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PL-12-0661Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172396 Scheduled Inspection Date: December 23, 2013 Inspector: Diaz, Osvaldo Owner: DEVINE, MICHAEL & CLAUDIA Job Address: 54 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Permit Number: PL -4 -12 -661 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 305 - 759-4883 1132060131470 Contractor: JMS PLUMBING CORP Phone: (786)200 -3506 Building Department comments PLUMBING WORK FOR GARAGE CONVERSION, KITCHEN & BATHROOM REMODEL 08/13/2012- PENDING LIABILITY as per approval, ok to exten permit 6 months. Passed Failed Correction Needed Re- Inspection Fee Inspector Comments Ea RJ�io,-6.1-Y No Additional Inspections can be scheduled until re- inspection fee is paid. I. G C` December 23, 2013 For Inspections please call: (305)762 -4949 Page 1 of 39 Owner Information Address Phone Coll MICHAEL & CLAUDIA DEVINE 54 NE 102 Street 305 - 759 -4883 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone JMS PLUMBING CORP (786)200 -3506 of Work: PLUMBING of Piping: Tonal Info: Bond Return : Residential Fees Due Amount CCF $1.80 DBPR Fee $2.25 DCA Fee $2.25 Educabon Surcharge $0.80 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 Valuation: $ 2,500.00 Total Sq Feet: p r , Scanning: gyy {� £ 9 Pay Date Pay Type Amt Paid Amt Due I Invoice # PL -4-12 -43936 04/13/2012 Credit Card 08/10/2012 Credit Card $ 50.00 $ 112.30 $ 112.30 $ 0.00 Wailable Inspections: Inspection Type: op Out nal derground Applicant Copy For Inspections, Call (305) 762 -4949 or Log on at https:H bldg .miamishoresvillage.conVcapl. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. August 10, 2012 2 t,blp- 3AV, 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 2010 Permit �QM' APR 13 2012 BYo A e_________�___o_ Permit No. 012: C(01 Master Permit No. OWNER: Name (Fee Simp el°'Phl<heWer)— )441 QAP Phone #: 60—=o 6" 1 —( Address: City: State: Zip:.�'3 I �i Tenant/Lessee Name: Phone #: Email: ii. fig ___�' �vav-,� 1 �(. _ CLjy,­e_—, JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: JW-5 60A00� Phone #: 7 &eO ' 36 Address: e,�S _S AIJAJ .3-Z— 00T. City: State: Zip: .1.3 Qualifier Name:'- Ju -% ® Phone #• ���' State Certification or Registration #: 604=— / 7& !Certificate of Competency #: Contact Phone #: 19 As i4AMCEmail Address: � aJl Pdk1& 4 WAA 40A17 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 0 ��® Square/Linear Footage of Work: Type of Work: ❑Address 1_<r4 ❑ iteratio ❑ e ❑Repair/Replace ❑Demolition Description of Work: Submittal Fee $ Permit Fee $ ® _ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ tt nn TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 inspec ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi t e approved and a reinspection fee will be charged. Signature f " L Sign a a 4✓ z Owner or Agent %VThe ntractor The for oing i strument was me fore oing instrument was acknowledged before me thissq� day of , 20 �by of 2 , 20 t � by �' who rson ll -Vkn%o,n Ame or who has produced who is ersonally known o me or who has produced NOT Sign: K / J Print: My Commission Expires: APPROVED BY and who did take an oath. �A9 C °mom \sst°s a \ona\ G�fi�phN (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) as identification and who did take an oath. NOTAR BL C: 2S. °t�g15 Sign: Print: IZSq� p5g °. N °\ y Commission bans Examiner Structural Review EXPIRES October 26, 2014 Zoning Clerk CERTIFICATE OF LIABILITY INSURANCE moron iuffm � I 1 04/0312012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CONTINENTAL INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 144660 ALTER THE COVERAGE AFFORDED Y THE POLICIES ES BELOW. CORAL GABLES, FL 33114 JMS PLUMBING CORP. 933 NW 32 PL. MIAMI, FL 33125 INSURERS AFFORDING COVERAGE NAIC # INSURERA, HARLEYSVILLE MUTUAL INS. CO. INSURER B. INSURER C: INSURER D. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIT, 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 HE REIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MIMI BEFORE THE EXPIRATION TYPE OF INSURANCE POLICY NUAABER awyllylM MKITMEW LaIrTB FAILURE TO DO BO SHALL A ❑ GENERAL LUIBILRIf 71 COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE © OCCUR GEN'L.AGGREGATE LIMpTAPPLIES PER POLICY Fl PROJECT rl LOC GL7133B 04/22/2011 04/22(2012 EACH OCCURRENCE $ 1 �� PREMISE $ 100,000 APED EV (Ary am ) $ 6,000 PERSONALaADVINJURY s 1,000,000 GENERALAGGREGATE S 1,000,100 PRODUCTS - COMPIOPAM $ 1,0001000 El AUTOMOBLE LIAB.ITY ANYAUTO ALLOWNWAUrOS SCHEDULED AUTOS HIREDAUTOS NON- OWNEDAUTOS CEO SINGLE LIMIT ll�� $ BOOIL ) RY ((PP�� $ BODILY INJURY (Perms) $ (PPR =7AMAGE $ E] GARAGE LIABILITY ANYAUTO AUTO ONLY- EAACCMENT $ m EAACC AUTO ONLY, AM $ S ❑ EXCESS I UMBAELI.A LIABILITY OCCUR ❑ CLAM MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ S $ S CO ]IONAND YIN ANY PROPRIMRIPARTNERfiDMCUTIVE OFFICERMIEMBER EXCLUDED? (�M yInNH) SPECIN. PRONI88 DNS below TWO' LMT3 M ER E.L. EACH ACCIDENT S E.LDBEASE- EAEMKO11B S E.L. DISEASE - POLICY LMT 1 $ OTHER cawr�F�carw M 11 ll Fw ■z Mrzr l 1 Ar191N /r 1 A% VRD ze PzUISMI ru®e , or A 01938 -3 acoRD coRPORanON. All rVi tB reseAved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES GEANC BEFORE THE EXPIRATION MIAMI SHORES VILLAGE DATE THEREOF, THE ISBUN0 I N URER WILL ENDFIAV R TO 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH FAILURE TO DO BO SHALL 10050 NE 2 AVE , I IMPOSE SE NO OBLIGATION OR LIABILITY OF Y AN INSURER, ITS AGENTS OR MIAMI SHORES, FL 33138 jUP4N REPRESENT 71TNE8. AUTHORS REPRESENTATIVE A% VRD ze PzUISMI ru®e , or A 01938 -3 acoRD coRPORanON. All rVi tB reseAved. The ACORD name and logo are registered marks of ACORD VlI4aW V � a.i.Sli AtVl� DBPARTMOT Of BUSINESS AND PROF8SSi0iQAL REGULATION CONSTRUCTION R�� INDUSTRY BOARD (850) 487 »1395 TATITABASSBB 33399 -0783 RODRIGM JMIO JM8 PMRW CORPOR&TION INC 9m 32ND P CI3 FL 33125 i#Ci4R 0 4 /02-10 098170452. cm R rxc t �.. �. Saar: #- t.���, z %�.00s►a0tee2e - f, VL —IV AVIA SiATE' Oi=' FLORIDA . OF FWA46AL smviCES .iCATf flir ECI ice..tt#Pf Fiiflli tORIDA` WORKERS'::COMPENSATION LAW `RiM1CT 4N iiti1DUSTRV EXEMi" rtifies that the mdiv deaf "listed b � yr has eluted to be exempt from Florida Workers' Compensation law. is DAM f?2h5120i2 EXi" iRATION DATE: 02/14/2014 ROD IGUEZ. JULIO PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE DEPARTMENT OF FINA4NC AL SERVICES . DMSION OF WORKERS` COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO 13E EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW _` EFFECTIVE 02/15 /2012: EXPIRATION DATE: 02/14/2014 PERSON: JULIO RooarouE2 FEIN: 264361499 BUSINESS NAME AND ADDRESS: ims PLuimm coRPORA -not me 933 N W 32 PLACE NIAML FL 33125 SCOPE OF QUPR.Y =SS OR :TRADES 1- CERTffIED.PLiAA9� ORTF IMPORTANT OPursuant to Chapter 44&05 (14), F.&. an officer of a corporation who elects exemption from this chapter by filing a certificate of election Dunder this section may not recover benefits or compensation under this chapter. H 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 on Rthe 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 on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The departIfient shall revoke a certificate at any time for failure of the person named on the certificate to most the requirements of this section. - - -- - -- - - - -- - - - -- - - -- QUESTIONS? (850) 413 -11 CUT HERE C ilril 'poctioair on the job, [seep upper portion for your records. WC -252 D 01 -11