PL-16-2797 (3)Miami Shores Village
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
0 T 14 2016
BY:
FBC 20 t 14 5�
Master Permit No.W=16- K0pj�_
Sub Permit No-0- (�o ''2� 9-1
❑ REVISION ❑ EXTENSION [:]RENEWAL
ffp"LUMBING? ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS:
'F- �/6 Sr
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
(OWNER: Name (Fee Simple Titleholder): 15A 7 (/(1/�/,4, 1616 �,,L� Phone#:�0 o 14G, �
Address: 2,OS1331 S
City: jiP�l��T//Y/�1.y State: �l Zip: ?2:3ly-n
Tenant/Lessee Name:
u;w . Phone#:
Em�ail: /A' he.> '4jiy, cq�Lr,,
CONTRACT/OR:: Company Name: / ' le a O I vr-1 �,-G•—c Phone#:
Address: lC(,'0 AL, 741' V-
City: Cooum-- C State: L Zip: Gil
Qualifier Name: 4 0�JQ 1-4 JR Phone#: Z 3 ti -CC,3— 3 / S3
-11
State Certification or Registration #: Gc y2 �I Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: f/ City: State:
Z
Value of Work for this Permit: $ p ;'vb(9- JY�j '7f� ' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: •R." 1 Qk W G -me-
Specify color of color thru tile:
ibmittal Fee $ Permit Fee $
inning Fee $ Radon Fee $
New ❑ Repair/Replace
tc:� • 1 S
hnology Fee $ vLq`W Training/Education Fee $
ctural Reviews $__
Zip:
❑ Demolition
CCF $ 2—' • 2.J CO/CC $
DBPPR/$ O . (� Notary $ (25
T� Double Fee $ ZP
Bond $ T _
TOTAL FEE NOW DUE $ 32.G • a k'
d02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
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.
i-Signature I Z*�<
OWNER or AGENT
The foregoing instrument was acknowle ged beforemethis
Z� day of 20 / by
JY e,/t �ai✓ who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PU
Sign
Print: V �—
���.•�bs�4 CRISTY A G RCIA
Seal: Commission # FF 926841
'-' My Commission Expires
October 13, 2019
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
- 2? r� ` day o//f�� 20 I,� by
,//e,/etnII(.G, who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal:
APPROVED BYn l -t / Plans Examiner
Are
CRISTY A GARCIA
Commission # FF 926841
My Commission E
as
Zoning
Structural Review
(Revised02/24/2014)
Clerk
JEFF ATWATER
CHIEF FINANCIAL OFFICER
•�r'M WS
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: 2/27/2016 EXPIRATION DATE: 2/26/2018
PERSON: CARMONA ALFREDO JR
FEIN: 271610831
BUSINESS NAME AND ADDRESS:
ALDAN PLUMBING INC.
2527 AMBASSADOR AVE
COOPER CITY FL 33026
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 certificate of election under this section
may not recover benefits 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 listed on the nofice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing 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 certificate. The department shall revoke a
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
e A j
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S, fr*ndrewsAve- Rm. n-100. Ft. Lauderdale, FL 3301 1895 4- 31-4000
VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 3o, 2017
DBA: �. Receipt # 2- 964 27 say r:cf F
Business Name: ; �:' Business 'hype
Owner Name: AL RL—: c I Business Opened C,9/ 8 ` 1
Business Location: 9600 NW 39 ST State/County7Cert/Reg ��"L .-= 8'.
HOLLYWOOD Exemption Code:
Business Phone:
Rooms Seats Employees Machines
2
Professionals
For Vending Business Only
mber of Machines: Vending Type:
Tax�AmoujntTransfer
Fee NSF Fee
Penalty
Prior Years
Collection Cost
Totaf Paid
^v.00 G.GC
Q.OQ
Q_OQ
G.t3Q
27.QQ
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 -regulatory in nature. You must meet all County and/or Municipality planning
and zoning requirements. This Business Tax Receipt must be transferred when
,iWHEN VALIDATED the business is sold, business name has changed or you have moved the
business location, This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
ALDAN PLUMBING INC
9600 NW 39 ST 33024
HOLLYWOOD, FL
2016 - 2017
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Inspection Number: INSP-001349-2018 Permit Number: PL-10-16-2797
Scheduled Inspection Date: November 05, 2018 Permit Type: Plumbing - Residential
Inspector: Massanet, Maykel Inspection Type: [Miscellaneous 1
Owner: POL ZAZADZE Work Classification: Addition/Alteration
Address: 1201 NE 96 ST Phone Number: 3057902785
Miami Shores, FL 331382553 Parcel Number: 1132060143830
Project:
Contractor: JC PLUMBING SERVICES INC Phone Number: 3059701612
JUANCARLOS LEON
Building Department Comments
PLUMBING FOR ADDITION AND INTERIOR RENOVATION.
Checklist Item Passed Comments
Inspector Comments
Passed
El
TCO INSPECTION
Failed
Correction
Needed
Re -Inspection a
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 02, 2018 For Inspections please call: 305-762-4949 Page 24 of 38
FIA
FjGIR UM LING
S E RSV t C',E S , ' !}N C:'
www.-icplumbingserv.com
info@icplumbinZserv.com
Drop test report
Date: 11/01/2018
Permit#: PL-10-16-2797
Customer Name: Lowes Home Centers Inc.
Address: 1201 NE 96 Street
City: Miami Shores State: Florida Zip Code: 33138
Open Pressure: 6112"_
Test Time:-5 min._
312 Bouganvilla Ter.
Hollywood, Fl 33019
CFC-1426227
Office: 305-970-1612
Cell: 786-251-8027
Lock up Pressure:_67—
Test Pressure:_5"
STATE OF FLORIDA, COUNTY OF AV uJ a erk
Sworn to and subscribed byre me this 2 day of �oy� 20 AP
for Qualifier
Personally Know _X OR Produced Identification
_ MARIA VELAZOUEZY COM
MISSION #GG080751
EXPIRES: MAR 14, 2021
Bonded through 1st State Insurance