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PL-13-357Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795.2204 Fax: (305)756 -8972 Inspection Number, INSP-205766 Permit Number: PL- 2- 13-357 Scheduled Inspection Date:.April 01, 2014 Inspector-. Diaz, Osvaldo Owner. , Job Address :77 NW 101 Street Miami Shores, FL 331 50- Project <NONE> Contractor T&C GOLDEN PLUMBING INC Permit Type: Plumbing - Residential inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010180190 Phone: (954)226 -6337 Building Department Comments PLUMBING. FOR INTERIOR REMODEL 03/0612013 - PAYMENT DELETED AND SUBMITTAL FEE PAID WITH A CREDIT CARD. ORGINAL PAYMENT WITH CHECK NOT CLEAR BY BANK. OWNER REP CAME IN TO PAY WITH CREDIT CARD. As I ctio P INSPECTOR COMMENTS Comments False Passed Failed Correction Needed Fie- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee :is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 205055. CREATED AS REINSPECTION FOR INSP- 203778. QUALIFER REQUIR'D FOR INSP, AND VALVES ARE IMPROPERLY INSTALLED APPROVED FITTINGS REQUIRED FOR CONNECTION OF SINKS RELIEF LINE 3/4 TO F.F. CUALK SINK TO WALL March 31, 2014 For inspections please call: (305)762.4949 Page 10 of 60 BUILDING 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 FED 2 1 2b FBC Z(�1 Permit No. �J I 1,(,- 1,(,— ?;6-1 PERMIT APPLICATION Master Permit No. 11:2C, I'3 5 Permit Type: PLUMBING JOB ADDRESS: City: Miami Shores County: Folio/Parcel #: /i� — 01 01 S " 0/ 90 Is the Building Historically Designated: Yes NO Miami Dade Zip: 33,•1 3 ,/ Flood Zone: OWNER: Name (Fee Simple Titleholder): 6U.); L.L C. Phone# ,g- 324. -010'4 Address: ,13-4 4-0 C,c // .5. /t.K) 0..6 City: `&n„ty .mss /,ems f A-c . State: F! Zip: 3',,// Tenant/Lessee Name: ,t%jp. Phone #: Email: �Lv,ztG� �G CONTRACTOR: Company Name: f C 6d t-b Address: 95-I (.&(1' JYLf, 4 �- �✓ ' City: f% L ®4-v o� € State: Qualifier Name: 7 v rJ 6o Lr, i■e State Certification or Registration #: �' /42 40,75- Contact Phone #: 9Y 2 Z 6 (,3 37 DESIGNER: Architect/Engineer: *"16-Phone #: Email Address: Phone #: Certificate of Competency #: Cfo ki eot I C cJ/z.( .� Phone #: Zip: 3 3 3 I 9'S.l 226, 633-1 CI=A' //2(07s z ,0t960 .cvy Value of Work for this Permit: $ 2,75®0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑Demolition Description of Work: /26i—/-64 0A UNew 12Repair/Replace Submittal Fee $ Permit Fee $ /523 .® 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 A 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 comm for the first inspection which occurs seven (7) days after the building permit is issued. inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this UPI day oij, 20'2S, by 44i in personally-i 'rni to me or who has produced if 2,0 e22.1.36 ,As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: "mkt T( t3 .Vi alc- My Commission Expires: APPROVED SIBILA MENECIER lifitOONIMSSNINVELOISINIktk EXPIRES: AUG 02, 2014 Bonded through 1st State Insurance Signature cement must be ' ted at the job site the ab nce o such; posted notice, the f Contractor The foregoin, instrument was acknowledged before me this day of , 2O' , b Ailar who has produced � e � - �j � `-- �►s as i en ficahon and who did take an oath. NOTARY PUBLIC: Sign: Print: 1L My Commission Expires: xaminer SIBILA MENECIER MY COMMISSION #EE013884 * *I 4 ** Bonded through 1st State Insurance Structural Review (Revised3/l to d 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) Zoning Clerk BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301 -1895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 Business Name: T & C GOLDEN PLUMBING INC Receipt #:p BL INO/LWN SPRNKL /CONTRA Business Type: (CERTIFIED PLUMBING CONTRA Owner Name: TREVIS LAMAR GOLDEN Business Opened:09/16/2005 Business Location: 851 WYOMING AVE StatelCountylCertiReg :CFC1426752 FT LAUDERDALE Exemption Code: Business Phone: 984-933.-6123 - Rooms Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Trams Fee NSF Fee Penallyr Prior Years Coltedian Cost Total Paid 27.00 0.00 0.00`, 5.40 0.00 25.00 57.40 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax Is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VAUDATED and zoning requirements. This Business Tax Receipt must be trtmsferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is In compliance a with State or local laws and regulations. Mailing Address: TREVIS LAMAR GOLDEN 851 WYOMING AVE FORT LAUDERDALE, FL 33312 2012 - 2013 Receipt #035 -12- 00002078 Paid 12 /10/2012 57.40 • R R) 01 -20 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFRCER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF SON 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: 01/20/2012 PERSON: GOLDEN FEIN: 201623173 BUSINESS NAME AND ADDRESS: T & C GOLDEN PLUMBING INC 851 WYOMING AVE FT LAUDERDALE FL 33312 SCOPES OF BUSINESS OR TRADE 1- PLUMBING EXPIRATION DATE: 01 /19/2014 TREVIS L * IMPORTANT: Pursuant to Chapter 440 . 05114). F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pennant to Chapter 440. 05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed an the notice of election to ire exempt Pursuant to Chapter 440.05113). 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 tie certificate, the per on named on the notice or certificate no longer meets the requirements of this neaten 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. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1609 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 EFFECTIVE 01/20/2012 EXPIRATION DATE: 01/19/2014 PERSON: TREVIS L GOLDEN FEIN 201023173 BUSINESS NAME AND ADDRESS: T & C GOLDEN PLUMBING INC 051 WYOMING AVE FT LAUDERDALE, Fl. 33312 SCOPE OF BUSINESS OR TRADE 1- PLUMBING IMPORTANT F Pursuant to Chapter pter 440.05(14), F.S.„ an officer of a corporation who elects exemption from this chapter by filing a certificate of election L snider this section may not recover benefits or compensation under this D 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 thole 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 department shall revoke a certificate at any time for failure of the person maned 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 CERTIFICATE OF UABILITY INSURANCE ems misennwo 01/28/2013 THIS CERTIFICATE IS RESTED AS A MATTER OF INFORMATION ONLY AND COWERS NO RIGHTS WON THE CERTIFICATE HOLDER. VW CERTIFICATE DOES NOT AFFWEATIVELY OR NEGATIVELY AMID, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tin CERTIFICATE OF HIMMANCE DOES NOT =MIME A CONTRACT BETWEEN THE MEMO INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCIM, AND THE CERTIFICATE HOLIER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polky(ks) mint be endorsed. N SUBROGATION IS WAIVED, subject to the terms and candalons of the policy, certain policies may require an endorsement. A statement on tins certificate dues not confer Vint to the certificate holder in lieu of such endorsement(s). paonucot THE MORGAN EXECUTIVE GROUP 860 NORTH STATE ROAD 7 SUITE 5-A PLANTATION FL 33317 COM= kenyeazzoa NAM PHONE Hp.stik pm) 516-3755 I Km* (954) 530-2414 imam Icayekenymergeninsurance.core )COVERAGE DistmERA: TAPCO I. Lloyds of landini mice 0 severe T& C Gotten Phoning Mc. 851 waning Ave Fort Lauchndele FL 33312 INBURERC: DEURERD: INSURBI : COVERAGES CERTIFICATE NUMBEIt REVISION WASHER: THIS IS TVCERTIFY THAT DE POLICIES OF INSURANCE LISTED MOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NiniNITHSTANDING ANY REQUIREMENT. TERM OR COMET= OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AIM CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID MI0,000 100.000 5.080 300.01V MOW MED TVT OSSCRiFflON OF OPERAMINSMICAMINS tiffiliKLES Math MORD MOtAddiUmailternads SOMA% Maass spate is smoked) Pkunbing Contractor CEMTWICATE HOLDER CANCELLATKIN City of Miami Shaun Village 10050 NE fl Amin Miami Shores Wage, FL 33138 sumo ANY OF THE ABOVE DESCIERLD POLICES BE CANCELLED BEFORE THE EILPMADON DATE THERMO, NOTICE miLL BE MEWED IN ACORDION:a VOW TIE POLICY PROVISIONS. Kelly A. Morgan ACORD 25(2010105) ©1988-2018 ACORD CORPORATION. AII rights reserved. The ACORD name and logo are registered media of ACORD STATE OF FLORIDA EMMERT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCT/ON INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET SEE FL 32399 -0783 GOLDEN, TREVIS LAMAR T & C GOLDEN PLYING INC 851 WYOMING AVE FT LAUDERDALE FL 33312 Congratulatlons'i 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 wwwi.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department neweetters 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! (850) 487 -1395 DETACH HERE THIS DOCUMENT DOCUMEr■Ir HAS .A COLORED't3ACKCROUND'• MICROPRINTING • LINENIARK PATENTED PAPER STATE OF FLORIDA B JSXN] 58 AND LI PROFESS O iCTIOk�. INDII TRY I REGULATION B SEQ# L12 o 90 100888. DISPLAY AS REQUIRED BY LAW