PL-13-2321f
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 201070
Permit Number: PL -10 -13 -2321
Scheduled Inspection Date: January 08, 2014
Inspector: Diaz, Osvaldo
Owner: ALVARO JOSE HUERTA, PATRICIA
CI CNA DADDATCD D
DA euATT
Job Address: 1566 NE 104 Street
Miami Shores, FL
Project <NONE>
Contractor: MPS OF MIAMI INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320320390
Phone: (305)627 -0199
Building Department Comments
INSTALLATION OF NEW KITCHEN CABINETS AND
APPLIANCES SET SINK DISHWASHER GARBAGE
DISPOSAL ICE MAKER TOILET AND LAVATORY
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Cf
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
- -'`-cr
o<<.
January 07, 2014
For Inspections please call: (305)762 -4949
Page 7 of 27
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
C IVE -
OCT 112013
BY ;'
FBC 20
Permit No. pi , ; _
Master Permit No.y.
Permit Type: PLUMBING
JOB ADDRESS: 15 I 04-4-in 5
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: I l ' 22.32 03 2 - 0390
Is the Building Historically Designated: Yes NO X
OWNER: Name (Fee Simple Titleholder): l' O 4-4-3C74 j/?ajriciq
Address: 15CC.6 LEE
Flood Zone:
X
hone #: -9 2.02x2
City: 1110 m• )I e..s state: I zip: 33158
Tenant/Lessee Name:
Phone#:
Email: -p 441.1 p - Yrw
• c-wYi
CONTRACTOR: Company Name: ° _ )93 a F cim Phone #: - 60 - C I gri
Address: 15'G'i w r"1°1 i,. 0+ y
City: fi,ci /(Z 1/ State: Zip: 33c 16'
Phone#: V(- s 6 - 41(90
State Certification or Registration #: C FC l'( aeC a Certificate of Competency #:
Contact Phone: Email Address: fi 2S / 1iQ/ %r %/ 0„/e4 I/04> -
DESIGNER: Architect/Engineer: Phone #:
3 5 ct
42.4 'Imes
ODemolition
Qualifier Name: CI g y h/ 114,05/4,0--
Value of Work for this Permit: $ 4 �� 1.110 Square/Linear Footage of Work:
Type of Work: OAddress DAlteration
Description of Work: In f)
tiaric.
a le Gnct Lo, ..073 (9/ .
t * * r*****d ** ak*****aF* *aaatr**k,Yk***i * **F **�1r *,k** k*�ir*ir*** ****** &********* r** *******
Submittal Fee $ ,_) Permit Fee $ /5®, % CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ X.
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature R C—e_g pot p f Signa
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me The foregoing instrument was acknowl ged before me this) /
day of / 9 , 20 �, by part( 010. fi. trir4 day of( /7 , 20% 3 , by � / / fie /9 /
� P� r y
who is personally known to me or who has produced FL ®Y I1PIS who is personally known to me or who has produced /4, s 3
L&CQI $ e, . . lion and who did take an oath. S L//► 7-1S-69/as identification and who did take an oath.
NOTARY PUBLIC: / NOTARY PUBLIC:
Sign: _ �
�
Print F _ illi
My Commission Exp
Notary Public - State of Florida
My Comm. Expires Apr 25, 2015
'40 „.0 Commission #t EE 192788
* * * * * * *** * ** ********* ** ******* * **It*
APPROVED BY
Sign:
Print
My Commission Expires:
• a
tYAr4nktk9tAkirsrdrw*4r4r** nkak**** aFs r*& **atr****sk*ir***dr*av*sk* aY ****atr lots *U14 i JFVeaka ***fir
/d .1 f) Plans Examiner Zoning
Structural Review Clerk
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)Revised 3/15/09)
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. , COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: /A.? et (' VII C rj
BUSINESS ADDRESS: 7E I CO dq 441 Wet/ CITY - I►q[ea!n
STATE F l ZIP CODE 53 01
BUSINESS PHONE: (3 235 ) i e a 4 2 _ „ T (F FAX NUMBER ( 78,6) 5y-18
CELL PHONE rag ) 2...3 c-iltit0 QUALIFIER'S NAME: 'i'nG1/Y4 \ SQ
QUALIFIER'S LIC NUMBER:c_e a 26 3-o0
E -MAIL ADDRESS (IF APPLICABLE): fil\Vg5MVia \ ey'C;ZVOC3.. C.,0'g '
Created on 3119109 BY MLDVI RV 3126109 MLDV I RV 6127111 AS
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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: 4/15/2013 EXPIRATION DATE: 4/15/2015
PERSON: MASSANET MAYKEL
FEIN: 223885236
BUSINESS NAME AND ADDRESS:
MPS OF MIAMI INC
7955 W 28 AVE
HIALEAH FL 33018
SCOPES OF BUSINESS OR TRADE:
MACHINERY OR PLUMBING NOC AND
EQUIPMENT ERECTIO DRIVERS
Pursuant to Chapter 440.05(14), 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. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope
of the business or trade meted on the notice of election to be exempt. 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 t, at any time after the filing of the notice or the issuance of.the certificate, the person named on the notice or
certificate no longs. 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.
DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609
CERTIFICATE OF LIABILITY INSURANCE 10-10-13t
watanuecwww,
THIS CERTIFICATE IS ISSUED AS A MATTER OF iltlgORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOWER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEtAln AFFORDED BY THE POUCIES
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 the cornball holder is an ADDITIONAL INSURED, the pollcyftell must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policlesMay require an endorsement. A statement on this certificate does not confer rights to the
certificate holder inileu of such endoreementie
PRODUCER Latin ArtutrIcan litituaIlneUrante
PO BOX 361088
Miami, FL 33135
INSuRm WM OF MIAMI
7661 WEST 29TH WAY
HIALEAH, FL 33018
COVERAGES
CyLle1417,4CT Cecilia Gonzalez
1747,1240, 91* 309442-7616
lamialneesol.con
r-FAX
Not 305-642-7516
1 INC
INSURERMI AFFORDMO COVERAGE
INSURER : CANOPIUS US INSURANCE INC
INSURERS:
MUM C:
NAIC
INSURER D:
INSURER :
INSURER F:
CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND COMMONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PAR
GEM. AGGREGATE LIMIT APPLIES PER:
Flpoucy 28.- LOC
OTHER:
AuOE uAatny
ANY AUTO
ALL omen
AUTOS
HIRED AUTOS
IKJLX-0
!08/1912013
08/19/2014
UNITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea oorserence)
MED EXP (Any one person)
Is 1,000,000
$ 100,000
s 5,000
PERSONAL & ADV INJURY g 1,000,000
GENERAL AGGREGATE $ 2,000,000,
PRODUCTS - COMP/OP AGO 5 1,000,000
SCHEDULED
AUTOS
NON-OWNED
AUTOS
EXURMREUACESS UABLIA9 EcLAoccum_hR w3E
DED ri RETENTIONS
WORMERS COMPENSATION
AND EMPLOYER, LIABILITY f
ANY PROPRIETOR/PARTNEFUEXECUTIVE
OFFICER/MEMBER EXCLUDED1
Mandatory in PM)
IMusTioNeseribe wider
OF OPERATIONS balm
s
COMBINED SINGLE LIMIT I $
(Ea ookienn
BODILY INJURY (Per parson) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE , $
(Per aclodent)
NSA
$
EACH OCCURRENCE ' 5
AGGREGATE
LIFER E OTti-
sTATuT ER
E.L. EACH ACCIDENT $
E.L. DISEASE. EA EMPLOYEE) $
E L. DISEASE - POLICY LIMIT ' $
DESOMPTMN OF OPERATIONS LOCATIONS , VEHICLES (ACORD 101, Additional Rowans Seheduis, rose 0010t$01100 Emma 111000 Is follark•M
PLUMBING
DOORS INSTALLATION
CERTIFICATE HOLD
-
fOrwid Slims Map
MAI ftpartmett
10050 N.E 2adAv
Muni Shores FL
33138
CANCELUITION
MUD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
MB EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORRED REPRESENTATIVE
CECILIA V. GONZALEZ
A307480
ACORD 25(20t4101)
48 1985-2014 ACORD CORPORATION. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD
Pro using POMO Boss Web software. www.FonnsBowasoau Co impressive Publishing MISIOSMITT
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
MASSANET, MAYKEL
M P S OF MIAMI INC
7561 WEST 29 WAY
HIALEAH
FL 33018
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Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
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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.myflorldailcense.com.
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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!
DETACH HERE
.7t0t...KORMA AC#1, 2 L38O 9
';ARTIWINPr-'. OF BUSINESS AND
OFESSIQE. REGULATION
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IS CERTIF ./AD Under the provisions of ah.489 PS
*ration easel AUG 31, 2014 412071901016
THIS DOCUMENT HAS A COLORED BACKGROUND f..1,CRODR1NTINS • LINEMP.F-K PATENTED PAPER
AC# 62 38
DATE' GA iTO SOMBER FiKi-M177W: •
Named below IS CERTIFIED
Under - the provisions of b
Expiration date: AUG 31,
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GOVERNO
DISMAY AS RECILIIRDBY LAW
KEN LAWSON
SECRETARY