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DGT-15-2805 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, Fl- Phone: LPhone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-257822 Permit Number: DGT-11-15-2805 Scheduled Inspection Date: May 02,2016 Permit Type: Decks/GazebosJTrellises Inspector: Naranjo, Ismael Inspection Type: Final Owner: CONIGLIARO, MICHELE MARIE Work Classification: Deck -Wood Job Address:489 NE 95 Street Miami Shores, FL 33138- Phone Number (305)793-3955 Parcel Number 1132060140640 Project: <NONE> Contractor: COSTA SOL CONSTRUCTIpN INC Phone: (305)345-3747 Building Department Comments REPLACE WOOD DECK WITH NEW Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-247184. Provide guard rails on Ed� the section of deck with a drop greater than 30"and provide handrail on one side of the stairs. Failed S "o Correction ❑ � b Se, ,_ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 29,2016 For Inspections please call: (305)762-4949 Page 20 of 25 Miami Shores Village 10050 N.E.2nd Avenue NE 'I Miami Shores,FL 33138-0000 Phone: (305)795-2204 W ,r Expiration: 02812016 Project Address Parcel Number Applicant 489 NE 96 Street 1132060140640 MICHELE MARIE CONIGLIARO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MICHELE MARIE CONIGLIARO 489 NE 95 Street (305)793-3955 MIAMI SHORES FL 33138- 489 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 5,000.00 COSTA SOL CONSTRUCTION INC (305)345-3747 ,�.... ...�._._�.,µ._� _-....-_...• Total Sq Feet: 312 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type Const:Wood Deck Additional Info:REPLACE WOOD DECK WITH NEW Framing in Progress Classification:Residential Scanning:1 Review Planning Scanning:1_ Review Planning Review Structural Review Structural Review Building Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# DGT-11-15-57652 DBPR Fee $2.30 11/03/2015 Credit Card $50.00 $364.60 DCA Fee $2.30 Education Surcharge $1.00 04/01/2016 Credit Card $364.60 $0.00 Permit Fee $153.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $4.00 Total: $414.60 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 foregojigLinformation is accurate and that all work will be done in compliance with all applicable laws regulating construction a zoning. Futh re,I authoriz a ab a-named contractor to d e work stated. April 01,2016 Authorized Signature:Owner / Applicant / Con ra or / Agent Date Building Department Copy April 01,2016 1 . 51Miami Shores Village EBY:G07raUC( Building Department10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fwc(305)756-8972 WEVECFION LH E P (30S)762-+4949 FBC 201 Lj BUILDING MasW PenMato. b6T- t&- 2g®� PEMIT APPLICATION �t ft. ZB-UILDING ❑ELEURIC ❑ ROOFING ❑ RIEVWN ❑OMNSKM ❑RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBM WORKS ❑GIANGE OF ❑CANCELIATION ❑SHOP Q �-�'j CONTRACTOR DRAWINGS JOB ADDRESS., 4f39 UC_- � c JZl��., City- Rami Shores County: Wand Dade 7P: Follo/Parcel#: b the Building Histericaft Yes NO Occupancy Type: I T pe: ,,, ,,,u�__ }} /nFlo,w Zone: 6FE: FFE: OWNER:Name(Fee Simple Tdleholder): IU.L w� NAH�N lJ /l o Phone#: 3c}S 7R3- 9SJ Address , • �q liq t SI! S—N .A City: IUMMI 53bte57 State: f Tp• �_�� Tenant/Lessee Nares 04 Phonel#., Email: AlC5(d'I�Le'. (r_U 4ay (�? f�MAI L-Cp!6d CONTRACTOR:Company Nature.C�,�A_ cvw Address: 11(D4 15w 2A<`* W &A 9 clty: &MEn3mb State: - Zip: !0& Qualifier Name: dwko, /+��Y 1�12IE�U State Certificateon or Registration 6,-: �tA-� I SQ 40 Certificate of CwWelency# " DESIGNER:Arrcchitect/Engiru er. INI�(JaWI. $. (� i Phone# c-2 Address: E3R2.1 SW 181 sT SM Crit': N[16M 1 State:I Z:�(o'T Value of Work for this Perm($ �� �— Square rof Work 12- Type of Work: ❑ Addition ❑ aeration El Nen► Repawlteplace El Demolition Descdptlon of work 2jET4*Cj9 W-0-00 '�;,r ,(,C to ("q-A N Cith J . .e specify c—PW . .. t 4 VItb��,Wb! fl6idZt71lif ei�. C� qpw df. ,o',•' �» �^,e� (h a d•f.A:'A Ifrtnc► 1 iU�t 8ka9 i� Submittal L., V94.1 Fee$ Fee$ 'a . > DBPR$ Notary$ Technology Fee$ T Fee$ Dom fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 13Z4- r6o (ReAsedO2/24/2(114) Bonding Company's Name(if ) p , 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 oertii0'y that no work or installation has commenced prior to the issuance of a permit and drat all work vA be performed to meet the standards of al laws regulating construction in this jurisdiction. 1 understand that a separate permit must be secured for ELECTRO, 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 Amlicant: As a condition to the issuance of a fmddwg pennk with ari esfim&ed voice amwdirw$250,the applicant must promise in good faith that a oar a,f the notice of commencement and aonstruttian Men law brae wff be wed to the person whose property is subject to attachment Also,a certified copy of the recorded notice of cmnmenc+ement must be paAed at the job site for the first inspecbm which oracrirs seven(7)days after Use bugcgng permit is issuedIn.the abseirre of such pasted notice, the inspection will not be armed and a reinspection fee wffl be charged. , Signature Suture OWNER or AGENT CDNTRACTOII The foregoing instrument was acknowledged before me this The foregoing instrument was a edged before me this !y day of .ZQ by day of Zo ,by k.MM bx31W1A11O_.who is personally known to ab" id"Ji personally known to .Me orwho has produced as nw or whohm.praduced. as identiflcafia d' n oa identification and who di a NOTARY U IN=OTAf9Y Sign: Sign: PrintANDREW J.1.09WATRFAN Print: Seal: = Seal: �` Nc-State of Florida _• Cwfskin rt FF 231096. ' Illy Com. Jyf 1,30 9 6blMlblf APPROVED BY Plans Examiner 3 i! Zoning i ,SNORES �M Miami shores V Building Department � rR� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE" D. COPY OF WORKERS COMPENSATION INSURANCE' (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE' E. COPY OF WORKERS COMPENSATION INSURANCE" (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) !YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:�OR r-kx� Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. hP c LvkV ••rrrrrarrarrrrrrarrrrrrrrrrrararrrrrrarrarrrarararrrrrrrrrrraarrrrrrarrarrrrraarrarraaara. BUSINESS NAME: �� �� -0,0 ✓ Rt &`h'0 liu BUSINESS ADDRESS: L o &x jy'' CITY >T& 4 STAT L.el—ZIP . 1:�'3 7_ BUSINESS PHONE: 3{ C T! 6 3 I y -7 FAX NUMBER CELL PHONE ( 0 ) ' ��'"� �11� QUALIFIER'S NAME: )U4444�)-LZ QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 REYNA RODRIGUEZ, OONA F COSTA SOL CONSTRUCTION, INC. PO BOX 331 IMMOKALEE FL 34143 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CGC1505876 ISSUED: 08/14/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more Information CERTIFIED GENERAL�N f TOR about our divisions and the regulations that impact you,subscribe REYNA RODRIO)bjifil. to department newsletters and learn more about the Departments COSTA SOL CONSTRUCTION, INC. initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you getter so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date:AUG 31,2016 L1408140001t184 `t aur`a-i, wu:J:>ks't.�a-r: hr..✓s'k»�+u`s . ......- `.tea'.>..;i.a..<«��. _.,u..-- ,.. DETACH HERE _-.......-.-___.-.....-__-........_. KEN LAWSON,SECRETARY RICK SCOTT,GOVERNOR STATE OF FLORIDA - ',. ma DEPARTMENT O BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1505876 : The GENERAL CONTRACTOR `> Namedbelow IS CERTIFIED Under the provisions of Chapter 489 FS. . Expiration date: AUG 31,2016 REYNA RODRIGUEZ, OON OL CONSTRU �t� C COSTA ` X\ 17624 SW 245 T9 R _ w .. HOMESW 0 Local 0.0s o"$Tax 8 itipt Miami-t)adeCbunty.State of FloridaLBT THIS($Nf77A BI6l �N0T PAY.`. BLiSIWBss N/iaA§!L OOA iv RECEIPT NO. E/�P� GS " Casra$ot coNSTRUC710IN RENEWAL SEPTEMBER � ��16 INC aiivaat L dtspuoyed.atpiadeof dray DOING BUSINES$JNDADE Pursu(jirttoCaumy'Code COUNTY Chapter 8A—Art 9&W " OWNER SEC_TYPE OF BUSINESS•; PAYMENT RECEIVED COSTA SOL CONSTRUCTION INC 196 GENECiAI.Bt)ILDINf3 BY TAX CCL:LEMR CONTRADI CfR 82.50 10/29/2015 Workers) .2. CGC1505876 0223-16-Oi48 This Lad Bnsi M Tax o*aoa8-M-13 ddm Local BaaioassTwL ThwBeeeW is toot a Aoense patmil,oractlaaeffkelde�sgaalgons to•do6 BotderoaaacomplyerftkaaygovaaareDtBt a regglgiawsaad wktehe�mthe6�la�s.. TAe PrB0.aboirsQ 6e OaaN'6MINIeebtclas -i le Cob SecBa-276.. . ftm m mormadom ais& ; i 11/022/15 CERTIFICATE OF LIABILITY INSURANCE DATE YY) 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 pollcy(les)must be endorsed. If SUBROGATION 13 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: Merilin Ruiz Preferred Insurance Advisors,Inc. PHONE (305)698-9880 FA.No: (305)698-5756 8000 Governor Square Blvd Ste 106 ADDRESS. mruiz@preferredinsuranceadv.com Miami Lakes,FL 33018 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)698-9880 Fax (305)698-5756 INSURERA: GRANADA INSURANCE COMPANY 16870 INSURED INSURER B Costa Sol Construction INSURER C: P.O BOX 1769 INSURER D: Homestead,FL 33090 (786)226-7849 INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F 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. ILTRR TYPE OF INSURANCE INSR ADDL WVD BR POLICPOLICY NUMBER MMIDOY EFF MPOM�LICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000-00 PREMISES Ea occurrence $ A ❑ F-1CLAIMS-MADE0 N 01/31/2015 01/31/2016 OCCUR 0185FL00033424 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY �MeBINd Dt INGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL T�OWNED ❑ SCHEDULED AUTOS ABODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ NON NED PROPERTY DAMAGE $ 1:1❑ r a ddeenn $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATU- 1:1OTH- AND EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El f A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yyea describe under DES6RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space is required) CGC1505876 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg.Dept. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)OF The ACORD name and logo are registered marks of ACORD .� WE JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 11/2/2015 EXPIRATION DATE: 11/1/2017 PERSON: REYNA-RODRIGUEZ OONA F FEIN:• 592322164 BUSINESS NAME AND ADDRESS: COSTA SOL CONSTRUCTION INC. 161 THORNTON AV LEHIGH FL 33974 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL MASONRY NOC WALLBOARD,SHEETROC PAINTING NOC&SHOP CONTRACTOR K,DRYWALL, P OPERATIONS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the Ming of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Miami Shores Village Building Department tpR1pA 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: Owne State of Florida County of Miami-Dade The foregoing was acknowledge before me this 92 day of No\KM?)2y- ,20 1 By VlUt(k W m Gu A 9-p who is personally known to me or has produced �` CF,N S-1; as identification. Notary: SEAL: i4c ary Public State of Florida Sindia Atvarez a My Commission FF 156750 OF 4� State of Florida County of Dade Before me this day personally appeared Ernesto Rodriguez who is beim,sworn,deposes and says That he or she will be the only one working on the project located at 499 NE 95 Street. Swornto{or affirmed}and subscribed before me this_,,.' day ofd,2Qs by Penally Known Or Produced Identification Type Of Identification nt,t to N Y e c(! Lary 44 ah 1111111111111111 � .. R o,•,; Y E S 0 a Z g Notary Public Statr of�torida £a* = My Comm.fxptres ncr 3,2017 1 Z Commission#FF 059.45 � 11111111111111111111 111111111111 � � 1111111111111111111111111111111111 � C CERTIFICATE OF LIABILITY INSURANCEI 030=16 °"� WN " 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 aerBDaste bolder is an ADDnMONAL INSURED,Bae pofiay(ire)mad ba endorsed.H SUBRO 1ATION ISAWED,subject to the terms shad conditions of the policy,certain policies may require an anent.Astatement on this certilloata does not confer rights to the csrdfloaba hDMw In Bet of such endorsoment(s). PRODUCERCT ME MahilIn Preferred Insurance Advisors.Inc. 6W9880 X56 5000 Gm mor Square Blvd Ste 106 mndz@pmfenwbsumnceadv.com Miami Lakes,FL 33016 APFOWNG COVERAGE NAIC S Phone M 699-9850 Fax WM 89&5756 IN A: Endluance American Specisk Insurance Co. INSURED INSURERS: RoCIM Insu WCB COMParr Costa Sol consirudon u R PO BOX 1769 NSUR D: Homestead PL 3M INSURERS: COVERAGES CERTIFICATE NUMBER: INSURERF: 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 DR CON0171ON OF ANY CONTRACTOR 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. 1 TYPEOFINSURANCEFOLICY ACM SMa tffffn PO LIMITS ® COMMERCIAL GENERAL LIABILITY EACH Q9T=CE $ 1,000,000.00 ❑ CUUMS MADE ® OCCUR MISSES rD noa $ 100;000.00 A ❑ Y Y 13643200D10W-100 01/26J2016 011282017 MED EXP(Any one pwaan I 5,000.00 ❑ PERSONAL h1,ADV INJURY $ 1,000,000.00 GEWLAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ Z000,0W.00 ❑PaucY ® V ❑ LDC FRooucTs-ccmPIDPAGG $ 2000,00000 ❑ OTHER $ AUTOMOBILE LIABILITY SIN Dh LE LIMB ❑ ANY AUTO BODILY INJURY(Per preop) S ❑ IV I SCHEDULED S NED ❑ BODILY INJURY(Pere dders) $ ❑ MREDAUTOS ❑ AUTOS $ S ❑ UMBRELLA LMB ®OCCUR EACH OCCURRENCE $ 1 000 000.00 B ® MCCE S Ld►9 ❑CLAIMS MADE Y Y RXSLVVGROD2098-00 0112612415 01126/2017 AGGREGATE s 1,000,0 .00 DED DN $ WORIMRS COMPENSATION PER TH AND EMPLOYERS,LUIBIUTY Y I N ANY PRDPRIETORIPARrNERIEXE E.L. ACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? NIL A =N NH) E.L.DISEASE.EA EMPLOYE $ DESCRlPnONft under DFOPERATIONS below t E.LDISEASE-POLICY LIMIT $ DESCIBPTIDN OF OPERATIONS I LOCATIONS IVENCI (Attach ACD01M,Add aft Remartm Sol>0dute,R more apace Is hequLed) CGCIM5876 Remove and replace wood deck CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Misml Shores Vftp Building Dept THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 Ave ACCORDANCE tlWTH THE POLICY PROVISIONS. Miarrd Stmies FL 33139 AUTHORIZED REPRESENTATIVE �[ ®1 6-2014 ACORD CORPORATION. A8 rights reserved. ACORD 26(2014101)QF The ACORD name and logo are reghttered marks of ACORD I CP Miami Shores Village . Building Department A 11 o16 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �` _---- INSPECTION LINE PHONE NUMBER:(305)762-4949 k..::'t1k FBC 20 04 BUILDING Master Permit No.--t�)GTJ S-2eDS PERMIT APPLICATION Sub Permit No. %BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP �y CONTRACTOR DRAWINGS JOB ADDRESS: D q O� l � IDYL( 4y' q l f z_ �{31j b 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�Titleholldde�yr�){: 91 C HE(. E r Q)1Jf ij L t �� Phone#: ?yS'►q -3 3 9 ST Address: 4-1?1 /�✓t 9 5- ` �F7e7_r City: M1410M_-_-_jifDet-7 State: FL Zip:-53136 Tenant/Lessee Name: e ` Phone#: Email: ( 2E _E� � A'N(2 (,,/Y-t A ( C.. LVt CONTRACTOR:Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: 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: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color 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) 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 inspection will not be approved and a reinspection fee will be charged. Signature/ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of aj�.N�Ae=`f ,20 Jro ,by day of 20 ,by MI.O+W-CT CON (SLIAN%)rho is personally known to .who is personally known to 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 PUBUC: NOTARY PUBLIC: Sign Sign: Print:. Print: Seal: Hca p�Qy_ Notary Public State of Florida Seal: Sindia Alvarez eg My Commission FF 156750 q p�o'F Expires 09103/2018 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) t � 44 L (�fiI S X05 �. 1 CAJ C � K yam . o a Notary Public State of Florida Sindie Alvarez my Commission FF 158730 Expires 09103/20`18 J 1 1 16 ovtAoe- 0 Iwa/I el.- �� �, Waslon: Birk Scott To protect,pia, &irrpoust aheellh Gmetnor of aq peoplein Fla�aih y eel ir>Degated - a stft omrt vi John H.Arn sbmM MD,FACS & HEALTH State&rWonGenerai&,%mt3y Yldon:To bathe Hon iBdest State m the Nation February 18,2016 P� Andrew Lenahan 489 NE 95 Street Miami, FL 33138 MAR 19 2816 �Y: RE:Modification to a Single Family Residence-No Bedroom Addition Application Document Number: AP1223604 Centrax Permit Number: 13-SC-1658906 489 NE 95 Street Miami,FL 33138 Lot:23 24 Block:53 Subdivision: Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 02/05/2016 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. This project entails the replacement of the wood deck t This office has reviewed and verified the floor plan and site plan you submitted,for the proposed remodeling addition or modification to your single-family home. Based on the information you provided,... the Health Department concludes that the proposed remodeling addition or modification ys not�adding%i....• •• bedroom and that it does not appear to cover any part of the existing system or encroacif ppth� required setback or unobstructed area. No existing system inspection or evaluation and essessment,'..°.: ....:. or modification, replacement, or upgrade authorization is required. 000:00 • .... Because an inspection or evaluation of the e)asting septic system was not conducted,the t1ed1fartmenf cannot attest to the existing systems current condition, size, or adequacy to serve the pr6D@1s0e*a use. e90 •• • You may request a voluntary inspection and assessment of your system from a licensed joSppoig jank •• contractor or plumber, or a person certified under section 381.0101, Florida Statutes. : • ; • •�;• If you have any questions, please call our office at(305)623-3500 00 •• �' Si cerely, Pa LeVe1t-Andre Prol sional Engineer Supervisor I Depa ment of Health in Dade County J o.�.se a ewe in Dade County• •,Florida TWITTER:HeaIthyFLA PHONE: (305)623-3500 FACEBOOKFLDepartrnentofHeaith YOUTUBE:fldoh SETBACK TABLE LEGAL DESCRIPTION NOTES PROPOSED ALLOWED NM181 5 $RNE&T101V ( 2 BASED ON FLORIDA BUILDING CODE 2014-5TH EDITION Z WEST PROP LINE 20'-0" 10''0" ON ID t'LI� LOWEST HABITABLE FINISHED FLOOR ELEVATION-11.57' PER NGVD 1929 Oto SOUTH PROP LINE 28'�1/4" 10'-O" A I- AAUD �C Q w 0 E%18M V FIGH NEW DEClCTO REPLACE EABfFNO DAMAt D oEGc v�ooD PEKE—� BE BYWH c80811M2PDRAIEE.DMINIMUM r-0^FROM HOUSE W I I � 26'-6j" 91' 15' zTarlt� _ � U _ �—EXISWWWWUNETO EXISTINODRAINFIELD PARKING COURT E>QSIINii 20QAW NOUSIII PANEL I- 489 NE 96th STREET EXWMsHMi ZALUMINUM PENCE W " ONE STORY •••••• RESIDENCE •••• •••••• N N El ..a 0 0 • • • • co EUlmm tl1OVERHEADago.�••• • •• •• • r 0.11000 IDWING POOL 7C �PMENNOAD v0 0 s • 11 0 0:• • • DG•0:y 00• r•:0110 •11 •*•11110 y •r r •• m . .y r . . SWIMMING POOL D sreau° 4 HKdH ALUMINUM FENCE °"0wu�a e'"'mie�tlon m w�oarm 0 is �,ma n mom® ASPHALT PARKING r- .d... .A« ® .� : ampo tvadgma,mn• 20' ASPHALT Pn�NO.: eee, sonic mimm SW DaW %-" N.E. 5th AVENUE Nwrlbw A1 .00 OFFICE COPY Permit Holder ` / ,.-a9 Permit# F.B.0 Violation AMA4./ 0 Address Q� S i Date d l By Building Official