CC-14-1449Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-223247
Scheduled Inspection Date: November 13, 2014
Inspector: Rodriguez, Jorge
Owner: ,
Job Address: 9190 BISCAYNE Boulevard
Miami Shores, FL
Project: <NONE>
Contractor: PERFECT ROOFING & SERVICES INC
rsuiming uepanment comments
Permit Number: CC -7-14-1449
Permit Type: Commercial Construction
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number
1132060100030
Phone: 305-895-9237
FASCIA EXCHANGE ROTTEN WOOD PAINTING THE Infractio Passed comments
FASCIA BACK TO ITS ORIGINAL WHITE COLOR AND INSPECTOR COMMENTS False
PRESSURE CLEAN THE WALLS
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-215427. No permit posted
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 13, 2014 For Inspections please call: (305)762-4949 Page 36 of 45
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PER IT APPLICATION
BUILDING ❑ELECTRIC P400FING
JUL 0 8 2614
FBC 20/0
Master Permit No&, /Y— j
Sub Permit No.
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
('t
City: Miami Shores County: Miami Dade Zi D: f ,5 9
Folio/Parcell#:��� �® Oti9— CO3 0 Is the Building Historically Designated: Yes NO �
Occupancy Type: Vboad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): b rl one#:��
Address: qro
City: T I amt SZ M.O.W
Tenant/Lessee Name: �1
Email: "f
a
CONTRACTOR: Company Name: ` P
Address: `,rrAq C S,
City: 6A I 4M A!
Qualifier Name: Z 4,
State: i _ `°fit `
I
%(S Phone#: �f2- f�
State Certification or Registration #: �L J -C�� Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Add
Value of Work for this Permit:
Type of Work:. ❑ Addition
❑ Alteration
p:L�1
City: State: Zip:
Square/Linear Footage of Work: L/ n f -q v F -e -e-7_
❑ New Repair/Replace =+yC44A_ CA
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ E Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Rev1sed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 inspecti�p which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not 4 �p{�roved and a reinspection fee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 Iq by
A))' &M6 , Who is p��n n
.me or who has produced as
identification and who did take an oath.
Seal:
53
MY COMMISSION #FF001132
EXPIRES March 20, 2017
Signature
CTOR
The foregoing instrument was acknowledged before me this
!�— day of ECS , 20�� , by
`���nrho is personally known to
me or who has produced V--i—y as
identification and who did take an oath.
NOTARY PUBLIC:\\\e\\����1111'
Pie
Sign:
— ev
'' C°°i o7e
Print
= �
Seal.
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APPROVED BY Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case
of an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation iniuries of anyperson allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owne
Print Name:
W --N
Signature
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me this
day of Z 1 , 20_x.
(SEAL)
Tvpe of Identification
Print Name:
State of Florida )
County of Miami -Dade)
Sworn to and subscribed before me this
day ofU 1. l 2OA,
v\`,
By
i
LISMAN SEAL)
EXPIRES March 20.2017
of Identification
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JUL 082014
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IM CERTIFICATE N IGUED ABA MATTER OF INFORMATION ONLY AND CONFERS NO RIi1ti'18 UPON THE CEBTIRiC No HOLDIUL
CERTIFICATE DOES NOT AFRRMATWMY OR NEOATNELY AREM EXTEND OR ALTER TIB COdERAGE AFFORDED BY THE POUCIE6
BQ.01AL THEE CERTIFICATE OF INSURANCE DOES NOT CON6MUTE A CONTRACT BETWEN THE WtON0 DOMMM AWHORIM
REP 1NTAWE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: ffUm s b ae ADDITIONAL INS REED► tie poftoos) nmN M emloraed. 1f 8UBROOATION I8 WANED, m
the Wm and o�lone of the Poft, omtatn popetesay man endorseneent A s on We dos eat conKor�Ib tis
GmOhft holder to ftu of a mh
Enterprise Insurance Group. LLC
donaum BIe
94350 Carlson Circle J6
Tampa, FL 33626
Lbense It L059361 COMWAR
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Perfect Roofing and Services, Ina o
284 North East 196th 8b vet
111 IMI, FL 33969
ENT. TERRA OR CONDITION OF ANY OONTRACT OR OTHER DOCUI=T VM RESPECT TO WFGCH THIS
THE pVSURANCE AFMM BY THE: POLICIES D1 BED HEREIN 18 SUBJECT TO/LLL THETWA
3L LWTS SHomm MAY HAVE BEEN REDt)cED BY PAID cLAm
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CwdUoab Is for evidence of Insurance only.
CCC# 1325929
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MIAMI SHORES VILLAGE BLDG DEPT WMNXPMATIONDATBTHIBUW KancesJILmom vmmni
ACCORDA1MY=7M POLICKPROUMMM
10050 NE 2ND AVE
MIAMI SHORES, FL 33138 eanroaaaarnmle
0IM-MO ACORD CORPORATION. AI r1qMs reserved.
ACORD 26 (201O" The ACORD name and logo we mgbknd matte cfACORD
Pdntod by.Rrz onO .EN.2M4 atM4PU
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Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,oy u maybe
personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
Print Name: 42-kO dpi. .
Signature:
State of Florida )
County of Miami -Dade )
Sworn toapd subscribed
day of &K,
before me this r Q
V1- 20 i
Print
State of Florida )
County of Miami -Dade )
Sworn t d subscri ed
day of�
By '! i
before me this
—� MY COMMISSION # EE871832 w'•'Fo EXPIRES March 28, 2018
(SEAL) •.a • � EXPIRFs pah.....:... .....- (SEAL) 1d�T - - - -
04/09/26.13 11:13 850-413-1979 CUSTOMER ASSISTANCE rAUt t7��n�
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.
EFFECTIVE DATE: 2/6/2.013 EXPIRATION DATE: 2/6/2015
PERSON: TURNER BILLY
FEIN: 4216030'1 Q
BUSINESS NAME AND ADDRESS:
PERFECT ROOFING & SERVICES INC
284 NE 116TH STREET STE: 2
MIAMI FL 33161
SCOPES OF BUSINESS OR TRADE:
ROOFING - ALL KINDS
AND DRIVER
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certlticate 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 shalt be subject to revoc afl06 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 certiftrate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609
RICK SCOTT, GOVERNOR KE - i , S llj T Y
..T -�
0 t
Y
ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408310003808