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RF-16-466 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253274 Permit Number: RF-2-16-466 Scheduled Inspection Date: February 26,2016 Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Roof Owner: SHEA, SEAN Work Classification: Repair Roof Job Address: 1053 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132060143600 Project: <NONE> Contractor: SEGARRA ROOFING INC Phone: (305)822-7541 Building Department Comments TILE REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 25,2016 For Inspections please call: (305)762-4949 Page 15 of 33 sNO1S o, Miami Shores Village " PBmlJt T} i Rif 10050 N.E.2nd Avenue NE � 6 � work C/ass ak4i:R+F3pajr Roof Miami Shores,FL 33138-0000 v Per�rt�tatu� p"E A` Phone: (305)795 2204 Issue` a :2/2 2t 16 Expiration: 08/22/2016 Project Address Parcel Number Applicant 1053 NE 95 Street 1132060143600 Miami Shores, FL Block: Lot: SEAN SHEA Owner Information Address Phone Cell SEAN SHEA 1053 NE 95 ST MIAMI FL 33138-2547 Contractor(s) Phone Cell Phone Valuation: $ 950.00 SEGARRA ROOFING INC (305)822-7541 Total Sq Feet: 25 Type of Work:Repair Available Inspections: Additional Info: Inspection Type: Classification:Residential Roof Repair Scanning:3 Final Roof Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoke# RF-2-16-58751 $2.00 02/19/2016 Check#:16460 $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 02/24/2016 Credit Card $64.60 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology,Fee $0.80 Total• $114.60 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 zoning. Futhermore authorize the above-named contractor to do the work stated. February 24, 2016 Authorized Signature:Owner lr Applicant / Contractor / Agent Date Building Department Copy February 24,2016 1 Miami Shores village VBD Building Department 20% 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 FES 1 g Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 ��e FBC 20 IA BUILDING Permit No. y PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: 1053 NE 95 ST 2 City: Miami Shores County: Miami Dade Zip: Foho/Parcel#: 11-3206-0143200 Is the Building Historically Designated:Yes NO X Flood Zone: OWNER:Name(Fee Simple Titleholder):Sean Shea Phone#:I ` Cl�_��C"7 Address:1053 NE 95 ST City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:Jegarra Roofing Inc Phone#: 305- '8`)-�-j-5Q2, Address: 7175 W 4 Ct City: Hialeah Stats: Florida zip: 33014 Qualifier Name: Manue egarra Phone#: State Certification or Registration#: RCA024333 Certificate of Competency#: 000014509 Contact Phone#: 786-712-6458 Email Address: MARYP411 @GMAIL.COM DESIGNER:ArchitecdEngineer: Phone#: value of Work for this Permit:$950.00 Square/Linear Footage of Work: 25 SQ FEET Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition ri 'on of Work: Tile Repair _ Submittal Fee$150 Permit Fee$ I CCF$ O CO/CC$ ri Scanning Fee$ 9 Radon Fee$ DBPR$ Bond$ Notary z Training/Education Fee$ Technology Fee$ C) Double Fee$ Structural Review$ (oq -G6 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: 1 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 MPROVEMENTS 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 cin estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will he delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must he posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice. the inspection will not he app ed and a reinspection fee will be charged. `- � � Signature Si a gnature a Owner or Agent Contrador The foregoing instrument was acknowledged before me this The foregoing' stry t,,was ac M ow e g e,fi1eis ,�!rlr , o ' day of ,20 by A �- day of ot�6y , 4' n '� PA Com r j 8 who is personally known to me or who has produced who is person .y �r�11 mOr;w$o has producetuU& As identification and who o do oath. NOTA PUB ,a�O pRV PUgli MARY Hq E ffio NOTARY Notary Public -State of"Florida `QE My Comm.Expires May 11,2018 Sign: —Commission#FF 121661 Sign: Print: ' pmt My Co ssion Expires: My Commission Ex ires: APPROVED BY ° Plans Examiner Zoning Structural Review Clerk iF mow Sam gem - AAAaIF 5. RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION,,INDUSTRY LICENSING BOARD. RCA024333 The ROOFING CONTRACTOR 3 Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2017 ^ . (INDIVIDUAL MUST MEET ALL LQ.;. IC SING REQUIREMENTS PRIOR TOn IN ANYAREA ) SEGARRA, MANUEL ' Q' '■� SEGARRA ROOFING INO 7175 W 4TH CT HIALEAH IMR- _._ ---- ---=-��' `' (�;� - Wit•, � /� � ISSUED: 07/2&2015 DISPLAY AS REQUIRED BY LAW SEQ# L1507260000666 OaX7Y Local Busi ness Tax mei pt Miami-Dade County, State of Florida -THIS IS NOTA BILL-DO NOT PAY � I _ BT 578592 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES SEGARRA ROOFING INC RENEWAL 7175 W 4 CT 578592 SEPTEMBER 30, 2016 HIALEAH, FL 33014 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS pAYM ENT RECEIVED SEGARRA ROOFING INC 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 08/26/2015 Worker(s) 10 0OW14509 0235-15-005938 This Intal Busirms Tax Pecdpt cNy cmh"mhs payment of the Local Business Tax.The Receipt is rot a license, permit ora Gerd"cation of the holdeesquali"cations,to do business.Holder mat comply with any governmental ornongovermrs M regLdatorylawsarxlrequUei.m, whichappytothebusiness. The RECBPTNQ above mast be displayed on all comae ial vehicles-Miami-Dade Code Sec 8a-276. Formoreinf ., cn,visitwww.rriamidadaagMghZcdlector Municipal Contractor's Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL-DO NOT PAY CC NO: 000014509 X BUSINESS NANIE&OCATION SEGARRA ROOFING INC RECEIPT NO. EXPIRES HIAL w 4EAH,FL L 33014 7470525 SEPTEMBER 309 2016 MAL Pursuant to County Code Sac 10-24 OWNER TYPE OF BUSINESS SEGARRA ROOFING INC SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR 175.00 08/26/2015 0235-15-005938 This receipt Is not valid in the following Mmrinipallties Ar Miami Gardam,Miami Lakes,Palmet0o g emacs,Dmal,Blaleab,Key Biscayne, MIAM ay.Pineere4 Sunny Istes Bea Toxin of Co ler Bay. � for more infamhatan,visit From SmartMail Fax Tue Feb 16 13 :50: 15 2016 Page 1 of 1 SEGR001 OP ID:KM A�O-RU~ CERTIFICATE OF LIABILITY INSURANCE T21161 016 02!1612016 THIS CERTIFICATE 1S 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 certificate holder Is an ADDITIONAL INSURED,the policy(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 certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT J.W.Edens&Company 'PHo .-- -- FAX -- Commercial ins of Brevard Inc (A/c,Nor. 325 Fifth Avenue,Suite 10i EMAq DRE. Indialantic,FL 32903 — — Scott M.Steels,AA1 INSUR2(81 AFFORDING•COVE IAGE NAIL 0 _ INSURER A:A IS Surplus Ins.Co. 26620 INSURED 3egerra Roofing Inc. INSURERS; Mrs.Segarra _ tNsu 7176 West 4th Court n c:. Hialeah,FL 33014 asurtER o INSURERE: INSURER 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. ILTRNR TYPE OF INSURANCE A D UB — POUCV NUMBER gP110r/LIICY F POLICY ERP '--'--- LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300,08 A X COMMERCIAL GENERAL LLABILITY -FLGLN01698AX 06/30/2015 06/3012016 Tt@NTEo -' CLAIMS-MADE I X.00CUR I i PREtaIiSESSEa $ 60100 _ _— I MED EXP(Any one eraonl s 5,00 PERSONAL&ADV INJURY $ -- 300,00 ---------......._---- i AG TRALAGGREGATE $ 600,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG $ 300,00 - i X POLICY JECT PRO 1 LOC $ AUTOMOBILE UABIUTY CO WED$INflLE LIMIT (Ea accMenll — ANY AUTO ii BODILY INJURY(Per Person) $ ALL OWNED AUTOSBODILY INJURYP SCHEDULED _-... AUTOS AUTOS ( er accident) $ FTROPEFII Y - HIRED AUTOS AUTOS i PET2 C N $ I ( I UMBRELLA LIAR I OCCUR I i EAGi_OC_CU_RRENCE S EXCESS LIAO CLAIMS-MADE I AGGREGATE S - — DF.O :RETENTION$ $ WORKERS COMPENSATIONi VdC STATU 9TH-� AND EMPLOYERS'LIABILITY —_....... ............_ ANY PROPRIETORIPARTNERIEXECUTIVE YIN E L l3ACH ACCIDENT $ OFFICERIMEMBER EXCLUDED) NIA I( atory In i ±E.L.DISEASE-EA EMPLOYEEI$ l a ItMyyeadeagoder 1 E.L.DISEASE-POLICY LIMIT $ DESGIRIPTIN OF OPERATIONS below t i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 10i,A"ttonal Remarks SchadWs,U more apace Is requtred) Manuel Segarra License li RCA024333 CERTIFICATE HOLDER CANCELLATION MIAMISV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WDLL BE DELIVERED IN g Inspection Departmenet WITH TH THE POLICY PROVISIONS. 10060 NE 2nd Ave AUTTH,ONZ.E.D REPRESENTATIVE Miami Shores,FL 33138 �/�� �� \D's." ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD Date CERTIFICATE OF LIABILITY INSURANCE 2/4/2016 producer: Plymouth Insurance Agency Tills 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 afibrded by the policies below. (727)938-5562 1 Insurers Affording Coverage NAIC# Insured. South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurers: 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 indicatedNotwithstanding 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. 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 reined premises(EA Claims Made ❑ Occur occurrence) Med Exp .neral aggregate limit applies per: Personal Adv injury General Aggregate Policy ®Project ❑ LOC Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2016 01/01/2017 X we Statu- OTH- Employers'Liability I tory Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,ow,ow excluded? NO E.L.Disease-Ea Employee 1 $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Otter Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/Locatlons/Vehicles/Exciusions added by EndomementfSpecial Provisions: Client ID: 92-67-125 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Segarra Roofing,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL Coverage 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 02-04-18(TLD) Begin Date i s oris CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date theref,the issuing insurer will endeavor to mail 30 days written notice to the certficate holder named to the left,but failure to BUILDING INSPECTION DIVISION do so shall impose no obligation or liability of any kind upon the insurer,its agents or re presentatives. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 �� _a r i!S f X11 'Ii - t!' !1 Io'ml -Iff 01 \, \ y ` / � r e.r -� I rill!iii■sii■iilaislsiiia■m■■iiiaaa■■laatiif711faisliiisii■asllaiiiasi■alliai filiiiil■■illi■■■■illi■sliiailsilaiia■iiiiia■1611!!GC��-"=-_^-"'--- --���lil Ills[71li1■liiaafi7ililiaaillaililiill■ii■illTil■l■lli■iiEiiilil�iYl■illill i■ Ililaliif7■■Bili!■i■■isailliall■■■a■■!ala■sii■ill■1■■ilsPlliilii■■1■s■■slaii Ill■■■111■■1■soli■li■i■1■il■■■li■■!■lilR■lislls111Ranal i1s111ilialrlT■■■sin rlisa7aaiailaalisisiiitaiiis■iii■!hili■liiiri7iiisaaalil 7iialllsiaRiiiisii rsaaiiialsiaaliliii■iliiataiaiii■alssallas■illi!tas■aslisliliilillallills■1)al Illilii,laiasiirfiilllliiraaalailalllaliifiai■saiiiiaiaia!:'aliiilialiislililal Iliiill1111i1ii■lililiiliiililiilllliil■cilliiii......�r�:t1■iillliillil■ill if Ilaiiilialililils[s■sillasa!■illalilaiaaliaiGaaaaas[aiiiJaalsaaiaaiittlaalrii Iiia■■aialilliiiiii■i■sl■7ilaailiisaallassill!Mo laliiaiiliilasisiill■liiirrli Illi■■iii■■siia■iiaarlaislrlllal1:Bilis■■las!■sairillirlsillirHailiiiia!!i■ fiaaaillaaaa7lisaa'lilliiillii0aliaillsa■illi!isiiiiisi■sililillsli1111aa1a111 tillali■iiialilail■alis■i7aiaiials7aiiliiiai9i■aiial>aiiiialfiaall7a#lllaii H rli■titiiitliiiliiiiiiilliiiii�l��sau�fiti�f<�iiiiillii■ii711itliiiilllil■ill ii /liillillaisilsii■1liisiiill■lilEiaas■■Ill■■■■al■■■■slas■i1i1■s1■ilii!■■■111 it Iii■tilll1171!hili■fililiimanA liiifili■!i■�iililillilillililllfiiiflltil ■; l■■■ilii!ailiiiss11ii1aUilslilSilaiiiiasliilai■■aliUii■lllllilafililarli� i■ rsaaillR■■iii■!sa■■111i1■li7ilialrl■Qis■■s■lilrsi■■1■■1Rtliaaa��O�rrr�ssgral i7 it■■illas■1■llllsla■■■lillll[■l]■1■lHalE N l■lisa■ss)s airaasa■ia■1t■■1■■L11 Isiiariiiialililli7lalllia■sl■1`iliiissiii■ililtX■L%iiiic�ailiilisailaasalal�ili (ialiiailliaiaiai[ll[■11111!!al�iii■■■iiali■illi.liTli■�i7,A[I11111ii1i1Tii)i1i■ riilaliliaaai■illi!■al■ailiisai ■11[filiiil■■■i1iaIllafaLa r1a1711irllaililili rliaailiaiaa■Iii■aliilills!aiirlii■illalii■Iialltl(llaail�lsiiailaiii■sriisl!■ Islitliriiii7■alliliasil■iPc..■.aailiaal7■■iiiiii�`_�lrii3saiaiasaa■saiailsl a■ lisaaataia■■■liiiafaiiiiliilliiallaliiaalsailaaiiy►1t'.11�airaiilaiiaaliiiiraai {faasa■■iatairilaiasariasiifiaarifisaa■s7aiiiiia■17!SliYiaslialilfil■[fil■lil■■ iiMass*sl■■ialiiisillaliili ■■ililiaitils7■lilV!�iiiailll■ii■■ialillli■iii I7[11Li1C1Caa�7liil"Siliii!!!r■�■17111111■■iiiiaili�♦\■iilliQiiail1i1i17s7aili IliiC■t'iCl�a❑liailialiii■■7!■111i�liiiitalial11i11,:111'a■)1■ilii?aR■x111111■!al liIlI. 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