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RC-14-2750Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233939 Permit Number: RC -12-14-2750 Scheduled Inspection Date: May 05, 2015 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Inspection Type: Final Building Owner: BERNSTEIN, HOWARD Work Classification: Alteration Job Address: 178 NE 111 Street Miami Shores, FL 33161-7048 Phone Number Parcel Number 1121360040140 Project: <NONE> Contractor: DYNAMIC DESIGN & SERVICES Phone: (305)845-9915 comments REPLACE KITCJHEN CABINETS INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 04, 2016 For Inspections please call: (305)762-4949 Page 32 of 40 IF; ICA BUILDING PER IT APPLICATION UILDING ❑ ELECTRIC Miami Shores Village 'C�"�, DSC 17 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 FBC 20 �+ Master Permit No.RC H ZISo Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION 0 SHOP //� �� CONTRACTOR DRAWINGS JOB ADDRESS: �� ` City: Miami Shores County: Miami Dade zip: 3341 Folio/Parcel#: 11-2136-0091- Is the Building Historically Designated: Yes NO 1--' Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): D WOIa 8 ��( r1S -�1 n Phone#: "3� 3"_ -75 City: �Q ft �N QfeC" ` State: ft-. Zip: Tenant/Lessee Name: Phone#: y CONTRACTOR: Company Name: ) e, Irm i �i J S °► Qt A-114 i 04--4 Phone#: (, Address: .1 1 15 'nW 3 1 G C1 City: 1^ State F t- Zip: 330)-4 '1 a iA Phone#:®� �"1�—g��s Qualifier Name: State Certification or Registration #: Certificate of Competency #: (A DESIGNER: Architect/Engineer: e#: Address: -1 ,o City: State: I Zip: Value of Work for this Permit: $ 1®0 1 " 14 Square/Linear Foo ge of Work: J 1,1.5 L - [ j Type of Work: ❑ Addition ❑ AlteratioX1,'Qen) El New Repair Replace El Demolition Description of Work: �Q�I /� (� / CA /� �� p7/ Specify color of color thru tile: Submittal Fee $ - Permit Fee $ Scanning Fee $ W Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ .0e `. 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 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 on 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. Signatur Signature OWNER or AGENT The or goP,'t'e-V%A6tr- t was acknowledged before a this 20l I% who is p rsonally know me or who has produced as identification and who did take an oath. NOTARY PUBLIC: .� Print - Vii► CONTRACTOR The foregoing instrument was acknowledged before me this ILL day of Ve-PJ. ' V- 20 by , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Seal: LEE DAVII)D<IUN IVELISSEALARCON MY COMMISSION # FF 180883 * *EXPIRES: 28 8 g M�YyCpOMMISSIONJ FF]77�,3248 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) n►� CERTIFICATE OF LIABILITY INSURANCE DATEMIDD/YYYY) TYPE OF INSURANCE 12/11/14 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 to an ADDITIONAL INSURED, the poltcy(les) must be endorsed. If SUBROGATION IS WAIVED, su*tct to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this cortificate daft not confer rights to the Certificate holder In llau of such endomemen s PRODUCER C Lucie Estrella Accurate 8300 West Flagler Suite 114 Miami, FL 83144 P g 305)226-8767- (30 226-8761 o AIL ludaestrella bBllsouth.net PRODUCER Phone (308)226.8727 Fax (305)226-8767 INSURER(S) AFFORDING COVERAGE NAIC a INSURED Dynamic Design 8 Services INSURERA: Endurance American Specialty Ins Co INSURER 0, 1740 West 32 PI / 1750 West 32 Pl INSURER C: INSURER 0. Hialeah, FL 33012 INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: ® POLICY ❑ M ❑ LOC INSURER P THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUhREMENT, TERMOR 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. TR TYPE OF INSURANCE PAWL wildti POLICY NUMBER LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CL41MS40M iR OCCUR ❑ Y Y CBCIODO1719300 08!20/2014.08/20!2015 EACH OCCURRENCE g 1,000 000 ti s 50,000 MED EXP An are Oran $ 51000 PERSONAL SADV INJURY s 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ® POLICY ❑ M ❑ LOC PRODUCTS - COMPIOP AGO S 1,000,000 $ AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SWGLE LIMB $ (Ea aunt) BODILY INJURY (Per parson) $ ❑ ALL OWNED AUTOS BODILY NJURY (Per g ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON-OWNEDAUTOS ❑ PROPERTY DAMAGE (Per awft4) $ $ S ❑ UMBRELLALIAS ❑ OCCUR ❑ EXCESS UAS ❑ CLAIMS.MADE $ $ ❑ DEDUCTIBLE MAGGREGATE WORKERSCOMPENSATION ANO EMPLOYERS' LIAEILtT Y YIN OFFtCERIMEIMS CUTIVE N Kdesalbewwar N OF OPERATIONS below NIA N E.L. EACH ACCIDENT $ E.L. DISEASE - EA E 0 $ E.L DISEASE - POLICY LIMIT s DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (ARach Aeon /p1, Ad"Ona( Remarto Sd ;1vI% If more spa= Is requlmd) Type of work: Kithcen G(nmtertop Installation aA 1 1�1i S CTQS-MIBSO0498 Dynamic Design & Services lsMn-Cin.,arn?. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELWERLD IN Miami Shores Village ACCORDANCE WITH THE POLI ONS. Building Dept '10050 NE.2 Ave AUTHORIZED REPRESENTATIV Miami Shores, FI 33138 Luria Estrella All rinhte ^%,W w 40 tAUVO14001 Wr The ACORD name and logo Bre registered m rks of ACORD 1�1i; Ir • - � CERTIFICATE OF LIABILITY INSURANCE DATE(M1/20 12/91 /20 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: N the certificate holder Is an ADDITIONAL INSURED, the policy(ies) 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 Workers Compensation Group Boca Raton, FL 33429-0410 Workers Compensation Group CONTACT Workers COm nsation Group PHONN .561-392-3300AX NQ:561-361.1132 E- L ADDRESS: wcgroup@bellsouth.ent INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: Associated Industries Ins Cc INSURED Dynamic Design Service, Inc 1740 W. 32 Place INSURER B INSURERC: Hialeah, FL 33012 INSURER D : GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECTT El LOC OTHER: INSURER E: PRODUCTS - COMP/OP AGG $ INSURER F: {. V=R =, LL -R 1 ipi"® l r ml1mlS W- WGI/lvlf m M" GD. 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. LTR TOF 114"RANCE COMMERCIAL GENERAL LIABILITY CLAIMS-MAOE D OCCUR POLICY NUMBER M PgLITYPED uMrrS EACH OCCURRENCE $ _ PREMISES E nce $ MED EXP (Any one person) $ _ PERSONAL d ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECTT El LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOg COMBINED SINGLE LINT$ Ea p*dsnl BODILY INJURY (Per person) $ BODILY INJURY Per acddsnt $ ( ) Per accR1 V ldemDAMA E o. $ $ UMBRELLA LIAR EXCESS LIAR HOCCU, CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If �s RIPTIdescrN under DESGIRIPTION OF OPERATIONS below N / A AWC1038389 11/15/2014 11/15/2015 PE OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space is required) Ivan Figueroa CTQB License #09BS00498 ) Type of Work: Kitchen Countertop Installation Village of Miami Shores Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2014/01) MIAMIS3 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 w.1 %MU-AU14 AUUKU GUKPUKATION. All rights reserved. The ACORD name and logo are registered mrks of ACORD