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RF-13-304Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 185906 Permit Number: RF -2 -13 -304 Scheduled Inspection Date: March 21, 2013 Inspector: Bruhn, Norman Owner: BUENCONSEJO, RODRIGO Job Address: 9424 NE 1 Avenue Miami Shores, FL Project <NONE> Contractor: JOHN BUSTA ROOFING INC Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1132060130440 Phone: (305)757 -7620 Building Department Comments REPAIR FLASHING AROUND ENTIRE FIRE PLACE 4X5" ANGLE FASHING AND 5" FACE STUCCO STOP Infractlo Passed Comments INSPECTOR COMMENTS False Passed Failed Inspector Comments 4.eil-Ar Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 21, 2013 For Inspections please call: (305)762 -4949 Page 14 of 40 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FB 1 j3 BY: �000avavamoo�o ®o ® ® ®® FBC � o BUILDING Permit No. b)4 PERMIT APPLICATION Master Permit No. Permit Type: BUILDING JOB ADDRESS: 9929 hid E. / /46. City: Miami Shores County: Folio/Parcel #: 1/ 3206 £'/3 O/4% ��// Is the Building Historically Designated: Yes NO s'!„ OWNER: Name (Fee Simple Titleholder): "-OAR/ � 0 /j%, �Gfif er:7,( Phone#: 786.- &5 (99'30 Address: 941 .z 11, , / Ace City: /4j/ 4 Al/ State: J1s,. Tenant/Lessee Name: 'WA Email: f 8 4t.-A/ CoxJ's.k70c N /,qrl g AiRAlor . C-�A� CONTRACTOR: Company Name: `.J -0'�// 8,457,4 Phone #: 39-4.--7.57-74X09 ROOFING Miami Dade zip :43/39- 7®/ Flood Zone: zip:(3 /3 g Phone #: i(% /if4 Address: 300 AZ E, 9/67% City: /PAW/ &ORES. State: iCZ Zip:3 3/31 ®3/ 12 Qualifier Name O/7 7 S A Phone#: ®.a 75-7 7 State Certification or Registration #: C �p�C 5 0410 Certificate of Competency #: Contact Phone #: ZS . 2 !' • 06 9. Email Address: e A 300 j Lr 694 DESIGNER: Architect/Engineer: /(l /q Phone#: AVA Value of Work for this Permit: $ /500, Square/Linear Footage of Work: _ g2_ 6Q lip Type of Work: DAddition OAltera on ONew eplace DDemolition Descaiption of Work: S. %1/6 A ■ P /M EE% A-sW i AA) " ,s71/eiv) Hof 1.1/ r 24 cA Color thru tile: ,; , ******************* *** * *•x�x�x�x�xx�a�s�n��x** ***F �x•x�x�x+xa� *a�x�a� *•x****** *4 *** ****;x ****** ** *** *** Permit Fee $ CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) IV/� Bonding Company's Address /VA City e/A State -� —' Zip �✓� Mortgage Lender's Name (if applicable) /VA Mortgage Lender's Address ".. /4 City IV// 3 State A/A Zip /(%/4 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 FT.F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 Mir kik 0 1 e or Agent The oi fore" ng'instrument was acknowledged before me this 1 The fore day of wh day of C.t, 20 U, by who • rsonally known) me or who has produced As NOTARY PUBLIC: Sign: Print: My Commission Expires: e an o *= MY COMMISSION # DD 992040 EXPIRES: September 14, 2014 Bonded Thru Notary Po* Undeiw hers (5.4).E-. I cf. (Ix) L ff Contractor strument w • ckn by or who has produced as identification and who did take an oath. NOTA ; Y PUBLIC: • Sign: Print: My Co ss1eltp RRre§tonded Through Natiu3a1 Notary 5 ,, EE 128810 * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY JdiPlans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /1012009)(Revised 3/15/09) • - Florida Building Code 2010 Ed High Velocity Hurricane Zone Uniform Perm 11.• .t LLL Master Permit No. Contractor's Nano 6Wil 80-45.7 AppIicatioflFOffli Shows ViNai:je 141!/41ii a °,0L. IP Alt Process Job Adak*. 9V24' Ale DATE NING DEPT , ROOF CATEGORY , UBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS O Low Slope 0 Mechanically Fastened Tile <12, Mortar/Adhesive Senile O Aaphaitic 0 Metal Panel/Shingles 0 Wood ShinglesiShakes Shingles Are there 0- Prescripllve BUR-RAS 150 Gas vent Ur? Yes° ROOF TYPE %Ike: Naturall:1 LPG)(0 O New Roof 0 Re-Roofing 0 Recovering (a/Repair 0 Makdenerme ROOF SYSTEM INFORMATION Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 32. 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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 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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER Southeast Insurance Agency 5001 S University Drive Suite K Davie, FL 33328 Phone (954) 680 -2255 Fax (954) 680 -3208 CONTACT NAME: (AC No, ern- (954) 680 -2255 , No): (954) 680 -3208 AE A; southeasiinsuran@bellsouth.net INSURERS) AFFORDING COVERAGE RAC # INSURER A ; NORTH POINTE INSURANCE COMPANY A INSURED JOHN BUSTA ROOFING INC. 300 NE 91 Street Miami Shores, FL 33138 (305) 219 -9699 INSURER B : INSURER c : 12/09/2012 INSURER D : EACH OCCURRENCE INSURER E : PR M INSURER F : V COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LIR TYPE OF INSURANCE ADDLSUBR INSR WVD POL/CY NUMBER P01.� (MMID POLICY E CP LIMITS A GENERAL LIABILITY 2094123466 12/09/2012 12/09/2013 EACH OCCURRENCE $ 1,000,000.00 PR M $ 100,000•00 V COMMERCIAL GENERAL LIABILITY PREMISES (Ea oc cunence) ❑ ❑ CLAIMS -MADE n OCCUR MED EXP (My one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEM.. AGGREGATE OMIT APPLIES PER ❑ POLICY ❑ JEC ❑ LOC PRODUCTS - COMP /OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS ED ❑ AUTOS SCHEDULED NON -OWNED HIRED AUTOS ❑ ❑ AUTOS ❑ ❑ O INEED�SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per aooident, $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA UAB ❑ OCCUR ❑ EXCESS IJAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N /A ❑ TORY S ATU- ❑FOR E.L. EACH ACCDENT $ OFFICER/MEMBER EXCLUDED? (111andatory In NH) EL DISEASE - EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATORS / LOCATIONS /VEHICLES (Attu ACORD 101, Additional Ren drs Schedule, I more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 -2382 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 MASSIMO PULCINI ACORD 25 (2010/05) OF © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD