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PL-17-1213 `� - e Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795.2204 Fax: (305)756-8972 0 Inspection Number: INSP-284188 Permit Number: PL-5-17-1213 Scheduled Inspection Date:June 12,2017 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner. , Work Classification: Addition/Alteration Job Address:1009 NE 104 Street Miami Shores,FL 33138-2655 Phone Number (305)608-9839 Parcel Number 1122320290140 Project <NONE> Contractor: H.BETO'S PLUMBING INC Phone:(786)368-1902 Building Department Comments DRAINAGE 5 SHOWER Inftecdo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 9J CREATED AS REINSPECTION FOR INSP-281864. not ready Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections an be scheduled until re-inspection fee is paid June 09,2017 For Inspections please calk(305)762-4949 Page 30 of 31 Per""""N' •6474 2,13 Naos a i t a ii n>b r> Restttentia[ �e,��+„ oMiami Shores Village � ,�� 10050 N.E.2nd Avenue NE � � ' � 1�'tttz Ctassr��a;FFrsr�:A�tE��itic9tAltat`��on Miami Shores,FL 33138-0000 Phone: (305)795 2204 A8n?71a Suers A ! � ! =017" Expiration: 1X11/2017 Project Address Parcel Number Applicant 1009 NE 104 Street 1122320290140 Miami Shores, FL 33138-2655 Block: Lot: LENILAN INVESTMENT LLC Owner Information Address Phone Cell LENILAN INVESTMENT LLC 1009 NE 104 Street (305)608-9839 MIAMI FL 33138- 980 BELLE MEADE ISLAND Drive MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,900.00 ` H. BETO'S PLUMBING INC (786)368-1902 _. _.. .,... . .:__ _.... . . .,,.v... Total Sq Feet: 0 4, Type of Work:DRAINAGE & SHOWER Available Inspections: Type of Piping: Inspection Type: Additional Info:DRAINAGE & SHOWER Top Out Bond Return Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# PL-5-17-63891 DBPR Fee $3.38 05/15/2017 Check#:1290 $567.76 $0.00 DCA Fee $3.38 Education Surcharge $1.00 Penalty Fee $100.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $4.00 Work without Permit Fee $225.00 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,ROOFI G and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate th II work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor o th ork s ated. May 15, 2017 Authorized Signature:Owner / Applicant / Contractor / 101ent Date Building Department Copy May 15, 2017 1 Miami Shores Village RECEIVEC Building Department MAY - 3 °'!17 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 to BUILDING Master Permit No. i --� - �6- PZ PERMIT APPLICATION Sub Permit No. 21 R - IZ13 ❑8b-1LJhV6 ❑-FL8CT.41C ❑'ROO.FIA-6 L^ REV,-5X-N C EXTENS.-ON C^R,ENEW4—�L OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1009 NE 104 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2232-029-0140 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):LEN ILAN INVESTMENT LLC Phone#:305-608-9839 Aridress-.1009 NE 104 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Ct1faH. CONTRACTOR:Company Name: H. BETO'S PLUMBING INC Phone#: 786-253-6727 Address: 8454 NW 24 PL City: MIAMI State: FL Zip: 33147 Qualifier Name: HERNANDEZ, SAYDA WALESKA Phone#: State Certification or Registration#: CFC 1428937 Certificate of Competency#: DESIGNER:Architect/Engineer: JORGE D. MANTILLA(LIC# 14320) Phone#: 305-815-4649 Address:5901 SW 63 COURT City: SOUTH MIAMI State: Zip: Value of Work for this Permit:$ ' el c - Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace / Demolition / Description of Work: /?t2 1 » 5 h o w(E ? SheIV Specify color of color thru tile: Submittal Fee$ Permit Fee$ �_ .5 �_ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ CD 4- Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ P- (4P, - (Revised02/24/2014) {-G —3 6 Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's AddressCity State 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. INCA TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT Y RESULT IN YOUR PAYINGGCE FOR IMPROVEMENTS T YOUR RERTY. IF YOU INTEND TO OBTAINFINANCING, CONSULT WITH YOUR LENDER R 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 oved and a reins e ion fee wffl be charged. Signature Signature INNER or GENT CONTRACTOR The foregoing instru nt was ac owledged before me this The foregoing instrument was acknowledged before me this day of App.i L _ 20 Iq by day of a p't'� _.__...._.__,20.1_ -_by &V}_ who is perste onally to �• PZ who is personal^ lY knownto me or who has produced as 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: 0„•� tJP� Print: ,",,,•r"% NATALIALARA Print: •` MYif ennn�nnn Seal: WedMMM �e Seal: , LIDICE ALCANTARA Q MY COMMISSION#FF953054 *CO3 FIRES:Jaw�y24,2020 APPROVED BY 94 --- ' Plans Examiner _ Zoning Structural Review Clerk (Revised42/24/2414) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD _ CFC1428937 The PLUMBING CONTRACTOR r Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 HERNANDEZ,SAYDA WALESKA H. BETO'S PLUMBJNG INC 8454 NW 24TH PLACE MIAMI FL 33147 . DATE(MMIDDNYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE kk , 04/27/2017 THIS CERTIFICATE IS ISSUED AS A 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 policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER NAME: JOHNNY TUNON ROYAL CARIBBEAN INSURANCE AGENCY 11 P11ONE305-642 4541 wX No;305 642 1087 no aI 1772 WEST FLAGLER STREET L .JTUNONROYALII@GMAIL.COM MIAMI, FL 33135 INSURERS AFFORDING COVERAGE MAIC# INSURERA:UNITED STATES LIABILITY INS.CO. INSURED INSURER B:ASSOCIATED INDUSTRIES INS.CO. H. BETO'S PLUMBING, INC. INSURER C: 8454 NW 24 PLACE INSURER D: MIAMI,FL 33147 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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. INSRLTR TYPE OF INSURANCE ADOLSUBR POLICY NUMBER POLICY yy MOMLIyl ICY YYPY LIMITS A X COMMERCIAL GENERAL LIABILITY CL1746996A 04/15/2017 04/15/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea occu encs $ 100,000 MED EXP(Any Oneperson) $ 5,000 PERSONAL&AOV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY 11PRO JECT F]LOC PRODUCTS-COMPIOP AGG S 1,000,000 J OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acci ent ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NONE NEO PROPERTYDAMAGE S HIREDAUTOS H AUTOS e $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION$ $ B WORKERS COMPENSATION AWC1080469 04/15/2017 04/15/2018 X STATUTE I I ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICEtVMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached If more space is required) PLUMBING CONTRACTOR/PLUMBING STATE CONTRACTOR LICENSE#CFC1428937 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE EXP TION DAT EREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDAN E WITH T PO )CYPROVISIONS. 10050 NE 2ND AVENUE RIZ REPRES iVE MIAMI SHORES, FLORIDA 33138 198 2014 A DRD CORPORATION. All rights reserved. ACORD 2512014/01) The ACORD name and lono are rea)stered m rks 010169 Local Business Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY ".646 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES H.BETO'S PLUMBING INC RENEWAL SEPTEMBER 30, 2017 8454 NW 24 PL 7442943 Must be displayed at place of business MIAMI FL 33147 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS H.BETO'S PLUMBING INC 196,PLUMBING CONTRACTOR PAYMENT RECEIVED C/O SAYDA W HERNANDEZ CFC1428937 BY TAX COLLECTOR Worker(s) 1 $75.00 08/01/2016 CREDITCARD-16-044905 This Local Business Tax Receipt only confirms payment of the Local Business Tax,The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. For more information.visit www.miamidade.govltaxcoilectar . C3 WFR L CEWE CLASS E _ SJcYRA '.844 NYS* 'ir4 rt.AG MIAMI,FL 33143 DOB`11-24-1903 She: cp MI -2011" ISE S,n;