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RF-11-1510Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163437 Scheduled Inspection Date: December 13, 2011 Inspector: Bruhn, Norman Owner: PODOLSKY, ABRAHAM Job Address: 10500 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: USA PROFESSIONAL GUTTERS INC Permit Number: RF -8 -11 -1510 Permit Type: Roof Inspection Type: Final Work Classification: Gutters Phone Number (917)885 -6666 Parcel Number 1122300010500 Phone: (305)835 -7461 Building Department Comments RAIN GUTTERS Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments e c__ December 12, 2011 For Inspections please call: (305)762 -4949 Page 9 of 33 \11 -140- 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): Address: City: O 1st) )4 R.t6ikei ROOFING I MY pammumn IR AUG 1 6 2011 Permit No. KT J l Master Permit No. Phone #: 5 'f1 s4' Tenant/Lessee Name: Email: State: Zip: ,ii 3 Phone#: JOB ADDRESS: icy 122))'e—ieirz.0 pi City: Folio/Parcel #: Is the Building Historically Designated: Yes Flood Zone: Miami Shores County: Miami Miami Dade Zip: 531'3 ,2 CONTRACTOR: Company Name: Address: City: ,,v/ A .M / Qualifier Name: �i G. 9.. J c ( 4 State: g, (4 Phone iO S) $3s -94/ 6 Zip: 33 lit T Phone #: State Certification or Registration #: Certificate of Competency #: 09 QS oa5%' Contact Phone# 303) I34 `7'4/ , i Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ o t.L ° ( r Square/Linear Footage of Work: Type.of Work: ❑Addition ❑Alteration Description of Work: ° O„ ' ! a ❑New.. :q r.; Repair/Replace ❑Demolition ************ * * * * * * * * * * * * * *** * *** * ***,>: ** Fees * * * * * * * * * **** *** * **** * *** * *** * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /0 0 ° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ v✓�'On • Bonding Company's Name (if applicable) Bonding Company's Address 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 be approved and a reinspection fee will be charged. Signature KIN ' l Owner or Agent Contractor 1 The foregoing instrument was a l owleeddged a re,me this b The fore oing ins + ment w ackn le • ged before m this 1 1 day of 0 , 20 /1 , by 19 m I , day of , 2011 , byJ . - I nally known to me or who has produced U; €/I v wV I,(vho i perso ally known to me or who has produced 'P / 2 As identification and who did take an oath. 11-1, 1 ° S' a _ . • dentification and who did take an oath. NOT ' UBLIC: ' OT ' PUBLIC: , Sign: Print: My Commission Expires: APPROVED BY Sign: Print: My Commission Expires: kt 4444t141 A"k e�`v'l% Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09BS00591 USA PROFESSIONAL RAIN GUTTERS INC D.B.A.: RIVERA JOSE G Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL 09/30/2012 ALEX SINK CHIEF FINANCIAL OFFICER V OD�4.,ra✓ STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 09 -30 -2009 * * 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: PERSON: FEIN: 09/30/2009 RIVERA 270661185 BUSINESS NAME AND ADDRESS: USA PROFESSIONAL RAIN GUTTERS INC 8920 N.W. 33 AVE. ROAD e MIAMI FL 33147 EXPIRATION DATE: 09/30/2011 JOSE G SCOPES OF BUSINESS OR TRADE: 1- GUTTER INSTALLATION 2- SHEET METAL WORK (5538) IMPORTANT: Pursuant to Chapter 440. 05(14), 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 440.05113), 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW 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: 09/30/2009 EXPIRATION DATE: 09/30/2011 PERSON: JOSE G RIVERA FEIN: 270661185 BUSINESS NAME AND ADDRESS: USA PROFESSIONAL RAIN GUTTERS INC 8920 N.W. 33 AVE. ROAD MIAMI, FL 33147 SCOPE OF BUSINESS OR TRADE: 1- GUTTER INSTALLATION 2- SHEET METAL WORK (5539) IMPORTANT F • Pursuant to Chapter 440.05(14), 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.:05112), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed E the notice of election to be exempt. R E 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. 0(1 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 09 -06 .4Ci :,Rbe CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 09/27/10 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 dips not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone 305 266 -6493 ( ) Fax (305)262 -0679 NAMEACT MARTA ALONSO PHONE 305 266 -6493- FAX 305 262 -0679 _INC No Ext): ( ) (NC, No): ( ) marta @floridabankersinsurance.com ADDRESS: CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE INSURERA: AMERIVA VEHICLE INSURANCE CO NAIC # INSURED USA PROFESSIONAL RAIN GUTTERS, INC 8920 NW 33 Ave Rd MIAMI, FL 33147- (305) 360 -3684 rnvcoeccc _ ---- _ _ __ INSURER B : INSURER C : INSURER D : INSURER E INSURER F: T IN CE EX INSR LTR HIS IS TO CERTIFY THAT THE POLICIES 0 DICATED. NOTWITHSTANDING ANY REQ RTIF)CATE MAY BE ISSUED OR MAY PER CLUSIONSAND CONDITIONS OF SUCH P REVISION NUMBER: F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS TAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL POLICY EXP INS: (MM /DD/YYYY) TYPE OF INSURANCE A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY El PRO- ❑ LOC JECT SUBF WVD POLICY NUMBER GL- 0504006059 -00 POUCY EFF (MM /DD/YYYYL 09/25/2010 09/25/2011 EACH OCCURRENCE DAMAGE TO RENTED LIMITS PREMISES (Ea occurrence) $ 300.000.00 $ 100.000.00 MED EXP (Any one person) $ 5.000.00 PERSONAL & ADV INJURY $ 300.000.00 GENERAL AGGREGATE 300.000.00 • PRODUCTS - COMP /OP AGG $ 300.000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NONOWNEDAUTOS COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTWEj OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe unde DESCRIPTION OF OPERATIONS below N/A EACH OCCURRENCE $ AGGREGATE $ $ STATU- j❑ TORY LIMITS I I EOTH- R E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHI CLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION MIAMI DADE COUNTY BUILDING CODE COMPLIANCE OFFICE 140 W FLAGLER ST. SUITE # 1603 MIAMI FL. 33130 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 ACORD 25 (2009 /09) QF © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD T TOZ /LT /8 in= qu;<•ua= itizsdEtu /tuoyo0oo•sdutu / /:duq •dew o; ixeu >Iull „lupd„ aye asn 'u99.1os ay} uo alglsl■ aae ;ei sIelap eqi Ile aas of i JO I o Ed SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULE=S AND REGULATIONS sduyA1 ai$.oD - 73 `saJotis iuxuti^i `p.runainog auku-g OOSOT /U Co,t t' iLd'sa sdew ti USA PROISSIONAL MIN sups In RESIDENCIAL & COMERCIAL 8920 N.W 33 Av. Rd Miami FI, 33147 Ph: 305 835 7461 FAX: 305 835 7485 CUSTOMER: Name: Address: City,State: Phone: Date: Time: Customer #: JOB SITE: Address: City,State: CC # 09BS00591 PROPOSAL I CONTRACT GUTTER COLOR ❑ WHITE ❑ MUSKET BROWN ❑ BRONZE ❑ CAMEO ❑ EGGSHELL ❑ SANDTONE ❑ GREEN ❑ CLASSIC CREAM ❑ GRAY ❑ ROYAL ❑ ALMOND BROWN ❑ omEI i ja . Ilfrl►1 t 11.101 N•101 a ❑ WHITE 0 MUSKET BROWN ❑ BRONZE 0 CAMEO ❑ EGGSHELL I-I SANDTONE ❑ GREEN - `❑ CLASSIC CREAM ❑ GRAY ❑ ROYAL ❑ ALMOND BROWN ❑ 2113 03x4 ❑ ❑ CONDUCTOR HEAD ❑ OTHER .J l.,. ` ` Iv ! — „ CT 1` i C TOTAL FOOTAGE: > TOTAL DOWNSPOUT -� TOTAL $: �• CASH: DEPOSIT $: CHECK: BALANCE $: SALES REP: ❑ ALUMINUM ❑ COPPER ❑ GALVANIZED CREDIT CARD: ❑ STAINLESS STEEL 5 YEAR GUARANTEE ON LABOR 120 YEAR GURANTEE ON MATERIAL : EXCEPT. Damage resulting from accident, misuse. abuse. neglect, or from other than nomad and ordinary use of the produd TERMS OF PAYMENT. Payment in full due upon completion.. Contracts which state a draw cut of date and payment release date are the only exceptions and must be signed by representatives of both parties. FINANCE CHARGE: Finance charge In amount of the lesser oft.8 %per month (18% per annum). or the maximum allowed by law. will be added to all invoices that are 30 days past due. APPROVAL: No alterations or additional work shall be performed unless agreed to by USA Seamless Rain Gutters, Inc, beforehand, in writing. We are not responsible for damage to roof tiles. shingles or fascia boards. CLIENT SIG TORE• DATE* AUTHORIZED SIGNATURE email usaprofessionalraingutters @hotmaii.com USA PROFESSIONAL RAIN GUTTERS Inc.