PL-13-307 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-1$5943 Permit Number: PL-2-13-307
Scheduled Inspection Date:July 16,2013
Inspector: Diaz,Osvaldo Permit Type: Plumbing- Residential
Inspection Type: Final
Owner: PIMIENTA,f~RIC Work Classification: Addition/Alteration
Job Address;6 NE 106 Street
Miami Shores, FL
Phone Number (786)2$0-3974
Project: <NONE>
Parcel Number 1121360060080
Contractor: CASTELLON PLUMBING CORP Phone: 305-553-1490
Building Department Comments
RELOCATE PLUMBING FIXTURE Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
93L-9 8000/9000d 889-1 - -WO€i3 8S:90 Ell-LZ-LO
Miami Shores Village
Building Department UP 14 X013
90050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 --
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 L
BUILDING Permit No. I __3 CT --
PERMIT APPLICATION Master Permit No. T21,13 - 3d a
Permit Type: PLUMBING
JOB ADDRESS: (P O P�' (®� 4;;r
City: Miami Shores County: Miami Dade Zip:
Folio/P arc ew L --3 b0 ".0 0 Ca
Is the Building Historically Designated:Yes NO ;x, Flood Zone:
OWNER:Name(Fee Simple Titleholder): @ C' l I y�()\- Phone# _%(9-ZT0-1"Lf
Address: (.0 /JC (o& 4;T—
City: M(A-M ( `j State: Zip:
Tenantlessee Name: Phone#:
Email: A VA-CL i
CONTRACTOR:Company Name: 6 140111;, , Phone#
Address:
City: /2� �i //1�,,P���v—c--C State: /7Q Zip: 2 .7,0/e
Qualifier Name: �e4e, Ida C S / E'��Oz� Phone#(7 '/, �S'`-S /_
State Certification or Registration#: C/-2C_ ®/?l Certificate of Competency#:
Contact Phone#(��2 =5 � S Email Address: e� g�(
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: UAddress DAlteration DNew epair/Replace ODemolition
Description of Work:
v
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$ ___
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 on 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 w occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection W. t b approve and a reinspection fee will be charged.
Signature Signature
Owner or Agent `v Contractor
The foregomg instrument was acknowledged before me this ` l The foregoing instrument was acknowledged before me this
day of 2013by e<gkC-. 1 a�'1) _ , day of V5:�r-" ,2d2-,by
who is personally known to me or who has produced C---: �6,) who is personally known to me or who has produced t�L
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: \�e►u uur/,,,��
Sign: ` /�. Sign:
g.
Print: z �O 'rn°° 9 Print = '�'= ���' UJ
My Commission Expires: - ' y g x: _ My Commission Expires:
co
°.•�° °�� iG
%'O � � Sr•�•�� '�Pf�/fib.. • \`�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Reviw.6/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Mar. 01 2013 10:06AM P1
�--
CERTIFICATE OF LIABILITY INSURANCE
GATE(MM/DD/YYYYi
10/zzr12
THIS CERTIFICAW IS issurrD AS A MATT R Olr INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE'CERTIFICATE r OLDER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 13Y 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; t the eeMflcate holder Is an ADDITIONAL INSURED,the ppftAies)must be endorsed, if S BROGATION IS WAIVED,Subject to
the I-=and condltlons'of the policy,certain policies may require an endorsement A•statement'on this certincate.does not'corderrlgras to the
certitiaate holder In lieu of Such endorsement(s).
PRODUCER C .
First Class Insurance Market s
(305)441-2997 ar (305)441-6443
4101 NW 9th Street '� A ' tclmo�aol.com '
Miami,*FL 33126 INSURER 'APFC DINGCOVERAGE NAIC#
INSURe 3054i-29w Fait (305)441.6443 INSURER A: ATLANTIC CASUALTY INSURANCE COMPANY '
INSURED
INSURER B:
CASTELLON PLUMBING CORD wsuR@RC:
9841'NW 130 STREET' INSURER D
HIALEAH GARDENS,FLI=1$ 7 -255 im INSURERP:
IN R
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS•18 TO CERTIFY THAT THE POLICIES OF.INSURANCE LISTED BELOW HAVE-BEEN 1ssum 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 MAYBE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED-HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.Was SHOWN MAY HAVE BEEN 9EDUCED RY PAID CLAIMS,
It�SR. TYPE OF INSURANCE D BR ppL10Y NUMBER MPOLtCY E ICY EXP LIMITS
GENERAL LIABILITY EACFE OCCURRENCE $ 1.000.000.00
® CCMME DIAL GENERAL LIABILITY DA MaPETO RENTED 100,000.00
❑ ❑ CLAIMs•MADF ® OCCUR PR I:9; 06aunenae' $
A ❑ 01025a12• 10/29/2012 10/29/2013 MPm ax tan,ane n S 5,000.00
PERSONAL&ADV INJURY S 1,000.000,00
❑ • $
•GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000,00
P
RODUCTS-COPrtProP'AGG Ei 000,000.00 E POLICY '
❑ ❑ LOG•
AUTOMOBILE LIAaILITY Bi ED SINGLE 1Mri
ace da
❑ ANY VAI wDt4Y INJURY(Per person) S _
{-•� ALL 01Md @D qSCF�DULFD
U AUTOS ❑ MUMS ED BODILY INJURY(Per toddento a
❑ HIRED AUTOS ❑ AUT05 MMERdWe AOE a
❑ ❑
❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $
❑ EXCESS LIAR ❑CLAIMOWACE AGGREGATE $
❑ CEO ❑ RETENTIONS $
WORKERS COMPENSATION
YIN N '❑W SYATU- r'"J O -
AND EMPLOYERS'LIABILITY '
ANS'ppR1�gqvRt��a aRrNERrE7cE01J'nVE
OFFICER/MITA8ERIXCLUDE.D'! NIA' EL•EACH ACCIDENT $
(MantlaLUy In NH).
U y�8�de66Nlfe under EL DISEASE-GA EMPLOYE $
DESCRIPTION OF OPERATIONS Mew al.DISEASE-POUCY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tAt=h ACORD ICA,Additional Remarks SehedIsW If mere spaee Is required)•
PLUMBING CONTRACTOR
CERTIFICATE HOLDER CANCELlAT10N
SHOULD ANY OF'TH5 ABOY6 DESCRIBED POLICIES BE CANCELLED BEFORE
VILLAGE OF MIAmi-SHORES THE•EXPIRATtON DATE THEREOF,NOTICE WIM BE DELIVERED tits
10050 NE 2 AVE ACPNWAlq0SkVlTH THE POLICY PROVISIONS.
MIAMI SHORES,.FL 33138 A R R RESEN IV13
®1 2010 ACORD CORPORATION, All rights reserved.
ACORD 25 0010106)OF ✓ he J3 name end logo are reglstered marks bi'ACORD
1.
10-11-2011
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: 11/2312011 EXPIRATION DATE: 11/22/2013
PERSON: CASTELLON GERALDO
FEIN: 5591678886
BUSINESS NAME AND ADDRESS:
CASTELLON PLUMBING CORP
9841 NW 130TH STREET
HIALEAH GARDENS FL 33018
SCOPES OF BUSINESS OR TRADE:
t- REPAIR SERVICE 2- SERVICE CONTRACTOR
3- PLUMBING
IMPORTANT: Pursnaat to Chapter 440 . 06(14), F.S., an officer of a corporation who elects exemption from ibis cheater by filing a certificate of election under this
settlers may not recover bar"110 or compensation under this chapter. Pursuant to Chapter 440.06ft27, F.L. Certificates of cleciloa to be exempt... apply only withto the
scope of the basiness or trade listed on the notice of election to be exempt. Pursuant to Chapter 440,116031, F,$., Notices of election to be exempt and cortincatas ai
election to be exempt shall be subject to revocation it, at ally time alter'the filing of tike notice or the issuance of the certificate, the person named on The notice or
certificate no longer moots the requirements of this section for issuance of a certificate, The departmoet shall revoke a certificate of hay time tot laiiure of the person
aimed oil the tertificate 14 meat the requirementi of ibis section.
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1809
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE Ri:FERENCE
STATE OF FLORIDA IMPORTANT
DEPARTMENT OF FINANCIAL 3ERVIC89
DIVISION OF WORKBRS'COMPENSATION F Pursuant To Chapter 440:DS(14), F.S., an officer of a corporation who
CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election
CERTIFICATE of ELECTION To Be EXEMPT FROM FLORIDA � L. under this Section may not recover benefits or compensation under this
WORKeR5'COMPENSATION LAW �' L chapter.
EFFECTIVE; 11I23/2011 EXPiiZATION DATE: 11/22/2013 Pursuant to Chapter 440,05(12), F.S., Certificates of election to be
PERSON: CIRALDO CASTELLON H exempt- apply only within the Scope of the business or trade listed on
FEiN; $91676886 R the notice of election to t.
be exempt
BUSINESS NAME AND ADDRESS! E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
San I JgwN 30rif ST ET and certificates of election to be exempt shall be subject to revocation
gear Nw 13orH STREET If, at any Time after the filing of the notice or the issuance of the
HIALGAH GARDENS, PL 33018 certificate, the person named on the notice 4r certificate no longer meets
the requirements of this section for Issuance of a certificate. The
department shall revoke a certificate at arty time for failure of the
SCOPE OF BUSINESS OR TRADC- person named on the certificate to meet the requirements of this
I- REPAIR SERVICE 2- SERVICE CONTRACTOR Section.
3- PLUMBING QUESTIONS? (850) 413-1809
CUT HERE
* Csrry.bottom portion on the job, keep upper portion for your records.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
i
CERTIFICATE OF LIABILITY TE(MI yl
�3tLITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF 1012
INFp MATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER-niE'COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORIZED
REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLDER.
IMPORTPAT: ff the certlficate holder Is an DITIONAL INSURED,the pwicypes)must bq erMorsed. If SUBROtiATION 13 WAIVED,subject to
the terms anti Condithms of the•poiloy,Certain policies may require an endorsement. q•statement on this JBRC tsATIO o IS WAVED, bject'to the
certttieate holder in lieu of suety,endprsement(a).
PRODUCER C '
First Class Insurance Market MA
aNS 305 1-2897
4101 NW ft Street EMAIL FAX No:' {3O6)441r$443
EOlmtt�aol.com
'Miaml,'FL 33126 . . .
IN5UR S AFFORDtI CpYSRAQ
Phone 1- 97 Fax 305 441-6443 INSURER A: ATLANTIC CASUALTY INSURANCE COMPANY Nal a
INSURED
CASTELLON PLUMBING CORP INSURER B:
INSUREKC:
9841 NW ISO STREET IN------R D,
HIALEAH GARDENS,FL•33018 7gg.2g 1 INSURER E:
COVERAGES INSURER F• '
CERTIFICATE NUMBER: REVISION NUMBER:
j 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"TH.RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN t3 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POL•ICIF,S,UNTS•SHOWN MAY HAVE BEEN DEDUCED BY•PAID CLAIMS.
IL7RR __' TfPI:OF INSUR/CNCE A6 U8R MPOLICY LI6V EXP LIMITS y 11 GENERAL LIABILITY, POt It Y NUMBER bDiY
C S/ COMMERCIAL GENERAL LIABiLfK ON OCCURRENCE S 1,000,000.00
DAnrtAp' F_Nrm
A ❑ ❑
CLAWS-MADE 0102$812 REMis ovcu S 100,OOp.00
05
® OCCUR MEDEXP A anepawn S 5,000.00 r
❑ 10/29/2012 1 O179/2013 PERSONAL s ADV INJURY is 1,000,000.00
G3ENERALAGGREGATE s 2,000,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PO4lCY El PRODUCT$-O(WProP Ado s 2,000,000.00
� ❑ - LOO
AUTCMOEL"LIABILITY $
5 .«
y ❑ ANY AUTO L`O aaeNSi D LI
81N6LE
ALL NED i�DU BODILY INJURY(Apr pemn) s
❑ Auro°�" t O/NED ' BODILY INJURY(Peraccident) S
❑ I•IiREpAUT09 ❑ AUTOS PR�OPW nDAMAt3E $
uM1aR>LB s
OCCUR
❑ E1tnk❑•CLAIMS•MACe EACH OCCLlRR9VCE
❑ DEa NrioN AGGRMOATE 1 WORKEBATtON S
AND EMI?LOY A6 Li Y/N ApV�Yy PR OPRI6RTNER/DtECUTIVE
FIGl�R/MEMLUDED7 ❑ NIA E L EACH ACCIDENT tMa�watory in E L.btSEASE.EA EMPLOYE 5
!fy�.,deaoHBe DESCRIPTION ERAnONS b®bw EL DISEASE-poijoy LIMIT
r
DESCRIPTION 4F'OPERATIONS I LOCATIONS 1 YMIC1,e3(Attach ACORD 101;Addltlonal Remarks Ochedule,ff Imam xmve is required)
s ---PLUMBING CONTRACTOR— .
CERTIFICATE)iOLDER GANCELI.ATION ry
. SHOULD'ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
I VILLAGE OF'MIAMI•SHORES THE."MRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10050 NE 2 AVE AC ITN THE POLICY PROVISIONS.
MIAMI SHORES,.FL 33138 q0"RR EN ,IVe
I
ACORD 25(201Q106)OF cO 1B 20160 ACORD CORPORATION. All rights reserved.
ORD t=ame and logo are registered marks of ACORD
a'
t
. w
Ed Wt12-0:0T 2TOZ TO -xew ZT9T BSS SOz: 'ON Xdd dMOO ONIawmd NO-11S1SUO: WONJ
FROM :CASTELLON PLUMBING CORP FAX NO. :305 558 1617 Mar. 01 2013 10:08AM P3
it
STATE`OF FLO MA
DE11ART243N ' OF BUS%NESS AND FROWN8010>,T,i L 1RGULAT7:0N
c0Xg TRUCTION 3=112TRY LIC�l7SINC� BOiARU (8''x0) 487-I395
i ]r940 ;NORTH XONROE .STREET
+� TALLAHASgEn VL 323.99-0783'
. CASTELLONr QIRg��pp
Cl\fiTBLLON 'PLBiKBINS CORP.
9841,;• NDP•130 ST.
g�a.rrrnsr .GARAS° PL .3.3018
9rainiatiors_ _•:!;•. r.:'1 ..., ,^ . ... . .
Con I With,�s R you become one of the ready 11ne
Floridians Hceri'sW by +e Deparhtaent Of Susiness and Pro€essiy rriUton
Our professronaw and t�si okiey Reguratien. ;�' 3, ��.:
passes ra a ni "s:.a,
� �P• 8rd'1'rtecEs to yacht broker,fro �-' •9
bOxemto barbeque.reswararts and m. tr�,,... 4 :z ;,R �:r y Dlt31
a they keep l=lorida's economy strong. v�'•'_":•:r.. •:r�a.,�a:.,�� :~< '�c�-•�J. ••.t::;•�� ;•;�"":��
Y Y work fo ve the Lip C41 u
��or information.shout� YViaes way we do business in Orddr to s'siv8 you bet#er,,r�••",.•;.;:.'•".;'`' .•,,x{��� •'��p ,:�?'0.4•a.4
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