CC-15-2086 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-241544 Permit Number: CC-8-15-2086
Scheduled Inspection Date: September 23,2015 Permit Type: Commercial Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: VILLAGE, MIAMI SHORES Work Classification: Repair
Job Address:10000 BISCAYNE Boullevard
Miami Shores, FL Phone Number
Parcel Number 1132050200010
Project: <NONE>
Contractor: ARCO CONSTRUCTION Phone: 305-892-6507
Building Department Comments
RE-BUILDING OF UTILITY STAIRS(REPLACEMENT OF Infractio Passed Comments
TWO DETERIORATED GIRDERS INSPECTOR COMMENTS False
CLOSING EXPIRED PERMIT.
TO CLOSE#BP-2002-928
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
September 22,2015 For Inspections please call: (305)762-4949 Page 12 of 36
00,
4
Miami Shores Village = �l Type Cr C3Ii iorcial Construction
' 10050 N.E.2nd Avenue VIl�G1 � i&��flepar
Miami Shores,FL 33138-0000 a
Phone: (305)795-2204 ' ., / APPRPVEq.:.
Expiration: 03/20/2016
Project Address Parcel Number Applicant
10000 BISCAYNE Boulevard 1132050200010
Miami Shores, FL Block: Lot: MIAMI SHORES VILLAGE
Owner Information Address Phone Cell
MIAMI SHORES VILLAGE
Contractor(s) Phone Cell Phone Valuation: $ 1,430.00
ARCO CONSTRUCTION 305-892-6507
..w .. Total Sq Feet: 0
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied:
Review Building
Type of Construction: Occupancy Load:
Stories: Exterior:
Front Setback: Rear Setback:
Left Setback: Right Setback:
Plans Submitted: Certification Status:
Certification Date: Additional Info:
Bond Return: Classification:Commercial
Scannin :3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# CC-8-15.58748
$2.25 09/22/2015 Check#:2805 $166.70 $0.00
DCA Fee $2.25
Education Surcharge $0.40
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is a rate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-na tractor to do the work stated.
September 22, 2015
Authorized Signature:Owner / Apicant Co or / Agent Date
Building Department Copy
September 22,2015 1
I
~1
Miami Shores Village i
AUG 17 2015
Building Department5�9�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20►.'-i
BUILDING Master Permit No. LC� -, 1!57—2L _
PERMIT APPLICATION Sub Permit No.
;EfBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: )0 ®o P.2111-5c-Ay N 6 L y
City: Miami Shores County: Miami Dade Zip: 12t L�
Folio/Parcel#:_ 1 (�3.9.® 150200 0 10 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): MI 116'. V L j '. Phone#:
Address: IjQ- ina
City: IA61 , oA 0 LkAA State: Zip: ( 7
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �1 ��6 r�a �} Q Phone#: 7
Address: z .0CLL 7
City: !�, t . State: Zip:
I
Qualifier Name: ^ � w& Phone#: ..fc, 07
State Certification or Registration#: i c:;,r��, l�e� Certificate of Competency#:
DESIGNER:Architect/Engineer: A .6 Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �' � Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: U-q zA
Specify color of color#liRru ales
Submittal Fee$ Permfit fQqe$; ` � CCF$
g�
Scanning Fee$ Radan T DBPR
TechnoloFee
gy =�� � ratinIng/Education Fee$ Doub'Fe'feff$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 9 GE)
(Revised02/24/2014)
Bonding Company's Name(if applicable) (�
Bonding Company's Address 6 I
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 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a roved and a reinspection fee will be charged.
9
Signature �° Signat
OWNER or AGENT CONT R
The foregoing instrument was acknowledged before me this The foregoing instrument w ac_^owledged before me this
1 JL day of AJ X,3 A 20 d`� ,by day of 20 by
:F3= ,who is personally known to ho is personally known to
me or who has produced as me or who has produced Nati e f'5 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: (4Print J
Seal: Seal:
TERESA NUNEZ-APONTE
���►A""La'• TERESA NUNEZ-APONTE
=a ., My Comm.Expires Jah 26.201
?�• My Comm.Expires Jan 26,2018
Commission#�FF 0663 a�`�°,'� Commission S FF 066355
APP V�YYY°�`V4' Plans Examiner „ Zoning
.XC PT -
Structural Review Clerk
(Revised02/24/2014)
♦5Ni�c.��'s'pr
,,,, "milr" Miami shores Village
Building Department
�ZpRtpA 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 and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BEL YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
i
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of d ,20—t-1.
By who is personally known to me or has produced
as identification.
Notary:
SEAL:
TERESA NUNEI APONTE
r• jO' t a
My Comm.Expires Jan 26.2018
Commission#FF 086355
Arco Construction Corporation
August 17, 2015
State of Florida
County of Miami Dade
Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and
says:
All work to be performed by Lester Jensen or licensed and insured subcontractors.
Sworn to (or I ed)and subscribed before me this day ofAWjQ X120 t5 ,by
V6
Personally know
Or Produced Identification
Type of Identification Produced T
I C\
Print,Type or S Name tary
;off Pwt Notary Public State of Florida
Sindia Alvarez
` My Commission FF 156750
o,poo� Expires 00/03/2018
General ContractorsXG050516311665 N.E. 137"' Terrace/N.Miami, FL 33181
305.892-6507