DEMO-12-23Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
F-t`'iG , 11 -2 2143
inspection Number: INSP- 168486 Permit Number: DEMO- 1 -12 -23
Inspection Date: July 11, 2012
Inspector. Hernandez, Rafael
Owner: SFARA, VERONIQUE
Job Address: 1080 NE 105 Street
Miami Shores, FL 33138-
Project: <NONE>
Permit Type: Demolition
Inspection Type: Final
Work Classification: Plumbing
Phone Number (305)799 -2006
Parcel Number 1122320280090
Contractor: PLUMB TECH GROUP INC Phone: (305 )428 -8685
Buildina Denartment Comments
DEMOLITION OF SOME PLUMBING TO RECEIVE NEW
REMODEL & ADDITION
Passed
Inspector Comments
Failed El
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
July 11, 2012 Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PRONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWN
Addre
City: _
Tenam
Email:
JAN
Permit No. ..'"" 11,2b
Master Permit No , �b41
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: FIUMf3 f (°C8 6 rV O e Phone #: S� ° qn %fs
Address:. 5A -3 T
City: it l i State: 'f e— Zip: �3 -i/ 6 ,-
Qualifier Name: R 41 roar �r� �" �(r/ �L Phone #:
State Certification or Registration #: L C3 C ( N G/ J i
Contact Phonek 30 S — 3 52 Email Address:
DESIGNER: Architect/Engineer: 1 Phone #:
Value of Work for this Permit: $y" Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace
Description of Work:
Submittal Fee $ Permit Fee $ / CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
ODemolition
TOTAL FEE NOW DUE $
®6
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In he absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent /51-
Co tractor
The foregoing instrument was acknowledged before me this
day of 16A , 20 t2 , by y &DN!q& S& O, ,
who is personally known to me or who has produced
U CP AVI As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Cili!i S$
My Commission Expires:
tt /lU11013
APPROVED BY
Public State of Fiodda
MY Gomm"M uo
Wres 11116=13
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
The foregoing instrument was acknowledged before me this
day of Pl , 20 V2 , by 04M o►> 6PArn (,C ,
who is personally known to me or who has produced
Jam( CUIlL5e s identification and who did take an oath.
4 Plans Examiner
NOTARY PUBLIC:
Sign:
Print:
My Commission Ex�
►Ill (0 /wt
11C
S of FVe�
gub
Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH ~ v TALLAHAS EEMONROE STRFLT32399 -0783
RODRIGUEZ, RAMON OSVALDO
PLUMB TECH GROUP INC
8931 S.W. 52ND STREET
MIAMI FL 33165 -6607
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
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' MIAMI -DADE COUNTY
-
2011 LOCAL BUSINESS TAX RECEIPT 2012
FIRST -CLASS
TAX COLLECTOR
MIAMI -DADE COUNTY - STATE OF FLORIDA
U.S. POSTAGE
140 W. FLAGLER ST.
EXPIRES SEPT. 30, 2012
PAID
1st FLOOR
MIAMI, FL 33130
MUST BE DISPLAYED AT PLACE OF BUSINESS
MIAMI, FL
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10
PERMIT NO. 231
592030 -2
THIS IS NOT A BILL - DO NOT PAY RENEWAL
Bu '"t i TAf I 11" O '86P
RE
INC STATE#_TlQ x+27217617587
-1
8931 SW 52 ST
33165 UNIN DADE
COUNTY
O PLUMB
TECH GROUP
INC
��I` UM
WORKE2 /S
CONTRACTOR
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY
ZONING
ZONING LAWS OF THE HE
COUNTY OR CMEB NOR
DO NOT FORWARD
DO EXEMPT ES
PLUMB TECH GROUP INC
REODUIRED BY LAW. THIS
RAMON RODRIGUEZ PRES
NOT A THE HOLDSM QUA"ALILIFCA --
8931 SW 52 ST
„ ®Ns.
MIAMI FL 33165
PAYMENTRECENED
M"-DAVE COUNTY TAX
COLLECT 07/27/2011
60000000190
000075.00
88
SEE OTHER SIDE
0
10 -12 -2010
0.0"/
ALEX SINK 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: 11/27/2010
PERSON: RODRIGUEZ
FEIN: 205410523
BUSINESS NAME AND ADDRESS:
PLUMB TECH GROUP INC
8931 SW 52ND ST
MIAMI FL 33165
SCOPES OF BUSINESS OR TRADE:
1— CERTIFIED PLUMBING CONTRACTOR
EXPIRATION DATE: 11/26/2012
RAMON O
IMPORTANT: Pursuant to Chapter 440 . 0604), F.S., en officer of a corporation who elects exemption from this chapter by filing a certificate of election under this r
section may not recover benefits or compensation under this chapter. 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 the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of
election to he exempt shalt 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 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 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL. SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW Ia
EFFECTIVE: 11/27/2010 EXPIRATION DATE: 11/26/2012
PERSON: RAMON 0 RODRIGUEZ
FEIN: 205410523
BUSINESS NAME AND ADDRESS:
PLUMB rECH GROUP INC
8931 SW 52NO'ST
MIAMI, FL 33165 '
SCOPE OF BUSINESS OR TRADE:
I- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
O elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt... apply only within the scope of the business or trade listed on
R the notice of election to be t.
exemp
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 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 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
IWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
CERTIFICATE OF LIABILITY INSURANCE 01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UP()N THE CERTIFICATE S
HO
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LMixg
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHOR]
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the PORCY(les) Must be endorsed. 9 SUBROGATION 13 WAIVED, subject to
the terms and conditions of the Pollm certain Policies may require an andOrgemenL A statemerd on this Certificate does not confer rights to the
certificate holder in Reu of swh enclorsementils),
Miami, FL 33125 (A
Phone (305) 635-28DO Fax (305) 636-3002
Plumb Tech Group Inc L'INSURERA: MOUNTVERNON
Miami, FL 33165-
(305) 42"6W INSURER E:
REVISION NUMBER:—
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM FORi�E FbdCY PER Oil
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EXCLUSIONS AND CONDITIONS OF SUCH POL:��ES. LIMITS 3 NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBXCT TO ALL THE TERMS, I
mCWN MAY
N811- HAVE BEEN REDUCED By PAID CLAIMS.
| LIABILITY — LIMITS
/
t
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
CLAIMS-MADE
100000
GwL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE 200M
POLICY PRO-
El LOC
I PRODUCTS - COMP/Op 1000000:
ANY AUTO
(Ea accidarrD
ALL OWNED AUTOS
pemorl)
SCHEDULED AUTOS
O.ODILY INJURY (Per accident)l III I
HIRED AUTOS
NON-OWNED AUTOS
(Per accident)
OCCUR
I EXCESS LIAS
I_ CLAIMS-MADE
EACH OCCURRENCE
AGGREGATE
MRKERSCOMPENSATIC T-1
AND EMPLOYERT LIABILITY YIN'
ANY
PROPRIETOWPARTNERIEXECUTIVE
(Mandatory in NH)
E.L. EACH ACCIDENT
If rs. describe under
D SC Rip
I— DISEASE - EA EMPLOYE S
01, Additional
i-----'--`''—^
space � .
� |
|
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCS i BE�ORE
Miami Shores Village
THE EXPIRATION DATE THEREOF, NOTICE MLL BE DUX49M IN
Building Depariment
ACCORDANCE WITH THE POLJCY PROVISIONS.
10050 N.E. 2nd AVE.
MIAMI SHORES, Fl. 33138
The ACORD narte and logo are registered marks ot ACORD