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RC-16-1512 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-262751 PermitNumber: RC-6-16-1512 Scheduled Inspection Date:July 08,2016 Permit Type: Residential Construction Inspector: Mesa, Michel Inspection Type: Final Owner. OCAMPO, DAVID Work Classification: Alteration Job Address:755 NE 91 ST Street 4-F Miami Shores,FL Phone Number (305)962-6888 Parcel Number 1132060440310 Project <NONE> Contractor: COASTAL CONTRACTING&DEVELOPMENT INC Phone:(754)212-5651 Building Department Comments REMOVE EXISITNG PORTABLE AC UNIT AND BLOCK UP Infractio Passed comments WHILE IN THE WALL INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-262632 PLEASE CALL OWNER TO GET DIRECTIONS 305-962-6888 Failed r J ' Correction Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid July 07,2016 For inspections please call: (305)762-4949 Page 29 of 32 Miami Shores Village �8' � 10050 N.E.2nd Avenue NE a Miami Shores,FL 33138-0000 x Phone: (305)795-2204Ail IN, n � 7. Expiration: 12/14/2016 Project Address Parcel Number Applicant 755 NE 91 ST Street Number: 4-F 1132060440310 DAVID OCAMPO Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DAVID OCAMPO 755 NE 91 Street (305)962-6888 MIAMI SHORES FL 33138- 755 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 750.00 COASTAL CONTRACTING&DEVELOI (754)212-5651 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Framing Type of Construction:REMOVE EXISITNG PORTABLE AC Occupancy:Single Family Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Planning Review Electrical Bond Return: Classification:Residential Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review structural CCF $0.60Review Mechanical Invoice# RC-6-16-60002 DBPR Fee $2.00 DCA Fee $2.00 06!17!2016 Credit Card $64.60 $50.00 Education Surcharge $0.20 06/01/2016 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 an z Futhermore,I authorize t above named contractor to do the work stated. June 17,2016 Authorized Signature: der / plicant / Contractor / Agent Date Building Departmen Copy June 17,2016 1 Miami Shores VillageCF Building Department artment JUN 01 2016 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 2014 1SJA BUILDING Master Permit No.r-1 '0 PERMIT APPLICATION Sub Permit No. 0 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 755 NE 91 st Street, Apartment 4F City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-044-0310 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Elisa E. Perinen Ocampo Phone#:786-556-6294 Address:755 NE 91 st Street, Apartment 4F City: Miami Shores State: FL Zip: Tenant/Lessee Name: None Phone#: Email: CONTRACTOR:Company Name: Coastal Contracting & Development, Inc. Phone#: 754-212-5651 Address: 2050 SW 17th Drive City: Deerfield Beach State: FL Zip: 33442 Qualifier Name: Gary MCGeddy Phone#: State Certification or Registration#: CBC 056347 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$750.00 Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Remove existing portable AC units and block up whole in the wall Specify colorofcolor thru tile: Submittal Fee$ J 0, � Permit Fee$ < �' CCF$ CO/CC$ Scanning Fee$ i 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) None Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) None 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. 1 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 noticeof ommencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is iss a in the bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or NT CONTRACTO The foregoing instrument was ac owledged before me this The foregoing instrument was acknowledged before me this 23 day of May 20 2016 ,by 23 day of May ,20 2016 ,by Elisa Pirinen Ocampo who is personally known to Gary MCGeddy who is personally known to me or who has produced Personally Known as me or who has produced Personally Known as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Jennifer Cara Print: Jennifer Cameron ,; «: :.= MY COMMISSION S EE 85394J JENNIFER CAMER�ISeal: �= EXPIRES•March 25,2017 Seal: ;,: :,= MY COMMISSION9EE853945i9<�h, Balled Thru No"Public Underw �• � EXPIRES:Match 25,2017 i q�t.,�' W.0 Thru Notery Public Unda wttere *x�*�*�w�•�s<�x**wx�tx�>k****x�s<*�xw�� �x** Qx�x *x��a��x�*******��*s<**t��x�*��+��**�*����**�w�*�x*��*�x�**�x***rr���x�rx�x�s<x���*+� APPROVED BY ` L Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application-Miami-Dade County Page 1 of 2 OFFICE OF THE PROPERTY APPRAISER Summary Report Generated On:5/23/2016 Property Information . Folio: 11-3206-044-0310 755 NE 91 ST UNIT: 4-F '"' " R Property Address: Miami Shores,FL 33138-3243 Owner ELISA E PIRINEN OCAMPO DAVID OCAMPO Mailing Address 755 NE 91 ST#4F MIAMI SHORES,FL33138USA ' Primary Zone 5000 HOTELS&MOTELS- � � GENERAL 0407 RESIDENTIAL-TOTAL r � Primary Land Use VALUE:CONDOMINIUM- ; RESIDENTIAL p » " Beds/Baths/Half 0/0/0 `� x ' o Floors 0 , ' �I Living Units 0 Actual Area Sq.Ft Taxable Value Information Living Area 685 Sq.Ft 2015 2014 2013 Adjusted Area 685 Sq.Ft County Lot Size 0 Sq.Ft Exemption Value $48,660 $25,000 $0 Year Built 1949 Taxable Value $25,000 $22,428 $44,396 Assessment Information School Board Year 2015 2014 2013 Exemption Value $25,000 $25,000 $0 Land Value $0 $0 $0 Taxable Value $48,660 $22,428 $52,470 Building Value $0 $0 $0 City XF Value $0 $0 $0 Exemption Value 1 $48,660 $25,000 $0 Taxable Value $25,000 $22,428 $44,396 Market Value $73,660 $62,960 $52,470 Regional Assessed Value $73,660 $47,428 $44,396 Exemption Value $48,660 $25,000 $0 Benefits Information Taxable Value $25,000 $22,428 $44,396 Benefit Type 2015 2014 2013 Sales Information Non-Homestead Assessment Cap Reduction $8,074 Previous Sale Price OR Book-Page Qualification Description Portability Assessment $15,532 05/20/2014 $98,000 29160-3155 Qua[by exam of deed Reduction 05/31/2013 $70,000 28655-3644 Qual by exam of deed Homestead Exemption 1 $25,000 $25,000 11/01/2006 $130,000 25188-4147 Sales which are qualified Second Homestead Exemption 1 $23,660 $0 09/01/2001 $37,100 19925-1612 Sales which are qualified Note:Not all benefits are applicable to all Taxable Values(i.e.County, School Board,City,Regional). Short Legal Description SHORES PLAZA EAST CONDO UNIT 4F-2ND FLOOR UNDIV.01786%INT IN COMMON ELEMENTS hq://www.miamidade.gov/propertysearch/ 5/23/2016 into noun In Miami hores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONT CTORS' REGISTRATION Fax: (305) 756.8972 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: 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. mmommmmmmmmmoo®aemmmmmmmmmmmmammmoa®omrtmmmmmmmmmmmrsw®®®ommmm®mama®©©momoocaammmmmnmAmmmmmmo BUSINESS NAME: cx a a, g BUSINESS ADDRESS: ao5o S %a 1-1 CITY b eAr-C:sA�MSTATE r-� ZIP 33 Vy'a BUSINESS PHONE: 054 )-QV a - S b S% FAX NUMBER(ij N oh-*- CELL PHONE '9 j ' S 'b -3o y(4QUALIFIER'S NAME: G ��� `f`r\c. C-% e a 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 MC GEDDY, GARY JOSEPH COASTAL CONTRACTING& DEVELOPMENT INC 807 N NORTH LAKE DRIVE HOLLYWOOD FL 33019 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, and they keep Florida's economy strong. DEPARTMENT OF BUSINESS AND PROFESSIONALREGULATION Every day we work to improve the way we do business in order to CBC053647 "ISSUED.- 08/17/2014 serve you better. For information about our services,please log onto www.myflorldaticenise.corn. There you can find more information about our divisions and the regulations that impact you.subscribe CERTIFIED BLULDING CONTRACTOR to department newsletters and learn more about the Department's MC OEDDY,GARY JOSEPH, initiatives. COASTAL CONTRACTING&DEVELOPMENT Our mission at the Department is:License Efficiently,Regulate Fairly We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED uncier the provisions Or Ch 489 FS and congratulations on your new license} E-Oxabar,402 AUG31 2afG DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARDNrh T 411� -11 CBC053647 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 MC GEDDY,GARY JOSEPH. COASTAL CONTRACTING.&DEVELOPMENT INC 807 N NORTH LAKE DRIVE HOLLYWOOD FO3big LE ISSUED. 08/17/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408170002308 i BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 115 S � VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 180-2401 DBA: Receipt#:GENERAL CONTRACTOR (BUILDI Business Name:INCSTAL CONTRACTING & DEVELOPMENT Business Type:CONTR) EDDY Business Opened:0 6/14/199 6 I Owner Name:GARY MCG CBC053647 Business Location:2050 SW DR DEERFIELD7 BEACH State/Exempt on Code: I Business Phone: 954-920-7444 Rooms Seats Employees Machines Professionals 6 For Vending Business Only � Vending Type: Number of Machines: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 6.00 0.00 4.05 0.00 0.00 37.05 3 {1 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS t THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GARY MCGEDDY Receipt #05A-15-00001134 "' 2050 SW 17 DR Paid 11/12/2015 37.05 DEERFIELD BEACH, FL 33442 of 2015 - 2016 CERTIFICATE OF LIABILITY INSURANCE TM DORl'IF"M IS.WSUED AS A FITTER OF NOXWOWMI OMY AND OONFERS NO THE CEKTIFICATE HMVt GE CA'M DOW NOT AFFOMMMY OR WMTPMY AINEW MOM OR ALTER THE CQVVkAGE AFFORDED BY IM THO CERMCATS Or-INSUP0M UM NOT CONSTTMM A "BETWON YHE USUM 01SUROW.AUT"tRWED 3''EPRE3MATNE OR PRODUCER,AND THE INFORMT. isvouvw to 4 a[ 1 ► . . a�rei uneini AsbftmftonWb WtWAaW does taA4o"wr to $ PAx >c&c 1T�#Tiff� SiL 141 pmbmkeft"FLM TCS► ONWOM ft%*FL COVERAGO CERTWYDATIE. 'fit is Is TO CEO"THAT THE OF O USTM BELOW"AVF-BEEN MEW—TO 7K WSUMD WZ&V ABOVE FOR THE FOLCY PES IMXATW, N0TVWT TAN0M AW REQU0 T oR coNDMON OF AW CONTRACT OR OTHF-R DOCUMEW VVUH FWEPBDT TO WKCH THIS #CATIA MAY BE I S$=OR MAY PERTAK IM MISUFMCE AFFORDED BY THE P#ISS DESCRM"EREW IS WWCQ'P TO AL3.THE TERNS, EXCLUSKM AND CONOMM OF WCH POLICES LIMM SMOVM VAY HAVE BEEN M==BY PAM CLAM: rYPsar AAW iriiav A. x r ,ttrSam imp 4IA &RA444� 4 45 wimm! I ,_.. 1 zx" SCHEDULED r L Y WAY } S A{#m Autos S UMOMIA Cts Thi - EL WDA AQ=Qff A I�4831,87"t is► 111A �. E i TitpF 4T16 6Ft4E llK+s 0 fAftsh. "I.. wamm GPM isampbom J*bdwaW4w Rewim 3 * n*g & up Ian 'TTS m"SHOW 1 ANY OF TM MOVE 063CHOW POLIC4[;Sr BE CANCELLED*VKM VXM TIM POLICY IOWNEMAW MMSHMKFL33138 t 1 T 1. Alfd re md. ACORD 25(MMM The ALCM mum end lago we togbkmW maft of ACORD Re 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: 5/6/2016 EXPIRATION DATE: 5/6/2018 PERSON: MCGEDDY GARY J FEIN: 650013610 BUSINESS NAME AND ADDRESS: COASTAL CONTRACTING AND DEVELOPMENT, INC. 2050 SW 17TH DRIVE DEERFIELD BEACH FL 33442 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR 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 filing 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 f Coastal Contracting & Development, Inc. 2050 SW 17th Drive Deerfield Beach, FL 33442 Ph. 754-212-5651 Coastal Hollywood @..aol.com CBC 053647 May 24, 2016 State of Florida County of Broward Before me this day personally appeared Gary McGeddy who, being duly sworn, deposes, and says: That he will be the only person working on the project located at: 755 NE 91st Street, Apartment#, Miami Shores, FL Sworn to (or affirmed) and subscribed before me this 24th day of May, 2016, by Gary McGeddy. Personally Known X OR Produced Identification Type of Identification Produced Jennifer Cameron JENNIFER CAMEWN COWISSIM#EE 653945 EXPIRES:Match 25,2017 AP,S Bonded Vint"Nft undmwdters oaaa m®ate Miami Shores village Lam- � Building apartment R 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. y 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'compensati insurance verage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING L W Y KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this ab day of M o.V ,20 1b . By C1 a-4,v who is personally known to me or has produced as identification. 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