RF-15-1546 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-271487 Permit Number: RF-6-15-1546
Scheduled Inspection Date: November 22,2016 Permit Type: Roof
Inspector: Diaz, Guillermo Inspection Type: Final Roof
Owner: ROSE,CHARLES Work Classification: Repair Roof
Job Address:150 NW 108 Street
Miami Shores, FL 33138- Phone Number 954-882-3338
Parcel Number 1121360090050
Project: <NONE>
Contractor: JOHN BUSTA ROOFING INC Phone: (305)219-9699
Building Department Comments
REPAIR TILE ROOF FRONT SIDE AR EAVE. Infractio Passed Comments
INSPECTOR COMMENTS False
Permit extended. Work was performed under the
mechanical permit final on 09-07-2016
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-237421. 10-21-16
no plans, no permit, no ladder.
Failed
l �
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 21,2016 For Inspections please call: (305)762-4949 Page 27 of 35
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ORES !- � � rTi��)z.
Miami Shores Village
�n 10050 N.E.2nd Avenue NW ftrk SlftG�t�On I palr.0,tlilt
Miami Shores,FL 33138-0000 etmt Status.-t
ti Phone: (305)795-2204
R1°�`
Expiration: 01/12/2016
la» t� 716/�A15
Project Address Parcel Number Applicant
150 NW 108 Street 1121360090050
CHARLES ROSE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
CHARLES ROSE 150 NW 108 ST 954-882-3338
Miami Shores 33138
Contractor(s) Phone Cell Phone Valuation: $ 650.00
JOHN BUSTA ROOFING INC (305)757-7620
Total Sci Feet: 75
Type of Work:Repair Available Inspections:
Additional Info:REPAIR TILE ROOF FRONT SIDE AR EAVE Inspection Type:
Classification:Residential Roof Repair
Scanning:3 Final Roof
Review Roof
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# RF-6-15-56068
DBPR Fee $2.00 07/16/2015 Check#: 1976 $64.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 06/23/2015 Check#: 1969 $50.00 $0.00
Permit Fee-Repairs $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 and zoning. Futhermore,I authorize the abov ontr or to do the work stated.
July 16, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 16,2015 1
Miami Shores Village
RECEM 913
Building Department JUN 3 NIS �
10050 N.E.2nd Avenue,Miami Shores,Florida 3313
Tel:(305)795-2204 Fax:(305)756-8972 By:—
INSPECTION
X:INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2010
BUILDING Master Permit No. " IJ �✓��
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC COOOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 4�0 A/Uo /00 1977-1
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):f A� L� Phone#:
Address: !ss�o&����� c
City: id✓I/ State:)5z. Zip:v
Tenant/Lessee Name: eA Phone#: N
Email:
CONTRACTOR:Company Name:e!`IW 9,(Z6_r 4 Phone#:
Address: _�;'Or,7 MeF psc�'M
City: State: 7��> Zip:
Qualifier Name: ® Phon ,-•,;Z/9• g'�
State Certification or Registration#: Certificate of Competency M
DESIGNER:Architect/Engineer:/1 Phone#:
Address: iv4 City: State Zip:
Value of Work for this Permit:$ rtes 10,7 Square/Linear Footage of Work: Z
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ EM Permit Fee$ 6 b0 • a CCF$ CO/CC$ ,
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ COY , GO
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address /
City &I'd State �/� Zip x>✓
ff
Mortgage Lender's Name-Kapplicable) A/,SCI
Mortgage Lender's Address
City /A 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.
l r a
Signature /d,/ Signature d
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of_d&A 20 �.S ,by day of 20 by
who is personally known to ���,/ � a� who is personally known to
me or who ha _produceddZ;_/0P/M�'r�1/��F as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: OLS Print: S 1'-,
Seal: Seal:
sANDRaaNN I?usta .,far"�: SMDRA ANN B:FF159120
MY COMMISSION i FF 159120 r MY COMMISSION 9EXPIRES:September 14,2018EXPIRES:Septemb2018knded ThM NOW Pubkn � Bonded Thru Publiw t m
/ 1
APPROVED BY 1 1 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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SECTION R4402.13
HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING
CONSIDERATIONS
R4402.13.1 Scope. As it pertains to this section,it is the responsibility of the roofing contractor to provide the
owner with the required roofing permit,and to explain to the owner the content of this section.The provisions of
Section R4402 govern the minimum requirements and standards of the industry for roofing system installations.
Additionally,the following items should be addressed as part of the agreement between the owner and the
V
er's initial in the adjacent box indicates that the item has been explained.
tics-Workmanship:The workmanship provisions of Section R4402 are for the purpose of
fing system meets the wind resistance and water intrusion performance standards.Aesthetics
t aconsideration with respect to workmanship provisions.Aesthetic issues such as color
or architectural appearance,that are not part of a zoning code,should be addressed as part of the agreement
n e owner and the contractor.
2 Renalling Wood Decks:When replacing roofing,the existing wood roof deck may have to be
re ailed in accordance with the current provisions of Section R4403.(The roof deck is usually concealed prior
to removing the existing roof system.)
Z2L3. Common Roofs: Common roofs are those which have no visible delineation 6e#weaen 0000:0
n ' hboring units (i.e. townhouses, condominiums, etc.) In buildings with commoa.rools, the Beefing •
cont or and/ owner should notify the occupants of adjacent units of roofing workot0.b�perfoNea. 9 000000
4.Exposed Callings:Exposed,open beam ceilings are where the undersickW4the rookleck4ng •
c;
viewed from below.The owner may wish to maintain the architectural appearanee,stberefora,roe%ng •••••
•
nail penetrations of the underside of the decking may not be acceptable.This provides th"eiq of maiMaipirp ••e••
this earance. •• •• •• •• 9006••
5. Ponding Water:The current roof system and/or deck of the building miay not drain:VeJl•�d :0000:
cause water to pond (accumulate) in low-lying areas of the roof. Ponding car bq oan indication of 660060
structural distress and may require the review of a professional structural engineer. Potidirig may sthcM 0 •
the life expectancy and performance of the new roofing system. Ponding conditions may not be AVidefit
until the original roofing system is removed. Ponding conditions should be corrected.
6.Overflow scuppers(wall outlets): It is required that rainwater flow off so that the roof is not
ov o ed from a build up of water.Perimeter/edge walls or other roof extensions may block this discharge
i overflow scuppers {wall outlets) are not provided. It may be necessary to install overflow scuppers in
accordance with the requirements of Sections R4402,R4403 and R4413.
.Ventilation:Most roof structures should have some ability to vent natural airflow through the
in or f the structural assembly{the building itself).The existing amount of attic ventilation shall not be
reduced.It may be beneficial to consider additional venting which can result in extending the service life of
the roof.
Exception:Attic spaces,designed by a Florida licensed engineer or registered architect to eliminate the attic
venting,venting shall not be required.
Owner' gent's Signature Date Contractor's Signature
Property Address Permit Number
yNonFs
EKG
Miami shores Village
Building Department
OR10050 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. § 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 b e••
exempt if- •
. . .... ......
1. The officer owns at least 10 percent of the stock of the corporation,Ar""e case pf' ..•.;
an LLC,a statement attestingto the minimum 10 percent ownership;,P p,......
2. The officer is listed as an officer of the corporation in the records.o£the Florida. :••••
Department of State,Division of Corporations;and • •
.... . .. .....
3. The corporation is registered and listed as active with the Florida 40apa tment•of• •• •••
State,Division of Corporations. •• •• •• •• ••••••
No more than three corporate officers per corporation or limited liability company mefnbers fie••;• ••••••
allowed to be exempt. Construction exemptions are valid for a period of two:yea&?pr 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 Z3 day of�_,L
B S /e0<� who is personally known to me or has produced
as identification.
Notary: Soi
SEAL: .
CIA '1�� OMMANN BWA
'� 159120 ° :3 Ml'CMUSSIQN Y FF 159120
F t 14,2018 ', ;,, Bonded%Nay NbftUndew
UndwWBeB