PLC-11-2381Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 168283
Scheduled Inspection Date: May 02, 2012
Inspector: Hernandez, Rafael
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue Wiegand & Annex
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: CV OCEAN PLUMBING INC
\ s(os
Permit Number: PLC -12 -11 -2381
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360010160 -09
Phone: (305)525 -7916
Building Department Comments
ROUGH AND SET PLUMBING FIXTURES SINK AND
LAVATORY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled.until
re- inspection fee is paid.
Inspector Comments
May 01, 2012
For Inspections please call: (305)762 -4949
Page 6 of 25
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
tl
!. DEC 2 a 2011 !P1
8 Y' ..... e o00
Permit NoP1C 1 — Th 1
Master Permit No. /1 t
"
OWNER: Name (Kee Simple/Titleholde ): ��/ L+W ll/ J �, y Phone#:
Address: �
City: 19�, dal .. "1� � State: _PG°
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: AUK Nt J A t '(- VitRIANO 2S3
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
NO Flood Zone:
t -A-A i t o u i N Phone #: (30S) i s ? / /k
Address: 4)X /a7 L
City: State: Zip: e3 340
Qualifier Name: -./°7Z) 6029-7--361-711--e) Phone#:
State Certification or Registration #: - /4t2 7353 Certificate of Competency #:
Contact Phone #:( ) C 2S -.79/ Email Address: __En,fJ/L 4 -72-1:, )4j ,41L` a ‘.9X
DESIGNER: Architect/Engineer: Phone #:
J/ b
Value of Work for this Permit: $ `7/(� Square/Linear Footage of Work:
Type of Work: ❑Address talteration ONew ORepair/Replace ODemolition
Description of Work: ZCJZ 41 "' a.J%S $ '7` art, -,C)7.)/Z ,-
*** * *********** **** *+ x ** ** *** *+x********Feesmp*** * * * ** x***+r**** ** * *********** ** x** ****
Submittal Fee $ Permit Fee $ `2,2 -tI,. °'_CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE$ 2,4
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence ofjuch posted notice, the
inspection will not be appr i and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 7Z
day of Mc . , 20 II , by ?AA Cob le0141,021
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expir
** *********** **** * *** **m*
APPROVED BY
Signature
Contractor
The foregoing instrument was acknowledged before me this Z
day of XL.f tQIIt , 20 f 9 , by w 7 el t - Lkf -+Qo ,
who is personally known to me or who has produced 5fcf
as identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
My Commission Expires:
ADAM J. MUELLER
Commission DD 789410
74 ._ If Expires May 18, 2012
IftealtV Bonded Thu Troy Fain Insurance t - 338.7919
* * * * * *** * *** ************************************** * * * * * * ** * * * ** * * * * * * * * * * * * ** * ***
I S ( Z' Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
01/01/2006 00:08 7864841958
INSURANCE
A o'er CERTIFICATE of LIABILITY INSURANCE
THIS cERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
BELOW. THIS C RTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. must be endorsed. If SUBROGATION IS WAIVED, subject to the
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(Ies)
terms and Conditions of the policy, certain policies may require an endorsement A statement on this certificate does net confer rights to the
certificate holder in lieu of such endorsement(s).
PAGE 01
DATE IMNIIDcn.YYY)
12/28/201 i
PRODUCER
M & E INTERNATIONAL BROKERAGE GROUP INC.
8511 NW SOUTH RIVER DRIVE
MEDLEY
INSURED
FL 33186
CV OCEAN PLUMBING
8745 NW 1074 LANE
HIALEAH FL 33018
CONTACT —.
Nose
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mss �elbgC�tilsoutb.nei
_ INSURER131AP1;ORDING COVERAGE NATO d
mistime A: GM Und / MOUNT VERNON FIRE INSURANCE CO
INSURER B b ,
MISUREe C 1
. INSURER D 1
INSURER61 •
INSUR F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 HE 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. —
INSR use_ `DBR PDUCY NUMBER DD.DYY ML4 Y XP LIUI'I'S
LTR TYPE of INSURANCE JNSF�,1t3tD Mro t IN riIYYYh
GENERAL LIABILITY EACH OCCURR NCE , 3 1.QOO,,OOSI
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I X1 OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER
X POLICY P1 1-OC
AUTOMOBILE LABILITY
ANY AUTO
_.
ALL EA
HIRED AUTOS
SCHEDULED
NON.00WNED
AUTOS
UMBRELLA UM
EXCESS LIAR
OCCUR
CLAIMS -MADE
fE:
DED I I RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY pROPRIETORJPARTNERIEXECUTNE Y�
OFFICE/MUMMER EXCLUDED?
(MendMary In NH)
11 yax, describe under
D1=SIE Ie_N gPERATIONS tmIew
t41 r'
CL2595391
NIA
N/A
N/A
04/22/2011
TIANDSIC ED
PREMISES' (Ea ccc urotACe)
MED EXP (Any cite person)
04/22/2012 PSR.eONAL R ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGt3
100,000 ,
$ 5 000
$ 1,000,000 ,._
o 2,000,000
$_ZP00,090
S
_(pp��•■ 'I t I UMII
ee+tc I)
EODILY INJURY (Per person)
BODILY INJURY ('er necidenI)
(Per aL,
EACH OCCURRENCE
AGGREGATE
0
E.L EACH ACCIDENT 1
E.L DISEASE. EA EMPLOYEE
EL DISEASE - POLICY LIMIT $
1_.. it:
N/A
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 V6NICLES (Attach ACCRD 101, ApolHcnal Remarks Schedule, IT more apace Is roamed)
PLUMBER
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 33138
L
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
W 1980 4010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
FIRST -CLASS
UPS. POSTAGE
PAID
MIAMI, FL.
PERMIT NO. 231
605747 -5 THIS IS N O T A BILL -- DO NOT P A Y RENEWAL 631901 -b
aUS S ►3+PENA NG INC STATergeTh27353
8745 NW 107 LA
33018 HIALEAH GARDENS
ow OCEAN PLUIMBI =NG INC
seciriffilliriNG CONTRACTOR
MIS IS BUSINESS LOCAL IT
DOES NOT PERMIT THE
TO VIOLATE ANY
LAWWS OF THE
OR NORM
WORKER /S
DO NOT FORWARD
CV OCEAN PLUMBING INC
ERNESTO CABALLERO PRES
8745 NW 107 LA
HIALEAH GRDNS FL 33018
lltB„,)1,19 fii„m„1„1i, iflt„,stii„,hitt itit,ift
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 05/12/2011 EXPIRATION DATE: 05/11/2013
PERSON: ERNESTO CABALLERO
FEIN: 208520801
BUSINESS NAME AND ADDRESS:
C V OCEAN PLUMBING INC
8745 NW 107 LANE
HIALEAH GARDENS, FL 33018
SCOPE OF BUSINESS OR TRADE:
1- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT
ri 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
L under this section may not recover benefits or compensation under this
D chapter.
H
E
R
E
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 440.05(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.
• 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 01 -11
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
CABALLERO, ERNESTO
C V OCEAN PLUMBING INC
8745 NW 107TH LN
HIALEAH GARDEN FL 33018
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Floridians licensed by the Department of Business and Professional Regulation.
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Thank you for doing business in Florida, and congratulations on your new license!
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