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DGT-16-1723 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-263112 Permit Number: DGT-6-16-1723 Scheduled Inspection Date: July 26,2016 Permit Type: Decks/Gazebos/Trellises Inspector: Mesa, Michel Inspection Type: Final Owner: DIAZ, CARLOS AND ASHLEY Work Classification: Pergola Job Address:9230 NE 2 Avenue Miami Shores,FL 33138-2805 Phone Number Parcel Number 1132060133050 Project: <NONE> Contractor: GLOGOZ CONSTRUCTION COMPANY Phone: (786)447-8129 Building Department Comments In actio a ommen PERGOLA 20'X 12' INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-261439. 7-1216 need to check set back. need to correct overhangs. Failed El Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until reinspection fee is paid �ID July 25,2016 For Inspections please call: (305)762-4949 Page 23 of 42 Miami Shores Village � rePrm lines; 10050 N.E.2nd Avenue NE Wtkle551% `C� ( ` Miami Shores,FL 33138-0000 < Sa`etuSr APPROVEP " fi Phone: (305)795-2204tf,: issue Dow Expiration: 01/07/2017 Project Address Parcel Number Applicant 9230 NE 2 Avenue 1132060133050 Miami Shores, FL 33138-2805 Block: Lot: CARLOS AND ASHLEY DIAZ 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: $ 5,500.00 GLOGOZ CONSTRUCTION COMPANY (786)447-8129 _..,, ., _... ... Total Sq Feet: 240 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Slab Date Denied: Final Type Const:Pergolas Additional Info:PERGOLA 20'X 12' Framing Classification:Residential Scanning: 1 Footing Scanning: 1_ Review Planning Review Building Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# DGT-6-16-60280 DBPR Fee $2.03 DCA Fee $2.03 07/11/2016 Credit Card $227.66 $50.00 Education Surcharge $1.20 06/21/2016 Credit Card $50.00 $0.00 Permit Fee $135.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $277.66 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 ELECTRI ,PLUMBING,MECHANICAL, NDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI IT: I certify that all fore g ing ormatio s ccu to andfast all work will be done in compliance with all applicable laws regulating construction d zoning. Fut ore, a horiz t e ve-n contr ctor o the work stated. July 11,2016 Au orize4partment nt e:Owner / A licant / Contractor / Agent Date Building Copy July 11,2016 1 Miami Shores Village &(®vip BuildingDepartment -dam p ' JUN 2 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 1`1 BUILDING Master Permit No. —7A3 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP f CONTRACTOR DRAWINGS JOB ADDRESS: a ' `OPe- City: Miami Shores p County: Miami Dade Zip: Folio/Parcel#: 3®5o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ;��� o C a 1— Phone#:IF 3-S 7 C Address: A� 3 U /v Jl�' /�l/S� k � City: (moi ! 1�� Y't'/5 State: Zip: 3 ) 3 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: � ,,e dC/ G®r\ Phone#: Address: 5-5-7 � �,/ /6) 6 Cell 6a bto City: .A jet, Sta � � Zip: Qualifier Name: 6 � A B ra Z " Phone#: State Certification or Registration#: Certificate of Competency#: T DESIGNER:Architect/Engineer:�J o- 'e— yl"rd Phone#: '`' Address:�� (� �Vf— City: /—I 1 c-1 I State: � Zip: Value of Work for this Permit:$ 5 0 —o Square/Linear Footage of Work: 0 Type of Work: ❑ Add1tiW Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: x12 Specify color of color thru tile: / Submittal Fee$ '. Per it Fee �' $_ CfiJ/ -e fi . �e pew �0 °� CCF Scanning Fee$ `'� Radon Fee$ �� �-� DBPR$ ` Notary$ YJ Technology Fee$ c `5�r3 Training/Education Fee$ ) 7-0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 iPer o,a certified copy of the recorded notice of commencement must be posted at the job site for the first insp (7) days after the building permit is issued. I the bsence of suc aste notice, the inspection will nction fee will be charged. Signature Signature ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrumeynt was acknowledged before me this day of �` ,20 1( .byday of �` d 20 / ,by // who is personally known to to o a sonally known me or who has produced Q D 00 A 100- ''dz�-®4s-ome or who has produced A W as identification an who did take an oath. identificati n nd who dth NOTARY PUB IC NOTARY U LIC: R Sig Sign: baa;e /r Print _ - - - = Prin a i,- S I: N 1 . E.aSYYilll9!f dCC:�.�S " Boom nffth Nationa.►.Notary Assn: << NatloiW Notary Assn. APPROVE -- -- - J ` D BY /�l I b Plans Examiner ` Zoning v/ Structural Review Clerk (Revised02/24/2014) R a ♦SNORE& s� Miami shores Village NINE 891 ..... Building Department 10050 N.E.2nd Avenue LOR NA 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 B OW OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS.- Signature: ONTENTS.-Signature: State of Florida County of Miami-Dade The foregoing was acknowledge before me this Zd day of ©`(/,A--e ,20 16. $y' Y S D� 2 a who tr-rsnally o to me or has produced as identification. Phi tr,i„n �CT{EUE Notary: l , r pass 5,017 SEA EcrJn�aryF� lc Un Pnuriters c