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