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RC-14-1383 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251895 Permit Number: RC-6-14-1383 Scheduled Inspection Date: February 01, 2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: FRAME, ROSALINE Work Classification: Garage Enclosure Job Address:680 NE 97 Street Miami Shores, FL Phone Number (305)302-1784 Parcel Number 1132060171610 Project: <NONE> Contractor: VERSATILE STRUCTURE INC Phone: (305)370-4777 Building Department Comments CONVERT TO CABANA WITH A NEW BATHROOM Infractio Passed Comments ELECTRICAL PANEL AND 1 A/C UNIT INSPECTOR COMMENTS False 04/22/2015-Check#295478 for the amount of$2107.82 was returned unpaid. No inspection or review untill check is repaid with an additional$105.39 return check fee, for a total due of$2213.21 A.S Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 29,2016 For Inspections please call: (305)762-4949 Page 29 of 36 INSPECTION RECORD - P ST ON SITE PerrrlYtNO. RC-6-14-1383 Miami Shores Village traction Pemi t Type Resid+0rtti { 10WO ME.2nd Avewe ,'•, I ria shores,IF 3313"M Wolk, abon.-Garage Enclosure Phom. (30t)785.2204 Fax ,(305)75MO72 �! •R[I�'' issue Date:4r � Expires:02 0212016 iNsPEcION,REouEST's: (305)762-4949 or Log on at httpe-11bW rn9amish4resv itage.comlcap REQUESTS ARE ACCEPTED DURING 8:30AM-3-30PM FOR THE FOULOWING BUSINESS!DAY. Requests must be received by 3,=for following day irrspettions Residential Construction Parcoi#.1'13206017'1610 Owner's Name:ROSALINE FRAME Owner's Phone: (305)30,2-171 Job Address 6B0 NE 97 Street Total Square Feet 500 Miami Shores, FL Total Job Valuationi $ 25,I�00_00 BondNumber: 2 - - _ WORK iS A4L0,WED MONDAY THROUGH SATURDAY; 7:30AM-6:00PM.NO WORK IS ALLOWED ON Contractor(g) " Phone Primary Contr8t,tbr, 'SUNDAY OR HOLIDAYS. VERSATILE STRUCTURE INC (305)370-4777 Yes CQJVWELL$c ASSOCIATES CONSUI 305)962-5673 No BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTION$ARE DONE MONDAY THROUGH FRIDAY. Nt5 BUILDING INSPECTION$DONE ON FRIDAY. NO INSPECTION'WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE.ATtS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND IXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: r YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED `ON z THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. r l /F.r INSPECTION RECORD ZONINIG: PLUMBING INSPECTION DATE lNSP INSPECTION PATE INSP INSPECTION_ DATE INSP Foundation Zoning Final old Stemwall ZONING COMMENTS Rough Slab - Water Service Columns(1st Lift) �d_ ` Coiumins(2nd Lift) - 2 Rough Tie Beam Top Out Truss/Rafters - fire Sprinklers RoofSheathi Sgtic Tank - - Sewer Hcrok-u Bucks Roof Drains Windows/Doors. /d Gas itaterlor Framin INSPECTION DACE INSP LP Tank v -- ,Insulation Temporary Pole - Wei1 - CeilingGrid _ - - - = 30 Day Temporary Lawn Sprinklers Drywall Z Pool Bonding Main Drain Fi rewall - Pool Deck Bonding Pool Piping` Wire Lath Pool Wet Niche - - Backflow Preventor - Pool Steel Under round Interceptor - Pool Deck - - - _ Pool ins Footer Ground Catch Bas Final - _ - _ Slab Condensate Drains Final Fence WallRough HRS Final Screen Enclosure Ceiling Rough,—,, - RO, inreway _ RoughPLUMBINGG M ENTS [driveway Base Tele•hone Rough - En Ca - Telephone Final Roof in'Pro ress TV Rou h - - - _ Mop in Progress TV Final - - Final Roof - Cable Rough = - Shutters Attachment Cable Final Finai Shutters Intercom Rough_ Rails and Guardrails - - Intetfrt Final - IMECHANICAL ADA Cc11111 k1ic7nte Alarm Rough INSPECTION DATEA #NSP Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough- Sail Bearing Cert Fire A-larm Final Rau h - - Sol]Treatment Cert Service Work With _ floor Elevation Survey - Ventilation Rough Reinf Vrilt Mas Cert - - - ELECTRICALCOMMENTS Hood Rough - Insulation Certificate -- Pressure Test Spot Survey Final'Hood Final SurveyFinal Ventilation -- - - Truss Certification FinalPoolHeater STRUCTURAL COMMENTS Final Vacuum FIRE MECHANICAL COMMENTS INSPECTION PATE tNsh Final Sprinkler Final Alarm 11 72!� 4 - Oct.08/RV 8/31/09 .�.,.{e ^�,1r'�• wla�-... _ a,�hAy;< � .'•. i' .��.. .�� - - _'•29c' �- ^"',.,.^ J �'A .J�. _ � �Y it _ Com♦ S',�.� Y ,. :.. ` rs;i -= •, w �.�: c:r :.-. ` ,,. .„:az .._..,t',G. -.C: ,�?i t=; .�.nom.,,,.r�'a`�tSF+i" r ,x. !..a...... _'r.'.. `� 4F. Certificate of Completion =ti " i Miami Shores Village - 10050 NE 2 Ave, Miami Shores FI, 33138 Tel: 305-795-2204 Fax: 305-756-8972 Building Inspection Department r _ This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: :tr + Permit Type RESIDENTIAL CONSTRUCTION Bldg.Permit No. RC14-1383 Owner ROSALINE FRAME Contractor VERSATILE STRUCTURE INC F� u • 'a�' � � Subdivision/Project NONE Date Issued February 8,2016 � Occupancy • •g'. Construction Type V-B Load N/A t T Occupancy Square Footage 500 Type R-3 a Description of GARAGE CONVERSION TO CABANA Applicable 2010 FLORIDA BUILDING ^ Work Code t i 7 Location Flood Zone N/A F.F.E N/A 680 NE 97 STREET Miami Shores FL 33138 ' nrt. �.ra Building Officials Approval Ismael aranio, B < "c�� Not Transferable POST IN A CONSPICUOUS PLACE x f '�- Yr k '� 1p6-*t. =z '�cr. "'�,'�"�a� I�'r_��-m• h.F m'J�`�,�� r •'�4.:=^r- a55 � ��� �i� ,�..,_._ k.�" x'�, v.�.. .., i�tv. k "`,• I�S� � •C 'tea+~ '�M, 1 . Date: January 29,2016 Miami Shores Village 10050 NE 2"d Ave Miami Shores, Florida 33138 Re: Permit# RC-6-14-1383 Folio: 11-3206-017-1610 Address: 680 NE 97th Street Miami Shores, Florida Attn: Building Department, I K-C,"Id 4Ilwl��9► , having performed and approved the required inspections at the renovation and addition. I hereby attest to the best of my knowledge, belief and professional judgement,the structural and envelope components of the above referenced renovation are in compliance with the approved plans and other approved permit documents. I also attest that to the best of my knowled e, belief and professional judgment,the approved permit plans represent the as- built condition of th structural and envelope component of the said structure. This document is ing repared in accordance with Chapter 1 of the Florida building Code and must be submitted to the illa a of Miami Shores Building Department in conjunction with the application for a Certificate of Co pe ition for the above referenced structure. Should you hav a y questions or need any additional information please do not hesitate to contact me. Sincerew ff. e Arch' ct y orida# l' MIA Miami-Dade County Building Department 11805 S.W.26 Street, Miami, FL 33175-2474 www.miamidade.jzov/bui1dinjz ENERGY,SOUND AND IMPACT CERTIFICATE Building Permit No: RC-6-14-1383 Project Name: Robert& Rosalind Frame Job Address: 680 NE 97 Street Miami Shores, Florida STATEMENT OF COMPLIANCE We,the undersigned,hereby certify that the ENERGY SOUND AND IMPACT INSULATION has been installed in the above referenced project,in compliance with the latest edition ofthe FLORIDA BUILDING CODE.the APPROVED ENERGY CALCULATIONS and Plans and in accordance with good construction practice.The insulation furnished and installed has the characteristics shown below:(check only applicable boxes). X1) Exterior CBS Walls Insulation:R- 5 (Min.):Material: Rigid Board Thickness: 5/8" inch(es):Density: XXX lb/ft:Mfgr: -2) Exterior Frame/Metal Stud Walls:R- (Min.):Material: Thickness: inch(es):Density: Ib/ft:Mfgr: X3) Exterior solid concrete walls:R- 5 (Min.):Material: Rigid Board Thickness: 5/8" inch(es):Density: XX lb/ft:Mfgr: F 4) Interior walls separating A/C from non A/C spaces insulation:R- (Min.) Material: ;Thickness: inch(es);Density: Ib/ft IJ 5) MULTI-FAMILY RESIDENTIAL CONSTRUCTION ONLY:The COMMON(PaM)walls to two separate conditioned tenancies shall be insulated to a minimum of R-11 for frame walls,and to R-3 on both sides of common masonry walls See ENERGY CODE,2007,paragraph 13-602.ABC.1.1,on page 13.74,latest edition.These"minimum levels of insulation",are not included in the Energy Calculations,but shall be installed in the field. X6) Ceiling insulation R- 30 (Min.);Material: Batts Thickness: 10 " inch(es): Density: lb/ft:Mfgr: —7) Walls,partitions and floor/ceiling assemblies between dwelling units or between dwelling units and adjacent public or service areas such as halls,corridors,stairs,etc.must have a sound transmission class(STC)of not less than 50(penetrations must maintain the required rating). -8) Floor/ceiling assemblies between dwelling units or between dwelling units and public or service areas such as halls,corridors, stairs,etc.must have an impact insulation class(IIC)rating of not less than 50. Make photocopies of this sheet in your office,as required for future jobs. Installed by: Insulation Company Name Insulation Contractor Si ture Insulation Contractor CC# Date Certified: O.C./Builder: Versatile Structure, Inc Company Name G.C. /Signature Building Contractor CC#: CGC 1518777 Date Certified: �V ��, 3���p Note:For lightweight Insulating concrete,use appropriate forms,separate from this one. Revised 02-26-2009 1 C�1 © U �` F A SV ,� LEGAL DESCRIPTION: �MJRV �H OF Bo u��-�--�--� Y HUJ"� E '`� LOT 1&2 BLOCK 100 OF AMENDED PLAT OF MIAMI SHORES SECTION No.4 SUBDIVISION,ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 15 EIV9_7th STREET AT PAGE 14 OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA. _ _ . . _ _ _ PROPERTY ADDRESS: 680 N.E 97th STREET,MIAMI SHORES,FLORIDA 75.00'Total R/W 19'Asphalt CERTIFICATION TO: SCALE: 1"=20' 16.00' 40.92' 1 5.40' �� ROBERT H.FRAME&ROSALINDA S.CN iI � 'I U" °� JUN 2 2014 LAl OIL OCATION MAP ° 23.5'Parkway DRIVEWAY By. N.T.S. Brick 5'Conc.Walk 143.38' (NO ID) FND.I.P.1/2" / NE: 9 7 TH S�h --------- ———— — ----- FND.I.P.1/2" 1104.4 ,0 98' (NO ID) 50 (NO ID) .. 890 I / i o i 10 9 8 7 . 6 5 9 3 I U D=114°39'00"LO q�i N Concrete " N R=25.00; IN f / l I L=50.03 ALUM. FENCE ATConcret i 7 16.601 GATE ALUM. FENCE i 7a� it °1z 13 14 1,5' lb 17 0.30' Planter 1 cri ' %'36.45' / so .� SO - r� Planter', .�_. .. /,Y 3 T9 o /. S60' FN .NAIL Q C 0 t..! L. .G... j .�. 1 D ---�•� c /� , O ID) / �'• aril71 0 0o %>%ONE STORY CBS UL: U N j RESIDENCE#680',/', c 20 CiSURVEYOR'S NOTES: v ui 5.85'03.20' �;% �'f / I.A 1.)EXAMINATION OF ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY,AFFECTING THIS PROPERTY. 1;1ure O r' / O 2.)LOCATION AND IDENTIFICATION OF UTILITIES IF ANY ARE SHOWN IN ACCORDANCE WITH RECORDED PLAT. O —— ''! �' % 18'80' ' O 3.)OWNERSHIP IS SUJECT TO OPINION OF TITLE. Lot 3 O // /' '�p. ❑ 22 68. *b� / v 5.)THIS E OF SURVEY I NOTOVAL DpUN ESS SURVEY-.NED AND SEALED BY THE SURVEYOR OF RECORD. Block 100 �"� A/C 6.)ALL RIGHT OF WAYS SHOWN ARE PUBLIC UNLESS OTHERWAISE NOTED. n M En21.40': °' PUMP 7.)LANDS SURVEYED AS DESCRIBED. N WoWell o POOL w 8.)NO UNDERGROUND INSTALLATIONS ON IMPROVEMENTS HAVE BEEN LOCATED,EXCEPT AS NOTED. Tiles oOFLOOD ZONE INFORMATION O Community Number Panel Number Suffix Date of Finn Index Firm Zone Base Flood Elev. 120650 0306 L 09-11-2009 X NONE O SOURCE ELEVATION PROVIDED BY COUNTY SURVEY DEPARMENT 22.20 Tiles RELATIVE TO MEAN SEA LEVEL NATIONAL GEODETIC VERTICAL DATUM OF 1929 O_ LOCATOR INDEX BENCHMARK NO. ELEVATION 7 COPYRIGHT ROBERTO BRIZUELA&ASSOCIATES,INC. (� y�2+ P.R.M:PERMANENT REFERENCE MONUMEMT U.E:UTILITY EASEMENT CS fQ� PCP,PERMANENT CONTROL POINT WF:WOOD FENCE Concrete f�e n fOC S.I.P.- SET IRON PIPE I?STAMPED R.- RECORD 10.00' L7.20' DrivewayN PIPE M.- MEASURE L1J _J `� v (Q FD.H:FOUND DRILL HOLE S.N.D.-SET NAIL&DISC STAMPED PIS. 25 OO' - , 0 Q J h Q S.D.H:SET DRILL HOLE F.N.D:FOUND NAIL&DISC CIL :CENTERLINE C.B.S.-CONCRETE BLOCK STRUCTURE J , O y / RES:RESIDENCE ENC.-ENCROACHMENT i - Q j a fq / L.F.E.-LOWEST FLOOR ELEVATION RNV.-RIGHT OF WAY One Story v _o 2.30' O N Q F.F.E.-F.F.E.-FINISH FLOOR ELEVATION CL-CLEAR I a C.L.F.CHAIN LINK FENCE CBS N I b o20, I xn 1 � 13.60' 10.00' 25.00 I � 7•9�, 1 ° 4° ROBERTO R. BRIZUELA &ASSOCIATES IHEREBY CERTIFY.THAT THE ATTACHEa'SKF CK OFFURVEY'OFTHE I 3 / ABOVE DESCRIBED PROPERTY IS CORRECT TO r M BEST OF MY KNOWLEDGE O N/L N N "2 GA t 19.00 N 9OO AND BELIEF AS RECENTLY SURVEYED UNDER MY DIRECTION,AND TW.T THERE ? 90 I Land Surveyors ARE NO ENCROACHMENTS OTHFR THAN THOSE SHOWN,AND MEETS TetE INTENT FN D.I.P.1/2" 82,70' OF THE MINIMUM TECHNICAL STANDAI'.DS SET FORTH BY THE FLORIDA BOARD OF LAND SURVEYORS IN CH1APTER 61 G 17 OF FI ORIDA ADMINISTRATNE CODE, I� PURSUANT TO SECTION 472:327 FLORIDA STA`,1TES. (NO ID) o F .I. OFFICE: 15' ALLEY (NO ID) 7319 WEST FLAGLER STREET JOB NUMBER- 13-06-115A FIELD BOOK: MIAMI,FLORIDA 33144 FIELDWORK DATE: 02-08-2014 TO R R - ELA NOTE:THIS SURVEY HAS BEEN PREPARED FOR EXCLUSIVE USE OF THE ENTITIES NAMED REVISIONS 1 UP DATE:02-1014 (!P7R0FESSION LANDSi1EYOR HEREON.THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. PHONE: (305)551 4393 REVISIONS 2• Vo.LOR FAX: (305)266-6112 REVISIONS 3' 4TC Or=FLORIDA ! ' Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 - - Tel:(305)795-2204 Fax:(305)756-8972 -7- INSPECTION LINE PHONE NUMBER:(305)762-4949 91 �� FBC 2Ok"4 BUILDING Master Permit No.1 A — OAS PERMIT APPLICATION Sub Permit No. LT�UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS HANGE OF ❑ CANCELLATION ❑ SHOP �qONTRACTOR DRAWINGS JOB ADDRESS: (V E 9 J� le@-'f City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: .1016 - bi R7 ( -16 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone:t%0A e- BFE: FFE: OWNER:Name(Fee Simple Titleholder): rA" 11' R4 rT%a Phone#: Address: 7 City: State: L Zip: �3 Tenant/Lessee Name: Phone#: 30,-, 30o• Email: CONTRACTOR:Company Name: � GYU Phone#: --M'j 970 `/7'17 Address: P Nul '67 Af/r Alb. A 01 City: u / State: �L Zip: 77 J/��• Qualifier Name: z'• Phone#: 3v z57 97® .4-r77 State Certification or Registration#: 1"57/0 777 Certificate of Competency#: q DESIGNER:Architect/Engineer: 2_ r` �- h o- �l �� "'` �e- Phone#: T-Cr6// 2O S e2e �(` IV Address: 3 j Vl0 26 9 � f $'r City: /�;aM,` �" St te• f/-Zip: ©5D� Value of Work for this Permit:$ / j ©® 0 Square/Linear Footage of Work: 5-;0'0 Type of Work: ❑ Addition ❑ Alteration Ei<ew ❑ Repair/Replace ❑ Demolition Description of Work: LQ i(ted and d oL)r cx td w 0A i n <<n-E ;1 r\ LIS �vn ® as . 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$ �I (Revised02/24/2014) f y 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 C Signature OWN or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument w` s acknowledged before me this day of 20 ( � by Z day of�1�T 20 by c, INS S � who is personally known to `"X who is personally known to me or who has produce L UUNVtL, me or who has produced as identification and who did take an oath. identification and who did take an oath. �ry NOTARY PUBLIC: NOTARY PUBLIC: " Sign: Sign: Print: Print: 9"� �-U 'S 1,O pub Notary Public State of ori a Seal: a Sindia My C mml ssle FF 156750 Seal: Mrlp� PAULA LUSS �Ao� Expires 09!03!2018 COA9MISSION#EE872528 t EXPIRES,FEB.09,2017 CWAPPROVED BY /v Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦ NORES SLi 3� ��► Miami shores Village logo � o Building Department L, aO �LORiDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.–RC-14-1383 Owner's Name (Fee Simple Title Holder): Robert&Rosalind Frame Phone#: 305 3021784 Owner's Address: 680 NE 97th Street City: Miami Shores State: Florida Zip Code: 33138 Job Address (Of where work is being done): 680 NE 97th Street City: Miami Shores State:—Florida Zip Code: 33138 Contractor's Company Name: Conwell&Associates Consulting Co. Phone#: 305-926-5673 Address: 11771 SW 137 Ave City: Miami State: FL Zip Code: 33186 Qualifier's Name : Kenneth F.Conwell Lic. Number: CGC1515386 Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: window blockage,window and door installation I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. 1 hold the Building Official and the nI res harmless of all le volvement. Signature Signatu ✓Owner or taknowledged Contractor or Architect The foregoing instrument before me The foregoing instrument was aknowledged before me this ®rdday of 69 ,2011�,by 65,AU S F2 this 20 y �1 r cij1"f L( Who is personally known to me or who has producedwho is ersonall kn a or who has produced t�L0i _ vis-N.9C._ as indentification. as indentification. Notary Publ Notary Public: Sign: Sign: l.0 �m�'Carolyn onwe Seal: Seal: __CommMon#EE840934 R, o,� Notary Public State of Floridan Expires Oct 07,2016 r° ^ Sindia Alvarez '° °F `� °�nu�or WWW.AARONNOTARxcom e My Commission FF 156750 NOFpp� Expires 09103!2018 Robert&Rosalind Frame 680 NE 97th Street Miami Shores, FL 33138 305 302 1784 Conwell&Associates Consulting Co. Attn: Kenneth F. Conwell 11771 SW 137th Place Miami, FL 33186 Date: July 14, 2015 RE: Master Permit RC-14-1383 680 NE 97th Street Mr. Conwell, My wife Rosalind and I have elected to go with another contractor for the work to be performed at the above address. Please sign and notarize the attached Change of Contractor form and return to the above address. A self-stamped envelope is enclosed. Please feel free to call me with any questions. Thank Yo , Robert Frame ♦,5NOR 93, Gl �a■ ® mn Miami shores Village y..— .� Building Department �LpR1"p 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. f: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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this tDro day of IG ) ,20T�2_. By C)9AU l,,P �� <<<=� who is personally known to me or has produced �, N kCl as identification. Notary: ��P e` Notary Public State of Florida y, ; Sindia Alvarez SEAL: �lp� , Expires 09/0312018 156750 VERSATILE STRUCTURE,INC Date: State of Q— County of \� Before me this da rsonally appeared �- who,being duly sworn,deposes and says: X 6 That he or she will be the only person working on the project located at: l D IAV'Ci q T S 6lC1rw� 5ho-e S J F"L. Sworn to(or affirmed)and subscribed before me this day of ' I " \3 20�s by Personally know OR Produced Identification �)(oXc� `-f 32 -)S S Type of Identification Produced Print,Type or Stamp Name of Notary ,�p�agYPp°e p, PAULA LUIS _COMMISSION#EE 872528 ;`�,• .•'EXPIRES: FEB.09,2017 •''4r`'� WWW.AARONNOTARY.com un,� IMG-6503.png 12/8/15 4:44 PM ' '2c ('4- 13U Ua4J10 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILI - DO NOT PAY k1LBT _/ 6801980 BUBINEBB NAME/LOCATION RECEIPT NO. EXPIRES VERSATILE STRUCTURE INC RENEWAL SEPTEMBER 30, 2016 8600 NW SOUTH RIVER DR STE 110 7078888 Must be dlsplaVnd dt pick#)of husinus.; MEDLEY FL 33166 PuiGudnt to(ounty Cudr Chaptur 8A-Art 9&10 OWNER BeC.TYPE OF BUSINESS VERSATILE STRUCTURE INC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR Workers) 1 CGC1518771 $7500 07/28/2015 CHECK)1-15-107395 This Lowl Bmilte se Tax Recorpt anly oonhann;paymorri al the local Busman Tax Thu Receipt to not o haonan. permll or•cordHaaBoa of Iho haldar s slHtcattom,ro da 6nsleaea Holder must comply with any governmental or aoagovarmaorNel regalaimy laws Imd roquircmaras which apply to the baMum. The RECEIPT NO.above mmit be displayed an all commercial vehicle--Mutmi-Bede Code Sac 80-276 Far=to lidwmolion,visit Imyw mtemtlladtl Sw/taxcellaslar For Information regarding Transfer NIAM of Business/Owner,please visit1=10 www.mlamidade gov/taxcollector/ PAID %am, F t P..nnit o271 Tax Collector 220 NW Irl Slteel Miami I I 111:11 004370 VERSATILE STRUCTURE INC JOEL L PEREZ FIRES 8600 NW SOUTH RIVER DR STE 110 MEDLEY FL 33166 =Ll�l—�;P1 ;�:�1E,E; Illlllllllllrllrll'III'111111'1111'I'I'I'lllllll"1'111"1111'111 about:blank Page 1 of 1 ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE(MNNIIDDIYYYY) 12/1/2015 ' 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 ceri flcate holder is an ADDITIONAL INSURED,the pollcy(les)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 certlficate does not confer rights to the certificate holder In lieu of such endomeme s. PRODUCER COt FACT Sentinel Casualty Insurance 09NNEa. . (877)408-9499 IFAX N (877)408-9498 P.O. BOX 551718 E41AILADDRESS: DISI B AFFORDING COVERAGE NA1C# Davie FL 33355 IISURERA:Arch Specialty Insurance Company 21199 INSURED INSURERS: VERSATILE STRUCTURE, INC INSURER C: 20 NN 87TH AVE INSURER D; A-218 INSURER E. ,MIAMI FL 33172 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1512100763 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 ASL JU POLICY NUMBER 00M'W;4FF POUCY'yr LI In's X COMMERCIAL GENERAL Lman-nY EACH OCCURRENCE $ 11000,000 A CLAIMS-MADE ❑X OCCURoAIANA E RENTED 100,000 PREMISES Ea r. n e $ eGL0023244-00 3/11/2015 3/11/2016 MED EXP(Any Ong persan) $ 10,000 PERSONAL&ADV INJURY $ 11000,000 GEN'LAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ja [:] LOC PRODUCTS-COMP/CW AGG $ 2,000,000 OTHER $ AUTOMOBILE Lu+BILRY �IacBIN® T $ sn ANY AUTO BODILY INJURY(Per person) $ SCHEDULED AUTO ALLOWN® O BODILY INJURY(Per accident) $ AUT HIRED AUTOS I�AUTOS NED PROPERTY DAMAGE $ AUTOS $ UMBRELLA L" UR EACH OCCURRENCE $ - EXCESS LIAR fS MADE AGGREGATE - $ -- DED RETENTION $ WORIMRS CONPENSAMON AND EI4PLOYOW LIABILITY YIN STATUTE _ - --- -- ANY PROPRIETORIPARTNERMWCUTNE E.L.EACH ACCIDENT $ OFFICEi1MEMBER EXCLUDED? N I A (Mandatory M NH) E.L.DISEASE-EA EMPLOYE $ If yes de�ribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCROPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AdOlonal Reffwft Solmdule,may be allwJwd If more space Is nequlmd) General Contractor. License CGC1518777. CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND. AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORS REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD IN8025(2o1a01) CR! -6- -1383 Oyu s y�� Miami Shores Village Perfi*Type Residelntial Construction 10050 N.E.2nd Avenue NE W m'Clascad6n.,Garage Enclosure Miami Shores,FL 33138-0000et Sfatr -ASE Phone: (305)795-2204 �'toRivt* , �, ;4112{)"15 Expiration: 10/03/2015 Project Address Parcel Number Applicant 680 NE 97 Street 1132060171610 Miami Shores, FL Block: Lot: ROSALINE FRAME Owner Information Address Phone Cell MROSALINE FRAME 680 NE 97 ST MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone $ 25,000.00 CONWELL&ASSOCIATES CONSULT (305)962-5673 (305)926-5673 Valuation: Total Sq Feet: 500 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Review Structural Date Denied: Review Structural Type of Construction:CONVERT TO CABANA WITH A NE Occupancy:Single Family Review Electrical Stories: 1 Exterior: Review Electrical Front Setback: Rear Setback: Review Electrical Left Setback: Right Setback: Review Electrical Bedrooms:3 Bathrooms:3 Review Planning Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Building Bond Return: Classification:Residential Review BuildingReview Mechanical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Mechanical Bond Type-Owners Bond $500.00 Review Mechanical CCFInvoice# RC-6-14-52097 Review Plumbing $15.00 06/27/2014 Check#:545 $200.00 $1,518.50 CO/CC Fee $50.00 Review Plumbing DBPR Fee $11.25 04/06/2015 Check#:295478 $ 1,518.50 $0.00 Review Plumbing DCA Fee $11.25 Bond#:2644 Education Surcharge $5.00 Permit Fee $750.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $40.00 Plan Review Fee(Engineer) $160.00 Scanning Fee $36.00 Technology Fee $20.00 Total: $1,718.50 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 AFFIP IT. I I at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an onirg. F thermore, I authorize the above-named contractor to do the work stated. April 06,2015 ffut-hityKized Sig ature:Owner / Applicant / Contractor / tAgent Date Building Department Copy April 06,2015 1