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DEMO-11-1651ti Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165188 Scheduled Inspection Date: October 06, 2011 Inspector: Rodriguez, Jorge Owner: , SHORES SQUARE INVESTMENTS Job Address: 9025 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Project <NONE> Contractor: RUMAC CONSTRUCTION GROUP INC Permit Number: DEMO -9 -11 -1651 Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1132060110051 -25 Building Department Comments INTERIOR DEMOLITION PARTIAL Passed s 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 - 164260. October 05, 2011 For Inspections please call: (305)762 -4949 Page 23 of 24 01 (31 � 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: (05) 762.4949' BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. esn'zi SEP 0 8 "2011 Permit : BUII,DIN ROOFING OWNER: Name (Fee Simple Titleholder): S1 O C Stti/1M Z1Vet ,I1rjP.IE ,.Phon 3 °S- 77q P`y;a Address: 3850 6; a4 go ;t% i 8° 1 City: M i Stoll State: F L ,Zip:. 3.3 ./ y` . Tenant/L:essee Nam e: tali., full ',do . R. T i� A'14 vo M. D. P� 4 phonel JOB ADDRESS: g025 - 963 7 City: Miiami Shores Folio/Parcel#:. j I .3 2 o6 -; 0 / Is the Building Historically Designated: Yes -47.7c a1v 1 County: Miami Dade 0070 zip: .5313P NO t Flood Zone :, CONTRACTOR: Company Name: RuPVC Cons MM wit: P . C `p, "T`'" ph 305-24.6-rigs- Address: 70.180:: e m c' /Qo9 d# q 2 o City: M. 4 ••+ , ' State: ICj. Qualifier Name: Rube,, fl. Moi c 4 5 State Certification or Registration #:' C 6C 15/3/ / L Certificate of Competency #: Contact P Cdne#:` : 3 0.5 - -�26G - 8185' Fmful Address: �?Ml C 145) Ri T4CCPA s ¢R 4.04.0,, C. Al DESIGNER: Atchitect/Engineer:. Phone#: ne*ws. 0-511 zip: 53/55 Phone#: 3os- 244- g88 5, Value of Work for this Permit: $ 4i24.4•14- wear Footage of Work: Type of Work: DAddition OAlteration ONew ORepair/Replace . Demolition Description of Work: •n 4eg 1flt vie M /;4404 p4ia f ! eee a * ** *F *t oss ** $ Snbndttal Fee $ Permit Fee $ ®l gtl 7� CC,F $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ yr Training/Edncation Fee $ Technology Fee $ le Fee $ �" Structural Review $ TOTAL FEE NOW DUE $ �� 5 . 6'L Bonding Company's Name (if applicable) ' Bonding Company's Address City State Ztp Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Staff Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or ingtallatibt 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 CONDmONERS, 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 , , ace of commencement and construction lien law brochure will be delivered to the person whose ' operty is subject to attachment, a certified copy of the recorded notice of commencement must be posted at the job site for the fn ection which occurs , en (`\ days after the building permit is issued In the absence of such posted notice, the inspection ' • t be approved and a n fee will be charged L? __e Signature Owner or Agent Contractor. The foregoing instrument was acknowledged before me this % The foregoin instrument was acknow edged before me thie . t r. • W day of or who has produced As identification and who did take an oath. NOTARY PUBLIC: 20.-°.J., by P 4Ac44s who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY RICARDO E. BERMUDEG NOTARY PUBLIC ' " L STATE OF FLORIDA Comm#DD971115 fit,` lea My Commission Expires: NORMA CASTELLANOS Notary Public, State of Florida Commission #DD05600e My Gommbsbn Was Jan. 27,2414 /7 Plans Examiner Zoning Structural Review ' Clerk (Revised 07n0/07)(Revised O6110l2009)(Revised 3/15/09) Permit F I : 1 -1651 Job Nar-e: Septem i 3, 2011 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 2nd 1) P all permit applications for subcontractors prior to any further reviews. Plan revi not complete, when all items above are corrected, we will do a complete plan review. If any sh , re voided, remove them from the plans and replace with new revised sheets and include c t of voided sheets in the re- submittal drawings. Norman CBO 305 -795 -: Permit No: 11 -1651 Job Name: September 12, 2011 1 of 1 Miami Shores Viiiage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide approval from Miami Dade County Fire Dept. 2) Provide approval from Miami lade County DERM. 3) Provide all permit applications for subcontractors prior to any further reviews. Page 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 - 795 -2204 PERMIT #:%:/401(— 1 651 I, KContractor kef ❑ Owner ❑ Architect Picked up 2 sets of plans and (other) Address: Miami Shores Village Building Department RECEIPT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: c ' 13. II Qo2- From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Departme t to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: 11GCalli_q PERMIT CLERK INITIAL: QJ RUMAC -1 OP ID: WG A4c„°R °� CERTIFICATE OF LIABILITY INSURANCE 1 09102111 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(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 954-883-2900 Tanenbaum Herber of Florida 2900 SW 149th Avenue 954-517-7400 Miramar, FL 33027-8605 Aline Larraz, CPCU, AAI, CRIS CaE AIC ExtP. 1, Not DD Lam: INSURER(8) AFFORDING COVERAGE NAIC N INSURER A :Western Heritage Insurance Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED RUMAC Construction Group, Inc. 7480 Bird Road Suite 420 Miami, FL 33155 INSURERS :Commerce & Industry Ins. Co. SCP0859746 INSURER c . 08113112 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTSRR TYPE OF INSURANCE INSR W VD POLICY NUMBER (MMIDDD YYYTY) JMMIDDIYYY LIMITS A GENERAL X` LIABILITY COMMERCIAL GENERAL LIABILITY X SCP0859746 08/13111 08113112 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ee oocurren�} $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,,0�0,0r X HIR/NO AUTO $1MIL $ 1,000,000% PRODUCTS- COMP/OPAGG GEN'LAGGREGATEUMITAPPUESPER: —1 POLICY n JJReT rn LOC $ AUTOMOBILE LIABIJnY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED NON-OWNED AUTOS Cd cN SINGLE UMIT $- $ BODILY INJURY (Per person) BODILY INJURY (Per crackled) $ PROF�ERTY DAMA,L (Per acciden° $ $ B X , UMBRELLA MB EXCESSLIAB X OCCUR CLAIpS•ADE BE058251494 08113111 08113112 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED 1 X 1 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS OABIJTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? LJ (Mandatory In NH) H yes, describe under DESCRIPTION OF OPERATIONS below N 1 A WC STATU- 1 jTH- TORY LIMITS ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEIICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg g g 10050 NE 2nd Ave Miami Shores, FL 33138 MIAM138 pt 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 .._6:1,---- ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER STATE OF FLORIDA CHIEF FINAIVCIAf. OFFICER DEPARTMENT I 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. EFFECTIVE DATE: PERSON: FEIN: 04/29/2011 EXPIRATION DATE: 04/2812013 MACIAS RUBEN D 263509293 BUSINESS NAME AND ADDRESS: RUMAC CONSTRUCTION GROUP INC 7480 BIRD ROAD #420 MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05114), F.S., an officer of a corporation who elects exemption Nom this chapter by filing a certificate of election ander 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 oa 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 meats 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 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 RUMAC-1 OP ID: ED `� �®' CERTIFICATE OF LIABILITY INSURANCE DATE 08/11D/YYYY) 08/11/11 THIS CERTIFICATE 15 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 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(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 9554 -883 -2900 Tanenbaum Herber of Florida 2900 SW 149th Avenue 954-517-7400 Miramar, FL 330274605 Aline Larraz, CPCU, AAI, CRIB M ACT coN , Ent: FAX Nok Dom: INSURERS) AFFORDING COVERAGE NAIC $ INSURER A : Western Heritage Insurance Co. LIABILITY COMMERCIAL GENERAL LIABIUIY INSURED RUMAC Construction Group, Inc. 7480 Bird Road Suite 420 Miami, FL 33155 INSURER a :Commerce 8 Industry Ins. Co. SCP0859748 INSURER c 08113112 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBE 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE + • n&s - W W POLICY NUMBER POLICY EFF lMWflDlVYYY1 PO EXP IMMID IYYYYI " A GENERAL X LIABILITY COMMERCIAL GENERAL LIABIUIY SCP0859748 08/13/11 08113112 EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED PREMlSE9 (Ee ocaartsrt�) $ 100,000 MED EXP (My one meson) $ 5,000 CLAIMS-MADE l X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 X HIRINO AUTO $1MIL PRODUCTS - COMP/OP AGO $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER 7 POLICY n JCC T I-7 LOC $ AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AU Amos COMBINED SINGLE LIMIT $ BODILY INJURY (Per pennon) $ BODILY INJURY (Per scoldent) $ (PO tDAMAGE $ B X UMBRELLA UAB EXCESS UAB X OAR CLAIMS-MADE 8E058251494 08/13111 08/13/12 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED 1 X RETENTON$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ff y DESCRIPTION OF OPERATIONS below NIA �p I WC I I ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule 11 mere space 18 required) __ -. - -_ _ _,_ CITYMI2 CITY OF MIAMI 444 S.W. 2ND AVE, 4TH FLOOR MIAMI, FL 33128 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORgD REPRESENTATIVE ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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. 03 -09 -2011 EFFECTIVE DATE: PERSON: FEIN: 04129/2011 EXPIRATION DATE: 04/28/2013 MACIAS RUBEN D 263509293 BUSINESS NAME AND ADDRESS: RUMAC CONSTRUCTION GROUP INC 7480 BIRD ROAD #420 MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR * IMPORTANT: Pursuant to Chapter 440. 05114►, F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election trader 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 I1, at any time alter the filing of the notice or the issuance el the certificate, the person named on the notice or certificate no longer meets the requirements of this section tor issuance 01 a certificate. the department shalt revoke a certificate at any time for irritate of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11