Loading...
PLC-18-3770Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 F(�Nfi)x Issue Date: Location Address Parcel Number 716 NE 92ND ST 1M, Miami Shores, FL 33138 1132060440510 Permit NO.: PLC-12-18-3770 Permit Type: Plumbing - CornImercial Work Ctossfflcativn: Alteration Permit status: Approved Expiration: 06/26/2019 Contacts ROBERT GONZALEZ Owner SYSTEMATICS PLUMBING & DESIGN INC Contractor 9120 NE 8 AVE UNIT 4G, MIAMI SHORES; FL 331383247 KAREL VALDES 2211 W 52 St unit 202, Hialeah FI , FL 33016 Business: 7863267354 Inspection Requests: Description: NEW SHOWER VALVE, KITCHEN WATER AND Valuation: $ 1,100.00ti5 62-4949 MOVE WASHER. Total Sq Feet: 0.00 j �gn. Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Payments Date Paid Amt Paid Total Fees $111.10 Cash 12/28/2018 $50.00 Cash 01/04/2019 $61.10 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS' AFFIDAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction 90 zoning. FuthQn or thorize the above ed contractor to do the work stated. � 4 _ C'f�v l Authorized Signature: Owner Contractor h Agent Page 2 of 2 January 04, 2019 �,cN Miami Shores Village'�'��'� �_N Building Department artment d C 2gg2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 i_� BUILDING Master Permit No. G"C — ��— /S- — PERMIT APPLICATION Sub Permit No. -Rc/(9 -3 0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ,,L CONTRACTOR DRAWINGS JOB ADDRESS: 7�� /uG-r 6lZ �•S1 City: Miami Shores County: Miami Dade Zip: se_�' /3 Folio/Parcel#: /I 320f- - 0¢4 - 0$/(D Is the Building Historically Designated: Yes NO `__ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 4?191.144 60A) Z4 C-j9Z_ Phone#: 3C!5 G 27— Address: 9/ City: /'ttState:Zip: 'o- Tenant/Lessee Name: Phone#: r— Email: CONTRACTOR: Company Name: :FZ? eAf%"g - % c IJ Phone#: 7K0 32-( 73,� Address: ZZ.1/ W -5 Z �}" -,#r' 2-0 Z— �7 City: 41 Ac,GA-ff State: jC-7 k__ Zip: 33 0/6 Qualifier Name: 1111A2G V ,4 L-_� E:5 Phone#: Z& State Certification or Registration #: cit�_- /42_c� 6 oo Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ k POO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New FVr Repair/Replace ❑ Demolition �,/ Description of Work: Specify color of color thru tile: Submittal hee $ Permit Fee $ CCF Scanning Fee $ Technology Fee $ Structural Reviews $. Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ L7 1 ' I (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address auI 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. / Signature Signature OWNER o ENT CONTRACTOR The foregoing instrument was acknowledged before me this -�;O! day of NIP Urdu 20 % 9' , by (JL" /,GoN ZAt1:; who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as The foregoing instrument was acknowledged before me this 12`0 day of D . 20 �. by who is personally known to me or who has produced U 4.3Z-,AW —%3 —.3T qs identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Commission N FF 908556 �[ Seal: My Commission Expires rjj August 1 1 , 2019 Commission p FF 9a My Commission E> August 1 1 , 2C- APPROVED BY r/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) k RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY dbpr a p STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS, OF CHAPTER 489, FLORIDA STATUTES J' �� VA D S, KA EL f r1 `✓l0. SYSTEMATICS PLUMBING & DESIGN INC 2211 W 52 STREET 202 HIALEAH`FL 33016 '► LICENSE NUMBER: CFC1429600 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT ABILL - DO NOT PAY 7204035 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SYSTEMATICS PLUMBING & DESIGN INC RENEWAL SEPTEMBER 30, 2019 2211 W 52ND ST 202 7486950 Must be displayed at place of business HIALEAH FL 33016 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE of BUSINESS SYSTEMATICS PLUMBING & DESIGN INC 196 PLU}�./IBING CONTRACTOR PAYMENT RECEIVED C/O KAREL VALDES PRES CFC1429600 BY TAX COLLECTOR Worker(s) 1 $45.00 07/09/2018 CREDITCARD-18-051806 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or.a certificatioa,-of the holder's qualifiiiations, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector ACORUe19/7/2018 DATE(MM/DorrYrrl CERTIFICATE OF LIABILITY INSURANCE 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: It the certificate holder Is an ADDITIONAL INSURED, the polIcAles) must be endorsed. H 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(*). CONTACT PRODUCER NAME; ADVANTAGE INSURANCE OF AMERICA PHONE (305) 649-5566 FAX (305) 649-5559 AlC, No. E:t 4520 NW 7th St EA•DDRRESS: marts@advantageisuranceofamerica.com Miami, FL 33126 INSURERS) AFFORDING COVERAGE NAIC1 WSURERA. HALLMARK SPECIALTY INS CO INSURED Systematics Plumbing and Design inc INSURERS: INSURER C : 9131 NW 152 ST INSURER D' MIAMI LAKES FL 33018 INSURER E : CERTIFICATE NUMBER: INCVlJlvn NUMOr-M. COVERAGES 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 REOUIREMENT, 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. R plaftsum LIMITS LT LTa TYPE OF INSURANCE am m wvw ND POLICY NUMBER (MMIMIDDrYYYY (MM/ODNYYY) GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 RENTED PREMISES (Ea occurrence 3 100, O O 0 X COMMERCIAL GENERAL MED EXP IAm one P«.en) S 5,000 (L�IABILITY CLAIMS -MADE IL OCCUR PERSONAL aADVINJURY S 1,000,000 l I C09400463-0 09/13/18 09/13/19 GENERAL AGGREGATE S 2,000,000 PRODUCTS • COMP/OP AGG S 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER:. S POLICY X JP LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) S BODILY INJURY (Per parson) S ANYAUTO BODILY INJURY (Par accident) S ALL OWNED F— SCHEDULED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE 3 HIRED AUTOS AUTOS (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE — S AGGREGATE S EXCESS LIAS CLAIMS -MADE DED RETENTION S S WORKERS COMPENSATION WC STATT OTH- To,' LIMITS ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOAPARTNE"ACUTWE El. EACH ACCIDENT $ E L. DISEASE • EA EMPLOYEE S OFFICEWLiEIABER EXCLUDED'/ D (Mandatory In NH) NIA E.L.DISEASE •POLICY LIMIT $ If yes, describe under OF DESCRIPTION OPERATIONS bebw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. AdditiorW Ramada Schedule, if more space is required) PLUMBING MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES FL 33138 SHOUL NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE , RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCO ANCE WITH THE POLICY PROVISIONS. S Q WE JIMMY PATRONIS CHIEF FINANICAL 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: 6/28/2018 PERSON: KAREL VALDES FEIN: 811742071 BUSINESS NAME AND ADDRESS: SYSTEMATICS PLUMBING & DESIGN INC 2211 W 52 ST UNIT 202 HIALEAH, FL 33016 SCOPE OF BUSINESS OR TRADE: Licensed Plumbing Contractor EXPIRATION DATE: 6/27/2020 EMAIL: KARELVALDES@HOTMAIL.COM IMPORTANT: 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 notice 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 2211 W 52ND ST 202 H FL SYSTEMATIP. 7LE CS PLUMBING 7 DESIGN ING WA326- 337354 - � 4 016 E. SYSTEMATICS_KV@HOTMAIL.COM 12/27/2018 State of Florida Miami Dade County Before me this day, personally appeared /<-+ ems- UMJ) �E-f5 who,being duly sworn,deposes and says: That he or she will be the only person working on the project located at: ilk //4r Z Contractor signature Sworn to (or affirmed) and subscribed before me this 2 7 day of 20f& By KrzEz VA�� Personally know.,._. Or produced Identification Type of Identification Produced 47,7 PATRICI`KROMERO Commission 8 FF 908556 My Commission Expires August 1 1 , 2019 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Uwner — 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 z% day of �j , 7, 20 f42) . By /203E 8 i '0,V LA Z_ E Z who is personally known to me or has produced Notary: PAMICIA RO"F.RO Coln In1s`.. u556 My f • noes Au,. 19 as identification.