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RC-14-2139Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231165 Scheduled Inspection Date: April 01, 2015 Inspector: Rodriguez, Jorge Owner: AMANDA B SAMPLE, MICHAEL Mr1AtTCVCor%C Job Address: 77 NW 100 Terrace Miami Shores, FL 33150 - Project: <NONE> Contractor: RITEWAY INSURANCE REPAIR SERV du comments INTERIOR REMODEL REMOVE LOWER KITCHEN CABINETS THEN PUT BACK DETACH AND RESET SINK AND OUTLETS REMOVE AND REPLACE TILE FLOOR MINOR WALL REPAIR PLASTER Permit Number: RC -10-14-2139 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1131010180300 INSPECTOR COMMENTS False Inspector Comments Phone: (954)923-3677 Passed CREATED AS REINSPECTION FOR INSP-226502. CREATED AS REINSPECTION FOR INSP-226364. Must pass trades No access Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 31, 2015 For Inspections please call: (305)762-4949 Page 20 of 36 BUILDING PERMIT APPLICATION Miami Shores Village Building Department IBI - 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 M BUILDING ❑ ELECTRIC ❑ ROOFING 1 T OCT 01 2014 FBC 20/® Master Permit No. Bc Q 4" z:2i29' Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 77 NW 100TH TERRACE Folio/Parcel#: R m 3 t®1 ®0 kW —®3Q0 "e Building Historically Designated: Yes NO —Z-- Occupancy ✓Occupancy Type: GSL. Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): AMANDA SAMPLE ,,,, )il,4gPfbPhone#: 305-797-2222 gtiji' g7 Address: 77 NW 100TH TERRACE 64IC Oty; MIAMI SHORES State: FLORIDA Zip; 33150 Tenant/Lessee Name: � Phone#: CONTRACTOR: Company Name: RITEWAY INSURANCE REPAIR SERV. Phone#: 954-923-3677 Address: 2144 JOHNSON ST. City: HOLLYWOOD State; FL. Zlp; 33020 Qualifier Name: GUSTAVO MARRERO JR Phone#: 954-923-3677 State Certification or Registration #: CGCO48689 Certificate of Competency #: DESIGNER: Architect/Engineer. N/A Phone#: Address: City: State: Zip: Value of Work for this Permit: $ .6,300.00 Square/Unear Footage of Work: Type of Work: 1:1 Addition ❑ Alteration El New ❑ Repair/Replace ❑ Demolition Description of work: REMOVE LOWER KITCHEN CABINETS THEN PUT BACK. DETACH AND RESET SINK AND OUTLETS. REMOVE AND REPLACE TILE FLOOR, MINOR WALL REPAIR, PLASTER AND PAINT Specify color of color thru tile. Submittal Fee $ Permit Fee $ s� CCF $ L', CO/CC $ Scanning Fee $ Radon Fee $ DBPPRj $ Notary $. Technology Fee $ Training/Education Fee $ DDouble Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (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 Zip 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 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. fi Slgnature�*—�""�'� 0 NER or AGENT Signatur - P CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -� a day of i 20 / , by �3 day of •� �� . 20 , by ho is personally known to , a•%(0 1A #--ti' LO ho is personally known to m m or who has produced as or who has produced as identification and who did take an oath. Identification and who did take an oath. NOTARY PUBLIC: NOTA UBLIC: r Sign: ° irint-!L Print:Iii Seal: Seal: RAUDEL COMIPANIONI Notary Public • State of FhMa ilk► Comm. Expires Jan 17, 2016 —e 6mnNesien-PEE 160375 NWNotmr Assn. a+0�'sky •'684 HAYi OISAF $ my C #:sR �e d��k �&akdaKe lFOF FLOQ' *O�Oitdld'Et�§Ej�� p`�y� �Nak �S dt%e�Yde �k ekok ��k HtAk�#t�7K8t 7k t$i�fleKt�t ape$t$��ksK�¢o�HaoR Kt7[t�k BaeR>k7R8t �B �k HeB��B �RtR4otA �b�k �k �k�k$��&&�k �k�H�+7��s�tuBtk�k�k APPROVED BY �� / l Plans Examiner Zoning Structural Review Clerk IRevisedo2/24120141 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY -Q'rAT= OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD -96CO48689 TI)e'.,GENERAL CONTRACTOR affied--belbwl'S GERTIFIED- Q'rrddi-thL-P.F6-vision.-of-Chapter 489- FS. -I�Xpi6rlb'rf�dabg: AUG 31 ,-2016 - - -NIAkRCR6�'-GUS-rAVo JR -l3.ITtWAY--,lNSU- �Dft- CE i T N�Affl FSS ISSUED: 07101/2014 0 7 % It I DISPLAYAS REQUIRED BY LAW SEQ # L1407010001505 OP ID: RF ,4`coRa CERTIFICATE OF LIABILITY INSURANCE COVERAGES 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 DATE 4 14 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: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(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 endorsement(s). PRODUCER Abacoa Insurance Group - MIA 8000 NW 7th Street, Suite 202 Miami, FL 33126 Kathleen Betancourt CONTACT ON a/c° No Ext): N No): E-MAIL ADDRESS: PRODUCER RITEVU-2 CUSTOMER ID @ INSURER(S) AFFORDING COVERAGE NAIC @ INSURED Riteway Insurance Repair Service, INC. 2144 Johnson St INSURER A: Lloyds of London 085202 INSURER B :Aspen Specialty Ins Co EACH OCCURRENCE $ 1,000,00 Ft Lauderdale, FL 33020 INSURER C: INSURER D: INSURER E; PGIARK01690-02 INSURER F: 01/21/2015 COVERAGES 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. INSR LTR TYPE OF INSURANCE Kathleen Betancourt POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 TED PREMISES Ea occurrence $ 100,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR PGIARK01690-02 01/21/2014 01/21/2015 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,00 A X Pollution PGIARK01690-02 01/21/2014 01/21/2015 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,00 PRO LOC X POLICY F1 Pollution $ 2,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY GE $ (ERACCIDEN) $ NON -OWNED AUTOS $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTNEE.L. OFFICERIMEMBER EXCLUDED? f_1 N / A WC STATU- I OTH- TORY LJMITS ER EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B BUILDING PBZ827714 01/21/2014 01/21/2015 BLDG 1,076,40 $2,500DEDIWIND EXC BPP 113,70 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Aftech ACORD 707, Additional Remarks Schedule, H more apace M required) Location: 2144 Johnson Street, �ollyywwood, FL 33020 License Numbers: CGCO20392 & CGC048689 GUSTAVO MARRERO JR. GENERALCONTRACTOR(STATE 7,10ENSZ NO. CGC048689) CERTIFICATE HOLDER CANCELLATIAN ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHOR® REPRESENTATIVE Kathleen Betancourt ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD RITEW-1 OP ID: KD A�oRn CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YM 09/17/2014 F 09117120Y4 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: 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 endorsement(s). PRODUCER W.F. Roemer Insurance Agency 3775 NW 124 Avenue CONTACT Jon Remes PNAMNE FAX o Ext : 954-332-0188 ac No : 954731-8438 A/c No, E'MaIL ADDRESS` 1 Tamesroamer-ins.com Coral Springs, FL 33065 Jonathan F. Ramos INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: Association Insurance Co. 11240 COMMERCIAL GENERAL LIABILITY INSURED Rlteway Insurance Repair Service, Inc INSURER B: 2144 Johnson Street INSURER C : CLAIMS -MADE F—I OCCUR INSURER D : Hollywood, FL 33020 INSURER E: MED EXP (Any one person) $ INSURER F: COVERAGES 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD(MIMIDDIYYYY) POLICY EXP LIMITS Miami Shores, FL 33138 GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS -MADE F—I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO LOC POLICY JECT $ AUTOMOBILE LIABILITY CEaOMBINED SINGLE LIMIT ecddent BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDE HIRED AUTOS HONIED AUTOS UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY N TY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? El (Mandatory In NH) N I A CV 0145598 01 03/21/2014 03/21/2015 XWC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS VOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) GUSTAVO XAR1 R!RO JR. G$NSRLL—CON-TRACTOR__(STATE LICENSE NO. CGC048689) CERTIFICATE HOLDER CANCELLATION MIAMASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Sflores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 •-f -J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD a as ,., 1• , 's,t < .� .. •_ >. ;_ . . . _. *.� .rr- � .c" ��'.�� ,u?,_'�a^ BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Receipt #:GENE AL2 CONTRACTOR (GENERAL Business Name: INCEWAY INSURANCE REPAIR SERVICE Business Type:CONrR) Owner Name: MARRERO GUSTAVO TR. Business Opened:03/17/1982 Business Location: 2144 JOHNSON ST State/County/CertfReg:CGC048689 HOLLYWOOD Exemption Code: Business Phone: 954-923-3677 Rooms Seats Employees Machines Professionals 2 For Vending Business Only Numhrar of Mar_hlnc�c� Vending Tvn6: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 1 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax Is levied for the privilege of doing business within Broward County and Is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business Is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MARRERO GUSTAVO JR Receipt #iCP-13-00013055 2144 JOHNSON ST Paid 08/20/2014 27.00 HOLLYWOOD, FL 33020 OCT 01 2014 PERMIT , 1?� MUUIAI SHORES VILLAGE APPROVED BY DATE ZONING STRUCTURAL ELECTRICAL PLUMBING MECHAWAL BLDG. SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REC °LATI li"".N -1 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. , - I) I I , - -; IiAN i , I-) BE mo ll�- � NO POIN I AWN' c_IE0 RECEPTAClE. 2 FEET I`ROMG-E-1 PkUTEC PLIT 91,VV fir-CEPTACLE UNDER SINK. L .11 _ I I ICATED CKTS. ALL Fll%� .— , ON DE) i J,