PL-11-1095Permit Number: PL -6 -11 -1095 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1 D1"5
nspection Number: INSP - 161009
Inspection Date: October 28, 2011
Inspector: Hernandez, Rafael
Owner: HERNANDEZ, FRANCISCO
Job Address: 126 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: NOVO & SONS, INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number (786)282 -9014
Parcel Number 1132060133130
Phone: (305)444 -7177
Building Department Comments
PIPING FOR POOL
Passed
.
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
October 28, 2011
Page 1 of 1
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING , I',
OWNER: Name (Fee Simple Titleholder): A7 S 1 ')� Cl/ Phone#:
-177 77rirt-,7
JUN 5 2011 4
Address: A.2-41 71I
(
City: !fit' t �1V'1c1 State: Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City: Miami Shores
County:
Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: t' // � S O 4/ c Phone #: 3 (' L/ L/Y 7/ 77.
Address: 17L/ I. p _Ca./ 2, S j-
City: , j/ 4 1 / State: / . Zip: _2,11—.?
Qualifier Name: R D0(-1 jYL?-0 4 1/4)
Phone #: ?Or-11 / )7:-
State Certification or Registration #: C / 412 Certificate of Competency #: &APO /// 6 3
Contact Phone #: 3 ®S'' j 771. Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 6 •1 .0 Square/Linear Footage of Work: - `loS
Type of Work: Address ❑Alteration ❑New ORepair/Replace
Description of Work: D ) ( °
ODemolition
* * ***** ** :***** * * * ** *** * * * * ** ********` * Fees ** * * *** x*********m**** **u:****:x**** * *** * * ** n
Submittal Fee $ Permit Fee $ ,„29.5-c"--
,,Z:5- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 S
V1)
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
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.
Signature Signature 4d'-i � G-7;-9
Own yj•,' A "ent
The forego' i<g instrument was acknowledged before me this
day of , , 201 L , by , day of
Contractor
The foregoing instrument was acknowledged before me this / 3
, 204_, by
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.
NOTARY PUBLIC:
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
p?P.:?!;j .''11`:).3ADO
743806
26.''2012
Bonded Thru Notary Pubic Underwriters
Sign
Print:
My Com
My Commission 00850579
Xp&1pes 03/15/2013
**** ***+ l< **gt +k***ek+k************ did• ***e k* ******* **% k*******Nesk***HrskeE***
APPROVED BY ' ' ; i ' , -/ 1 Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
CERTIFICATE OF LIABILITY INSURANCE ! DATE tMl1N/DtRYY}
03,04,11
PRODUCER Morgan tnsuranoe Group
13155 SW 42nd Street, Sine #107
Nam!, FL 33175
Phone (305) 2229001
Fax (305)222 -9006
INSURED NOVO & SONS INC
4470 SW 2 St
Miami, FL 33134
' 005 j 444 -7144
COVERAGES
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERT1ICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED RY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE NAM #
INSURER, AMERICAN VEHICLE INSURANCE 1
INSURER 5:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD EXCATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED SY THE POLICES DESCRIBED *HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
{ POLICES.
INSR
ADM
AGGREGATE LIMITS SHOWN MAY HAVE =WY Kttnx:W DT rwu weirme.
I
TYPE OF INSURANCE POLICY NUMBER
POLICY EFPECrnE !POUCY
DATE i YYY
EXPIRATION
DATE IRN t►'IYL
LENTS
,q
12
J0❑
0 l
GENERAL LIABILITY
COMMERCIAL GENERAL LABILITY
CLAIMS MADE ® OCCUR
GL05004000700
03/02/2011
03/02/2012
EACH OCCURRENCE ,
100,00C
DES RENTED )
50,000
LED EXP (Any one person)
5,000
PERSONAL. & ADV INJURY
100,0001
100,000t'
GENERAL AGGREGATE
❑
PRODUCTS - COMP/OP AGO
100,000
GENT. AGGREGATE UST APPLES PER:
0 POLICY ❑ PROJECT • LOC
o
AUTOMOBILE LIABILITY
❑ ANY AUTO
r ALL OWNED AUTOS
0 SCHEDULED AUTOS
COED SINGLE LINT
(Ea
BODILY INJURY
person)
BODILY INJURY
(Per I)
• HIRED AUTOS
❑ NON OWNED AUTOS
❑
PROPERTY DAMAGE
(Per )
.j
•
❑
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
• ANY AUTO
AUTO ONLY: AGS
❑
Q
EXCESS / UMBRELLA LIABILITY
0 OCCUR 0 CLAIMS MADE
❑ DEDUCTIBLE
❑ RETENTION $
EACH OCCURRENCE
I
(Ii
AGGREGATE
'1
WORKERS
EMPLOYERS'
ANY PROPRIETOR
OFFICER
(Mandatory
It yes
COMPENSATION AND
LIABILITY
/ PARTNER I EXECUTIVE YIN
/ DER EXCLUDED?
decry in NH)
describe under
PROVISIONS below
q�.
d TORY yqC g TUMiTS ❑ ERH
E.L. EACH AOcIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POUCY LET
SPECIAL
OTHER
DESCRIPTION
PLUMBING
OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL. PROVISIONS
CERTIFICATE HOLDER
MIAMI SHORES VILLAGE
BUILDING & ZONING DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
ACORD 28 (2008101) OF
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL
30 DAYS wRrrTEN NOTICE TO THECERTWtCATE HOLDER NAME! TO
THE LEFT, BUT PAILURH To D0 so SHALL IMPOSE NO OBUOAT(NN OR LU►BiLUTY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHDRIZIED REPRESENTATIVE
1880 -2009 ACORD CORPORATION. AD rights reserved.!
The ACORD name and logo are registered marks of ACORD
JEFF ATWATER
cHEF FU4ANC.IAL OrlIcat
• STATE OF fil:$11DA
DEPARTMENT OF FINANCIAL SIfflificES
DIVISION OF WORKERS COMPaISMION
- •
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below t. to be exempt from Amide Workers' Compensation law.
EFFECTIVE DATE
PERSON: NOVO
FEB% 591701880
BUSINESS NAME APO ADDRESS:
NOVO AND SONS INCORPORATED
4420 SW 2 sT
MIAMI FL 23124
01/18/2011
SCOPES OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING CONTRACTOR
EXPIRATION DATE 0111712013:-..
ROBERTO
IMPORTANT : Pursuant to Chapter 449 05(14 F.L. an officer t* z asp mho elects miethtdian from this chapter by filing a ceitificate at anther smith this
section may oat recover benefits or sampeasatina seder this draper. Perseat to Chapter 449-951121. LS, Certificates of eleslies to be exempt— amply oak *Mb Se
scope of the business ar bade listed on the noise of elastics to be emompl- Pursuit in Cismter 449.93fl3. LS, flatices of election to be exempt tettilicales
elective to be exempt shall be subject to revocation i1 et any than after the Ming of the notice or the haulms al the certificate. the peruse =wit a the entice or
certificate no longer meets the requirentems al this section for istmance of a certificate. The department shall revoke it cerlificate at esy time for tenure of the person
named en the certificate to meet the requirements of this section. mtsgrop151 (850) 413-1609
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT IIEVISE0 01-11
PLEASE CUT OUT THE CARD BELOW AND RETAIN. FOR FUTURE REFERENCE.
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DWISION OF WORKERS' COMPENSATION
CONSTINIMON 1102ISTRY
CERTIFICATE OF ELECTION 70 I* EXEMPT FROM FLORIDA
WORKERS' CINAPENSATION LAW
EFFECTIVE 01/18/2011
pERsobk ROBERTO NOVO
iEt 591701880
BUSINESS NAME AND ADDRESS
NOVO ANO SONS INCORPORATED
4470 sw 2 sr
MAK FL 33134
EXPIRATION DATE: 01/17/2013
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING cONFRACUIR
IMPORTANT
0 Pursuant to Chapter 440.05(14), F-S, an officer of a corponnion who
, elects elieth0(111 from this chapter by ERN a certificate' of election
1- Inbar this Sicilia, only not recover benefits or compensation under This
D dueter-
plesuant to Chapter 449.05(12), F.S. CortiNcates of election to be
H, exenipt- apply only wfthin the scope of the business or trade fisted on
R c the notice of ehaction to be exempt.
E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt
and CenifiCE1102 of election to he eximmt shall be subject to revocation
it at any One after the fWmg of the notice or the issuance of the
certificate, the person maned an 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 awned on the certificate to meet the requirements of this
sectian
IBESTIONS7 (8519 413-1609
CUT HERE
* Corry bottom portion on the jab, keep upper portion for your records.
ONVC-252 CERTIFICATE OF GRIMM TO BE EXEMPT ROMEO 01-11