PL-12-686Inspection Worksheet
Miami Shores Village
70050 N.E. 2nd Avenue Miami Shores, FIL �0/1-1
Phone. (305)796-2204 Fax: (305)756-8972
Inspection Number: INSP- 172501 Permit Number: PL -4 -12 -686
Scheduled Inspection Date: April 09, 2093 Permit Type: Plumbing - Residential
Inspector. Hernandez, Rafael
Owner. MORALES, RUTH & ALFREDO
Job Address: 769 NW 190 Street
Miami Shores, FL 33769-
Project <NONE>
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 9929360030590
Contractor: PIPEMASTERS PLUMBING SERVICES INC Phone: (305)687 -7574
Department Comments
NEW BATHROOM AND RELOCATE KITCHEN
Passed �
Inspector Comments
��-����+ � / /�`'" �',•l �1.3
Failed El
Correction
Needed
Re- inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee Is paid
810-3 L000/9000d ZOE -1 -WOii3 LZ:90 EL Z0 -i70
sI
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
PERMI LICATION
FMC 20 L
Permit Type: PLUMBING
u77-,3P r
APR 17 -;j 14
4eA
Permit No. ' ` u.) ?—:7,
Master Permit No. )Q C_ —.3 — I ?_ - g �
OWNER: Name (Fee Simple Titleholder): COAS JA J"RA LAfi/ Phone#: 7 &( -3,5 p D V t
Address: � 6 i ..J k) /l0 � , S 'r-
city: to ffl i °jl S hd 90-S State: N L Zip: 3 3 t 6j
Tenanftzssee Name:
Email:
JOB ADDRESS: / 6 Aji't'l
City: Miami Shores County: Miami Dade
Folio/Pa rcel #: ' %/� l3 9 ° 0,0 3- 0 & t ID
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company
Address: 7S�; _Al W
30 S— 6 6/ --: 7�
City: .&RTV iipm>1 Stater Zip: 3 3 4 1! j
Qualifier Name: CIES14 / Phone #: 3 O �;— `j l .2;7�S3 /
State Certification or Registration #: G' L / 1/2 30 Certificate of Competency #: C66-1(12-6307
Contact Phone#: 5 O: & x^75- S.�31 Email Address: 2)!6M ht9 Y 5 In' i Aj6 P J4 oL i L j)A4
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit:
Type of Work: DAddress
J� a_mription of Work:
Footage of Work:
❑New ORepair/Replace ODemolition
Submittal Fee $ &4�7 Permit Fee $ 2� CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bondf*g Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Si
Owner or Agent Contractor
The foregoing ' instrument was acknowledged before me this
day of i , 20 J L by . &WaN ,
who is dnonally known to me or who has produced—EL,�V_
As identification and who did take an oath.
NOTARY PUBLIC:
6�pC `o�da
Sign: �$ 1
Print:
,, � C•��15 `O� ar
My Commissio Expires.
APPROVED BY
(Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09)
The foregoing instrument was acknowledged before me this
day of . 20 _, by ,
who is personally known to me or who has produced
1-Plans Examiner
Structural Review
Zoning
Clerk
FROM :Boa Forma
FAX NO. :3056857574 Apr. 17 2012 4:46PM P3
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
'va TALLAHASSEE FL 32399 -0783
GARCIA, CESAR A
PIPENASTERS PLLiMBING SERVICES INC
755 NW 131 ST
NORTH MIAMI FL 33168
Congratulations] With this license you become one of the nearly one million
Floridians licensod 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.
Cvery day we work to improve the way we do business in order to serve you better -
For information about our sWiices, please log onto www.myfioridalicanse.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`% initiatives.
Our mission at tho 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 licensal
DETACH HERE
J.
r;ir 6 . , .... , ..`;` ;_ ... ' STATE OF FLOK
a' "/. � •t::� •�• .•• X15. �' A• • ,Yl
•75 NFT 3
,P"} �a4^;.!'i " �,} �. t. ;••:.tee ••.
"'FL 33168 �,`; "' �:•,;
aye
C..i'`.�..s : =:�yr••:'i 'a -j�rrr •}i.C. -: .!7' �;�.as,.r -.,-r ::i.:�•
`C-
FROM :Boa Forma FAX NO. :3056657574 Apr. 17 2012 4:47PM P4
MiAMi -D
TAX CuLL�CYOR "! 1 ' ,
740 W. NLAaaI.FR ST. �� LOCAL SLU9'N0$SV "r j� REC "'
7 6I FLOOR A"j -"AGE COUNTY - STATE OF'F lUAJQA 22072 PIRST-CLAS;s
MIAMI, FL 33730 MUST BE DI xpm s SEPT. 30.2072 us- PAID AGE
PURSUANT TQ CQUMy�D DE PLACE OF BUSART.
COLE CFiAATEfi BA - ART. 9 & 7Q MIAMI, FL
540860 -4 :j;,
PERMIT No. 231
tBUSINE4,S NAMJF / LOCA'nON RENEWAL
PIPEMASiERS PLUMBING SERVICES INC S ATE# 6 755 N CFCZ 307
�b8 NORTHI
33 MIAMI 564789 -7
OWNt17
0ooPr PEMASTERS PLUN$INO SERVICES Iij
V1a or [lushes
LTY PLUMBING coNTRACTOR WORKER /S
I
PAYaue.NT 1+C4Etv:,p
n° •UADt 0UNrY TAX
L�l.LE1: � OR:
09/(36/2011
60020000163
000045 -00
SEE OTHER 31DE
DO NOT FORWARfj
PIPEMASTERS PLUMBING SERVICES .INC
CESAR GARCIA PRFS
755 NW 131 ST
N MIAMI FL 33168
94
A ,
FROM :Boa Forma
FAX NO. :3056857574 Apr. 17 2012 4:47PM P5
CERTIFICATE OF LIABILITY INSURANCE TAc
12022 DATEIMM/pp/YYYY}
04 -17 -2012
r'
HIS CER'I IFICATEIS ISSUM AS A MATTE pp
IN 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 BETNIlT► THE ISSUING INSURER {S ►, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the ficate hoider is an ADDITIONALiNSURED.the poicy w* Mun be efldolse It SUBROGATiONIS WAIVED, subject to
the terms and exmditians of The policy, terrain polities may require an endorsement. A stapemem on this
certificate hoiden In H of ---h Endo s), certificate floes not confer rtg}Yis to the
Awnuaw
NORTHEAST AGENCIES INC /PHS
210204 P:(866)46'7-8730 P.-(800)308-5459 SS6)4 7 -8730 F N&r (800)308 -545;
301 WOODS PARK DRIVE
CLINTON NY 13323 mr.
AA'ORDtNB COVERAGE NAIL 0
It�1Fi9RA: RartgOiL� C3S17,pi IrxS CO
PXPE MASTERS PLUMBING SERVICES INC. B'
755 NW 131ST ST Vic:
NORTH MIAMI FL 33168 I o I
THIS I5 TO CERTIFY THAT THE POLtC1E5 OF I — HLVISIfUN NUMBER:
INDICATED. NOTWITHSTANDINO ANY REWI CE LISTED BELOW HAVE 8Eij11 ISSUED TO THE INS D NAtNm ABQVE FOR THE AOl]CY PFR10D
CERTIFICATE MAY BE ISSUM OR MAY pawAnV. TERIMI OR CONDITION OF ANY CONTRACT OR OTHER CCU NT WITH pESPECT TO WN H THIs
EXCLUSIONS AND CONOMONS OF SUCbt POUCIES. bUM C8 �� THE Pa! C� DESCRIBED HEN IS SUBJECT TO ALL THE TEIewS.
-- — p SNQWN MAY HAV6l3EEN RIZOCED BY PAID CLAM&
aMtx rrleu�r �—
R 7Mi OF _
dFJId�RA[ vggwy L I } (�B4YYEeY1'YT/ �$
_
X
COMMERCIAL GM RAL UASIUTY
CLAIMSIyADE OCC=
Gen ai 14AI
01 SBM AM7514
08/06/203.
06 /06 /203.2
FACK OCCU E }
lam. 95 {Eg --n-4-0 9
�Aawo a
PERSON iL aAvvpu}JRy a
AUGFEWT. Umff --
X PER:
LLiC
liB�AL ABATE 8
T5 - COMF/OP AGa a
irr
$
<rA a 1 -MZ
TOS
BODILY NU}iY awTOS eODn.Y IKuw {ae
NtDS°O��
Pt y DAMAQE
per
S
r+ r4a flea
OCCUR
4
8
—
i1Rb CUUM`...WAM
DEDUCTIBIE
A 'A:E Q
AW 0ft0Yd14r&ARBJ7Y YIN
ANY PROPMh'rOFRIP I
4 �QXCLUDEO
8
01000
0,0
000
0
«rsc7wlWN OF OPFAA7A?/}gf /iOCA7[Rxlrs /f4. (Attsa0AO01RD 107. AaAObga►ROeq�g��s�����
Those usual to the Insured's Operations,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE AI3OVE DESCRIBED POLICIES BE CANCELLED
Miami Shores Village Building Dept- BEFORE THE EWIRATION DATE T14EREOF, NOTICE WILL BE
10050 NE 2ND AVE AaDANCE THE POLICY PROVISIONS.
MIAMI SHORES, FL 33138
AcaFm 25 (2009/09) ° 19$$,2009 ACppp CORPORA ION, Ap
The ACORD nmft and logo are reSISt�d mark$ of ACORD
FROM :Boa Forma FAX NO. :3056857574 Apr. 17 2012 4:48PM P6
f
1
12- 02 -2oil
JEFF ATWATER
CHIEF FINANCIAL OFFICER DEPARTMENT OAF Of IINANCIIAL 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: 01/27/2012 EXPIRATION DATE: 01126/2014
PERSON: GARCIA CESAR
FEIN: 200416997
BUSINESS NAME AND ADDRESS:
PIPEMASTERS PLUMBING SERVICES If11C
755 NW 131ST STREET
NORTH MIAMI FL 33168
SCOPES OF BUSINESS OR TRADE.
A- PLUMBIAts
••••• ••n, —vet rowmi w aaaprer 440 . 06(14). F.S.. an officer of a earpnrmlon whn elects exemption Irum this chapter by fiffag a certlficate Of election under this
BEOtion may not recover benefits ar compensation under this chapter. persaB41 ro Chapter 440.0602), F.S., CeffAreates of alectios to be exam
scope Qf Wa DualriasB or trade listed op the aortae at efCLliaa to be exempt. OWSOUT to Chapter 440.05(13), f,5., Notices of alsctiaa to be exempt lapel avert fl aces of
olaction to De exempt s &ell be Subject to ruvocattoQ if, a say time Niter the f,ling of tea rtotiee at the tssuaaca N the Cerlfticale, The person named as the notice or
certiticese qn NOW meats the requirements at ats Section for Issuance of a cerrflicere. Tya department shall fevohe a catttficate as Bay time for failure of the person
named On the celtilicma to meet the requiramosts of this section.
)WC -252 CERTIFICATE OF F.LEC71ON TO BE EXEMPT REVISED 01 -11 QUESTIONS? (860) 413 -1609
a..
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
0I A I C Wt- PLORIOA
bEPARTi V-NT OF FINANCIAL SMMCUS —
DIVISION OF WORKERW COMPENSATION
CONSTRUCTION INDl1STRY
CERTIFICATE OF ELECTION TO BE EXEMPT FRAM FLORIDA '
WORKERS' COMPENSATION LAW
EFFECTIVE 01/27/2012; EXPIRATION DATE: 01/26/2014
PERSON: CESAR "RCIA
FEIM 200416997
BUSINESS NAME AND ADDRESS:
YIPUASTCn "u PLUM0lNC1 P,Cf(VICC ^u INC
Ye.6 NW Isisl slrb):Y
NONIIi MIAMI, FL a:ilaa
SCOPE OF BUSINESS OR TRADE-
t - PLUMetNG
IMPORTANT
O Pursuant to Chapter 440.05(14), RS., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not reeover benefits or compensation under thiS
D chapter.
H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
Rexempt.. - apply only within the scope of the business or trade listed an
the notice of election to be exempt.
E Pursuant to Chapter 440.05(13), F,S., Notives of election to be exempt
and certificates of election to be exempt shall be subject to revocation
If, at ttuy time after the filing of the notice or the issuance of the
certificate, tete person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shalt revoke a certificate at any time for failure of the
person named on the Certificate to meet The requirements of this
Section.
CUT HERE
QUESTIONS? (850) 413-1809
at Carry bottom portion on the job, keep upper portion for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11