CC-15-2726 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-248167 PermitNumber: CC-10-15-2726
Scheduled Inspection Date: November 20,2015 Permit Type: Commercial Construction
Inspector: Rodriguez,Jorge Inspection Type: Final Building
Owner: CHURCH, ST MARTHA'S CATHOLIC Work Classification: Alteration
Job Address:9221 BISCAYNE Boulevard
Miami Shores, FL
Phone Number
Parcel Number 1132060160010
Project: <NONE>
Contractor: NATIONAL BUILDERS GROUP CORP Phone: (786)488-2576
Building Department Comments
REPLACE ROTTEN FASCIA BOARDS. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed ; CREATED AS REINSPECTION FOR INSP-248071. No contractor on site
PLEASE CALL REY 305-318-5481
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 19, 2015 For Inspections please call: (305)762-4949 Page 26 of 28
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Miami Shores Village �1� 1 +la% NIt
10050 N.E.2nd Avenue ., 1tl1t? ttl
Miami Shores, FL 33138-0000
Phone: (305)795-2204
alt, _..
PPIRO
omry
Expiration: 4/2016
Project Address Parcel Number Applicant
9221 BISCAYNE Boulevard 1132060160010 ST MARTHA'S CATHOLIC CHUR
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
�STARTHA'S CATHOLIC CHURCH 9401�L3
YNE BLVDMIAM38-2970
Contractor(s) Phone Cell Phone
[Total
aluation: $ 3,400.00
NATIONAL BUILDERS GROUP CORP (786)488-2576 Sq Feet: 0
Approved: In Review Available Inspections:
Comments: Inspection Type:
Date Approved: : In Review Window Door Attachment
Date Denied: Tie Beam
Type of Construction:REPLACE ROTTEN FASCIA BOAR[ Occupancy Load: Slab
Stories: Exterior: Termite Letter
Front Setback: Rear Setback: Framing
Left Setback: Right Setback: Store Front Attachment
Plans Submitted:Yes
Certification Status: Insulation
Certification Date: Additional Info:
Drywall Screw
Bond Return : Classification:Commercial Final PE Certification
Window and Door Buck
Scannin :3
Gelling Grid
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Fill Cells ColumnsReview Building
CCF $2.40
DBPR FeeInvoice# CC-10-15-57559 Review Planning
$2.25 11/06/2015 Credit Card $ 119.90 $50.00
DCA Fee $2.25 Review Electrical
Education Surcharge $0.80 10/26/2015 Credit Card $50.00 $0.00 Review Plumbing
Permit Fee $150.00 Review Structural
Scanning Fee $9.00 Review Mechanical
Technology Fee $3.20
Total: $169.90
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,ME HANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that (I he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and•lcotiing. Futhermora! I uthorize the above-named contractor to do the work stated.
(J' November 06, 2015
Authorize Sign re:Owner / Applicant / Contractor / Agent Date
Building De artment Copy
November 06,2015 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 -
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 ('TH
F BC 20 J
BUILDING Master Permit No. 00 I " Z� 2—(S
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
u n yy�� CONTRACTOR DRAWINGS
JOB ADDRESS: / 2 /.� l S C V A✓e /y I.r
City: Miami Shores County: Miami Dade Zip: 3 / 3
Folio/Parcel#: 11 — 3 ) 4 0 f — 00 10 Is the Building Historically Designated:Yes NO
Occupancy Type: )14L't Load: Construction Type: C S Flood Zone: BFE: FIFE:
OWNER: Name(Fee Simple Titleholder): c C - /Yorf 44 r CGt cJ ✓L C Phone#: 3o-5- 7-5-1 oy o
Address: g 5't4 Ai e QZ2-i
City: State: L Zip: '7 .
Tenant/Lessee Name: / Phone#:
Email: 4A4-nett w (�gcdv e 34
WAYIt64 A4jpq � 1 C Gj"
® t
CONTRACTOR:Company Name:W A I (l�h//�! 1l �j�([- ( lF_6 0 (4 Phone#: � 5(^ `l t P' dyl C
Address: c St �T`t (� IZ- -3Cjt7'-- �
City: C`\ State: 1 Zip: .? l �
Qualifier Name: PO 14 \'� C `f Z Phone#: `d C,
State Certification or Registration#: t� Certificate of Competency#:
DESIGNER:Architect/Engineer: N \,A Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 0 D Squar Linear Footage i'o '�O��emCo'l
v
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ition
Description of Work:
Specify coloro--f/ncolor thru tile:
Submittal Fee$ / Permit Fee$ (So ` QCCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ! 9
(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.
r
Signature ' �``'�'Dia _ Signature
7 OWNER or ALEN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
L _day of 20 l 5 by day of h �tZ ,20 by
Th, l� hQZ, Cou..�►o�ho is personally known toC5tA�rf� (0 who is personally known to
me or who has produced as me or who has produced L %Z,oO 6p -,43` Zd t-0as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
ti
Print: J& Print: u r^cJ @ U l c'.
Notary Public State of Florida
Seal: ;4 Mayra Neulina Rosseii Seal:
1% My Commission FF 198149 Nota p
or n Expires 02/10/2019 a Public Ros
State Florida
May
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res 02/10/2019
CY
APPROVED BY ' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT; GOVERNOR KEN LAWSON,SECRETARY
STATE OF"FLORIDA v
DEPARTMENT OF'.BU.SINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
w,
s ;. 'CGC1505556;
The'GENERAL CONTRACTOR
INamed below:IS CERTIFIED
r {
Under the provisions:of Chapter 489 FS.
Expiration date: AU.Goo
'
err
01
91
a
LOPEZ,:BONIFACIO
NATIONAL BUILDERS CSR
; ��d�eSYw'wv�
9$06 NW 80&'A"' b
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ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290002181
n ,
0023U4
rpm
Local Business Tax Receipt
Miami-Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
6865902
BUSINESS NAME/LOCATION RECEIPT NO.. EXPIRES
NATIONAL BUILDERS GROUP CORP RENEWAL SEPTEMBER 30, 2016
14 NE 1 AVE 2ND FLOOR 7140551 Must be displayed at place of business
MIAMI FL 33132 Pursuant to County Code
C!,)a ter SA--Art,9& 10
OWNER SEC. TYPE OF IFStN
NATIONAL BUILDERS GROUP CORP 196GENERAL B 0 IL D i . b { PAYMENT RECEIVED
CGC15Q5S56 Y TAX COLLECTOR
Worker(s) 1 $45.00 09/21/2015
CREDITCARD-15-047549
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit,or a certification of the holder's qualifications,to do business, Holder mast comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec ga-276,
For more information,visit WM.miamidade uoyAax-nlle for
Scanned by CarnScanner
"TE 081118001YYYY1
CERTIFICATE OF LIABILITY INSURANCE F 10112*015
TI*S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, UMEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CBE'VW-'ATE NOLDElt
IMPORTANT, If the cwWlca*holder is an ADDITIONAL INSURED,the p~$n)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and condMons,of#w policy,certain policies may require an endorsement.A statement on this cerfiftaft does not confer rights to the
certificate holder In Rau of such endorsemenffs.
PROMICIM CONTACT Tema M,De Paz
Sanchez Insurance Agency Inc. PNONE 305-889-0704 306-889-0679
!tet2300 W 84th St Suite 112 V
net
So
..............
Hialeah .. ...
FL 33016 GRANADA INSURANCE COMPANY
............ - -------- --- ...... .......__ _. .................................... .......... .............. ......
INSURED
was_
National&A%Ws Gm*Corp
roc:.......... ....................
98%NW 80 Ave
................
NIS
Hialeah FL 33016 La UREIt F,
COVERAGES CERTIFICATE NUMBER. REVISION NUMBER-
THIS 13 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 VMtCH 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.
wsk
TYPE or INSURANCE L"TS
GENEVAL UokeILIT Y
EACH OCCURRENCE 3 1,001),000
X jq!?MWIERCIAL GENERAL LL*SIfTY
100-000
$
CLAWS4AADEWED EXP(Am om 5,0W
OCCUR
A X � 0185FL00029639 091=2015109rMM16 &AOV INJURY $ 1,000,000
GENE
AGrR aTt a 2,ODO,000
GEN4L AGGREGATE LJWT APPLIES PER,
PRODUCIFS-COMPIOPAGG S 0
POLICY 10C'T F
AUTOMMLE UAISMAY C WED SINGLE LIMIT
ANY AUTO BODILY IN"Y(Per pwsw)
SCI.WDULED
ALL OVVNED
BODILY KAW(Pvx acodwo)i S
AUTOS AUTOS
HIRED AUTOS AUTOS
UMBRELLA LIAR
Ld OCCUR
EXCESS LIAR CLAWSMADE! EACH OCCtRI NCE $
.DED 'I RcTENnON$
140OPENSATM Y4C STAR}
YIN DTH-1
AND EMPLOYERS!LUU39M
ANY PROPRIETORMARTNEROEXECUTIVE
OF*ICEPMEMBER EXCLUDFWMIA
Obodd-yWNH)
U
E.L DISEASE-CA E�Lowd,�
desefte WdEw es-CRIPTtON OF OPERAnoNs betow EL DISEASE-POLICY Lurr S
ADDITIONAL INSURED:Miami Shores Village Building Department
General construction services.
CERTIFICATE HOLDER CANCELLATMN
SHOULD ANY OF TM ABOVE DESCRIBED POLICIES BE CAW-ELLED BEFORE
TW EXPIRATION DATE TMtEOF, NOME VALL BE DELIVERED IN
Miami Shores Village Building Department ACCORDANCE VATH THE POLICY PROVISION&
10060 NE 2 Ave
Miami,FI 33138 AL"140RE"REPRESENTAIM
?-&00 V*.Ut 4-t- I
ACORD 26(201=5) 0 19W201 0 ACORD CORPORATION.All tights reserimd.
The ACORD name and logo are registered marks of ACORD
a =
ry W
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: 4/20/2015 EXPIRATION DATE: 4/19/2017
PERSON: LOPEZ BONIFACIO
FEIN: 272807182
BUSINESS NAME AND ADDRESS:
NATIONAL BUILDERS GROUP CORP
14NE1AVE
MIAMI FL 33132
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL
CONTRACTOR
Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing 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 if,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
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
e /
NATIONAL BUILDERS
NEW CONSTRUCTION, RENOVATION & MANAGEMENT
M)Bo.X371 101 Miami,Fl.31137 P11 (786),189-2576
F.mail nazi<�n�lbuildersgrcup(ti�yaha�.c�n
WC 1505556
October 20.2015
State of Florida
County of Miami-Dade
Before me this day persona Ily appeared Bonifacio Lope who,being duly sworn,deposes and says:
I,Bonifacio Lopez will be the only person working on the property located at:
9301 Biscayne Boulevard,Miami Shores. FI,33138
Sworn to(or affirmed)and subscribed before me this 21st day of October,2015
R, L--11 - — -
�?Yfi-on�ffacio Lo
Personally known
OR Produced Identification
Type of Identification Produced
NAYDA MORALES
rnY Cot.4MISS1CN#FF175848 j
EMRES November 12.2018Flo W4010Y
ii ��, �
�No»ES
1
161
Miami shores Village
Building Department
��ORtiDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
SOMME
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: lO
O nen
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of '20 15 .
By ,. L&), C who is personally known to me or has produced
pu as identification.
Notary.
NWeryPublic Stsir.:�iHimtl9
SEAL: Mayra Neulins
Notary Public Stets of Florkla MY Commissiona,q b
Expires 0211012+.-
at My
Mayra Noulina Romll
r
aidExpiros 02110/2019
3
ARCHDIOCESE OF MIAMI 1 Biscayne Boulevard
Hand Shores,Florida 33138
Office of the Archbishop Telephone.305-757-6241
Facsimile,305-757-3947
May 4,2412
Reverend.Wildredo Cron
Saint Martha Catholic Church
21 Biscayne Boulevard
Miami Shores,Florida 33138
Dear Father Contreras:
In the name of the Father andof the Son and of the Holy Spirit.
I am hereby appointing you as Administrator of Saint `sh,effective June 4,2412. At the
same time,T am relieving you of your appointment as Parochial Vicar of Saint Patrick Parish.
Allow me to take this opportunity to express my thanks and appreciation for your service as
P chial Viowof Saint Patrick. At the same time,T am confident that yourptiestlyministry at Saint
Martha will also be of much pastoral and spiritual benefit to the faiffiffil there as we start afresh froze
Christ_
The parish pastoral and financial councils are important advisory bodies to assist you in your many
onszsibilities as Administrator. Please submit to e a report on these advisory councils at Saint
Martha by November 10, 2412. Your report should indicate the names of those serving on these
councils as well as the minutes from the most recent mectings and the schedule for the upcoming
Finally, it is my hope that you will encourage vocations to the priesthood and religious life from
among the many young people at Saint Martha Paris& With the grace of Almighty Clod and your
good example of the priesthood, i pray that many will choose to dedicate themselves to a life of
service to the Lord and the Church.
aythe Lord continue to bless your priestly ministry abundantly. with personal good wishes,I am
Sincerely yours in Christ,
4-1 sem;
Most Reverend Thomas 4.Wenski
Archbishop of miami
Attest:
VeryReverend Ch eI Jeanty, JCL
Chancellor for Canonical Affairs
L,S.
MOST REVEREND THOMAS G. WENSKI
By the Grace of God and the Favor of the Apostolic See
Archbishop of Miami
DECREE
FOR THE SPIRITUAL WELFARE OF THE PEOPLE OF GOD
I HEREBY APPOINT YOU,
THE REVEREND WUIRED0 CONTRERAS,
PASTOR OF
ST, MARTHA PARISH,
MIAMI,FLORIDA
I entrust to you the full pastoral care of the people of this Parish,with all the jurisdiction,obligations
and rights attached to this office by the General Law of the Church, as well as other particular
legislation of the Archdiocese of Miami.
This appointment became effective on June 4, 2012. My representative, the Very Reverend
Christopher Marino, V.F., will preside at the ceremony of Installation.
I exhort you to carry out this priestly service with zeal and dedication, under the authority of the
Archdiocesan Bishop in whose ministry of Christ you have been called to share.
Faithful to the Gospel and its spirit, you are to fulfill the duties of teaching, sanctifying and
governing, with the cooperation of your pastoral staff and the assistance of the lay members of
the Christian faithful.
May God, the Father,grant you the grace and health to carry out this priestly service in the name
and power of Christ.
Given at the Archdiocesan Curia, Miami, Florida, on the 20th day of July, 2015.
�j
Z' Archbishop of Miami
Reverend Monsignor, hanel Jean i ty, JCL WL
&CEL
Vicar General and Chancellor for Canoni #a..
OCT 2015
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