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RC-12-23897 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188170 Scheduled Inspection Date: March 29, 2013 Inspector: Bruhn, Norman Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project: <NONE> Contractor: A&J GENERAL CONSTRUCTION CORP. Permit Number: RC -12 -12 -2389 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1131010330050 Phone: (305)599 -2782 Building Department Comments BATHROOM REMODELING Infractio Passed Comments INSPECTOR COMMENTS False 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- 188002. re- scheduled by nancy March 28, 2013 For Inspections please call: (305)762 -4949 Page 27 of 32 NOTICE OF CO ENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION 1111111 1111111111 1111111111111111111 11111111 PERMIT NO. (�- ©�� j 1 TAX FOLIO NO. //-- /20/- ,05,,3 -4650 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Lam.I description of property and street/address: Cd i 4,--' __ ' ! CF P4 2013R0003254 OR Bk 28425 P9 4395; Ups). RECORDED 01/02/2013 15 :3405 HARVEY RUVIM, CLERK OF COURT MIAMI-DADE COUHTYr FLORIDA LAST PAGE rmmalturigmfger)fr_, e4 ✓ / 2. Description of improvement: riu 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder Space above reserved for use of recording office /f!:4 =-6 X150 %1 1; /►�• mil rr/m, .! 4. Contractor's name, ,address and phone number: a. T '7 � 62.#57- 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: ,30/o 29 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration 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 • e) or 0 er(s)' Autho ' ed 'repared By )■Print Name peg Title/Ofice STATE OF FLORIDA COUNTY OF MIAMI -DADE The forer oing instru ent was acknowledged before me this By ZItL •1, il4,7S ❑ Individually, or ❑ as for Personally known, or ❑ produced the following type of iden Signature of Notary Public: Print Name: (SEAL) PUR UANT T • SECT! • N 92.5 FL • RIDA STA f perjury, I declare that I have read the foregoing and ed 1 it are tru -• to the best of my knowledge and bel r/Director/Partner /Man Prepared By Print Name{ a.0 Title /Office 2 day of 3"� ,. v lam/ VERIF A ON Under penalti that the fact Signature(s) By 2,E) 13 rr7T Y ) or:O . r(s)'s Authorized Officer/Director/part 123 01-52 PAOEE3 9/12 By .SEA. y -;�Ifi�tif�—S;a � � e" eZA[eW;Ivaiw.�,,....w, G?� aer•�Ytjy� ,, PG .,`�4Rie'i,�' A d " . 4' • +...'c4� ";..� "!Sad.''".`' 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: JOB ADDRESS: .5�o'�-/V G() 9%61 City: FBC 2010 Permit No. Master Permit No. C(a 351 ROOFING Miami Shores Folio/Parcel #: 1131 0 6 0 - 6 ( ' ) 0 5 (� County: Miami Dade Zip: 3 3 `5-4e) Is the Building Historically Designated: Yes NO 0/ Flood Zone: OWNER: Name (Fee Simple Titleholder): J. to, rlo_ r�� Phone #: Address: .5 Q_.. A) (A,.) C49 34 City: M i0. lrn S-0 r2 S State: E ( Zip: 3 Tenant/Lessee Name: N) I A Phone #:. Email: CONTRACTOR: Company Name: A 4. S 6'Q 'e (OJ cor\--(ra c) r 0.4 Phone #: eays -s95 Address: 17 9.51 7 /j t.t) 6.6/ 6. City: is.-Pia ; State: rif Zip: 3 3 / Co Phone #: Qualifier Name: M 16 V €.1 ClU err e gr Q State Certification or Registration #: C. E7C 15/ (4 4 c7,5 Certificate of Competency #: Contact Phone #: 3 Ds" X99 g Email Address: 5 d Q a QVrc1 3 & G e rr DESIGNER: Architect/Engineer: IQ Phone #: Value of Work for this Permit: $ : NNNN / Uv U Square/Linear Footage of Work: Type of Work: Addition n Alteration ❑New epair/Replace Description of Work: o Q sit kja Demolition • a {; ******** *** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * *** * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ �0' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Ill • 90 Bonding Company's Name (if applicable) N� 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 o curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve, a ,.' a : inspe n fee will be charged. Signature Owner o Agent The foregoing instrument was acknowledged before me this 5 day of 2c.— , 20 I2- , by L/`/ I/Aq e■ke who is psh to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /I/I /9ri' / G','/e'/ 6 Contractor The foregoing instrument was acknowledged before me this day of cery43.er,20TZ. ,by 1M, \4v@j er who is personally known to me or who has produced as identification and who did take an oath. My Commission Expires:/r/R /t A • =3UE1. GUER • MY COMMIS S ON # DD973 i0 EXPIRES Match 22.2011 NOTARY PUBLI !/. /1 Sign: Print: APPROVED BY sae.Ote3 Structural Review (Revised 3 /12 /2012XRevised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) • emission Expires: Prtr..r1 D- `i• -ZVl Zoning Clerk NER: Liliana Leret ADDRESS: 52 NW 99th Street, Miami Shores, EL 33150 RE: Bathroom remodeling Scope of Work: Demolish and remove existing bathroom and fixtures Replace existing tub with a ceramic tiled in shower Replace existing toilet with a new toilet Replace existing vanity cabinet with a new one Install new sink, faucet and shower fixtures INSUIJ\I T 'COD 4Cr � O §NQXIDE DETECTOR TIC ,E \ND RUBBER SRS TO BE REPLACED. APPROVED:: Miami Sbbote. VIII e ZONING DEPT .................. _....._.. BLDO.:DEPT UBJECT - FEDERAL STATE AN, CC!. 5 l t E, TNT EGULATIONS • (TOTAL) Mslress 52 N.W. • 99th STREET qa m i �a,�Ptig 16.00' PARKWAY 100.00v (R41,) t. p+rM Act ri NORTH SCAT :1 " = .2C' -24.85' Jx i„ 1.c r�a 14.E 1.45' A/4; ba-tir room 3" ?t3 "9\4244)4e A1.1 02..ynerri- iboarck Ghoouar 0.cect keptosz Re j3lc ce, Li tit f -kkore R.ep tat& e kc) w e r . 6kotter vat tie ONE -STORY U)ENCE \1o.52 sEPs kftw r 15" ALIZY -�.�.. 1 o,oG' ASPHALT PAVCMEV91 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 187320 Scheduled Inspection Date: March 13, 2013 Inspector: Devaney, Michael Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ON CALL ELECTRICAL CONTRACTORS INC Permit Number: EL -12 -12 -2391 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010330050 Phone: (786)388 -5880 Building Department Comments REPLACE FIXTURE 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 2)/2— / 3 e a (.J" March 12, 2013 For Inspections please call: (305)762 -4949 Page 43 of 43 Miami Shores Village Building Department DEc 18 2012 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 Typ ,' Electri JOB ADDRESS: R /i%W 9/61 City: Folio/Parcel #: FBC 20 (0 Permit No. L $ 2 - s9 Master Permit No.i2-L Miami Shores //3/ County: Miami Dade Zip: 3 3 L.-® Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): /4124 f- Phone #: Address: 5A- /vW q6. City: it-ha ,/l7% 6,12o .-e5 State: F/ Zip: 33/50 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 6,r d1,11 Address: ti Address: 4-Letkac. v L...m i, a.... 1-'SS 4- 44 "I City: µt hw4e State: Q� Qualifier Name: VEv % iZo as Phone #: 3 L S- Zip: 33 1 2-2• Phone #: State Certification or Registration #: n -0 ? Y 7 Certificate of Competency #: Contact Phone #: i' c . ° SI 7° 1 51 .4 Email Address: - ®v I C tk. sta. sta. e.lil@ 1 t%+1I _ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑Newepair/Replace ❑Demolition Description of Work: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $S ,... Permit Fee $ / ✓-G° / G' 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 AN'1+'IDAVIT: 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 oc l' seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not, ipproved an' reinspection fee will be charged. � I Signature rwner or Agent The foregoing instrument was acknowledged before me this, day of be_ , 20 !L, by Lite :444 who is ersonay know to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis�sio ' Expire': *itch 24 2.d/ NIGUEL GUERRERO MY COMMISSION # 0D973716 EXPIRES March 22, 2014 APPROVED BY 8,00 sz_ C Plans Examiner Zoning Contractor The foregoing instrument was acknowledged before me this `? day of '- , 20 t12, by k/u2 LA) Co-Olt , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Structural Review (Revised 3/12 /2012 evised 07 /10 /07XRevised 06 /l0/2009XRevised 3/15/09) Clerk MIAMI -DAD1E COUNTY TAX COLLECTOR 140 W. FLASLEN ST. it FLOOR MIAMI, FL 33130 2012 LOCAL BUSINESS TAX RECEIPT 2013 dUlJMtl -DADS COUNTY - STATE OF FLORIDA ERES MUST BE DISSPPLAAYEDS AT PLACE OF BUSINESS PURSUANT TO COW rY CODE CHAPTER OA - ART_ 9 & 10 PBH8T -CLASS 0.0 POSTAGE I PAID MIMIC FL PERMIT No. 231 awa4110i LOCAT}GN wImmiNSPEwAL ONCCALL ELECTRICAL CONTRACTORS STATE# EC0000947 205161 -3' 7593 NW,* ST 7 ow 226 UNIN DARE COUNTY sJ.,CTRICAL CONTR INC 't c ,CTRICAL aL J Bar V M 11)1 O AA ANY � o gLAO 1r COUNTY OR CRIER, Non THE ODES rir MOUNT THE HOLM YEW OR ANY mien • REBBIBEP BY LAW TM IC NOY A CEffJ ICATIQN OF TRH LOE R% QBAUFICA- COUN v TAX 09/06/2012 09014045001 nnnn7+L An CONTRACTOR WORKER /S 2 DO NOT FORWARD ON INC CONTRACTORS ELECTRICAL' KEVIN F GILLIS PRES 20947 SW 122 PL MIAMI FL 33177 • 1 11 11 111 11 1 1 1 1 3 1 a is s to 7 eta: JEFF ATWATER STATE OF FLORIDA *IMF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEiMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Taw, 02 -01 -2012 EFFECTIVE DATE: PERSON: FEIN: 02/01/2012 EXPIRATION DATE: 01/31/2014 GILLIS KEVIN 200345752 BUSINESS NAME AND ADDRESS; ONCALL ELECTRICAL CONTRACTORS INC 7E20 NW 25T11 ST, #4 MIAMI FL 33122 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440. 02t14), F.S., on off Ica of a corporation who erects exemption from this cheptor by thing a certificate at election motor Ihl* station My 1101 recovet begeftls Dr eollpeuoulon e44W 7.1111 Chapter. Pursuant to Chapter 440,051121, F.S., Coo Rinke of alaartoo to be exempt... apply only mono the scope of the business or trade Il i d on the $otlea of elucltgt to be exempt. PDrl1eet to Chips/ 440.06113i, B.S., Notices of election to be exempt and mind fates of election to bo exempt shell be cub Oct to revocation 11, et my time after the 1111ng of the ounce or the iaat.vnee of the certificate, the per000 named on the males or serltticaue ua longer meets the requirements of this *action for issuance of a curtlf!cele. The deportment shall revoke a certificate 01 my Woo for felleto al Om parson mimed 011 the coati to moot the requiremeai* of this sentian. QUESTIONV 1850) 413.1609 3WC -252 CENTIFiCATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OR FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKE=RS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF NO ION TO SE EXIT FROM Km= WORKERS coNIFENSAT1oN LAw EFFECTIVE 02/01/2012 PERSON: KEVIN ©ILLIS FEIN: 200343752 BUSINESS NAME AND ADDRESS: ONCALL ELECTRICAL CON'rRACTOks INC 7020 NW 25TH 3T, 44 M1AMi, FL 39122 EXPIRATION DATE: SCOPE OF BUSINESS OR TRADE: 1 • CERTIFIED ELECTRfCAL CONTRACTO 01/31/2014 IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a vertificete of election L under this section may not recover benefits or compensation under this D chapter. Li 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 at El the 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 an the notice or certificate no Longer meets the requiremon'IS of this section for issuance of a certificate. The department shell revoke e certificate at any time for failure of the person nomad on the certificate to meet the requirements of this Section, QUESTIONS? , (650) 413- 16( 9 CUT HERE * Carry bottom portion on the Job, keep upper portion for your records. )WC-252 CERTIFICATE OF ELECTION TO RE EXEMPT REVISED 01-11 FROM (THU) DEC 27 2012 20:03/ST.20 :02/No.7537538775 P 1 ‘sr IN 1 1rIve∎ c Jr I.,IMDILI 1 T IIVaVI(HNtit PRODUCER JVS Insurance Agency 9600 SW 8th St. Suite 27 Miami. FL 33174 Phone (305) 652.5250 Fax (305) 552 -5292 INSURED ON CALL ELECTRICAL CONTRACTORS, INC 7640 NW 25th Street # 105 Miami, FL 33122- 12/28/12 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI ; BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: NOVA CASUALTY INSURANCE INSURER B: I RER C: INSURER D. INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 SUBJCCT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS QF SUCH POLICIES. AGGREGATE LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN$R ADM J.IR .1143RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE A GENERAL LIABILITY IV COMMERCIAL GENERAL LIABILITY ❑ ❑❑ CLAIMS MADE ® oc0UR GEM AGGREGATE UMIT APPLIES PER ❑ POLICY fl PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AurO U ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS [-1 HIRED AUTOS I� NON OWNED AUTOS C1 GARAGE LIABILITY O ANY AUTO ❑ EXCESS/UMBRELLA LIABILITY I. ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE rJ RETENTION $ DATE (6111/DO 09AL069921 01/10/12 POLICY I ADDIY) 01/10/13 WORKERS COMPEMSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yea. describe under SPECIAL, PROVISIONS below OTHER LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurence) . MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG 1,000,000 100,000 5,000 1,000,000 2,000,000 INCLUDED COMBINED SINGLE UMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per ambler%) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE TORY LIMITS I"'1 ERA EL EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENOOR$EyIENT / SPECIAL PROVISIONS CERTIFICATE HOLDER City of Miami Shores Village 10050 NW 2 Ave Miami Shores, FL 33138 fax 305 - 758 -8972 ACORD 25 (2001 /08) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH+LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY,r. OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sergio E Delgado ® ACORD CORPORATION isee • ;;••:•..:."': • 1 w • • ,,s• • , : • • • , •—• • lICAR ° -PAZAZI, IA..' • • :.:: , ...;•••.:;;•••.• :•,: . •• • . • ••,, :2, :•••• • •'• .47::•1•.• ' . . • I.:. • • . . . . . . 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PtigitAalf, .:40:149•14Alititrev9.410Aer0:461:1104.*Weir.fg-04019;• • PRartOal .-**11:0****140.6,4*00•46.0%.04.0.144:folulW4.0 • ;tag• -0,0'0„:***Y. -1`403Fug:Yektragrpserve:ye.*.tgaNgsers., •• ..:.; •41 ...I91'461PF.4301.2140 Woid aqd 46130041014000,WrirOtipOitY04Skiii•O :":•• . • ••-••••:..e , •.**;••• . * • • ; • •*2 • . • •• • •• ... PAtki 0 • , a THIS DOCUMENT HAS I. COLORED BACKGROUND . IVEICROPRINTIFIG . LINE-MARK"' PATENTED PAPER 1 ,.• ,,,,,,Azyg- V: ,''' 1.,, li•!•-' •• . ,.tal •+:••V r 1.41; .41 1'6 1.'r,1',14.::44, ". ,.. , --, ,..I w.t, ,, 11',•i Vitra: • '' ' V ' t*, ,...... 1,141fair....' •*'' ,e. . , 4 e , wt4 ..Atf ltiK. • . 4 4 Aro '2,47 ni•r- . •:431',1)0- Jct., Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 187874 Permit Number: PL -12 -12 -2390 Scheduled Inspection Date: March 25, 2013 Inspector: Hernandez, Rafael Owner: LERET, LILIANA Job Address: 52 NW 99 Street Miami Shores, FL 33150- Project: <NONE> Contractor: BIONIC PLUMBING CORP. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330050 Phone: 305 -498 -9100 Building Department Comments INSTALL SHOWER PAN 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 REINSPECTION FOR INSP- 183151. March 22, 2013 For Inspections please call: (305)762 -4949 Page 41 of 48 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 20t0 Permit Tygr—PLi OWNER: Name (Fee Simple Titleholder): ' 6,74' DEC 1 2012 Permit No. Ft-- 1 0 Master Permit No. 2_(i Z 2381 Address: City: —State: fL Tenant/Lessee Name: Phone#: Zip: -3 /Z.c) Phone#: Email: JOB ADDRESS: 5 a_,(jc,€) City: Miami Shores County: Miami Dade Zip: 3 / 5V Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: --.-.‘ bAr‘ C,4- Pil 1 WI h in- c7-19 Phone#: '3 _silz Address: 1(0 / / 5 W .511411 cL+ City: i'VI I a VA; State: 1-- L Zip: 33/ 73 Qualifier Name: Garry Art ti &:L (.) C. Ic Phone#: State Certification or Registration #: Cr— 1 a. („2 44 (., Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 2- / 60c) Square/Linear Footage of Work: Type of Work: °Address °Alteration °New CIRepair/Replace ODemolition Description of Work: ----ty\c-)\--ta(A. hc_--)(1),e_ r pa. ye 4- ---p., ,0 Co- 0-G, aiLA • -0•1•014***iinii4014 '• At********************!1!lifunFees***10.********************44******************** Submittal Fee $ Permit Fee $ //, ° CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip to Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip ply 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 estirnated 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 inspe _ ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will approved an%a reinspection fee will be charged. Signature • wner orgent The foregoing instrument was acknowledged before me this 3 day of t , 20 /L, by `// 4ho r -VS who is peso y cn n to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /Ole ", My Commission Expires: ,near r-42 z 2d /N APPROVED BY Signature .4 62.h Contractor The foregoing instrument was acknowledged before me this , day of bec. , 20 by /a YP 7' /2V,.4/ /vc4 who is personally known to me or who has produced as identification and who did take an oath. MIGUEL. GUERRERO ..•MY COMMISSION # 00973110 EXPIRES March 22, 2014 3980163 4.9"----Plans Examiner (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review NOTARY PUBLIC: Sign: Print: My Commission Expir 1114 a.a -a a/5,4 1",', iy`, 0 .'M' COMMISSION # gg1973'16 • EXPIRES March 22, 2014 140i398-0163 • PlorkbNofaY3 •ceA Ai Zoning Clerk Dec 28 2012 9:55RM HP LASERJET FAX CERTIFICATE OF LIABILITY INSURANCE p.1 DATE(MMIDDVYYYY) 12128/12 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: lithe celtlfka a holder Is an ADDITIONAL INSURED, the paicy(1es) must be endorsed. IP SUBROGATION 18 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 endoraement(s). PRODUCER US-1 Insurance 9808 S. Dixie Hwy. Miami, FL 33156 Phone (305)870 -1422 Fax (305)870-0013 INSURED Bionic Plumbing Corp. 8011 SW 99 Ct MIAMI, FL 33173- (305) 299 -9741 =ACT PHONE I ); (305)670 -1422 FAX Nol: (305)570 -0013 s. tedusa204tGbalsou h.net INSURERS) AFFORDING COVERAGE NAIL INSURERA : GRANADA INSURANCE COMPANY W8URER B : INSURER C : INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 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 SUBJECTTOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8V PAID CLAIMS. • TYPE OF INSURANCE INBR IMVD POUCY NUMBER pUMlpD/YY% ( TIN GENERAL LIABILITY ® COMMERCIAL GENERAL LIASIUTY ❑ ® CLAIMS-MADE ❑ OCCUR ❑ :moo 0 GEN'L AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ JECT E LOC AUTOMOe LE LIABILITY ❑ ANY AUTO 0186FL00040778 11/09/2012 1/09/2013 LASTS EACH OCCURRENCE PREMISES/Ea D 1 DAMAGE RENTED ooeurrencel $ 1,000,000.00 MED EXP (Any arse person) PERSONAL &ADV INJURY GEN AL. AGGREGATE PRODUCTS - COMP/OP AGO ❑ OWNED ❑ SpiFDULED ❑ HIRED AUTOS El ED O 0 ❑ UMBRELLA LIAR ❑ =Cm ❑ EXCESS LMAB ❑ CLNM344ADE ❑ DED ❑ RETENTIONS WORD COMPENSATION AND EMPLOYERS LJAatLLTY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Myaronsed,Mtory In NH) DESGRIP7IQ N OF OPERATIONS below FeaMa D INGLEOMIT BODILY INJURY (Per person) BODILY INJURY (Per acoldent; I Pg} ldantDAMAOE EACH OCCURRENCE AGGREGATE a s 5,000.00 $ 1,000,000.00 2,000,000.00 $ 1,000,000.00 $ s a a $ $ $ $ NIA OSSE❑ TRY UMITS I-1 R S E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Sdtedu**, If more s aao Is required) GL---- ..COMMERCIAL / RESIDENTIAL PLUMBING CERTIFICATE HOLDER E.L. DISEASE - POLICY LIMIT I $ CA•CELLATIO MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES , FL 33138 SHOULD ANY THE EXPIRATIt ACCORDANCE AUTHORIZED REPR ACORD 25 (2010/06) OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DATE THEREOF, NOTICE WILL BE DELIVERED ITH THE POLICY • •.J DNS. 740; y 1088-2 I ' ACORD C ACA -a • name and I ON. All rights reserved. are registered marks of ACORD CT '^B 8aard Construction Trades Qualifying BUSINESS CERTIFICATE OF COMPETENCY 000012646 BIONIC PLUMBING CORP /< D.B.A.: 'ROBULdCK GARY W Is certified under the provisions of Chapter 10 of Miami -Dade County VAUD FCR CONTRACTING UNTIL 0913012613 e0 8Zaea Jan 02 13 03:24p JEFF ATWATER CHIEF FINANCIAL OF STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * dE CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * 4E CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual fisted below has elected to be exempt from Florida Workers' Compensation taw. EFFECTIVE DATE 08/26/2011 EXPIRATION DATE: 0$/25/2013 06 -15 -2011 4 PERSON: ROBULOCK GARY FEIN: W 591911797 BUSINESS NAME AND ADDRESS: BIONIC PLUMBING CORP 8011 SW 99 COURT MIAMI FL 33173 SCOPES OF BUSINESS OR TRADE: 1— PLUMBING CONTRACTOR IMPORTANT: Puneaet le Chop 440. 061141, r.S., en Arm of a cotparalon who eleCte exemplloe Iron ale Chaplet by filing a corlOrcate of election under this saline may not recover Mollie or compeoutlnn molar Ihla chapter. Pummel la Chepte► 440.06(121, F.S„ Conllrcatox of election le be exempt,,, apply only Wfthin the crape of the boUnen Di Uedr 1b10d on the nonce et election to Ito oomph Perms! to Chapter 440.06(13/, i,8„ Notices al election to be exempt and eerulleatos of Aimee to be mind ebell be subject lo revecaifon 0, el any Ilxw ellrr iho filing DI the notice at Mr Isaeancr 01 the rurullaats, 160 IOHllh■te De Inngrr mePIn Ihx taquiramentt al Ms entice far bunco of a ceplfleero. The dop.emaat NMI reyehr a coniflceto al any limo for fefluro of the person Denied DD the rattillre' la mean Ihx rago6 mismi al lhfo archon. parson e0med ea the aeuce or nw(: 762 CIIIIIFICAIE OF ELFCTION TO OF EXEMPT REVISED 01.11 QUESTIONS? (850) 413 -1609 Jan 02 13 03:21p k MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 . MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10-24 EXPIRES SEPT. 30, 2012 R[CEIpT 1V0. 30-4289005 BUSINESS NAME / LOCATION BIONIC PLUMBING CORP 8011 SW 99 CT OWNER :BIONIC PLUMBING CORP THIS IS NOT A BILL — DO NOT PAY CC NO: 000012646 SEE BACK OF RECEIPT FOR A LIST OF NON- PARTICIPATING MUNICIPALITIES Receipt holder must min the city .Thane work is to be done. eloweawtsmm 1wl,.u.ae COUNry TAX 001 7 V2072011 60020000329 000200.00 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. PLUMBING CONTRACTOR DO NOT FORWARD BIONIC PLUMBING CORP GARY ROBULOCK PRES 8011 SW 99 CT MIAMI FL 33173 2 1lTlIIIIIh3 fll1IITI�I11i,II,lJIh Ii,JJl1II,, ,, /tJ ►Il1IJi /!JI 410702 -5 THIS 1S NOT A BILL — DO NOT PAY RENEWAL EUSINESF ,NAIVJE / LOCATION BIONIC PLUMBING CORP RECEIPT NO. 428900 -5 33173 UNIN9DADE COUNTY CC 0 000012646 BIONIC PLUMBING CORP S T"^, o? Business 196 PLUMBING CONTRACTOR • .!•...4• is C t� F 71Tf " ' TAF. !!:X.1.7: t ' '.Se—;.TE ANT ••CL , F:= R:!;ATtii, �7f2U4f:C 2 OF (2 -.1. COUNT': Al L.. DOES I! FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 X TO: t 1 iv„. <,:, lC TIOH Of: THE ri"ti.f:(;5' 1: CJAunrA_ Tx:ru:. 1 N,NuEPJT EEC ;,•!Eo 1+21AI^I-g COu2jr, 7A% f COLL {t -c . Q7/26/2012 60010000117 000075.00 WORKER'S 1 DO NOT FORWARD BIONIC PLUMBING CORP GARY ROBULOCK PRES 8011 SW 99 CT MIAMI FL 33173 ht111 [Illm.flhuIAJIIIl11 „,fi LLJllil lli,H+ did p.1