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DGT-15-3152 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-255288 PermitNumber: DGT-12-154152 Scheduled Inspection Date: March 23,2016 Permit Type: Decks/Gazebos/Trellises Inspector: Rodriguez,Jorge Inspection Type: Final Owner: LEDESMA, MARCOS Work Classification: Pergola Job Address:46 NE 93 Street Miami Shores, FL 33138- Phone Number (305)495-8880 Parcel Number 1132060130190 Project: <NONE> Contractor: ARCHADECK OF MIAMI Phone: (305)424-1314 Building Department Comments INSTALL ONE PRESSURE TREATED WOOD PERGOLA IPassed Comments INSPECTOR CTOR COMMENTS False TO BE ATTACHED TO THE MAIN HOUSE. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-255129. No permit on site Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 22,2016 For Inspections please call: (305)762-4949 page 24 of 34 i Miami Shores Village Building Department RED 18 toll 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 -1 BUILDING Master Permit No.DGT-12-15-3152 PERMIT APPLICATION Sub Permit No. ®BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS © CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS; 46 NE 93rd St, Miami Shores, FL 33138 City Miami Shores County Miami Dade Zia• dip/pa 1132060130190 Is the Building Historically Designated:Yes No NO OccupancyType: Res Load: 15 PSF Construction Type: Flood Zone: X BFE: -9999 FFE: OWNER:Name(Fee Simple Titleholder):Marcos Ledesma and Silvana Far Phone#:305-495-8880 Address:46 NE 93rd St may; Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: marcos.r.ledesma@hotmail.com CONTRACTOR:Company Name: Archadeck of Miami Phone#: 305-424-1314 Address: 1325 NW 93rd Ct.#B113 City: Doral state: FL Zip; 33172 Qualifier Name: Marta Quinone? Phone#: 305-424-1314 State Certification or Registration#: CGC1523952 Certificate of Competency#: DESIGNER:Architect/Engineer: Barry Mullin Phone#: 786-646-2344 Address:8181 NW 154th Street, Suite 247 aty: Miami Lakes State: FL Zip; 33016 Value of Work for this Permit:$13,340.00 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition Description of Wo& Install one 27'x13'3" Pressure Treated Wood Pergola Specify color of color thru We: Submittal Fee$ Permit Fee$ CCF$ CA/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RevL%ed02/24/2014) 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$25W,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 flrst 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 rfpecdon fee will be charged. Signature Signature r OWNE or AGE CONTRACTOR The foregoing instrunt was acknowledg before me this The foregoing instrument was acknowledged before me this day of =aril .20 r(O ,by day of FIFO F ecl ,20 1(e ,by JI lY ir—A TM_( ,who is personally known to I4TTWA 1 • 0 J iNVA)k-Z ,who is personally known to Wr who has produced as me or who has produced iV UrtA2 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC. Sign: (_)P9;q . Sign: Print: me ibQ Print: CLIO ; -!OFF"S ridaSeal: roti;::».e� LIMAR,(yamSeal: 201eIwIY�i#FF 18p78 5MY COM. EXPOS(art 20t9 + NAW.BOIIM�NiIit # # l APPROVED BY i Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami ,shores Village Building Department I�R I OOSO N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795.2204 Fam(305)756.8972 CHANGE OF CONTRACTOR/ARCHITECT Permit N.DGT-12-15-3152 Owner's Name(Fee Simple Tide Holder):Ma's Ledesma and Silvana Far Phone#:305-495-8880 Owner's Address: 46 NE 93rd St City: Miami Shores State: FL Zip Code:33138 Job Address(Of where work is being done):46 NE 93rd St City: Miami Shores State:—Florida Zip Code:33138 Contractor's Company Name: Archadeck of Miami phone#:305-424-1314 Address: 1325 NW 93rd Ct.#8113 City: Doral State:FL Zip Code:33172 Qualifier's Name: Alkedo UOP Lic. Number: CGC1522202 Architect/ Engineer of Record Name: Barry Mullin Phone#:786-646'2344 Address. 8181 NW 154th Street, Suite 247 City: Miami Lakes State: FL 7jp Code: 33016 Describe Work Install one 27x1313"Pressure Treated Wood Pergola 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 Mi ' Shores harmless of all legal i volvement. :7 Signature Signature 0,,W Corina or Ardnkm The foroing instrument was aknowledged before me The for r instrument !::0 The before me this 1 I 'day of bru0 20 6,by Si I YtNL� this ay of 201(&y Who is personally known to me or who has produced who is personally known to me has produced . as indentification. vP as Wentifka tion. Notary Notary Publ N Public Sign: Sign: ROW ACOSTA Seal: Seal: Pulft-State of FAft WMA Ft.M&M Mf Com.Eon 8eP21,2018 * MAY COMBVQSSIOPI#FF IM Commisew#ff 181488 EXPIRES:Ift 12,2019 MNitaryIm ��'�o*F��r B�adTlauelN�rYBM�es STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 01523952 The GENFRAL CONTRACTOR ftmed below IS CERTIFIED ttiv, the,;pravis sns of Chapter 489 FS. Extratlon date: AUG l;2i)16 QUINONEZ, MARTA I, ARCI-IAD CIC OF MIA I • 1325 NW 93 CE3kJ [ 110 3 - _F ISSUED: OMS/2016 `` wDIS0L.AYASRECQuIR Q BY LAW SEQ# t166ii6000528 Local Business Tax Receipt Miami-Dade County,State of Florida -THIS 1S NOT A BILL-00 NOT PAY LHT' 7170273 BUSINESS NANIE&OCATION RECEIPT NO. EXPIRES ARCHADECK OF MIAMI RENEWAL SEPTEMBER 30, 2416 1325 NW 93 CT B113 7449081 Must be displayed at place of business DORAL,FL 33172 Pursuant to County Code Chapter 8A-Art.9&10 oWNER SEC.TYPE OP BUSINESS EIVED DECKS DOCKS&BEYOND LLC 196 GENERAL BUILDING PAYMENT COLLECTOR MARTA I QUINONEZ,QUALIFIER CONTRACTOR 54.00 12t04f2015 Worker(S) 1 CGC1623952 CREDITCARD-16-013371 This kcal BasiasssTax fieceip aat canfirms wimew ofthe tmai Business Tax.The Recap S nota licease, paras ora cediftaties. d 6 hatdar's qualillcakiw4 to do busiItess.Hohler mom awn*With aapcovanmtental rel r�ntatary h a tacairearetNs Whish eppiF to dta bashmm The T NO.ahs man be dbptqW an all commercial vehicles-gni-Dade GWe Sea 9a-M wals for mare laftm Him,AM -1 least ACVK/JP DATE(MMMONYYY) CERTIFICATE OF LIABILITY INSURANCE 2/10/2016 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 certificate holder is an ADDITIONAL INSURED,the poiicypes)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 Coastal Insurance Group PHONE 305-887-5999 FAX 305-887-7809 150 Westward Drive Miami Springs FL 33166-1660 E-MAIL ,cig@coastalinsgroup.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:SCottsdale Insurance Company 15580 INSURED DECKS-1 INSURER 13: Decks,Docks&Beyond LLC INSURER C: DBA Archadeck of Miami 1325 NW 93rd Court Suite 8113 INSURER D: Doral FL 33172 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:726852992 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LT INSD POLICY NUMBER DJYYYY) (MMIDDLYYYYJ LIMA A X COMMERCIAL GENERAL LIABILITY CPS2307073 10/13/2015 10/13/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X1 OCCUR DAMAGE T RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY D JECT El LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ AUTOMOBILE LIABILITY I I I $ a accident ANY AUTO BODILY INJURY(Per person) $ AAULLI QVSIMED AUUHrEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPER DAMAGE AUTOS Per aooide $ UMBRF1 IA UA13 HOCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space M required) General Building Contractor,License#CGC1523952 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 2/10/2016 Producer. Plymouth Insurance Agency This Certlflrate is rued as a matter of Information only and confers no 2739 U.S. Highway 19 N. rights upon the Certify Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer s: 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. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate may be rued 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 Damagento ce)rented premises(EA Claims Made 11 Occur Mad Exp snared 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/l1MBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2016 01/01/2017 X I WC Statu- OTH- Employers'Liability tory 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/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 92-69-165 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Decks,Docks&Beyond,LLC DBA Archmleck Of Miami 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: MARTA I.QUINONEZ LICENSE#CGC 1523952 AS QUALIFIER.ISSUE 02-10-16(TLD) In Data 2 2 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 left,but failure to do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138