PLC-12-157Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number. INSP - 174225
Permit Number: PLC -1 -12 -157
Scheduled Inspection Date: May 30, 2012
Inspector: Hernandez, Rafael
Owner:
Job Address: 9031 -65 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project: <NONE>
Contractor: J &J CARDONA CONSTRUCTION INC
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)779 -8040
Parcel Number 1132060110051 -31
Phone: (305)696 -5112
Building Department Comments
CONNECT PLUMBING FOR PINCH A PENNY RETAIL
STORE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 169353. not ready
May 30, 2012
For Inspections please call: (305)762 -4949
Page 46 of 47
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 )2H1 ✓ j
Permit No. VIC
Master Permit No.CC 0 2 I
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
JAN 30 z:
OWNER: Name r
(Fee Simple Titleholder): �t*%4?2-J ��� ��, �/tQ 'r �hon�e#; 305 305 9 149
Address: 6, 9C ME d d-S '
i State:
f4-
City: AI "A-41 .."A-41 pH,.• zip: 3 yt f:
Tenant/Lessee Name: ORev Eels-}Sde Poo1 Si )0 avid i�-(i'aoce. Phone #: 305- SOO -09aq
Email: t inn ‘ V Cols ac Mt, Yip+ 1613A 'Pock A ?emit Lew 12, Luca S
JOB ADDRESS: 10 (9 CI f 9 o `7) ?J 15 co 9 rn,
City: Miami Shores County:
Folio/Parcel #: '' " 0 t % •' 005
Miami Dade Zip: 3
Is the Building Historically Designated: Yes NO
Flood Zone:
CONTRACTOR: Company Name: JT e � I, Jn4 �G�� hona# 6 -d0
Address: 9 9 & /947 7--
City: dt/ State: Widit2
10M
Qualifier Name:
State Certification or Registration #: 6TCi
Contact Phone#: , 4 , 24Z
DESIGNER: Architect/Engineer: GA13.04...
Email Address:
Sex) or
Zip: /6/
Phone #:
Certificate of Competency #:
)�1 011 �{ . a A / nisi; L
Phone #: q a70 °- qo(O �—
Value of Work for this Permit: $ l+�'tV Square/Linear Footage of Work:
Type of Work: Address L°JAlteration r �" DNew DRepair/Replace DDemolition
Description of Work: Co,, D .eGf 7, o ribi,ic P//1cir1 Pefin re r&,
* * * * * * **** * * * * * * * * ** **** ** * * ** a+x**+x***F ************ ** * *** x*a : ********+x*+x***** **** ***
c^
Submittal Fee $ Permit Fee $ �� • CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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.41 t 1e foregoii giliformation 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 $2$00, 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 approv ' , nd a reinspection fee will be charged.
Signature
The foregoing instrument
day of Y c44,20
III,
I \, gent
.v4 mkt
a a� \ owled ed before me this'
by t own AzIrto.t.
who is personally known to me or who has produced
1 <-
4t
Signature
Contractor
oing instrument was acknowledged before me thi
, 20kA, by X80 ,
me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
„° Pit Notary Public State of Florida
r Claudia M Lopez e° My Commission DD993321 0
Sign: �� i�� '� Sign:
Print: C ACI��a '' ,.r '�_ Print: i A 172,1e770 ✓, r�/ �h
My Commission Expires Mgtla Teresa Marrn-Garcia
Commission # DD859380
Expires: MAR. 31, 2013
TMu ATLANTiCBONn 10 CO.,0
APPROVED BY / VC % �� Plans Examiner Zoning
NOTARY PUBLIC:
`t„\ My Commission Expires:
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review Clerk
STATE OF FLORIDA.
DEPARTEUINT OF BUSINESS .AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH NO400E STREET
TALLAHASSEE FL 32399-0783
CARDONA JOSE TUN
J a J cimma CONSTRUCTION INC
990 -HE -146M- STREW
NORTH MIAMI FL 33161
: ' .7...-. ...:
Ccmgmbilaffonsl VIM 0*th:erne you income one tithe nearly one maxi -,_,-,,,,,j1-3-- - —
- -,. „. --.._.- '..`•;:l..
Floridians Beamed blithe Dapadment of Daiwa and Prdesskatal Regulation. ..S.:::,;:-:- '-.1 -"I-2:f' ' '.1' . . .1•40.6.T*C. ...........
•-::4= .2„..?I' ,.... * 7 ,,.7,,1 um
Our cadesslortals and businesses range from archftecis to yacht brokers, from ...
boxers to batheque restanawds, and they keep Florkla's eamony strong. e-::
CFC14*.8020; '- 08/05/10 '00059450
Every day We work to lasmove the way we (k) tuskless in order to setae low better.:
For inkarrialbm about me services, plasm log onto www.myttorkialloense.coin. : -:....., CERTIFIED PLUMBING CONTRACTOR
There you can find num Information about mw rfivisions and the megdations that . .q.'.: =MINA, JOSE IVAN
knpact you. subsoil's to deparkward newsielleas and leam mom about Eva - '-.1.10'2%-so ol...:- -CARDONA CONSTRUCTION -3:NC: :
• Demodulate inftbdives.
. .
Our misska et the Demetrius* im license Efficiently, Regulate Fairly. We -
amstantly drive to marvel sus better so that you can serve your =storms.
Thank you tor dothg busktess In Florida, and congpsdubations on your new license! _1---,.. IS- elaTrYIED under tim- Pzt`vlau*? (4.143'489c"
..-, 4ratiefi date* AUG -31,.: 242% '.-,r4osaf5e3210*-7,
--:•••-i- . .:;&;L.......II:.------
(850) 487-1395
DETACH HEW.
STATE-OF FL
DEPARTmiroNsguBcHoirffiniriK
er'7'
*,•
.. • - ..... •
' *
"4- ••-••••
FESSIONAL REGULATION
ICENSING BOARD
SEQ#1,10080501734
DATE • -'1***,* BATCH NUMBER
LICENSE NBR
,061:05/2010
100059450 - CFC1428029
The PLUMBING CONTRACTOR.
/Mmed'below IS CERTIFIED
Unde provisions of -Chatitex:: 489 FS.
Expiration date: AUG 31, 2012-7
_aimCM‘ `B-rit-zr-AVa±11- Xviv,
990 ,
' NE 146TH STREET-;.--
NORTH MIAMI FL 33161
HARIIE RIOT
. • . .•-• • ••
"*. -•
•
•
08 -04 -2011
JEFF ATWATER STATE OF FLORIDA
C IEF FINANCiAL o ICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA MORROW COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation jaw.
EFFECTIVE DATE
PERSOikk
FEIN:
08/04/2011 EXPIRATION DATE 08/0312013
CARDONA JOSE I
841668059
BUSINESS NAME AND ADDRESS:
J & J CARO0NA CONSTRUCTION INC
990 NE 146 ST
N. MIAMI FL 33181
SCOPES OF BUSINESS OR TRADE
1- PLUMBING CONTRACTOR
3- GENERAL CONTRACTOR
2- ROOF/NMI CONTRACTOR
IMPORTANT: Pursuant to Chapter 440 . 05(14). F.S., an officer el a corporation who elects exemption from this chapter by filing e certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(121 F.S.. Certificates of election 10 he exempt —. apply only within the
scope of, -the_ business or trade listed as the notice of election to be exempt. Pored to Chapter 440.05(19), F.S., dices of election 10 be exempt and certificates of
election to be a - tf be subject to revocation 0, at any time after the filing of the notice ar the issuance of the certificate, the person named on the Mice or
certificate no longer meets the ieqoireareM of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named en the SWUM:ata to meet the regaireineets of this section
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT IONISED 01 -11
QUESTIONS? (850) 413 -1609
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL IAL S S
DIVISION OF WORKERS* CrSATION
CONSTRUCTION INDUSTRY
CITE OF ELECTION TO SE EXEMPT FROM FLORIDA
TION LAW
EFFECTIVE 08/04/2011 EXPIRATION DATE: 03/03/2013
PERSON JOSE I CARDONA
FEIN 841668059
B1JSIPESS NAME AND ADDRESS:
1 & J CARDONA CONSTRUCTION INC
990 NE 146 ST
N. MIAMI, FL 33161
SCOPE OF BUSINESS OR TRADE
t- PLUMING CONTRACTOR 2- ROOFING CONTRACTOR
3- GENERAL CONTRACTOR
IMPORTANT
Pursuant to Chapter 440.05(14), F.S. , an officer of a corporation who
O efts exemption from this chapter by filing a certificate of election
I- 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 rnatio: of election to be exempt
E Pursued 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 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 named on the certificate to meet the requirements of this
section.
MOTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep wiper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
-F =0R Tv
140 FLA(3LEk1 Si.
1St FLOOR
WAM R 33130 •
E COU - STATE €f
30'
AT .._. _
g _.
IS IS NOT A 3112._ —DO NOT RAY
Figs r-cLWsS
U.S. POSTAGE
PAID
MIAM , FL
PERIdR' NO. 231
646899 -5 RENEWAL
BUSINESS NAM LOCAiiOFi RECEIPT NO. 673805-9
J & J CARDONA CONSTRICTION INC STATE& CFC142802
990 NE 146 ST
33161 NORTH MIAMI
WN
O j & J CARDONA CONSTRUCTION INC
'Dpe Stac.1PL INS CONTRACTOR
IRAS IS ORLY A f_OCAI.
DOES HOT PERSbTm THE
HOWER 10 %cum may
EXISTING REGW.AiORY OR
ZONSIG
en �
ROWER FROM ANY OTHER
DOES IT EXEISPF ThE
PERM' OR iscsisa
REWIRED flY LAW. THIS IS
HOT
»off 11011 OF
TIMM
PA
mamma COUNTY TAX
COLLECMFE
07/18/2011
60000000275
000045.00
i SEE OTHER SIDE
WORKER'S
1
DO NOT FCNIWAM
J & J CARDONA CONSTRICTION INC
JOSE I CARDONA PRES
990 NE 146 ST
NORTH MIAMI FL 33161
111111111111111111111% ilIlift%IISalsf1311111114116
MTAMF�
LINTY
C UN'[Y
C Q
Carlos A. Gimenez, Mayor
06/06/2012
Fernando J. Alonso
Miami Dade Water & Sewer Department
3071 SW 38 AVENUE
Miami, FL 33146
E -mail: FALONS0 @miamidade.gov
Re: Shores Square Shopping Center
9031 BISCAYNE BLVD
MIAMI SHORES, FL 33138
RER Permit Number: 2011 - SEW -EXT -00121
FDEP Permit Number: 253649- 681 -DWC
CERTIFICATION OF: 100%
Dear Fernando J. Alonso:
Permitting, Environment and Regulatory Affairs
Environmental Services
11805 SW 26th Street, Ste. 124
Miami, Florida 33175 -2474
T 786 - 315 -2800 F 786 - 315 -2919
ELECTRONIC CORRESPONDENCE
miamidade.gov
This letter shall serve as notification that the above referenced Sewer Extension project has been certified by Aristides
Reyes - Gavilan, P.E. Said certification, signed by the corresponding utility on 04/09/2012, indicated that the project was
completed in conformance with the approved plans and specifications.
Pursuant to the above, and inasmuch as all the specific conditions in the FDEP construction permit have been complied
with, we hereby clear these facilities for service. This notification does not relieve applicants from building permits,
requesting to connect to this sanitary sewer facility, from the requirements of a Sewer System Treatment and
Transmission Certification in accordance with the terms and conditions set forth in paragraph 16C of the First Partial
Consent Decree (Case No. 93- 1109CIV- MORENO).
If you have any questions, contact me or Oscar Aguirre at (786) 315 -2800. When referring to this project, please use the
sewer extension number indicated above.
Sincerely,
Carlos Hernandez, P.E., Chief
Plan Review and Development Approvals Division
CC: Yoram Izhak Ifuentes @cfhgroup.com
Aristides Reyes - Gavilan P.E. ari @revesgavilaneng.com
Sergio Garcia, P.E. GARSERG @miamidade.gov
e l e; i t c Lxc. e t 7F JZ c f.
i "er' . 11 {1/
1
.----.--,.-=,-,---
MIAMI-DADE WATER & SEWER DEPARTMENT
METER OPERATIONS & MAINTENANCE
MIAMIDADE CROSS-CONNECTION CONTROL UNIT_
COUNTY , 1001 kW. 11TH STREET, MIAMI, FL 33136-2209
I Phone (305) 547-3046 • Fax (786) 268-5485
PREVENTION ASSEMBLY TEST REPORT FORM
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OMER CONTACT:
, . ,
PHONE.
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ADDRESS OF OWNER -
ZIP-CODE
2
NAME OF TESTER:
CERTIFICATION #:
9,0 ed-F6
EXPIRATIOp DATE:
// .,/,-M /V--
PHONE:
-98,i_4 -3 03 - (rfl ?*5e
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BUSINESS NAME:
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BUSINESS ADDRESS: -
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mi. r4 err- i , , F1'
ZIP CODE:
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Tit/
, 7
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3
TEST la MAKE:
/
MODEL #:
-174 - IS-6
SERIAL #:
ST 36 ti
DATE LAST CAL.
v,a, 1,)
SITE TUBE:
YES / la
MAKE OF ASSEMBIY:
6
MODEL NO.: 47 SERIAL #: SIZE: /
/3-6? r 4.,
LOCAR/1 OF ASSEMBLY:
°.' ZARD/SERVICE: r MEER NO.( 57-....3,.., - r,
DATE OF TEST: i 2 METER READING:
INITIAL TEST: " 1 ANNUAL TEST: 5/4--Cif—t9 4-1—
./'
SHUT OFF VALVE #1: "
SHUT OFF VALVE #2: i'' ":
,
CLOSED TIGHT: A,"
CLOSED TIGHT: .0,. .." .6
LEAKED: /4,...??
LEAKED: it_,/to LINE PRESSURE: (rj r...,, PRESSURE STABLE: YES - NO
,.., , vtortgr;,,,A,votAzesgg-h-vv is,,-. .,;,-------,-, ,s,imfgkttryrqkgtvaTazitp-*vUvttgAIK''''tR**MTfq*WA'MiAN ' " guiougit*MVI;
' ,:,-- -"4.1t •=z,-- i-,-.4a.ActAt.t,m ",o- , VzsettP-Wv-wit*Vixliesttlx,.., ,....,. z-r•st.,**,:4,04Vitt...iv-w,--, ,,,,... -;tegt-m4fAjwo
- -PFaiti44;::jiiattitnjij*itt*tYr;
titi4Itik*:::;"''it,,!„*.lini
AIR INLET
1—
U)
W
I—
Closed Tight: V
Closed light
FAILED TO OPEN LIC)
—
FAILED
TO OPEN
OPENED AT:
PSI.
LEAKED:
Leaked:
HELD AT:
PSI
A..j(c11
Leaked. ....--
"
OPENED AT: 5 O PSI.
PRESSURE DIFFERENTIAL ACROSS CHECK
/ PSI.
PRESSURE DIFFERENTIAL ACROSS CHECK
11; r PSI.
REMARKS / REASON FOR FAILURE (IF APPARENT):
REPAIRS
4MAS-A
CLEANED:
CLEANED:
CLEANED:
CLEANED:
REPLACED:
REPLACED:
REPLACED:
REPLACED:
1—
in
LU
CHECK VALVE NO. 1
CHECK VALVE NO. 2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
Closed Tight:
Closed fight
FAILED TO OPEN
FAILED
TO OPEN
LEAKED:
_ ---.
Leaked:
Leaked:
OPENED AT: PSI.
OPENED AT:
PSI.
PRESSURE DIFFERENTIAL ACROSS CHECK
PSI.
PRESSURE DIFFERENTIAL ACROSS CHECK
PSI.
HELD AT:
PSI
-Ii";:- -,,..:-
1,1 ' • 4,. '''.:;.`'''-i''''''':-..-ii.-Zr'..::',:;liii,.'p!--' Ir,nr.;41-ti;'. ' ti iVI-iniii",00
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, -,P .1 VI . `,14‘Wq.
SIGNATURE OF CERTIFIED TESTF_R:
_ - -
'
NOTE: TEST FORM MUST BE COMPLETEthN4SENTJRETY. INCOMPLETE TEST FORMS WILL BE RETURNED.
110_01458 8/09 www.miamidade.gov/wasd/cross-connection.asp
CUSTOMER