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RC-16-696 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)785.2204 Fax: (305)756$972 9 Inspection Number: INSP-263928 Permit Number: R"-16-696 Scheduled Inspection Date:July 22,2016 Permit Type: Residential Construction Inspector: Mesa,Michel Inspection Type: Final Owner. DENTICO,JAMES&JANE Work Classification: Alteration Job Address:10055 BISCAYNE Boulevard MIAMI SHORES,FL 33138-2645 Phone Number Parcel Number 1132050340030 Project <NONE> Contractor. JAMES DENTICO CONTRACTING INC Phone:305-756403 Building Department Comments REPAIR SOFFIT LEDGE OF ROOF. Infracu° Comments INSPECTOR COMMENTS False Inspector Comments Passed gl_ G 6� Failed El Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee Is paid Y July 21,2016 For Inspections please call:(305)76241948 Page 29 of 29 Miami Shores Village .~ 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 :, Expiration:09/18/2016 Project Address Parcel Number Applicant 10055 BISCAYNE Boulevard 1132050340030 MIAMI SHORES, FL 33138-2645 Block: Lot: JAMES&JANE DENTICO Owner information Address Phone Cell JAMES&JANE DENTICO 10055 BISCAYNE Boulevard MIAMI SHORES Fl-33138-2966 10055 BISCAYNE Boulevard MIAMI SHORES Fl-33138-2966 Contractor(s) Phone Cell Phone Valuation: $ 500.00 JAMES DENTICO CONTRACTING INC 305-756-6553 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:REPAIR SOFFIT LEDGE OF ROOF. Occupancy:Single Family Insulation Stories:1 Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms:3 Bathrooms:2 Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Planning Bond Retum: Classification:Residential Review Electrical Review Plumbing Fees Due Amo]$2.00 Pa Date Pa T Review structural Pay y Type Amt Paid Amt Due Review Mechanical CCF DBPR Fee Invoice# RC-3-16-59045 03/22/2016 Check#:1397 $64.60 $50.00 DCA Fee Education Surcharge 03/17/2016 Check#:1329 $50.00 $0.00 Permit Fee $1Scanning Fee Technology Fee Total: $11 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foreg ' nfonn on ' accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I orize a ab v n ed tractor to do the work stated. March 22,2016 Authorized Signature:Owner / plicant / r / Agent ate Building.Department opy March 22,2016 1 Miami Shores Village REC-ELI ! Building Department 7BY: s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 - Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 r FBC 20 t BUILDING Master Permit No. ®-� PERMIT APPLICATION Sub Permit No. `BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS /� JOB ADDRESS: f�d � �Jl f P l e(telV City: Miami Shores County: Miami Dade Zip: Folio/Parcel$: Is the Building Historically(Designated:Yes NO Occupancy Type: S47 Load: Construction Type: Flood Zone: BFE: FFE: Ar- OWNER:Name(Fee Simple Titleholder): Phone#: ✓�.�- �� '" �7 Address: 4 City: ( t State: 3 Zip: 313 Tenant/Lessee Name: Phone#: Email: ` CONTRACTOR:Company Name: �ne#: Address: U City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: �� ra �` _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/Replac ❑ Demolition Description of Work: �t Specify color of color thru tile: J4 W11 Submittal Fee$ ���^-11``� Permit Fee$ k ' G3 CCF$0 a 6rr) CO/CC$ Scanning Fee$ W Radon Fee$@ ` 0 U DBPR$ 'W Notary$ Technology Fee$ o o Training/Education Fee$ Igo Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ro (ReAsed02/24/2014) 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. 4z -'e I Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -1 S' day of_ M 020 1(-- .by �s day of M&-le L-\ ,20 16 ,by rvVS who is personally known to JpZvtL1-d ,who is personally known to me or who has produced rl.D L' as me or who has produced FL- PL- as identifica ' n and who did take an oath. identification a who did take an oath. NOTA R P BLIQ / NOTARY PUB v Sign• Sign Print: Print: •N'r Seal: '•h JAYMY BEN6110 Seal: •••`�N JAYMY 8EN610 ..•� Y ag Notary Puslto-State of Florida Notary PubNo-State of Florida Comm.Expires Mar 31,2017 z• •i My Comm.Expires Mar 31,2017 NA +, P�• Commission B EE 870357 - %�+ pm Commission#EE 870357 ********** Offi4 Y8�@ir�R ***************** ***+kiYY1E***�Q4 914IdtW ********** APPROVED BY i!Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DENTICO, JAMES L JAMES L. DENTICO CONTRACTING, INC. 10055 BISCAYNE BOULEVARD MIAMI SHORES FL 33138 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 CGCO13750 ISSUED: 08/17/2014 serve you better. For information about our services,please log onto www:myfloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe DENTICO,JAMES L- to department newsletters and learn more about the Departments JAMES L.DENTICO CONTRACTING,INC. initiatives. 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 under the provisions of Ch.489 FS. and congratulations on your new license! Eviration dffie:AUG 31,zona L1408170002856 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ' 2n CGCO13750 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 a rr` o DENTICO, JAMES L JAMES L. DENTICO CONTRACTING, INC. 10055 BISCAYNE BLVD a MIAMI SHORES FL33138-2645 a_ ISSUED: 08/17/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1408170002856 004962 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL - DONOT PAY BT ) 913062 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES DENTICO 1ZES L CONTRACTING INC NNFWAL SEPTEMBER 30, 2016 10055 BISCAYNE BLVD 913082 Must be displayed at place of business MIAMI SHORES FL 33138 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS DENTICO JAMES L CONTRACTING INC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED CGC013750 BY TAX COLLECTOR Worker(s) 10 $45.00 09/23/2015 FPPU12-15-004276 This Loam Business Tax Receipt only confirms payment of the Local Business Tau.The Receipt is not a license, permit,or a certification of the holders quaiHication%to do business. Holder must comply with arty goverwngntal or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec ga-276. For more information,visit www.miamidade.gov/tsxcoilecter J s r� Policy Number. Date Entered: • ACORO® CERTIFICATE OF LIABILITY INSURANCE 3/16/2016 DATE(MODNYMII/DD/YYYY) 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 cerdflcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cerdflcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT SALMEN INSURANCE NAME:_ ALLISON _ FAX_ 730 SW 4TH ST. 3 PHONE . (866)587-7147 ('VC 888 Ne; ( )542-3507 E-MAIL BRIAN@SALM6NINSURE.COM CAPE CORAL, FL 33991 ADDRESS: ---------INSURER(S)AFF ORDING COVERAGE NAIC 9 INSURER A:PREFERRED CONTRACTORS INS. CO. (RRG) 12497 INSURED JAS L. DENTICO CONTRACTING INC INSURER 8: JAMES DENTICO INSURER c 10055 BISCAYNE BLVD. INSURER D. MIAMI SHORES, FL 33138 INSURER E: -- ---- INSURER F COVERAGES CERTIFICATE NUMBER: 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. _ 'NSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR 1 POLICY NUMBER (MMIDDIYYM IMNUDDIYYYYI A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 DAMAGE TO RENTED CLAIMS-MADE LAO OCCUR PCIC5026—PCA70585 6/25/2015 6/25/2016 PREMISES(Ea occurrence)_ $ 50,000 —06 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY__ $ 1,000,000 GEN'.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 1,000,000 _ POLICY[::]ECT C_]LOC PRODUCTS-COMP/O_P_A00_ $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS — — NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Paracciden�_-_ UMBRELLA LIAREC�L�AIMI-MADNE EACH OCCURRENCE $ EXCESS LIAR AGGREGATE----- $ DED RETENTION$ $ WORKERS COMPENSATION IPER ER- AND EMPLOYERS'LIABILITY Y i N STATUTE_ - ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yea,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached"more apace Is required) LICENSE NUMBER GCGO13750 Building CGCO13750 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. 305 756 8972 AUTHORIZED REPRESENTATIVE ¢F n Zi ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ProduceduskV Forms Boas Pius software.www.FormsBoss.comlmpresslvePublisMV 800.208.1977 5d12W4 M"L Via"01 AffA,wAE STATEOFH.Oi A CHIEF FINANCIAL OFFICER DEPNM04rOFfVUWl4ClALSERVICES ISVISM OFWORIO'COMPENSATION **(38R!TIFICATE OFH.ECtlON TO W-DST FRM FLORIDA WOR1013TS'COMPE!"TM LAW'• CONSTRUCTION INDUSTRY EXWPTION This certifies that the individual listed below has elected to be exempt horn Florida Workers'Compensation law. EFFECTIVE DATE 5/3/2014 EXPIRATION DATE: 5=016 PERSON: DENTICO JAMES L FEIN: 592246282 Bt RIESS NAME AND ADDRESS: JAMES L DENTiCO CONTRACTING INC 10055 BISCAYNE BOULEVARD MWA SHORES F1. 33136 SCOPES OFFS ORTRADE: LICENSED GENERAL LICENSED PLUMBING LICENSED ELECTRICAL HEATING VENTILATION, CONTRACTOR CONTRACTOR CONTRACTOR AIR-CONK P0=0ttokh"N4QD.OB(14)F.S andhwda=pwsdwWw4e�s nlYanO Idna� ueae dAgfiwwd UftoafMW rmtrmaerla am�paa nmda9iadu�Oa.RrauaROoCh�0ar4/006(t�.F.S,Ca -dS.W toba0sept.. A11 tlwsmya dQwhebesaotrodstteeedonihenMtaadetse8oa toba ftowdochgow4�pp� F.&,NaBooe ddoeBaato6e wYfaamd tieaBonmbee�R elatl pa6� tl,daq&twalBer OteaSEng dtlwnu8toarSedgw ,thapetamttsaadmthenoEkeor pea�an�reto�mdregatrema�d9is� daaa�atiw�patbtfa+depsflradeaae�effianylbrefvfaEutedOw OFSF24)WC M CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0742 QUESTIONS?(860)413-1809 i e Miami shores Village logo Building Department 10050 N.E.2nd Avenue l0>EtD�' 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this ZZ— day of�-(�,�"G V� ,20 16 - By Ta w%e S p e i C,f!7 who is personally known to me or has produced L 1, as identification. Notary: JAYMY 9ENG0� � Notgry PubIM-State of HorMa '?My COMM,Expires Mar 31.2017 SEAL: cortrmiesion#EE 870357 oQ; Bonded Throuo National Notary Assn. GENERAL ELECTRICAL • MECHANICAL • PLUMBING ROOFING JAMES DENTICO CONTRACTING, INC. March 21, 2016 State of Florida County of Miami Dade Before me this day personally appeared JAMES DENTICO who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 10055 Biscayne Boulevard, Miami Shores,Florida 33138 unless the person(s) working have workman's compensation coverage. Sworn to (or affirmed) and subscribed before me this Z I day of 2016 by Personally known OR Produced Identification (N Type of Identification ProducedL ,,,S Y PN•IJAYMV BEN= Nogry P -State of FfWda. • My COMM.Ea0ea Mar 31.2017 s�ri,FOff4 O CMMISBion#F EE870357 •'�����^ Bonded Through National Notary Assn. 'nt, a or Stamp Name of Notary 10055 Biscayne Boulevard • Miami Shores, Florida 33138 Telephone: 305-756-6553 State of Florida Lic. CGCO13750 Fax: 305-754-9605 IA 7 ®S .•.. . 0000 00,00. • . 0000.. ., ... 0000.. 000009 . . • ,0000• •.9• • • • 9 • 0000•. 0000 • 0090• 9 • •99.9• ••• • 9.9•• 00 00 0 • 9..99• • . • •• • .• • 9.9.9• 000,0• • 009 • •9 s Ty WIN IVOpy. s6Tt+ n 'aml Shores Viiiage APPROVED BY DATE ZONING D`PT - i I d, BLDG DEPT ;I IHUF('T TO GOMPI IANCE WITH ALL FEDERAL ti I f1 ANI)C()UN iY 11111.FS AND RFGUI ATIONS