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DS-15-1906 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240178 Permit Number: DS-7-15-1906 Scheduled Inspection Date: September 15, 2015 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: PEARSON, LEONARD Work Classification: Repair Job Address:246 NE 103 Street Miami Shores, FL 33138-2431 Phone Number Parcel Number 1132060134880 Project: <NONE> Contractor: BUILDING CONCEPTS OF FLORIDA Phone: (305)796-0096 Building Department Comments REMOVE WALKWAY 7 REPLACE IN SAME LOCATION Infractio Passed Comments WITH 6" CONCRETE 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 14, 2015 For Inspections please call: (305)762-4949 Page 26 of 56 11 Nt` Fpru �snO1s y Miami Shores Village PB��t 7"YPari��!a�fs�S��ralk�lat •� 10050 N.E.2nd Avenue NE W' kasaw titin_Repair Per v''.. Miami Shores,FL 33138-0000 z P{ �rlTt7%I~ (8t� i�P�R �" -gll Phone: (305)795-2204 E CORIDA �, - 81r312t11 Expiration: 02/0212016 Project Address Parcel Number Applicant L NE 103 Street 1132060134880LEONARD PEARSON mi Shores, FL 33138-2431 Block: Lot: Owner Information Address Phone Cell LEONARD PEARSON 3320 N 34 Street HOLLYWOOD FL 33021- Contractor(s) Phone Cell Phone Valuation: $ 700.00 BUILDING CONCEPTS OF FLORIDA (305)796-0096 Total Sq Feet: 120 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work: REMOVE WALKWAY 7 REPLACE IN SAME Additional Info: Review Planning Bond Return: Classification:Residential Review Planning Scanning:3 Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DS-7-15-56515 DBPR Fee $2.00 DCA Fee $2.00 08/06/2015 Credit Card $64.60 $50.00 Education Surcharge $0.20 07/29/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume reMECH all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL LUMCAL,WINDOWS,DOORS,ROOFING and SWIMMINGPOOL work. OWNERS AFFIDAVIT: ert' toing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin , u r he above-named contractor to do the work stated. August 06, 2015 Authorized gnature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 06, 2015 1 Miami Shores Village Building Department JUL 2q 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ILI BUILDING Master Permit No. � S e 9 � PERMIT APPLICATION Sub Permit No. 7�5UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: SM City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: div` ) OWNER: Name(Fee Simple Titleholder): �v Phone#:�� Address: `t6? ( -:�,4- 15w— City: 414 1 A_wl ) State: L Zip: Tenant/Lessee Name: Phone#: Email: Gi�r-'fiD1ST F 1 '&C,1 %025 Co- tib • �-� �� CONTRACTOR:Company Name: ((,D 1j, one#: Address: City: A-410 I State: �L Zip: _�7 7? L�� Qualifier Name: L'Cp fj( Phone#: State Certification or Registration#: GfJ� �� '� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: orb ii Value of Work for this Permit:$ `70C� Square/Linear Footage of Work: Type of Work: ❑ Addition (ry ❑ Alteration ❑ NewRepair/Replace ❑ Demolition Description of Work: namc Vd:_7 WA'L_K wp q 5t LbG -'C') 0N1 Lo (tl �,Specify color color ofcolor thru tile: Submittal Fee$ISC ADD Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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. 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this f-A day of 201� by day of 20 15— by L0�Jl.{t)-+� �P►3 5 � who is asr onally known o �IC���L ey0,41 who i personally know to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: �p�";:::;'4r4, KELLEL J>t NOTARY PUBLIC: KELLE L * * MY COMMISSION i FF 901375 * MY COMMISSION EXPIRES:July 20,2019 :July 20,2019 Sign: �� - n N Print: C 1 �� 1—, '���C`- (�5 Print: 1�4C I62 L . �J �C;� �`— Seal: Seal: r— /1 APPROVED BY / Plans Examiner l.' L Zoning Structural Review Clerk (RevisedO2/24/2014) t A4CC>Rd> CERTIFICATE OF LIABILITY INSURANCE DATE /09/20IYVVY) kw 07/09/2015 • 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 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 CONTACT Tiffanie Ellis Heritage Insurance Services LLC NAME: PO Box 1508 PHONE EXt: (941)723-1400 FAX PO No):(941)723-1440 Pal metto,F L 34220 ADDRESS: tiffanie@heritagefla.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Lloyds of London,LLodW A0063 INSURED Building Concepts of Florida INSURER B: 8089 NW 67th ST Miami,FL 33166 INSURER C: INSURER D: INSURER 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MMIDD/YYYY A GENERALLIABIUTY CIBFL0015220 04/22/2015 04/22/2016 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ CLAIMS-MADE 12 OCCUR NED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,E GENERAL AGGREGATE $ 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 J POLICY JECT —1 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OW4ED PROPERTY DAMAGE P $ AUTOS er accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTI+ AND EMPLOYERS'LIABILITY Y/N TORY, rr ANY PROPRIETOR/PARTNER/E)ECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ V yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Victor Leoni Building Contractor:CBC0031847 CERTIFICATE HOLDER CANCELLATION Fax#:(305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N E 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r Ate'<>_ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMY1) 07/08/2015 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 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 CONTACT NAME: PHONE A/C,No,Ext): 1-800-277-1620 x4800 FAX A/C,No): 727 797-0704 FrankCrum Insurance Agency, Inc. E-MAILADDRESS: 100 South Missouri Avenue INSURER(S)AFFORDING COVERAGE NAIC# Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: FRANKCRUM L/C/F BUILDING CONCEPTS OF S FLORIDA INSURER C: CORP INSURER D: 100 SOUTH MISSOURI AVENUE INSURER E: CLEARWATER FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 246540 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTR INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurrence $ MEX�CLAIMS-MADE OCCUR (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GENE AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Perperson) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC201500000 01/01/2015 01/01/2016 X WC STATUTORY OTH- A EMPLOYERS'LIABILITY Y/N LIMITS ERR ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 000'000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,if more space is required) EFFECTIVE 08/15/2011,COVERAGE IS FOR 100%OF THE EMPLOYEES OF FRANKCRUM LEASED TO BUILDING CONCEPTS OF S FLORIDA CORP (CLIENT)FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM.COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Building Dept. AUTHORIZED REPUSENTATIVE �e� 10050 NE 2nd Ave. Miami Shores,FL 33138 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD .juL—y G—lIwl �a vx� O � \ ge C oq °'fin � TF t s s • • � •.••• •. • ••f• . • • t { • ED r•ts•• sf•• { t • r, �-� ►� d�o� s� a � l JUL 29 201 -1101, r' .'tw r cla, '•�.,'.N y{'j{- .•j^; yPI ••1 1111 . rte• _�_ � �_ � � _ .�.-'RTS' ���i V'� • IL Al x1R.� r �� •ts ti� � wine •�` r r..,f` .1Y) .i+NJ'�• 1 c i,.� ^, • l .•0._c t.:y •�""'�' �.'.� r �t4 7,!'^ rix sz f 4 _ � _ of �t .��' 'rS .,.# '• ,���`f'4`��f� .,..+r+k�+'"^' ��� � iqs.r tom�t "+" F* t's.�`x, 00* , � • J• � t J 1'S S.af'`5,'y�t h}irf�1"S 4 • • • • • • • • • • • •• • • • • • • • • • • •• • • • • • • • ••• • • • ••• • •