans and specifications to correct the structural deficiencies for the above referenced single family residence. Please be advised that the work as described will not reduce the structural strength or the stability of the structure, or any individual member, thereof as per FBC 2010 Section 506.2.4, 1.2. The structural repairs are less than 25% of the replacement value of the building. Structural damage does not exceed 50% of the market value (FBC Existing Building section 202). P.E. 21181 AMERICAN SOCIETY NATIONAL SOCIETY OF OF CIVIL ENGINEERS��' . PROFESSIONAL ENGINEER: „ NATIONAL ACADEMY FLORIDA ENGINEERING OF BUILDING INSPECTION CONSULTING ENGINEER SOCIETY ENGINEERS PROFESSIONAL BUILDING INSPECTION 12420 S.W. 75th AVE., / MIAMI, FLORIDA 33166 TELEPHONE: (305) 378-1244 Established 1976 10 November, 2014 Village of Miami Shores Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 Att: Building Official Dear Sir: We have been retained by the owners of 9275 North Bayshore Drive, Miami Shores, to provide special inspector services as defined in section 105 of the F.B.C. 2010 edition. The repairs are to be performed by Robbins Gunite under contract to the owner. The repairs will consist of the following: 1. Structural repair of two (2) reinforced concrete rib joists. Area of repair is shown on attached site plan Repair Procedure -Structure 1. Remove all loose and spalling concrete using a light chipping hammer. Note: no additional chipping without approval of Engineer. 2. Inspect exposed interior reinforcing steel and replace any steel damaged in excess of 10%. Should laps be required, at least 48 bar diameters or 30 inch minimum is required as per ACI 318-11. Concrete strength to be 5000 psi. Steel is to be 60 KSI. Concrete cover for steel rebar is to be a minimum of 1.5 inches. 3. Should steel replacement be required, embedment of rebar into existing concrete structures is to be a minimum of 9 inches and Sika. 31 Gel epoxy is to be used. No areas are to be concealed without Engineer's approval. 4. Sandblast existing exposed rebar and coat with Epochem 110 or equivalent. 5. Restore to original dimension using pneumatically applied concrete (Gunite). Engineer's inspection required to verify removal of all loose debris and adequate coating of rebar prior to application of Gunite. Concrete batch mix must comply with ACI Table 4.2.2 for locations subject to salt spray. Rebar cover must comply with FBC 2010-1926.5. No work to be concealed without inspection by the Engineer -of -record. The engineer's inspections are in addition to those required by the Building Department L AMERICAN SOCIETY NATIONAL SOCIETY OF OF CIVIL ENGINEERS n@ Age ��_ ,! ��. PROFESSIONAL ENGINEER: NATIONAL ACADEMY / �!�� FLORIDA ENGINEERING OF BUILDING INSPECTION CONSULTING ENGINEER SOCIETY ENGINEERS PROFESSIONAL BUILDING INSPECTION 12420 S.W. 75th AVE., / MIAMI, FLORIDA 33156 TELEPHONE: (305) 378-1244 Established 1976 Page 2 9275 N. Bayshore Drive All work to comply with the 2010 Florida Building Code, ICRI, ACI 318-11, and ACI 562-13. A work log will be maintained and a letter of final acceptance will be submitted upon completion of the work. P.E. 21181 r AMERICAN SOCIETY OF CIVIL E GINE RS r i NATIONAL SOCIETY*F, Ej f""" RROFESSIONAL€ENGI E S NATIONAL-ACAQEMX • .-- _%- ' ` - -- ' �' FL i OF BUILDING INSP�ECTIO�J CONSULTING ENGINEER W FLORIDA-ENGIN R G�-- :SOCIETY : I ---"-ENGINEEF $ : -7 RROFE SIONAL BUILDING INSPECTION - - _..._. -_-f ......_.�_ .2424 S. 5th AVE.;1 MIAMI, FLORIDA .33156 ' TELEPHONE: (305) 378-1244 Y -14--'; Established 1976 • �� � bac �- �. S� r > i re L-- A9104d i ��O - • 1 j i I I •