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DGT-16-723 N� dl Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-272492 Permit Number: DGT-3-16-723 Scheduled Inspection Date: December 09,2016 Permit Type: Decks/Gazebos/Trellises Inspector- " 30S--q. PC r Inspection Type: Final Owner: ZULUAGA,JUAN Work Classification: Pergola Job Address:580 NE 106 Street Miami Shores, FL 33138- Phone Number Parcel Number 1122310140170 Project: <NONE> Contractor: FLORIDA PERGOLA LLC Phone: (305)400-0200 Building Department Comments BUILD NEW PERGOLA Infractio Passed Comments INSPECTOR COMMENTS False tz" Inspector Comments CREATED AS REINSPECTION FOR INSP-255121. 12106f2016 8:53 AM Passed I Juan >owner cancelled inspection Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until mminspection fee is paid December 08,2016 For Inspections please call: (305)762-4949 Page 20 of 31 sh trx Miami Shores Village r 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 �E 'oto Phone: (305)795-2204 j,•. tse.iaa�. Expiration: 03/29/2017 Project Address Parcel Number Applicant 580 NE 106 Street 1122310140170 JUAN ZULUAGA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell JUAN ZULUAGA 580 NE 106 Street MIAMI SHORES FL 33138- 580 NE 106 Street FL Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 FLORIDA PERGOLA LLC (305)400-0200 (305)213-4141 Total Sq Feet: 320 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Slab Date Denied: Final Type Const:Pergolas Additional Info:BUILD NEW PERGOLA Framing Classification:Residential Scanning:3 Footing Scanning:3_ Review Planning Review Planning Review Structural Review Structural Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# DGT-3-16-59075 DBPR Fee $2.33 09/30/2016 Check*20039 $277.46 $50.00 DCA Fee $2.33 Education Surcharge $0.60 03/21/2016 Credit Card $50.00 $0.00 Permit Fee $155.00 Plan Review Fee(Engineer) $80.00 Plan Review Fee(Engineer) $80.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $327.46 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 above-named contractor to do the work stated. September 30,2016 Authorized Signature:Owner / Applicant / ontractor / Agent Date Building Department Copy September 30,2016 1 Miami Shores Village 7B — Tel: R 2 1. 201 Building Department J10050 N.E.2nd Avenue,Miami Shores,Florida 33138IS' (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 &R FBC 20 1L( BUILDING Master Permit No. G�' ��- -fz3 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: JTZ I E I 6 i"� 9—h-e �- City: Miami Shores County: Miami Dade Zip: 3313s Folio/Parcel#: 11'ap-ogi-0/`(" Is the Building Historically Designated:Yes NO Occupancy Type: .Si A . Load: Construction Type: A d Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �� Z L+1 lino R� Phone#: D'r�-3-� 3 Address::t,� 5� �V E— I D bi'h S+reej— City: I l'amj Jk°rt-'5 State:- zip: 3-3/3Y Tenant/Lessee Name: t Phone#: Email: CONTRACTOR:Company Name: 1 o►'la 10, -PL) o R- Phone#:.:3D-5`fes Address: Iaa 5S sPO b fh S- �h- Miami City: State: F�- Zip: Qualifier Name: Matkw &VQll Phone#: State Certification or Registration#: Gf�G � Certificate of Competency#: �1 T DESIGNER:Architect/Engineer: CY n e-k- r/ Zlm ZG�d !` Phone#: 5Z1- 6D3-5y1 Address: h -O Sf7j-n�e L---rk'eCity: "fie-14P�Dh. State: rt- Zip: Value of Work for this Permit:$ co-LJ Square/Linear Footage of Work:® Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition Description of Work: &l l't /e L�c Specify color of color thru tile: Submittal Fee$ 4LE:D-1 c• M Permit Fee$ (J 5 - CCF$� CO/CC$ I0 Scanning Fee$ :E3 - 0�) Radon Fee$ Q•3E DBPR$ cP-- 3S Notary$ Technology Fee S,D• pTraining/Education Fee$ 0 - � Double Fee$ Structural Reviewy s$ 0 - ck 0 .10�3 Bond$ la TOTAL FEE NOW DUE$ �� ('0 (Revised02/24/2014) . Bonding Company's Name(if applicable) A�/(1` 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. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2 day of f [' ?-V9LT 20 16 ,by day of / [Clerk ,20 16 ,by M � � l�• �V�V� A ,who is personally known to / I&44-eLJ &oe4/ ,who is personally known to me or who has produced " DIL- L C 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: g Print: Print• �/,� N' ALN SEBASTIAN B01 Z JIMNA N.MAOERA Seal: ow. Seal: NolmY -SWe o!Florida ,e`erNotary pwft•Spb o1 FMrlda My Coram.Erre:Aub 22.2018 = Commissin t FF 986428 Commission 0 FF 129543 Qae; My Comm.E><ptros Nov 18.2019 �f APPROVED BY Plans Examiner LZ Zoning Structural Review Clerk (Revised02/24/2014) P E Ry( resoles•cra�ebae•1 •Dem•nrbols Tel.3o&4wm=o/Fax.3og400.mm X1518817 Date: 9 1.30 � l 1, State of Fl®t-nom County of M ice""i — -bcqd Before me this day personally appeared MCI414'e"o �V-611 who,being duly sworn,deposes and says: That he or she will be the only person from Florida Pergola working on the project located at: 580 NE 106'h Street, Miami Shores,FL 33138. Sworn to (or affirmed) and subscribed before me this 3 b day of �=� .20 [�,by Personally know A Type of Identification Produced FMI1111 AUDREY CHIOUITO Notary Public-State of FloridaCommission 160 024512 y Comm.Expires Avo 25,2020 G V��► (Ih,61)LLtfiv Print,'Type or Stamp Name of Notary Florida Pergola,Inc., 12255 SW 128 Street,Suite 406,Miami,FL 33186 PH:(305)400-0200 Fax:(305)400-0201 .... d,„ Miami Shores Village Building Department A R1Dp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption pq/y px 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 fall.-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,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: x,�Da— Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this ) day of �e M 1& 20_LV . By__J lit a-0 David i Z L-1 14 n a who is personally known to me or has produced Dp I V'C r f 11U-Me, -Z 9 2 0 -'-t 2 b -I U U-0 as identification. �a"w a ' AUDREY CHWWTO Notary i (�l�I'� s NOWY P -State of Floft It SEAL: � Commission#00 024512 2020 MY Comm.Expires Aug 25. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 BOVELL, MATTHEW CHRISTOPHER FLORIDA PERGOLA INC 12255 SW 128TH STREET,#406 MIAMI FL 33186 Congratuiationsi 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 DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFES5lOA'fA F_.teGULATION Every day we work to improve the way we do business in order CGC1518817 IS°5LtE1 09/04/2016 to serve you better. For information about our services;please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENAL CONTRACTOR information about our divisions and the regulations that impact BOVELL,MATTHt W ISTCQ I f J yu,subscribe to department newsletters and learn more about FLORIDA PERGO I oe thDepartment's 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! Expa�afiwdaW AUG 31,2018 L1609040001911 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1518817 .' The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 x � UN BOVELL, MATTHEW CHRISTA FLORIDA PERGOLA INC • 12255 SW 12871 MIAMI . .e ..< .. i ISSUED: 08/04/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1609040001911 INSPECTION RECORD STRUCTURAL PLUMBING INSPECTION DATE INSP INSPECTION DATE INSP INSPECTION DATE INSP Foundation Zoning Final Stemwall ZONING COMMENTS Rough Slab Water Service Columns(1st Lift) 2nd Rough Columns(2nd Lift) Top Out Tie Beam Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior Framing INSPECTION DATE INSP LP Tank Insulation Temporary Pole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Rough 7 Driveway Rough PLUMBING COMMENTS Driveway Base Telephone Rough Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final MECHANICAL ADA compliance Alarm Rough INSPECTION DATE INSP Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert Service Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum MECHANICAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final Alarm