RF-12-2411Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 184556 Permit Number: RF -12 -12 -2411
Scheduled Inspection Date: January 23, 2013
Inspector: Bruhn, Norman
Owner: PUYANIC, DAVID
Job Address: 9259 N BAYSHORE Drive
Miami Shores, FL
Project: <NONE>
Contractor: ACEBO ROOFING CORP
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Repair Roof
Phone Number
Parcel Number 1132050270580
Phone: 305 -685 -2534
Building Department Comments
ROOF REPAIR & SOME FASCIA REPLACED
Infractio Passed Comments
INSPECTOR COMMENTS
False
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP - 184357. CREATED AS
REINSPECTION FOR INSP- 184225. CREATED AS REINSPECTION FOR
INSP- 183306. ALL WORK COVERED. JR
NO PERMIT
NO LADDER ON SITE. JR
January 22, 2013
For Inspections please call: (305)762 -4949
Page 31 of 34
Ir�y �n112
l�^
G
Rwer APPLICATION
Miami ores Village
Building Department
/9050 N,L2t d Avenue, Miami Shoff, Florida 33138
Te is (305) 795.2204 Fate (305) 756,8972
lilUN'S PHONE NUMBER: (305)762.4949
Permit Types BUILDING
JOB ADDREggt 9259 N BAYSHORE DR
FoiioRarccl#: 11-3205-027-0580
Is the B ieg' Histories By bid: Yes
Permit No -4-- a— 0411
Master Permit No. 12-447
ROOFING
i de zip: 3
8
NOX
Flood Zone:
OWNER: Name (Fee Simple Titleholder): DAVID PUYANIC Pho : ( 6J ;q5-; `J q�
Address: 9259 H BAYSHORR DR
city: MIAMI SHORES
Tenant/ Lessee Name: A
Email: Davin eco/ruv.othzC<ee- tiy.0nn ..
CONTRACTOR: Cody Name: ACEBO ROOFING CORP
Address: 4305E 10 LANE
city: HIALEAH
Qualifier Name: PEDRO L ACEBO
State Certification or IttNgiatratian #i: 0=058112
contact Phoney#: 305-8-22 4 Email Address: a
DESIGNER: Architect/Engineer:
State: FL
State: FLQ
zip: 33138
Pho
305 -685 -2534
ip: 33013
Phone#: 3056852534
iftcate of Competency #:
oofingcorpcyahoo.com
Phone#:
Value of Work for this Permit: $ 3 500
Square/Linear Footage of work:
Type of Work: °Addition QAhem-don °New XRepair/Replace
Descriptionofwork: Roof repair t som. e •Foci A giz \�t �
CUDemoliti
Color tlrri tile;
* s�+a±►a tlas* air** *** *ss*sts***** ***Fees* * * ******* *s *** **s *s*
Submittal Fee $ Permit Fee $ O ` � CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Traitdug/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $1
CO } YOUR PA
TO YOUR YOU TO O
LTG, ULT Y LE ER OR .' A ° ' ` Y BEFORE
YOUR OF COMMENCEMENT."
Notice 10 Applicant As a condition to
promise in good faith that a copy
Wane property arse
for the first' awe"
�lion will not b app
istt i
an%nh
pert° y f h.' riledn
7) s er the
CERTIFICATE OF LIABILITY INSURANCE.
I DATE (MMIDD0YYY)
12/3!2012
8 art#IFIDATE 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 POUCIES BELOW. THIS CERTIFICATE OF
INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
`I11,? LATE HOLDER,
e " RANT: if the certificate holder is an ADDITIONAL INSURED, the policy (les) must be endorsed. If SUBROGATION IS WAIVED, 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
FRANKCRUM INSURANCE AGENCY, INC.
100 S. MISSOURI AVE.
CLEARWATER FL 33756
CONTACT
PHONE
, EM): 1-800 -277 -1620 x4800 IIZ, Nep 727- 797 -0704
EawL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAICO
INSURER A: FRANK WINSTON CRUM INSURANCE CO.
11600
INSURED
-
FrankCrum 1-800- 277 -1620
100 S MISSOURI AVENUE
CLEARVVATER FL 33756
INSURER B:
INSURER C:
INSURER D:
INSURER E: .
$
INSURER F: .
•
11),I' THIS 1S 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POUCY NUMBER
POLICY EFF
(MMIDDNYYY)
POLICY UM
(MMIDD/YYYY)
LIMITS
GENERAL
LIABIUIY
COMMERCIAL GENERAL UABIUTY
ICWMS -MADE
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES qEa occurrence)
$
OCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEM. AGGREGATE UMRAPIPUES
PER
E]LOC
PRODUCTS - COMP/OP AGO
$
POUCY ' T (PRJECT
$
AUTOMOBILE
UABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON -OWNED
AUTOS
COMBINED SINGLE UMTT
(Es accident
$
BODILY INJURY (Per person)
$
_
BODILY INJURY (Per accident)
_
PROPERTY DAMAGE
(Per accident)
$
_
$
UMBRELLA UAB
EXCESS UAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
_
AGGREGATE
$
DEDI 1 RETENTIONS
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABIUTY
ANY PROPRIETORIPARTNER/FJ(ECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In
Ryes, desalbe under
DESCRIPTION OF OPERATIONS below
NIA
WC201300000
1/1/2013
1/1/2014
tACSTATU- OTH-
�C TORY UMTTS I ER
/
EL. EACH ACCIDENT
$1,000,000
Il—J
EL. DISEASE - EAEMPLOYEE
$1,000,000
.
EL DISEASE - POUCY UNIT
$1,000,000
DESCRIPTION
EFFECTIVE
IS REPORTING
OF OPERATIONS! LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remark* Schedule, Emote space is required)
12/31/2003, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ACEBO ROOFING CORP. (CLIENT) FOR WHOM THE CLIENT
HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES.
CERTIFICATE HOLDER
CITY OF MIAMI SHORES
10050 NORTHEAST 2ND AVE.
MIAMI SHORES, FL 33138�S
..^•-- -- --"—'-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
--
ACORD 25 (2010/06)
The ACORD name and logo are registered marks of ACORD
81988 -2010 ACORD CORPORATION. All rights reserved.
- CERTIFICATE OF LIABILITY INSURANCE
DATE(MNI/DDIYYYY)
05/16/12
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 WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer fights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
First General Insurance
7900 NW 155 St, Suite 102
Miami Lakes, FL 33016
Phone (305) 817 -0303 Fax (305) 817 -0333
CONTACT
NAME:
PHONE
Ezt): I INC. Not
E- I dIUL,
D �;
floRDI�icER
CUSTOMER ID 0:
INSURERS) AFFORDING COVERAGE
NAIC 0
INSURED
ACEBO ROOFING CORP.
4305 EAST 10 LANE
HIALEAH, FL 33013
(305) 685 -2534
INSURERA: CENTURY SURETY
CCP654463
INSURER B:
05/19/2013
INSURER C : .
$ 1,000,000
INSURER D :
$ 100,000 •
INSURER E :
MED EXP (Any one parson)
INSURER F
• II CLAIMS -MADE M OCCUR
•
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 POUCIES DESCRIBED HEREIN IS.SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Iej
TYPE OFMSURANCE
IINSRWVD
POLICY NUMBER
DYEP
(MA DD Y)
��nu0DrTTT TI
LIMITS
A
GENERAL LIABILITY
N
CCP654463
05/19/2012
05/19/2013
EACH OCCURRENCE
$ 1,000,000
DAMAGE10 RENTED
PREMISES (Ea occunence)
$ 100,000 •
• COMMERCIAL GENERAL LIABILITY
MED EXP (Any one parson)
$ 5,000
• II CLAIMS -MADE M OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
5 1,000
GENERAL AGGREGATE
$ 2,000,000
MI
GEM AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP /OP AGG
$ 1,000,000
$
• POLICY • 3E8j: • LOC
AUTOMOBILE LIABILITY
II ANY AUTO
• ALL OWNED AUTOS
• SCHEDULED AUTOS
COMBINED COMBINED SINGLE UMTT
(Ea accident)
EXCLUDED
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
• HIRED AUTOS
• NON -OWNED AUTOS
$
$
• -
EACH OCCURRENCE
$ EXCLUDED
UMBRELLA LIAB • OCCUR
AGGREGATE
$
• EXCESS LIAR • CLAIMS -MADE
$
• DEDUCTIBLE
•
$
• RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? _
N / A
OTH-
❑ TTORY LIMITS 1 ER
EXCLUDED
E.L EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
Byes dLdRescribe urder
DESIPTION OF OPERATIONS below
E.L DISEASE - POLICY LIMIT
$
DESCRIPTION
ROOFING
OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required)
CONTRACTOR
GCK I if" mot I c nvLUCR
MIAMI SHORES VILLAGE
10050 NE 2 AVENUE
MIAMI SHORES, FL 33138
i
-• •• •-- _ - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ROSIE BRUZON
www •no.en nnnnne ATIAW All Ankh: raa:w:rr
ACORD 25 (2009/09) QF
v lades' LUU ?%WIW vv..r.+.................o.. -- .--_. - - -•
The ACORD name and logo are registered marks of ACORD
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUStRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
ACEBO, PEDRO L
ACEBO ROOFING CORP
4305 E 10 LN
HIALEAH
!EFL 33013
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 from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto Iwww.myfloridalicense.com.
There you can find more information about our diva ions and the regulations that
impact you, subscribe to department newsletters and leam more about the
Department's initiatives.
Our mission at the Department is: License Efficien , Regulate Fairly. We
constantly strive to serve you better so that you ca serve your customers.
Thank you for doing business in Florida, and con; tulations on your new license!
DETACH HERE
STATE OF FLORIDA AC# 6 3 4 6 2 3'
DEPARTMENT OP'BUSINESS AND
PROFESSIONAL REGULATION
CCC058112 09/07112 110434172
CERTIFIED :ROOFING CONTRACTOR
ACEBO, . PEDRO L•
ACEBO ROO'XNG CORD
IS CERTIFIED under the provisions of ch.489 Fs
Expiration date; AVG 31, 2014 7,12. 090702836
THIS DOCUMENT 1-IAS A COL RED BACKGROUND MICROPRINTING • LINEMARKPATENTED PAPER:, -'
AC# 6.3.4.6
STATE OF FLORIDA
DEPARTMENT BUS /NESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ #L12090702B36
LICENS NER
DATE BATCH NUMBER
09/07/2012 .11043417.2
• The ;.N ROOFING.' CONTRACTOR
a t ed below .,.XS CERTIP:IEi
IUsider the provisions of Chap
Expiration date: AUG 31, 201
ACEBO, PEDRO',.14
" ACEBO ROOFING CORP
4305 E 10 LN
HIALEAH
DISPLAY AS REQUIRED BY LAW
KEN LAWSON
SECRETARY
M; 9N±S -DARE f;€➢UNi Y
" AY. CC1LFCTOR
140 W FLAQLER ST.
lei FLC)CFR
MIAMI, FL 33190
,2012 LOCAL BUSINESS TAX RECEIPT 2013
MIAMI -BADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 30, 2013
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 8 & 10
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A BILL — DO NOT PR'':'
054546 -8 RENEWAL
°BU ii EW:: Isil. / LOCATION RECEIPT NO. 054546 -8
ACEBO ROOFING CORP STATE* CCC058112
4305 E 10 LA
33013 HIALEAH
OWNEEci
ACEBO ROOFING CORP
Sec. Type of Bustnesh
THIS to 1N9.6 SPECIALTY BUILDING CONTRACTOR
XAL
BUSINESS' TAX RECEIP'.. 3r
DOES NOT PERMT THE
HOLDEP TO VIOLATE ANY
EXISTING REGIS. &t OH? OR
°ONI1 G LAW OF THE
COUNTY on CITIES. N' :JR
DOES IT EXSih "T THE
HOLDER FROM ANY OTHER
PERMIT S LICEYS *-
REQUIRE) E. LAW.
NOT t CERTIFICATION 0'
THE HOLDER'S 0UALIPiGA-
itOttS.
PAYMENT RR tEI 'CF∎
MIAMI -DADS COtA'n Y TAX
COLLECTOP:
07/24/201
6000000015
000045.00,
SEE OTE1EN SIDE
WORKER /S
10
DO NOT FORWARD
ACEBO ROOFING CORP
PEDRO L ACEBO PRES
4305 E 10 LA
HIALEAH FL 33013
f„ ffllfff, ff��, Il1 ff, �ff�rfflf�l ,I� „f�l,ff „fi „�,frfltf>,If
29
Rf�
PRINTED WITH
ENVI!GNMENTALLY
FRIENDLY INKS
FsC
Mixed Sources
P. atmmmaum..u.mm.wa
aron sod ca rumwmasoaps
Con.. 248404031110
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aw•mnm+uaw■cm...
No: 238160 -24
City of Hialeah
Business Tax Receipt
Mayor Carlos Hernandez
(OLD- 1761 -8) Amount: $ 150.00
The person, firm or corp. listed here has paid the business tax required to engage in or operate the business specified subject to the
regulations and restrictions of the City of Hi4leah, Florida
2012 -13
Type of Business: Roofing Contractors
ACEBO ROOFING CO.
215 E 15 ST
HIALEAH, FL 33010
Validating No.: 0000
Owner: PEDRO L. ACEBO
THIS IS NOT A BILL
Business Location:
4305 E 10 LN
Expires September 30, 2013
/1-1$-" /01,7=3ri(
CUMULATIVE SUBSTANTIAL IMPROVEMENT
VERIFICATION WORK SHEET
In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all
improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed
improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished
materials (include those donated), labor (including volunteer and self - performed), construction supervision and
management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is
attached for your reference. (A Copy of the Contract must be attached)
PROPERTY OWNER:
PERMIT #
ADDRESS: Ctg �, t-� . '-13� . bor, cJeS a mil. cam: 33>-15e
FOLIO NUMBER. v,‘ OD-°, - %CI' FLOOD ZONE:
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS (12 MONTHS): 2o 7,/ 2 gal s J�
COST OF PROPOSED IMPROVEMENTS:
(ATTACH COPY OF CONTRACT)
TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): 2. C1 J 5i7. s 1
VALUE OF PRINCIPAL STRUC
(— I>7IZ".ac)
OWNERS SIGNATURE: DATE:
40/(2
PLANREVIEWER: /V/2f &ea/77W
PLAN REVIEWER SIGNATURE:
Created on June 2009
NO. CCCO
112
ACEBO ROOFING CORP.
4305 E. 10th LANE
HIALEAH, FL 33013
PH: (305) .5-2634
FAX: (3:05-)687-5526
DENMAR CONSTRUCTION GROUP
N.
MIAMI
YSHORE DR
ESTIMATE
rna-a4v[
EccmEvimi.
r17,,,i 0 L:z
1
BY:
OATE: December 3, 2012
PROJECT NA
DENMAR CONSTRUCTION GROUP
9259 N. BAYSHORE DR
MIAMI
, Pk7.44-
WTION: 1
GRAVEL ROOF REPAIR
1. SCRAPE PERIMETER OF GRAVEL STOP.
2. REPLACE ROTTED SHEATHING BOARDS ON EAVE. WE WILL SPLICE
SECTIONS OF 2X10 RAFTER ENDS WHERE NEEDED.
2. INSTALL NEW 2 BY SUBFASCIA AND 1 BY FASCIA AROUND PERIMETER,
4. SEAL METAL WITH 2 STRIPS OF F.G. USING PLASTIC CEMENT.
5. INSTALL 1X6 VJ SOFFIT AROUND PERIMETER.
WE WILL GIVE A 5 YEAR GUARANTEE FOR LEAKS CAUSED BYGRAVEL STOP
AND OUR SEALING OF.
50% DUE UPON ACCEPTANCE , 50% DUE UPON COMPLETION OF JOB.
DATE AUTHORIZED SIGNATURE
ESTIMATE MACE
caw
$5,244.00
CONSTRUCTION GROUP
FORM OF CHANGE ORDER
CHANGE
ORDER
PROJECT:
Puyanic Residence
CHANGE ORDER NUMBER:
DATE: November 27, 2012
TO CONTRACTOR:
Denmar Construction, Group. ARCHITECT'S PROJECT NO:
3180 NW 97th Way
Sunrise, FL 33351 CONTRACT: FY12 -001
CONTRACT DATE: Qctober 20, 2012
The Contract is 'hereby reviseDdP set forth below:
Change Order Oa, , encompasses all of the following work:
Change Order — Scope of work as detailed in Revised Si, 82, & S3 Drawing dated 11/02/12.
Replacement of Eco Windows and Doors for COI
(15% discount offered by CGI Windows) ($0)
Additional Roof repairs at perimeter of roof - $5,244
Credit for using AGA Contracting :
Stucco - ($365)
Masonry - ($1,446)
Tub Pour- ($530)
Floor Repair - ($270)
Roof Soffit& Fascia (200)
Credit for using Wood Express:
Millwork - ($4145)
Total ($6,956)
pr!
Net Total $.(1,7 >12)
This Change Order incorporates all documents and the work and services required by those documents as listed above.
The following are specific exceptions and are not settled by this Change Order:
No exceptions.
G -1
DP
OCONS-TRUCTION GROUP
Authorized:
Not valid until signed by both the Owner and Architect.
Signature of the Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract
Time.
The original (Contract Sum) (Guaranteed Maximum Price) was
Net change by previously authorized Change Orders
The (Contract Sum) (Guaranteed Maximum Price) prior to this Change Order was
The (Contract Sum (Guaranteed Maximum Price) will be (increased/decreased)
by this Change Order in the amount of
The new (Contract Sum) (Guaranteed Maximum Price) including this Change Order
will be
The Contract Time will be (increased) (decreased) by
The Date of Substantial Completion as of the date of this Change. Order is February 23. 2013.
$203,289.51
$0
$203,289.51
($1,712.00)
$ 201,577.51
(0) Days
AUTHORIZED:
(Company)
ARCHITECT
(address
DeflMar C.andiurILA Gnat'
(Company)
CONTRACTOR
(address
31 VC! A/. 6v I/ Ivy,
9‘14/0 1t"Li 33iSj
(Own
ne) d /)ilo,Atc.
By
By
DATE
DATE % 2/2 Z - •
By
DATE A2/2/2
Not valid until signed by both the Owner and Architect.
Signature of the Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract
Time.
G -2
PARTIAL SUBCONTRACTOR'S AFFIDAVIT
6
•
,...TIAThOF FLORIDA
COUNTY OF Miami - Dade,
BEFORE ME, the undersigned authority, personally appeared ACEBO, PEDRO L who, after being first duly swom,
deposes and says of his/her personal knowledge as follows:
1. HE/SHE is the President of ACEBO ROOFING CORP., which does business in the State of Florida,
hereinafter called the "Subcontractor."
2. Subcontractor, pursuant to a contract with DENMAR CONSTRUCTION GROUP, LLC., hereinafter
referred to as the "Contractor," has fumished or caused to be furnished labor, services and materials for the construction of certain
improvements at the property described below:
PROPERTY NAME:
STREET ADDRESS:
LEGAL DESCRIPTION:
DAVID PUYANIC RESIDENCE
9259 NORTH BAYSHORE DRIVE, MIAMI, FL 33138
ATTACHED AS EXHIBIT 'A'
3. This Affidavit is executed by the Subcontractor in accordance with Section 713.06(3)(d) of the Florida Statutes, for
the purpose of obtaining a progress payment from the Contractor in the amount of Three Thousand Two Hundred Dollars
($3,200.00).
4. All lienors under Subcontractor's direct contract have been paid in full, except for the following:
AMOUNT DUE OR TO BECOME DUE FOR
NAME OF LIENOR LABOR, SERVICES OR MATERIALS
5. Through the date of execution of this Affidavit, the undersigned has not asserted any claims and has not
encountered any conditions or circumstances which constitute grounds for asserting a claim against Contractor, DAVID A.
PUYANIC, Commodore Realty, Inc., and/or the property described above for any reason including, but not limited to, requesting
additional compensation and/or contract time, except for the following:
6. By executing this Affidavit and by failing to identify any claim as described above, the Affiant understands and
acknowledges that the same constitutes an irrevocable waiver of his right to file a claim for any reason including, but not limited to,
requesting additional compensation and/or contract time for any circumstances preceding the date of this Affidavit.
Signed, sealed and delivered this 5 day of C - , -Z- b 1 Z
ACEBO ROOFING CO J /
By:
Print Name: j7 -edi6 G-✓ 1)
STATE OF FLORIDA
COUNTY OF Miami -Dade
C
The foregoing instrument was acknowledged before me this 5 day of ^D Q 20 IZ- by
k)(2.0
L. -Ace'1w , who is personally known to me >4: OR produced identification (type
of identification produced: ) as
and who did / did not take an oath.
•
STATE OF FLORIDA
COUNTY OF Miami -Dade
WAIVER AND PARTIAL RELEASE OF LIEN
UPON PROGRESS /PARTIAL PAYMENT
The undersigned Ilenor, in consideration of the progress /partial payment in the amount of Three Thousand Two
Hundred Dollars ($3,200.00), paid by DENMAR CONSTRUCTION GROUP, LLC. hereinafter referred to as
"Contractor", receipt of which is hereby acknowledged, releases any claims against Contractor, DAVID A. PUYANIC,
Commodore Realty, Inc. Its successors, assigns, and against said property including any Hens, lien rights, claims, or demands of
any kind whatsoever through December 1,2012, hereinafter referred to as "DATE ", which the undersigned now has or might
have against the property described as:
PROPERTY NAME:
STREET ADDRESS:
LEGAL DESCRIPTION:
DAVID PUYANIC RESIDENCE
9259 NORTH BAYSHORE DRIVE, MIAMI, FL 33138
ATTACHED AS EXHIBIT 'A'
on account of labor or supervision performed and /or material furnished for any improvement thereof. That all labor, equipment
and materials used by the undersigned through Date, in the erection of said improvements, have been fully paid for.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J day of b. Cn , 20 /
Witnesses:
Witness Signature
Print Name
Witness Signature
Print Name
STATE OF FLORIDA
COUNTY OF Miami -Dade
The for egping m n�
of identification produced:
was acknowledged
, who is
By:
ACEBO ROOFING CORP.
cj,- o2.Aceoe
Print Name
Title: President
before me this
personally known to
day of e C , 20 /Z- by
me > OR produced identification (type
) as for
and who did /
did not take an oath.
My commission
C: IDOCUME- 1WUNNACALS- 11TemPttar$D100.3751Partial Subcontractor's Progress Payment (Subcontractor) - Deposit.doc
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ACEBO ROOFING CORP
9259 N BAYSHORE DR
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contractor to provide the owner with the
ction The provisions of Chapter 15 of
nts and standards of the industry for roofing
as part of the agreement between tfte
The item Maas been explained
15 (High Vetecdty Hurricane Zone)
resistance and water intrusion
not a consideration with respect to wortunensh+p
ppeerance, that are not part of a boding code should
the contractor
firm, the erg wood roof deck may have to be renailed
6 (High Velocity Hurricane Zones) of the Ronda Building
the ®': roof system)
3. Common Rte: Common row are tfisose which have no visible delineation between neighboring
townhouses, condominiums, etc.). in bufldings with common roofs, the rooting contractor and/or owner
the occupants of adjacent gilts of roofing work to be performed
4. posed Ceti . Exposed, open beam ceilings are where the untie de of the roof decking can be
viewed from be4ow. The owner may wish to maintain the architectural appearance, therefore, rooting nail
peenetnttons of the .underside of the decking may not be acceptable The Florida Building Code prevides the
option of maintaining this appear .
OP 5 Walter The current real System ardor deck of the building may not drain well and may
cause water tO pond a ta*aj in ►vwgyllg areas of the roof. Panning can be an indication of structural
end may et pfre t naview of a profterstortal structural engineer - Ponding may shorten the tile
and pertain:arms of the new roofing system Ponding conditions may not be evident until the original
is removed. Partditap ocinditlons Should be corrected
Steepens Ned ou ). It is required that rainwater flow off so that the roof is not
up of water. Perimeter/edge ter /eedge waits or other roof extertsiotks may block this discharge if
tutu) are not provided. it rriay be necessary to install overflow scuppers k accordance
Cods. Pig,
lay to vent natural airflow through the interior of
ate ventilatton shaft not be reduced It may be
in earta:tding the service life of the roof
Date
9259 N t AittittORE DR Al 1a.1; S JVes
Property Address pc 3313 Permit Number
is
Contractor's Stgnatur .
-a PLEASE 1 POR-FAVOR
NOT : PLEASE SION AND INITIAL FROM 1 -7
POR FAVOR FIRMS Y PONOA SUS 1NICIALES DEL 1 -7
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