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BPP-15-1368 Inspection Woiksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249524 PermitNumber: BPP-6-15-1368 Scheduled Inspection Date: December 30,2015 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: GALLESI, FERNANDO J Work Classification: Addition/Alteration Job Address:68 NW 100 Street Miami Shores, FL 33150- Phone Number (954)461-5550 Parcel Number 1131010180460 Project: <NONE> Contractor: AMENGUAL ELECTRIC INC Phone: (954)410-6364 Building Department Comments BEACH AREA WITH STEPS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-249285. CREATED AS REINSPECTION FOR INSP-236189. NO PLANS NO PERMIT NO ONE HOME Clean front of property andfinish sod or landscaping Failed Correction a Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 29,2016 For Inspections please call: (305)762-4949 Page 16 of 34 � 3a Miami Shores Village r �iri r 10050 N.E.2nd Avenue NW ' ft nIA t 0.. Miami Shores,FL 33138-0000ft � Pit� one. (305)795-2204 Expiration: 02117/2016 3 P Project Address Parcel Number Applicant 68 NW 100 Street 1131010180460 FERNANDO J GALLESI Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell FERNANDO J GALLESI 68 NW 100 Street (954)461-5550 MIAMI SHORES FL 33150- 68 NW 100 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 AMENGUAL ELECTRIC INC Total Sq Feet: 140 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fence Date Denied: Final Type of Work:Swimming Pool Occupancy:Private Pool Deck Additional Info:BEACH AREA WITH STEPS Bond Retum: Wall Steel Classification:Residential Scanning:3 Review Planning Review Structural Review Mechanical Review Building Review Building Review Building Review Electrical Fees Due Amount _Pay Date Pay Type Amt Paid Amt Due Review Electrical Bond Type-Owners Bond $500.00 Review Plumbing CCF $1.80 Invoice# BPP-6-15-55867 Review Plumbing Co/CC Fee $50.00 06/05/2015 Credit Card $50.00 $748.30 Review Plumbing DBPR Fee $2,25 08/25/2015 Check#:275 $748.30 $0.00 DCA Fee $2.25 Bond#:2819 Education Surcharge $0.60 Permit Fee $150.00 Plan Review Fee(Engineer) $80.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $798.30 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,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 z nin . Futhermore I authorize theabove-named " contractor to do the work stated. � August 25, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 25,2015 1 I Miami Shores Village PLUG 13 2015 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 FBC 201 (4 —. BUILDING Master Permit No.-a--PF I'�5– G8 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [—] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP e� ! , CONTRA OR DRAWINGS JOB ADDRESS: fJ v �/ �O® AY-09 City: Miami Shores County: Y& Miami Dade Zip: 3 �� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 2y!°!Q G! �j�6 //2-�e Phone#: � Address: g �� 00 City: State: o Zip: Tenant/Lessee Name: �— Phone#: Email: � G�G c 0 2 —Sid T-Z CONTRACTOR:Company Name: X2.0 e5(/0` Phone#: �� Address: �� f E- r ! Z City: �cP P ti� State: � Zip:—3-3 Qualifier Name: �`�fl �'� At:L�. A L Phone#: o L4® � State Certification or Registration M 0®-7-77-0 Z( Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ®©� ' ©`� Square/Linea;Repair/Replace tage of Work: Type of Work: F-1Addition ❑ Alteration ❑ New ❑ Demolition Description of Work: �� e=►�t 0 71 Specify color of color thru tile: �---�� Submittal Fee$ Permit Fee$d (IN CCF$ CO/CC$ �1 - Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 1 (Revised02/24/2014) O 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence-.q(such posted notice, the inspection will not be approved and a reins ection fee will be charged. Or Signature O(Signature WNER or AGENT C OR The foregoing instrument was acknowledged before me this The foregoing instrument was a knowle ed before me this day of NVG<1 20 kS7 by i3 day of 20 1 s by who is personally known toCTzN P�c�l GVFiL,who is personally known to me or who has producedtL I$W\2 E�V me or who has produced l --r>421 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sige: Sign- Print: Print: Seal: Seal: mo =PllblicStste State of Florida,,ptC!°vNotary Public State of Florrclarez� ^ Sindia P,Ivarez ion FF 156750MyCommission FF 156750 !2016 c s 0 103f2018� � � � �r****�x��x�x�*x�x�x�*�x APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village - d: g r J Building Department JUN 05 2015 6 � g p o 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �Y' INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC ZO ®D BUILDING Master Permit No, ?f 0'� —Z.--36�? PERMIT APPLICATION Sub Permit No. (BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 60 jQUj �O U th E-L--e e City; (tike Miami Shores Countv:Azde- 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):_ Kfik�a I o 6'A/l st Phone#: ?Sq �1�7 Address: 6 O w f City: � �= � .73 State: �L Zip: 0 � Tenant/Lessee Plaine: P - Email: CONTRACTOR:Company Name: s Phone#,-.. ;5 Address: -30-5-1 City: M M t. e: „. k = Zip: 931�2� Qualifier Name: LS p :a n Phone#: R'ry ryoic'm C State Certification or Registration#:<2 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this-Permit:$ ,�2, . V oo BQ6 Square/Linear Footage of Work: �y0 s F Type of Work: 0 Addition L_J Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Ace r, Ir 04A A/q 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$ t 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 bt 41d'^g permit is issued. in the absence _ osted notice, the inspection will not be approved and a reinspection fee w' a charged. 1 Signature Sign OWNER or AG T ONTRAC�OR r The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this A day of R 20��by Z day o _ f J R'A-e ,20 11—— ,by C w o is personally known to c X10 0+-t— ,who is personally known to me or who has produced flag ;.,,a. as m.�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: JO GE RoSSEAU Print: 'P�e Print: <MYCO crllN0121 y _ Notary Public State of Florida �� Nf���` EXPII2ES MAY a. y Seal: '• •' Seal: i40'�;9R-n1s3 PloridsNotarYg�r, ?N Q°My Comm.Expires Jun 26,2016 ��iFOF F`OpC�� Commission#EE 211426 �II11111\\\ APPROVED BY Plans Examiner l Zoning Structural Review Clerk (Revised02/24/2014) I ' Date CERTIFICATE OF LIABILITY INSURANCE 4/9/2015 Producer: Plymouth Insurance Agency This Certificate Is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policy below. (727) 938-5562 1 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: tion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer El: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstan Ing arty requirement,tens or condition of any contractor other document with respect to which this certificate maybe issued or may pertain,the Insurance afforded by the policies described herein Is subject to all the terms,exclusions,and conditions of such policies.Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises(EA Claims Made ❑ Occur occurrence) $ Med Exp General aggregate limit applies per Personal Adv Injury r. General Aggregate Policy ®Project ❑ LOC Products-CompfOp Agg AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) $ Any Auto Bodily Injury All Owned Autos Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur 1:3 Clairjts Made Aggregate Deductible A Workers Compensation and WC 71949 01%01/2015 01/01/2016X WC Statu- OTH Employers'Liability to f Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company Is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocatJons/Vehicles/ExclusIons added by EndomementlSpecial Provisions: Client ID: 92-68-589 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Amengual Electric,Inc. Coverage only applies to injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:Fl- Coverage LCoverage does not apply to statutory employee(s)or Independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 0408-15(MT) Bealn Date 313/2015 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof,the issuing Insurer will endeavor to mail 30 days written notice to the certificate holder named to the lett,but failure to do so shall Impose no obligation or liability of any kind upon the insurer,Its agents or representatives. 10050 N.E.2nd AVE. MIAMI SHORES, FL 33138