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PL-11-2013Miami 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 Permit No Fl ) )1 5 Master Permit No. (`'"C 1 0-07-13 BUILDING PE ' PLICATION FBC Permit Type: PLUMBING FED 0iPq;2 OWNER: Name (Fee Simple Titleholder): Phone #: Address: 1ti d+ 10 L 5 Ir, City: 1.1-\ ,t Q i$0 t State: Zip: . Y 3 & Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1" 4 `1 B 0 4 S e City: Miami Shores County: Folio/Parcel #: I s°. ` p 3 L' 0 Is the Building Historically Designated: Yes Miami Dade Zip: 5_3i NO Flood Zone: CONTRACTOR: Company Name: CC j1 ("A h` \ Q ( ice, 4° !'e f i tY . Phone #:(!) t Address: ! 0 SO A€ sr City: f`f \ 1 a tnra t State: r L Qualifier Name: tai u i 1 c, E+„ ail _r-e kv ■ 9 - State Certification or Registration #: c e c a `,? A 3 Email Address: C �` zip. .- 51 Phone# p y) —? °7 a. 3 Contact Phone #: Certificate of Competency_ #: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Type of Work: U Description Square/Linear Footage of Work: New ❑Repair/Replace ******** ******* * ***** *** *** *** * * * * * **** Fees***** ** * ****** * ***** ************** ** 9.'** S +'ttal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Double Fee $ Structural Review $ Training/Education Fee $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 ajachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whic 1 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appro d a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of JssttReet� `f, 20 1 Z by rce1lca CortheC?O' , L< who is�ersonally known to me r wko 1 product to FF As identification and who did take an oath. NOTARY PUBLIC: Sign:, o) US-PO ;-es'" Print: H C E we lc-1 C[ct1 t -e9 ea My co , G,Exp g�sslla Gallegos % GOMMiSS:ON # DD966767 y VAR. 01, 2014 1 APPROVED BY -1-fri 2-p (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Signatu Contractor •G ��i_ The foregoing instrument was acknowledged befo me this day of 50 ra:nrti0 , 20 9 , by 111-1 A nAr,4 -4 v ,2 who i , personally k9nown to me�or who has produced as identification and who did take an oath. NOTARY PUBLIC: lans Examiner Structural Review Sign: Print: My Commission Expires f .L /ap 3 ;� • GLADYS" VARGAS MY COMMISSION # DD946724 r r ' EXPIRES December 16, 2013 I1tcom Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I( -20-) Inspection Number: INSP - 166066 Permit Number: PL -10 -11 -2013 Scheduled Inspection Date: March 02, 2012 Inspector: Hernandez, Rafael Owner: Rengstl, Jack Job Address: 1496 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: RODLAND ENTERPRISES INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320320340 Phone: (786)462 -5447 Building Department Comments PLUMBING WORK FOR BATHROOM REMODEL AND 1/2 BATH Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 01, 2012 For Inspections please call: (305)762 -4949 Page 1 of 8 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 MOST-VT OCT 31 J' Permit No. ' I I) — ao Master Permit No.J2C' 10 I E:2000 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): [1) 15 /V v1/1 Phone #: ^q I0 21 tillqc Address: 14 _I to N E 104 Si: City: Miami Shores State: FL Tenant/Lessee Name: Phone #: 33I3 e Email: JOB ADDRESS: 14 rue log ST City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: I I - a 3 a- 03A - 0 3 40 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: I IQ�3 e44-erpri ses, Phone #: (%) ILoa- Sy I 1 Address: I of eg, too St..) a.e ST. City: m► ant t State: F L Zi ,33 I'7S- Qualifier Name: 3 (A I (o A. R O r i 3U e Z Phone #(7)0251 " 8'7 oZ 3 State Certification or Registration #: CPC. .14 a s813 Certificate of Competency #: Contact Phone #: Email Address: roe:Marla 01000 e bel l Sough. ne+ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ t 00 Square/Linear Footage of Work: Type of Work: °Address Alteration °New DRepair/Replace ge mode \a-t tan O 4- efort y ov vvn oov\d ' 12 lop h (,pick\ 2805F• Description of Work: °Demolition * ***+u**************+ + x****************** Fees*** **+ x**** **+ x*** ******** ****** *** **x•**** **** Submittal Fee $ Permit Fee $ /iv i CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ) 18 '16 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 Signatur: Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this o2ga day of , 20 _, by , day of Oi o ber , 20 111 , by 3.-1.411'0 A". Rodriguez who is personally known to me or who has produced who ' personally known to me r who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: Sign: Print: 4-/pf. dih'yS i as My Commission Expires: '`yE: GLADYS VARGAS /a // Jlaoi3 ' *' *: MY COMMISSION # DD946724 EXPIRES December 15, 2013 ****************** ****w***** ***************************************** ** *** **** ***AY'i+Y1F�P+Fw-ww+Y 9`iY�YYr' �'MOS.com APPROVED BY 2 as Plans Examiner Zoning Structural Review (Revised 07!10 /07)(Revised 06/10/2009)(Revised 3/15/09) Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 RODRIGUEZ, JULIO ARMANDO RODLAND ENTERPRISES INC 12260 :SW 28 ST MIAMI FL 33175 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridallcense.com. There you carrfind more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 3A C f R pit r 3, '- r� 5 -L �]7.c.�t�it�.e�.t s �' ���►'L�i :lag '�M�Ktl� t t ti �• rls 497696 -6 BUSINESS NAME / LOCATION RODLAND ENTERPRISES INC 12260 SW 28 ST 33175 UNIN DADE COUNTY FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 519664 -7 STATE* CFC1425813 OWNER RODLAND ENTERPRISES Sec. of THIS 1S ONLY A LOCAL. BUSINESS TAX RECEIPT. IT GOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR MITES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE NOT UA C CERTIFICATION THE NOLOEWS QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 09/22/2011 09010080001 000075.00 SEE OTHER SIDE INC CONTRACTOR WORKER /S 1 DO NOT FORWARD RODLAND ENTERPRISES INC JULIO A RODRIGUEZ PRES 12260 SW 28 ST MIAMI FL 33175 11 1111 / III lililltlllil X11{111111111 ill l ltl I l 11 111 11111 II 11414'I • • ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID 19 RODLA -1 DATE(MMIDDIYYYY) 03/11/11 TYPE OF INSURANCE PRODUCER Emmanuel Insurance Agency Sarai Medina 2370 E 8 Ave Hialeah FL 33013 Phone: 305- 693 -0003 Fax: 305- 691 -4381 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 Rodland Enterprises , Inc . 6965 NW 43 Street Miami FL 33166 INSURER A: American Vehicle Ins. Co. 10790 INSURER B: GL- 0506003153 -00 INSURER C: 03/06/12 INSURER D: $ 1,000,000 INSURER E: PR" MISES(E �'occurence) COVERAGES THE POLICIES 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. INSK LTR AULIL INSRJJ TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM/DDIYY) POLICY EXPIRATION DATE (MMIDDIYY) LIMITS A GENERAL UABI TY COMMERCIAL GENERAL UABIUTY GL- 0506003153 -00 03/06/11 03/06/12 EACH OCCURRENCE $ 1,000,000 X PR" MISES(E �'occurence) $100,000. CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY Ii Ter n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMB (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 UABIUTY EACH OCCURRENCE $ 7 OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below f WC LIMIT S S I ER R- TORY L I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS General Contractor/ Plumbing Contractor. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg. Dept . 305 - 756 -8972 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sarai Medina ACORD 25 (2001/08) © ACORD CORPORATION 1988 10 -13 -2010 ALEX SINK 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. EFFECTIVE DATE: PERSON: RODRIGUEZ FEIN: 650994890 BUSINESS NAME AND ADDRESS: RODLAND ENTERPRISES INC DBA ROLAND PLUMBING INC 12260 SW 28TH ST MIAMI FL 33175 11/20/2010 EXPIRATION DATE: 11/19/2012 JULIO A SCOPES OF BUSINESS OR TRADE: 1- PLUMBING CONTRACTOR 2- GENERAL CONTRACTOR * * IMPORTANT: Pursuant to Chapter 440 . 051141, 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 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 11/20/2010 EXPIRATION DATE: 11/19/2012 PERSON: JULIO A RODRIGUEZ FEIN: 650994890 BUSINESS NAME AND ADDRESS: RODLAND ENTERPRISES INC DBA ROLAND PLUMBING INC 12260 SW 28TH ST MIAMI, FL 33175 SCOPE OF BUSINESS OR TRADE: 1- PLUMBING CONTRACTOR 2- GENERAL CONTRACTOR OPursuant to Chapter 440.05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt R E 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 an the certificate to meet the requirements of this section. IMPORTANT QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06