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RC-16-3097 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,Fl- Phone: LPhone: (305)795-2204 Fan: (305)756-8972 Inspection Number: I NSP-271 065 Permit Number: RC-11-16-3097 Scheduled Inspection Date: December 09,2016 Permit Type: Residential Construction Inspector. ' -3os--t �6r.�, Inspection Type F ung Owner: FAY, DANIELLE AND ARTHUR Work Classification: Additio /Alta eration Job Address:9312 NE 9 Place Miami Shores, FL Phone Number (203)470-2671 Parcel Number 1132060070070 Project: <NONE> Contractor: PALMER HOLDINGS, INC Phone: 305-310-4673 Building Department Comments RE-TILE 25 FT OF BACK SPLASH Infractio Passed Comments RE-TILE 60 FT OF KITCHEN TILE INSPECTOR COMMENTS False Inspector Comme is Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid I 1 December 08,2016 For Inspections please call: (305)762-4949 Page 14 of 31 E Miami Shores Village j8trh 10050 N.E.2nd Avenue NE ' ° A of" 1d�l�nlAltt�n ••'• Miami Shores,FL 33138-0000 f Phone: (305)795-2204 y s ' 11 Expiration: 05/27/2017 Project Address Parcel Number Applicant 9312 NE 9 Place 1132060070070 Miami Shores, FL Block: Lot: DANIELLE AND ARTHUR FAY Owner Information Address Phone Cell DANIELLE AND ARTHUR FAY 9312 NE 9 Place (203)470-2671 MIAMI SHORES FL 33138- 9312 NE 9 Place MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 PALMER HOLDINGS, INC 305-310-4673 Total Sq Feet: 85 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Drywall Date Denied: Miscellaneous Type of Construction:RE-TILE 25 FT OF BACK SPLASH Occupancy:Single Family Window Door Attachment Stories: Exterior: Tie Beam Front Setback: Rear Setback: Final Left Setback: Right Setback: Framing Bedrooms: Bathrooms: Insulation Plans Submitted:Yes Certificate Status: Final PE Certification Certificate Date: Additional Info:RE-TILE 25 FT OF BACK SPLASH Truss Insp Foundation Bond Return: Classification:Residential Window and Door Buck Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Columns CCF $1.20 Fill Cells Columns DBPR FeeInvoice# RC-11-16-62044 Wire Lathe $2.00 11/14/2016 Check#:8737 $50.00 $71.20 DCA Fee $2.0o Review Building Education Surcharge $0.40 11/28/2016 Credit Card $71.20 $0.00 Review Mechanical Notary Fee $5.00 Declaration of Use Permit Fee $100.00 F.Termite Letter Scanning Fee $9.00 F.Elevation Certificate Technology Fee $1.60 Review Planning Total: $121.20 Review Structural Review Electrical Review Plumbing 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. uthermore,I authorize the above-named contractor to do the work stated. November 28,2016 Authon ignet Owner / Applicant / Contractor / Agent ate Building a rtment Copy November 28,2016 1 Miami Shores Village ---- • r Building DepartmentNOV 4 2616 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B�' Tel:(305)795-2204 Fax:(305)756-8972 S-�I INSPECTION LINE PHONE NUMBER:(305)762-4949 ` �1 FBC 20)(_j BUILDING Master Permit No. C �- PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: ` Ale F City: Miami Shores County: Miami Dade Zip' J Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Lodd: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): A147AIiz Ile alvo/ _�'AA Phone#: o?of y?o oZG 7/ Address:�la? AlZ! 9Th P�Q� City: 1dt&1 cr/ ,s•jd%e�, State: . Zip: Tenant/Lessee Name: Phone#: Email: CONTRACT R:Company Name: L Phone#: , f cz� Address: AM City: I► State: Zip: -Ptq Qualifier Name: ``""�nn6 ? -� �� Phone#: State Certification or Registration#:(,b 0� (4_ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: :Address: City: State: Zip: Value of Work for this Permit:$ �r Square/Linear Footage of Work: Type of Work: ❑ Addition j Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: �' + Submittal Fee$ � Permit Fee$ CCF$ ( Z® CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Z ' Notary$ Technology Fee$ - Training/Education Fee$ ® Double Fee$ Structural Reviews$ Bond$ -------- TOTAL —®TOTAL FEE NOW DUE$ q I 2� (RPv1aPd07/74/7n141 Bonding Company's Name(if appli able) Bonding Company's Address f` 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 NER or AGENT U CONTRACTOR The foregoing instru ent ihas a knowledged befor a this The f regoing instrum nt was/anowledged befor a this dayof20 by day of / 20 by who is personally knowrLt0 /..e who is onaliy known to me or who has produced .�— as me or who has produced S as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Q S MOM WMERSig z�� Print: y Ru�� State of Florida Print: I O� I Seal: •y My Comm.Expires May 23,2020 Seal: .a ` • MAHARIU K GONIN 9 B�9throuyh National Notary Asan ZALEZ Y COMMISSION#GG 044802 EXPIRES:November 2020 F Iden Thru Notary Pwft UmWmihn APPROVED BY Plans Examiner Zoning Structural Review Clerk to—i—an9/9A lona Al Q I PALMER HOLDINGS INC 1900 SOUTH BAYSHORE DRIVE MIAMI FLA. 33133 STATE OF FLORIDA COUNTY OF DADE BEFORE THIS DAY PERSONALLY APPEAR WHO BEING DULY SWORN, DEPOSES AND SAYS: THAT ILL BE E ONLY P SON WORKING ON THE PROJECT LOCATED AT: MIAMI SHORES. SWORN TO(OR AFFIRMED)AND SUBSCRIBED BEOFRE ME THIS DAY OF NOVEMBER,2016 BY PERSONALLY KNOWN OR PRODUCED ID TYPEOFID MARTIN J.PALMER 4►pY PV�,�, Notary Public State of Florida NOTARY STAMP = � ;•__ Com 967104 omm.Expires Ma 23.202 Bonded tMou9h Na n lay t . � �S�oR� s� Miami shores Village E"' ""'I" Building Department artment 0 10050 N.E.2nd Avenue ttiR11�' 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: caner State of Florida County of Miami-Dade / The foregoing as acknowledge before me this day of �v ,20/1 B who i ersona o to me or has produced as identification MARTIN J.PALMER °a0, W'; Notary Public-State of Florida Notary: Commission#t FF 987104 ,s;= My Comm.Expires May 23,2020 SEAL: ` `�'� Bonded through National Notary Assn JEFF ATIMATER CHIEF F4L OBER 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 Workers'Compensation law. EFFECTIVE DATE: 6/30/2016 EXPIRATION DATE: 6/30/2018 PERSON: PALMER MARTIN J FEIN: 650839631 BUSINESS NAME AND ADDRESS: PALMER HOLDINGS INC 1900 S.BAYSHORE DRIVE MIAMI FL 33133 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Punumd to Chapter 440.05(14).F.S.,an officer of a corporation vft elects exemption from thus otter by"a oetificebe of election under this section a"not recover bend or Compensation curet this cdepter.PwwjwU to Chapter 440 05(12),F.S.,Certificates of election to be exempt..apply only ver the scope of the bre or bad Iced on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of elect to be exempt and certificates of election to be exempt stall be subject to revocation ti,at any time after the fift of the notice or the ismence of the certificate, Me person named on the mice or certificate no lori;ier meets the requirements of this section for issuance of a oerfflloift The department shall revue a DFS-F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(8W)413.1 WO RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTM, INDUSTRY LICENSING BOARD ,_ C=594M 2 The GENERAL CONTRACTOR " Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 ❑O" PaPALMER, MARTIN JOHN a PALMER HOLDINGS, ='1900 Soo-TI 1 AY x' z,,; ry ISSUED: 08/04/2016 DISPLAY AS REQUIRED BY LAW SEQ# L160804=1434 )11687 Local,Business Tax Receipt Miami-Dade County, State of Florida THIS IS NOTA BILL—DO NOT PAY 4822681 BUSMI SS a"mo m-noN RBCBtPr NO. EXPIRES PALMER HOLDINGS INC PtI NEWAJ_ SEPTEMBER 30, 2017 1900 S BAMORE DR 4087404 Must be displayed at place of business MIAMI RL 33133 Purrelant to County Code Chapter 8A-Art.9&10 OWNER SBC.TYPE OF StfSiNESS PAYMENT RBCEIV� PALMER HOLDINGS TRIC 196 GENERAL BUILDING CONTRACTOR By TAX.CDLWCTM Worker(s) 1 CGCO59420 $45.00 08/03/2016 CREDITCARD-16-045649 This total eadnesaTexagodpowy payment of the Laced Bashress Tax The Receipt is aet a 1t , permit,ora O+yaldie s a do budewL HaIderared eam*w tg eay gam r lava regair vol" pplytotlretmsivass. 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