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PL-10-55Inspection Number: INSP- 133301 Permit Number: PL- 1 -10 -55 Scheduled Inspection Date: August 09, 2010 Inspector: Hernandez, Rafael Owner: QUINTON, ALBERT Job Address: 457 NE 95 Street Project: <NONE> Contractor: ROBAINA WELL DRILLING INC Building Department Comments WELL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 06, 2010 Miami Shores, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 CL- Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Well Phone Number Parcel Number 1132060140630 Phone: (786)683 -7437 Page 4 of 32 BUILDING PERMIT APPLICATION FBC20 Permit Type: PLUMBING 4 /13*Ep-1'E. ea Owner's Name (Fee Simple Titleholder) 7 i a ,',1e r (;� w , �,-Jr, h Phone # 766 ° 3 75". / 7 70 Owner's Address G 7 "if; 1 s-t& 51-reet CityPl lei re S State FL Tenant/Lessee Name /1/4///4 Email e M 4 � Q a hi" sg Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO Architect/Engineer's Name (if applicable) 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 1 . 0 Zip Notary $ r"" Training/Educatgon Fee $0 2 J O Scanning $ (�'� Radon $ DPBR $ Permit No. a Master Permit No. 33(3x) Phone # 95 "Ve 7 5/re e County Miami -Dade Zip Phone # Bond $ P CENE JAN 1 .2 2Cila Flood Zone to -5S Contractor's Company Name r 9-0 y7 4 .. k'efi Dr X 11 h5 Phone Contractor's Address P. (ten sei, City State Zip /3 Qualifier Name 05e i F Phone # 7.6Z— g 83-7Y37 State Certificate or Registration No. / /al e) Certificate of Competency No. /49.10 Contact Phone 7756443.-2 Y 3 3 E P weilpf ,?/ 1'A gfi)Jel 504k, A yg 7(1 57 Value of Work For this Permit $ ip-04500)00 Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New ❑ Repair/Replace El Demolition Describe Work: Irr g ) r 2 LA/ if a / itc A t° * * * * * * * * * * * * * * * * * * * * * * * * * ** * *'fFe s*�************ * * * **** * * * * * *** * * * * ** * ** * * * * * ** Sx Submittal Fee $ V . Permit Fee $ / C' CCF $ 0' CO /CC $ Technology Fee $ 0� Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 104 tQ,0 See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 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. APPROV Sign: Print: My Commission Expires: * * * * * * * * * * ** * * ** /04 Signature ,,, //! i Contractor The foregoing instrument was acknowledged before me this ...S The foregoing instrument was acknowledged before me this day of AVW:11 , 20 /0 , by 4446,27g, Qa/DR)/).l? , day of , 20 , by Owner or Agent who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: (Revised 07 /10 /07)(Revised 06/10/2009) EXPIRES: October 20, 2013 •;jq it ; • Bonded Thru Notary Public Underwdters * * *,u* * * * * * * * * * * * * * ** * * ** ** * *** ** * * * * * * * * * ** ** * * * * *? i -�7 R Plans Exathiner Engineer Llama WUNII Sign EC ek0 Print: Y P1‹._ My Commission E;„«, ..a NE •••• „ ••• ro C bD0550002 • Expires 0 /8/2010 a Zoning Clerk checked 20119 • 054001 .-:430 SEE OTHER SIDE = 1111111 1111 111111111111111 111111111111111111111111111111i II ROBAINA JOSE ANGEL , Is certified under the provisions of Chapter 10 of Miami-Dade County 9i3 0003 -ttisb - 01104 - * ISLE A.134.-TL; , DO NOT FORWARD ROBAINA WELL DRILLING INC 24401 SW 214 PL MIAMI FL 33031 CTQB. Cons Trades Qualitying Board BUSINESS CERTIFICATE OF COMPETENCY 09P000660 ROBAINA WELL DRILLING INC D.B.A.: _ QUALIFYING TRADE(S) LAWN SPRINKLER Herrninio Gonzalez P.E. Secretary of the Board Miami-Dade County retains all property rights herein. wow.miamidadegovibuikilngcode I -CLASS AGE i .231 4 )N IIIIUUBd OIVal LSOd'SYl 10 ALEX SINK 1 "111ll 01. - T£0££ l3 IWMIW ld 'TZ MS TOW S321d VNIVOO21 3SOf 3NI ONI11INO 113M VNIVOON ailvmIi0d ION 00 O- ZL ON-1413030 1tlM3N32t Add ION 00 — 1'118 H . 1141 SCOPES OF BUSINESS OR TRADE: 1- WELL DRILLING DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 21431S Ii3H10 3ES O0•SL0000 TOOZD£OIO6O 6OOZIOE /6O xvi AmuncoO a3AI333tt 1N3@!AVd -v3tdtwno S.t$tri iC Id d0 NOLLV3 3 V JON MV � St SW. • 1A1 t 2DI ; 3SN33n NO 111/403d N3H.LO ANV VIONd 1413131014 3141. AMMO saoa NON 'SWIM up. AJ Nf1Q3 o N0 3.13/101A ANV 3.1O!A OL #13a1OH 3141 JJ.SN3d ION 3300 J t "14130311 XVI 4f1e - 1V301 V A1N0 St 41114.1. 1 21013vaitiO3'�9NI$ Ild A11VI33dS 61 sserllsn8 IE S 361 111I�la 113M VNIYff0 AJ.N MVO VO NIN 7.d 's1Z MS E 10'.' II.9�II11IlIa 1131 VNItll#0 NOLLYOO I/ 31M1n N SS3NISf 8 lON 81 S 9- 6019$S EFFECTIVE DATE: 09/28/2008 EXPIRATION DATE: 09/28/2010 PERSON: ROBAINA JOSE FEIN: 061790496 BUSINESS NAME AND ADDRESS: ROBAINA WELL DRILLING INC 15714 SW 302 TERR HOMESTEAD FL 33033 ti) c 0 07 -22 -2008 STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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. IMPORTANT: Pursuant to Chapter 440 . 05114), 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 440.05112), 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 440.05113), 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. QUESTIONS? (850) 413 -1609 RD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD /YYVY) 01/14/2010 TYPE OF INSURANCE PRODUCER (407)831 - 3832 FAX (407)830 -4681 Bl ackadar Insurance Agency 1436 N. Ronald Reagan Blvd. Longwood, FL 32750 Patti Tommaso THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Robaina Well Drilling, Inc. 15714 S.W. 302nd Terrace Homestead, FL 33033 INSURER A• Auto-Owners Insurance 18988 INSURER B: 7268860009 INSURER C: 09/25/2010 INSURER D: $ 500, 000 INSURER E: $ 300,000 I t I'LJLIL;ItS 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. I N TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE nATP (MM1nnA/Y1 POLICY EXPIRATION nATF 7tnn/YY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 7268860009 09/25 /2009 09/25/2010 EACH OCCURRENCE $ 500, 000 PREMISES (Fw nmr $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 500,000 $ 1,000,000 $ 1,000,000 GEN'L 7 AGGREGATE LIMIT APPLIES PER: POLICY n J EC fI LOC 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) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY I OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below II — W_C STATU- r L151RY LIMITS I 1°F,/ TH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Vi 11 age 10050 NE 2nd Ave NE Miami Shores, FL 33138 -0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � ;. fir ✓ - . r 7 - Sissy Beery /RPM ,." rte: 1/14/2010 Time: 11:50 AM To: Miami Shores Village 1- 305 -756- • ©ACORD CORPORATION 1988 t 0. dew I ',CO, AIP ALL Wed Nese air I •• se 11 WOW awl orfr „ ZL.L.LA 314 21 iefer ; 5 AereS • Pr o' A#6M.., 4.460161 WIN WINN= woos Me CM Tatis10 Faro eresnw.,_ issatiestertatf_ FA& tee 0 nettlee0w 00*kwer " .1* /APPROVED LVAISPOACE COUNTY tlIALTH DEPAIMAINT PEWIT q -161.7/8, fig.=.- 4 w oe NI Op 1 12^ Pi e0094: Roatmo DRIL 7 STATE OF FUNIEDA PESAM'AFPUOATEN4 TO ooESFRuOT, lm% MOSIFY, OS ABANDON A WELL Ci Soulheerst le Northwest 0 St. &Me War teeming 1:1 S erteeleeWOW OWN Ellerldi Suwannee Paver allelearaukameneenaNaallitatrwaratreawrae4 Art e 4,4 .5. i itr i 4 ,k 9' oals_l readieselsollwareewenseekerseirasseee ,....._ WM* lorplerpyreq '?�W' tags* ws-11;r ...........„4—. Otaimareenespeo swan E,. .11. 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Tele perite e valid he ee awe new ewe et Wage, „ Inge plow sot was uttntirixretvslaueDAYAmtamelen mu*. gad oc ri ta fe rtiktii.eemiAnAgr Ferin mei Eat MSS • Inspection Number: INSP - 133300 Permit Number: PL- 1 -10 -55 Scheduled Inspection Date: January 27, 2010 Inspector: Levrock, James Owner: QUINTON, ALBERT Job Address: 457 NE 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ROBAINA WELL DRILLING INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments paper work taped to the well Oi//0 January 26, 2010 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Well Work Classification: Well Phone Number Parcel Number 1132060140630 Phone: (786)683 -7437 Page 7 of 12