DEMO-15-2706 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-246416 Permit Number: DEMO-10-15-2706
Scheduled Inspection Date:April 04,2016 Permit Type: Demolition
Inspector. Perez,JanPierre
Inspection Type: Final
Owner: ARMSTRONG, MARVIN Work Classification: Mechanical
Job Address:138 NW 107 Street
Miami Shores,FL 33168- Phone Number
Parcel Number 1121360080200
Project: <NONE>
Contractor: AIROLOGY INC Phone: (754)366-5380
Building Department Comments
DEMOLITION MECHANICAL. 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
April 01,2016 For Inspections please call: (305)762-4949 Page 7 of 36
44
g Miami Shores Village
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138.0000
Phone: (305)795-2204 ° ����ME
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Expiration: 0911912016
Project Address Parcel Number Applicant
138 NW 107 Street 1121360080200
MARVIN ARMSTRONG
Miami Shores, FL 33168- Block: Lot:
Owner Information Address Phone Cell
MARVIN ARMSTRONG 138 NW 107 Street
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone Valuation: $ 250.00
AIROLOGY INC __ __ m.. (754)366-5380 a Total Sq Feet: 0
Type of Demo:Mechanical Available Inspections:
Additional Info:DEMOLITION MECHANICAL. Inspection Type:
Classification:Residential Final
Scanning:1 Review Mechanical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# DEMO-10-15-57532
DBPR Fee $2.00 03/23/2016 Credit Card $58.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 10/222015 Check#:2201 $50.00 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $108.60
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 a zoning. Futhermore,iIaauthorize the above-named contractor to do the work stated.
March 23,2016
ignature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 23,2016 1
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Miami Shores Village -- _ --- -
Building Department OCT 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 -
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC201 `��
BUILDING Master Permit No. 9—/57t-2 �
PERMIT APPLICATION Sub Permit No. nIE1W 15- c72�1G.6
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING 0 MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 138 NW 107th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 112136080200 Is the Building Historically Designated:Yes NO X
Occupancy Type: snEFa"nx Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):MARVIN ARMSTRONG Phone#:305 308 4250
Address:138 NW 107TH STREET
City: MIAMI SHORE State: FL Zip: 33168
Tenant/Lessee Name: Phone#:
Email: MARMST1312@AOL.COM
CONTRACTOR:Company Name: ftk X0 Phone#:CI%y
Addrress-eq�?'C)
City: State• _. Zip: 31�"
Qualifier Name: Phone#:
State Certification or Registration M t I<0 LO Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$250.00 Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Q Demolition
Description of Work: � 09 e4?gr 1~ A4"&t O '!'I LA-,o T
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ k.nCCF$ G '6d CO/CC$ OS
Scanning Fee$ 3 ` OZ) Radon Fee$ 6 , DBPR$c2 00 Notary$ Yj
Technology Fee$ . PJ�3 Training/Education Fee$o ' D�O Double Fee$
Structural Reviews$ Bond$ ��,
TOTAL FEE NOW DUE$ GC!! - GO
(Revised02/24/2014)
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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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspectio4will t beapprove and a rel on fee will be charged.
SignatSignature •
ttacknowledged
or AGENT CONTRACTOR
The for oing instrubefore me this The foregoing instrument was acknowledged before me this
day of 2� .20 ,by day of .20 by
who is personally known to tit f'-'-\ 12Jf;I�L7�. ho is personally known to
me or w ath s produce RL as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign. SignI&c-rz
Print Print: 12
�, .tMy COMMISS10tJ OP""468
Seal: •Infra 1111111ift Seal: EXPIRES Apra$..X017
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APPROVED BY Q Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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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 CERTIFICATn Vr jr4b mt; wM wor GOMMTUYB A CONT-RACT
REPt2ESENTATIVE.011 LRODUCE N.AN}? ME CEI;' TATE HOLDER.
IMPORTANT: if the tsertl holder is an ADDITIONAL INSURED,tho policy(les)must be andorsed. If SUBROGATION IS WAIVED,subject re the
t6rasa a„�r aetu sl,o of fllto E/011C;r�oKaln-pcNlClw rn�l�f ratpaim an s nnrwgprr a,N-•1. ,
certificato holder In lieu of such arrin,xR,ru!,d(s� _
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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NoraTLm-TnitMol x. YRFCtPR.FMFNT.NT. TFRM f1R S:SINnMnN SIF ANY coffmv 4R OTHER DQCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE it3c3ti
EXCLUSIONS AND CONDITIONS OF SUCH POOCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR AWLSU t?PF P
TYPE OF WWRANCE CY ARBER W= 0M LIMITS
OBN6RAL UwLM EACH OCCURRENCE $1,000,90
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X COMMERCIAL GENEIM LIABILITYPREGAISEB E9 2&=2r=*) $100,000
CLAIMS-MADE FRI OCCUR .7.111 MED EXP(AM am P°von} $5.0w
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GENMRALAGGREGATE $ 1,000,000
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10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES,FL 33138 AUTHORIQR MWO NTATAN
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dj988-Z010 ACORD CORPORATION. All rights rwarved.
ACORD 215(2910106) The ACORD name and logo ara registered marks of ACORD
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954-797-6061
admin@airologyac.com
October 21, 2015
State of Florida
County of Broward
Before me on this day personally appeared Kimroy Turner(Airology)who, being duly sworn
deposes and say that he will be the only person working on the project located at 138 NW 107''
Street Miami Shores,FL. 33168. Sworn to(or affirmed)and subscribed before me this 21'day
of October, 2015,by person.
k`.
Personally know
OR Produced Identification_
Type of Identification Produced
SIMO MANSOR
•! MY COMMISSION#FF006468
�e o del EXPIRES April 9.2017
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{407)39&Ot53 Horklallot Semice.com
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Print,
ZPrint,Type,or Stamp Name of Notary
www.afrologyac.com
Iasi 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' Com ensation Insurance Exem tion
IT,
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 CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
er
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of 0 � 201r
By //UI� �
who is personally known to me �produc
Z— as identification.
Notary:_(QY- � C 4�irll2
SEAL.
My Coaam.EWbes Feb 17,2019
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