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DEMO-13-196Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 185055 Permit Number: DEMO -2 -13 -196 Scheduled Inspection Date: February 19, 2013 Inspector: Bruhn, Norman Owner: VELEZ ABREU, OSCAR Job Address: 9377 NE 9 Place Miami Shores, FL 33138- Project: <NONE> Contractor: JAY CONSTRUCTION COMPANY Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1132050070100 Phone: (305)610 -6688 Building Department Comments REMOVE DECK TO CANCEL PERMIT# DGT08 -66 Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 15, 2013 For Inspections please call: (305)762 -4949 Page 14 of 32 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 e�c --ro Su[SlmT�( f ,J12:410 FBC 20 0 BUILDING Permit No. PERMIT APPLICATION Master Permit NoWn 0 1 .m) 61 co Permit Type: BUILDING ROOFING JOB ADDRESSi al 3 ? 7 //t' f `'� ,3ce City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO ✓ Flood Zone: R70 OWNER: Name(F)e- Simple Titleholder): C / . Alieg.ze Phone #: 4)' 7 C° 7 - 1 2 — f , & , : W ►Dc, / a ce dl� /41 a/'� �� a s� ,X)271,4-11 f City /1./4 .i: '/ ( State: Ic- Zip: ' s 7 Tenant/Lessee Name: ®� Phone #: Email- /;%,,,t & / P ieG (/a: , "Li',/,' CONTRACTOR Company Natne: d i r0 Phone #: 3 o S `c I C "644 Address: 10 3 Z., ( 00 r Q City: &— State: V:k Zip: 36 11-'4- Qualifier Name: 1 Phone #: 3C�� 7s° 46;a - State Certification or Registration #: C.6 c ®5 & ,' 6 f Certificate of Competency #: Contact Phone #: Email Address: J� CGS ir•�a ah �!P . DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ®0 Square/Linear Footage of Work: t J Q :76 6772-0 Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replaceemolition t Description of Wot•k: decA / e : tam f 2 7 d / ° y' 6C Color thru tile: ******** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** Submittal Fee $ ^ Permit Fee $ 1/LJ a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Bonding Company's Name (if applicable) • Bonding Company's Address �a 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 ELECTRICAL 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 b, 'proved and a rein pection f e will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of �� rvd.�' , 20 :3, by awl.) Tc\--nu\I who is personally known to me or who has produced R. ID As identification and who did take an oath. NOTARY PUB #C: 1 I' 04i6 Sign: Print: My Commission Expires: Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 la by '5 \ `t who is personally known to me or who has produced 1/4C4--”( as identification and who did take an oath. eirri.."* Sign: . Print: 5 My Commission Expires: , f err ,,' / / /lII II I i iNiI6@`��4�4 *** * *************************** ******************* * fir ************* Y********** *********** **** **************** APPROVED BY / Plans Examiner Zoning Structural Review (Revised 5/2/2012XRevised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007) Clerk AC.ORO., CERTIFICATE OF LIABILITY PRODUCER Gulfstream Insurance Agency, Inc. 5833 Johnson Street Hollywood FL 33021- INSURANCE 1 02/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Jay Construction Company 10321 E. Broadview Dr. .Bay Harbor COVERAGES FL 33154- INSURERA:Mid- Continent Casualty CO. INSURER B: INSURER C: INSURER 0: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION OATS (MM BABY) DATEIMMIDDACY► A GENERAL LIABILITY 04 -GL- 000860584 X COMMERCIAL GENERAL UABIUTY 1 CLAIMS MADE © OCCUR GEML AGGREGATE LIMIT APPLIES PER POLICY 1 1 Ta n LOC 10/14/2012 AUTOMOBILE UABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOM -OWNED AUTOS / / l / / / / / / / 1 / / / / I LENTS EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Arty one Ere) $ 100,000 MED EXP Any one person) $ PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 COMBINED SINGLE LIMIT (Ea acddent) BODILY INJURY (Per parson) BODILY INJURY (Per accident) GARAGE LIABILITY ANY AUTO I 1 / / PROPERTY DAMAGE (Peracddent) AUTO ONLY - EA ACCIDENT $ $ OTHER THAN EA ACC AUTO ONLY: EXCESS UABIUTY OCCUR DEDUCTIBLE RETENTION $ CLAIMS MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY / / / / / / EACH OCCURRENCE AGO $ $ AGGREGATE I / / / ITORYUAS+ 0 5 / E.L EACH ACCIDENT E.L DISEASE - EA EMPLOYEE OTHER 1 I E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONSA/EIS CLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED* INSURER LETTER: MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES ACORD 25-S (7/97) INS026S (9510).01 FL 33138 -2382 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE INSURER, AUTHORIZE SHALL IMPOSE NO OBLI OR REPRESENTATIVE ON OR LIABILITY QE ANY KIND UPON THE ATIVE ELECTROPIC LASER FORMS, INC. - (800)327.0545 © ACORD CORPORATION 1988 Pagel of 2 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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. 01-18 -2013 EFFECTIVE DATE: PERSON: FEIN: 01/18/2013 EXPIRATION DATE: 01/18/2015 MEISELMAN JAY 650546435 BUSINESS NAME AND ADDRESS: JAY CONSTRUCTION COMPANY 10321 EAST BROADVIEW DRIVE BAY HARBOR FL 33154 SCOPES OF BUSINESS OR TRADE: 1- LICENSED BUILDING CONTRACTOR • IMPORTANT: Pursuant to Chapter 440 . 05414), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. MC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW QUESTIONS? (850) 413-1609 AND RETAIN FOR FUTURE- REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 01/18/2013 EXPIRATION DATE: 01/18/2015 PERSON: JAY MEISELMAN FEIN: 850548435 BUSINESS NAME AND ADDRESS: JAY CONSTRUCTION COMPANY 10321 EAST BROADVIEW DRIVE BAY HARBOR, FL 33154 SCOPE OF BUSINESS OR TRADE 1- LICENSED BUILDING CONTRACTOR IMPORTANT FO Pursuant to Chapter 440.05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 SU IFiEI46PJE / LOCATION THIS IS NOT A BILL — DO NOT PAY RE mnik6NEWAL 348620 -6 STATE# CBC056965 JAY CONSTRUCTION COMPAW INC 10321 E BROADVIEW DR 33154 BAY HARBOR ISLANDS OWNER J�,y atISsTRUCTION COMPANY INC FIRST -CLASS U.S. POSTAGE 1 PAID MIAMI, FL PERMIT NO. 231 mIS Is bleb ASLUrGENERAL BLDG CONTRACTOR WORKEi /S BUSGVED,R TAX I�CEIPT. R DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OP THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER UCENSE ERMIT R" QUIREO YLAW. E JAY CONSTRUCTION COMPANY INC NOT A CEAt1RCATION OP JAY MEISELMAN PRES Timmmmi LDEs Gca 10321 E BROADVIEW DR uma PAYMENT RECEIVED BAY HARBOR ISLAND FL 33154 COLLEC OR COUNTY TAX . 08/01/2012 09010227001 000045.00 SEE OTHER SIDE I�alltetllRRrl!! tlltlslet�tltllttti�ItieitilMltsltltttf1feIII STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET. TALLAHASSEE ' FL 32399 -0783 MEISELMAN, JAY EDWARD JAY CONSTRUCTION COMPANY 10321 EAST BROADVIEW DRIVE BAY HARBOR FL 33154 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 www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department'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, and congratulations on your new license! • STATE OF FLORIDA,; AC #`6 2':26-0111. DEPARTMENT OF BUSINESS MW PROFESSIONAL .REGULATION.. 2 128015526 15 CERTIFIED radar tl a rrovieions of ch 4.8.9 a8_: sap �tati.on Bate: AUG'r 31, 2014 *120'054097 DETACH HERE _ THIS DOCUMENT, HAS A COLORED BACKGROUND MICROPRINTINC_ • LINEMARK' PATENTED PAPER, AC# 6226097 STATE OF FLORIDA DEPARTMENT OF-BUSINESS AND PROFESSIONAL RE TION CONSTRUCTION INDUSTRY LICENSING BOARD BATCH NUMBER SEQ# L12072501097 LICENSE NBR 07/25/2012 128015526 CBC056965 The BUILDING CONTRACTOR:. Named below IS CERTIFIED. Under the provisions of thapte Expiration date: AUG 31, 2014 MEISELMANI JAY EDWARD JAY CONSTRUCTION. COMPANY 10321 EAST BROADVIEW'DRIVE BAY HARBOR FL 33154 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY N.E. 95TH STREET 80' RICYT• •0E- WAY S. RIGHT- OF -WA? LINE S.90'00'00 'W. 428.50' REM,9 /NDER OF LOT F f M E/F,19.6'E.1.5'N 6 125 STIRLING RD. BROWARD (954)587 -2100 D4VIE, FLORIDA 33314 PALM BEACH (561)488 -9628 FAX (954)587 -5418 QC 2006 ATLANTIC COAST SURVEYING INC. - APPROVED /O'NI_ NG DEPT G DEPT % �E /F,22.2T,1.0'NN 90'00 ►00 "E 100 0 F(C,0.4'N,0.3'W x- x - x x —x —x= �T �� r� -�i E 1 REM4 /NDER OF LOT F N.0741'34 "W. 428.4 4',NO ID S.90°00 00 . ,:100.00 ` wc,19.9'E,0.7'S THE W. 100' OF LOT 'F' REMA /NDER OF LOT F N.90'00'00 "E. 428.50' c. CENTERLINE WOOD FENCE —x—x— METAL FENCE ICHAT. WOOD i BRICK CONCRETE BLOCK WALL - - - - �- OVERHEAD WIRES CONCRETE FENCE GUY ANCHOR 5.50' DENOTES ELEVATION MONITORING WELL CABLE JUNCTION BOX POWER /LIGHT POLE WATER METER FP&L /SBT PAD LIMITED POWER OF ATTORNEY BE IT KNOWN TO ALL MEN BY THESE PRESENTS: That I, Oscar Velez-Abreu, domiciled in and a resident of Miami -Dade County, Florida do hereby make, constitute, and appoint Donn S. Dutton, Esq., domiciled in and a resident of Miami -Dade County, Florida to be my true and lawful attorney and in my name, place and stead to act as my attorney with full power and authority for me in my name to exercise or perform any act, power, duty, right or obligation whatsoever that I now have or may hereafter acquire the legal right, power or capacity to exercise or perform in connection with or relating to utility services (MDWS (water), TECO (gas), FPL (electric) services as well as with regarding to any and all matters with the Village of Miami Shores relating to code violation, liens, permits, etc. on that certain real property owned by me and located at 9377 NE 9th P1, Miami Shores, Florida 33138, and to sign all appropriate instruments relating thereto. This Power of Attorney is non - delegable and shall be valid until such time as the principal shall die, revoke the power, or be judged incompetent. It is the intent of the principal that the power conferred on said Attorney shall be exercisable from the date of this instrument, notwithstanding a later disability or incapacity of the principal, unless otherwise provided by statute. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of Vet ow iz- , 2012. TOR: OSCAR VELEZ AB ATTO; YIN FACT: so%ik-rw DONNS. DUTTON ACKNOWLEDGEMENT THE FOREGOING instruent was acknowledged before me this 3!— day Of c. , 2012, by OSCAR VELEZ ABREU who is personally known to me and who did did not (check one) take an'oath. My commission expir