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RC-15-2656 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251425 PermitNumber: RC-10-15-2656 Scheduled Inspection Date: January 22,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: LAFRENIERE, KATHY Work Classification: Alteration Job Address:1100 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132050010390 Project: <NONE> Contractor: PRECISION ART CORP Phone: (786)325-7755 Building Department Comments REPLACE EXISTING PLUMBING FIXTURES WITH NEW Infractio Passed Comments IN EXISTING LOCATIONS IN MASTER BATHROOM. INSPECTOR COMMENTS False RELOCATE LIGHT FIXTURES AND OUTLETS IN MASTER BATH AND MASTER CLOSET. ADD WALL IN HALLWAY TO CREATE MASTER CLOSET. Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until reinspection fee is paid. January 21,2016 For Inspections please call: (305)762-4949 Page 39 of 40 Prot Miami Shores Village i�8171t } k L s(t£tIt)I t#) Etl UGt€!CI S► 10050 N.E.2nd Avenue NE Work €h;J ftration Miami Shores,FL 33138-0000 W Ferrnit Status:APpROVEt3 Fc"o � Phone: (305)795-2204 issue Date: 11/2l3l2a15 Expiration: 05/18/2016 Project Address Parcel Number Applicant 1100 NE 91 Terrace 1132050010390 KATHY LAFRENIERE Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell KATHY LAFRENIERE 1100 NE 91 Terrace MIAMI SHORES FL 33138-3404 1100 NE 91 Terrace MIAMI SHORES 33138- Contractor(s) Phone Cell Phone $ 25,500.00 Valuation: PRECISION ART CORP (786)325-7755 _. Total Sq Feet: 200 , Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:REPLACE EXISTING PLUMBING FI Occupancy:Single Family Window Door Attachment Stories: Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Mechanical Review Electrical Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $15.60 Review Plumbing DBPR FeeInvoice# RC-10-15-57474 Review Building $11.48 10/20/2015 Check#:609 $50.00 $908.56 DCA Fee $11.48 Review Building Education Surcharge $5.20 11/20/2015 Check#:626 $908.56 $0.00 Review Structural Permit Fee $765.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $20.80 Total: $958.56 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 c.rtify tha a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. uth ore orize the above-named contractor to do the work stated. November 20,2015 Authorized Sign ure:Owneir / licant / Contractor / Agent Date Building Department Copy November 20,2015 1 Miami Shores Village IFKaill00 Building Department OCT 0 2915 ek �� \� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 _ ST.,{ FBC 20(, BUILDING Master Permit No7pq�I 0�;-2Gt PERMIT APPLICATION Sub Permit No. M BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION []RENEWAL F-1 PLUMBING ❑ MECHANICAL ]PUBLIC WORKS CHANGE OF CANCELLATION [] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1100 NE 91 st Terrace City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3205-001-0390 Is the Building Historically Designated:Yes NO Occupancy Type: R Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Kathy Lafreniere Phone#:508-259-9793 Address:1100 NE 91 st Terrace City Miami Shores State: FL ---Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Precision Art Corp. Phone#: 786-325-7755 Address: 777 NE 62nd Street Suite C412 cit: Miami state: FL Z;p; 33138 Qualifier Name: Corey Lafferty Phone#: 786-325-7755 State Certification or Registration t CGC1520521 Certificate of Competency#: DESIGNER:Architect/Engineer: JCD Architect Phone#: 305-285-4343 Address:1385 Coral Way Suite 207 city: Miami State: FL Zip: 33145 Value of Work for this Permit:$$25,500 Square/Unear Footage of work: 200 sq.ft. Type of Work: ❑ Addition M Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: Replace existing plumbing fixtures with new in existing locations in Master bath. Relocate light fixtures and outlets in master bath and master closet. add wall in hallway to create master closet. 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$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r Sodding 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 obse ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 1.11A A Signature Signature OWNER il.AGENT 1v7 ONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ( �^ day of O 4o iAi .20_1 S •by 134 1 day of O sA cpobc m .20 IS , by 1Z ATh a r 2n 4 r ,who is personally known to C�R,E•.t C+A��,�'}. who i personally known t me or who has produced 6q 68 0413 as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PU ,_ LORI HOROWITZ NOTARY PUB LORI HOROWITZ =•: At MY COMMISSIONEE201437 -'..• :I.a MY COMMISSION 0 EE201437 •. EXPIRES May 23-2016 EXPIRES May 23,2016 Sign Sign: ��''��•'• Print• Print• Seal- Seal: Ita' APPROVED BY A Plans Examiner Zoning im6dj Structural Review Clerk (Revised02/24/2014) 7 1 .... a...� Miami Shores Village = -yam Building Department RiDp� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LICENCES B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE* D. X COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: Precision Art Corp. BUSINESSADDRESS: 777 NE 62nd Street C412 �rryMiami STATE Zip33138 BUSINESS PHONE: (3 456-6759 FAX NUMBER(� CELL PHONE7( 86 ) 325-7755 QUALIFIER'S NAME: Corey Lafferty QUALIFIER'S LIC NUMBER: CGC 1520521 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ; CGC1520521 The GENERAL CONTRACTOR r ' Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LAFFERTY, COREY J • PRECISION ART CORP. 777 NE 62ND STREET C-412 r MIAMI FL 33138 RM 1. 91 07/20/2014 DISPLAY AS REQUIRED BYLAW SEQ# L1407200001774 DATE_01q�ao�s THIS IS CERTIFICATION OF COMPLIANCE WITH THE CITY OF MIAMI'S"BUSINESS TAX RECEIPT" IT IS IN EFFECT WHEN DATED, NAME OF CITY PERSONNEL STAMPED AND INITIALED,AND UNTIL THE PERMANENT"ONE"IS RECEIVED. mat FINAN E DEPARTMENT OFFICIAL Please, note that this Business Tax Receipt(BTR)may expire on September 30th of the year that this INTERIM BTR has been issued.Ensuring renewal by October 1st is the responsibility of the business entity. For further information you may call:(305)416-1570 or(305)416-1918. Favor de tomar nota que este Recibo de Impuesto para Negocio INTERINO puede vencerse el 30 de Septiembre del a1lo emitido.Asegurar la renovacion para el 1 ro de Octubre es la responsabilidad del negocio. Para mis informacion puede Ilamar al: (305)4164570 o(305)416-1918. Souple pran nat ke Resi Enpo you Biznis sa ap exspire 30 Septanm ane ke yo kap ba`w lysans tampor4-an.Se responsablite dirijan Biznis so you Ii renouvle-I Pwemie Oktob kap vini.Si-w bezwen plis enfomasyon sou zaf6 so,pa bllye rete nan (305)416-1570 ou byen(305)416-1918. POST THIS DOCUMENT IN A CONSPICUOUS PUCE. THIS IS NOT A BILL (ntttt 0 TtTItTt NOT TRANSFERRABLE OR VAUD AT ANOTHER ADDRESS y UNLESS APPROVED BY THE FINANCE DEPARTMENT, DO NOT PAY 4 PCITY OF HONE(3MIAMI 444 .W.2 AVE 6"FLOOR,MIAMI,FL 33130, RECEIPT FOR PRECISION ART CORP Ties I mnxo m e ouwroee m feoNW aoee not Pomp We frotaer to Wotefe My amdrp I&M of Ne ISSUED Oct 19,2015 TOTAL FEE PAID .131,00 City mdon itonnpthe holder(tam myOconee INTERIM m Pee"d4 Not Mydoes notuoM w aw. TN► t ftl f dobe not e"&J 1 e. eaffifkatron Nal the froteer to euaW*d ft enpepe In the . eua'afan.Proteeeton m­1"W epedMd Mrein. TM d"WMM fr4W*$Payment of fr.Duemen tab reeeWr only. CUSTOMER NUMBER 107399 RECEIPT NUMBER 46695 NAME OF BUSINESS PRECISION ART CORP LOCATION 777 NE 62 ST 412C INTERIM IS HEREBY IN COMPLIANCE TO ENGAGE IN OR MANAGE THE OPERATION OF: ADMINISTRATIVE OFFICE Jose M.Fernandez Finance Director .d►C RD® CERTIFICATE OF LIABILITY INSURANCE 10116/015 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: N the certificate holder Is an ADDITIONAL INSURED,the pollcy{lesj must be endorsed. If SUBROGATION IS WANED,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 Rau of such endorsement(s). PRODUCER IL R.Scot Brown Brown Brothers Insurance, LLC oI1E PO Box 06 352-237-5300 FAx . 352-291-2933 Ocala, 1=L 34478 INSURRRR AFFORDING COVERAGE NAM IASURER A: i S C 16632 ��'�° Precision Art Corporation D' N 0: 777 NE 62nd Street Suite C412 INWRERC Miami, FL 33138 INSURER D; INSURERE: INSUITER 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. TYPE OF INSURANCE A901. EMMM POLICY NINl16ER =F EXP LDaTS A X COMMERCIAL GEN11MAL LMam► X GLP 019724300 6/12/2015 6/12/2016 EACH OCCURRENCE FS—1 A 0_0,0 c Aws-t ❑occuR r , g 100,000 aAEo ExP An r mre arson X PD Ded 1,000 $5,000 PERSONAL SADV INJURY $ 1,000,000 GEN'L AGGREGATE LUT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 �m=Elm ❑Loc PRocucTs-comp OP AGG $2,000.000 OTHER: $ AUTON COME UABUiTY 1 $ ANY AUTO BODILY 0@MY(Perpmaw) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(PeraxWeng $ -OWNED ;V HItED AUTOS AUTOS PERTY D GE $ $ UtrBRELLALIABHCL= lREACH OCCURRENCE $ EIfCSeSLUISgbpDE AGGREGATE $ DED RETENTION $ WARNERS COAAPENSAT(ONpgs AND EMPLOYERS'LI UMITY Y f N ANY PROPRIETORIPAR OFFICERAAEMSER EXCLUDED? ❑N 1 A EL EACH ACCIDENT $ obndawy In NM E.L.DISEASE-EAUrAw ENiP10YE 9080M OF OPERATIONS balm E.L.DISEASE-POLICY LWIT $ DESCRIPTION OF OPERATIONS/LOCAMNS I11EFICLES(ACORD 101,AddWml Rasadm Sdmdulo,nervy Aye anached Imam apace Is tegaheery Certificate Holder is included as Additional Insured wilh respect to General Liability. Corey Lafferty General Contractor License#CGC1520521 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHCHMED REPRESENTATIVE Scot�l�vn, of �32/7d, ®1 OW2014 CORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 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: 7/17/2015 EXPIRATION DATE: 7/16/2017 PERSON: LAFFERTY COREY J FEIN: 800465338 BUSINESS NAME AND ADDRESS: PRECISION ART CORP. 777 NE 62ND ST. C412 MIAMI FL 33138 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 ate 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 hated 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 to subject to revocation if,at any time after the fUing of the notice or the Issuance of the certmcate, the person named on the notk a or certiftate no longer meets the requirements of this section for issuance of a certificate.The department Mail revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1608 °� PRECISIONART DESIGN + CONSTRUCTION LIC # CGC1 520521 infon„precisionartdesign.com P:305-456-6759 '*K i \ Q ► 1 777 NE 62nd ST.C-4 12 MIAMI,FL 3311.8 F:786-752-3127 October 19, 2015 State of Florida County of Miami-Dade Before me this day personally appeared Corey Lafferty who, being of duly sworn, deposes and says: That he will be the only person working on the project located at: 1100 NE 915t Terrace, Miami Shores, FL 33138. Swore to(or affirmed)and subscribed before me this 2-0 day of 201 By ebQY-Y Personally know OR Produced Identification L Ir.3-1 Type of Identification Produced R_ otpgr v e4 Notary Public State of Flori r Sindia Alvarez My Commission FF 156750 4 Print, Type or Stam Name of Notary ExPires 0910312018 logo Miami Shores Village Building Department I.pRtpA 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: t_ Owne State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20 _/ By who is personally known to me or has produced as identi ��,,,,,,,� RO7JEREZNo ?oy Pc•. NotaryPublirida= Commissl92' pMy Comm.E ,019SEAL: °•• OFF;,%q Bonded througy Ass