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DS-15-745Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231447 Permit Number: DS -4-15-745 Scheduled Inspection Date: May 11, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Owner: , Job Address: 9699 NE 2 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: BRM CONSTRUCTION INC Building Department Comments Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060134050 Phone: (786)443-7107 CONCRETE SLAB ON FRONT AND BACK DOOR inrracuo rassea t-ommenis ENTRANCE TO BE COVERED WITH TRAVERTINE INSPECTOR COMMENTS False MPSAIC WITH THIN SET May 08, 2015 For Inspections please call: (305)762-4949 Page 15 of 42 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 08, 2015 For Inspections please call: (305)762-4949 Page 15 of 42 1 o Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 ProjeCtAddress Parcel Number Applicant 9699 NE 2 Avenue 1132060134050 Miami Shores, FL 33138- Block: Lot: 1101 MIAMI SHORES LLC Owner Information Address Phone Cell 1101 MIAMI SHORES LLC 9063 BISCAYNE BLVD MIAMI SHORES FL 33138-3221 Contractors) Phone Cell Phone BRM CONSTRUCTION INC (786)443-7107 In Review Approved:: In Review Denied: of Work: CONCRETE SLAB ON FRONT AND BACK Additional Info: Return: Classification: Residential nino: 3 Fees Due Amount CCF $0.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 Valuation: $ 900.00 Total Sq Feet: 100 I Pav Date Pav Tvae Amt Paid Amt Due I Invoice # DS -1-15-55024 05/04/2015 Credit Card 04/01/2015 Credit Card $ 64.60 $ 50.00 $ 50.00 $ 0.00 Avaname, Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. ��' May 04, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 04, 2015 W" r II'I Wami SiCres Village API- ,10,v ED . BY D.z ZONING DEPT � f� BLDG DEPT , t T�I_1CJECT TO CGNIPLIPMCE Wi H ALL, FEDERAL c I ATE AW) C(-IjN i "f r I;L-S AND REGI JILAT! ,N3 I o M SURVEY aaoc� rpr ti 04- e 4- t, David, 96S a e aAe,r err a.� a�• . wia:a �.r•.• .... w. tril••eAsnisitwlrM 1 A�6 �w Oduo � pp ssN'L' B APR 6 2 15 Ln to y, 1--Z �— 11 a I o M SURVEY aaoc� rpr ti 04- e 4- t, David, 96S a e aAe,r err a.� a�• . wia:a �.r•.• .... w. tril••eAsnisitwlrM 1 A�6 �w Oduo X26 Miami Shores Village N Building Department JAP a 12015 10050 N.E.2nd Avenue Miami Shores Florida 33138 d Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 M:tilI0111 PERMIT APPLICATION Permit Type: BUILDING FBC 20®_ Permit No. nis 0'� Master Permit No. ROOFING JOB ADDRESS:— I 1 (0 99 Pz A'J r,; City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 3 2 0 i, 1 j– 1�0 5-r3 Is the Building Historically Designated: Yes Vo Flood Zone: OWNER: Name (Fee Simple Titleholder): (10�� i `�0�� /' r u Phone#: Address: 6Lom 45 - City: Tenant/Lessee Name: Email: State: Zip: CONTRACTOR: Company Name: 4 1® m 51 roj r l i 0j'J Phone#: T94 3 01-3 Address: Z S 1 ` 6- 9 r I A Ce City: �� i A'44 D State: Zip: :33 1 �1 9 Qualifier Name: 4 C 1yQ MA ATO' 6 Phone#: State Certification or Registration #: 1 4� ?_ I -)` 9 g Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ q 0() g Square/Linear Footage of Work: ( 100 Type of Work: ❑Addition OAlteration ' . .CiRRT'_ a ODemolition Description pf VS'ork: Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $6 `T Bonding Company's Name (if 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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�spection fee will be charged. Signature Ownor Agent The foregoing instrument was acknowledged before me this day of �lU , 20`,L, by L4 VIC6 0` ('tom es w is personally knov to me or who has produced As identification and who did take an oath. Signature Contractor The foregoing ins ent was acknowledged before me this day of C , 20)1, by NW -Al f ZC- V ,e,`,,j` who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB is Sign:. /n--- Sign: Print: "`.+ `''•.. Print: S lam c Notary Public - State of Flo M My Commission Expires: `"".:°�'o I tEE1 My Comm. Expires Sep 23, 2017 My Commission Expires�o q?s Commission # FF 058728 * * EXPIRES: November 15, 2015 �'9��aL°�`o� 'ThruBud�Sen� APPROVED BY ;T;Ttf Plans Examiner 7,/5 Zoning Structural Review Clerk (Revised 5/2/2012XRevised 3/12/2012) XRevised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT, D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: l -t BUSINESS ADDRESS: '2 13 to Y6PLA '' CITY STATE FL- ZIP. 33, l BUSINESS PHONE: ( '�% ) 3q 3 '-�Y6� FAX NUMBER (� CELLPHONE( ) QUALIFIER'S NAME: C��Z�.�� tz (Gm2 9 -rim' QUALIFIER'S LIC NUMBER: (7 C ) S 111-16 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAIr REGULATION CGC1521798 -ISSUED 07!27/2014 CERTIFIED GENERALCONTRAGTOR MARGARITINI, BRENb -- BRM CONSTRUCTIQi� ItG, IS CERTIFIED under the provisions of Ch.489 FS. Exphdbn date : AUG 31, 2016 L1407276fI0Z' Local Business Tax Receipt Miami -Dads County, State of Florida —THIS IS NOT A BILL —DO NOT PAY 7164179 BUSINESS NAMEAX)CATION RECEIPT NO. SWCONSTRUCTION INC RENEWAL. 990 NE 212 TER 3 7442428 MIAMI, FL 33179 EXPIRES SEPTEMBER 30 2015 Must be displayed at place of business Pursuant to County Code Chapter SA — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED BRM CONSTRUCTION INC 196 GENERAL BUILDING BY TAX COLLECTOR CIO MARGARITINI BRENO R CONTRACTOR 75.00 07125f2014 Worker(s) 1 CGC1521798 CREDITCARD-14-029M This Loval ltsit *" Tax it"* only eoa4uss payment of the Lowt Sasiaess Tan fihotMeoipt is set a ficamso. permit or a codification of the bolder's gaaligoadons to de business. Holder mint comply wi& any governmental or uongevetememal regulatory laws and regairemeotswhicb apply to the bosinesa. The RECEI f NO. above must be displayed on so commercial vehicles —Miami-tmde Code Sec So -276. MMM for mer# iniormatioa,visitwww.miamideHIM do aov/taxeoReator '''� CERTIFICATE 4F LIABILITY INSURANCE DATE(MMIDD/YYYY) 03124/15 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 A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the pollcyr(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an ondorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement{s). PRODUCERgrT Get Smart Insurance Inc. 20286 NW 2 Ave Miami, FL 33169 Phone (305)653-7977 Fax (305)654-0293 Gregg DitrJan PH E 7977 F (305)654-D293 MAIL irdoonsure smartcom I AFFORDING COVERAGE MAIC s INSURERA: Preferred Contractor Insurance INSURED BRM Gonsbvciion Inc 990 NE 212 Terrace #3 Miami, FL 33179 (786) 393-7467 INSURER 8: INSURER C: INSURER D : INSURER E: INSU F : GOVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. II-TTRR TYPE OF INSURANCE �D B POLICY NUMBER tAMAM, LILY ERP LIMITS A GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY F]❑ CLAIMS -MADE © OCCUR ❑ N N GL124537 12!12/2014 12/12/2015 EACH OCCURRENCE $ 1,000,000.00 AMAGE PREMISESTO RE $60,000.00 MED EXP (AM one person $ 5,000.00 PERSONAL & ADV NJURY $ 1,000,000.00 ❑ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO El GENERAL AGGREGATE $ 2,000 000.00 PRODUCTS - COMPIOP AGG $ 1,000,000.00 BI PD Deduc tiMe $ 1,000.00 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AAIL/LL OWNED ❑ OS SCHEDULED RULED TOS❑ HIRED AUTOS ❑ AAUTOS NED ❑ ❑ E 1IN�Di SSINGLE LIMIT BODILY INJURY (Per Person) $ BODILY INJURY (Per aWdert' $ DAMAGE $ tp $ ❑ UMBRELLA UAB ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYS LIABILRY Y I N ANY PROPRIEfOR(PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory M NH) If yy� describe under DrsdRd1PTION OF OPERATIONS t:9aw N I A ❑ WC STATU OTH- RfLUD 9R E.L. EACH ACCDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdMonal Rwnarhs Schadule, N Mona epees 18 MVMM General Contractor Cerificate Holder and Additional Insured. CERTIFICATE HOLDER CANCELLATION ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 �Greg tt069236 &an ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This ceMes that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 121=2013 PERSON: MARGARITINI FEIN: 462808578 BUSINESS NAME AND ADDRESS: BRM CONSTRUCTION INC 990 NE 212 TER APT.3 MIAMI EXPIRATION DATE: BRENO FL 33179 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR 12/12/2015 R Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a cartfficate of election under this section may not recover beneflffi or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply ortly within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notify of election to be exempt and certificates of election to be exempt shag be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the perm named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for tabors of the person named on tare certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 BRM CONSTRUCTION 21310 NE 08 PLACE S. # 2 MIAMI FL 33179 04.01.2015 ESTATE OF: FLORIDA COUNTY: DADE BEFORE ME THIS DAY APPEARED BRENO MARGARITNI WHO BEING DULY SWORN, SAY THAT HE WILL WORKING ON THE PROJECT LOCATED AT: 9699 NE 2 AVE MIAMI SHORES FLORIDA 33138. SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS 01 DAY OF APRIL 2015 BY .�7 PERSONALLY KNOW ( ) OR PRODUCED LD TYPE OF LD PRODUCED. PRINT, TYPE OR STAMP NAME OF NOTARY it � *- - * W CONNISSION # EE 135 S" EXPIRES: November 15, 2015 '.., F�� ftftmTleu euaw Novy woes 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 777 7 71 7 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 and has acknowledge that he or she will not use day labor, part -rime 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 CONTEN'T'S. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this � 0� day of C14 J1, 20 I � . By LaLn _V_ Cn ��C;� ho is personall known to me or has produced Notary: SEAL: as identification. ANA L.BALLOVERAS Notary Public - State of Florlds My Comm. Expires Sep 23, 2017 Commission # FF 058725