RC-12-1287Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 175738 Permit Number: RC -7 -12 -1287
Scheduled Inspection Date: July 23, 2012
Inspector: Bruhn, Norman
Owner: SITES, JACK
Job Address: 10401 NE 4 Avenue
Miami Shores, FL
Project <NONE>
Contractor: INTEGRAL CONSTRUCTION CORP
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122310150100
Phone: (954)663 -1110
Building Department Comments
REMOVE OF BATHTUB AND REPLACE WITH A PRE
FABRICATED SHOWER BASE AND ACRYLIC WALL
PANELS
Inspector Comments
Passed
-,704
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 20, 2012
For Inspections please call: (305)762 -4949
Page 24 of 43
Miami Shores Village
Building Department
14050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
101 101 1 L -4 -C-
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: 3 3 t 30
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
M 1 12;z V
FBC2�2 ��
Permit No.
Master Permit No.
ROOFING
OWNER: Name (Fee Simple Titleholder): 014 C t&.. S t T. S Phone* :
Address: (0 `L M C ,R('a+.•t,.
City: (Ak ti00.06•.-�t_.. E l , ,' ' 4 State: f2 l • Zip: 3 3 ( 38
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name:
Addr eOkiA,..6—+VAA �et r ' l
l - Va, *12 Go
City:
State: t .
Qualifier Name: 93 i L-L t.PeNt ST.C. ..e..1(2—
State Certification or Registration #:
Contact Phone#: k-
DESIGNER: Architect/Engineer: 1\)1
Phone #: ' r
:2.Certificate of Competency #: C. C t 68c
-U0 3 ' (1 j d Email Address: I, ( 1 n # rn C L + Ca) 1M
Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: °Addition °Alterrattion (' New C epair/Replace °Demolition
Description of e Work: . uAtt v i. W bCh'f k, °�- e"..4 r t(3.0 . W i T(aZ
Pre- 'Y4 v-1 r c*4 eiS locket rz e.- u0o-tApauf
Color thru tile:
* * * ***** * ****** ** x** *** * *** ***** * * *** Fees* **************** ******* ******** * *** ********
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ CW4
Bonding Company's Name (if applicable)
Bonding Company's Address
City • State Zip
Mortgage Lender's Narita (if applicable) _ --(14144- rrrrA ' J ST—' Lei Ato R e9.6
Mortgage Lender's Address • f 0 ( o i Ar4
city M ■ l state ft.e Ai-_ Zip . 3 3, 3 2
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANGS 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 construcrlon 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 he posted at the job site
for the first inspection w • h occurs seven (7) days after the building permit is is In die absence of such posted notice, the
inspection will not be app % roved and a rebaspection fee will be charged
y known to me or who has produced
As identification and who did take an oath.
UBLIC:
NOT
Sign:
My Commission
• r::� 1RES � vem
�XP gervwa.cam
) 3 , �ddallo ry
(407) 395.0193
Sign
Contractor
IV
The; • c, strument was acknowl :ed before
day • �' 2012 , b '
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
EZ
MY COMMISSION # DD838957
EXPIRES November 17 2012
(407) 398.0153 FlorKlalloteryServico.com
ass*******ldl **** ***h+i******* ******** **** 1 ********* ****** *** ***** ***** ***44:******* *ib*Mi******** **4
APPROVED BY
Plans Examiner
Structural Review
(Revised 3/12 O12)(Revised (7ri011 10/2009Xlitevised 3/15109)
Zoning
G'lerk
06/18/2012 16:15 9544861172
INTEGRAL CONST
2- CERTIFI® GENERAL CONTRACTOR
•
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A -100. Ft. Lauderdale, FL 33301 -1895 — 954-831 -4000
VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012
DBA:
Business Name: INTEGRAL CONSTRUCTION CORP
Owner Name: WILLIAM STE=ER
Business Location: 6919 W BROWARD BLVD STE 264
PLANTATION
Business Phone:
Rooms
PAGE 04/05
Receipt #:180.6435
Business Type:grT CONTRACTOR
CONTR)
Business Opened:05 /01/1990
State/Cou my /Cert/Reg:CGC4 2 0 99
Exemption Code:NOmPT
•
Employ*. .. • • Maehlnes
10
Professionals
For vending Business Only
•
Vending Type:
(GEM
Tax Amount
Transfer Fee. •' . '
: „NSF' Fee' , •
Penalty •
,,,: I: Prior Y
• • -; •
; Collection Cost
Total Pald
27.00
0.00.';• '
O'iif0'
•
,•.N
'..2:x%.0 •
•',..'•.%•:•••:. ,.,•x'::0'..00.
*.
0.00
29.70
06/18/2012 16:15 9544861172
AC I124�e
INTEGRAL CONST PAGE 05/05
INTECON -01
CERTIFICATE OF LIABILITY INSURANCE
SPNA
DATE (AI M DDIYYYY)
6/1812012 •
THIS CERTIFICATE •I5 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 QF 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(ee) 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 thin certificate does not confer rights to the
certificate bolder In lieu of ouch endorsement(s).
PRODUCER Company - PCF (954) 772-0448 .carr Nancy Spencer Fa)t
The LoOMIS 2929E- Conenerclai Blvd iuo. I, (954) 772-0445 2130 wc, No (954) 772.0447
Suite706 AD : nspencar@loomisco.com
Fort Lauderdale, FL 33308 INSURERS) AFFORDING cVveRAGE Nn:e
INSURERA:Mid- Continent Casualty Comdr
INSURED
. Integral Construction Corporation
6919 W Rroward Blvd. 5264
Plantation, FL 33317 •
COVERAGES
INSURER B :
INSURER C
INSURER D :
INSURER E:
INSURER F :
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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
INSR REDUCED BY PAID CLAIMS.
L rR TYPE OF INSURANCE I NAM POLICY NUMBER EMaE WIYIM�
LIMITS
CENnRAL uAeIJTY
A ' X coMaaERCIALGENEI ^ uAnam - 04GL00847373 412912012 4/23/2013
CNAIMSMADE 1.21j OCCUR BED EXP (Any one perSen)
PERSONAL & ACV INJURY
EACH OCCURRENCE
PREMISES (En occurrence) $
s 1,000,000
GERI AGGREGATE UMIT APPLIES PER:
xIPOLICYI— IJP* f LOC
AUtOMIa3/Le LIAsruTv
ANY AUTO
OWNED ALL
AUTOS
HIRED AUTOS
UMBRELLA NJA5
FJ(DESS WAS
100,000
GENERAL AG R G&TE
$ excluded
8 1,000,000
2,000,000
PRODUCTS - COMP/OP AGG
S 2,000,000
SCHEDULED �{
pp
AUTOS
NED
DED 1 1 RETENTION $
woman COMPENSATION
AND EMPLOYERS' LIASI nY
ANY PROPRIETORMARINER/EXECUTIVE Y❑
OFFICERRAAEMeeR ExCLUDEDT
tiondgitol yes describe �r
DESCRIPTION OF OPERATIONS below
OCCUR
CIAIms-RAGE
COMBINED SINGLE QUIT
,L9 60ddenfl
BODILY INJURY (Per paBen)
s
3
BODILY INJURY (Peramdent)
PROPERTY Dnm*C,S
(Per accident)
5
NIA
EACH OCCURRENCE $
AGGREGATE 3
5
I WC STATU- rOTH-
Td?YLSS S 1 ER
E.L. EACH ACCIDENT $
E.L, oISEASE - EA EMPLOYE d
EL. DISEASE - POLICY UNIT S
DEscWPTION OF OPERATIONS / LOCATIONS (YELBBCLES (Adam AC MD 101, Addltion i Remake Schedule, r more some is required)
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138-
SHOULD ANY OF THE ABOVE OF-SCRIBED POLICIES BE CANCELLED asioRE
THE EXPIRATION DATE THEREOF, NOTNCe WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD
Permit No: 12 -1205
Job Name:
July 9, 2012
Miami Shores Village
Building Department
Building Critique Sheet
1) Provide a building permit.
2) Provide a detailed scope of work.
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 762 -4859