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RF-16-889 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-256139 Permit Number: RF-4-16-889 Scheduled Inspection Date: May 13,2016 Permit Type: Roof Inspector: Porto Jr,Jose Inspection Type: Final Roof Owner: DIAZ, CARLOS AND ASHLEY Work Classification: Repair Roof Job Address:9230 NE 2 Avenue Miami Shores, FL 33138-2805 Phone Number Parcel Number 1132060133050 Project: <NONE> Contractor: JOHN BUSTA ROOFING INC Phone: (305)219-9699 Building Department Comments REPAIR VALLEY&CRICKET AREA NORTH SIDE OF Infractio Passed Comments FLAT ROOF INSPECTOR COMMENTS False Inspector Common PassedEa Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 12,2016 For Inspections please call: (305)762-4949 Page 6 of 19 Miami Shores Village` , 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 \', Phone: (305)795-2204 2., ; � Expiration: 10/05/2016 � �., Project Address Parcel Number Applicant 9230 NE 2 Avenue 1132060133050 CARLOS AND ASHLEY DIAZ Miami Shores, FL 33138-2805 Block: Lot: Owner Information Address Phone Cell CARLOS AND ASHLEY DIAZ 9230 NE 2 Avenue MIAMI SHORES FL 33138- 9230 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,800.00 JOHN BUSTA ROOFING INC (305)219-9699 Total Sq Feet: 200 Type of Work:Repair Available Inspections: Additional Info:REPAIR VALLEY&CRICKET AREA NORTH Inspection Type: Classification:Residential Roof Repair Scanning:3 Final Roof Review Roof Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# RF-4-16-59262 DBPR Fee $2.00 04/082016 Check#:2033 $72.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 04/012016 Check#:2032 $50.00 $0.00 Notary Fee $5.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $122.80 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 above-n or to Ado the work stated. April 08,2016 Authorized Signature:Owner / Applicant / Contractor / Agent a e Building Department Copy April 08,2016 1 Miami Shores VillageO-1 7 _V; Building Department APR 0 1.2019 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 544 FBC 20)q BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC M ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL MPUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10BADDRESS: 9230 NE 2nd.Avenue City: Miami Shores County: Miami Dade Z)p: 33138-2805 Folio/Parcel#:11-3206-013-3050 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Carlos Diaz Phone#:305-761-5655 Address: 9230 NE 2nd.Avenue City: Miami Shores State: Florida 33138-2805 Tenant/Lessee Name: n/a Phone#:n/a Email: cdiazC valuestoreit.com CONTRACTOR:Company Name: John Busta Roofing Inc. Phone#: 305-219-9699 Address: 300 NE 91 Street City: Miami Shores State: 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:$2'800.00 Square/Unear Footage of work: 200 S.F. Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition Description of work: repair valley&cricket area north side of flat roof Specify color of color thru tile: Submittal Fee$ M . qz� Permit Fee$ CCF$ CJV CO/CC$ Scanning Fee$ tq 'fiRadon Fee$ O0 DBPR$ Notary$ ` - Technology Fee$ QL-, `0 Training/Education Fee$ Gb Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r N/A Bonding Company's Name(if applicable) 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 COMMENCEMLNT 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 no 'on fee will be charged. Si nature Signature g OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of MA vC1:/ ,20 /�,by day �of 20 by C'A&o67 Q/47 ,who is personally known to ��' IJyJ ,who is n y kno me or who has produced�40&i0 ,0-RJ U1J 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: a Sign: 11NIIIIHeq Print-150W AX—W &Z5* Print: -N&� •••• *G O Seal: Seal: MY X14 FF 112(! $• DME&Sem 14,2013 <`�' • Banded nru ft"Pu66eUMen�ws 9 °•` 'b09 / N055 •� s*sass ' APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department �lpR�► 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: er State of Florida County of Miami-Dade The foregoing was acknowledge before me this 3l day of AM eell ,20 /,( By e A7 who is personally known to me or hasroduced as identification. Notary. 40�� SE SAWMAM SISTA Bxd�lThuNRt John Busta Roofing, Inc® 300 NE 91 Street Miami Shores, FL 33138 phone . 305-219-9699 . email .jrbusta3OO@aol.com April Is'.2016 State of Florida County of Miami Dade Before me this day appeared John Robert Busta who being duly sworn,deposes and says that he will be the only person working on the project located at 9230 NE 2 Avenue Sworn to(or affirmed)and subscribed before me this 1'. day of April,2016 John Robert Busta. Personally known X SCL'V . a• 'C:!q U4 Sandra A. Busts Print type or stamp Name of Notary �Y SN MAIOISWA W COAMSM i FF 159190 EXPIRES:September 14,2018 8OrAWT1WWWPdktk s • F f • T IM ill ■ r.« Ii 1 NEON MEN ■E.■■■■■■■■■■MEN ■■■■.■.■■ ■■■■■■■■.■...ONE■■MEMO ■■o smomomma■.■■■D ■ ■N,FIA.�■■■■■■■■ ■■■■■■.■■■■■um,o■■MEN S■■■ ■■.■■■'■M■.■■ .■,■■MEN ■.■■ MEMERIM UNIMMIWHEN1�������� ■ommmon!WWWW ERRE 11m, MENNEN ■EMEMEMIMMEN�� ��il�������� MEN MORMON ':UTIRNAT10NAL C 0 0 E COUNCIL 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. 2. Renailing wood decks:When replacing roofing,the existing wood roof deck may have to be renailed in accordance with the current provisions of Section R4403.(The roof deck is usual(V concealed prior to removing the existing roof system). 060. . . 6060 .00000 . . 00 0 :606 00 4 Exposed Ceiling: Exposed,open beam ceilings are where the Uh 91de of Ve�pof deckipg*�6; can be viewed from below.The owner may wish to maintain the architecturar 00000 rance, �RR� 'tD@@fore :....: roofing nail penetration of the underside of the deckingmay not • y be acre tabf$.J� rovidesthe o t,on•of6•• maintainingthe appearance. P P P . . PPe -0000. 0000. .600.0 60 .. . 606006 666666 . 6 . . . 60610 6. Overflow scuppers(wall outlets): It is required that rainwater�.ws rf so .t the'roof is 6 not overloaded from a buildup of water. Perimeter/edge wall or other roof exteg4i8n=nay bloc*.his Gee**: d' if overflow scu rs wall outlets PPe ( )are not provided. It maybe necessary to install ovt&w cup ce with the requirements of Sections R4402, R4403 and R4413. ®.-3 Owner/Agents Signature Date Contractor Signature Date 923® 9 A,,9. Property Address Permit Number Revised on 7/9/2009 LD;07/01/2015;