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DS-15-1778 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-239194 Permit Number: DS-7-15-1778 Inspection Date: September 02,2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: DENTICO, GILDA Work Classification: Repair Job Address:260 NW 112 Terrace Miami Shores, FL 33168-3332 Phone Number Parcel Number 1121360010280 Project: <NONE> Contractor: CHAMPION CONCRETE Phone: (305)252-8055 Building Department Comments CONCRETE PAVERS FOR WALKWAY AREAS Infractio Passed Comments INSPECTOR COMMENTS True Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 September 02,2015 Page 1 of 1 Z Miami Shores Village �M PfM', tri e� iae )� 10050 N.E.2nd Avenue NW =3 Miami Shores,FL 33138-0000 �' � E A �rm � ti d Phone: (305)795-2204 � �� ME RT r ; '01� � Oa F Expiration: 02/16/2016 � z Project Address Parcel Number Applicant 260 NW 112 Terrace 1121360010280 Miami Shores, FL 33168-3332 Block: Lot: GILDA DENTICO Owner Information Address Phone Cell GILDA DENTICO 260 NW 112 Terrace FL 260 NW 112 Terrace FL Contractor(s) Phone Cell Phone Valuation: $ 600.00 CHAMPION CONCRETE (305)252-8055 (786)402-4802 _..».�_._.�._ __ _ ..w_... ._.__. ......_ _ ... .... Total Sq Feet: 270 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:CONCRETE PAVERS FOR WALKWAY AR Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# DS-7-15-56359 $2.00 08/20/2015 Credit Card $114.60 $0.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 yself, my agent, servants, or employes. I understand that separate permits are , required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOO ROOFING nd SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is a and th I work will b done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named cont or do e a� August 20, 2016 Authorized Signature:Owner / Applicant / on r / Agent ate Building Department Copy August 20,2015 1 Miami Shores Village Building Department AUGRECEjVffD 10 205 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/L/ s BUILDING Master Permit No;/ 1s PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP � rr CONTRACTOR DRAWINGS JOB ADDRESS:_ �® 4v�I/a' rCr City: Miami Shores County: Miami Dade Zip: 33 14, Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: 0/>7-6 83-4 fY Address: ck-O tV K) )l P4A Tri t�(2-r'it-C City: )"'l f/+MI S'Ac> ✓&S State: FLD'P_!4D'-4- Zip: 3 3),6d' Tenant/Lessee Name: Phone#: "-'1/7-to I'P �o Email: ,�C CONTRACTOR:Company Name: z'jfA j1Wj Phone#: ,"5 Zv_j r Address: ffz *D� 5"-e-- Lg3 City: State: J _ Zip: �3 3*t Qualifier Name: ,I �1sd� _ Phone#: State Certification or Registration#: Certificate of Competency#: � DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ®� Value of Work for this Permit:$ 6 Square/Linear Footage of Work: S 00,5,r— Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �$Jst Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ l TOTAL FEE NOW DUE$ l - O (Revised02/24/2014) a 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 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 po ted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of suc posted notice, the inspection will not b approved and a reinspection fee will be charged. Signature—e Signature OWNER or AGENT C61lKRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of � 20,_,_,5, by t dayofAkUi� S'T ,2D ( 5 by who is personally known to T r� X16 who is personally known to me or who has produced /(], I PC as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI . tap" Sign Print: otary Public State of Florida Seal; : Sindia Alvarez oanna M Fedan0 v My Commission FF 156750 y Commission FF 082753ofpoo pires09/0312018spiresOlH2/2018 APPROVED f , 0 ED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) II'� r � ♦SNuIR�Es j? Miami shores Village Building Department R' ► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT Permit Np—,* — � Owner's Name(Fee Simple Title Hglder): �' ��'Tt.C�; Phone# Owner's Address: Z W7, <M City: e State: Zip Code: Job Address (Of where work is being donW. 0 OU) /I KIAC-Ci City Miami Shores State:—Florida Zip Code: �✓ Contractor's Company Name:, �� . "ix e# Address: D� a Wtl City: C h i c Ws Stater Zip Code: Qualifier's Name: Lic. Number. �'� ' 4 ''6 Architect/Engineer of Record Name. Phone# Address: City: State: Zip Code: Describe Work: 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all leeal invol ent. Signature Signature V�a�-) Owner or Agent Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this day of 2Q/ by�y�,t!U_Z ��✓ this 1—day of v !/�� 20ff liy_7 , Who is personally known to me or who has produced who is personally known to me or who has produced as indentification. Aj- L r' as indentification. Notary Public N blit Sign: Sign: Seal: ea public:CFA FI ride.ptd Notary Public State of FloridaNoFJoanna M Feliciano o Joanna N182753My Commission FF 082753 CommissiExpires 0 111 212 01 8 ` Expires 0111 'Fly p� Miami Shores Village r CFTN7FD Building Department JUL 16 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Yf. •„ Tel:(305)795-2204 Fax:(305)756-8972 - — INSPECTION LINE PHONE NUMBER:(305)762-4949 �T ,�F,BC 20 j� Q BUILDING Master Permit No.��/ F-79 PERMIT APPLICATION Sub Permit No. &BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP N CONTRACTOR DRAWINGS JOB ADDRESS: bo I V L%l T@('mce City:' 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): (g-, LL- ,(d 4 C-6 Phone#: r�jAddress: I o (- City: '� �. State Zip: Tenant/Lessee Name: Phone#: Email: r l�c � CONTRACTOR:Company Name^ � � �®/e' Phone#: ��5' Address: City: MPA, T \ State, Zip: Qualifier Name: 2? Phone#: State Certification or Registration#: Certific e of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: 6446LL44 City Sate- Zip: Value of Work for this Permit: ��r�Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Descriptions of Work: 0 5 Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revisedo2/24/2014) 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 Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 Gen 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 b approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this Thef/o�egoing instrumentwasacknowledged before me this day of Jy� ,, .20_r s .by .7by day of �+� r'� .20 t-� by bilr'J en-6c c; .who is personally known to J Wt 17P.n L d .who is personally known to me or who has produced as me or who has produced rL, D L as TARA LEVINE identification and who did take an oath. identification and who di %%W%W P IC-STATE OF NEW YORK NOTARY PUBLIC: , NO. O1 LE6010990 NOTARY PU C: Qualified In Wesicheler County Commission Expires e �, ami Y Sign: ��tLQg `J Cep-ce' ��t/i-�.@ Sign• �' Print: :Ea rC, j_ �tln� Print Jpuy pbyi JAYW O Seal: Seal: ?• =: Notary powle.State of Rook =N -oQS p �Iretr:A�ar�3t 2017 commission#FE•'870357 BondedThrouphNationai.War yAssn. ####ek+6###�k##aM#########aF�k######+kik###!�#ak#+►###+6###ik#######'Rik#######aR####B1uR############# ## 3 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02I2412014) ♦' 0 .•. ® o•.• Miami shores V tooLA= �� Building Department ��(iAIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONT CTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C.ii��_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 description of operations or contractor license number. .............................................MONRO E. ..... ................................ r BUSINESS NAME: �— G� lC� ��!� (/4 BUSINESS ADDRESS: I Vo�� l `�� CITY �� 7�' 6TE � ZIP-331,_ BUSINESS PHONE: LIE ) M'6SS 2 FAX NUMBER( ?& A1 — �S CELL PHONE QUALIFIER'S NAME: L Aecu460 QUALIFIER'S LIC NUMBER: C Gyc 0 13-7� b uwu i o Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 913062 �LBT ) BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DENTICO JAMES L CONTRACTING INC RENEWAL SEPTEMBER 30, 2015 10055 BISCAYNE BLVD 913062 Must be displayed at place of business MIAMI SHORES FL 33138 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS DENTICO JAMES L CONTRACTING INC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED Worker(s) 10 CGCO13750 BY TAX COLLECTOR $45.00 09/11/2014 ECHECK-14-142703 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must he displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. For more information,visit www miamidade gov/taxcollector J s v GENERAL ELECTRICAL MECHANICAL PLUMBING a ROOFING JAMES DENTICO CONTRACTING, INC. July 14,2015 State of Florida County of Miami Dade Before me this day personally appeared JAMES DENTICO who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 260 NW 112 Terrace,Miami Shores,Florida 33138 unless the person(s)working have workman's compensation coverage. Sworn to(or affirmed) and subscribed before me this 1 `� day of v l 2015 by Personally known OR Produced Identification D` Type of Identification Produced L- AW BENG10 •*�• Nay public-State of Florida My Gtlmm.Expires Mar 31,2017 ••tib � ,� Commission IF EE 870357 ended_Through National Notary Assn. P ' or tamp Name of Notary 10055 Biscayne Boulevard a Miami Shores, Florida 33138 Telephone: 305-756-6553 State of Florida Lic. CGCO13750 Fax: 305-754-9605 Ii r Miami shores Village `4p Building Department ioR,mp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner- Workers' Compensation Insurance Exemption 4�, 7rida ,Florida Law requires workers' Compensationinsurance cov s „1-allows corporate officers in the construction Indus to ex erage under Chapter 440of the Fls. Fla. Stat. § 440.05obtaining a building permit. Pursuant to the FloriDivisionof Workers Compensationm this gEmployerent for any urea�pmJ prior toAn employer in the construction industry who employs one or more part- timeemployees,includingtheowner,must obtain workers' compensation coverage. cersor members of a limited liability company (LLC) in the construction industryo be exempt if: I. The officer owns at least 10 percent of the stock of the corporation,or in the rase 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 B LOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner` State of Florida County of Miami-Dade The foregoing was acknowledge before me this _1 rr y of da Y ,2a V fs. By Z i_p A �F A3 f J-C 6 who is personally known to me or has produced TARA LEVINE as identification. NEW YORK Notary: No. O l LE6018990 SEAL: Commission Exp7�nty 9 X_ J Notary Public w - a .q[ C3 i t • • ' The C7 .:. •• :• ►ad s WCc • • • • •#> Ml .0 U vat N 2 Z 2Eo ® o ° sloz CD v ccQ Q NO U) W, 12th T EHHAUC u� � r. 18' ASPHALT PAVEMENT t,� : colt • _•; �' PARKWAY 4i FI.RI/ate k Lt z ONE STORY s O �- RESIDENCE 1280 J , f I