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PL-15-3163 Permit NO. PLA 2-15-3163 �sNO1tEs y,� Miami Shores Village Permit Type:Plumbing-Residential 10050 N.E.2nd ANE venue Pen�� t Work Classification:Addition/Alteration " Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 t0Fwro issue Date:3/17/2016 Expiration: 09/13/2016 Project Address Parcel Number Applicant 1051 NE 92 Street 1132050160010 Miami Shores, FL Block: Lot: ALFONSO DEL CASTILLO Owner Information Address Phone Cell ALFONSO DEL CASTILLO 1051 NE 92 Street (305)613-5552 MIAMI SHORES FL 33138- 1051 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 15,000.00 AA MASTERS MECHANICAL AIR MOV (305)559-7004 .... �� Total Sq Feet: 00 Type of Work:REPLACE WATER SUPPLY PIPES METER RE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $9.00 DBPR Fee Invoice# PL-12-15-58138 $�$$ 03/17/2016 Credit Card $567.76 $0.00 DCA Fee $7.88 Education Surcharge $3.00 Permit Fee $525.00 Scanning Fee $3.00 Technology Fee $12.00 Total: $567.76 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 accurate and that all work will be done in compliance with all applicable laws regulating construction and z -- bove-named contractor to do the work stated. March 17, 2016 th ed Si natur p scan Contractor / Agent Date Building Department Copy March 17, 2016 1 �, c is Inspection Worksheet Miami Shores Village (D2-FLPhone: 10050 N.E.2nd Avenue Miami Shores,(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249890 Permit Number: PL-12-15-3163 Scheduled Inspection Date: December 06,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: DEL CASTILLO,ALFONSO Work Classification: Addition/Alteration Job Address:1051 NE 92 Street Miami Shores,FL Phone Number (305)613-5552 Parcel Number 1132050160010 Project: <NONE> Contractor: AA MASTERS MECHANICAL AIR MOVING AND ENGINEERIP Phone: (305)244-0667 Building Department Comments REPLACE WATER SUPPLY PIPES METER REPLACE ALL Infractio Passed Comments WATER PIPES INSIDE HOUSE HOT AND COLD REPAIR INSPECTOR COMMENTS False AND REPLACE ALL DRAIN PIPES EVERYTHING ACCORDING TO PLANS 5/3'V16-qualifier must be at job site as per inspector request. Qualifier must call the inspector when at job site. SL Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. Miami Shores Village - Building Department DEC 2`22015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. -z lC'=?/� F-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP G CONTRACTOR DRAWINGS JOB ADDRESS: 10,51( N Q l2 51 City: Miami Shores County: Miami Dade Zip: 33l3� Folio/Parcel#: 3 40i O Is the Building Historically Designated:Yes NO IK Occupancy Type:�_Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): s0 oN&i 1LQ Phone#: 3oS=6(3-jT*2 Address: AIX 12-14• tl City: x'111`` SUW14 State: Zip: 3' 3/ Tenant/Lessee Name: Phone#: Email: n lh C CONTRACTOR:Company Name:A A M plzyeo q"ALte4 At� [LVi1 Phone#: 3u3 - zly-o6 Ce Address: 1rj45C1 ( QW TPW A City: Z(l State: ylk-. Zip:'93Ict(// P Qualifier Name: ' g /o_p,we, Phone#: State Certification or Registration#: CFc I�Z��09 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ dow Square/Linear Footage of Work: , Type of Work: ❑ (Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition � pp�Q ' Description of Work: It c,� uf►� WAM 1�`�S t5oK Iw�1€2 %E&C4 &„ WV?'1- Specify color of color thru tile: Submittal Fee$ Permit Fee$ _ Lt CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 5(p-7•-7 Ko (Revised02/24/2014) j w Bonding Company's Name(if applicable) Bonding Company's Address 4- 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 approved and a reinspection fee will be charged. Sign a Signature ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The f oilng ins rum was acknowledged before me this day of � G+�, 20 14 _, by day of pp e 20 S by y� who is personally known to J:A iy p JO.J& (0,YQ'I'rt` ,who is personally no n to me or WHO has pro uced�Y as me or who has produced as identification and who did take an oath. ide tifaj���c`S1alRE�MMdGtMBEnMUt+IE.Z NOTARY PUBLIC: NO A1;Y ! *:j(�M� Y COMMISSION#FF16666s -jW Z11'*k Notary Pudic State of Florida '••.'�ARM-9, -EXPIRES October 7, 2018 Patricia Faggionato (407 ' 153 Florida taryservice.com My Commission EE 179869 # os a Expires 03H 5/2016. Sign: Sign: Print: Print: U Seal: Seal: APPROVED BY -I(f4 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦SNoRFs yi logo Miami shores V &` Building Department ORtiDp' 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 AC OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: caner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of �r ,20_g. By 4w who is personally known to me or has produced as identification. Notary: ry PuW Stats of Florida • Patricia F gionato SEAL: y Commis br EE 179869 � df Expires 03/ 016 AA MASTERS MECHANICAL AIR MOVING & ENGINEERING SYSTEMS CORP. 15591 SW 105TH Terrace Date: 12/21/15 Miami, FL 33196 State of Florida County of Miami-Dade Before me this day personally appeared Felix Jesus Guerra who,being duly sworn,deposes and says: That he or she will be the only person working of the project located at: 1051 NE 92nd Street,Miami Shores,FL 33138 Swo to(or ffir ed)and subscribed before me this le day of December.2015,by Personally know X OR Produced Identification Type of Identification Produced y� WASHINGTON D SCARANO ��' MY COMMISSig>AFF927862 frfiJf' PIRES O er 15,2019 I�Gr� Print,Type or Stamp Name of Notary To: Page 5 of 5 2016-05-16 14:27:19(GMT) 18883301123 From: Gretell Gonzalez DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/13/2o,s THIS CERTIFICATE IS ISSUED ASA 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 pollcy(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 CONTACT Gretell Gonzalez Usa General Insurance PHONEnia EXt>: (305)386-3305 F°x /888 330-1123 -MAIL ------.—......-.....__. .(A1C,..f!'.Ql: \..--- 13631 SW 26st greteligonzalez@yahoo,com Miami,FL 33175 INSURERS AFFORDING COVERAGE NAIC d Phone 305 386-3305 Fax 888 330-1123 INSURER A: WESTERN WORLD INSURANCE CONPANY INSURED INSURER B AA MASTERS MECHANICAL AIR MOVING&ENGINEERING SYSTEMS INSURER C 15591 SW 105 TERR #525 Contractor License#CFC1426169 INSURER D Miami FL 33196 INSURER E INSURER F COVERAGES CERTIFICATENUMBER: REVISIONNUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIG CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ---........— ------- —... __....— ....-....__....... ------ LTR TYPE OF INSURANCE ADOL UBR ( POLICY EFF POLICY EXP NSR %IVO POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS © COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1,000,000.00 ElF-1O OCCUR AG N tu PREMISES.(EaoccurTnce..,,,,.-S 100,000.00 A ❑ N N NPP8362217 05/06/2016 05/06/2017 MED EXP(Any one person s 5,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PERSONAL&ADV INJURY $ 1,000,000.00 ❑ POLICY ❑ PECOT- ❑ LOO GENERAL AGGREGATE s 2000,000.00 ❑ OTHER PRODUCTS-COMP/OP AGG S 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea accident ❑ BODILY INJURY(Per person) $ ALL E] AUTOS OWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS NON-OWNED ' ❑ AUTOS i PROPERTY DAMAGE LPer accSdent .---__...-.._-1.._......._.__............_...-...__...._.-._..--- ❑ UMBRELLA UAB ❑OCCUR I EACH OCCURRENCE s ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION s I WORKERS COMPENSATION $ AND EMPLOYERS'UABIUTYY/N aTATLITE❑ PER ❑ETH_ ANY PROPRIETOWPARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? N/A E,L,EACH ACCIDENT $ story In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE S It yes, DESCRIPTION OF OPERATIONS below I E.L DISEASE POLICY Lih11T $ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Re:CFC1426169&CAC057226 CERTIFICATEHOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue —..........._._.............. — Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE / '��'---_-- r ACORD 25(2014101)QF ©1988-2014 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD G'3