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PL-13-2691Inspection Number: INSP-203746 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Permit Number: PL -11-13-2691 Scheduled Inspection Date: January 14, 2015 Inspector: Diaz, Osvaldo Owner: DEL C NUNEZ, MARIA Job Address: 17 NE 107 Street Miami Shores, FL 33161-7029 Project: <NONE> Contractor: G & R PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360070340 Phone: (954)822-3614 Building Department Comments PLUMBING WORK AS PER PLANS Infractio Passed Comments INSPECTOR COMMENTS False Passed fi Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. nspector Comments LW' January 13, 2015 For Inspections please call: (305)762-4949 Page 3 of 28 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: I V" (d .54 FBC 20 Permit No.'1 i 2691 Master Permit No. (3 — 6Y City: Miami Shores County: Miami Dade Zip: 33)� Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): l'1,eKte ) C Nie3. Phone#: ��S �� l 3 ct`� Address: N E. 101 SfCity: il" ect(AC SklorQ3 State: �) zip: 3'0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: C9 4 lz. ell 1\ J is Phone#: SL/ q zz 3 6((( Address: (IQ C0142 1t u City: C Ci.State: Zip: '37 33 ( ) Qualifier Name: Ok'k o O 3 Phone#: State Certification or Registration #: Ci, ®3 3 '8 (2. Certificate of Competency #: Contact Phone#: ec,Sck 1, 22. % 19 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ S fr® Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew dRepair/Replace Demolition Description of Work: crn,(i) e (1.9 GS eec cs.�ipr-5-J ***************************************F **, *********************,ria****************** Submittal Fee $_ 50 .00 Permit Fee $ 0.50 . -- CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 9 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 inspectioli hick occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap oved and a reinspection fee will be charged. Signature or Agent The foregoing instrument was acknowledged before me this 2 J day of tjtai , 201.3 , by i ---ton Gl t V C 1 Signature Contractor The foregoing instrument was acknowledged before me this day of KU\( , 2013 by N V IDErr%S who is personally known to me or who has produced who is personally known to me or who has produced-Tip/0- II as identificatio z'6 V. -A0 vJ d'\ As identification and who did take an oath. ' . ho did take an oath 41'0.'1 Py NOTARY PUBLIC: ►jYP�1 BARBARA CRISTINA RODRIGUEZ MY COMMISSION # EE053785 Sign: � ti .9.,.„0•a1• ' EXPIRES January 09, 2015 • 10R.clp.,datiGt✓ ,yS"^ Print: I ' C. , OClY , "Z1 My Commission Expires: i % 0.1 J %<- APPROVED BY 2 4-43 Plans Examiner Structural Review (Revised3/12/2012XRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: ttgt BARBARA CRISTINA RODE.., ,�-` .�; MY COMMISSION # EEO, "•'.'ornt EXPIRES January 09, 2C (407 398-0153 FlondallotaryService com • 120* >� My Commission Expires: i' c1 1 Z-() )S Zoning Clerk VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30,201 Business Name: G & R PLIBMING INC Owner Name: tsti3O TORRES Business Location: 4420 NE 20 AVE it OAKLAND PARK BUSlitelle Phone: 954-822 -3614 Rooms Seats Employees 1 Receipt #; r� ]i a sPRNKL/CONTRA Business Type: (PLUMBING CONMacilti Business Opened:oslaa/aoo7 Stat e&County/CertiReg:CPC 033812 Exemption Code: Machines Profesehmale Number 01 Macithism For Vending Btu Only • Tex Amount Trate Fee NSF Fee PemMY Prior Yds Collection Cast Tom Paid 27.00 0.00. _ 0.00 0_00, a_oo 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIFT This tax is levied far the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County andtor Ntunicipably planning WHEN VALtDATM) and zoning menta This Business Tax Receipt must be transferred when the business is :old. business Hants has changed ar you have moved the busing location. This receipt does not induate that the Mess is lewd ar that it is in compliance with Stats or local laws and regulations. Mafing Address: KILO TORRES 2769 NW 84 TERR COOPER CITY, FL 33024 2013 - 2014 Receipt 9010-12-00011379 Paid 07/12/2013 27.00 _QDI'% a atDrt "CUla. r i / ev%axt DIlwtl=C .11*I1.]% tl'NCP!►emir ' HRTIFISA 'umder the provisipne-os-ch<489 rs; Stan mtc:'AUG 3Tt, 2014 v:-..444082 3 O .CFF AC -WATER Chile FINANCU1. OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL S AVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed 3efOw las Erected to 3e Exempt :ion Fiuriva Workers Compensatior 03-22-2012 EFFECTiVE DATE PERSON FEIN: 03/2312012 EXPIRATION DATE: 03'23 / 2014 KIMRON GIL 202673742 BUSINESS NAME AND ADDRESS: & R PLUMING INC 2708 N V B4 TER COOPER CITY FL 33024 SCOPES OF BUSINESS OR TRADE- 1- PLUMBING CONTRACTOR * 11jPORTrieT Annan l0 :Oaple/ 140 011111 i.S. as allieat Itl 1 t:artaratiaa woe elects v.00101101, troll ties cbaple, tt Iiliaq t terlilicq@ O! -(.'iron trader tela recites ami ae1 rK0 11 1(1001.1* 9( c®arpteytliaa aadat (00 car**. ela*ttel r0 earrofai 440 05t1i1. ! i Sefl•I,irt,l•s 01 l34. R 10 at @leapt, 0001: 9411 111A4ia at scope o1 IM 0111(1*4¢ 01 1110e listed o■ +ea 00141! *1 *WOOD to 0e *wits. °®,s,* 10 Caalae/ 14e ow s!. P, S (latices sl sleet+@o to be eisei i sad certiticetea 0r .reutao le as trona, 0001 tit sealed +m ratite/tits it et ma time noir (0* 111049 1(e 113 gouge z, iae ssatece of *0* celtitwcate Ise ovum $11011* a. lam 1014D0 mt :aftillcala *0 :lags, area* i1* ld *srserali of tars urfieo low =11001(0[0 11 t ateldiett._ tar eeeertme+e 10111 +eteat = 'A./044'01e la Inti 7i414 1-a/ 1-0/10(. pet:00 01*0** .t+ no ettitt,cu. +. ale. Ito +adjal+e+eems s+ ra•s sett ole WC- 2S2 CERTtt:1CA!E OF ELECTION #3 3E EXEMPT itevo$EQ ?: 1UESTIONS' •350) 113• o*.EASE Cur OUT 'Of CARD BELOW AND RET4,4 =]R FUTURE REFERENCE STATE OP FLORRIA ORPARTRIENT OP FINANCIAL SERVICES otvtstoN OP INCODUER, coca T+Q CONSTRUCTION INDUSTRY WIRTIPICATE OF ID.00TION TO SS tt**MP? MON RAMA CATION LAW E ECTiVE: 03!2$/2012 PERSOIV GIL KUNGN FR* 202073742 BUSINESS wo E ANO ACQRESS les r v 0i gF :oOsEa - s1-..:.+ GXPIRATION GATE 03/23/2014 SCOPE OF BUSINESS OR TRADE ImPotwAr4rr OPursuant to :haves, 441) 35114I. 'S.. an oft.eer or a n:orparigtart wno affects e'enitrio*'rtxn ills Cheater iy flints a certificate of election L under Inns sae.tt.t Alas y1 •eeorer »enef.ts of corttOorsenort wider thea 0 master 1°urSoant to :Mese' 44 135021, F,5„ Certificates ii olefins* w ire eitemDt way r ily wain the Scope *1 the busutess or trade :Moil 0' ER the -nave 11 lie=ns* is oto nemet E t'urwant -o=tsear.Ft s4O151131. 1.S.. Notices o4 erection to be enempl and certii,utes t erection to pe eoemot snail be Suotoct to roves**, f at any nme tier the Siting of the nonce or me Issuance 0' the cert,f,eate, the **Iron molest On the notice Or cenrf,tara nQ longer me the rewllrerra>srlfs ,01 this section for +9itience Of R certtficese_ The department shit! ,'evoke o r;ertrf,cote at arty time 'w failure of me Gerson ',armed on the ;au' Estate its meet the let1111rements of this Section. aUESTioNsi I Sel 113- 116E CUT MERE • Carry bottom portion on the job, keep uppaf portion for your records. DWC-252 CERTIFICATE T cLcCTPCty 'D if EXEMPT REVISED ;,1 _ 11/26/2013 10:13 Page 1/1 OPID:T A� i''- CERTIFICATE OF LIABILITY INSURANCE °A'11 /13 91/26/13 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCEi954-616-1800 Roebuck Associates Insurance Excn LLC 954-616-1 en, ha 5599 S University Drive, # 301A1� Davie, FL 33328 Roebuck Associates °1 FAX mp' Ext): INC, No): POUCY EXP IMMIDDIYYYYI P=a=MMCR CUSTOMER ID a: GB.RPL-1 INSURERS) AFFORDING COVERAGE NAIC S INSURED 0 & R Plumbing Inc. 2765 NW 84th Terrace Cooper City, FL 33024 INSURER A: Federated National Ins. Co. INSURERB: 02/19/13 INSURER C : EACH OCCURRENCE INSURER D : X INSURER E : 100000 $ � INSURERS : CLAIMS -MADE X OCCUR 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. LTR TYPE OF INSURANCE tN°R awn POLICY NUMBER (MMIDD(YYY POUCY EXP IMMIDDIYYYYI LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL050401030500 02/19/13 02/19/14 EACH OCCURRENCE $ 1,000,00( X DMAREEU PRAEMISEGES IlO Ea occuNIrence) 100000 $ � CLAIMS -MADE X OCCUR MED EXP (My one person) $ 5,00E PERSONAL & ADV INJURY $ 1,000,00E GENERAL AGGREGATE $ 2,000,00E GENL AGGREGATE LIMIT APPLIES PER: I POLICY IT qi IT LOC PRODUCTS - CO_MPIOP AGG $ 2,000,00E GEj $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ — BODILY INJURY (Per person) $ — BODILY INJURY (Per accident) $ -- PROPERTY DAMAGE (Per accident) $ — $ — $ UMBRELLA LIAB H OCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ — AGGREGATE $ DEDUCTIBLE RETENTION $ $ — $ WORKERS AND ANYPROPRIETORIPARTNERIEXECUT)VE OFFICER/MEMBER (Mandatory If yes, DESCRIPTION COMPENSATION EMPLOYERS' LIABILITY YIN N 1 A WC S1ATU- 1OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ EXCLUDED'? Et. DISEASE - EA EMPLOYEE $ In NH) describe under OF OPERATIONS below E L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space le required) CERTIFICATE HOLDER CANCELLATION City of Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD