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PLC-17-728 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL f Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-284063 PermitNumber: PLC-3-17-728 Scheduled Inspection Date:June 12,2017 Permit Type: Plumbing -Commercial Inspector. Hernandez,Rafael Inspection Type: Rough Owner: , Work Classification: Addition/Alteration Job Address:9806 NE 2 Avenue Miami Shores,FL Phone Number Parcel Number 1132060132241 Project: <NONE> Contractor. ALLSTATE PLUMBING CONTRACTORS INC Phone: (786)457-9163 Building Department Comments LEGALIZE BATHROOM Infractlio Passed comments INSPECTOR COMMENTS False 14 Inspector Comments Passed �f Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 09,2017 For Inspections please calk(305)762-4949 Page 18 of 31 r N 447-728 �� w errt�T041K in Co ,"'arcia Miami Shores Village 10050 N.E.2nd Avenue NE ONS+ ( trC►rt �C&Ut1,661A tit+ETi, Miami Shores,FL 33138-0000 'etmit 5ikus Aia' %Foy Phone: (305)795 2204 511112Q t7 Expiration: 11/0712017 Project Address Parcel Number Applicant 9806 NE 2 Avenue 1132060132241 MIAMI SHORES CENTER, LLC Miami Shores, FL Block: Lot: T_.... Owner Information Address Phone Cell MIAMI SHORES CENTER, LLC 210 71 Street ro MIAMI BEACH FL 33139- 210 71 Street MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 ALLSTATE PLUMBING CONTRACTOF (786)457-9163 _., Total Sq Feet: 0 i Type of Work:LEGALIZE BATHROOM Available Inspections: Type of Piping: Inspection Type: Additional Info:LEGALIZE BATHROOM Top Out Classification:Residential Re Pipe Scanning:1 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PLC-3-17-63351 DBPR Fee $2'25 05/11/2017 Check#:10813 $ 112.30 $50.00 DCA Fee $2.25 Education Surcharge $0.60 03/16/2017 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate an ork will in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contra o do the or st ed. May 11, 2017 Authorized Signature:Owner / Applicant / Contractor / Date Building Department Copy May 11, 2017 1 �� - X67 �� �® AC Ro® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMOWYYYY) 05/01/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 terns 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 endomement(s). PRODUCER CONTACT NAME Renzo Campanella Allstar Assurance PHONE ; (954)616-5092 _9141%FOM FaAxc No: 888)246-5787 510 Shotgun Rd,Suite 530 ADDRESS: renzo@allstarassurance.com INSU S AFFORDM0 COVERAGE MAIC S Sunrise FL 33326 INSURER A: Granada Insurance Go. INSURED INSURER 8: AIIState Plumbing Contractors Inc INSURER C: 19800 nw 44 th ct INSURER D: INSURER E Miami Garden FI 33055 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. INSR LTR TYPE OF INSURANCE L S B POLICY EFF POLICY EXP SD NM POLICY NUMBER M DIVYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FJ OCCUR DAMAGE T RENT D PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 0185FLOW95609 04-30-2017 04-30-2018 PERSONAL&ADV INJURY $ 1,000,000 GEW AGGREGATE LIMIT APPLIES PER: POLICY❑ GENERAL AGGREGATE $ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ O OTHER: $ AUTOMOEILELIABILITY COMMWED TINGLE LIMIT $ Ea accident ANY AUTO B ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ WNED HIREDAUTOS AUTOS PROPERTY DAMAGE Pet Accident $ UMBRELLA UAB OCCUR C EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION a WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN 5TATU ER ANYPROPRIETOR/PARTNER/EXECUn VE D OFFICER/MEMBEREXCLUDED4 NIA E.L.EACH ACCIDENT $ (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT J$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mare space is required) Plumbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shore Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd ave AUTHOR¢EDREPRESENT , Miami Shores Village FL 33138 ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD i Miami Shores Village MA 16 2917 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 FBC 2011 BUILDING Master Permit No. — I PERMIT APPLICATION Sub Permit No. VU1Lo F-1 BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS LJCHANGE OF ❑ CANCELLATION ❑ SHOP JOB ADDRESS: q Q & N-t,-- 2`' kj✓� CONTRACTOR DRAWINGS 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): Phone#: Address: �I 0 1 L ' `f City: State: Zip: J�I Tenant/Lessee Name: ("44 �(� 12— Phone#: �� Email: P ® CONTRACTOR:Company Name: � T ��1'!d9��12� Phone#: '�®6-.,q Szi,-9163 Address: 101 ®� r City: State: Zip: Qualifier Name: V� n Loy Phone#: State Certification or Registration#: C 'e, L ''C Z*�(0 Ss Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: ' Address: City: State: Zip: Value of Work for this Permit:$ 2,500 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: (A Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$_ QS DBPR$ 09 Notary$ sv Technology Fee$ Training/Education Fee$ �' Double Fee$ 10 Structural Reviews$ Bond$ 10 TOTAL FEE NOW DUE$1 (Revised02/24/2014) 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 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. P Signature Signature OWNER or AGEN CONTRA TOR The foregoing instrument was cknowledged before me this The fo going instrumenii was acknowledged before me this day of 20 by day of f �U ( 20 L`1 by 0ri(fVt Ve we,who is rsonally known t C�'� I`� ,who i ersonally kno n to 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: /Y Print: Print: ®Il ma i =Q. MY COMMISSION 4 FF 064212 .a ., """' YOLIMA L. DE AVILA Seal: '` Seal: a;.��^ao''., EXPIRES:December 14,2017 a ��s F :fid BondedThruNotaryPublcUndenariters *c Commission 1i GG 34889 f.• �1�1 My Commission Expires September 29, 2020 APPROVED BYR�3f- 1?f' I� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 40STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 . 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MONZON,JULIO VICTOR V ALLSTATE PLUMBING CONTRACTORS INC 19800 N.W.44TH COURT MIAMI GARDENS FL 33055 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIO1�iL--REGULATION Every day we work to improve the we do business in order CFC1426658 iUEI 06/14/2016 way to serve you better. For information about our services,please tog onto www.myfloridelicer�.com. There you can find more CERTIFIED PLUIk!}3p G GONTRAUQR information about our divisions and the regulations that impact MONZON,JU>tl€��'K�I{�Tf3 'V- you,subscribe to department newsletters and learn more about ALLSTATE PL C CTO�S INC the Department's initiatives. Our mission at the Department is:License Efficlentiy,Regulate Faidy.We c onstantlystrive to serve you better so that you can serve your Customers. Thank you for doing business in Florida IS CERTIFIED under the prdvrslons of Ch.489 FS. and congratulations on your new license! =auc 3t. e u�sr ,oe DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY UCENSING BOARD CFC142608 The PLUMBING CONTRACTOR Named below IS CERTIFIED ¢' Under the provisions of Chapter 489 FS. ' Expiration date: AUG 31, 2018 MONZON,JULIO-VICTOR ALLSTATE PLUMBING C ORS INC ti 19800 NW 44T]i COURT MIAMI GARDENS, t=L - NZ u� • ■ ISSUED: t]fPl DISPLRI( S UIR€D SEQ# LIM140MO1108 _ uuetaa Local Business Tax Receipt Miami-Dade County, State of'Fiortda -TRIS IS NOT A BILL-DO NOT PAY 5543393 BUSINESS NAME/LOCATION RE46fPT 1 . ALLSTATE PLUMBING CONTRACTORS INC 11F-141M'" P"FEflI1BR 30, 2017 19800 INW 44 CT 57839©8 Must be displayed at place of business MIAMI GARDENS FL 33055 PursuantV courts Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT R19CEMD ALLSTATE PLUMBING CONTRACTORS IN096 PLUMBING CQNTRACTOR RY TAX COU ECTQR CFC1426%8 Worker(s) 1 $45.00 07/13/2016 CHECK21-16-084570 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt is not a license. permit,are certification of theholder sgoeHficatimm to do business.Holder must comply VAM any governments! or nongovernmental regulatory laws and reipmementawhich apply to tin business. The RECEIPT N0.above mustba displayed on all commercial vehicles,-Miami-Dade We Sac Ba-216. For more information.vise maw miemidadaaov/taxcolleccor Q 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: 11/30/2016 EXPIRATION DATE: 11/30/2018 PERSON: MONZON JULIO V FEIN: 463662565 BUSINESS NAME AND ADDRESS: ALLSTATE PLUMBING CONTRACTORS INC 19800 NW 44 CT MIAMI FL 33055 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a cerfificate of election under this section may not recover benetits 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 fisted on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Noir of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the fiHng 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 c ardfical s.The department shall revoke a DFS-F2-DWG-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Company Letter Head WrkeComp Company Letter Head Date:3/14/20017 State of:Florida County of:Miami Dade N� Berofe me this day personally appeared L0 V� � Lan who being duly sworn,deposes and says: T/hat he the w'll be the only pgrsos working on the project located at: 00 p� �� S T- Sworn IQSworn to (or a f}'rmed and su cribed before me this day of GrG°'i .20�,by J�to r�� W all Person y know Or Produced Identification Type of Identification Produced JOSE A DELGADO '~ Yy69 NSS-MIMPFR of Notary EXPIRES July 04.2019 ��oi� &o as ibrianNa�. sorvrw car Page 1 s� Miami shores Village Building Department artment 10050 N.E.2nd Avenue �IORIUp' 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 CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this c) day of Aa 0 Y B kPA yl IIL w o is personally kno to me or has prod ed as identification. "WY-11", ..tORrrMIMOUN `APMY COMMISSION#FF 064212 Notary: EXPIRES:December 14,2017 swded rnN Noun Pobrio Underw t m SEAL: ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 103-16-2017 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.B.S.Insurance Consultants ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 7500 NW 25th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 256 Doral FL 33122 INSURERS AFFORDING COVERAGE NAIC# INSURED Allstate Plumbing Contractors,Inc INSURER A: Arch Specialty Insurance Co. 21199 19800 NW 44 Court INSURER B: INSURER C: Miami Gardens,FL 33055 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE WM/DQ= LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY AGL0012679-02 04/30/2016 04/30/2017 $50,000 CLAIMS MADE FXI OCCUR MED EXP(Any oneperson) $2,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP OP AGG $1,000,000 X POLICY AprT PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND NC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under P S bl.w E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village Building Department DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 10050 NE 2nd Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Miami Shores,FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENTATNE <DA> Ar ACORD 25(2001/08) • • 0 ACORD CORPORATION 1988