RC-14-2177Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-225612 Permit Number: RC -10-14-2177
Scheduled Inspection Date: December 23, 2014
Inspector: Rodriguez, Jorge
Owner: BROWN, MORGAN
Job Address: 29 NE 102 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: AMERICAN CONTRACTING, INC.
Isuucang uepartment comments
BATH ROOM TILE WORK
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
1132060131650
Phone: 305-759-7000
December 22, 2014 For Inspections please call: (305)762-4949 Page 17 of 30
Inspector Comments
Passed JW.
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 17 of 30
BUILDING
PERMft APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department
10050 N.E.Znd Avenue, Miami Shores, Florida 33138
OCT R 281
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 l Q-�)
Master Permit No. 1z U 4 _ 1. 1
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,, . CONTRACTOR DRAWINGS
JOB ADDRESS:
N
City: Miami Shores County Miami Dade Zip:
Folio/Parcelk . Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Ar A ie Q -T-761 1�� SIS- l('Rone#: -1,.)4 $q & 93&,+
Tenant/Lessee Name: Phone#:
Email• Kiel 6S aO "+ Wl a i I • ci> re-)
CONTRACTOR: Company Name:
Address: __ t—zl- &0
City: Ad I A.rK. Ft State: Zip: 3,317 S;
Qualifier Name: (C�cz Phone#:
State Certification or Registration #: C- a C Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
1!
spr$al; In seoirlttc a iilo El Alteration
5,10S.If lubi"s'� t1 ^Wor'k,.. . s
446 Al ..-9 Wil!!
City: State: Zip:
Square/Linear Footage of Work:
❑ New Repair/Replace
❑ Demolition
.... .
Specify color of color thru tile:
Submittal Fee!" Permit Fee $ - CCF $ a CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $GL • Notary $
Technology Fee $ 40 Training/Education Fee -$ Double Fee $
�c
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ v
(Rev1sed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
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 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 theperson
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. the absen "?f su posted notice, the
inspection will not be approved and a reinspection fee will be charged.. � it � lAI i,Fa J1�.
Signature lttj rw
OWNER or AGENT
The foregoing instrument was acknowledged before( cme this
day ofd - 20 `I , by
II J
761 who is personally known to
me or who has produced b k� F �0o0-t
-
- i `► %1`J
identification and who did take an oath. ofp(�l �f
NOTARY PUBLIC:
Sian- dP,'*i
Print: 1'P_�oC
Seal: OLOAOBERLENI ER-FIMM
* * My COk9dMN 9 EE 854653
EXPIRES: March 29, 2017
Bondwl¢nww"wiks
APPROVED BY
(Revised02/24/2014)
The foregoing instrument was
acknowledged beforb me this
I day of � � � .20 tJ by
1 1 0 2, who isaersonat vin =own to
me or who has produced /Q 1 A- as
identification and who did
NOTARY PUB AWAL FOW
jj tel► pow - UM Of Fbft
.L�=7 "�a9, A:• Cc alxp r" JW 31, 2018
y„ Sign: """" • I FF 147125
Seal:
Plans Examiner
Structural Review
Zoning
Clerk
r
F21Ck SC0'TT G®VE N0R PEEN LAWS4 y SECRETARY
6
W1194
n
JEFF ATWATER
CHIEF 06WMAL OFFICER
CONSTRUe"bN INDUSTRY EXEMPTION
-EFFEclWo DATE: M, ..... � { 92 � _ . R ,., t"' 3 s -i"' R-•.. ,.. .. _ 9. : � ♦ w ». '�`< 3t' Ql f i W ,' {�., A Y.".`. - "'M € if. r
013 EXpIRATION 7125=15
PERSON: CRUZ JULIO
• !'.
BUSINESS NME SADDRESS:
AMERICAN CONTRACTING INC
AMERICAN CONTRACTING, INC.
i SW 47TH STREET
MIAMI FL 33175
i'"_ TRADE:
GENERAL
CONTRACTORR
PLUMBING NOC AND ROOFING b.
D" AND DRIVER
. d� :r i}A„ n- r Psr .a. _.. £�. b t aac e • enr a—' ati '.a .,
Y � - r s._ .�. s: •� > ., aN3 . 1 % p. p ? srs 4. . e � :' % 4 Y a .- a � x n 4 e,�:
R
'19- t8 d..e .. A -P ` s�Y' A•2'...E €1 b•t Y ) :-!2'i. As�'l
- ( � s.�.i - � a t� .sii a .. az a•. t «:� - �. 9 . v.. £ e+, .. ti _ e, , �
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 cMensation injuries of any person allowed to work under this permit Please check with your
insurance carver 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: -A-Y(° Te (_ -15(a inAo
Signature: (I V\(:A r r -Q t Q
State of Florida)
County of Miami -Dade) ik-,
Sworn to and subscribed
day of,. .
ter°, JANELL FONT
„ Notary Public - State of Florida
By My Comm. Ex Ires Ju131, 2018
'-g,p;;;°�� Commission # FF 147125
(SEAL)
Type ofIdeniffica46upkoduced7 F6732- 00 0
Contractor
Print Name: Cka____
Signature:
State of Florida ) t-1 71n, 1 r if)
County of Miami -Dade) TT4J
Sworn to and su scribed before me this
day of bEl6; '�_ , 20 LA.
0
Notary PublicCo -state Florida
1 res Jul 1, 2018