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DS-16-927 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-256364 Permit Number: DS-4-16-927 Scheduled Inspection Date: May 24,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Mesa, Michael Inspection Type: Final Owner: DOWSON, DAVID AND NANCY Work Classification: Addition/Alteration Job Address:65 NE 95 Street Miami Shores, FL 33138- Phone Number (305)754-1685 Project: <NONE> Parcel Number 1132060130710 Contractor: LIVING EARTH REMODELERS Phone: (954)925-5003 Building Department Comments CONCRETE DRIVEWAY Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed [XI N�"ea -Vo Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 23,2016 For Inspections please call: (305)762-4949 Page 25 of 42 DS-4-16-927 Miami Shores Village � 'eirrr> IV3t#63Wui , 10050 N.E.2nd Avenue NE Glassffloation:Additi©nlAtteratifpn Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status.-APPIR 016j Expiration: 10/12/201 Project Address Parcel Number Applicant 65 NE 95 Street 1132060130710 DAVID AND NANCY DOWSON Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DAVID AND NANCY DOWSON 305 NE 91 Street (305)754-1685 MIAMI SHORES FL 33138-3129 Contractor(s) Phone Cell Phone LIVING EARTH REMODELERS Valuation: $ 6,000.00 (954)925-5003 Total Sq Feet: 1500 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:CONCRETE DRIVEWAY Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 CCF Invoice# DS-4-16-59306 $3.60 04/06/2016 Check#:21072 $50.00 $648.86 DBPR Fee $2.63 DCA Fee $2.63 04/15/2016 Check#:21073 $648.86 $0.00 Education Surcharge $1.20 Bond#:3057 Permit Fee $175.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $698.86 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 inf ation is a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abov a d confactpefo do the work stated. April 15, 2016 Authorized Signature:Owner / Applicant / C ntractor / Agent ate Building Department Copy April 15, 2016 1 12 Miami Shores Village YZEC Building Department APR 0612016 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201`1 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. B'B'UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP II __ , ` � Ct�� - CONTRACTOR DRAWINGS L JOB ADDRESS: � `V S-• City: Miami Shores County: Miami Dade Zip: �Z k Folio/Parcel#: 1` ` ?��p w-0 Li " b l7l Is the Building Historically Designated:Yes NO c/ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): WS O h Phone#:�Q Address: IQ S 1\1�,-7 � S L- City: aim,hc�i �11 C,1 1`•e� State: �' Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: )-"%, i in j �CD- j Q?A rAQtkrS. Phone#: !R,!"t-j ae J� Address: ��• � ��Y�-1�4� c_ City: ) t, 1 ob r)A State: `L-- Zip: V a- QualifierName: I 19('11,f'����►nSS�I �1F �� Phone#:9,'�'"� q ( State Certification or Registration#: ��rc 14 LA-. LA Q ((W _ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Ise I DD 0 Square/Linear Footage of Work: 15-0 0 Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$c Permit Fee$ L9 G; - G. ) CCF$ CO/CC$ Scanning Fee$ Iq � Radon Fee$ 0-C3 DBPR$ " �� Notary$ �( Technology Fee$ Training/Education Fee$ li ZO Double Fee$ Jam' Structural Reviews$ Bond$ '_� TOTAL FEE NOW DUE$ �Jb (Revised02/24/2014) ro C ', s 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 reinspe tion fee willbe charged. Signature G' 1 Signature F OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 1 (,o by _�day of20 1 f,,7 , by � D, CLW.R) -%who is personally known to l '1� Q� �' ✓t ,who is personally known to me or who has produced 1—D as me or who has produced lz A-D as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: EAMON TO „ m Seal: Seal: 1 �SnR P`'9" EAMON TONER 's Notary Public State of Florida a =' = My Commission Expires Mar 5,2017 #�"�`. Notary Public-State of Florida Commission# EE 880934 9► •o; My Commission Expires Mar 5,2017 t Commission#EE 880934 G1� APPROVED BY Plans Examiner 00Zoning Structural Review Clerk (Revised02/24/2014) yH C.I dm'h Room .m®,® Miami hores uVillage Building ent R 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305) 756.8972 CONTRACTORS' REG ISTMT10 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. yCOPY 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: 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. ■rrrrrrrrrrrrarrrrrrarrrrrarrarrrrrrraarrrrraarrrrararrrrrrrrarrrrrarrararrraarrrrrarrrrrs BUSINESS NAME: 1 X11 Yl( mar- h _! r� r ��r BUSINESS ADDRESS:�D S KI CITY STATE—D,ZIP: 0 BUSINESS PHONE: ( q3,4� FAX NUMBER f -4. — 1� � CELLPHONE( QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: CC� D L{ �_ STATE OF FLORIDA. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION f .. . CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 . ars 1*940 NORTH'MONROE STREET TALLAHASSEE FL 32399-0783 GOSS�;LIN,YVAN P LIVING EARTH REMODELERS INC 5640 SANTIAGO CIRCLE BOCA RATON FL 33433 Congratulations! With this license you become one of the.riearly 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 fm's DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. "<s.:v=`" PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC044266 ISSUED: 11/1712015 to serve you better. For Information about our services,please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENERAL.C.ONTRACTOR information about our divisions and the regulations that impact GOSSELIN,YVAN P . ., you,subscribe to department•newsletters and learn more about LIVING EARTH REMORELERSINC the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We'constantly strive*to.servie you*better so that you can serve,your customers..Therik'yot,�f6r.d6ing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulation&.on your new'l'icensel' Ezpirahon dale AUG 31,2016 1_1571170001965 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ' CGC044266 The GENERAL CONTRACTOR �,,.•., '':;•-;;�,,,.; r, Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GOSSELIN,YVAN'P LIVING EARTH REMODELEI�S INC 2208.N 2QT,H.AVENUE.- HOLLYWOOD' VENUEHOLLYWOOD' FL 33020 a> ®P ISSUED: 11i17/2015 b18SPLAY AS REOUIRED BY LAW SEQ# L1 511 110001 966 LIT- .I i P_ t o4 os ,1A ON 00 City of OD D .'``' ao�coas F L, O R I D A h O 2015/2016 LOCAL BUSINESS TAX RECEIPT Business Name:LIVING EARTH REMODELERS,INC Account Registration#:B9055919-2016 DBA: Expiration Date:9/30/2016 Business Location:2208 N 20 AVE Tax Paid:$251.00 Business Category:SERVICE/LICENSED BUSINESS Classification:Contractor/General Tax Basis:2-4 WORKERS Dalb i ERT � '�m�6�A �, � �U71 :,. . 12/31/2015 pYoduceY: Plyn'iorith'I'n5urance Ageh'Cy" ' :'. "' ' �' ;" This Certfflcate vflf sued as'a Tniatter;of,inforrhation only and-confers no rights upon the Certincate H'old'er .This Certificate does not amend,extend 2739'U. 11g�IVday:1:9'i�.'::: :, or alter the cbverape afforded`liy th"e'polfilies below. "' ' Holiday, FL:34.691' : (727)938-5562 )nsurers Affording Coverage:. , NAIL dR 1 Insurer A: Lion Insurance Compariy' 11075 tlnsured: South•East PeCsolan�l•L�asing, Inc.&Subsidlari�s Insurer 8: " ' •' ` N 2739 U.S: 1-li.gbWaj A,9 , Insurer C: 'Holiday, rL 34691 ' Insurer D: Insurer E: Coverages 'Tha policios of insurance listed below have.been Issued to the insured named above Ior the policy period indicated.Nolwilhslanding any requirement,term or condition of any contract or other document Will respect to which this cedlficals may be issued or may pertain,the Insurance afforded by the policies described herein is subject to all the termsxcluslpns,and,condiUons of such policies. Aggregate ,a .Ilmils shown may have been reduced by paid plasms. Policy-Effective -Policy E90trallon' Limits INSR ADDL Type of Insurance Policy Number Date Dale. LTR INSRD (MM/DDIYY) (MM/DDIYY) GENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises(EA Claims Made OCc4r• : occurrence) $ ivied Exp • 9 Personal Adv injury s General aggregate limit applies per. General Aggregate Policy Project 0 LOC P4oduc4S:>Comp/Op Agg :6 Combined Singly Limit AUTOMOBILE LIABILITY (EA Accident) $ Any Auto 9odli 'Injury,. . All Owned Autos (ParlPeison) ' Scheduled Autos Bodily InJury ' •.., Hired Autos .i ;.... Nan Owned Autos:.' .. • (Par Accldertl) • ' :F ' I „- ,)' ,•t• ,{•,:�,`..:: :c , P.roAerly 6ag,499 „ . .. 4 '' ;. :(PerAtcidenl) l•, °� .,a '+ '�'•'•Hach Occurrence ExCESS1UMBRELLA LIABILITY Aggregate OcCur, p, g Claims Made �.t4. iSadoclible l� •:.• .. , � •.•, . .. • WC Slalu- OTH- WC'71940 01101/2016 0110112097.:......... •A Workers Compensaki,pn•an.c]' l'o'"'L'tmils ER Employers'Liability E.L.Each Accident �i,000,000 Any proprietor/partner/exeaulive officer/member E.L..Disease-Ea Employee S1.000,000 excluded? NO' t If Yes,describe under special provisloris below. E.L.Disease-Policy Limits si,000,000 Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Other Descriptions of OperationslLocationslVehClient ID: 91-68-732 icleslExclusions added by EnclorsementlSpecial Provisions: . sonnel Leasing,Inc.&Subsidiaries that are leased to tie following"Client Company": Coverage only applies to active employee(s)of South East Per r Living Earth Remodelers Inc. Coverage only applies to injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while worldng in:FL. Coverage does not apply to statutory employee(s)-or independent conlTaclor(s)of the Client Company or any otter entity. 727 938-5562. A list of tie active employees)leased to tie Client Company can be obtained by faxing a request to(727)937-2138 or by calling( ) Project Name: PPC-ISSUED 12-31-15(CF) Be in Date i 1 2016 CANCELLATION -• _ _._._ Should ally of the above descritied,policias be canceiled.oefore the expiration dale thereof,the Issuing CERTIFICATE HOLDER Miami Shores Village Bldg Dept Insurer will endeavor to mail 30 days wrllldo notice to the certilicale holder homed to the left,but failure to y do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2nd Ave :X. Miami Shores,FL 33138 a� M y ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 03115/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION COVERALL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5800 W.ATLANTIC BLVD. • ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MARGATE FL.33063 PH 954 956-0006 FX 954 956.0555 INSURERS AFFORDING COVERAGE NAIC A INSURED LIVING EARTH REMODELER'S INC wsURERA: FEDERATED NATIONAL INSURANCE COMP, 2208 N 20TH AVENUE INSURER B: HOLLYWOOD FL 33020 INSURER C: INSURER D: INSURER E: COVERAGES 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 16 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATFimminntyYj LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY OL•0504008495.03 1211612015 1211612016 DAMAGE TO RENTED $100,000 CLAIMS MADE ®OCCUR MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,()00 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO s2,000,000 PRO LOC XPOLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per acWdent) $ PROPERTY DAMAGE $ (Per accldent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE . AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC WORKERS COMPENSATION AND I IMITS FR 0TH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ Ifyes describe 'V'1'$10" P GI L ROVI ION bel E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS LIC#CGCO44266 CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THEA13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village Bldg Dept DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE 70 DO SO SHALL 10050 NE 2 Ave :.:•. IMPOSE NO O` ATI0 'fl LIABI �(IND UPON THE REP,ITS AGENTS OR Miami Shores,FL 331384 � REPRESENTAT AUTHORIZED REP W,.. ENTATIVE (7 ACORD CORPORATION 1988 ACORD 25(2001108) E ,,•• f," . ••. 000 • . . •.. •Yn 5.; -,� fit at Jim; C If[[K ,:;'f'•, C LAND SURVEYORS,, ' r�sHtlQ,•. � ° '� �.• : J J ' • • • " • • • • •• • I• •sa• ••.:.c+....:,ter:y :::( :?� f>• .:,.' • 0 • W. 'ETH OF SURVEY scale ",. 0 ' C ' I • -:0: •• • • • • •• • y `� , J�F+7 •, .,' , ;.yi•"}�"LI�I;"w '"IC�:'�i.�'•:F.�•tJ.�•''•.Y• ..7!1'F 1 9;L •� .u�,.'�ii 4Y 4,3 It ox •N '�lp � ,►. A 1" ' �q th ILI VIAJ ,!r ..• +• :• '�,-^�.. 77 D NO OBJECTION , Florida Health Miami-Dade County O:S.T D,S. & Well Program Application No. Date: ; Signature NO OBJECTION Florida Health Miami-Dade County17 O.S.T.D.S. Well Program ,P•ti 2 201 Application No.: t23Lt Date: �"'� — t F3Y: Signature r