Loading...
PL-10-523Inspection Number: INSP - 139208 Permit Number: PL -3 -10 -523 Scheduled Inspection Date: April 19, 2010 Inspector: Hernandez, Rafael Owner: Job Address: 1365 NE 105 Street 3 Project: <NONE> April 16, 2010 Miami Shores, FL 33138 -2133 Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Contractor: ALWAYS ON TIME AND AFFORDABLE PLUMBING INC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments For Inspections please call: (305)762-4949 L V Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320540030 Phone: (954)351 -8012 Page 14 of 28 1365 105 Street Number: 3 Miami Shores, FL 33138 -2133 1122320540030 Block: Lot: WILLIAM KAY Contractor(s) Phone Cell Phone ALWAYS ON TIME AND AFFORDABLE (954)351 - 8012 Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $2.40 $0.80 $150.00 $3.00 $50.00 ($50,00) $3.20 $159.40 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 13, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 10 /03/2010 WILLIAM KAY 1365 105 Street MIAMI SHORES FL 33138 -2133 Type of Work: NEW TUB LINER Type of Piping: BATHROOM VALVE Additional Info: PLUMBING Bond Retum : Classification: Residential Pay Date Pay Type Invoice # PL -3-10 -37428 04/13/2010 Check #: 2615 03/29/2010 Check #: 2548 Amt Paid Amt Due $ 109.40 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Water Main Final Lavatory Underground _ 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 and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. April 13, 2010 Date 1 BUILDING PERMIT APPLICATION FBC 2004 Is Building Historically Designated YES NO Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 cw %v0 L te/ G Ve Permit No I 0 — 5 3 Master Permit No. 120MICAn AR 9 201D Ni DY: . Permit Type: Plumbing / Owner's Name (Fee Simple Titleholder) /(C A /40 Phone # " 3 1 ( 1735 - 3 " Owner's Address 514 3 5 Y �: t 0 S 5T` 3 City t / V . 0 /a> S r- '- Zip 33 t S' Tenant/Lessee Name N Phone # E -MAIL: (4 Job Address (where the work is being done) ( 3 (o.S /S( d ( S7 *-3 City Miami Shores Village County Miami -Dade Zip 33 (3 S FOLIO / PARCEL # a -• Z Z 3Z. .- 03Y.. 0 0 30 Contractor's Company Name/ (W dot 77.4/4 1 ,444/1/1b4 Phone # i , L " Contractor's address 2-Q 1 TJ$C Gec y D P(✓4i b, �. , /vt t. Cit Z7 le ' Be C� G6 / State FL Zip 33 Y Qualifier Name ,,,J) 4, y DA `( use Phone # Q 3 , !Z State Certificate or Registration No. C F' L ( (Z7 f E- MAIL: Certificate of Competency No. Architect/Engineer's Name (if applicable) - /� / �- Phone # Value of Work For this Permit $ 3 , 7 ' ° Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration [New D 1 epair/Replace ❑ Demolition Describe Work: Submittal Fee $--- .J' 00 Permit Fee $ /5 — .2 p. CCF $ Q CO /CC Notary $ Training/Education Fee $ lam' 1 Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -i Bonding Company's Name (if applicable) ^/ Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) (V 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 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 rein ction fee will be charged. (Revised 07/08/06) NOTARY PUBLIC: Contractor The foregoing instrument was acknowl ed before me this �' cI N �" f!A , day of I44C V �' , 20(9_, by <Al bite J 111,44 (who is personally known to me or who has produced as identification and who did take an oath. The foregoing instrument was acknovlledged before le this Z2— day of 04 0,c 4 , 20 l 'J, by / [( who is personally known to me or who has produced As identification and who did take an oath. Sign: 1 Print: J A' 7 V i'•+ My Commission Expires: APPLICATION APPROVED BY: ROBERT M TAMBURRI Commission #DD901559 My Commission Expires Imp 29, 9013 NOTARY PUBLIC: ROBERT M TAMBURRI Si �,, y My Comm Commission Sign: ���"vT"s !�> Jule 22, 2013 Print: /a4,,1 toffee My Commission Expires: ************************************* aYariranY, 4eY*at*aYs4irardFSn1 / #***********scar*SO*m **s its zF*,t,ret,t+dr*****sdr,t,t,r****olska***ar+ *** 3/314a. Plans Examiner Engineer Zoning Primary Zone: 2009 CLUC: 0007 RESIDENTIAL- CONDOMINIUM Beds/Baths: 0/0 Floors: 0 Living Units: 0 Adj Sq Footage: 997 Lot Size: 0 Year Built: 1960 Legal Description: DIAMOND APTS CONDO UNIT NO 3 UNDIV 22.096 % INT IN COMMON ELEMENTS CLERKS FILE 69R -22567 OR 9770 -0756 OR 09770 -0756 0877 00 Year: 2009 2008 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $25,000/$21,197 $25,000/$21,151 County: $25,000/$21,197 $25,000/$21,151 City: $25,000/$21,197 $25,000/$21,151 School Board: $25,000/$21,197 $25,000/$21,151 Folio No.: 11- 2232 - 054 -0030 Property: 1365 NE 105 ST 3 Mailing Address: H C ALLEN 1365 NE 105 ST UNIT 3 MIAMI SHORES FL 33138 -2133 Year 2009 2008 Land Value: $0 $0 Building Value: $0 $0 Market Value: $1 14,360 $127,070 Assessed Value: $46,197 $46,151 Sale Date: 8/1977 Sale Amount: $29,000 Sale 0/R: 09770 -0756 Sales Qualification Description: Sales which are qualified View Additional Sales Year 2009 2008 Homestead: $25,000 $25,000 2nd Homestead: NO NO ' Property Information Report Property Information Report Summary Details: [Close windowl Property Information: Assessment Information: Exemption Information: Taxable Value Information: Sale Information: [Click here to Print] This report was created on 3/22/2010 12:23:41 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Page 1 of 1 http: / /gisims2. miamidade .gov /myhome /proptext_print.asp ?folio= 1122320540030 &cmd = 3/22/2010 Customer's Last Nam d, First grime (x'6 //5 /c 5 ,T Servic Address Billing/Mailing Address (If different from Service Address) City CGsto e s Daytime Tel. No. Payment: Sales Tax: Total Amount of Sale: CUSTOMER'S INITIALS: BY INmAUNG, YOU AGREEE THAT BY YOUR SIGNATURE BELOW, HOME DEPOT, ITS AFFILIATES, OR AN AUTHORIZED REPRESENTATIVE MAY CONTACT YOU BY PHONE, FAX E-MAIL ABOUT OTHER SERVICES THAT MAY BE OF INTEREST TO YOU. YOU MAY ALWAYS CHANGE YOUR MIND LATER; JUST LET US KNOW. 7/" — Due immediately. *Any finance charges will be determined by your separate cardholder or loan agreement. Home Depot is NOT a party to your cardholder or loan agreement. Please see the General Terms and Conditions following this page for more details regarding other charges which may apply. Anticipated Installation Schedule Start Dater' / 6 4/ Finish Date: 411- 1 'I 25 Please note that neither Home Depot nor Installation Professional are responsible for start/ finish delays resulting from events beyond their control including, but not limited to, acts of nature, governmental actions, manufacturing/delivery delays caused by thins parties, damage to merchandise, labor strikes/unrest, Your financing, any incorrect information You provide, legal encumbrances on Your property, Your property's nonconformance with zoning regulations or building code requirements, hidden/unforeseen physical hazardous conditions (including, but not limited to, environmental hazards such as mold, asbestos and lead paint) at Your service address, Your noncompliance with this Agreement, or Change Orders. Home Depot reserves the right to terminate this Agreement and/or require Installer to discontinue Installation given any of the foregoing conditions. Definitions: "You "P'Your" means the customer identified above. "Installation" means the installation services specifiied in this Agreement. "Installation Professional" or "Professional" means an independent contractor authorized by Home Depot (licensed and insured as required by Home Depot and applicable law) and die contractor's employees, agents and subcontractors. "Agreement" means this Special Services/Home improvement Agreement between You and Home Depot U.S.A., inc. (interchangeably referred to as "Home Depot" or "EXPO Design Center "), which includes this page, the General Terms and Conditions following this page, the State Supplement, the Invoice or Specifications and any other documents expressly made a part of this Agreement. Please see this Agreement's General Terms and Conditions for additional definitions. Acceptance and Authorization: By signing below, You authorize Home Depot to (a) arrange for installation Professional to perform Installation and/ or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Home Depot (or by Installation Professional or its authorized representative on Home Depot's behalf) and You. This Agreement expressly supersedes all prior written or verbal agreements or representations made by Home Depot, Installation Professional, You, or anyone else. Except as set forth in this Agreement, You agree there are no oral or written representations or inducements, express or implied, in any way conditioning this Agreement, and You expressly disclaim their existence. Do not sign if blank or incomplete. (Installation Professional's/ permitting information may need to be provided to You later.) By signing, You acknowledge that You have read, understand, and accept this Agreement in its entirety. You further acknowledge receiving a complete copy. Keep it to protect Your legal rights. Accepted Customer $ T If applicable. ❑ Financing Program $j 1 f Includes all applicable discounts, rebates, and taxes. Excludes finance charges.* I /f Date Customer's IniO also at BY INITIALING, YOU AUTHORIZE DELIV RY OF MERCHANDISE TO SERVICE ADDRESS OVIDED ABOVE WITHOUT OBTAINING DELIVERY AGENT'S SIGNATURE AND AGREE TO INDEMNIFY AND HOLD HOME DEPOT HARMLESS FROM ANY RESULTING CLAIMS. > Store No. Customer's Evening Tel. No. r Order No. State C 1l State Zip 13/45 Zip Rrofessronal's� naAdrllress and License No. or Nos. as Apple: 4 o Prot IOn ' t'No. j .90fi i2 / Billing/Mailmo Address (If different from Service Address) City Primary Account Number: Customer's Mobile No. Customer's Daytime Tel. No. __ ---- ` Discover ❑ MasterCard Q VISA Primary Payment Method: Q Check /Money Order ❑ Home Depot CardlHome Improvement L C1 Expiration: d ! A Authorization # Payment Amount: Ca ver MasterCard VISA Card/Home Improvement Lo Q AMEX El Discover ❑ Secondary Payment ❑ Check/Money Order 0 Home Depot ---� Secondary Account N Authorization #_. Expiration: Number: Payment Amount: — Pavmerrlt Schedu� You agree that payments will be due as in di�THD Representative below. If Yo are paying b ion t, debit or The Home Depot card, the account may be charged or debited (as applicable) on the same day that it is accept y Payment: $ •— Due immediately. Sales Tax: If applicable. ❑ Financing Program 0cludes all applicable discounts, rebates, and taxes. Excludes finance charges.' Total Amount of Sale: $� our separate cardholder or loan agreement. Home Depot is NOT a party to your cardholder or loan agreement. Please see the *Any finance charges will be determined by y General Terms and Conditions following this page for more details regarding other charges which may apply. When you provide a check as payment, you authorize us either to use io m as a check o m your c check t o m we use one- time electronic fund transfer from your account or to process the payment information from your check to make an electronic n transfer, funds may withdrawn from your account as soon as the payment is received, and you will not your ocument *THD Representative or Installation Professional must destroy this portion the The Home within 10 days of the Install Completion Date unless otherwise approved ` NOTICE OF COMMENCEMENT Mill 11, f�'! 11111 131 t 11 �� 1 1 �� � 131 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTIONC F N 210 1 0 8.019 235 2 OR Bk 27223 Ps 2011; (1as4 RECORDED 03/23 /2010 09:47:05 HARVEY RUVINe CLERK OF COURT MIAi1I -DADE COUNTYe FLORIDA LAST PAGE PERMIT NO. TAX FOLIO NO. /1 2 Z 3Z' " 8 `N" 0 STATE OF FLORIDA COUNTY OF MIAMI -DADE THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: Olb,u6.4 ,4ef9 C3..t. v-%,f # 3 3 G s /vs " # 3 wita.f4 5Pa ore 3 - 33r3 2. Description of improveme . 7,( /./ce . ‘Z/ve 4. • = ctor's name and address: Pk , ci9 64 3. Owner(s) name and address: #41 4 4 • " S la Q /e !, F t 33f) 8 Interest in property. Name and address of fee simple titleholder. (4 WA S ON 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 4: ,e../ a. et • ignatur Owner h ile4 Print Owner's Name h. 020/ T Sc G4 1 ail es, ` 4.4 t 33 ) 7. Persons within the state of Florida designated by Owner uponwhom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) Prepared by Pc e( 1 AO `GI•GJ Sworn to and subscribed before me this d day of 4//0/t.. , 20 ` . ROBERT M TAMBURRI A Lip , gC Notary Public: 1 . Q Kld� p`, At F, 3,33y � - � �S ' • mm s on Print Notary's ame: �:��,,� Y Tres p My commission expires: ' STATE OF FtORIDA, COUNTY OF DADE I HEREBY CERTIFY that this t copy of the odgtn:. fited thts office , � of y /J# Wit ... AD20 WIT ` S - ` h., • and • . me HARVEY RUVI of Circuit and County Courts B �; � l� '"g D.C. Y th I �,�r ID SINGLE CONTROL PRESSURE BALANCE MIXING VALVE WITH SCREWDRIVER STOPS Description • Temperature limit adjustment • Back to back installation feature • Mounting bracket & plaster guard included Flow & Valving GPM 9 7 5 3 1 Standards • ASME A112.18.1 • CSA B125 • ASSE 1016 • Listed IAPMO /UPC Warranty FLOW RATE CHART 20 40 Danze products are covered by a manufacturer's limited "lifetime" warranty for manufacturing defects. PLASTIC GUARD 60 80 PSI Specific Features E E E E m D112000BT Submitted Mode! No Danze, Inc., 2500 Internationale Parkway, Woodridge, IL 60517, USA WWW.DANZE.COM Available Colors & Finish • Rough Brass Special Packaging • Trim kits for this valve are packaged separately. Fits all Danze single handle tub /shower & shower only trims • Model numbers for trim kit items include the suffix "T" a, EC, t a;t' a l�i Aic 2 9 2010 #:1 - V 1) M ami Shores Village APPROVED - ZONING DEPT 5 DG DEPT BJECT i O CC,MPI.IANCE WITH ALL FEDERAL . AND CLUN HULES AND REGULATIONS 11/16" (18mm) 3/8 "Max (10mm) 3 1/16" 2 3/4" (77mm) (70mm) ► io E E S D 112000 BT /09 -07.01 I* Z 1 4 S d d.. • ..144H8 0,441 te c Coati i s Label to'.tPe. Licensing Portal - License Search Data Contained In Search Results Is Current As Of 03/29/2010 01:40 PM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Name Certified Plumbing ALWAYS ON TIME AND Contractor AFFORDABLE PLUMBING INC Certified Plumbing Contractor License Location Address *: Main Address *: License Location Address *: Main Address *: DOLLWET. JAHN HELMAR Name Type 201 TUSCANY D DELRAY BEACH, FL 33446 PO BOX 810002 BOCA RATON, FL 33481 201 TUSCANY D DELRAY BEACH, FL 33446 PO BOX 810002 BOCA RATON, FL 33481 License Number/ Rank CFC1427599 DBA Cert Plumbing CFC1427599 Primary Cert Plumbing 1:39:49 PM 3/29/2010 Status/ Expires Current, Active 08/31/2010 Current, Active 08/31/2010 * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. 1 Terms of Use ( 1 Privacy Statement 1 Page 1 of 1 https:// www.myfloridalicense.com /w111,asp ?mode= 2&search= LicNbr &SID= &brd = &typ= 3/29/2010 Wednesday, April 07, 2010 1:56 PM On Time Plumbing 561 496 4878 p.01 c CERTIFICATE OF INSURANCE I ISSUE DATE 312212010 PRODUCER Northeast Agencies. Inc. 2495 Main Street - Suite 209 Buffalo, NY 14214 INSURED Uollwet, Jahn , Always On Time & Affordable Plumbing Inc. PO Box 810002 Boca Raton, FL 33481 CoVERAOe$ A '11778 GENERAL LIABILITY PERSONAL LIABILITY FX('FSS I !ABILITY PROPERTY FCLUM-P DESCRIPTION OF OPERATIONS/ VEHICLES/ SPECIALTY ITEMS Plumbing oommeralal & industrial, Plumbing residential or domestic CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NORTHEAST 2ND AVENUE Miami, FL 33138 3/813010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONKERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE HOES NOT AMEND, EXTG AID, OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. COMPANY LETTER COMPANY B N!A LETTER COMPANY C N/A LETTER COMPANY LETTER COMPANY E N/A LETTER AUTHORIZED SIGNATURE COMPANIES AFFORDING COVERAGE A Western World Insurance Company THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE CSTED 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 13 SUBJECT TO ALL THE Tt" KIM, EXOLUSION6 AND CONDITIONS OF SUCH POLICIES, moms &HOWN MAY WAVE 8SSW RGOt7CCD BY PAID CLAIMS. CO I YPh Of BINDER ID POLICY POLICY LIMIT'S INSURANCE EFFECTIVE DATE EXPIRATION DATE 3/W2011 NiA GE1IERAL AGGREGATE PRODUCTS - COMPASS. PERSONAL & ADV. INJURY I. Act 1 ocXCUr*21.Nt3: UAMACit; P EM RENTED TO YOU MEU bXIJkNSE (Any one person) COMBINDED SINGLE LIM T MEDICAI. PAVMFNTR TO O n re.na FACH OCCURRENCE ASGRI f8A1 BUILDING CQNTiFNT6 I MS Or USE THIS INSURANCE I3 ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNUCENSED INSURER. SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. SURPLUS LINES ASIONT VIRAINIA C. PHILLIPS LICENSE# A2osesa 13577 FEATHERSOUND DRIVE PO BOX 17068 CLEARWATER, FLORIDA 33762 Shouldany of tha above donated polictos be GaMmeow Uetore the eupintUon nate. t he company shell Andeivor to mail 90 nays written notice to the cert111catc holder n8meo tome rem out motile to mall awn nonce Man impose no obligation or liability d any kind upon the company, its agents, or represontabwwx 2,000,000 1,000,000 1,000,000 1,000,000 50,000 5,000 954 351 9182 US REMODELERS INC. SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 11:32:42 a.m. 04 -08 -2010 5 /6 07 -01 -2008 ALEX SINK STATE OF FLORIDA CHIEFFINANOIALOFFIt;ER 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: 06/18/2008 EXPIRATION DATE: 06/18/2010 PERSON: DOLLWET JAHN FEIN: 261440606 BUSINESS NAME AND ADDRESS: ALWAYS ON TIME AND AFFORDABLE PLUMBING INC PO BOX 810002 BOCA RATON FL 33481 * IMPORTANT: Possum to Chapter 440 . 05414), F.S. a officer of ■ corporation who elects mummies from this chapter by filing a certificate of election seder this section may not reeovar benefits or corapemallon wider this chapter. Perused to Chapter 440.05412), LS., Certificates a1 election to be exempt... apply only within the scope of the basin or trade listed go the notice of election to be exempt. Personal le Chapter 440.05113) F.S., Notices of election to be exempt and cerltflcel.. of .40.11oe to be euumpt shell be subject to revocation It at any flee alter the filing el the entice or the lasagne. of the certificate, the person named an the notice or certlllcete no longer amen the regaIremenp of this *501 ref Iasosne* el a certificate. The department shall revoke • c.tllleat• at any time for louvre of the persan gamad as the certified/ to meet Me regdrements of this section. QUESTIONS? (850) 413-1609 954 351 9182 US REMODELERS INC. ALWAYS ON TIME AND AFFORDABLE DOLLWETT JAHN H PO BOX 810002 DELRAY BCH FL 33481 -0002 0,4„, Tax Collector 2009 -12350 �f.J♦tiYl.{t'7ti� ANNE M. GANNON TAX COLLECTOR, PALM BEACH COUNTY Anne M. Gannon, Tax Collector P.O. Box 3715 West Palm Beach, FL 33402 -3715 wwwtaxcotlectorpbc.com Te1:(561)355 -2272 STATE OF FLORIDA PALM BEACH COUNTY LOCAL BUSINESS TAX RECEIPT EXPIRES: SEPTEMBER 3 0, ALWAYS ON TIME AND AFFORDABLE " LOCATED AT PLUMBING INC DOLLWETT JAHN H 201 TUSCANY D DELRAY BEACH FL 33446 This receipt is hereby valid for the above address for the period beginning on the first day of October and ending on the thirtieth day of September to engage In the business,professlon or occupation of PLUMBING CONTRACTOR CFC1427599 11:30:38 a.m. Account Number: 2009 -12350 Dear Business Owner: This is your new local business tax receipt. Please keep the upper portion for your records and detach the bottom of this form. Verfiy the information and display it conspicuously at your place of business, open to the view of the public. This receipt is in addition to and not in lieu of any license required by law. or municipal ordinance and is subject to regulations of zoning, health, and any other lawful authority (County Ordinance Number 72 -7). Receipts may be transferred to a new owner when evidence of a sale is provided; the original receipt is surrendered and a transfer fee is paid. Receipts may be transferred to a new location when proof of zoning approval is provided; the original receipt is surrendered and a transfer fee is paid. Business name changes require a new receipt. This receipt expires on September 30, 2010 Renewal notices are mailed at the end of June. If you do not receive the notice by the end of July, please let us know. I hope you have a successful year. ""'• DETACH AND DISPLAY BOTTOM PORTION, AND KEEP UPPER PORTION FOR YOUR RECORDS 2 010 CNTY 04 -08 -2010 1/6 OC -032 CLASSIFICATION $27.50 • TOTAL $27.50 THIS IS NOT A BILL - DO NOT PAY PAID. PBC TAX COLLECTOR $27.50 BTR 442 01665902 07/17/2009 THIS DOCUMENT IS VALID ONLY WHEN RECEIPTED BY TAX COLLECTOR 954 351 9182 US REMODELERS INC. ALWAYS ON TIME AND AFFORDABLE DOLLWETT JAHN H PO BOX 810002 DELRAY BCH FL 33481 -0002 Tax Collector 2009 -12350 This receipt Is hereby valid for the above address for the pertod beginning on the first day of October and ending on the thirtieth day of September to engage In the businass,profession or occupation of: PLUMBING CONTRACTOR CFC1427599 ANNE M. GANNON TAX COLLECTOR, PALM BEACH COUNTY Anne M. Gannon, Tax Collector P.O. Box 3715 West Palm Beach, FL 33402 -3715 www.taxcollectorpbc.com TeI:(561)355.2272 Dear Business Owner: This is your new local business tax receipt. Please keep the upper portion for your records and detach the bottom of this form. Verfiy the information and display it conspicuously at your place of business, open to the view of the public. This receipt is in addition to and not in lieu of any license required by law.or municipal ordinance and is subject to regulations of zoning, health, and any other lawful authority (County Ordinance Number 72 -7). Receipts may be transferred to a new owner when evidence of a sale is provided; the original receipt is surrendered and a transfer fee Is paid. Receipts may be transferred to a new location when proof of zoning approval is provided; the original receipt is surrendered and a transfer fee is paid. Business name changes require a new receipt. This receipt expires on September 30, 2010 Renewal notices are mailed at the end of June. If you do not receive the notice by the end of July, please let us know. I hope you have a successful year. "*" DETACH AND DISPLAY BOTTOM PORTION, AND KEEP UPPER PORTION FOR YOUR RECORDS "Th STATE OF FLORIDA PALM BEACH COUNTY LOCAL BUSINESS TAX RECEIPT EXPIRES: SEPTEMBER 30, ALWAYS ON TIME AND AFFORDABLE " LOCATED AT PLUMBING INC DOLLWETT JAHN H 201 TUSCANY D DELRAY BEACH FL 33446 11:33:07 a.m. Account Number: 2009 -12350 04 -08 -2010 6/6 OC -032 CLASSIFICATION 2 010 CNTY $27.50 • TOTAL . 1 $27.50 THIS IS NOT A BILL - DO NOT PAY PAID. PBC TAX COLLECTOR $27.50 BTR 442 01685902 07/17/2009 THIS DOCUMENT IS VALID ONLY WHEN RECEIPTED BY TAX COLLECTOR 954 351 9182 US REMODELERS INC. RESTRICTION: OWNER: BUSINESS NAME: LOCATION: CLASSIFICATION: DATE ISSUED: 10/01/09 CITY OF DELRAY BEACH BUSINESS TAX RECEIPT & CONTRACTOR REGISTRATION DOLLWET JAHN HELMAR ALWAYS ON TIME & AFFORDABLE OUTSIDE OF DELRAY BEACH .. CONTRACTOR- PLUMBING -CERT. ALWAYS ON TIME & AFFORDABLE PLUMBING INC 201 TUSCANY D DELRAY BEACH FL 33446 CITY OF DELRAY BEACH BUSINESS TAX RECEIPT INFORMATION 11:32:04 a.m. 04 -08 -2010 4 /6 9940 RECEIPT NO 10 00043437 CONTROL NO 129078 DATE ISSUED: 10/01/09 BUSINESS TAX FEE: .00 DELINQUENT FEE: .00 TRANSFER FEE: .00 I TOTAL AMOUNT PAID: .00 I BUSINESS TAX RECEIPT ISSUED FOR THE PERIOD OCTOBER 1 2009 TO SEPTEMBER 30 2010 BUSINESS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED TO PUBLIC VIEW AT BUSINESS LOCATION Notice: This business tax receipt becomes NULL and VOID If ownership, business name,or address is changed. Applicant must apply for Transfer. BUSINESS TAX RECEIPT ISSUED FOR THE PERIOD OCTOBER 1 2009 TO SEPTEMBER 30 2010 • Please conspicuously post this current business tax receipt so that it is able to be viewed by anyone upon entering your place of business. • This business tax receipt represents proof of payment of your business tax fee for the period October 1 to September 30. Continuous ['censure can be an important asset for certain business users; please exercise diligence in maintaining this business tax receipt. • Once you have obtained a Delray Beach business tax receipt, you will be sent a renewal notice each year 30 to 60 days before.ex iration to the address ress indicated on the face of the receipt. Please check all business tax receipt information and if there is an error, report it to us immediately. The City may impose fines and penalties for failure to renew this business tax receipt. • If you change your business name ownership or location, you must make a new application for the change and pay a $12.50 transfer fee. The business tax receipt must be surrendered prior to issuance of the new receipt. The back of the receipt must be signed and dated by the previous owner and indicated that all rights, interest, and title of the business is assigned to the new owner. • If you have more than one business location, you must obtain a business tax receipt for each location. • A separate business tax receipt is issued for each use performed within your business. Please check with us if you have any questions regarding the classification of your business by visiting us at 100 NW 1st Avenue, our website at MyDelrayBeach.com, or calling us at (561) 243 -7209. pvi►..n , • 1993 2001 Notice: The issuance of this business tax receipt is a result of payment of the business tar and shall not be Interpreted as: permitting the business to supersede the zoning code of the City, an endorsement by the City of a business, nor certification by the City of the competence of a business.