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RC-14-2356Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227376 Permit Number: RC -10-14-2356 Scheduled Inspection Date: January 30, 2015 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Inspection Type: Final Building Owner: , B&L REALTY HOLDINGS LLC Work Classification: Alteration Job Address: 170 NW 97 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010250030 Project: <NONE> Contractor: ACA CONSTRUCTION INC Phone: (305)788-8914 Building Department Comments UPDATE 2 BATHS, UPDATE KITCHEN. CHANGE ""'---- WINDOWS AS PER WINDOW SCHEDULE, REPLACE INSPECTOR COMMENTS False EXTERIOR DOOR. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-227270. No access Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 29, 2016 For Inspections please call: (305)762-4949 Page 27 of 34 4 / Miami Shores Village0 3N i ., 7 _ r� - Building Department d 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 0 T 2 3414 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 [Q� BUILDING Master Permit No.�- - PERMIT APPLICATION Sub Permit No. ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 :1 ® —7 -yr, . City: Miami Shores Countv: Miami Dade Zia: -It) -z'S (—�. Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholders f; `-- P- -c-C, (-1 v 140 1 Cl (rr(PhWg` -3 0';5 - �5 1 q fog Address: C) City: �� ► �;�� ,'' State: l_ Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: AGA �%�. C -I t i��;-� _ Phone#: ®� -� I �CI (e8 Address: i, ® --I �5 VD- J'vV City: rye' , G --v--% s State: Zip: -331 (25. Qualifier Name: �4��1 �yS- �—� LA Phone#: 2�0 �5 -519 - (0q(,:'P4 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: — Phone#: Address: City _. : "tate: -- Zip: Value of Work for this Permit: $- 1 d r 15C)p Square/Linear Footage of Work: 00 -ft-4 F4.- Type �Type of Work: ❑ Addition ,;'❑ Alteration ❑ NewRepair/Replace El Demolition _ ' ... .. Description of Work: Ci 'r--pn e w► -le cy"-s C43, r r -C �2I G Ctf Specify color of color thru tile: Submittal Fee $ Permit Fee $ _ �� CCF CO/CC $ 0 Scanning Fee LK) Radon Fee $ A. DBPR $ Notary $ Technology Fee $ C>,��/� Training/Education Fee $ DO Double Fee $ 99 Structural Reviews $ Bond $ 0 TOTAL FEE NOW DUE $ ti 04, OJ (Revised02/24/2014) 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. &-`�7 Signature GGG,,, Signatur"-91 4===�i N or GEN CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 0C.+ '20 \+- , by �y of O C,i— , 20 V4-. , by flj&y) Of e rt?'Y-) "h ersona I wn to 16y�C� -ej C 2 r�ll�l� , who is rsonally kno to me or who has produced / as me or who has produced as " "" RONNI ANN BLANK •. .•.. identification and who did tak * .ff `,� RONNI ANN BLAI�iil ification and who did to ; MY COMMISSION #FF15W14 MY COMMISSION #FF154 6 ARY PUBLIC: a'w EXPIRES October 1, 2018 NOTARY PUBLIC: `�+ , F EXPIRES October 1, 2018 (407) X183 aom ') 3B8 0183 FbrideNu�aryserviae com Sign: Sign: Print: , Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) C o'l`a 2011:4fi0708180 OR Bk 69345 Ps.4677, (Ips) IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL RECORDED 10/10/2014'11-'33147 CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA WaDOC TAX 1'Sr7'90 HARVEY RUVIN, CLERK OF COUR t rll:AfEI-DARE COUNTY* FLORIDA LAST .PAGE JPMORGAN CHASE BANK (NA) Plainti ks) / Petitioner(s) VS. VEERAWAT, TANITPORN , et al. Defendant(s) / Respondents(s) GENERAL JURISDICTION DIVISION Case No: 1202824WAOI Section: 32 Doc 3MMW. $1.587.80 suftac $0.00 Considembm $261,300.00 CERTIFICATE OF TITLE The undersigned clerk of the court certifies that a Certificate of Sale was executed and filed in this action on September 22,2014, for the property described herein and that no objections to the sale have been filed within the time allowed for filing objections. The following property in Miami -Dade County, Florida: LOT 3, BL#X 3, OF THE >I-SUBDIVISIM SOF BL= TJNEE, OF 90)0" PARK, ACCORM6 TO TM PLAT TMBOF, AS RE=DED Df PLAT B©OK 42, PAGE 60, OF THE PUBLIC RECORDS OF BADE COUNTY, FLORIDA. &WKtYA&r=:170NW9797RW,m1AWFL 331SOM was sold to: B&L REALTY HOLDINGS, LLC 3900 nw 2 we Miami, FL, 33127 C CD C W CD ROW lef gm Book29345/Page4677 WITNESS my hard and the seal ofthis court on Odober 07, 2014. �t Harvey Ruvin, Clerk of Courts Miami -Dade County, Florida 1 CFN#20140708180 Page 1 of 1 Detail by Entity Name • Florida Limited Liability Company B & L REALTY HOLDINGS, LLC 11150m= =11 Document Number FEUEIN Number Date Filed State Status Principal Address 3900 NW 2ND AVE MIAMI, FL 33127 Mailina Address 3900 NW 2ND AVE MIAMI, FL 33127 L12000005416 45-4288296 01/1112012 FL ACTIVE Registered Agent Name & Address BROMLEY, STEPHEN R 3900 NW 2ND AVE MIAMI, FL 33127 Name Changed: 01/25/2013 Authorized Person(s) Detail Title MGRM BROMLEY, MICHAEL W 3900 NW 2ND AVE MIAMI, FL 33127 LEIDESDORF, EDMOND H 3900 NW 2ND AVE MIAMI, FL 33127 Report Year Filed Date Page 1 of 2 http://search.sunbiz.org/lnquiry/CorporationSearch/SearchResultDetaillEntityNamelflal-1... 10/24/2014 MiamiShor'esVillage Building Department 10050 N.E:2nd Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Lave requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Ela. 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 m -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 ii~ 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 compensation Mjuries of any person allowed to work Hader 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. �1.fill . Ut - J State of Florida) County of Miami -Dade;} Sworn to and subscribed before me this day of Qg k , 20J4� (SEAL) , �• M Notary Public - state of ftorift w. ww.e 1101 Thro�A' P�fongi {��y INsn. Contctar. Print Name: Signature:'. State of Florida ) County of Miami -Dade ) Sworn to and sybscribed day of before me this ,014. JM fA: $WAWA 'My comm: Fac ►ee Fib 24,2017 APAWAP, MIM IO 0 ARATOA.-' M il�i�t it'li'll'i 'ILI "OTPA,