PL-12-2348Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182840 Permit Number: PL -12 -12 -2348
Scheduled Inspection Date: January 03, 2013
Inspector: Hernandez, Rafael
Owner: SOTOLONGO, SERGIO
Job Address: 1249 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: PHB LANDSCAPING CO LLC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number (305)206 -1767
Parcel Number 1132050080060
Phone: (305)255 -4000
Building Department Comments
SPRINKLER SYSTEM INSTALLATION
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
January 02, 2013
For Inspections please call: (305)762 -4949
Page 13 of 26
19\124,2 Itf+
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
3)E?Mli
glf � CEO: 1 1 2012
B Y: t ...._
Permit No )g,--)N?,
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): Phone#:
Address: 12., if I ®(' . 10 0
City: i I`1 i c� State: Zip: �:3 i 3 q
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 2. 9 C'
City: Miami Shores
County: Miami Dade Zip: "331 3R
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address: .. c
City: /Y/14
Qualifier Name: C AVA t7_s'
PH13
0
L'!
NO Flood Zone:
State: p
I\10 C.1)
Phone #:2O -410
CAW QP14"
Zip: 33 9 5 7 j
Phone #: 305 g 5° O2j
State Certification or Registration #: Certificate of Competency #: 0 P 0 0 1 I
Contact Phone #: 105- 3 41 5 02. CI L( Email Address: 10 1110 ® hev_ 1(3 ou+1'
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ C) 0 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ji1New ❑Repair/Replace ❑Demolition
Description of Work: LAW t)"04 1,67
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fees * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
* * * * * * * * * * * * * * * * * **
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 Fl ECTRICAL 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 ap 1, oved and a reinspection fee will be charged.
Signature
Signature
0 er or Agent
The foregoing instrument was a + owledged bef. = m: is .11_, The fore •ing ins
day of —, 201 P)! by
gait _u�� jkt� day of
i• 14
Pois pe �onall known to me or who as produced
OP `� 1.121 -M1 dentification and who did take an oath.
NOTAR PUBLIC: " •
Sign:
Print:
My Commission Expires
Contractor
ent was ac edg
20t2'b
w • is 1 e onally kn
to me or who has produced
ntification and who did take an oath.
TARY PUBLIC: -'
CLA St eta, of Florr
Public q 2015
r" m ExP`rr' 128810
° \•:M`om #EE
Commission Assn.
Bonded Through National Notary
* * * * * * * * * * * * * * * * * * * ** ** * **
APPROVED BY
Sign:
Print:
My Commission Ex
♦1
Fth *.11!� I _ stLLOS
Notary Pubic - State 01 Florida 015
5 My ar'm
Commission # EE 128810
h National Notary Assn. Through ` OF f 4'\\ Bonded 9
,'� /111111 \\
********************* * * * * * * * * **** * * * * * * * * * * * * * * * * * ** f * * * * * ** f * * * ** ***** * *** * **
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
DEC -25 -2012 23:00
ACORD. CERTIFICATE
PTL INSURANCE
OF LIABILITY INSURANCE
PRODUCER
PTL INSURANCE ASSOC., INC.
7201 CORAL WAX
MIAMI., FL. 33155
305 -262 -7094
INSURED
PEE LANDSCAPING
16440 SW 102 PL
MIAMI, FL 33157
J305)255-4000
COVERAGES
305 262 4907 P.01/01
UM I I. 1VUWUW U i 1
12/26 20'12
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 SY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURER k ASCENDANT
INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NAMED ABOVE
DOCUMENT WITH
IS SUBJECT TO
DATEYMM/DDD EFFECTIVE'
FOR THE POLICY
RESPECT TO WHICH
ALL THE TERMS,
PDATcEYEXP�D/YY
PERIOD INDICATED. NOTWITHSTANDING
THIS CERTIFICATE MAY BE ISSUED OR
EXCLUSIONS AND CONDITIONS OF SUCH
LIMITS
LTR
NSRD
TYPE OF INSU ' r:....
POLICY NUMBER
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
GL37622
06 -27 -12
06 -27 -13
EACH OCCURRENCE
3 1 000 000
X
PREMISES (Ea occurencc)
3 50,000
CLAIMSMADE fl OCCUR
MEDEXP (Any one poman)
$ 5, 000
PERSONAL & ADV INJURY
$ 1,000,000
1_12 000 , 000_
GENERAL AGGREGATE
GEN'L
—I
AGGREGATE LIMIT APPLIES PER:
POLICY n 28, f1 LOC
PRODUCTS - COMP/OP AGG
s 1,000,000
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON- OWNEDAUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
�—
BODILY INJURY
(Per person)
$
BODILY INJURY
(Peraccldent)
$
--
PROPERTY DAMAGE
(Perac ideal)
$
GARAGELIASILITY
ANYAUTO
AUTO ONLY- EAACCIDENT
$
—
EA ACC
OTHER THAN
3
AUTO ONLY: AGO
$
EXCESS/UMBRELLA
—I
LIABILITY
OCCUR E CLAIMSMADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
-7
$
WORKERS COMPENSATION AND
EMPLOYERS' LtASILITY
ANY PROPRIETOW1ARTNEwocECUTIVe
oROIC @RANEMBER EXCLUDED?
If yes, describeunder
SPECIAL PRDVISIONS below
TORYLIMITS DER
E L. EACH ACCIDENT
$
E.L. DISEASE • EA EMPLOYEE
$
E.L DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEWICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
LANDSCAPING
ALnTir.A A T.• IAA.. w -w VA.
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 33138
305 -756 -8972
ACORD 25(2001 /08)
CANCELLATION
SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOR
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR L /CITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REP'
CORD CORPORATION 1988
TOTAL P.01
CT B
Construction Trades. Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
06P000940
PHB LANDSCAPING CO LLC
D.B.A.:
TINOCO CARLOS
Is certified under the provisions of Chapter 10 of Miami-Dade Coranty
584328 -0 cc��cc
Bul illtibSG� lING co LLC
10271 SW 164 TERR
33157 UNIN DADE COUNTY
THES IS NOT A BILL - DO NOT PAY - RENEWAL
CC 0 06PUNS0940
P H B LANDSCAPING CO LLC*
WORKER/S
seegrOgrATTY PLUMBING CONTRACTOR 2
THIS EX ONLY A LOCAL
BUSS TAX RECEIPT. l
DOES NOT PEST THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY ZONING OF TIM
COUNTY OR ann. NOB
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE
NNAC
NOT ACERTIFICATION OP
HOLDER'S THE '�L'�A.
PAYMENT RCERSD
WMIHMDECMWMTAX
COIJLECTOM
09010086001
000082.50
DO NOT FORWARD
P H B LANDSCAPING CO LLC
CARLOS TINOCO PRES
16440 SW 102 PL
MIAMI FL 33157
FIRST -CLASS
U.S. POSTAGE I.
PAID
MIAML, FL
PERIMT NO. 231
609270 -4
17iliiilliiiiillddlinlilllinulidulllililllillill gid
SEE OTHER SIDE
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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: 8/812012 EXPIRATION DATE: 8/812014
PERSON: TINOCO CARLOS • E
FEIN: 650389199
BUSINESS NAME AND ADDRESS:
PHB LANDSCAPING CO LLC
10271 SW 164 TERRACE
MIAMI FL 33157
- SCOPES OF BUSINESS OR TRADE:
AUTOMATIC SPRINKLER
INSTALLATI
Pursuant to Ct r44o.05(14), F.S., an officer of a comoiafion who elects exemption from this diapter by tiling a certificate of eledon under this secdon may
not recur benefits or compensation under this chmter. Pursuant to Chapter440.05(12), F.S., Certificates of election to be exempt... apply only war the scope
of the business or trade listed on the notice of election to be exempt Pursuant to Chaps& 440.05(13), F.S., Notion of elecfimr to be exempt and certificates of
election to be exempt shalt 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
c erttfic ate no longer meets the requirements of ibis section for Issuance of a certificate. The department shy revoke a certificate at any tkne f rfafiure of the
person named on the certificate to meet the requirements of this section.
DFS- F2-DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609
LOT 3, BLOCK 1
F.I.P. 5/8°
NO I.D.
0.8'E,1.2'N
S.I.R. 1/2°
LB .#6135
(75.00') (25�0� x –}—
FENCE,0.4'S,0.6'E
LOT 2, BLOCK 1
F.I.P. 5/8°
NO I.D.
75.00`
5' U.E.
� E. 25..'
LOT ;1
BLOCK '
14.4'
H
0
J
O
2 STORY
RESIDENCE
#1249
F.I.P. 5/8"
NO I.D.
0 FEN
0
J
(50.00')
CE,0.1'5,0.0'W
CORNER
FALLS IN
FENCE
L�
0
w
b
O
a
. t�
W
D
01 Z --I o
11) ~ Z mo
O (f)—
W O
Z
FENCE,0.0'E U
20.1'
COVERED
PORCH
0
F.I.P. 5/8°
NO I.D.
0.8'E,0.9'N
(75.00'),74.87'(M)
175.00'(P)
$URVEY NOTES
- CONCRETE DRIVE
CROSSING THE SOUTH
SIDE OF LOT.
-THERE ARE FENCES
NEAR THE BOUNDARY OF
THE PROPERTY AND
CROSS THE WEST AND
EAST LOT UNES.
S.I.R. 1/2°
LB #6135
75.00'
S.I.R. 1/2°
LB #6135
F.I.P. 5/8°
(50.00') NO I.D.
75.10'(M)
N.E. 100th STREET
.:...: 60' R/W (ASPHALT).... :..
0
M
•
(SIGNED)
PAGE 2 OF 2 PAGES
BOUNDARY SURVEY
SURVEYORS CERTIFICATE
I HEREBY CERTIFY TFIAT THIS BOUNDARY SURVEY
ISA TRUE AND CORRECT REPRESENTATION OFA
SURVEY PREPARED UNDER MY DIRECTION.
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL,
OR A RAISED EMBOSSED SEAL AND SIGNATURE.
DIghtfly T by Clyde
McNeal
DN: CN = Clyde McNeal, C =
US, 0 = Target Surveying, Inc.
Date: 2010.12.1312:45:45 -
05'00'
Clyde
�--- McNeal
CLYDE O. MoNEAL, PROFESSIONAL SURVEYOR AND MAPPER #2883
LB #6135
TARGET
SURVEYING, INC.
SERVING ALL FLORIDA COUNTIES
6250 N. MILITARY TRAIL, SUITE 102
WEST PALM BEACH, FL 33407
PHONE (561)640.4800
FACSIMILE (561)640-0576
STATEWIDE PHONE (800) 22633807
STATEWIDE FACSIMILE (800) 741 -0576
•