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PL-13-150 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami shores, Fl- Phone:(305)795-2204 Fax: (305)758-8972 Inspection Number: INSP-198072 Permit:Number: PL-9-13-150 Scheduled Inspection Date:August 28,2013 Permit Type: Plumbing -Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: Job Address:9800 N MIAMI Avenue Work Classification: Addition/Alteration Miami Shores,FL Phone Number Project: <NONE> Parcel Number 1131010330470 Contractor: G WHITAKER INC Phone: (954)6589119 Building Department Comments INSTALL SINK, SUPPLY LINES, DRAIN LINES,SERVICE Infractio Passed Comments TO HOUSE AND MAIN DRAIN TO STREET INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-184783. Failed $ �l Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. 986-3 £T00/6000d 9OL-1 _ - -_- - -WOH9 03:90 ST,-63-80 Miami Shores Village Building Department p artment r 40050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 _,. __ -- FBC 20 � t BUILDING Permit No. {;° I PERMIT APPLICATION Master Permit NoVZC4 3® d �J Permit Type: PLUMBING JOB ADDRESS: grao X/. 04". City: Miami Shores County: Miami Dade Zip: 926r—.0 Folio/Parcel#: Is the Building Historically Designated:Yes NO Float Zone: OWNER:Name(Fee Simple Titleholder)4�' dt// t.If/q' k �T�"Phone#: ��✓� 'j'��'r Address: 9� D �/� ���?! -4z , City: w,*w f State: Zip: 33tSO Tenant(Lessee Name: Phone#: Email: A- / 7�`+�1'Atiyh� ! "Atli tw! j CONTRACTOR:Company Nude: 4 V#17-4-4 -• /W C, Phone#:'6^k V14 Address: Op N'x �,2gj'TTtr�1 'r.f J�` 1 D City: / A" A) State: Qualifier Name: rr Phone#: State Certification or Registration#: C} C 2 5 Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer. Phone#: Value of Work for this Permit:$ 01040 Square/Linear lKootage of Work: ff Type of Work: UAddress {]Alteration ONew epair/Replace ODemolition Description of Work: -, " /4 AAA4.41fV,p 8 t+ L,Pat J Z.AAA �/•u�S� .>'�r/t c� `7a "DDS'p AwA_4MAV r ,rte V s4a&xRsk��:Rak��skskIs3�Iss&�akskska8ank � ��sk:BF�daskaR�sRsk�skoR :ks��ssk��ssk:ksk�sI� 2R$a#sk&Iss§sk�kak�nkek Submittal Fee$ Permit Fee$ L'� � CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Company's Name(if applicable) A/A 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 c mC4 that no work or installation has commenced prior to the issuance of a permit and that all work will be wormed 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,BOHZRS,HEATERS.TANKS and AIR COMMONERS,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 OTTER: YOUR FAILURE TO RECORD A NOTICE OF CONMENCENUM MAY RESULT IN YOUW ft 'PAYING 11­ TWICE FOR EMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICEOF-COMMENCE IEENT 9, f Notice to Applicant; As a condition to the issuance of a budding 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 brochu✓e 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 a ' In the absence. such of posted notice, the inspection will not be approved and a rebtspectdon fee will be charged , Signature q�-- Signature or Agent 'Contractor The foregoing instrument was acknowledged before rum this A-® The foregoing' was acknowledged before me this day of 20 by, Q e-( day of_T 411 df .20/5.by OA_-Azt who is personally known to me or who has produced DG. who is personally known to me or who has produced T✓a�` ) � XAs identification and who did take an oath, as identification and who ' -take an oath. NOTARY PUBLIC: NOTARY PUBLIC: wc " �.�:s- print � P�e'a, RODRIG01 PENA Print: Notary Public-State of Florida " My Commission Expires: /#•_ MY CON1IttISWN#DD 676573 -�qr My Comm.Expires Apr 24,2015 My Commison 4`� ExIWRES:April 13,2013 `�,o`P Commission#EE 87255 +;;• •rr` S Thrut yPwftUawarnn APPROVED BY pins Examiner zoning .: Structural Review Clerk cxw[W 3n2r2ot2 xRevsedo°morm)MvdsetOfif][WW XRevfted3nsM1 2012-03-25 09:53 WHITAKER NORHPLUMBIM 9416297276» FAX P 1 10-31-2011 JEFF ATWATER STATE Of FLORIDA CHIEF FINANCIALOFFICER DEPARTMF-NT 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 exefTlpt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/31/2011 EXPIRATION DATE: 10/30/2013 PERSON: WHITAKER GRADY L FEIN: 270477023 BUSINESS NAME AN13 ADDRESS: G WHITAKER INC 400 NE 20 ST APT 104 D ROCA RATON FL 33432 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING IMPORTANT: Pursuant to Chapter 446 . units). r.a., on emitat at a corporation who sleets asemption tram ibis chapter by tiring a eartifieals of elevUoa under ms's section may not racoon bencllts or campenaalian bnaer this chapter. Pursuant to Cnaster 44US112), F.S., Cerrificates of election. to be exempt... xppiy only within the scope of the baseness ne trade listed on the notice of election to be exempt. Porsalat to Chapter 440.051131, f,S„ Notices of election to be eaampi and certificates of election to be esampi shall be subject to revocation if, at any time after the filing of the notice or me issuance at its certificate, the parson named as the notice or iucate no iea el meets the requirements of this section for Issnee e f a certificate. The department shait revoke a certiticate at my time lot failure of the person can g c a named on the ceniffeste to most me regefremsm4 oa this aeclton. QUESTIONS? 0501 413-180 OWC-252 CER11FICATE OF ELECTION TO 9E EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES OIVI$IONOF WORMS'COMPENSATION F Pursuant to Chapter 440141, PA, an officer of a corporation who CONSTRUCTION INDUSTRY O cleats exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO SE EI MPT FROM FLORIDA L. under this sktion may not recover benefits or ellimpensation under this WORKERS'COMPENSATION LAIN 10 D Chapter. EFFECTIVE 10131/2 f# EXPIRATION P4 10/3012013 Pursudltt to Chapter 440.0502). F.S., Certificates of elecvion to be PERSON: GRADY L WH�T*ER H exempt_ apply only within the scope of the business or trade listed on FEIN: 270477023 E the notice of election to be exempt BUSINESS NAME AND ADDRESS: Pursuant to Chapter 440503}, F.S., Notices of election to be exempt a WHITAKER INC ' and certificates of election to be exempt shall be subject to.revecation 400 NC 24 $T APT 104 0 if, at my time after the filing of the notice or the issvence of the ROCA RAT014, FL 33432 certificate, the person named on the Portico or certificate no longer meets the requirements of this section for issuance of a ctrtificate. The department shalt revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this t. r'LtlMearG section. QUESTIONS? 18501 413-1609 CUT HERE $ t upper artisan for your records. Gerry bottom portit�n on the jola.•'ktaep Capp portion OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 III` 01/29/2013 15:19 18504827042 TODD-DORROH INS. PAGE 02/02 OP 10:FT + -- CERTIFICATE OF LIABILITY INSURANCE Ot128193 THIS CERl11FICATE IS ISSUED AS A MATTER of INFORMATION ONLY AND CONFIRM NO RK*= UPON THE CERTIFICATE HOLI]W THIS CERTRCATE DOES NOT AFFIRMATIVELY OR W4ATIVEI..Y AMEND, EXTEND OR ALTRA, THE COVIZRACH APPORDIED BY THE PCLtCI1ZS BELOW. THIS CERTRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE =UWG INSURERS h AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPOWAUr If the c to holder la an ADOfflONAL INSURED.the polioy(iss)must be andamod. If SUBROGATION IS WANED,subject to the kends and CondltIom of the Policy,COTWn plal)It o may n>quke an endnmmerit A sbtement on dit cwffioM do n USA confer rights to the tleRiAlsatq holder In Neu of such en g PROCUGLDt 886482-2310 Todd-Donah Insurance,Inc. ��2 i� � 4388 Cliftin St No MBrinn w FL 52+446 Fronelns add �NtHIT-1 INSURED G.WHITAKER INC ItA:LLOYM OF LONDON 400 N.E.20TH ST ART D104 UNKIRMS: BOLA RATON,FL 33432 COVERAGES C€RTIFICA UMBER: REVISION NUMBER; THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SM ISSUED TO THE INSURED NAMED ABOVE FOR THE POI ICY PERIOD INDICATED. NOTVWMSTANDIl+N3i ANY REQUIREIV ENT, TFRM OR L:ANQITIcN d nr ANY t1x TRACT nR QTHFR norlle+ w vurrm RESPEOrr TO 011404 Tm$ CERTIFICATE MAY 09 ISSUED OR MAY PERTAIN, THE INSURANCE A"ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE=RMS. EKCLUSION_5 AND CONDITIONS OF SUCH POUCtES.LIMITS€iHOWN MAY HAVE BFEI REDUCE}8Y PAID CLAIMS. INC L 1YPt?oRINSURgptiE UNTg GENERAL.UPAPA' SAM OCCURRENCE S 1,000, A X commlERclAL eENm m LtA89.Ii'Y C113FLOOODOTO 01/1b/1S 01rAM4 r.�Ae�aa-dinoe �+t�eu�e G�It�TE6' A 1�i n.~„ c�u+r + ) 3 1" I tINft a ADV"ujRY $ 1,000,= GENERALAGGREGATE a 2,000, GEN'L AQGNPGATE LIMB APPLIES PFA: PRODUCTS•COW1OP AW S 2a(1E 1. P&a 7 M 7 Loc $ AMMOM E UAINL I Y enlalglon Alm P I not' (Ea I) ANY AUTO wmy INJURY(Pa'perm) 5 ALL OWNED AMS BODILY INJURY tier 8 9 _._ 3GIbULEO AUTQ$ PROPERTY OAMRGE HREDAUTOS (r+r�eaaReu) $ NON-OWNED AUTOS $ A l" ptE�r .LA M OCCUR EACH CGCU WNG4 S w= 4b4o CLAPASWADE AGGAMTE S DEDUCI'M ON vKNUMOCIAIPENIATION AND MVPWYERW UASIL ITY _ YIN d GEIV&% ER EWAUMO? NIA EL EACH ACCIDENT $ (umtookwy I*" E.LDISEAM-!AEMPLOY A $bulgo EL OIBEASE-POLICY UMR Dts TTCN OR OPSMATION&I I.Q17p noNsI VtOtIL M(ftwA At: W W,A*MW ftmft Schedale,Itrrweeepaaots I:EFtTIf° CANCELLATI MIASHOR SHOULID ANY QF THE AWM DEMMO PQLIM 13E CANCELLED$BROKE MIAMI SHORES VILLAGE T m EXPIRATION DATE TtOMOF. NOTICE WILL BEE DELIVERED IN 1000 N.E.SECOND AVENUE ACCOROMCE WITH THE P OVIBtO MIAMI SH MS,F1..3,3138 swtlo Francine T tit 791111-ZQQ9 ACARD+CORPORATION. All d tls rew ved. ACM 25(2009M) The ACM name and Wqo are mgbftmd marks of ACRD �" �o tr � • o• a •o1�e r -o•- � � � r . a . t I DRFART }'� t7SI vS AND F bF SSxC�3 I, 1L ` ]LATIQ r11/.0111 . /SE `I I 07 '7 2� r? to a 11 t i belr>w x;? CEI���FI�'I3 z�c er` the1;pr©vis-ads ofd 1atx �3 I Expa.arat a�n date• Au po I 4� WHITAI�ER, :.:GRA4Y Z x G WHI AXE. T 1tr' 40 0 NE'' 2 Q S' ' AFT BQCA BATON FT, $3431 . I { i'LF 3v k RICK GO�TERNQR w SFsR *ARY r _ ,. D13PLAY AS REQ'IJ,IRED B�LAW "' .. m NNu M. GANNON P.O.Box 3353,West Palm Beach,FL 33402-3353 **LOCATtD AT** 'gam. ' ALT 90LL R www.taxcollectorpbcxom Tel:(561)355-2272 Ktuft i 400 NE 20TH ST APT 104D BOCA RATON, FL 33431-8159 TYPE OF BUSINESS OWNER CERTIFICATION# I RECEIPT#/DATE PAID AMT PAID I BILL# 23-0069 PLUMBING CONTRACTOR WHITAKER GRADY CFCO22546 I B12.423758-07/16/12 $27.50 1 840072823 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 2012/2013 LOCAL BUSINESS TAX RECEIPT G WHITAKER INC LBTR Number: 201006054 G WWTAKER INC EXPIRES: SEPTEMBER 30. 2013 400 NE 20TH ST APT D104 This receipt does not constitute a franchise, BOCA RATON, FL 33431-8117 agreement,permission of authority to perform the services or operate the business described herein when a franchise,agreement or other county commission,state or federal permission of authority is required by county,state of federal law. r' ,