PL-12-1590r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177710 Permit Number: PL -8 -12 -1590
Scheduled Inspection Date: October 31, 2012
Inspector: Hernandez, Rafael
Owner: PACHECO, MANUEL
Job Address: 9080 NE 2 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: ACER PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)336 -4908
Parcel Number 1131010190090
Phone: 305 - 935 -4103
Building Department Comments
REPLACE FIXTURES IN KITCHEN AND BATHROOMS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Com ents
October 30, 2012
For Inspections please call: (305)762 -4949
Page 11 of 44 I
BUILDING
PERMIT AP
FBC 20
Permit Typ r, j
OWNER: Nam - i e older): �/�/ liV1/'V G1/ .P/take--CO
City: g • tM L //�1 i� -r7 State: AIL
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
TION
PLUMBING
Permit No. Pi 2--' 15
Master Permit No120
Address:
Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: /0 60 /VC' 5,.t.°
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
,
Address: 1 / / ���
City:
Qualifier Name:
State Certification or Registration #: C
NO Flood Zone:
Phone #: 93®5 35 (
zip:
Contact Phone #: C Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $
Type of Work: ❑Address ❑Alteration
Description of Work:
Square/Linear Footage of Work:
❑New epair/Replace
***************************************Fees*****. ***** x ** *************4 u * * * ** ***
Submittal Fee $ Permit Fee $ /66 s�
tOiCa
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $- 621.e0
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 accuiaie 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b, app1oved and a reinspection fee will be charged.
Signature
Si
wner or Agent / Contractor
The foregoing instrument was acknowledged before me this I41 The foregoing instrument was acknowledged before me this dl
day of Ib)1 ,20 i2, by M'�D)b P4((6 , day of _tiki, 20 /2,by .P,440'-‘) J ,
who is personally known to me or who has produced who is personally known to me or who has produced$L
As identification and who did take an oath. _
- identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
(�9
Sign:
Print: I. JA (ti -(,z
My Commission
APPROVED BY
B. SALVER
r. Notary Public - State of Florida
My Comm. Expires Dec 3, 2014
Sign:
Print:
IJ•;
a
My Commission E,\
*72720/3 s,
44.0F F10P°
-tARAENTERSI
* MY COMMISSION # DD 892205
EXPIRES: Sep4 mbar 22, 2013
Bonded Thru Budget Notary 5ervict°
*************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
Aug 21 12 12:09p david bonan
3059360013
p,1
AC #.6184536
THES DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK "' PATENTED PAPER
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L1207040032
DATE BATCH NUMBER
LICENSE NBR
07/04/2012 118205674 CFC053320
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014
BOMAN, DAVID
ACER PLUMBING INC
1851 NE 206 TERR
MIAMI
RICK SCOTT
• GOVERNOR
1
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
FL 33179
DISPLAY AS REQUIRED BY LAW
KEN LAWSON
SECRETARY
2011 LOCAL BUSINESS TAX RECEIPT : 2012 FIRST -CLASS
MIAMI -DADE COUNTY - STATE OF FLORIDA US. POSTAGE
EXPIRES SEPT. 30, 2012 PAID
MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 PERMIT NO. 231
270259 -6 -1i.;; 1 ;3 NCT r BILL - i,C? FJC PAY RENEWAL
+e BUSINESS NAME /LOCATION RECEIPT NO. 256407-9
ACER PLUMBING INC STATE* CFC053320
1851 NE 206 TERR
33179 UNIN DADE COUNTY
OWNER
ACER PLUMBING INC
Sec. T e of Business WORKER /S
196 PLUMBING CONTRACTOR 10
THUS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOY PERMIT THE
HOLDER TO VIOLATE AMY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY ON CMES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERM.. OR LICENSE
REQUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDER'S QUAUFICA.
PAYMENT RECEIVED
MIAMt•DAOE COUNTY TAX
COLLECTOR:
09010029001
000075.00
SEE OTHER SIDE
DO NOT FORWARD
ACER PLUMBING INC
DAVID SONAR PRES
1851 NE 206 TERR
MIAMI FL 33179
Aug 21 12 12:10p david bonan
3059360013 p.2
08-17-2011
JEFF ATWATER 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 f>
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE:
PERSON:
FEIN:
08/17/2011
BONAN
650953849
BUSINESS NAME AND ADDRESS:
ACER PLUMBING INC
1651 NE 206TH TERRACE
NORTH MIAMI BEACH FL 33179
SCOPES OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING CONTRACTOR
EXPIRATION DATE: 08/16/2013
DAVID
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S.. so officer of a cerperetioo who elects exemption from this chapter by Filing a certificate of election under Ibis
section may not recover benefits or compensation wader this chapter. Fermat to Chapter 440.05(121, F.S.. Certificates al election to be exempt.., apply only within the
scope of the heehaws or trade listed on the notice of election to be exempt. Parsuaal to Chapter 440.05(13), F.S., Notices of election to be exempt and cerlificoles of
election to be exempt shall be subject to revocation 1f, at any time after the filing al the notice or the issuance el the certificate, the person named en the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the person
named on the certificate to men die requirements al Ibis sestina.
QUESTIONS? (850) 413 -1E
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
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: 08/17/2011
PERSON: DAVID BONAN
FEIN: 650953848
BUSINESS NAME AND ADDRESS:
ACER PLUMBING INC
1851 NE ECM TERRACE
NORTH MIAMI BEACH, FL 33179
EXPIRATION DATE: 011/16/2013
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING CONTRACTOR
OPursuant to Chapter 440.05(141, 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 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
exempt.. apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt.
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 meet
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.
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 01 -11
Aug 21 12 12:10p david bonan
AWR/O®
3059360013 p3
CERTIFICATE OF LIABILITY INSURANCE
DATE IMMIDDIYYVY]
2/9(2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S )., AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Presidential insurance Services, LLC
2665 South Bayshore Drive #220 -16
Miami, FL. 33133,
INSURED
Acer Plumbing, Inc.
1851 NE 206 Terr.
Miami, FL. 33179
NA NTACT
NA Jeff Lampert
_ lwla No, Ext] , 305-423-0350 _ ... ..... ( . NY 305 -423 -0351
AD" IBS: jefffinsurancequotelive.com
INSURER] AFFORDING COVERAGE HAICI
INSURER A: Preferred Contractors Insurance Company
INSURER C:
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
• _. -.
LIR : TYPE OF INSURANCE ' MISR WW(D- POLICY NUMBER
POLICY EFF i POLICY E7Cp
UAINDO/YYYY) , MIND
LIMIT$
S GENERAL UABIUTY :
,..._�
X `COMMERCIAL GENERAL .. LIABILITY
.. _■ CLAIMSMADE X OCCUR .
• PC105043- PCA80297
1 ..
2/9/2012 i 2/9/2013
,
EACH OCCURRENCE i $ 1,000,000
D,raT€�- - -- -�..
PR ES (Ea gg}1{ ee 50 C100
__ -
MED EXP (Any Or Gerson) -. $ _._ 5,060
PERSONAL S ADV IN,:URY . $ _ 1,000,000
GENERAL AGGREGATE A : $ 2,000,000
GEN_ AGGREGATE UMRAPPL [ES PER.
PR•
X ; POL'CY : SECOT i LOC
PRODUCTS -COMP/OP AGG $ 1,000,000
$
AUTOMOBILE LIABILITY
_ ' ANY AUTO
ALL °MED SCHEDULED
AUTOS i AUTOS
NON -0LMIED i
_ : HIREOAUTOS ;_J AUTOS
I
COMBINED SINS/ a LIMIT
Eeno:41
INJURY(Perperson) $
«BODILY
BODILY INJURY (Per =Went) 5
PROPERTY OADAAGE
(PPreagden,] -._ __ $
s
UMBRELLA LIAB OCCUR
I CLAMS-MADE
EXCESS GAB (_
I
I
EACH OCCURRENCE $
AGGREGATE $
C C • RETENTIONS -
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y r N N. 1
.
WC TATU CTH-
' TOR LIMITS I . FR,
E'_L EACHACCIDENT S
_ --
E.L DISEASE - EA EMPLOYEE S
E L DISEASE - POLICY LIMIT S
ANY PROPRIETOR/PARTNERIEXECUTVE
OFRCER. MEMBER EXCLUDED? N / A.
(Mandatary In NH) 1
If yes. tesaibe ender I
DESCRIPTION OF OPERATIONS below
I
I
. I
DESCRIPTION OF OPERATIONS / LCCATIONSi VEHICLES (Attach ACORD 101. Additional Remeties Schedule, B more spate Is requIred]
CERTIFICATE HOLDER
Miami Shores Village
1 00'550 NE 2nd Ave.
Miami Shores, FL. 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE
ACCORDANCE WIT H THE �THEYEPROVI$OONSS. WILL BE DELNERED IN
AUTHORIZED ED %� A7N�
ACORD 25 (2010/05)
«/ 988- 010 ACORD CORPORATION. AV rights reserved,
The ACORD name and logo are registered `(Ttarks of ACORD