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PL-15-2670 Inspection Worksheet Miami Shores Village 10060 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax:(305)756-8972 IZQJ S _ 12 34-- 7 Inspection Number: INSP-246105 Permit Number: PL-10-15-2670 Scheduled Inspection Date: December 21,2016 Permit Type: Plumbing- Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: ARENAS,JORGE Work Classification: Addition/Alteration Job Address:286 NE 99 Street Miami Shores, FL 33138-2435 Phone Number Parcel Number 1132060134310 Project: <NONE> Contractor: CASTELLON PLUMBING CORP Phone:305-553-1490 Building Department Comments MASTER BATHROOM AND CABANA 1/2 BATHROOM,2 Infractio Passed Comments TOILETS, TUB, SHOWER,3 SINKS.ALL NEW INSPECTOR COMMENTS False INSTALLATION CONNECTING TO EXISTING SWER& WATER LINES Inspector Commend Passed , Failed Correction Needed Re-inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. �e+!Ow.' s w, Miami Shores Village ■ rr> W' iein 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ti ` Phone: (305)7952204 f StBttrs:APPR� �I `; 19121215 , Expiration: 04/30/2016 Project Address Parcel Number Applicant 286 NE 99 Street 1132060134310 Miami Shores, FL 33138-2435 Block: Lot: JORGE ARENAS Owner Information Address Phone Celt JORGE ARENAS 826 NE 99 Street MIAMI SHORES FL 33138- 826 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,800.00 CASTELLON PLUMBING CORP 305-553-1490 _...... ...... .. . _.. _...._ _.._._.. . . Total Sq Feet: 0 Type of Work:MASTER BATHROOM AND CABANA 1/2 BATH Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# PL-10-15-57488 $3.38 11/02/2015 Credit Card $ 197.16 $50.00 DCA Fee $3.38 Education Surcharge $0.80 10/20/2015 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $247.16 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWSM DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing infoati n accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- a e ntractor to do the work stated. November 02,2015 Authorized Signature:Owner / Applicant / I I& Date Building Department Copy November 02,2015 1 Miami Shores Villag - t Building Department ®C720 1s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 � , Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 = r FBC 2010 BUILDING Master Permit No.� PERMIT APPLICATION Sub Permit No. FL- 1-5-267:7-0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-]RENEWAL Pi PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ( N� �� el—t- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 3C) M�� ��-� Phone#:'.>'n& Address: C:�"' City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Address: SAP !ZZ 4/lam 6 City: ,4lP2 state: /��i�� zip: Qualifier Name: ze f M2 e�� /14_0�/" Phone#('ZST/)2 '::n�7 State Certification or Registration#: / Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ r���a Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition Description of Work: VAZ �A' L�Z.©c7Ml 443Z� GN5N Nk % 2-'Mk LA` S 'COZ. s ®w re Z i \-a • ALL Kr=; / 1"3_sML CA Specify color of color thru tile: Submittal Fee$ Permit Fee$ 2Z5 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ (( TOTAL FEE NOW DUE$ 1 1 q �• I (Revised02/24/2014) I 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 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 ins ection which ccursven (7J days after the building permit is issued. In the absence of such posted notice, the inspection will n t be approve and a e spection fee will be charged. Signature ature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 by al'Z) day ofII 20 r J by �� j who is personally known to �ewx-� f11 1 en4vho is personally known to me or who has produced�j����� �� me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: / e-A7—R rz P°'00 pug, Notary Public State of lorida tppr p� Seal: Joanna M Feiiciano Seal: ?°:•'•.�� BEATRQA.BUI M Pfly Commission FF OB2753 * * WCOMMISSION 9FF194734 Expires 01(1212018 EXPIRES:April 7,2019 nr ^tiRf- ga d�,a �'TQOVX� bft TIn134dNo"Soft APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) a ,5�pg�s p Miami Shores Village logo Building Department RipA 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTE S. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this I`4 day of ' 1 20= . Go N jEPs� � By�P - who is personally known to me or has produced � (J•�-I '� as identification. Notary: o40°fje` Notary Public State of Florida SEAL: + ; Sindia Alvarez c� My Commission FF 156750 NorpoP` Expires 09,0312078 CASTELLON PLUMBING CORP. 9841 NW 130 St Hialeah Gardens, FL 33018 (786) 255-5195 September 21, 2015 State of Florida Miami Dade County Before me this day appeared Giraldo Castellon who, being duly sworn deposes and says: That he will be the only person working on the project located at 286 NE 99 Street in Miami Shores, Florida 33138 Sworn to and subscribed before me this September 21, 2015. Nota Public aotM;;•Lepc WAVZA.B MOG * * WCOMMON#FF 154734 EXPIRES:AM 7,2010 a�i��o�e B �No�yServix� FROM_:CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. 02 2015 01:11PM P2 _ s .STATE'OP F'LOR115A DEPARTMENT OF BUSINESS ANO PROFESSIONAL REGULATION GOINSTRUCTION INDUSTRY LlCeNSING ZOARD (850) 487-1395 .,g 1940 NORTH MON.ROE STREET :TAALLAAHASSF-E PL 323999-07'83, CASTEL.LON',.GIRALDO• CASTELLON.PLUNISING CORP 9841-NW Tab$T,.. HIALEAH.GARDENS FL 3901.8 Congrattstetjods!. With-this license you-become orae•pf the nearly - one,million FloAdlans ilconseeVy the Department.-of Business and Professional RepUlaition. .Our prWessteriats•and businesses rain& STATE OF FLORIDA from`archttects•to yacht brokers,from boxers to barbeque'restaurants. DEPARTMENT OF BUSINESS AND and they keep Florida's.economy strong. PROFESSIONAL REGULATION .Every:day we-work twimprove the way We do-business in or¢et'•to CFC01-9069 ISSUED: '05x`29%2044 some yop better, For informatich about our setvices,p'iease log onto ww*trtyfloridaitoenWcbm•. There.you cOn find more Information CERTIFIED PL,01015MCONTRACTOR abotit our•divistdns and the regulatlonl;gthat:!mpact•you,sub0orlbe CRSTBLLON,Gd DO to deparfinertt.newsletteis'and learn more about the Department's CASTELLON•PLCWIR4E3=140- tnitiatiarea. Our mission at this Department Ise.Llcen0e:EfficlOtly,Regulate Fairly. Wel constantly strive to-setvie rou better zjO:that yoo,can serve ygtxr• Customers: Thank you-46r doing business in'Fiorida, IS CB.st'TfPIE0 and-st trio provisions of Ch.489 FS and congratulations,:on.your rleisix license,! Expottwi dffie AUG 37.2016 L140529=1729 DETACH-HERE: RICK SCOTT.,-.GOVERNOR KEN.LAWSON,SECRETARY STATE;OF FLORIDA _ DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION CONSTRUCTION.INDUSTRY LMENSING BOARD: C •1'c 1 CpGO't9tT58 _ TISK PLUMBING.GONTRAGTOR N2trn d.below IS CERTIPtEO Under the provistais of Chapter489 R5, Expiration date: AUG 3t,26 ■ Q CASTELLON•, GIRALQO- CASTELLON PLUMBING GORE 984.1 NW.130.ST, HIALEAH'GARDENS FL'33018 �.r� FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. 02 2015 01:12PM P4 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 46674$ \1LB.T'j BUSINESS NAMGli_OCATION RECGIPT NO. EXPIRES CASTELLON PLUMBING CORP RENEWAL SEPTEMBER S 20'!6 4841 NW 1301 ST ase74.tr nntsSt HIALEAH GARDENS,FL 33018 oe aPursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OR BUSINESS PAYMET RECEIVED CASTELLON PLUMBING CORP 196 PLUMBING BY TAX C'Ot 60TOR CONTRACTOR 45.00 07/14/2015 Worker(s) 10 CF0019059 CHECK21-15-093677 This Lacal'Busineae Tax Receipt oniv confirms pavmont of the Looti eusinass Tax.The Receipt Is net a license, permit,or a certification of the holder's quafiffawaos,to do Ilow ress.fielder must comply with any governmental Or u048avetnaranml regulatory laws and requirements which apply to the business The RECEIPT NO,above must be diapkrfed on OR ootamoMiRl vehicles-Miami-Rade Code See 88-270. M MF For Mors infmmatian,visitwww.mtamidKjtaVAMgl ctnr FROM :CASTELLON -. PLUMBING CORP FAX NO. :305 sse 1617 Nov' 0e 2015 01:12PM Po 41"- ^ Report Vlevyw CM OF PIMANCM OFFICER ST TE OF FLORIDA DWARTMENT OF FINANCIAL SERVICES DIVISION OFWOFU�COMPENSATION CONSTIMICTION INDUSTRY EXEMPTION Ibis cartilles thatthe InclNiclual listed below has eleclad to be exempt from Florida Workers'Compensation low. EFFECTIVE DATE: 11)2=015 EXPnRATION VATF_ 11)21/2017 PON, 591676886 9841 NW 130 ST HIALEAH GARDENS FL 33018 LICENSED PLUMBING CONTRACTOR FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Nov. 02 2015 01:10PM P1 p 11 I CERTIFICATE OF LIABILITY INSURANCE DAVE(ferMWYYM -......��. . ---------r tuna/1y THIS CERTI>=ICATE IS tSSUEO AS A MATTER OF INFORMATIQN ONLY AND CONFER$NO RIGHTS UPON THE CERTIFICATE Hik DER.THIS CERTIFICATE DOSS NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 13SLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED MPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- 11 the oerttficale f older loan ADDITIONAL 1005RED,the Vol iey(fes)must bo 4ndorsed. if fAWR0LvArrON Is WAf V65,subject to the terms and oondltIme,of the poucy,certain policies:ney require an endorsement.A statement on thts cereamile does not confer rights to the carftficate holdor in Iieu of such etttlorsetneaf(s). PRODuce" 'IStA75T - E: .......... fst Class Insurance Ilfladcet ^E F 4j • (. 306 441-2997 A1c Ho: f305)44$•6413 4101 NW 9th Street •••- ntwkass fdmc-0aolcom _ Miami,FL 33925 tasuRt faalAaFnRDuyc�covoi- _—- NAtox - _..._ rte (305)441-2997 Fax 449-6443 INsuReRA• GRANADA INSURANCE OOWANY FtER - CASTELLON PLUMBING CORP. CPC 019059 1eS t B s • 9841 NW 130 5T H ALEAl:H,FLORIDA 33015 J"—Mu: -- r SURs F t COVERAGES CERTIFICATE NUMBER: REVISION NUMSEIi: INDITHICATED. LS TO. NOT'P�1 I1 jAT TttE POIIdES OF INSURANCE L15TFA BEIOVti HAVE BERN ISSUED 76WE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDLCATED, NOTWITHSTANDWO ANY REQUIREMEN1T,TERM OR CONDITION OFANIY COPITRAC7 OR OTHER DOCUM9NTVf1fTH RESPECT'TO WH CH THm CERTIFICATE MAY IDS ISSUED OR MAY PEft rAfN,THE INSURANCE AFFORDED BY TNI:POLICIES DESCRIBED HEttEtN IS SUBJECT TO ALL THE TERMS. _EXCLUSIONtS AND OONDff IONS OF SUCH POLICIES.LiMiTs SHO_WNS MAY HAVE gEQ!RELtiICEO BY PAID CLAIMS. ` TYPE OF tlyS{tRgNCE A U LM.Y EFP PO EXP ' LrtdrTS _ 66 COWEROL L GENERAL LGtB CnY -- .... ❑ CLanas afAas ® actxrR E�9CcuRRENcri A,100.W0.00 A ❑ N 0186FL00064193 10129=15 1WJ291201f3 D PxP one rton S 5,000.00 OFNL AGORteGATE U�A�7f7 APAI.IE$PER: r+ERs0NAL&ADV INAIRY s 2,000,000.E ❑ pv(x,,y El LOQ OE�(EfZA!A 0MOATE $ 2.000 000.00 Ott ��T OtP UCTS-Cor�/pP AGG 8 1,000,000.00 AUTOMOME Lit Ury -- $ _ O D ANGLE tIMtT ... AM ❑ AL�LvNae ❑ — � sCIa ED AV= � 8e0oDnAlLYYItNIJRLYY((PPeerrapcacrsOonn) S❑ iDAU0ANUOTV >$ I�p •� RfMGf: _...- S - oOcuR ❑ e=ESS LIM 'U_0M R 7ENnONS , AOCREGAIM S _ Woft"NS00MPEN3AT10W - -r---, __ S AND R,MPLOYGW UASUfY YIN U PF.R Y ❑ ANYPRppti��ETTDRIPARTNERfUMUT E.I.FJICFI ACCIDENT -- OFFIMMEMBEREX0141DRM MIA {ffraloly b1 NH) EL.OISFASS-FA EkiPi oYE $ .- DYee,eeSe j,wedor DE8tJR1FTIONOFOPERAYf"below - E.L.DISEASE-POLICYLUT S D N OP OPERA?"'MI LCOAIioNs/Vi tnCLES(Alt4ob ACORD iof.Aacmonai Rs n afmfthcdWe,f nwo spaee tg Mqultod) ._ ...,_.. Pltnnhing Contractor CERTIFICATE HOLDlE12 •-•-•-• ... '• •--.•• .._... CANCELLATION _...._. VII.LAGE OF MIAMI SHORES SHOULD ANY OF THE A80Ve DesCMBED POLICIES 89 CANCELLED BEFORE THE EXPIRA710N DATE THEREOF,NOTICE WILL.13I;DELIVERED IN 10050 NE 2 ND AVE. ACCORDANCE WITH THE POLICY PROVfSIONS. MIAMI SNORES,FLA.33138 AtITRADRfiPRE AT IVE _........._. FAX:(305)756-8972 ACORD 25(2014/01)QF lose 2014 A ORD CORPORATION. All rights reserved. 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