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PL-18-91 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)7564972 Inspection Number: INSP-295296 PermitNumber: PL-1-18-91 Scheduled Inspection Date: February 14,2018 Permit Type: Plumbing -Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: ROESSET,JOHN&NICOLE Work Classification: Sprinkler System Job Address:798 NE 98 Street Miami Shores,FL 33138- Phone Number (917)621-6251 Parcel Number 1132060142290 Project: <NONE> Contractor: BEACHSIDE PLUMBING INC Phone:(954)444-9646 Building Department Comments Infractio NEW UNDERGROUND IRRIGATION SYSTEM(EXISTING Passed Comments WELL&PUMP) INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 13,2018 For Inspections please calk(305)762-4949 page 6 of 16 a ...ilermit NO. PL-1-19-9'1 `SgoRES Miami Shores Village Perl Pe mit Type-Plumbing robing-Residential 10050 N.E.2nd Avenue NE system Worts Classifibafion:Sprinkler Miami Shores,FL 33138 0000 Permit Status.APP_ RRVED Phone: (305)795 2204 i yFA'tg6,N B FCORtDp` tssmoaft:1/18121118 j Expiration: 07/17/2018 Project Address Parcel Number Applicant 798 NE 98 Street 1132060142290 Miami Shores, FL 33138- Block: Lot: JOHN&NICOLE ROESSET Owner Information Address Phone Cell JOHN &NICOLE ROESSET 798 NE 98 Street (917)621-6251 (917)621-6251 r MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 BEACHSIDE PLUMBING INC (954)444-9646 Total Sq Feet: 0 Type of Work:NEW UNDERGROUND IRRIGATION SYSTEM( Available Inspections: Type of Piping: Inspection Type: Additional Info:NEW UNDERGROUND IRRIGATION SYSTEM( Final Bond Return Underground Sprinkler Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PL-1-18-66110 DBPR Fee $2'25 01/18/2018 Cash $ 118.05 $50.00 DCA Fee $2.00 Education Surcharge $0.60 01/11/2018 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.05 t In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate a d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-nam contractor do a work stated. January 18, 2018 Authorized Signature:Owner / Applicant / Contractor i Agent Date Building Department Copy January 18, 2018 1 ,\ Miami Shores VillageR,I=c :��,- D Building Department f VJAN21'�l10050 N.E.2nd Avenue,Miami Shores,Florida 33138 n_�+,r'Tel:(305)795-2204 Fax:(305)756-8972 —� INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 41-4 BUILDING Master Permit No. P j— PERMIT APPLICATION Sub Permit No. h ❑BUILDI ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL LUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -1 SME t Pr I City: Miami Shores County: Miami Dade Zip: 3/y v Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): C oc Phone#: Address: City:62 m l .5 State: Zip: L�31 Tenant/Lessee Name: Phone#: Email: K� CONTRACTOR(r:Company Name: OPhone#: G - S Addres • o� S4- City: RMOGMState: '1";l- Zip: 3- ?r) `-/ Qualifier Name: n f Phone#: State Certification or Registration M �y 1 b Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New- ❑ Repair/Replace ❑ Demolition Description of Work: n d'( \ U v� RA Specify color of color thru tile: Submittal Fee$ �50 id—Permit Fee$ 1. CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2• ' DBPR$ 2 ' 0 Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ Q _ TOTAL FEE NOW DUE$ t I8 O (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 PP Y 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. Signature Signature OWNER or AGENT ONTRACTOR The foregoing instrument was cknowledged before me this The foregoing instrument was acknowledged before me this day of 20J by day of l� 20/f .by �If 1OWS10 who is personally kn ear-to V Ia L ho t- aP�A►; ,who is personally known 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: PrinPri , r• JAMIE CAMUCCIO =�► ' JAMIE GAMUCCIO Seal: I MY COMMISSION#G0088519 Seal: MY COMMISSION#GG088519 "• EXPIRES April 01,2021 ; EXPIRES April 01,2021 s*s******»*»»»*»******s******»»»»»**s*s**s»»»»»»*****s*»*»»»*»»*s***s**s**»»s»»»»*»*s**s»»»»s»»s»******»**»» APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i Beachside Plumbing 2650 NE 91h Terrace Pompano Beach, FL 33064 (954) 444-5675 Date: 12/28/17 State of Florida f County of Licor Before me this day personally appeared VIA-Ceilt )�-6 rt01 bA n�/who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at:798 NE 98t'Street Miami S res, FL_33 8 Contracto ignature Sworn to(or affirmed)and subscribed before me this /d day of .20ZL , byvi,,4:g o- t, b my Personally know OR Produced Identification Type of Identification Produced JAMIE CAMUCCIO 1 '': •'e My COMMISSION#GG088519 EXPIRES '••,4.• April 01,2021 Print,Type or Stamp Name of Notary s� Miami Shores Village l"" ""'�' Building p Department 10050 N.E.2nd Avenue �lORiDp' 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 fall-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-rime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: TC)Q,�2 Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this L U day of 6,1 20R—. By r:Q 1a, doo-S��� who is personally known to me or has produced as identification. JAMIE ` ;.R•' CAMUCCIO Notary. MY COMMISSION#GG088519 SEAL EXPIRES April 01,2021 Property Search Application- Miami-Dade County Page 1 of 1 "0"' 0"m THE 12"RO"ERTY 'A' PP"RAISER OFFIUL F F Summary Report Generated On: 1/11/2018 Property InformationSEA Folio: 11-3206-014-2290 Property Address: 798 NE 98 ST Miami Shores,FL 33138-2531 ' Ov✓ner JOHN RICHARD ROESSET NICOLE ROESSET ' Mailing Address 335 S BISCAYNE BLVD#609 MIAMI,FL 33131 USAAr PA Primary Zone 1000 SGL FAMILY-2101-2300 SQ , Prima Land Use 0101 RESIDENTIAL-SINGLE FAMILY: 1 UNIT 4 Beds/Baths/Half 3/3/0 x Floors 1 Living Units 1 Actual Area 3,658 Sq.Ft Living Area 3,002 Sq.Ft Adjusted Area 3,303 Sq.Ft Taxable Value Information Lot Size 11,300 Sq.Ft 2017 2016 2015 Year Built 1955 County Exemption Value $0 $0 $50,000 Assessment Information Taxable Value 11 $698,681 $657,059 $399,589 Year 2017 2016 2015 School Board Land Value $338,884 $294,196 $270,921 Exemption Value $0 $0 $25,000 Building Value $327,357 $330,004 $266,121 Taxable Value $698,681 $657,059 $424,589 XF Value $32,440 $32,859 $21,894 City Market Value $698,681 $657,059 $558,936 Exemption Value $0 $0 $50,000 Assessed Value $698,681 $657,059 $449,589 Taxable Value $698,681 $657,059 $399,589 Regional Benefits Information Exemption Value $0 $0 $50,000 Benefit Type 2017 2016 2015 Taxable Value $698,681 $657,059 $399,589 Save Our Homes Cap Assessment Reduction $109,347 Homestead Exemption $25,000 Sales Information Second Homestead Exemption $25,000 Previous Sale Price OR Book-Page Qualification Description Note:Not all benefits are applicable to all Taxable Values(i.e.County, 12/08/2015 $830,000 29889-2093 Qual by exam of deed School Board,City, Regional). 08/01/2001 $460,000 19930-1934 Sales which are qualified Short Legal Description 04/01/1996 $255,000 17189-2888 Sales which are qualified 06/01/1989 $115,000 14167-3218 Sales which are qualified MIAMI SHORES SEC 3 PB 10-37 LOTS 1 &2 BLK 70 LOT SIZE SITE VALUE OR 19930-1934 08 2001 1 i The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp:/twww.miamidade.gov/info/disclaimer.asp Version: G \ http://www.miamidade.gov/propertysearch/ 1/11/2018 h RICK SCOTT,GOVERNOR KEN IAWSON.SECRETARY STATE OF FLORIDA DEPARTMENT CONSTRUCT N INDUSTRY LIBUSINESS AND CENSING PROFESSIONAL REGULATION OINDUSTRY '&C1425* lop The PLUMBING CONTRACTOR "" .�'' Named below IS CERTIFIED Under the provisions of Chapter 489 FS. �4 Expiration date:-AUG 31,2018 +. . KORTABANI,VINCENT JOHN e—, t BEACHSIDE PLUMBIND IN_ �Y 2850 N.E.9TH TERRACE;,y..-:: "� ^� `'; ' .' ,;,•. POMPANO BEACH-•�w4FL 33064 sEa# Lt6062o0000608 ISSUED: 06/20/2016 +'µ DISPLAY AS REQUIRED BY LAW BROWARD C NTY LO A�SINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2017 THROUGH SEPTEMBER 30,2018 DBA: Business Name:BEACHSIDE PLUMBING INC Receipt#:182-1305 Business T PLUMBING/LNK SPRNKL/CON CTOR Owner Name:VINCENT JOHN KORTABANI Type: PLUMBING CONT ) Business Location:2650 NE 9 TERR Business Opened:07/05/2002 POMPANO BEACH State/County/Cert/Reg:CFC1425746 Business Phone:954-946-1764 Exemption Code: Rooms seats Employees Machines 2 Professionals i Number of Machines: For Vsndhq Business Only Tax Amount Transfer Fee Vending Type: j NSF Fee Penalty Prior Years � 27.00 0.00 0.00 Collection Coat Tots)Paid 0.00 0.00 0.00 27,00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-reWHEN VALIDATED and zoning quirein ments.YThis Business Tax Rou must meet all ueceipt must be transferred when tthe business is sold, business name has changed or you have moved the is inecomss P lance with S a eis 'ordlocal laws and regulations.oes not indicate that the business is legal or that Mailing Address: VINCENT JOHN KORTABANI 2650 NE 9 TERR Receipt 1305C-16-00007132 POMPANO BEACH, FL 33064 Paid 09/20/2017 27.00 t Z as�'�7C."»*�'3�^J�S".�Y..'"c" 1".5C'.;;7ka.::i•L :a -1 BEACPLu OP IDD V AC'OR�" CERTIFICATE OF LIABILITY INSURANCE DATE 03/330/20101201 YY) ( �.� 07 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 have ADDITIONAL INSURED provisions or 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 561-487-6001 2CT Global insurance Services,Inc PHONE 561-487-6001 FA7C 561 151-9825 21301 Powerline Road#211 ac,N .E.: Arc No Boca Raton,FL 33433 Boca Commercial Lines INSURERISI AFFORDING COVERAGE NAIC K NSURERA:American States Insurance 19704 INSURED Beachside Plumbing,Inc. INSURER B: 2650 NE 9th Terrace INSURERC: Pompano Beach,FL 33064 INSURER 0 INSURER E• INSURER F: COVERAGES_ CERTIFICA E 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 TYPE OF INSURANCE ADD SUBR POLICY NUMBER IMMS EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY H OCCURRENCE S 1'000'000 CLAIMS-MADE OCCUR OIC16816156 04125/2017 04/2512018 OAMA ETORENTED 200,000 MED EXP iAny ane on 10'000 PERSONAL a ADV 1,000,000 MOTHER: L AGGREGATE LIMIT APP S PER: G NERAL AGGREG TE S 2'000'000 POLICY❑jEC7 "LOC PRODUCTS-COMP/OP AGG 2.000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Per per—son) S OWNED SCHEDULED AURRTEEO$ONLY AUTNOSyyry p BODILY INJURY Pe AUTOS ONLY AUTO ONIV M-0=0DAMAGE $ UMBRELLA LUIS H OCCUR EACH OCCURR EXCESS UAB CLAIMS-MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPIM IIETOERREXCLUDE � CVE F NIA AE. EACH ACCIDENT $ (Mandatory in NHi E.L.DISEASE-EA EMPLOYE H s,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ :: DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule•may be attached H mon space Is required) CERTIFICATE HOLDER CANCELLATION MIAMSHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE MTH THE POLICY PROVISIONS. Village of Miami Shores Building Department AUTHORIZED REPRESENTATIVE 10050 N E 2nd Avenue Miami,FL 33138 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 i I 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 fisted below has elected to be exempt from Florida Workers'Co I mperlsation law. j EFFECTIVE DATE: 10/6/2016 EXPIRATION DATE: 10/6/2018 PERSON: KORTABANI VINCENT J l FEIN: 113644452 i BUSINESS NAME AND ADDRESS: BE/►CHSIDE PLUMBING INC C 2650 NE 9TH TERR POMPANO BEACH FL 33060 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pu s;,ant to Cnaofer 440.05(14).F.S..an officer of a Corporationwho ekes exemption horn eds-apier Cy%v a certiricate of erection unser fns secthon may nm recover henebts or compensation uner this chapter.Phesuant o chapter 440.05(12).F.S..Cerbficates of election b be er wayrthm the scope of the business or Cafe listed on aha nocce of election to he a ...apply ■crept.Purswm m Chapter 410.05(131.F.S..Notices ekuion o be exempt and Can d on v Of erection m be erempl brae "tet, b revocation B,at arty orae after the fAv of the notice m the issuance of Che cerofieate. me person normae on she nohoe or cendhcak no kNhper meets Ire reQuremerhts of eyb Section for isau nce of a Merit ie.The deparonem sham revoke a DFS•F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08.13 QUESTIONS?(850)413-7609 f I i I r E� I a ! 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