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DEMO-15-527 (2)Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229890 Permit Number: DEMO -3-15-527 Scheduled Inspection Date: April 02, 2015 Inspector: Devaney, Michael Owner: CONTESSA, MICHELE Job Address: 9220 NE 2 Avenue Miami Shores, FL Project: <NONE> Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number (305)761-5243 Parcel Number 1132060133060 Contractor: MSD ELECTRICAL SERVICE INC Phone: (305)318-7005 comments REMOVE OUTLET AND ELECTRICAL WIRE AT EXISTING ' -..--- BATHROOM INSPECTOR COMMENTS False Inspector Comments Passed EE Failed r Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 01, 2015 For Inspections please call: (305)762-4949 Page 19 of 34 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 ❑ BUILDING Of CTRIC ❑ ROOFING FBC 20 Master Permit No.zE Sub Permit Noj�E i((:)'s' 5 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5Feewe_ Com: 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): Q_l_ Gp'4 a ESS + Phone#: City: "10dfkA CV.QKV;Z:T _ State: t' Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Wym �L� a c;gp &"4 'e't;' Phone#: Aer3 wr Address: SZO 129-' City: State: 10097e- Zip: �✓���� Qualifier Name.'_7;K25~//��®�L/� Phone#: State Certification or Registration #: e-12 1,361—W-6 2, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ _�;yo' Do Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ AlterationID New ElRepair/Rep Description of Work: e>v!]i tl__G AA(\-e6eQA1 ice% 10 ) Specify color of color thru tile: Submittal Fee $, Scanning Fee $ Permit Fee $ 1 4CO% v Vc-�' CCF Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ CO/CC $ Notary $ Double Fee $ Zip: Bond $ TOTAL FEE NOW DUE $ �' ition 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 node apkrgved and a reinspection fee will be charged. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day o 20J by � —r who is personally known to me or who has produced'��-/ / identification and who did take an oath. NOTARY PUBLIC: Notary Public State of Florida R. a My Commission FF 082753 jF�®� Expiros01/12/2018 Signature CONTRACTOR The foregoing instrument was acknowledged before me this /+O day of ;? " 20 - y �.r��tJ��✓ �� / ,/Gvho is personally known o me or who has produced as identification and who did take an oath. N Print: APPROVED BYPlans Exami Structural Review (Revised02/24/2014) N - MATILDE C. RAMIREZ Notary Public - State of Florida Av Comm. Expires Mav 30.2015 Bonded Through National Notary Assn. Zoning Clerk BARATO AQU I CENTURY SUPERMARKET C&C MULTISERVICE=2 copias -Fx- Semanal ID ANTHONY Y BRIAN SUPERMARKET DUNA SERVICE EL TESORO SUPERMARKET 'EL TRIUNFO SUPERMARKET *Sacar2Copia��T0953-0601) Ell ,MALECON = X Email MILAN BEAUTY SALON MONSTER= x Email • .... . .... . :NOO QUE BARATO iOLGA AND MIGUEL 'PHONELAZ SERVICES ;iTHE SILVER REDLAND = Hacerlo de 1ras. X Email a Adri BLUE SKY = X Fax y X Email a Miguel. BHR = Avisarle a Doris L/ Valles = Temprano x Email a Adri. PASITOS BABY = Semanal. De 1ras y X Email a Adri. WIRELESS HOMESTEAD = Hacerlo a 1ra hora. X Email antes de las 10:00 AM. Sacar 2 copias Avisarle a Vivi $* FRR WISDOM = Hacer el cuadro 20% yX Vendedor. Via Email FT I I I I T Miguel: BLUE SKY = X Fax y X Email a Miguel. BHR = Avisarle a Doris L/ Valles = Temprano x Email a Adri. 004060 n. s tt? z -am j , sXL b 3 n � ySit 11,xs 0712d 4 x mv All �r OR t o z �w �N s AIR"� �{ r : i irk �� c� � ,.�.� »aft �{4:, '3 is '_ S � �' � ��"� � . ,Se��.�� ����u�"� ir�,4;,N�`�'.. `�.��„n• ':. ,.,/, �� _ �h� aN WON vwM MR w Y dV1i1E�” i. T1Ci¢8f3 R�fkiifftVR fii$ i MCAL�� it G L3Itt'f; h �s� � € OOTO s *t + z t �" s�. l cc aro-u 71, "A3--� a h i° k2 REkA l\ 1 1 • 1 • 1 1 FACTURAS 'AYHACCOUNTING'ANGELES '1..--..-..-.. COHN LAUNDRY ARIES 'iCENTU •CHEAPER 1'-...- .. -... BY THE DOZEN COTTOS PHARMACY !D'ANTHONY1GARDEN ".. ---.--.-- '1�®.......... SHELL L F . STATION MALTESE 1'........... - MI 1 i A i • 't.....--..... MONTEROS OKEECHOBEE FUEL SERVICE (Mensual) '1�........... '!UNIVERSAL TOBBACO Migu el: Avisarle a DorisI'............ 3/10/2015 12:20 PM FROM: 3052757572 Ferrero Ferrero Insurance Inc TO: 3057568972 PAGE: 001 OF 001 `` CERTIFICATE OF LIABILITY INSURANCE DATE (3 03/10/1YYYY) /10/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(fes) 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 endorsement(s). - PRODUCER Ferrero Insurance Inc. 10637 SW 88th Street, Suite 71 CONTACT NAME: Marieta Ferrero -- A °NE (305)275-7572 A/, 7572 E MAIL ferreroinsurance@bellsouth.net Miami, FL 33176 Phone (305)275-7572 Fax (305)275-7572 INSURE S AFFORDING COVERAGE NAIC # INSURER A : Accident Insurance Co. INSURED INSURER B: M & D Electrical Service Inc. INSURER C: INSURER 0: 21152 SW 128 Ct INSURER E Miami, FL 33177-7425 (305) 318-7005 INSURER F, GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC THIS IS TO CERTIFY 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MMIDDTYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY F1 E]CLAIMS-MADE❑ OCCUR ❑ N N CPP 0006135 02 10/03/2014 10/03/2015 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTEDence 100 000.00 PREMISES Ea occurr$ MED EXP (Any one person) $ 5,000.00 PERSONAL& ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC I PRODUCTS - COMP/OP AGO $ 2,000,000.00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED ❑ .❑ AUTOS AUTOS ❑ HIRED AUTOS AI° OSWNED COMBINED SINGLE LIMIT Ea accidenC $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYAMAGE $ Per acadent $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED L RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If describe under $ TORY OTH- TWORYLIMITS❑ ER NIA E L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ As, DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAL WORK CFR'n FiCaTF wni rk=o Miami Shore Village Building Dept 10050 NE 2nd Ave Miami Shore, FL 33139 Fax -305-756-8972 ph 305-795-2204 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Report Viewer Page 1 of 1 O https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc 9MQ3 gH6TER... 10/27/2013 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 . f: 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 and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS Signature: AA Own r State of Florida County of Miami -Dade rr �p��j The foregoing was acknowledge before me this U day of M� , 20_E. By M t (��-� who is personally known to me or has produced as identification. Notary: 09L9R dd U0)Www00 AW S , SEAL: ZMAly BIPuIS 8P1J0W W GM9 *llqnd ti%0N M & D ELECTRICAL SERVICE. 21152 SW 12EP COURT, Miami, Florida. 33177 Ph: (305) 318 7005 State of Florida County of Dade; Miami shores Village Building Department Before me this day personally 03/12/2015 who, being duly sworn, deposes and says : Me Ihosvany Morales is the only person working under this permit Sworn to ( or affirmed ) and subscribed before this 6)�) day of L' ,20§�by Personally know OR Produced Identifications or stamp Name of Notary c 315 -5�2 7