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
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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
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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:
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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
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W COAMSM i FF 159190
EXPIRES:September 14,2018
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':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;