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RF-16-444 Inspection Worksheet Miami Shores Village +' 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-253168 Permit Number: RF-2-16444 Scheduled Inspection Date: March 08,2016 . Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Roof Owner: RUARK,JOHN Work Classification: Repair Roof Job Address:9909 NE 4 Avenue Road Miami Shores, FL Phone Number (410)610-2148 Parcel Number 1132060171310 Project <NONE> Contractor. JOHN BUSTA ROOFING INC Phone: (305)219-9699 Building Department Comments REPAIR AROUND PLUMBING VENT PIPE 2nd STORY Infractio Passed Con►ments SOUTH SIDE INSPECTOR COMMENTS False Inspector Com men Passed � e � 3 Failed (64C Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 07,2016 For Inspections please call: (305)762-4949 Page 24 of 44 C I VI I. Ro��gE e�rng Corp. 2370 Southwest 123 'Avenue Miami,Florida.33175-1174 Tel:305-823-8008/305-397-6414 ENGINEER Fax:305-823-3300/305-884-8834 Website:www reilehengineering.com March 7,2016 John Busta Roofing 300 Northeast 91 Street Miami Shores,Florida 33138-3130 Project: ROOF TELE UPLIFT TEST REPORT Residential Home 9909 Northeast 4 Avenue Miami,Florida Information provided by client: Permit Number: RF21044 Date Completion: March 2,2016 Roofing Contractor: John Busta Roofing Project Number: 16-0231 (Testing Laboratory Certificate#11-0715.04) Dear Sirs; In accordance with your request and authorization, a representative of Reileh Engineering Corporation completed the Roof Tile Uplift Test at the above referenced project. This testing was performed in general accordance with Roofing Application Standard TAS No.106 -- Standard procedure for field verification of the bonding of mortar or adhesive set tile system and mechanically attached,rigid,discontinuous roof systems. The total of the tested roof surface area was less than 10000 square feet,and the mean height of the roof is less than 40 feet above ground surface. The type of tile used for this project was reported to be concretelclay Roof Tile. This the was reported to have been foamed in place. At the time of our inspection,the entire area of the roof was examined for loose tiles. Not less than one(1)tile in ten(10)of all components in the field area and one(1)the in five(5)of all tiles in the perimeter and comer areas were physically examined. A minimum of one(1)test per every two(2) squares in the field, one (1)test per square in the perimeter area,ridge caps and(1) in the comer areas were conducted. guar t ,t`euS;we ��� CCa1jatif the ref teI e v �r neet�'t�etesta�ec�uire�nen��������+ �tc�tied prpto�ol attached I` ` ` � ' C«r,. Gi ' - rt /yr�.■��w Tp ''S'..rt+��5� wp hers ��S - ��� ; �. ���.,b:..,-�r�is:+..us�..?•.�t. ...c. _.�bi�..._ .,max..,..,_ ;.�-� Reileh Engineering Corporation appreciates the opportunity of assisting you in this project. If you have any questions or if we may be of further assistance, please do not hesitate to contact the undersigned. Respectfully submitted; Reileh Engineering Corporation r- MA= ad Sonny Salleh,P.E.49014 Project Manager THX UIPI T TESD Residential Home 9909 Northeast 4 Avenue Miami,Florida Reileh Engineering Corporation—Project Number-16-0231—Page 2 of 3 • Report of TILE UPLIFT TEST for Residential Home 9909 Northeast 4 Avenue Miami,Florida Project Number: 16-0231 N. dHa s01- t ,' u , t idoi �" r f , .ialVtuft 1 35 Pass 2 35 Pass 3 35 Pass 4 35 Pass Test 1-4 Field Reileh Engineering Corporation—Project Number-16-0231—Page 3 of 3 B' � 2 4 b NAV OF 11;51' mlammk a 0 5F O la9a CAr S5r LOCA11ON FEW m 4 COUR - 0 5F _ / ��77 COUP � - 0 t'I;�IM�11;i21715fMa,a¢ V L MNOM5 00%1�e 16-024 Lf Va CAP - 0 COUR MA- VX 5' AI'f'f2OX,WOF 11;51'IAGA11ON5 MV f71NMION5 r, Miami Shores Village 4 ? uC 10050 N.E.2nd Avenue NE 5 Miami Shores,FL 33138-0000 ` Phone: (305)795-2204 ��aa r ,,.. .yi , •...r , >u y Expiration: 08/2212016 Project Address Parcel Number Applicant 9909 NE 4 Avenue Road 1132060171310 Miami Shores, FL Block: Lot: JOHN RUARK Owner Information Address Phone Cell JOHN RUARK 9909 NE 4 Avenue Road (410)610-2148 MIAMI SHORES FL 33138- 9909 NE 4 Avenue Road MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 1,800.00 JOHN BUSTA ROOFING INC (305)219-9699 Valuation: -.-- �_-- Total Sq Feet: 96 Type of Work:Repair Available Inspections: Additional Info:REPAIR AROUND PLUMBING VENT PIPE 2n Inspection Type: Classification:Residential Roof Repair Scanning:3 Final Roof Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# RF-2-16-58728 $2'00 02/24/2016 Credit Card $66.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 02/182016 Credit Card $50.00 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 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,I authorize the ab ov ntra or to do the work stated. February 24,2016 Authorized Signature:Owner / Applicant r Contractor / Agent Date Building Department Copy February 24,2016 1 '4�EF CERTIFICATE OF LIABILITY INSURANCE M 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 CONSTTI`UTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHIOR12ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(hm)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A anent on this certificate does not confer rights to the certificate holder in Iheu of such mndorseatent(s). PRODUCER OAME:ONTEr N Southeast Insurance Agency PHONE (954)660-2255 FAX N,), (954)680-3208 50018 University Drive Suite K iffilase smoeasthmran@bellsouM.net Davie,FL 33328 AFFORDING COVERAGE N=s Phone (954)680-2255 Fox (954)680-3208 I R A: ARCH SPECIALTY INSURANCE COMPANY INSURED DOURER B JOHN BUSTA ROOFING INC. INSURER C: 300 NE 91 Street INSURER 0: Miami Shores,FL 33138 (305)219-9699 INSURER E 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. NOTWnIWANDING 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. 1LNSADDLSUBR TRR TYPE OF INSURANCE am WID POLICY NUMBER Y EFF POLICY EXP Lem GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,000.00 RENTED 0 COMMERCIAL GENERAL LIABILITY PREMISES Ea owunwwa $ 100,000•00 ❑ ❑ CLAIMS-MADE © OCCUR AGL0022583-01 MED EXP(Any one Person $ 10,000.00 A F] 02202016 02120/2017 PERSONAL&ADV KIURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LNC EOMBDDt INGLE LIMB ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per awklent $ ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AUTOS �PER)Y,DAMAGE $ ❑ ❑ �� $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LYAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION s $ WOR(ERS COM PENSRTION ❑WC STATU-LIMITS ❑OTH AND EMPLOYERS'LIABRnY Y/N ER ANY PROPRIEfOR/PARTNEROMCUTIVE E.L.EACH ACCDENT $ FFI InNN) EXCLUDED? ❑ N/A yyeess E.L.DISEASE-EA EMPLOYE $ DESG�RIPTION OF descrbe OPERATIONS bebw EL DISEASE-POLICY LIMIT $ DFSCRlP7WN OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AdMonal Remarks Schedule,I nwre spme Is requireM CONTRACTORS LICENSE If CCC-058048 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE POLICIES;BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVENUE MIAMI SHORES,FL 33138-2382 AUTHORIZED REPRESENTATIVE MASSIMO PULCINI ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(21111041M OF The ACORD tame anti logo are registered nurlre of ACORD \0 Miami Shores Village g f�lc� S�' Building Department FEB 1 8 2016. 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tei:(305)795-2204 Fax:(305)756-8972 INSPECrION UNE PHONE NUMBER:(305)762-4949 19K FSC 201 IN BUILDING Master Permit No. t r- 444 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC 0 ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL f-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS:9909 NE 4th. Avenue Road City; Miami Shores County Miami Dade Zip: 33(3 Fatio/Parcef#.11-3206-017-1310 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: SFE: FFE: /I .John W Ruark 410-610-2148 OWNER:Name(Fee$impie Titleholder): Phone#: Address:9909 NE 4th. Avenue Road City: Miami Shores state: Florida zip: 33138-2439 Tenant/Lessee Name: n!a Phone#:n/a Email:lruark10@gm�il.com CONTRACTOR:Company Name: John Busta Roofing Inc. Phone#: 305-219-9699 Address: 300 NE 91 Street Cm,: Miami Shores Sate: Florida Zip: 33138-3130 Qualifier Name: John Robert Busta Phone#: 305-219-9699 State Certification or Registration#: CCC-058048 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$$1800.00 Square/Linear Footage of Work: 96 S.F. Type of Work.: ❑ Addition ❑ Alteration ❑ New FBI Repair/Replace ❑ Demolition Description of Work. Repair around plumbing vent pipe 2nd. story southside Specify color of color thru tile: Submittal Fee$ Permit Fee$ l(n' C)3_ CCF$ co/cc$ ( _ Scanning Fee$ ` � Radon Fee$ ` '30DBPR$ G -(k Notary$� Technology Fee$ 1 . 15; Training/Education Fee$ a ' 46 Double Fee$ CJ3 Structural Reviews$ d Bond$ TOTAL FEE NOW DUE$ Gro ' -2u) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 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 Signatu OWNER or AGENT CONTRACTOR The fo�ggoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this {� IL of 20 by day ofb''7't a � ,20 by Qan IL av'k wdo is sonally known o Ty h n who is Orsonally known me or who has produced as me or who has produced as identification and who did take an oath. Identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: U} n:Si � ' g Print: � ''1o��'cc � Lk S Print: QC.nCkVex GC Seat: Seal: SAAmAt81BUST "•, SAAiDRAI tSMA Iff f ff 1%120 L' MY "#FF 159120 t-XME&Sepletst 14.205 IQfi. EXPIRES: 14,220 s .ae s�e�rasss:::: :*sssss::ss+s::.. . APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 44 1 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES F F 1 E FEB Is tote F/orlda B Ing Co is 5th Edition(2014) BY• 1 High-Velocity Hurricane Zone Uniform Permit Application Form. 1 COPY 1 Section A(General Information) 1 1 Master Permit No. Process No. 1 Contractor's n q 1 Job Address I �� / /�� q4w, !"��t V5, 1 ROOF CATEGORY 1 1 0 Low Slope ❑ Mechanically Fastened Tile- ❑ Mortar/Adhesive Set Tiles 1 0 Asphaltic Shingles ❑ Metal Panel/Shingles ❑ Wood Shingles/Shaket 1 O Prescriptive BUR-RAS 150 1 ROOF TYPE 1 ❑ New roof i Repair ❑ Maintenance ❑ Reroofing ❑ Recovering 1 ROOF SYSTEM INFORMATION 1 Low Slope Roof Area(SF) Steep Sloped Roof AREA(SSF) Total(SF) 9tol 1 1 i Section B(Roof Plan) 1 Sketch Roof Plan:Illudtrate all levels and sections, roof drains,scuppers,overflow scuppers and overflow drains. Include dimen- sions of sections and levels,dearly Identify dimensions of elevated pressure zones and location of parapets. 1 D C: ® o �' 1 M rn 1 z O 0 0 v 1 r R m = 1 M — 1 m 1 Z 1 .. . 1 • 1 1 . 1 >ARZA 49Fke ;R- FLORIDA BUILDING CODE—BUILDING,6th EDITION(20114) : : . ; • : : 15.37 1 1 ` Copyright to,or licensed by ICC(ALL RIt"M RESERVA)i 4"EBV Palaiio o�dre 1610151032:12 AM p=mt to Lianas Agreement.No further repradaatorte authorized. • ••• • • AW co SECTION 1524 HIGH VELOCITY HURRICANE ZONES—REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope.As it pertains to the section,it is the responsibility of roofing contractor to provide the owner with the required roofing permit,and to explain to the owner the content of the section.The provisions of Section R4402 govern the minimum requirements and standards of the industry for roofing system installations.Additionally,the following items should be addressed as part of the agreement between the owner ant the contractor.The owner's initial in the designated space indicates that the item has been explained. 2Renailing wood decks:When replacing roofing,the existing wood roof deck may have to Zbe renai accordance with the current provisions of Section R4403.(The roof deck is usually concealed prior to removing the existing roof system). 4. Exposed Ceiling:Exposed,open beam ceilings are where the underside of the roof decking can be from below.The owner may wish to maintain the architectural ap °therefore, roofing nail penetration of the underside of the decking may not be acceptable:T maintains provides the opts of the ra ng appea nk:e. 6. _Overflow scuppers(wall outlets):It is required that rainwater flows off so that the roof is not overloaded from a buildup of water.Perimeter/edge wall or other roof extension may block this discharge if overflow scupperswall outlets ( )are not provided.It may be necessary to install overflow scu in rdance with the u' nts of Sections R4402,R4403 and R4413. Owner/Agent's Signature Date Contractor Signature Date 1 Property Address Permit Number Revised on MM LD;07/01/2015; Miami shores Village Building Department 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of .20116 By who ispersonally knowif nx;o*1%*d1kiM g J05� *0 04 00: •• as identification. tN 00 wimmmsm % WC048=1 #FF== SEAL: W%j EXPWAM 80pumber A gms W, MiamishoresVillage � soon • °� Building Department , 10050 N.E.2nd Avenue R Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department Date:0.2-OF 10050 NE 2nd Ave Miami Shores, Fl 33138 Re: Owner's Name- 'R Property Address:0?a9 AE'I' -IX ; Roofing Permit Number: Dear Building Official: 4yek certify that I am not required to retrofit the roof to wall connections of my building because: o The just valuation for the structure for purpose of ad valorem taxation is less than$300,000.00. Please attach proof of ad valorem taxation. g The building was constructed in compliance with the provisions of the Florida Building Code(FBC)or with the provisions of 1994 edi ' f South Florida Bu' ode(1994 SFBC) Signature Print Name State of Florida County of Dade Y• 0•0 0 • The undersigned, being the first duly swom,deposes and says that he/shc!is tttf♦o r?oj*ebbe property mentioned. 00-- Sworn to and subscribed before me this -171A day of Notary Public, Sate of Florida at Large 'C' ; o When the just valuation of the structure for purpose of ad valorern taxation is equal to or more000.00.OW the • 0 liir�vuas t>Qt constructed with FBC nor a 1994 SFBC.Then you must provide a building application from a General contractor for the Roof to Wali coareoiH a ra"_ •i• i• •• • • •Soo ••••i Revlsed on 5/2112009 2/16/2016 Property Search Application-Miami-Dade County r Aerial Photography 60ft Featured Online Tools Comparable Sales Glossary Non-Ad Valorem Assessments PA Additional Online Tools Property Record Cards Property Search Help Property Taxes Report Discrepancies Report Homestead Fraud Tax Comparison Tax Estimator TRIM Notice Value Adjustment Board AWSSMENT INFORMATION Year 2015 2014 2013 Land Value $356,269 $312,313 $276,455 Building Value $485,708 $481,164 $487,413 Extra Feature Value $29,686 $29,989 $30,291 Market Value $871,663 $823,466 $794,159 Assessed Value $370,934 $367,991 $362,553 TAXABLE VALUE INFORMATION 2015 2014 2013 COUNTY Exemption Value $50,000 $50,000 $50,000 Taxable Value $320,934 $317,991 $312,553 SCHOOL BOARD p •• ••• • ; :$P ,b 500 $25,000 Exemption Value $25,000' '.; � � �' Taxable Value $345,934 � '• • $3429.1. $337,553 CITY • .•. Exemption Value $50,0N :. • ••• : 45Q,e)o0: $50,000 Taxable Value $320,934 $317,991 • $312,553 http://www.miamidade.gov/propertyse,archl#/ ' 318