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RC-14-1758Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225700 Scheduled Inspection Date: December 23, 2014 Inspector: Rodriguez, Jorge Owner: , Job Address: 150 NE 109 Street Miami Shores, FL 33161 - Project: <NONE> Contractor: APC ENGINEERING ENTERPRISES INC tiunamg uepanment comments Permit Number: RC -8-14-1758 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)219-8267 Parcel Number 1121360090120 Phone: (305)219-8267 REMOVE AND REPLACE ALL THREEE BATHROOMS ANC Infractlo Passed Comments THE KITCHEN. CREAT A LARGER MASTER CLSOET AND INSPECTOR COMMENTS False A LARGER MASTER BATH INT REMODEL. December 22, 2014 For Inspections please call: (305)762-4949 Page 30 of 30 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 22, 2014 For Inspections please call: (305)762-4949 Page 30 of 30 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: (30S) 762-4949 BUILDING PERMIT APPLICATION [!fBUILDING ❑ ELECTRIC ❑ ROOFING RECEIVED .AUG 112014 3Y: FBC 20 t Q3 Master Permit No.,G i =l®, Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: IS -6 >, E City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): A N KrA'( Phone#: Address: I L000 ki tj rw,G City: M:.<%, + 1-4 K,P1 State: R_ Zip• ITo f Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: f - e(_ G , neer'+H-? 07A+- Phone#: Address: ZI S 6 aj • 16+4 ave - City: #I'Ple4l' State: - Zip:.33U ®® Qualifier Name: D'qvr�j b f oc 1 /i di Phone#: State Certification or Registration M C4C /Sf 407 Pi Certificate of Competency M DESIGNER: Architect/Engineer: Address: City: State: Zip: Value of Work for this Permit: $ fid! e d,a - `'' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: ger-va°jY_ A,A i2e e%ctCe et kl < bore e 6 ceill cdo e,%S a h cL +fie k e,A rtw+e („,Rv- Y -e, rvn e, S 1-e-' e, (oS- 1. o n.o . Vic:. Z "j el,. I'✓I S tP r hec-4 rt, 4 �''e MG' S (• Specify color of color thru tile: Submittal Fee $ Permit Fee '$ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ -~ -Double-Fee.$ Bond $ TOTAL FEE NOW DUE $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. A Signature OWNER or AGENT The foreping instrument wps acknowledged before me this day of 20 by % i ersonally wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign f **e Corhgpsion # EE 116040 Sea �. My Commission Expires July 26, 2015 P Signature ��OJ- A 0,.1,vAAe, CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 by ) ® I - i personally know to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: v Sign: Print: �.•"::'�,, �'�- SANDY ROMERO Seal: `•° f f�: Commission # EE 116040 My Commission Expires July 26, 2015 APPROVED BY Plans Examiner Zoning ! �* Structural Review Clerk (Revised02/24/2014) OP 111i AA ✓'�CL/AL� �CERTIFICATE OF LIABILITY INSURANCE DAM (fi1WDDIYYYYj .r,.- 08/20/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN THE ISSUING INSURER($), 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 certificate does not confer rights to the certificate holder In lieu of such endomsemen s . PMDUCER MOW Insurance Group Ino 382 Minorca Ave Strategic c B sinesFL s�Unit m"T AOT Ane Montenegro FAX PHS 305-444-23124 me m • 305444.4980 A134 RDOR co- amorktonegro(&_mdwinsulrance-com cuww, ,,EFDES-1 INSURERS AFFORDING COVERAGE NAtc# e1gURMA:Accident Insurance Company INSURED EF Design & cionstrucrtion, Ino 297 NW 152nd Ave 101URER B: Pembroke Pines, FL 33028 INSURER C : INSURER D; A INSURER E RER F : .—VI-,V,\"wwj Vn2 THIS IS TO CEF(TIFY 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 bESCitIBE D HEREIN 15 SUBJECT TO ALL THE TERMS, q(CL USIONS AND CONDITIONS OF SUCH POI,�GIES. LIMITS SHOWN MAY HAVE BET JN REDUCED BY PAID CLAIMS. t TYPE OP INSURANCEUK MIM BULLPOLICY NUMBER POLICY EFF FOUDY EID+ LMR$ GENERAL W16H n7 A EACH OCOURRFNOE FREM9 E 100,0OU�® ERCIALGENERAL UJTY CPP00511102 08/2812094 08/25/2015 CLANS -ME OCCUR MED DIP (Any one parson) 5,00 PERSONAL & ADV INJURY S 1,000,0 X BLANKET ADDTL WS OENERM-AooREGAYE $ 2,000,00 GEMLAGGREGATELIIWTAPPLIESPER PRODUCTS.00MP)OFApp $ 2,000r 00 POLICY Fl,",",OT LOC $ AUT0111OB0.E LIASRRY COMBINED SINGLE UMIT ANYAUTO (Eaaaalaen0 $ AU-OWNEDAUTOS BODILYINJURY(Ferpww$ BODILY INJURY (Far ocddart) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (PER ACCDENT) Np 4-VWVN€0 AUTOS $ 3 UMBRELLA UABOCCUR EXCESS Me HCLAIMS4AADE EAOH OCCURRENCE $ AGGREGATE § DEDUGnoe S RETENTION 3 WC STATTL TH- $ MiORIED:RRS COMPENEATION AND �� LIABanY YIN D(CL TORY UMrf3 ER F_L. EACH A00015NT $ OFRCCARYPER MB RE 2Dw�D� MIA tmy &: NH) EL DISEASE - EA EMPLOY S If D�yesRIO�N � OPERATIQNS Lalow E.L. DISEASE -POLICY LIMIT $ OEscRffaGe><Lera? OF OPERATIDNS r L,ocAno=/ VENIOJ.EB (Armco ACDRo A�4a:e1 Remui:e Eenet0.:Ie, ff more epaee Is regrldsaa) contractors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DRJVERED IN 10050 NE 2nd Ave ACCORDANCE: WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORM R01`ftM+NTATI0 w -Iran Auua Awtw UVKPOKATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo ara regirterad Marks of ACORD ; r ISSUED,. DISPLAY.AS'REQI iWED:8Y'LAW- SP -04- L94&000d9l6W , CERTIFICATE OF LIABILITY INSURANCEL=019119/14 I)EV"M THIS CERTIFICATE IS ISSUED AS A Ur ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA`I E R T 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 pottey(lea) must he endorsed. 0SUBROGATION 19 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder In lieu of such endomwnent(aj. PRObUCVR Smart Insurance Inc. 20266 NW 2Ave CONTACT Gregg Dylan NAMEnGet JAICPN� E (306)663-7,97r F ft : (306)654.0283 U.MILrA. AMR Inioninsute-smartcom Mlami, F'L 33169 Phane ( 653-7977 FQX 305)654-0293 INSU AFFORDING COVERAGE NAIC0 IN3URIItA: Aculdent Insurance Company INSURED Ray E Williams Inc Ucense#EC13002989 INSURER B INSURERC: 4820 SW 134 Ave INSURER D: INSURER I:: Davie, FL 33330 (305) W2-6142 INSU P: COVERAGES / M5'r1H1AATB IMINN-1 Aravisrum NumI%I=K: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS UF -D TO THE; INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUM>;NT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU84ECT TO ALL THE TERMS, EXCLUSIONS AND CONt)1'i1ONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLU Arum P NPO EXP POLICY NUMBER GENERAL LIABILITY LUTS EACH OCCURRENCE $ 1,OOp,00O.00 ❑VF COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREME E S 100,000.00 A ❑ n Elcwrws MADE OCCUR CPPODa9528 01 MED EXP aepeP. S 6.000.00 N N 0810&2014 08108/2015 PERSONAL 8 ADV INJURY s 1,000,000.00 GENERAL AGGREGATE S 2,000,000.00 rnq ....... n PRfL a--1 AUTOMOME LIAmuTY ❑ ANYAUTO OWNED SCHEDULED ❑ OS ❑ AUTOS ❑ HIREDAUT05 ❑ AUTOS ❑ UMBRELLA LUW ❑ OCOUR ❑ F -X0109 LIAR ❑ CLAINsaADE ❑ DED ❑ RETENTION a WORKERS OOMPENSATXTN AND EMPLOYf�:$' I,was ITY Y I N NIA DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (Aueeh ACORD 7o7, AddlEm w RemAft Saheduk, if more spaca is raqufnal) 82478 ELECTRICAL WORK -WITHIN BUILDINGS Uoense#EC13002989 HOLDER CITY OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES, Fl, 33133 854438-4737 FAX# ACORD 28 (2010105) QF BUPD Deductlble i S BODILY INJURY (Ptd' pef w) $ BODILY INJURY (Per aclderTI) S Pec AMR E s S E.L. EACH -CA EMPLOYE I S • Pmjcy OMIT I S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL.I_I D BEFORE THE EXPIRATION DATE! THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRGV1910NS. AUTHORIZED R6Pk"ENTATIvja (9)7888-2010 ACORD CORPORATION. All rights rearved. The ACORD rime and logo are registered marks of ACORD Miami Shores Village Building Department,,:. 10050 N.E.2nd Avenue° { Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756 .8972 P g/ h� Permit No: k cl Structural Critique Sheet Page 1 of 1 STOPPED REVIEW Plan review Is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and Include one set of voided sheets in the re -submittal drawings. Mehdi Asraf