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RC-16-939 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL n Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-271420 Permit Number: RC-4-16-939 Scheduled Inspection Date: November 21,2016 Permit Type: Residential Construction Inspector: Diaz, Guillermo Inspection Type: Final Owner: SPIRK, BRANDON MYLES Work Classification: Alteration Job Address:269 NE 103 Street Miami Shores, FL 33138- Phone Number (305)519-3007 Parcel Number 1121360130430 Project: <NONE> Contractor: JAYN CONSTRUCTION INC Phone: (305)967-7580 Building Department Comments REPLACEMENT OF KITCHEN CABINETS. CONVERSION Infractio Passed Comments FROM ELECTRIC COOKING APPLIANCE TO GAS. INSPECTOR COMMENTS False RELOCATION&NEW ELECTRIC RECEPTACLES. NO MECHANICAL SCOPE. PLUMBING SCOPE LIMITED TO REPLACEMENT OF UNDER-SINK GATE VALVES. GAS SERVICE, ELECTRICAL SCOPE, AND PLUMBING SCOPE UNDER SEP. TRADE PERMITS Inspector Comments Passed E:J- Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 18,2016 For Inspections please call: (305)762-4949 Page 43 of 45 Permit Iry C ' a Miami Shores Village A,, Peimtt 'ype.,Res dentia[,Gonstwction 10050 N.E.2nd Avenue NE r pp L :: Iii b*Ct#ss tjon tit t"a ion Miami Shores,FL 33138-0000 Fi RmA Phone: (305)795-2204 0Date,.4I2 2#�'i� Expiration: 10/19/2016 Project Address Parcel Number Applicant 269 NE 103 Street 1121360130430 BRANDON MYLES SPIRK Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell =B� MYLES SPIRK 269 NE 103 Street (305)519-3007 MIAMI SHORES FL 33138- 269 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,900.00 JAYN CONSTRUCTION INC (305)967-7580 Total Sq Feet: 250 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:ELECTRIC COOKING APPLIANCE I Occupancy: Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Fill Cells Columns Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Electrical Review Electrical Bond Return: Classification:Residential Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Plumbing CCF $4.20 Review Structural DBPR Fee $3.11 Invoice# RC4-16-59323 Review Mechanical DCA Fee $3.11 04/22/2016 Credit Card $395.42 $50.00 Education Surcharge $1.40 04/08/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $207.00 Scanning Fee $9.00 Technology Fee $5.60 Work without Permit Fee $207.00 Total: $445.42 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 ELECTRIC_ MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID) rti t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an rmore, I authorize the above-named contractor to do the work stated. ,F April 22, 2016 Authorized Signa u ner / Applicant / Contractor / Agent Date Building Department Copy April 22,2016 1 Miami Shores Village tR.- .- � Buildin Department AFAR d8 a,g 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 k LA BUILDING Master Permit No. 'RC 1(0_ C1 3 PERMIT APPLICATION sub Permit No. ❑■ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 269 NE 103rd Street City: Miami Shores County: Miami Dade Z)a: 3(° Folio/Parcel#:11-2136-013-0430 is the Building Historically Designated:Yes NO X Occupancy Type: R3 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Brandon M. Spirk Phone#:305-516-3007 Address:269 NE 103rd Street City: Miami Shores state: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: mylestec@gmaii.com CONTRACTOR:Company Name: JAYN Construction Phone#: 305-967-7580 Address: 1125 NE 118 Street Suite 300-2 City: Miami State: FL zip: 33161 Qualifier Name: Alexander Perez Phone#: 305-975-1529 State Certification or Registration#: CGC 1516468 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$6,9_000.00 Square/Linear Footage of Work: 250 SF Type of Work: ❑ Addition OZ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Replacement of kitchen cabinets. Conversion from electric cooking appliance to Gas. Relocation & New of electric receptacles. No Mechanical Scope. Plumbing scope limited to replacement of under-sink gate valves. Gas service, electrical scope, and plumbing scope under sep. trade permits Specify color of color thru tile: Submittal Fee$ � ° Permit Fee$ � ° �� ccF$ co/cc$ Scanning Fee$� Radon Fee$ D��BPR$ � I f Notary$ C— • 0Z)Technology Fee$ ' 1UO Training/Education Fee$I ° ''i'pp ® Double Fee$ 2®—� Q Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �� (Revised02/24/2014) Bonding Company's Name(if applicable) N/A 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 abse,ee of such pos notice, the inspection will not be approved and a reinspection fee will be charged. Signature %—"' s Signature OWNER or AGENT NTRA R The foregoing instrument was acknowledged before me this The foregoing instrument as ackno ledged before me this /(v day of 104i-dl 20 14 by day of d 20 .by who is personally known to .GIRI who is personally known to me or who has produced as me r who has produced as identification and who did take an oath. identification and who ',d take an o th. NOTARY PUBLIC: NOTARY PUBLIC: Sign:_ / 4.�, r� C O/L,' �] / h Sign: Print: /`tom A L Ct7 A/ Arrc-, Print: Seal: MARIELA GORRIN ANA CommissionLCH�FF APA R86 O` commission#FF 043520 Expires December 7,2017 My Commission Expiros APPROVED BY ff 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 a vwma 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PEREZ,ALEXANDER JAYN CONSTRUCTION INC B01 NE 118TH STREET BISCAYNE PARK FL 33161 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 CGC1516468 ISSUED: 08/05/2014 serve you better. For information about our services,please log onto www.mlffloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe PEREZ,ALEXANDER to department newsletters and learn more about the Department's JAYN CONSTRUCTION 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! Expiration date:AUG 31 2016 L1408M0001839 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 4.z ; CONSTRUCTION INDUSTRY LICENSING BOARD Nowv rs CGC 1516468 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31. 2016 a =a PEREZ,ALEXANDER JAYN CONSTRUCTION INC 801 NE 118TH STREET t BISCAYNE PARK FL 33161 ISSUED: 08/05/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408050OD1839 VILLAGE OF BISCA'YNE PARK 640 NE 114 STREET * * BISCAYNE PARK,FL 33161 IM PHONE:305-899-8000-FAX:305-891-7241 This permit conveys no right to Permit Number: PH016-0010 occupy any STREET,ALLEY,or Issued: 04/07/2016 SIDEWALK,or any part thereof Expires: 12/31/2016 either temporarily or permanently. LOCATION OWNER APPLICANT 801 NE 118 ST ALEXANDER PEREZ HERNANDEZ ALEXANDER PEREZ 14ERNANDEZ 17-2231-007-1210 Lot: 801 NW 118 ST 801 NW 118 ST PlattSub: MIAMI 33161 MIAMI 33161 Phone: Phone: Fax: Fag: Work Description: Stipulations: Permit Item Work Type Fee Basis Item Total Home Occupational Permit Fee Standard Item 1.00 50.00 Fee Total: $50.00 Amount Paid: $50.00 Balance Due: $0.00 DATE MMMDIYYM ACS CERTIFICATE OF LIABILITY INSURANCE 4/5/2016 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 certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jon Rock The Contractors Choice Agency PHONE _ (800)918-3584 FAX :(877)684-9951 PO Box 13645 M..Jon@nginsuranceonline.com INSU S AFFORDING COVERAGE MAIC B Chandler AZ 85248 INSURERA:Preferred Cont. Ins. Co. RRG 12497 INSURED INSURER 8: JAYN Construction Inc. INSURER C: 333 NE 24th St. INSURER D: Apt . 1912 INSURER E: Miami )?L 33137 IISURERF: COVERAGES CERTIFICATE NUMBER:CL0911905423 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. R POLICY TYPE OF INSURANCE POLICY ER MWpownw LTEFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIAB1Lny EACH OCCURRENCE S 1,000,000 DAMAGE To R9?rRT- A CLAIMS-MADE ❑X OCCUR pig eau emmme S 50,000 PCIC5026-PCA509335-03 11/9/2015 11/9/2016 MM EXp(AM am person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEWL AGGREGATE LRNT APPLIES PER GENERAL AGGREGATE S 2,000,000 JET % POLICY❑ PRO -- F LOC PRODUCTS-COMPIOP AGG S 1,000,000 OTHER $ AUTOMOBILE LlABlLrryf (Ea acadent) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per acddent) S AUTOS AUTOS NON4YWNED PRO=AMAGE S HIRED AUTOS AUTOS (per S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION$ $ WORKERS COMPENSATION AND E IDLOYERS'LIABILITY IN ANY PROPRIETORMARTNERiDECUTWE Y❑ NIA El EACH ACCIDENT S OFFICERIMEMBER EXCLUDED?? (Mandatory In PBI) E.L DISEASE-EA EMPLO S Ry�desatbe under DESCMMN OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addfftnal Remarks Schedule,amyr be attached D1 mare space Is required) CGC 0 1516468. Certificate Holder is additional insured, and included in Primary Coverage, and Waiver of Subrogation per GL endorsement where required by written contract. CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZE•DREPRESENTATM Robert Rock/JON O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 po14o1) Alexander Perez 1125 NE 125 St Miami,FL 33161 April S,2016 Miami Shores Village Building Department 10050 N.E.2"d Avenue Miami Shores,FL 33138 State of: Florida County of:Dade Before me this day personally appeared ALEXANDER PEREZ who being duly sworn,deposes and says: That he or she will be the only person working on the project located at: .,q ev c7 A5 ce-- /o3 A-6(5-br�' 4q"i 3 31.3 Sworn to(or affirmed)and subscribed before me this S"'day of April,2016,by Alexander Perez. Personally know Or Produced Identification Type of Identification Produced CARIELA G=WN a. C,om�,� w n_ds/��an 0FF043UD r eMIM 7,2D17 X17019 P&qWe or St p Name of Notary SNORES 1�X32 t Miami shores Village NINE Building Department artment 10050 N.E.2nd Avenue �OR1Up* 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 C The foregoing was acknowledge before me this day of L ,20_10- B `'' S who is personally known to me or has produced l WWok ' •••g\ON E,1p• -11, Notary: :.��4 6,2020 • :o= SEAL: s :g t,,/,i��pmlli ° 'w 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 Wt rl s Compensation law. EFFECTIVE DATE: V2212016 EXPIRATION DATE: 1P21f2018 PERSON: PEREZ ALEXANDER FEIN: 263627948 BUSINESS NAME AND ADDRESS: JAYN CONSTRUCTION INC 801 NE 118 STREET BISCAYNE PARK FL 33161 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pu suafd to ChapW 440.05(14).F.S..an officer of a corparoibn who by"aw of etechon under this section may not recover beat%or owMensation under Oris rte.Pursuant to Chapter 440.05(12),F.S.,Cerfiicatosof cfeWoa to be exempt..apoy*My w Min 0rarwps cif the bushreas or bade Rdad on the, of election to be ezeropt.Pursuant to Chapter 44005(13),F.S..Notices&eWc ion to be atmmo and car0ficates of dection to be errampt SW be subject to rein B.at any b m after the fTarg of the mom or Bre issuance of Ore oenilicaffi, the parson owied an the nctbe orombicate no border rrmeffi the raautrernents of oft section for issuance oda rczfff;cat&.The dmat4nerd chap rovdre 9 DFS-F2-Mr-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(8WI3-1M PARTIAL FLOOR PLAN 269 NE 103 ST.SCOPE NOTES: C Emma •=1'-0" 1. SCOPE OF WORK IS LIMITED TO THE KITCHEN. IT INCLUDES THE REPLACEMENT T'f OF THE KITCHEN INETS, 110I RC (6- �3 r INSTALLATION O NAEW SMALL F-- =e_ p_ I. APPLIANCE BRANCH OUTLETS,AND INSTALLATION APR 0 8 2016 OF NEW 220V CIRCUIT FOR CorY NEW RANGE. 2. HOME IS EQUIPED WITH _ EXISTING MONITORED BATTERY OPERATED SMOKE DETECTORS(ONE IN EACH BEDROOM)AND A 1110 POINT ALONG COUNTER TO RE M ;I!,, COMBINATION SMOKE CO2 ; FEET FROM G.F.I PROTECTED RECEP AC = DETECTOR IN THE CORRID R ,� PUT D/W RECEPTACLE UNDER SIN . OUTSIDE OF THE BEDROO jlvujjAM5 SHORES VILLAGE L FIXED APPLIANCES ON DEDICATED CK � I B� DA E i A LZ,�VrLJ NEW LP GAS TANK UNDER SEPARATE TRADE PERMIT G { HATCH DENOTES EXTENT OF WORK AREA(KITCHEN ST UC URAL ONLY) NEW WALL RECEPTACLE ON DEDICATED BRANCH I El ECTICAL CIRCUIT PLUMBING p�d �1A rY 0. NEW GATE VALVES AT x '- fC �C�LA IC GAS LINE MOUNT D DOMESTIC WATERALL BASE UNDER SEP. SUPPLY(EXTENT OF � )+I1 �'=� PLUMBING SCOPE) w � NEW SINK IN ORIGINAL LOCATION--------*' rf �rr �r . ` ti • tW, y�L FEDERAL � E6'100E 20A EXISTING DISHWASHER AND ;;CIRC. SM APDL. ELECTRIC OVEN) - DISPOSAL RECEPTACLE UNDER SINK-NOT PART OF SCOPE ' v " +�y," ,. �+!«< ,�, '• :t NEW 220v 50A ► . ,� . � RECEPTACLE AT WALL ... + � BASE. EXISTING REFRIGERATOR '� RECEPTACLE TO REMAIN " • NEW ELECTRICAL HOOD • ••• CONNECTION WITHIN EXISTING CEILING LIGHT ••• SHROUD OF HOOD CIRCUITS TO REMAIN •• ABOVE RANGE ON EXISTING KITCHEN FLOOR ••• •• DEDICATED SM.APPL.BRANCH CIRCT. TO REMAIN. • . . . . . . . . . . . •• •• • • . •• ..