ACT-12-177Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 169504 Permit Number: ACT -2 -12 -177
Scheduled Inspection Date: July 11, 2012
Inspector: Bruhn, Norman
Owner: TERR. LLC, BISCAYNE
Job Address: 8851 BISCAYNE Boulevard
Miami Shores, FL
Project: <NONE>
Contractor: CERTIFIED MARINE CONSTRUCTION INC
Permit Type: Awnings /Canopies/Tents
Inspection Type: Final
Work Classification: Miscellaneous
Phone Number
Parcel Number 1132060120020
Phone: (954)923 -5090
Building Department Comments
REPLACE CANVAS ON EXISTING AWNINGS.
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 10, 2012
For Inspections please call: (305)762 -4949
Page 4 of 39
B
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
eit40 ( INSPECTION'S PHONE NUMBER: (305) 762.4949
DING Permit No.
Master Permit No.
ROOFING
OWNER: Name (Fee Simple Titleholder): 0 I/4 119 Z JE W Phon
Address:
City: ti PIN I S//0 /F
zip: 3 .'513 �" -►
Tenant/Lessee Name: Phone#:
Email: rn " tJ t /nJ -ii, 1_ 1.
JOB ADDRESS:
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes
/r
#47tf 1 - Gdfn
County:
Miami Dade
Zip:
NO Flood Zone:
i95 9z3 5090 CONTRACTOR: Company Name: _.-- 'A 22 t i2= C P e#
�
Address: // 2 )0GLJ / ( ) f d siS DX 4/33
City: 224 J),4 y State: rL Zip: `33400
Qualifier Name: SYL4/ /- n , %/ 7 _ Phone#: 2 7z/-5472
State Certification or Registration -. C6d_ /so «' - 52 Certificate of Competency #:
Contact Phone#: '10-01.91P-.5-41 Email Address: X.111-1V tin ®/17 t: -.2
Phone#:
DESIGNER Architect/Engineer: N/�
sdA
Value of Work for this Permit: $ Square/Linear Footage of Work: ®D �.i//�/e /�
Type of Work: ()Addition ()Alteration ,, > ,q ()New -pair/Replace ()Demolition
Description of Work: ' / e,4 t �`4 evA) 4//0/") 6-R
*********** *** ************ *** * * ******rr*11*F ************* *** ***** * ********* ************s
Submittal Fee $ � Permit Fee $ C .� v CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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 AkkIDAVIT: 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:
promise in g
whose prope
for the first i
inspection will
the issuance of a building permit with an estimated value exceeding $2500, the applicant must
lice of commencement and construction lien law brochure will be delivered to the person
Also, a certified copy of the recorded notice of commencement must be posted at the job site
en (7) days after the building permit is issued In the absence of such posted notice, the
reinspection fee will be charged.
• Signature t�� Signature
or Agent Contractor
The fore g instrument acknowledged before me this / The foregoing ' 't was acknowledged before
dayo 20 ,byAn4a.ereF PPra /E) , day of L( 20 /2 by 5 1-WA
who ' personally known to me or who has produced who is personally known to me or who has produced
�L ), L . As identification and who did take an oath. as identification and who did take
NOTARY P ' C:
Sign:
Print
5
� f
�,...,,
24i , i .�; . rr.. _.. /
RUTH A. BVDASH
MY COMMISSION 8 DC956017
APPROVED BY "eft, J �c'Ie Plans Examiner
Structural Review
(Revised 07110 /07)(Revised 06/10/2009)(Revised 3/15/09)
or
/ /r
Clerk
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CON CTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF UABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT(
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTOON)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
CDMP1ErE CONTRACTOR'S INFORMATION
BUSINESS NAME: (I, a ri f1z /'✓If��'c/AJE %r ''A f �✓&
to 1433
USINESS ADDRESS: // 2 A! / CITY ..Atli�4
STATE " ZIP CODE --330°
BUSINESS PHONE: (9-5 �f) 92-3 —S-0 OFAX NUMBER ( )
CELL PHONE (9 ) 2-9V-567 2 QUAUFIER'S NAME: SYL'1///9
QUAUFIER'S LIC NUMBER: C& /5-0
E -MAIL ADDRESS (IF APPLICABLE): Cede Tick 47e :"Jed�.. / C
Created on 311969 BY MLDV I RV 3 MLDV
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100. Ft Lauderdale, FL 33301 -1895 — 95i4 -831 -4000
VAUD OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012
DBA: Receipt x;180 -5659
Mme. CERTIFIED NAM= CAST INC Business TypolumBRAL am rACrox
Owner Name: SYLVIA A Rowan
Business Location; 13.2 NW 1 AVE
DANIA BEACH
Business Phone: 954 -923 -5090
Rooms
Seats
Emidoyees
1
likablese Opened:04 /13/2004
SbiteiCountylCertIReg:CGC1504452
Exemption Code:
Residues Pmfessionais
T
(e:4 )l'
Tax A
. Trams Fee
_� ( Fee
Penally
Pdo Yews
Ga0on C�
Total Feld
27.00
0.00
0.00
2.70
0.00
0.00
29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMS A TAX RECEIPT This taps Isr the privilege of doh bas within Eireowd County and Is
non-regulatory hi nature. You must meet all County miler blunidpitity plamtrig
and zoning mquireinents. This Sushums Tax Receipt must be transferred when
the business is sold. business name has chant or you have moved the
location. business This rem does not ireicate that the business is legal or that
hi compiler= wit State or local taws and
WHEN VAuDATED
abaft Address:
SYLVIA A PULLER
ER
PQ BOX 433
DANIA BEACH, FL
t ;
33004
2011 - 2012
Receipt #05A -11- 00000571
Paid 10/26/2011 29.70
. - DATE .. -tt CH NUMBER
CITY OF DANIA BEACH
Business Tax Receipt
VALID THROUGH DATE BELOW
CERTIFIED MARINE CONSTRUCTION
PO BOX 433
DANIA BEACH FL 33004
Business Name: CERTIFIED-MARINE—CONSTRUCTION
Location Address: 112 NW 1 AVE
Number /Class: 12- 00001.812 1.152 - CONTRACTOR - UNCLASSIFIED TYPE
Issue Date: October 05, 2011
Expiration Date: S t ember 30, 2012
Primary Limn se Fee: $210 OO
Secondary License Fee: $0.00
Penalty: t $21.00
Total: $231.00
Comments:
Restrictions:
iE CONSTRUCTION
SUBJECT AND ISSUED ACCORDING TO BUSINESS TAX RECEIPT ORDINANCE CHAPTER 15.
This Business Tax Receipt does not permit the holder to operate in violation of any City taw, ordinance, or regulation. Any change in location
or ownership must be approved by the City, subject to zoning restrktions. This Business Tax Receipt does not endorse, approve. or
disapprove the holder's skill or competence or of the homes mince or non- cornpttance with other tars, regulations, or standards.
MUST BE POSTED CONSPICUOUSLY AT BUSINESS LOCATION
"Broward's First City"
100 West Dania Beach Boulevard • Dania Beach, Florida 33004 Phone: 954 - 924 -6805 ext. 3644
.`4, ° E, CERTIFICATE OF LIABILITY INSURANCE
DATE /25/
PRODUCER JW Insurance Services
100 North State Road 7, # 106
Margate, FL 33063
Phone (954)583 -7213 Fax (954 }583 -2045
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
NAIL 8
INSURED Certified Marine Construction, Inc
P.O. Box 433
Dania Bch, FL 33004
'Sylvia A. Fuller Qualifier
INSURER A Canal Indemnity Ins. Co.
INSURER B
INSURER C:
INSURER D:
INSURER E:
COVERAGES
INSURER F:
THE POUCIES OF INSURANCE LISTED 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
POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
OMD
TYPE OF INSURANCE
POLICY NUMBER
DATE
MATS
A
•
GENERAL LUBBUTY
V COMMERCIAL GENERAL LIABILITY
• ❑ CLAIMS MADE n OCCUR
•
GL101494
05/07/11
05/07/12
EACH OCCURRENCE
300,000
RISES TO a �)
MED EXP (Any one person)
5,000
PERSONAL a ADV INJURY
300,000
GENERAL AGGREGATE
300,000
•
PRODUCTS - COMP/OP AGG
300,000
GEN'L AGGREGATE LIMIT APPLIES PER:
'J POUCY • PROJECT • LOC
Fire Damage Liability
50,000
I♦
AUTOMOBILE LIABILITY
• ANY AUTO
• ALL OWNED AUTOS
II SCHEDULED AUTOS
• HIRED AUTOS
• NON OWNED AUTOS
•
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
rJ
•
GARAGE LIABIUTY
• ANY AUTO
•
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
•
EXCESSIUMBRELLA LIABILITY
• OCCUR • CLAIMS MADE
• DEDUCTIBLE
❑ RETENTION $
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION AND
EMPLOYERS' UABIUTY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER / MEMBER EXCLUDED?
it yes, describe under
SPECIAL PROVISIONS below
❑ WC STAB�}} ❑ OTH-
TORY MITS ER
EL EACH ACCIDENT
EL DISEASE - EA EMPLOYEE
E.L. DISEASE - POUCY UMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
***CARPENTRY - COMMERCIAL - EXCLUDING: ROOFING***
CERTIFICATE HOLDER
CANCELLATION
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE , BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KI UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
KIND
AUTHORIZED REPRESENTATIVE ,.
ACORD 25 (2001108) QF
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL VICES •
DIVISION Cr WORKERS' COMPENSATION
08 -23 -2011
* * CERTIFICATE OF ELECTION TO BE MOM FROM FLORIDA vammomr Com®HSATION LAW *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to he exempt from Ronda Workers' Compensation Iaw.
EFFECTIVE DATE 08/23/2011 EXPIRATION DATE 08122/2013
PERSOht FULLER
FEB* 650162038
BUSINESS NAME AND ADDRESS
CERTIFIED MARINE CONSTRUCTION INC
PO BOX 433 -
DANIA BEACH FL 33004
SYLVIA
SCOPES OF BUSINESS OR TRADE:
1- GENERAL CONSTI CTI0N 2- MARINE CONSTRUCTION
IMPONTANT: Porno to Chapter 440 . 05t14 F.S., an affiem ef e ormasstien oho e1acts OYAIRVIOU ham this chapter by titiao a certelate et skein wader
section may mit recover hits pa compensation ender this draper. Parsee& to Chaim 440.0812). F.S.. Certfikates of elation 0 be meant— sp10P euly wteb the
scepe of the business or trade Usled on the mace al eteetitm m be exempt. Poser& a Chapter 440.0503x: F.S., Natives of election in be exempt and certificates of
election to be exempt shall bee 4ea to ram N, at any time attar the filing of the or the imam et the certificate. the tie named on ton neliee or
certificate no Wager amts the requirements of Ms section for ism of a certifiente. The ilepotineet shall reaeke a certificate at any time ter FaDure of the parson
named as the cannot* a meet the resperements of ads sectice. QUESTIONS? (8501 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEtteT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTtNTOF FDIANCIAI. SBWICES
DIVISION OF WORKISer COMPENSATICRI
CONSTRUCTION INDUSTRY
CERTIFICATE OF t3£CUO N TO BE MOM FROM FLORIDA
WORKERW TKNLAW
EFFECTIVE 08/23/2011 EXPIRATION DATE: 08/22/2013
PERK SYLVIA FULLER
FEE* 801
BUSINESS NAME AND ACORES&
CERTIFIED MARINE CONSTRUCTION INC
PO Box 433
DANIA BEACM. FL 33004
SCOPE OF BUSINESS OR TRADE
1- GENERAL CONS Ructi01 2— MARINE CONSTRUCTION
IMPORTANT
F Pursue to augur 440.os114L F.S., an officer of a corporation who
elects exemplien from this chapter by firma a cutificate of election
1- umder this sett may not recover benefits or compensation under this
Dt.
Pam to C 440.055(12. F.S., Certificate of union to be
H exempt._ apply akin within the she of the btu or trade listed on
E the notice of eteedmt to be exempt
E Pursuant to Cif 440.05(13L F.S, Notices of election to be exempt
and certificates of election to be exempt shy be subject to revocation
if. at any time after the fig of the notice or the ism= of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issue of a certificate. The
deparoneat shy revue IS ccetif at any time for failire of the
person mimed on the certificate to meet the requirements of this
section.
OUESTIDNS? (85(8 413-1609
CUT HERE
on on the job, keep upper Peron for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT HEVISEO 01 -11
Certificate of itaint 1eitante
REGISTERED
APPLICATION
CONCERN No.
F -06901
ISSUED BY
HERCULITE PRODUCTS, INC.
WEBLON DIVISION
PO BOX 435
EMIGSVILLE PA 17318
— 000 -0000
This is to certify that the materials described on the reverse side hereof have been flame -
retardant treated (or are inherently nonflamable).
FOR ASTRUP COMPANY AT 2937 WEST 25th STREET
Dote Work Performed
2/08/07
CITY CLEVELAND STATE OHIO 44113
X
Certification is hereby made that: (Check "a" or "b ")
(a) The articles described on the reverse side of this Certificate have been treated with a flame -
retardant chemical approved and registered by the State Fire Marshal and that the application
of said chemical was done in conformance with the laws of the State of California and the Rules
and Regulations of the State Fire Marshal.
Name of chemical used Chem. Reg. No.
Method of application
(b) The articles described on the reverse side hereof are made from a flame- resistant fabric or
material registered and approved by the State Fire Marshal for such use.
Trade name of flame- resistant fabric or material used R F T NIFRC. n V T lvV IReg. No. F -0A901
The flame Retardant Process Used WILL NOT Be Removed By Washing
(will or will not)
PETER COHEN
Name of Production Superintendent
By STEPHANIE MUMMERT, G C MANAGER
Title
2,TkI ATJ T tITTJWUJ�z t 7 T?c.11TI [T T4TE I1«7«1� LTATAT]«J TI T7 T2T1 �I1:.�1 iKRILTT 17ITItll ITIt
We hereby certify this to be a true copy of the original "CERTIFICATE OF FLAME RESISTANCE" issued to us,
"original copy" of which has been filed with the California State Fire Marshal.
The ASTRUP COMPANY
By
Control/ lot # Quantity 200. 000 YD
Customer order # frank
Description WEBLON CP2704 -62 ISLAND
3442204 857204
4strup Invoice # Product Code
FRANK AWNING DOOR & WINDOW INC
119 LORI LN
HALLANDALE BEACH FL 33009 -3035
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