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CC-15-2052 >r Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-256808 Permit Number: CC-8-15-2052 Scheduled Inspection Date:April 19,2016 Permit Type: Commercial Construction Inspector: Naranjo, Ismael Inspection Type: Final Owner: PARDO,ROSEMARY Work Classification: Repair Job Address:1280 NE 105 Street Miami Shores,FL 33138- Phone Number (305)219-3762 Parcel Number 1122320270120 Project: <NONE> Contractor: CIMAG CONSTRUCTION INC Phone: (786)385-4410 Building Department Comments REPLACE THE DRYWALL CEILING THAT FELL DOWN. Infractio Passed Comments INSPECTOR COMMENTS False UNIT 8 02-16-2016 1. QUALIFIER FOR CIMAG CONSTRUCTION, INC. NEEDS TO SCHEDULE A MEETING WITH THE BUILDING OFFICIAL. Inspector Comments Passed E�r CREATED AS REINSPECTION FOR INSP-241394. BY IVAN CASTRO f9 Failed c� Correction a �� Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 18,2016 For Inspections please call: (305)762-4949 Page 14 of 25 cs — M5Z ENGINEER INSPECTION LETTER FERMIN MARTINEZ STRUCTURAL ENGINEER P.E.19363 7590 S.W.WO STREET.SUITE#12o MIAMI,FLORIDA 33143 PH:(3o5)296-3216. I Date:February 26,2016. To:Miami Shores Village. 10050 N.E.2nd Avenue Miami Shores,Fl.33138 RE:Inspection of Drywall. Permit Number:CC-8-15-2052 Property address:1280 NE 105 Street.Miami Shores.Fl.33138, Owner(s):Rosemary Pardo. Contractor:CIMAGnCo staruction.Inc. Gentlemen: I,Fermin Martinez,a registered Professional Engineer in the State of Florida, PE No.19 363,do hereby certify that I have personally inspected the property located at the above address. The purpose of this inspection is to evaluate the attachments of the drywall in a residential unit,in an area where a repair work was done.This repair area is approximately of 10 ft x 8 R,and it is located in the ceiling of the living room.This inspection is solely and exclusively in reference to this area. I find that the fasteners used for the attachment of the gypsum board to the framing members are spaced at 6 inches maximum on center to all supports,and not more than 3/8 inch from the edges and ends of the gypsum board;with 1-5/8 in.Bugle-head Coarse Thread sharp point drywall screws. Based on my visual examination,it is my professional opinion that the gypsum board attachments,at the inspected area,are in compliance with the section 2508.5 of the F.B.C.- Building, .B.C:Building,2014 edition. �oo���elel►�eooi Sincerely, e��� I� .• LIC °.• rn Engineer's Signa P.E.Stamv/date. °•A ° °• A ° °m°.®.•• ®ate Qelag -----------------------------------------------------� . . m t. STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTCONSTRUCTI S MY UEMPTIM4 e 'ER'nF t A OF ELEC=*717 fRW fLO ADA tEil[E mzms EFFEC'nVE DAM WON,' RsoCASMO S SiN SS NAME AND � CIMAG CONSTRUCTION INC ' E 6037 SW 16 ST MIAMI .. 33155 B,e E COPES OFjsuSttjESS OR TPA � � � �v���: . x » -«»rwv� - © �z ° » ~ � � .��d? . . \ . \������ < . . . �r. > . < � . . :.:� a . . . rm� ._ . y :\� ����y � . . . � ����+. < �\�/<\ . � \ ` \ � l � ^ \ �ƒ � � � � f ,j< � . . . . .p a>. � � .>. : . ; » < »1:?\ ��d . . , : . � � . . . � < 6�» . . - ; . ' : � � , � . y. . �»^ � { ' [ . ©� . :� . ^ : , 2�` � � � \ � � � \ > �2° �» I ( , � ��\. � � � �� � � .��d» � . \ � » '� ?z ww�� . � ���r . , . ya,�y: : . � � . . a -:��» . . . . . - ,. � ©©w�m� a �4< � � ����« �« / ���w© . . < � . �\ � \ / � . /« � \ � \ � . � . . � \ : \ ` i �� � . . \ � � :�\ � \�\ /. } \ � ` � ° . y . I \ �� . _ . . . �. . . . . . ... . . . . —��_.__.�.�.. . . . . . �. . � . . . . . . . . . . � Rim # - r- Miami Shores VillageC � 9R� - Building Department FZP2 2 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 1 D BUILDING Master Permit No.CC-8-15 - Z052 PERMIT APPLICATION Sub Permit No. MBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION V?r'EENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:1280 b i DS G"t�r AA. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): c�/h7 O rw el ab jfAr LLG phone#:rI'86'360-J X33 Address: 1.20 /UtC 10 S* S rlrel City:1"L/AA41=Ck,01e_C State: FL Zip: 3?/3 8 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: %;T` G Phone#:? 6— 1-7_441 b Address: 1607 City: State: `} Zip: Qualifier Name:. Layw^j �S�"r,r� Phone#: 206- State 06State Certification or Registration M eQC- i f'2 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State Zip: Value of Work for this Permit:$ Square/Linear-Footage of Work: Type of Work: E] Addition [-IAlterationElU New Repair/Replace ❑ Demolition Description of Work: R8 w 1 a, cz-- 0!" �1a4t,t. Specify c olor-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) f e' 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: 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 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 Signature OWNER or AGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was ack owledged before me this day of r-;-br.,aver 20 1t ,by day of 201 .by &y,Nd .who is personally known to T, Ta^c� ,who is personally known to me or who has produced 14 DAW f-S UC-04-t as or who has produced -- -7 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTAR UBLIQ Sign Sign: Print: h �o�ItY�ci Print: rN,"� �'z MM iism Seal: Seal: EXPIRES:Apra 15,2019 "r JUM D.GWIA , , B=WTWNo*PWftU0dvwhN IN •i IN COW SM#FF 933 of EXPIRES:October 20,2019 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) I 02/22/2016 To:the Village of Miami Shores From: Ivan Castro CIMAG Construction Inc. CGC1514312 To whom may concern;I'm Ivan Castro president of CIMAG Construction Inc. CGC1514312 request an extension for permit No.CC-8-15-2052 At property located at 1280 NE 105 street Apt 8,Miami Shores the reason we need more time is to obtain a report from and engineer in order to close the permit Thanks Ivan Castro I l� v\ 02 \* Miami Shores Villager=i - lop Building Department AUG 2015 Y. 1,(Ih 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 LB : A Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 20j i-I BUILDING Master Permit No c S 2® � PERMIT APPLICATION Sub Permit No. LRfiINLDING ❑ ELECTRIC ❑ ROOFING ❑REVISION ❑ EXTENSION ❑RENEWAL [—]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1.2,8o AZP l oS S7/'e:'P7 " L/N!7 6 City Miami Shores County Miami Dade zip: Folio/Parcel#: L 1-2 2 3 2 O 2.17-o 11 o is the Building Historically Designated:Yes No Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 'OWNER:Name(Fee Simple Titleholder): GA91 _r&S f Prone#: .35a - 331- 4149 Address: City: State Zip: Tenant/Lessee Name: Phone#: Email: 1 CONTRACTOR:Company Name: 6� N` `d ��/G� ()C,� Phone#: � nL% Address: sw 1( S f Z 33t5� city: r�QiT M C AM t State: `� Zip: Qualifier Name: =VA&I GA6 rte^ 0 �I Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit:$ 7=M' . Square/Umar of Work: Type of Work: F] Addition F1 Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: �r & :VW =!4 t�Ac& L' tcrI zlG'l 'f"-�8-1- T39& poLyej. Specify color of color thm tile: Submittal Fee$ '01 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) , 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. 1 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 issin t absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signat Signature OWNER or AGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was ack wledged before me this Zvi, day of Su►1a, ,20 e5 ,by 13'� day of V V 20 /S�- ,by —C'mr,4 U19 TOSI ,who is personally known to 1-194&yis-h) _ ,who is personally known to me or who has produced 5L. bL !�YQ 0110'?111 as me or who has produced -fQ-C_as 5. 2- ' �-,e J-W,2pIR identification and who did take an oath. identification and who d d to a oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si Print• SMerl: Print: v Seal: Notary Public Seal: Iry'Ppk +rN 9 Nht:".6 p tll: 1�' � �✓,a or►I State of Florida �•.N .# UPI /116 APPROVED BY lS Plans Examiner Zoning Structural Review Clerk (Rev1sed02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY 777 STATE Of MO. " DE!_ ENl",kiUSIARSS,ANtd.-nWvi IL 1514312 - £ENERAL CONTRACTOR , `ter below IS CERTIFIED- the the Orovis'rom of Chapter 48M. lion deter-AUG 31;W16 GASTRO-,- ,* CIMAP.C r 603?.SV11" °' • ISSUED: 07/30/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407300001763 G M ti 004165 i-Dada County, THIS IS NOTA OWL ' F NOWIC 64 52 Si 3316 OWN SEC. OP +t UCTION INC_ 9! GE RAL BP vn0ew c 1 CGC15 2 R TAX 5.0 28/2 ECK 5=15 This Leoal Bushmo T Bene in Buslaess Tax.The bade s Hal to tdhme 'The RECEIPT NO.abdve aaau 6e on all les Fw aprie bdoa, .Mdwrmiamidade i(�il „,� a:, ti ' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDIYYYY) 08/12/2015 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 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 NAME: MARIA CUERVO REGO Alhambra Insurance Agency PHONE (305)774-9210 ac No): (786)803-8463 4757 SW 8th StreetLADDRESS; alhambrainsuranceagency@gmaii.com Miami,FL 33134 INSU S AFFORDING COVERAGE NAIC# Phone (305)774-9210 Fax (786)803_-_8463_ INSURER A: UNITED SPECIALTY INS/SEC UNDERWRITING _ INSURED INSURERS: CIMAG CONSTRUCTION INC INSURERC: 6037 SW 16 ST INSURER D: INSURER E: MIAMI FL 33155 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 SU3JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I WyD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGES( RENTED PREMISES Ea occurrence) $ 1,000,000.00 A ❑ ❑ CLAIMS-MADE [ OCCUR SII I O03BI7110 08/11/2015 08/11/2016 MED EXP(Any one person) $ 5,000.00 ❑ PERSCNALBADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 El POLICY ❑ PRO El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �Ea a_ccident ❑ ANY AUTO BODIL''INJURY(Per person) $ ALL OWNED SCHEDULED BOD10 INJURY(Per accident] $ ❑ AUTOS ❑ AUTOS NON-OWNED PROPi tTY DAMAGE ❑ HIRED AUTOS ❑ AUTOS _LPcr ac dent $ ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AG_GRt GATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ SER ❑OTH- AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A -- (Mandatory yesin NH) E I..DI'SASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below rr ASE-POLICY LIMIT $ I i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DES(-,R1 ;ED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES THE EXPIRATION DATE THEREOF.NO T.ICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES VILLAGE FL 33138 YELISA MEDEROS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101)QF The ACORD name a nd logo are registered marks of ACORD .EFF ATWATOt ' CHISF FD ANCIAL OFF"M STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "•CERTIFICATE OF ELECTION TO IM:EXEMPT FROM FLORIDA Yom'COMPENSATION LAW*• CONSTRUCTION INDUSTRY EXEMPTION This colfin that the indhridtml Noted bW=has abed to be exempt from Fbdde Workers'ComWWWW law. EFFECTIVE DATE: 3d3=14 EXPIRATION DATE: 3/222016 PERSON: CASTRO IVAN B FEST: 280580237 BUSINESS NAME AND ADDRESS: CIMAG CONSTRUCTION INC 6037 SW 16 STREET MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pumwtto Chaow440.05(141 M.an offim ofaoa1 11, vWsofdecbAmmrtFor r►inmtthis byfWMaomiMatsofefturXWO&seattonnW not rttaover tlaMo or aartpmtsOm taw Oft dopter.Puratterttto Chaptm'440.06(13).F.8.,Cardnodw of ern to be eoam pL-aWy oidy wNh ft aoope atthe bt dnas or omb itded an the notice of ehmtlon to be mwnpL Ptsatwd to Chsptsr440.0ff(13j F.S.,NoVemofab abaft to be,,,,, and of deftn to be mmem;#shag be subjW f o irAcadmt ff at aryr ftw a16rft tft of the rtottce or#w hmd free ofthe ami,the pmeon rtartted on"t r o m or amti8oets no k ftw meets the requUmrtenffi of Gds s,,,do for haum ae of a IM Is The deperbttmd sW revd%a omN Ie at eny t m tbrflttte of the peraart rtmtted onft cmtUicats to nmmtUte rtmtt of this septi m DFS-F24*%C-2S2 CERTIFICATE OF ELECT=TO BE EXEMPT REVISED 07-12 QUESTK*W(880)41&16W 1 � Date: State offer d� County of g Before me this day personally appearedgVA",& C4qJW-0 who,being duly sworn,deposes and says: That he or she will be the only person working on the project located at: 17/Ar114 J�o�)Zc-;r PI&II960 Sworn to(or affirmed)and subscribed before me this .W day of 14lGte I� .20 !J;by Personally know roduc�d I cation T of Identification �?4 ,OA4�0Z- ZC4-5-04- 6 or Stamp Name of Notary FERENC SOCS! NOTARY PUBUC STATE OF FLORIDA . Comm#FF136794 Expires 70"18 f���fs��'i�"" �fi_ _ms µ,,,q..fi �`�.^✓-'i u`y �- t OF CIMAC Constnuch®n Inc. CGC#1514312 r � f W ? { x _ x e za f R Miami shores Village Building Department ��tlRhll 14050 N.E.2nd Avenue li mrW Shores, FbrWa 33138 Tel: (345)795.2204 Fax: (305)756.8972 Notice to Owner®Workers' Compensation Insurance Exam tion Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in tlu:coastruc tan ice+to exempt themselves from this requirement for any const tion project prior to obtaining a building permit. 1Rnsuaut-to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the duction inky who eToys one or more or full-tune employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited habildy cry (LLC) in the aonsirucbm m&XWY may elect to W exempt& 1. The officer owns at least 10 percent t of the stock of the corporation,or in the case of an LLC,a statement attesting to the min 10 percent owrans , 2. The officer is listed as an officer of tie corporatkin,in the records of tie Florida Depaitoent of Stats,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Departnient of State,Division of Corporations. No more than three ciaponde officers per corporation or hinded Habrh'ty.company members are allowed to be exempt. Construc6m 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 wear ibis workers'clan exemption and has acknowledge that he or she will not use day labor,part time employees or saw for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to wink on your projea In theme circumstances,M ma Shoties Vilkp does not rete verification of workers'compensation hastaance coverage from the conttactor's company for day labor,part-time employees or subcontractors. BY SIGNING BE Low YOU ACKNOVniMM THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. S Owner State of FlorWa County ofMiami-Dade tl^ The f was acknowledge me this day of t, ,2{i B who is personally known to me or has produced Y `!I•!�L- �C✓ d as identification. Notary: bdRoa SEAL: 'AoP n == i n . 1280 1 VE 105th St 8 1411111 Allied Buildinq ins ecti n Services Inspections .Testing. Engineenng August 3, 2015 Building Official City of Miami Shores 10050 NE 2 Ave Miami Shores Village FL 33138 RE: Structural Building Inspection SUBJ: 1280 NE 105th St, Miami Shores FL 33138(Unit 8) Folio: 11-2232-027-0120 The undersigned states the following: 9 I am a Florida registered professional engineer with an active license. Ori July 29"', 2015, i inspected the above referenced residential building unit and determined the following: 1. The,living room ceiling finish has collapsed, including drywall lath a nd plaster, falling to the tiled concrete floor below. 2. As a result, said unit has been deemed unsafe for occupancy by Ismael Naranjo of the Miami Shores Village building department since July 27th, 2015. 3. All affected ceiling materials have been removed from the unit and remaining portion of the ceiling is firmly affixed thereto. 4. Structural framing supporting ceiling is substantially intact and require no repair. Please allow this letter to serve as my certification of the above noted subject properly as being structurally sound and suitable for continued occupancy on ceiling is repaired by duly licensed professionals. Nil I'-W,Sir, Ilion!. ihiri:kt .1'LiO 224- •'" ' R ® 1260 NE 105M St 6 i Allied Buildinq Inspection Services °e7spections .Testing, Engineering As a routine matter, in order to avoid possible misunderstanding, nothing in this report should be construed directly or indirectly as a guarantee for any portion of the structure. To the best of my knowledge and ability, this report represents an accurate appraisal of the present condition of the building. Sincerely, , Ir . Alliec}= ` tion'Services, Inc. I ,J�� ..-,� re y Miami Shores Village E 10050 N.E.2nd Avenue NE r . .... . Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration:02/22/2016 Project Address Parcel Number Applicant 1280 NE 105 Street 1122320270120 COUNTRY CLUB VILLAS OF MIS Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell COUNTRY CLUB VILLAS OF MIAMI 1280 NE 105 Street (305)219-3762 - ---- - MIAMI SHORES FL 33138- 2135 ARCH CREEK Drive MIAMI FL 33181- Contractor(s) Phone Cell Phone Valuation: $ 700.00 CIMAG CONSTRUCTION INC (786)385-4410 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Review Building Type of Construction:REPLACE THE DRYWALL CEILING Occupancy Load: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Plans Submitted:No Certification Status: Certification Date: Additional Info: Bond Retum: Classification:Commercial Scannin :3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# CC-8-15-56712 DBPR Fee $2.25 08/14/2015 Credit Card $50.00 $115.10 DCA Fee $2.25 Education Surcharge $0.20 08/26/2015 Credit Card $115.10 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 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 accurat an at all work wil be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contract o do t work s August 26,2015 Authorized Signature:Owner / Applicant / Contractor / Agenta e Building Department Copy August 26,2015 1