RC-15-1584 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-242834 Permit Number: RC-6-15-1584
Scheduled Inspection Date: September 04,2015 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: Work Classification: Alteration
Job Address:265 NW 91 Street
Miami Shores, FL 33138- Phone Number (305)793-0592
Parcel Number 1131010331320
Project: <NONE>
Contractor: GG BUILDING CORP Phone: (305)793-0592
Building Department Comments
REPLACE KITCHEN CABINETS. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
September 03,2016 For Inspections please call: (305)762-4949 Page 40 of 42
Miami Shores Village
Building Department MT ,
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JUN 2
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 BYo
FBC20
BUILDING Master Permit No!�&
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �� ow
" q l siq�mL
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: �FFFE:
OWNER: Name(Fee Simple Titleholder): Q ��+ 00'"g � Phone#: Q T"(��os 1
Address: (� �"T la c- d �-
City: lcigj &JUt5 State: `� Zip: ('j
Tenant/Lessee Name: Phone#:
Email: a
CONTRACTOR:Company Name: G&1l pp.�1 �tK'LylCA f (J - Phone#:
�Address: D ,�C�rU
City: z ble-s State: '��. Zip:
Qualifier Name: rr**, Phone#: a
State Certification or Registr on#:6bc- (Z53 q2'1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �s. > �" .�� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration( ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$61C� •00 Permit Fee$ <<` _ CCF$_ � CO/CC$
Scanning Fee$ `'ll ( Radon Fee$_ - _�� �� i> D B P R$ 7 Notary$
Technology Fee$ Training/Education Fee$ o � Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
l
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 wqNEVorAGENT
ed and a reinspection fee will be charged.
Signature Signature L;_
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_day of Jt W ,20 L5 ,by day of
Jaw 20 b by
YN 0-bL &%0,who is personally known to Cj ,'�G AQ'� GV M0,who
is personally known to
me or who has produced F` LQXN�` as me or who has producedyt�Ue as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal g`
• P I Notary Public State of Florida Seal: P4, Notary Public State of F'n da
Sandia Alvarez Sindia Alvarez
MY Commission FF 156750 oa My Commission FF 156750
GrFt f aplraa 09/03/201a n,ptaD Expires 09/0312f)19
1�4
4"
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
GG BUILDING CORP
Date: o� ItLs I2DIS
State of twwvA
'
County of QNt Y
Before me this day personally appeared Q—MG A-&N � `h�g duly sworn,deposes and
says:
That he or she will be the only person working on the project located at: 205 ItiW ON S-C`
Sworn to(or affirmed)and subscribed before me this 2� day of v .20-P by
cmtG Aw(v G�Lvs�o
Personally know_
OR Produced Identification
Type of Identification Produced
Print,Type or Stamp Name of Notary
aoar"y1 N=Alvarez
f Florida
S
ea M166760
ogop E
RS
Miami shores V
Building Department
�lpRjDA 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 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:
O
State of Florida
County of Miami-Dade C
The foregoing was acknowledge before me this day of ,20 5 .
ByQ>JZCC LD ` E who is personally known to me or has produced
FL 19-1 NER AJ"SC as identification.
Notary:
"y a =��
te of Florida
SEAL: F 158750ai8
r as--
'�r..Pi
E - i ES. h\s
\S
hWS
* � Miami Shores Village,,,. 46
a
h
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000 i
Phone: (305)795-2204
Expirat!on:101/24/2016
Project Address Parcel Number Applicant
265 NW 91 Street 1131010331320
Miami Shores, FL 33138- Block: Lot: GG PROPERTY HOLDING LLC
Owner Information Address Phone cell
GG PROPERTY HOLDING LLC 1203 ASTURIA Avenue (305)793-0592
CORAL GABLES FL 33134-
1203 ASTURIA Avenue
CORAL GABLES FL 33134-
Contractor(s) Phone Cell Phone Valuation: $ 2,500.00
GG BUILDING CORP (305)793-0592 Total Sq Feet: 100
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final PE Certification
Date Denied:
Window Door Attachment
Type of Construction:REPLACE KITCHEN CABINETS. Occupancy: Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: Drywall Screw
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted: Certificate Status: Review Electrical
Certificate Date: Additional Info: Review Electrical
Bond Retum: Classification:Residential Review BuildingReview Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Planning
CCF $1.80 Review Plumbing
DBPR FeeInvoice# RC-6-15-56116 Review Plumbing
$2.00 07/28/2015 Credit Card $67.80 $50.00
DCA Fee $2.00 Review Plumbing
Education Surcharge $0.60 06/25/2015 Credit Card $50.00 $0.00 Review Structural
Permit Fee $100.00 Review Mechanical
Scanning Fee $9.00
Technology Fee $2.40
Total: $117.80
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 ELECTRICA MB G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFID IT: I certify all the regoi info
re- co ctor to dot stated.
tion ' cc rate and that all work will be done in compliance with all applicable laws regulating
construction a zoning. F ore,I aut orize a abovated.
July 28,2015
A rgnatur ner / Appkgrit / Contr or / Agent Date
Building Department Copy
July 28,2015 1