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RC-15-1057Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236112 Scheduled Inspection Date: June 05, 2015 Inspector: Rodriguez, Jorge Owner: RAMIREZ, MARIA Job Address: 1700 NEI 05 Street 502 Miami Shores, FL Project: <NONE> Permit Number: RC -5-15-1057 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (786)375-1694 Parcel Number 1122300500780 Contractor: GUSTAVO FUNES ENTERPRISES CORP Phone: (786)343-2366 rsunamg uepanment comments REMOVE CARPET INSTALL 290 SQFT LAMINATED FLOORS WITH SOUND PROOFING BEDROOM AND CLOSETS INSPECTOR COMMENTS False June 05, 2016 For Inspections please call: (305)762-4949 Page 21 of 27 Inspector Comments Passed 41 Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 05, 2016 For Inspections please call: (305)762-4949 Page 21 of 27 e R Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 1700 NE 105 Street Number: 502 1122300500780 MARIA RAMIREZ Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MARIA RAMIREZ 1700 NE 105 Street (786)375-1694 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone GUSTAVO FUNES ENTERPRISES COI (786)343-2366 In Review Date Approved:: In Review Amount Date Denied: $1.20 Type of Construction: REMOVE CARPET INSTALL 290 SQ Occupancy: Single Family Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Yes Certificate Status: Certificate Date: Additional Info: Bond Retum : Classification: Residential Fees Due Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 Valuation: $ 1,160.00 Total Sq Feet: 290 Pay Date Pay Type Amt Paid Amt Due Invoice # RC -5-15-55429 05/05/2015 Cash $ 50.00 $ 66.20 05/28/2015 Credit Card $ 66.20 $ 0.00 Available Insnections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Planning Review Plumbing Review Structural Review Mechanical Review Electrical Review Building Review Building 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 AFFIDAVI�T:.4 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction andpgaft amore, I authorize the above-named contractor to do the work stated. Mf May 28, 2015 Authoriz re: Owner / Applicant / Contractor / Agent Date Building Department Copy May 28, 2015 1 Miami Shores Village k T. 1 Building Department MAY ®5 2015 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 ZC 10 BUILDING Master Permit No.0S q— PE MIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1100 �J�, (C�; ST?_�ET' jiig�+ S City Miami Shores v- I Cl)unty PAP Miami Dade Zip: -3:s ) 75 Folio/Parcel#: I LZ;® ° 0;0 ' 0 a) tIs the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Ivl c A9.4 A e a -AM 1 � � Phone#: —1 TS 1604 Address: Ito � lo� t i SW_ City: AA ( IIniU6�, State:V Zip: 3sl�;b ri Tenant/Lessee Name: MAC� A C • 9— 9 IW Phone#: '17b;��ry�`t Email: M C,fAi°Iili1re-2:5070bftl1 iAD W1 CONTRACTOR: Company Name: 6V31 AI-) t➢ij'eS ZjjrC-P124 WSPhone#: =f8b° 3Li'•S23W Address: 2.M)SCS Vie, ftyp • * 3301 r M 14141. hl, -33139- AA�� , City: fy1 � ) State: � zip: . - Qualifier Qualifier Name: �1�.�(taV'� Phone#: '305-- S 29-6 110 State Certification or Registration #: 06F35, 005,5t3 Certificate of Competency #: DESIGNER: Architect/Engineer: 1� �� Phone#: Address: City: State: /� Zip: Value of Work for this Permit: $ I Square/Linear Footage of Work: 2-00 Type of Work: L? Addition Description of Work: ❑ Alteration ❑ New ❑ Repair/Replace x cAanr_-�Fro rI ,.;�TAl 19W sty Specify color of color thru tile: Submittal Fee $ 00.PermitFee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (RevisedO2/24/2014) ❑ Demolition 1— LOVII 10m, CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. Signature OWVAGENT The foregoing instrument was acknowledged before me this 4 day of 14&1 , 20 /� . by MA,? lA • C • RAM I(L-L-?� , who is personally known to me or who has produced PJ-:f?CA)W K UOWA, as identification and who did take an oath. Signature CONTRACTOR The foregoing instrument was acknowledged before me this ei day of ^f,/ . 20 /S . by 6o;TA\V *vn `C -F%-- . who is personally known to me or who has produced r►��1. > as identification and who did take an oath. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) MiamishoresV11age Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305) 795.2204 CONTRACTORS' REGISTRATION Fa": (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERT1FiED 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 form and Contractor 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 form and Contractor 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 descriptlon of operations or contractor license number. avevvvavvveveeevvavaeavvevaeevveaaavvrvvevaaevvvaveevvevavaavravavvvvravaeveveaavevesaevvvr BUSINESS NAME: _ busmA-L'o BUSINESS ADDRESS:ZP 01 8r S"Irj& c 3,.-,9 3'1 CITY �� STATE �ZIP 3-3l,37 BUSINESS PHONE:I( 8r _) 3`l -3 23 (0 (o FAX NUMBER ( ) CELL PHONE (3�) 5' _) (0? R a QUALIFIER'S NAME: G-'- U s1 -A-V o QUALIFIER'S LIC NUMBER:13E o o SSS CTQB r! Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY � s 06BS00553 AVO FUNES ENTERPRISES CORP D.B.A.: FUMES GU$TAVO Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL 09130/2016 Local Business Tax Receipt Miami -Dade County, State of Florida -?Hiv i5 rJC- T 4 BILL - Cv NGT F%Y LBT ,792727 BUSINESS NAMEILOCATiON RECEIPT NO. EXPIRES -'LINES GUSTAVO BENE-AIAL SEPTEMBER 30.2015 ENTERPRISES CORP 8+0110109 Must frstbedrspiayedC taceofbusiness Pursuant to County Code MIAMI. FL 33137 Chapter SA — Art 9 & 10 OWNER SEC. TYPE OF BUSINESS ='J NES - _ ."7 , *c. - Z_$ PAYMENT RECEIVED SPE J LDNG BY TAX COLLECTOR -- I C; .�82 r, 20r� OfKEC c _ ._L vRE (r iPL 33641 This Local Business Tax Receipt only confirms payment ofthe Local Business Tax. The Receipt's not a license, permit, or a certification of the holder's gnalifications,te do business. Halder must comply with any governmental or nongovernmental regulatory laws and require mentswhich apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles -Miami -Dade Code Sec Ba -276. ntanr For more information, visit wwr .mamdade..ta� co_llectsr Municipal Contractor's Tax Receipt Miami -Dade County, State of Florida -THISIS NGT A E3fLL -LSC N0T PAY M C BUSINESS NAMEILOCATION RECEIPT NO- NEW O- EXPIRES r�EnreusIHess SEPTEMBER 301 2015 - -' 7455570 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 OWNER TWE OF BUSINESS PAYMENT RECEIVEQ a.::,.�::; BY TAX COLLECTOR r�anrtut�E For more information,visitwww.miamidade.govltaxcolloctor DATE4 RIi0t1JYYYYj CERTIFICATE OF LIABILITY INSURANCE _ 0+1127M 6 THI$ CERTIFICATE Is ISSUI_D AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICA?E HOL09M THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NI GATIVEI.Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE: POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN THE ISSUING I SURE1fi(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. _ IMFORTA14T. If fhe cei1ftetlte holder Is an ADDITIONAL INSURED, the VdIcy(Ees) must be endorsed It SUOROGATION {$ WAIVED, sut4ect to the terms am eoudldans of the policy, cettaln fwilelas may require an emimement. A autement on thle cedl(ttate noes not 0DRIer rights to the eertlflcata holder In Ileo of such endomement(al, PROOUL R WCAMM deyso gol>Qalea 2250022 Yesinstiranoe 11 2711 5.W 137 Ave Suite 77 Miami, FL 33175 Phone (:105) 225-5283 FaX (305) 225-t3t12? !WA)Iteo GUSTAVO FUNES ENTERPRISES CORP, 2001 Biscayne Blvd apt 3309 Miarrlo, FI 33137 (3015) 627-67W (306) 2256283Q. Nab COVINVTON SPECIALTY IM COMP INSURERS' .. .._ IMSURE7q c :COVERAGES CERTIFICATE NUMBER, REVISION NUMBER; THIS i3 TO CER -n Y THAT THE FOLICItS OF INSURANCE LISTED BELOW MVE BEEN ISSUED 70 THE MORED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRREMENr, TERM OR CONDITUDN OF ANY CONTRACT OR OTHER DOCIl -tff WITH WSPECT TO WHICH THIS C eRTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSUAWCE AFFORDED BY 7HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SM" POLICIES. LIMITS SHOWN MAY HAVE 816EN REDUCED By PAID CLAIMS. © BtmEss LOB © CLA %18S 61ADS I R TYPE OF tNauRAIICE A 0t? MIR POLICY NUMdGR .. >A a ( NJY' YY I Y BLIP _ rAD UNITS . -- GMERAL LIMLITY $ N to EA-hoC�CURRENpF 6 1.000,0011'r --- •- �] COMMHROttlf E7N/,LLIAOlnY ❑ '70 SI'ATU- PR. • �• ._.... E.L.E.ACHACCIDF.MT ..._ 5 E.L. DMASE - EA EMPU04r 9 -• R.L.DISEASE - POLICY LIMIT S - ^ - MADS Rio EWMD 1p000000 PR ES swvjr@ 5 ❑ ❑ CLAIMMAA E ® OCCIM VBA3 00 O9l1d1201d 0911�IJ2C1S MIEDEKPNI1V-)eV�+- 5 5,000.00 A. '❑ y hER80NlIf &ADV!NJuaY 1-I GM-IIERALAGGRE,G TE ... - S 2. MOW.( - G�-E�rIrL AGORFGATE LbNT APPLIES PER PROOLCTS. CCAIP10P AG6 t 1,000,000.( LJ ❑ IfreR„ ©I,nC .l�OLIGY AUTOrWBILEISABII.IP' - M n NGLC LI[itii Q ANYAUTO aJCNLYIN1URYfPcrporeo,� 8 © ALLOWNEO Ej "EDULEO os BODILYINJURY tPnraavtlen S AMOS Ztt �--idEv dWREDAUT015 ❑ AUMS ttZZrrYY rArtGE r xa'den a --- M171 S © uMaR1 fJ A1lAB ❑ OCCUR_ e=tOMURRENM S © BtmEss LOB © CLA %18S 61ADS AOGR.7GJtTE S I -IONS _ ❑ ppD I RETENT woRRERS OOMPO NLATIO/t AND Eh1PLOYEPO LIARILlrlr Y N N ANY PRCMETOWi+AWNFOO(ECLrttVE OWCERNr SMSER 901-t;DEMrj pluddory Nn NH) ( 1 Ir ��ece desalbow�de,' (]ElClil°'iION.Of OPERAYIDN9 baueW. $ N to .... .. --- •- ❑ '70 SI'ATU- PR. • �• ._.... E.L.E.ACHACCIDF.MT ..._ 5 E.L. DMASE - EA EMPU04r 9 -• R.L.DISEASE - POLICY LIMIT S - ^ - oewRerrIOR OF OPERATIDtr J LOCJITIM f VF.HlCL99 (AdACh AGDRD Lel, Addlllwwl Remarks Schedule, If vara space Is reMi art) DRYWALL OR WALLBOARD, HANDY PERSON, CARPENTRY ADDITIONAL INSURANCE: THE BENTLEY BAY 540 WEST AVE MIAMI BEACH, FL 33139 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 211140 AVE MIAMI SHORES, FL, 33138 CAINCELLAT10N SHOULD ANY Of TF49 ABOVE DESCRIBED Pt ILMI ES BE CANCELLED 89FORRE THE ExPIRATRON DATE THERMP, NDITICE WILL BE DEUVMD IN AOCORDANCe WITH THIS AAM PRMSIONs AIITHORC.Eb -- 0-20.1!0 AC61 f 60woRATION. Ail rights reserved. ACORD 26 (3010108) OF ACORO rum and I*ge are regWtaored medrs of ACORD 'S -+,.. Ail JEFF ATWATERu 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 certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/10/2014 EXPIRATION DATE: 6/9/2016 PERSON: FUNES GUSTAVO FEIN: 204322765 BUSINESS NAME AND ADDRESS: GUSTAVO FUNES ENTERPRI; 7365 NW 54TH ST MIAMI FL 33166 SCOPES OF BUSINESS OR TRADE: CONCRETE OR CEMENT CERAMIC TILE. INDOOR CARPENTRY FLOOR COVERING WORK - FL00 STONE. MA INSTALLATION OF CA INSTALLATION- R Pursuant to Chapter 440.05(14). F.S.. an officer of a corporation who elects exemption from this chapter by fling a certificate of election under this section may not recover benefits or compensation under this chapter Pursuant to Chapter 440.05(12). F.S . Certificates of election to be exempt., apply only 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. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation ff. at any time after the filing of the notice or the issuance of the certificate. the person 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 failure of the person named on the 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 Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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. 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: Owner i State of Florida County of Miami -Dade The foregoing was acknowledge before me this 41 day of 147 �t+, , 20 /5-. By W IA - C R i1 I P who is per0J$%1t t +rt t me or has produced as identificatior��� y��embeS/O,y •.�;�'• "o `cf Notary: Gam` rn Ff �? SE i o •; o oaf i G .401 8PU der 0e -*gQ \ l '��� �a�►� reds; P.O. BOX 399106. Miami Beach, FI, 33239 Gustavo: 305-527-6790, Adhara: 786-343-2366 Miami, May 5th, 2015. STATE OF FLORIDA COUNTY OF M 1AM) PAQIE Before me this day personally appearedO S(Aids �iJ� who. being duly sworn. deposes and says: A That he will be the only person working on the project located at:_p�I012r`-2 Sworn to (or affirmed) and subscribed before me this day of 20_ r by C / M /-(1�e * Signature of Notary Public- State of Florida Personallyn 'vn AOR Pr )Ced Identification _Type of Identification Produced_ ',0,%'�N�tt�11999��N1�p� b�ANDA ���� ••' 015S10 R • Ob or 1,.o `- aQ ' =� #EE 126633 ; Q i9L ':1-p°nded thO moi, A .; bHc Undec+n`.•' � a� MARIA C- CE L:7863751694 1700 NE 1150m,T APT 502 MIAMI SHORES, FL 33138 CARPET REMOVAL AND LAMINATED FLOOR INSTALATION ON ONE BEDROOM & CLOSETS MAY 0 5/01 2015 4), o 11.5' FT WINDOW r�Jv/ S �vwr F n �S BED ROOM E7 ka LL x �. N � CLOSET 1 5.4'X6.7'FT CLOSET 2 4'X2.6'FT N/A MAY 18 2015 PREMIUM FLOOR UNDERLAYMENT FOR BEST RESULTS WHEN INSTALLING YOUR FLOATING FLOOR, USE NOISES GUARD PREMIUM FLOOR UNDERLAYMENT FOR SOUND DAMPENING, AS A MOISTURE BARRIER AND TO HELP RESIST MOLD AND MILDEW. IIC RATING 73 STC RATING 72 WATER RESTSTAW E 100% WATERPROOF/CLOSED CELL THICKNESS 3 MM ROLL WEIGHT 9.0 LBS (+/- 3%) SQ. FT PER ROLL 100 SQ FT