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PLC-14-548Inspection Worksheet Miami Shores Village 10050 M.E. 2nd Avenue Miami Shores, FL Phane: (305)795 -2204 Fax:, (3 )r -8972 inspection Number.: INSP- 20,9696 Permit Number, PLC-3-1.4- 60 . ;chedofed Inspect On bate. April 01, 204 Permit Type: Plumbing - Commercial inspector. Diaz, ©svaldd Inspection Tyo.- Find Owner: , BARRY UNIVERSITY Work Classiffeaftn. Addi#ionfAtto +<an Job Address:1 300 NE 2 Avanoe Fins Arts _ _ Mi ami Share, FL 33/304000 Phone, tVurrtiber Parcel Cumber 1121300010160 -0,6 Project BARRY UNIMSITY �> Contactor: SHARK K UMBING INC Phone: (305)3844-696 Boi#dIng 0# 0rt 0nt Cgrrilrx pht ��- 1it�I�p�on Fee No Addlional lnpecWnS Can be sclteduttd unYit m4napeWoo fee is paid, 3la�l � Miami Shores Village Building Department C 5 3�q 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 r INSPECTION'S PHONE NUMBER: (305) 762.4945 BUILDING PERMIT APPLICATION Permit Type: PLUMBING Perm Master Permit No. I �F ; My N' S K-S 1 04re JOB ADDRESS: �����_,�E���( \f' 1;3c +(i f'. �,t! City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): f �� ��� (��' 1���1" t�( l�� Phone #: Address: City: IA i O. i rq�)CLei E State: l.- zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: .Sf %f�i�/� 1��i/ �,o�C - //" Phone #: 30-T - 3 FV 6'S? Address: / 3 00 5—.,� !-j2- A N/ 4L City: 1-�i4 k r7 t > State: ��f` Zip: 33/ Qualifier Name: = ®5g S Phone #: - 3 -3q - 5 S-1 Y State Certification or Registration #:pFC 1127-3 C-0 Certificate of Competency #: Contact Phone #: 13103188 / -DOG Email Address: 56w, K nLw-%hu, !x 2-z DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 00 Square/Linear Footage of Work: Type of Work: ❑Address Dpp Alteration 17New ❑Repai eplace Description of Work: L e Submittal Fee $ Permit Fee $ dr 50. nY CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ODemolition 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of su posted notice, the inspection will not be approved and a reinspection fee v4 be charged. Owner or Agent i LL-do The foregoing instrument was acknowledged before me this day of H '2f c�-% , 20 by 5u6czr -, who 's pers�known me or w ho has produced As identification and who did take an oath. NOTARY PUBLIC: 0.24 — n Print: L My Commission Expires: APPROVED BY Notary Public - State of Florida My Comm. Expires May 30, 2014 Commission # DD 979550 Bonded Through National Notary Assn. The foregoing instrument was acknWIedged before me this day of LIA1961 -1 , 20 L, by JO-S fe . U; S / /,*/9; who is personally known to me or who has produced as identification and who did take an oath. —P—C -/q Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: CO2 WR Print: My Comm s: MILEDYS emiA Not* Public - State of Borlda V My Coadat. UJIMIe 00 3, 2018 %;,F .•`� Cotaedesielt # EE 810318 Zoning Clerk (wwwYYYY) CERTIFICATE OF LIABILITY INSURANCE DAre 03/104 THIS 'CERTIFICATE is ISSUED 'AS4MATTER 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: If a certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. ifsuefii)aATioNl6 WAIVED, "s'u"b*']*'ec*t*'I*o** 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 andorsement(s). PRODUCER Blanco Insurance Associated Inc. 1460 E. 4th Ave. Hialeah, FL 33010 Phone (305) $88-0524 Fax ..(3q5)..qS3'6218 ..... ........ ... .......... INSURED clh k 01 Maria Almolds ........... �0,jxl):._(305).8WO624 - 8 272-0044 ...... ..... ... ....... 68, ........... ......... . . ---- ...... .. ..... — !�oda@blaricoinsurance.com MR A. Granada Insurance co. tER B Business Fi First Insurance Co. -- . .... .. . ............. . . . ..... 1-1.11 ..... ............ . ............ ... .... —.— .......... ..... ............ .... ar um ing nc. 1300 Sw 92 ave INSURER D .............. .. Miami R. 33174 (305)384-5595 - . ....... .. ......... .. .. .. .... ....... .. ......... . . ........................ .... . ....... ........ COVi ii ......... . . ........ .. ............ REVISION NUMBER: -fk[Sis TO CERTIFY THAT THE POLfCiES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEQ TO THE INSURED NAMED ABOVE ­FOR 'THE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADD 'SUER ..................... ............... .................. ..... . .. .... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1.,000 000.00 6A COMMERCIAL GENERAL LIABILITY A-- 100,000.00 I ❑ El ci-Aims-wADE occuR A N 0185FL00031020 11/02/2013 11/0212014 ......... ....... -00 ........ ... ... ❑ .. .... . ......... ...... ..R IA-2,000,000.00 ' GENIL AGGREGATE LIMIT APPLIES PER: ' $ 2,000,000.00 PRO n LOC _�qau��-compioPAGej ............ $ ............. ... . AUTOMOBILE LIABILITY ------- ........................ LIMB ........ ... ....... . ......... ❑ ANY AUTO BODILY INJURY (Per person) ....... . .. ...... ALL OWNED CHEDULED S AUTOS AUTOS . ...... .... . ......... . . ........ ..... BODILY INJURY (Per accident) ... .......... .. ............... NON-OWNED El HIREDAUTOS ❑ AUTOS PROPERTY ?AM - AGE ----------- - P, ar a - UMBRELLA LIAR OCCUR ❑ .... .... .. _.............-------- ...._I . ....... . ...... r-1 EXCESS LIAR F-1 IN Ait&—uanr- I H OCCURRENCE $ WORKERS COMPENSATION STATUw, OTH" ORYLIMIT AND EMPLOYERS* LIABILITY YIN 1 ANY PROPRIETORIPARTNERIEXECUTIVE a OFFICERIMEMBER EXCLUDED? NIA 621-07749 $ I (Mandatory In NH) 11/0212013 11/0212014 escribe undar E.L. DISEASE - EA EMPLOYE $ 1 ,.--...-LwAA11IPTION OF OPERATION9 E.L. DISEASE .POLICY LIMIT $ 1 . . ........ . ............ ............ . . ............ ................ .. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) i PLUMBING WORK ......... ... . .. ..... CERTIFICATE HOLDER CANCELLATION . . . ......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cl I'Y OF MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHARES VILLAGE, FL. 33138 AUTHORREO F&RESENTATIVE MARIA ALMOLD&A.— ......... .... CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD 0,04487 Local Rosiness Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6754320 LPL BUSINESS NAME /LOCATION RECEIPT NO. EXPIRES SHARK PLUMBING INC RENEWAL SEPTEMBER 30, 2014 1300 SW 92 AVE 7027733 Must be displayed at place of business MIAMI FL 33174 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED SHARK PLUMBING INC 196 PLUMBING CONTRACTOR BY TAX COLLECTOR Worker(s) CFC1428368 $75.00 07/09/2013 TXHS1- 13- 016404 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec ffa -276. For more information, visit www.miamid@de.govttaxcollector C# 6150288 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ #L12060200272 DATE BATCH NUMBER LICENSE NBR 06/02/20121118196955 1 CFC1428368 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 PANES, JOSE LUIS SHARK PLUMBING INC 1300 SW 92ND AVE MIAMI FL 33174 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 01/20/2013 EXPIRATION DATE PERSON: JOSE L YANES FEIN: 272322506 BUSINESS NAME AND ADDRESS: SHARK PLUMBING INC 1300 SW 92 AVE MIAMI, FL 33174 SCOPE OF BUSINESS OR TRADE: 1- PLUMBING NOC AND DRIVERS KEN LAWSON SECRETARY IMPORTANT F Pursuant to Chapter 440.05041, F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election \`Y L under this section may not recover benefits or compensation under this ffe D chapter. 01/20/2015 Pursuant to Chapter 440.05021, F.S., Certificates of election to be H exempt.., apply only within the scope of the business or trade listed on E the notice of election to be exempt. R 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 meet 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