MC-14-2425 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-222837 Permit Number: MC-11-14-2425
Scheduled Inspection Date:August 31,2015 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre Inspection Type: Final
Owner: BUCKLAND, CASSIDY Work Classification: Addition/Alteration
Job Address:358 NE 94 Street
Miami Shores, FL Phone Number (786)797-0522
Parcel Number 1132060136150
Project: <NONE>
Contractor: DESIGN ENGINEERING CO Phone: 305-267-0844
Building Department Comments
NEW EXHAUST FAN FOR PROPOSED BATHROOM AND Infractio Passed Comments
INSPECTOR COMMENTS False
LAUNDRY ROOM AND NEW AC DUCT TO NEW
BATHROOM
-3
�.
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 28,2015 For Inspections please call: (305)762-4949 Page 2 of 26
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i
Miami Shores Village IZECEI`TED
Building Department Nov 04 2014
:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
F BC 20a �' y
BUILDING Master Permit No. V_C 14"��" � 1
PERMIT APPLICATION Sub Permit No. ff)C I 1—ZH 25
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-1 RENEWAL
❑PLUMBING MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 358 NE 94 ST
City Miami Shores County Miami Dade Zip:
Folio/Parcel#:1132060136150 Is the Building Historically Designated:Yes NO X
Occupancy Type: SGL FML Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):JONATHON C. BUCKLAND Phone#:
Address:358 NE 94 ST
city: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:_Aoqg �/��//� ,� �r(��ZPhone#:
Address: /9 '0!�ew o-�WjAfZ6-
City: State: Zip:
Qualifier Name: 42v_'2�to ,_4qV_ Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: FLORIDA INTERNATIO AL ENGINEERING Phone#: 305-378-1991
Address:7500 NW 25 ST, SUITE 241 City: MIAMI State: FL Zip: 33122
Value of Work for this Permit:$ ®� Square/Linear Footage of Work:
Type of Work: ❑ Addition A Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: INTERIOR REMODEL, ADD NEW BATHROOM, KITCHEN REMODEL, BATHROOM
REMODEL, RELOCATE LAUNDRY ROOMph.�g�S',,a4t,�- k,- (` r tropnNti b,, C,
!,Dara n,..J 41 V"-, ffi. e9�
Specify color of color thru tile:
Submittal Fee$ � Permit Fe �t �CCF$ CO/CC$
Scanning Fee$ �� Radon Fee$?° �``� DBPR$ c)<:;G Notary$
Technology Fee$ �I'� Training/Education Fee$ Double Fee$��
Structural Reviews$ Bond$ V
TOTAL FEE NOW DUE$ d`o�
(Revised02/24/2014)
1
9
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 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 N= Signature
OWNER of AGENT ONTRACTOR
--K1
The foregoing instrument was a nowledged before me this The foregoing instrument was acknowledged be ore me this
day of 20 by day of e( ,20 14' by
�p���,who is personally known to C� Up
gel'-U 'L ,who is personally known to
me or who has produced 'l[ 1���� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: - Sign:
Print: \ Print:
g1;dl6Alygfa lama Commission#1 EE 176036
Seal: •� My8at"Imim FF Jjff#® Seal: o �.E My Commission Expires
ewes' E-xo �0i/06/2091I o�° March 30, 2016
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APPROVED BY ` Pis Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CACO21299
The CLASS AAIR CONDITIONING CONTRACTOR <L y�.
N.
Named below IS CERTIFIED.
Under the provisions of Chapter 489 FS. .- -
Expiration date: AUG 31;2018 K,.
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LOPEZ,GONZALO
DESIGN ENGINEERING.CORP
13969'S W 142ND ST-- .-
MIAMI- FL33�8i ,. .
ISSUED: OSMS2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408250001514
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O� CERTIFICATE OF LIABILITY INSURANCE °A ,o,�,`"7,14"'
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:H the cevtil lcate holder)s an ADDITIONAL INSURED,the~es)must be endorsed,g SUBROGATION IS WANED,sub)sei to
the teams and conditions of the popsy.certain Policies may require an endorsement A statement on this certificate does not confer rights to the i
eertift d.holder In Beu of such endorsement(.).
aRamrcER CONTACT ARLES SUAREZ
Prime Rate Insurance LAM )5 17-3737 o 5173736
570e 47 St W36M prbmmteins@aW.com P
Hialeah,FL 33013 AFFORDING COVERAGE NAIL 4
Phone 17-3737 Fax 305)5173736 MsuRER A: GRANADA INSURANCE COINPANY
INSURED INSURER B
DESIGN ENGINEERING CORPORATION. WWFtER C:
PO BOX 347225 _INSURER D:
MIAMI,FL 33234- (305)3113-2484 M E. --
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 D=AIENT 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 TMM,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LQNTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMM.
LTR TYPE OF INSURANCE =ualPOLICY NUMBER Ap
EXP LIMITS
GENERALLIABILITY1.UDO,000.00
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COMMERCIAL 090M LIABILITY iNFSES TEa axi,,� S
❑ ®M AIMSMAM ❑ OCCUR 0185FL0403534o MEDEXP(Am are parson S SAW-00A ❑ 04h17P1014 04f1 7/2015 PERSONAL 6 ADV INJURY $ 1,000.000.00
❑ GENERAL AGGREGATE s 1,000,004.00
GESL AGGREGATE UNIT APPLIES PHS PROD UCTS-CXM RJOP AGG S 1,000,M0•00
❑POLICY ❑M ❑ LOC S
AUTOMOBILELwarM LELiMrr 3
❑ ANY AUTO BODILYMJURYOlaf persat) 5
❑ LL OWNED AUTOS ❑ AUTOS
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❑ MREDAUTOS ❑
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❑ UMBRELLA LIAR ❑O=JR EACH CCxXIRRFJICE S
EXCESS LIAR ❑CLU&SMADE AGGREGATE S
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WORKERS COMPENSATION WC STAB- ^OTH-
AND EMPLOYERS'LIABILITY Y I N
ANY PRaPwtTCxtIPARTNERlE]CEGtIfIYE EL EACH ACCIDENT s
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(P6�knssd�aaffi� ry In NH) � E.L.DISEASE-EA EMPLOYE S
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DESC FnM OF OPERATWNS I LOCATIOMS I VEHICLES(At wh ACORD 101.AddMonei Remarks Schedule,R tame space Is requktd)
LIC#CACO21299
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES BLD DEPT. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10650 NE 2nd AVE. ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES,FL 33138 A ATNE
} O 1588-2010 ACORD CORPORATION.Ali tights reserved.
ACORD 26(2010108)CIF The ACORD name and[ago are registered acarus of ACORD
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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 certifies that the Individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 12/3112013 EXPIRATION DATE: 12/31/2015
PERSON: LOPEZ GONZALO
FEIN: 591871378
BUSINESS NAME AND ADDRESS:
DESIGN ENGINEERING CORP
3151 SW 18TH TERRACE,REAL APT
MIAMI FL 33135
SCOPES OF BUSINESS OR TRADE:
HEATING,VENTILATION,
AIR-GOND
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•••• �� Miami shores Virillage
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
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.In these circumstances,Miami Shores Village
does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you may be
personally liable for the worker compensation iniuries of any person allowed to work under this Remit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner Contractor
T
Print Name: Print Name:
Signature: Signature:
State of Florida) State of Florida)
County of Miami-Dade} County of Miami-Dade)
Sworn t and subscri bef OINYArt Sworn to an
day of Y Y pUBUC day off a.:'m•y RJXW0 LEON M EJ IA
OF FLORIDA It Commission N EE 175035
By By My Commission Expires
E:xpi 2112/2018 suit
(SEAL)(SEAL) (SEAL)
Type of Identification roduced �� Type of Identification roduced