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PL-13-1257Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 194557 Permit Number: PL -6 -13 -1257 Scheduled Inspection Date: July 02, 2013 Inspector: Hernandez, Rafael Owner: RODRIGUEZ, LORENZO Job Address: 9212 NE 10 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: ONE WORLD PLUMBING SERVICES LLC Permit Type: Plumbing - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1132060060010 Phone: (786)346 -5020 Building Department Comments CHANGE CAST IRON TO PVC FOR SANITARY LINE Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 02, 2013 For Inspections please call: (305)762 -4949 Page 22 of 23 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 Permit Type: PLUMBING JOB ADDRESS: , q ° f-)`- E 11) t City: Miami Shores County: Miami Dade Zip: I fit' Folio/Parcel #: FBC 20 Permit No. pi !� Master Permit No. Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): /1"te,-1 71`thY Phone #: 1K1 17 . Address: (Z(2- Me- lO otLIE. City: fdf Am ,S i1C74f S State: F Tenant/Lessee Name: Email: Ct AC( Pi?,ua f 11 ex CONTRACTOR: Company Name: Address: 9,,m City: % 7I CaYn Qualifier Name:. otmo I'C0/NA Phone#: Zip: 33 C K, State: Phone #: r37 3� / �+►1 Zip. s;7 =. Phone #: 7 g C Lt C 57 5; State Certification or Registration #:.0 ce , 4 x 13 Certificate of Competency #• Contact Phone #: -.7 _ T- Jn,ail Address: GLCLi fril I %% .. sr a � j(' i J DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ eve, Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: eo (o OAlteration UN ?U34413 3 =� , _iSYd eb G4REIi9 !o s1 I . ai90vq gis! ©M! ******** * * * * * * * * * * ** * * ** * * * * * * * * ** * * * ** Fees************* * * * * ** * ** * * * * ** * * * ** * * * * * * * * * ** 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 $ ft S-3( Bonding Company's Name (if applicable) Bonding Company's Address r 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, BOIT.ERS, 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 ��r' - °'" Signature Owner or Agent The foregoing instrument was acknow edged bef re me this d� The foreg day of , 20 (3 , by .,iaw.. ` s y of who is ersonally known to me or who has produced who is pers As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expire APPROVED BY • identification and who did take an oath. -27 Contractor trument was ackno ' edged fore m this 1s 201 . by %1.`/ known to me or who has p oduced NO ARY PUBLIC: Sign: Print: My Commissi sss Bonded Through National Notary ssn. Zoning Structural Review Clerk (Revised3 /12/2012XRevised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) o This Warranty Deed Made this 14th day of November, 2012 by Lorenzo F. Rodriguez, A Single Man hereinafter called the grantor, to Andrew Thay, A Single Man whose post office address is: 9212 N E 10 Avenue, Miami Shores, Florida 33138 1111111111 11111111111111111111111111111111 CFN 201280939897 ' OR Sk 28421 Ps 13481 (1RS} RECORDED 12/29/2012 08117x39 DEED DOC TAX 2,280,00 HARVEY RUVIN► CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST PAGE hereinafter called the grantee: (Whenever used herein the term "grantor' and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) Witnesseth, that the grantor, for and in consideration of the sum of $10.00 and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee, all that certain land situate in Miami Dade County, Florida, viz: The North 60 feet of Lot 1, of Amended Plat of Golden Park, according to the Plat thereof, as recorded in Plat Book 7, at Page 84, of the Public Records of Miami -Dade County, Florida. Parcel Identification Number. 1132060060010 Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances. Subject to covenants, restrictions, easements of record and taxes for the current year and subsequent years. In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above written. elivered in our presence: eIl t(Lt,t'YI \ekj Print Name: Witnesk: (Si Print Name: t, State of Florida County of Miami Dade A Lorenzo F. Rodriguez , FL /4/,2-0 6r-' e l / / a/ Zr4 Ill it /// 41',, Fe_ 33/31 The foregoing instrument was acknowledged before me this 14th day of N¢vember, 2012, by Lorenzo F. Rodriguez, A Single Man , who is personally known to me or who has produced I -I CY 1 ctQ Oft I/CrS u ew, as identification. OTAR' :LIC(signahue) Print Name: Sbirlynn Webb My Commission Expires: Stamp /Seal: Prepared by: Shirlynn Webb Sunbelt Title Agency 15100 NW 67th Ave Suite 110 Miami Lakes, FL 33014 File Number: 7908120318 RETURN TO: Sunbelt Title Agency 2170 W. State Rd. 434 Suite 450 Longwood. FL 32779 Incident to the Issuance of a tide Insurance contract. WARRANTYDEED REV. 9#12/12 LSDIak Book28421/Page1348 CFN #20120939897 Page 1 of 1 .,s. 'ipaiti i v a.i.Ivv aaa..aao a. iw a: "4aY a., .. v.rs.0 a %aaa V rash iVi\ coN$TRUCTIoN INDUSTRY LICENSING BOARD SEQ# L12083103026 LICENSE NBR 2012 X27013594 CFC1427913 e PI,UMEING :CONTRACTOR ned:' below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG.31, 2014 MORISSEAU, JOSEPH ONE WORLD PLUMBING SERVICES LLC 92 NE 49TH ST MIAMI.,;, . FL 33137. K "SCOTT GOVERNOR � UAM1 -DADS COUNTY 1 TAX t OU.ECTOR 141 W. FLAOL.E ST MIAMI, FL. S:i130 692325 -5 BUSINESS NAME / LOCATION ONE WORLD PLUMBING SERVICES LLC 92 NE 49 ST 33137 MIAMI DISPI AY AS REQUIRED BYLAW _ 2012 LOCAL 81ESS TAX RECEIPT 2013 poss AC . t Y * SLATE OP FLORIDA SEPT: 39p 201$ PURSAi$ MT Bt E : YI TLAO OP BUSINESS I; OOE 9A - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 675909-7 STATE CFC1427913 OWNER ONE WORLD PLUMBING SERVICES Sec. T of Business 196 PLUMBING THIS IS ONLY A LOCAL. BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MUUD -DADS COUNTY TAX COLLECTOR: 09/28/2012 02250076001 000045.00 SEE OTHER SIDE CONTRACTOR LLC FIRST -CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD ONE WORLD PLUMBING SERVICES LLC JOSEPH MORISSEAU MGR 92 NE 49 ST MIAMI FL 33137 i1I III 11:I�IIIII111111h11t11Ii,111IL 1111, 11111111111J1Ls II KEN LAWSON SECRETARY 01 -10 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF RRANCUU. OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTI41 TO BE EXBIRPT FIROVI FLORMIA WOXERS' CON SATIt LAW CONSTRUCTION INDUS.JRY EXEMPTION This''certifies that the individual listed below has elected to be exempt from Rorida Workers' Compensation law. EFFECTIVE DATE PERSON: FEIN: 01/10/2012 EXPIRATION DATE: 01009/2014 MORtSSEAU JOSEPH 262624054 BUSINESS NAME AND ADDRESS: ONE WORLD PLUMBING SERVICES Lf.0 6821 MCCLELLAN STREET • HOLLYWOOD FL. 33024 SCOPES OF BUSINESS OR TRADE 1- CERTIFIED PLumma CONTRACTOR ' 3- SEPTIC TANKS 2- BACKFLOW SERVICES itarttaThR : Pomo to Derpi,er 440 . 05041. E.&. *o faker of a corporaolao who ekes Ire option trout his chapter by fniag •a eeraffc5te 01 electfaa ender this stolen war end recover beueliit.ea coespeosetioo owlet 1010 clover. Pommy to Ctrspler 448.051121. f.3.. Certificates 01 election to be eXeai. apply err ais& the scope at the 6atieeas err bale listed ea the =ace of election to be exempt. Persona to Draper 440.5611* F.S.. Bullies of eieafco to bri aia:pt aal certimcetes 91 etectioe io be except salt be sublet* to resanetioa N. at say time niter the palmy of the notice er the issuance ii the certificate. the pew aimed on the mice or certificate no longer meets Ma reenfreateat of this seeress fat issuance of a certificate. • Ile department *nit teroke a certificate at say time for failure N *9e hereof nome4 on lbe certificate to meet the requirements of title sectloa QUESTIONS? (850) 413 -1609 OWC -252 CERTIFICATE OF ELEnufd TO BE EXEMPT newsEri 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN . FOR FUTURE REFERENCE STATE BF.FLORLOA DEPARTN9iT OF FEWOJOAL SERVICES OMSION OF 1l 5 COMPEIMATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO SE EXEMPT FRCSS FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 01/10/2012 EXPIRATION DATE: 01/09/2014 PERSON: JOSEPH It1RISSEAU FEIN 262524054 . BUSINESS NAME AND ADDRESS: O E WORLD moss= soivr ES a L Sat: xOC:Ett4-1 A,KAt:- 40:.: . Et 3307a • SCOPE OF BUSINESS OR TRADE: • •; RT;FMG EVISIB .G CONTRACTOR 2- eRCaaLOw SERVICES 3• SEPT:C T4340 t IMPORTANT F Pursuant no chapter 44005(14 F.S., an officer of a corporation who elects exemption from this chaps by filing a certificate of election 1- under this section may rot recover benefits or compensation under this D owner_ Pursuant to Chapter 44©.16(121. F.S., Certificates of election to be H extmpt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. • E Pursuant to Chapter 440.15(131. F. Notices of election to be exempt and certificates of election to be exempt sfailrebe subject to revocation if, at any time after the filing of the notice• o the issuance of the ceraifscate. the perm named on the notice or itertificate• no longer meets the requirements of this section for issir4ice of a cerdficate. The department shad! revoke a certificate at tiny Mite for failure of the person named on the certificate to meet the re4uirerents of this section • QUESTION {850f 413 -1609 CUT HERE * Carry bottom portion on the job, !keep upper portion for your reports. -- OWC -252 CERTIFICATE OF ELECTION TO SE EXEMPT REVISED 01-1.1 May. 24. 2013 11:36AM No. 8153 P. ' CERTIFICATE OF LIABILITY INSURANCE MIbDIYYYY) 05-24-2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY MD 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 poticy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polleles may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER A.B.S. Insurance Consultants 11402 N W 41st Street Suite 213 Miami FL 33170 CONTACT NAME. PuuC. N F=0.(306) 5924144 1 n,i.(305) 715 -7227 " RFas_ Hlas(rDabsfnsurancefl.cam INSURERISI AFFORDING COVERAGE NAIL 0 INSURER A: Accident Insurance Company INSURED One World Plumbing Services LLC 0821 McClellan Street Hollywood FL 33024 CIOI /MR GAt: R IN,AIMPRa: Progressive Insurance Co. INSURER C: INSURER D: SOMBER E : INSURER P s REVISION 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 CONTRACTOR 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. ADDLSUMR INSR,WYD POLICY NUMBER IL75R TYPE OF INSURANCE GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY 1 CLAIMS -MADE a OCCUR B GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY I I Pia llfllf LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS CCP000S10B 00 POLICY YYf YY1 08/19112 IMMNI/DD Y1 08/19/13 LIMITS EACH OCCURRENCE DAMAGE TO AMMO PRFMISFS (Pa om,rrrnre) MED EXP Mrs: one personl $ 1,000,000 $ 100,000 PERSONAL &ACV INJURY GENERAL AGGREGATE $ 5,000 $1,000,000 52,000,000 PRODUCTS -COMP/OP AGO X AU07LED NON-OWNED s 08195478 -0 08111/12 08(11 f13 COMRINED SINGLE LIMIT (pia mMAwn�] RODILY INJURY (Per person) $ 2,000.000 $ 5,1,000,000 $ BODILY INJURY Ter accident) PROPERTY DAMAGE (par anrkian:) $ UMBRELLA LIAR EXCESS LIAM DED 1 1 RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Yl N ANY PROPi�J !_'1'OR/PARTNER/EXECL1TNl1--'N OFFICER/MEMBER EXCLUDED? I J (MandMOry In NH) r b , desofiDe under DESCRIPTION OF OPERATIONS beksv OCCUR CLAIM$ -MADE EACH OCCURRENCE $ $ AGGREGATE $ NIA DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (AUach, Plumbing Contractors CERTIFICATE HOLDER 1 TWCS T TU.1 1OT W. E.L. EACH ACCIDENT $ E.L DISEASE. EA EMPLOYEE $ E.L DISEEASE- POLICY LIMIT $ ACORD 101, AddIIMnal Remarks Schedu a timers apace le required) CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERiKOI', NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE <DA> ACORD 25 (2010105) ®1088 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD