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RC-12-2261Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 188357 Permit Number: RC -11 -12 -2261 Scheduled Inspection Date: April 02, 2013 Inspector: Bruhn, Norman Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: ACTIVE BUILDERS INC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132050070160 Phone: (305)638 -8420 Building Department Comments ONE BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 01, 2013 For Inspections please call: (305)762 -4949 Page 19 of 21 Im 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 �B LNG PERMIT APPLICATION Permit Type: BUILDING 32o NE f� JOB ADDRESS: City: Miami Shores County: Folio/Parcel #: t l— 3 g Q S -067-01G gaaME'VEn La 2 8 201 z� BY: Lsosomse2- FBC Permit Master Permit No. ROOFING 4ve- Miami Dade Zip: 32/1 Is the Building Historically Designated: Yes NO ./ Flood Zone: �o OWNER: Name (Fee Simple 'deholder): t ` ° ��Q l Phone#: �Q r Address: ��`�"'�i. as City: Tenant/Les e Name: Email: .\cl N -See t . State: CONTRACTOR: Company Name: Address: 1 S �: City: ' j ;t111>tit. Stag: Zip: Phone #: G �. VorS Qualifier Name: State Certification or Registration #: cc-7c 15' L C Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ WO Phone#: 5951-C(71-466 Zip: 7716 Phone#: Ce i icaatteeooff Co et cy • Type of Work: ❑Addition Description of Work: O'Alteration Square/Linear Footage of Work: ONew r OrNN Nit pair/Replace ODemolition Color thru tile: ******** * * * * * * * ** * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 7 J C- CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ NOV • CO /CC $ Bond $ 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 ETF,CTRICAL 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 COMIVIENCEMENT 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 b approved and a reinspection fee will be charged. Signature ` / t ( Signature Owner or Agent r Contractor The foregoing instrument was acknowledged before me this 3 I The for, �'.� ' strument was acknowledged before me this 6'r r day of , 20\ , by Jh ► —I ►fch&) , day o i 20 12, by_ Lpt o i21s9-457 who is personally known to me or who has produced who is personally known to me or who has produced F''L. As identification and who did take an oath. 'a)s24 vi_,(.. (!.as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My i J /41J 1 / onmlission * * * * * * * * * * * ** 11 , 11 APPROVED BY YAMILIA COLMENERO Notary Public - State of Florida • My Comm. Expires Sep 19, 2016 • Commission # EE83641X** * * ,W a#* j Assn, /�. C1/41 Plans Examiner ...rte Sign: —� Print: /ENV My Commi�.,�►rr NOTARY PUBLIC STATE OF FLORIDA Comm# DD961509 *�kM��h+ Nib+ 6N� +pd�b�Nb�N+PN�4M�BN�Psk�k.>'�,, M 14 Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3 /1909) ...maul. e.auuj rc■ viowge APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT. TO COMPLIANCE WITH ALL FEDERAL STATE AND COI INTY RULES AND REGULATIONS crEC' WENve. BATHROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED 13661emwievN +0 \De reinoAe/lerk w ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. 11 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. PL-+ I I - I "1- ��vt AX FOLIO NO. R1 - II °11-Z41 STATE .o�I STATE OF FLORIDA r:, Utz COUNTY OF MIAMI -DADE: 'HERESY JA pail! THE UNDERSIGNED hereby gives notice that improvements will be ma ' property, and in accordance with Chapter 713, FPorida Statutes, the folio is provided in this Notice of Commencement. NA By 11111111111 1111111111 1111111111 11111 1111 1111 CFN 2013R0028671 DR Bk 28439 Ps 4303; (199) RECORDED 01/11/2013 13:14:57 HARVEY RUVIN, CLERK OF COURT MIAl1I -DADE COUNTY► FLORIDA LAST PAGE DA, COUPITYOF DADE Mettles is a tuo copyofthe a on A"dy of A.►o;-1 . Space above reserved or use of recording office 1. Legal description of pr p rty and street/. •dress: S -q s 4 .1 4C PL (ice JJcN' fat. 0 t. / I S " ( 3 Si VE ()YT 4'Q viiavA; , 'S FL 3 ( 2. Description of improvement: r'1 fk( %\(r on Pe 1i 3. Owner(s) name and addressCC.5iL . 6, k Interest in property: 1'( St\ f, Name and address of fee simple titleholder: • '" l.• i '4 r, 4. Co ractor name, a and plume number: t C VJf( tawy H-- . 3iCa 3as - 3atk -,:ak 5. Surety: (Payment bond required by owper from contractor, if any) Name, address and phone /, mber: Amount of bond $ I re L �� Hi; C+ �1? J` ' 6. Lender's name and address: (CAA al0 `3tSc.& e LSD t �J"�� J� 7. Persons within the State of Florida desig ated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, r� /(9, �j /� ill sf 1 Noel-1N itgw,t 8(�4c� Nom, ddress and phone numba'CF lima / r s j Ft- ('42 3oS" �' . 2& ,11 8. In addition to himself, Owners designates the following person s) to receive a copy of the Lienor's Notice as provided n Section 713.13(1)(b), Florida Statutes. address and ph ne number. 1/1/ �` fit' SAC eta f S . 1 -;ate' 9. Expiration date of this Notice of Commencement: Baru 05 or cove (the xpiraon date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of • _ er(s) or Owner(s)' Authorized Officer /Director/Partner /Manager Prepared By Prepared By Print Name 111110,M 7M Print Name Title/Office Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE �- The foregoing instrument was acknowledged before me this day of ividually, or ❑ as for ❑ B y Personally known, or roduced the following type of id Signature of Notary Public: Print Name: (SEAL) 2 .1 ' ' , ; .. ,..Z . r V!EZ.V .: irAMNiffArAmw VERIFICATION PUR UANT TO SECTION 82.525, FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature( of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner(Mannager h 'gne above: By By 123.01 -52 ;ifYA firs- MARIAE. MYCOWIMSsioN #DD Bonded thru Nog/ S Public u 201 rs GE3 Otto 10-31-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO RE 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 I aw. EFFECTIVE DATE: PERSON: 12/07/2012 EXPIRATION DATE: 12/0712014 BERNSTEIN FEIN: 263052072 BUSINESS NAME AND ADDRESS: ACTIVE BUILDERS INC 1387 NE 179 ST NORTH MANX BEACH FL 33152 SCOPES OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR RODRIGO IMPORTAIT: Pursuant to Chapter 440 , O5i/44, p.S. an officer of 8 Carporotion who elects exemption from this caper by filing a certificate of election under ibis section may net recover benefits or compensatioa under this chapter. Pursuant to chapter 440.0511Z, P.S., Certifkates of election to be exempt._ apply only within the scope of the business or trade listen on the notice at election to on exempt. losesuant to Chapter 4411,00M F.S, Notices of election to be millet and certificates of election to be exempt shall he subject to revocation if, al any time after the filing et tag notice or the issuance of The certificate, the person runnel on the notice or certificate fle len" goads the ratitateRteeto of this Meilen for ;nuance of a certificate. The deparbsent shall revoke a tertificate at any time for failure rd the person named ea The certificate to meet the requiremems of thin &WW1. LIWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 OUESTIONS? (9.601 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES INVISION OF WORKERS' COMPENSATION CONSTRUCT/ON INDUSTRY CERTIFICATE OF ELECTION TO BE ExEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 12/07/2012 EXPIRATION DATE: 12/07/2014 PERSON RODRIGO BERNSTEIN FEIN: 263052072 BUSINESS NAME AND ADDRESS: ACTIVE BUILDERS INC IRB7 NE 'iS ST NORTH MIAMI SEACH, P, 362 SCOPE OF BUSINESS OR TRADE: 1- sACEtiSED GENERAL CONTRACTOR F r, Pursuant to Chapter 440,05(141, F.S., an ufficer of a corporation who ‘4 elects exemption from Cho chapter by filing a certificate of election IMPORTANT DL cutiandeptrerthis section may not recover benefits or comPensation wider this H Pursuant to Chapter 440.135(12), F.S. , Certificates of election to be exempt... apply only within the Scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), FS.. 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 !anger 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 4meet the requirements of this section. OLUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 d Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188001 Permit Number: PL -11 -12 -2262 Scheduled Inspection Date: March 27, 2013 Inspector: Hernandez, Rafael Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: FULL PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050070160 Phone: (305)303 -2157 Building Department Comments PLUMBING WORK FOR ONE BATHROOM REMODEL 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 CREATED AS REINSPECTIO FOR INSP- 182235. March 26, 2013 For Inspections please call: (305)762 -4949 Page 11 of 20 a CERTIFICATE OF LIABILITY INSURANCE DATE irMAIDDITYYY' r 12/18/12 THIA barrif lsemre IS ISSUED AS A MATTGR OF INFORMATION ONLY AND COWERS NO R1cI4TO UPON THE CERT1r GATE• MoLOGP. 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 etc certiticst• hoisted IS an ADDITIONAL MIMED, she poHeylinl must be endorsed. 0 SAIROGATION IS WAIVED, subject to the terms and Sammons am policy. certain pollees may require en endorsement A Statement on 0116 certUicate doh not caller rights to the certificate holder In ReU- ot.such en rsernelft(i). --• -• Paccomen All American Insurance 9038 SW 152nd St. Mleml, FL 33157 Phone (305) 233-0855 Fax (305) 235.8806 IN3uRED Full Plumbing Inc 1330 West 46th St 015 Hialeah, FL 33012 COVERAGES 305 IONQ MACGREGOR P„ot►F may 2330855 SANTI®KINOINSuRANCE.COM INSURERS) AFFORDING COVERA, iNsUREN A : LLOYDS OF LONDON `.ao�: 0305) 2�siios INSURER c : INSURER D INSURER E : _ INSURER F I _ CERTIFICATE NUMBER: REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TI•tE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT YO WHICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEMMS, EXCLUSIONS AND COMMONS OF SUCH POLICIES, WITS SHOWN WY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD BR ppLlGl OFF POLICY EX GENERAL LIAWLrr • COMMERCIAL GENERAL LIABILITY O o CWMS•MADE OCCUR A GENL AGGREGATE UNIT APPLIES PER: Se POLICY ❑ PRb- LJ LOC AUTOMOBLE LUAaILIDT LI ANYAUTO ❑ ILL OWNED ❑ SCHEDULED LED O Homo A11tos ❑ Aug NED L� ❑ ❑ UMBRELLA LIB Li ocGUR n wreESs –LIB ❑ oLAIMS.MAUE ND ❑ RETEIVT1ON POLICY NUMBER OME021030 WORKERS GOMPENa*T1ON ANA EMPLOYERS' UAaILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER,NEMBER EXCLUDED? IMendltary In M9 L. _1 II As,. describe under DESCRIPriOtt OF OPERATIONS Mow NIA —t 05/09/2012 05/08/2013 LIMIT$ EACH OCCURRENCE S 1,000.000.00 DAMAGE TO RENTED _' ... _ PREMISES fEa ocaure . 3 100.000.00 MLD Fxa (Any see mum) S 5,000.00 PERSONAL d ADY INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGG C�td$IISI E LIMIT s 1.000,000.0) s 2,000,000.00 $ 1,000,00.00 s BODILY INJURY (Per parsec) 8ODILY INJURY (Pet .. WAGE WI" S s i EACH OCCURRENCE AGGREGATE WC STATU• L EACH ACCIDENT El DISEASE + EA EMPLOYE $ E L DISEASE,. POLICY LIMIT S $ 3 OTH. erne npP'noa OF orquovnON$ r LQCAY$O►at r Vm41er.ES (Aem.ti Af:Mtn 141. Addilienal Rfl1efI5 Ec,10u4+ M MOM space 11 re1u1red) THE PARTY LISTED BELOW IS RECOGNIZED AS CERTIFICATE HOLDER WITH REGARDS TO GENERAL LIABILITY CERTIFICATE HOLDER CITY OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2nd AVE MIAMI SHORES, FL 33138 ACORD 25 (2010108) OF Z/Z d CANCELLATION SHOULD ANY OP THE ABOVE DESG*MED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDyQ+RESEH! 180111.2010 ACORD CORPORATION. All rights neservad The ACORD name and logo 030 registered marks of ACORC 0£5L 089 0081 tt 86L614'650£ X3NNV 1V1S0d 1E:91 11Z-Z1-210Z 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: (13';e, N % q- /*, City: Miami Stores Folio/Parcel#: O, '001- 0 6 0 Is the Building Historically Debated: Yes County: FBC 20 Permit No. Master Permit No TECM-11 \ri 13V 2. 9. 1e r,.,. �__�000e000 Miami Dade Zip: 3 3 13 g NO ✓ Flood Zone: � OWNER N a m e ( F e e Simple T i t l e h o l d e r ) : 1 \ i ‘ V Y " n 'r ) +C. {'i� ht Phone#: -116-2.2,1-7-463 Address: SO, Yvt P. ct s ctb a v-e- City: State: Zip: Tenant/Lessee Name: Phone#: Rmail: i0 In. v1 a5 fem 3vYa t t , ca m CONTRACTOR: Company Namef :� (d /l / U 4. b Address: /3,0 GJ T X77 �°— / City: i Gr /a-4 /1 State: PC Zip: 330/ Z Qualifier Name: 4I, -4 h/ a AA/7e r7 v Phone#: 3 t5 33 t 3 2( 5 State Certification or Registration #: / G / Y z » 3 Y Certificate of Competency #: Contact Phone#: 3 0 3V 3 2-/5--? Email Address: G, 4 L jP Z '» 6 /' c€ y 4 /Iv o o DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 1 Q00 Square/Linear Footage of Work: Type of Work: C3Address DAlteration New Uffepair/Replace Demolition Description of Work: %it OO VV rei w`o c Q) Submittal Fee $ Permit Fee $ / 5 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ / Structural Review $ , TOTAL FEE NOW DUE $ mien ii 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 FT 1 CTRICAL 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 ; ' proved and a reinspection fee will be charged Signature Signature Owner or Agent The foregoin ' , nt was acknowledged before me this I day of A®Y'thAei 20 i-,, by .b hir thAc \\e. `1 , who ;c xson&ly knn or who has produced As identification and who did take an oath. NOTARY PUBLIC: 40 ���`�►� +i +t�,,�� Or ,•`` N t4d ''' Sign: • *Comm Q 'r •: Print % i Il ell Tavarez = No. EE 3921' . NOTARY a. c My Commission Expires:0')- o)- ao ( i„ ,,,,gy�pp OF Ft.191r;, * * **** * * ******** *0** ****** * * * ******* ** ********** xa s***** ******s ***w *s+ ova+e********+ ****** ***** * * * **** ** Contractor The foregoing instrument was acknowledged before me this t ct day of ' , 20 12., by Xi who is personally known to me or who has produced DQ- as identification and who Do AS A. CANIZARES NOTARY PUBLIC: * NOTARY PUBLIC STATE OF FLORIDA Comm# EE023190 Sign: Expires '/� 9/19/2014 Print / � l' eA.4 rzs My Commission Expires: G1 s k� Zp �L1t APPROVED BY / 1. /02' 3 1 �' Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10/07)(Revised 06/10t2009)(Revised 3/15/09) Zoning Clerk 1/9/12 Mani -Dade County. Real Estate Tax Information Real Estate Tax information Show Me: PropertyR es Search By Select Item Detail Tax Information: Real Estate Tax Info 2012 Taxes Prior Years Taxes Due 2012 Ad Valorem 2012 Non -Ad Valorem 2012 Back Assessments 2012 Enterprise Folio 2012 Historical Abatements 2013 Quarterly Payments 2012 Tax Notice /Memorandum © 2002 Miami -Dade County. All rights reserved. Real Estate Tax Information Today's Date: 11/09/2012 Last Update: 11/07/2012 Tax Year 2012 Folio Number. 11 32050070160 MIAMI SHORES Owner's Name: JOHN MITCHELL WEI EN CHEN Property Address 9330 NE 12 AVE Mailing information : JOHN MITCHELL WEI EN CHEN 9330 NE 12 AVE MIAMI SHORES FL 33138 Legal Description : 5-6 53 42.25 AC PL OF GOVT LOT 4 PB 5-90 BEG NE COR OF LOT M W110.59FT SW109.21 FT E94.41 FT N ALG Ell. OF To view 2012 Tax Notice /Memorandum click here Amounts due if paid by 11/30/2012 in U.S. funds Please be aware that for security reasons only 1E6+ and like version browsers are supported for online payments PAY NOW If payment is not received by the specified date the total amount due is subject to change. Amounts due are subject to change without notice. IA QU (IDADE Contact Information( E -Mail: proptax@ miamidade.gov (305) 270 -4916 Downtown Office: 140 W Flagler St., Room 101 Miami, FL 33130 Office Hours: Mon - Fri 8:OOAM -4:30 PM Related Links: Tax Collector Property Appraiser Florida State Dept of Rexenue Property Tax Home 1 Real Estate Tax Info 1 2012 Taxes 'Prior Years 1 2012 Non -Ad Valorem 2012 Back Assessments 12012 Enterprise Folio 12012 Historical Abatements 12013 Quarterly Payments 1 2012 Tax Notice /Memorandum Miami -Dade Home 1 Using Our Site 1 About 1 Phone Directory 1 Privacy 1 Disclaimer E-mail your comments, questions and suggestions to Webm aster vsys. niarridade.gov:1608/w w w sere /ggvt/txcaw 01.dia?foio= 1132050070160 1/1 Scope of Work: 9330 NE 12 Ave. Miami Shores, FL 33138 1. Remove and replace all the tile /wall board on the walls and floors 2. Remove and replace shower, toilet and vanity 3. Remove and replace the shower faucet valve and drain. 4. Move the shower wall back against the other bathroom wall. Si Yom/. 03-02-2011 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 CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 03/02/2011 EXPIRATION DATE: 03/01/2013 ABREU ANTONIO 263597171 BUSINESS NAME AND ADDRESS: FULL PLUMBING INC 1330 W 48TH STREET, APT 15 HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(12), 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 at election to be exempt shall be subject to revocation If, at any time after the tiling 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) 413-1E DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK PATENTED PAPER AC 620240 STATE OF FLORIDA DEPARTMENT bF'BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEW L12o7140028 LICENSE NBR 07/14/2012 120007451 CFC1427.93' The PLUMBING` CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapt Expiration date: AUG31, 2014 FULL PLUMING INC 133Q WEST 46TH STREET HIALEAH RICK .;SCOTT GOVERNOR FL DISPLAY AS REQUIRED BY LAW 1LEN : LAWSON SECRETARY THIS BU4AESS NA / LOCATION FULL PLUMBING INC 1330 W 46 ST 33012 HIALEAH OWNER sE y J NG INC TazatURNWIALTY BUILDING DOES NOT PERMIT THE HOLDER ISTING REGULATORY ANY EXISTING R ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUAUFICA- T1ONG. PAYMENT RECEIVED MIAMI -DADE COUNT`, TAX reu I FCTOR: FIRST -CLASS U.S POSTAGE PAID MIAMI, FL PERMIT NO. 231 IS NOT A BILL - DO NOT PAY �EwAL RE �F 666364 -6 STATE* 'CFC1427934 15 WORKER/S CONTRACTOR DO NOT FORWARD FULL PLUMBING INC ANTONIO ABREU PRES 1330 W 46 ST 15 HIALEAH FL 33012 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 186487 Permit Number: EL -12 -12 -2364 Scheduled Inspection Date: February 28, 2013 Inspector: Devaney, Michael Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: SMART POWER ELECTRICAL SOLUTIONS, CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050070160 Phone: (305)525 -8322 Building Department Comments BATHROOM REMODEL\ 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 7=67/3 2 i3 February 27, 2013 For Inspections please call: (305)762-4949 Page 30 of 35 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: Electrical l�ectrical {� JOB ADDRESS: Sac 6 1 1'�'Vei FBC 20 /0 Permit No. XZ 69". Master Permit No. /02 �-�. 2 / City: Miami Shores County: Miami Dade Zip: 1 3 13 g Folio/Parcel #: \ 1" 5d\ O S' 001-0 It 6 Is the Building Historically Designated: Yes NO / Flood Zone: OWNER: Name (Fee Simple Titleholder): JOV�V1 10■1 "fc) ► 1 Phone #: 63 Address: 50V AR, a b C2b CM, City: State: Zip: Tenant/Lessee Name:_ Phone #: Email: y0`ryylag )tK\Gtt \ . (10 �M CONTRACTOR: Company Name: `� w. �:,r� �c . �� e r F { c �� 6 oe■ Phone#: 305 - 51 5 — ; 2 �. Address: 2 k' 5 5-,c.. `30 c---C City: Cx vw.:. State: � L Zip: 3'3 c 3 3 Qualifier Name: -To c sy. C) 2.,( v 0 .e 16 Phone #: 305 - 5 Z 5 -'6 3 2. Z State Certification or Registration #: ER, l ?6 0 \ `t 2-q "5 Certificate of Competency #: 0 9'E 0 0 02.0 6 Contact Phone #: Email Address: } 0 e \ '_ c -s t N Cc.L 1 0 kik o-c U,. 0.... e &0 w, DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 1 000 Square/Linear Footage of Work: 313 Type of Work: UAddress ❑Alteration 3N_w Description of Work: — �Q4(00 001 Vin ********* * * * * * * * * * * * * * * * * * * ******* ***** Fees**** *+ x**+ x******: x*+ x*+ n***+x************ ***x:+r*** Submittal Fee $ Permit Fee $ /.g (, ` CUO CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 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 ace of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature .)c)\4\v\ Owner or Agent The foregoing instrument was acknowledged before me this day of betanober, 20 I, by 1iibLn ME -6, , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My C Signature ontractor The foregoing instrument was acknow edged before me this da f ,e(24444:5420 by 0-76&.--F'41,1)W� f<ho is personally known to me or who has produced as identification and who did take an oath. mmission Expires: * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY . •.,, YAMIUA COLMENERO �'� Notary Public - State of Florida My Comm. Expires Sep 19.2018 Commission #► EE 838588 Bonded Through National Notary Assn. NOTARY P t LIC• Sign: Print: 1 1 My Commission Expires: ***************** ******** ******** ***** **** **** ** PUBLIC -STATE OF FLORIDA ,�a• "" Antonio Cubenas Commission # EE055273 .Expires: JAN. 30 2015 leg Z ATLANTIC u - m o „ss p.,11W. s' Z / b94- Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk