PL-14-1039t
LF i-&i'9
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 212781
Scheduled Inspection Date: May 27, 2014
Inspector: Diaz, Osvaldo
Owner: SHEPHERD, SARAH
Job Address: 1276 NE 93 Street
Miami Shores, FL 33138-
Permit Number: PL -5 -14 -1039
Project: <NONE>
Contractor: RADIANT PLUMBING & BOILER CO.
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1132050270230
Phone: (305)785 -6649
Building Department Comments
STACK WATER HEATER RE- CONNECT
Infractlo
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
i5 bt-)/
'p � ..�
May 27, 2014
For Inspections please call: (305)762 -4949
Page 16 of 30
UILDING
PERMIT APPLICATION
Miami Shores Village
Building Department MAY 0 20
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756:8972:
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit Type: PLUMBING
JOB ADDRESS: 1276 NE 93rd ST
FBC 20 V-)
��
.
Permit No. 11� L Cl
Master Permit N0M /3 -,921.??
City: Miami Shores County: Miami Dade zip: 33138 -2941
Folio/Parcel #: 11- 3205 - 027 -0230
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Sarah C. Shepherd TRS Phone#:(954) 588 -8120
Address:579 NE 55th TERR
City: Miami State: FL Zip: 33137
Tenant/Lessee Name: Phone#:
Finail•
/ n / 3v5- 2,(;) -26zr.
CONTRACTOR: Company Name: `� c---1;®q Plu✓✓l
f a lt- t 4r (F) Phone#: J)S' l7.16 to 6 49' .
Address: `) (3 ---5D S 73
City: ra.10,/ State: Zip: 5 3aS--
QuTlifier Name: c---0 "-r OA- (( e 5 Phone#:
State Certification or Registration #: C- 1- 0 `> Ai A) Certificate of Competency #:
Contact Phone#: .3ct05 7X5-66,0 Email Address: r tieS LcC5 e' y-4_40----) ai17
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 00 Square/Linear Footage of Work:
' s Type of Work: OAddress OAlteration ONew ,URepair/Replace UDemolition
Description of Work: i Z�A4 c Cc' 44.9,-- „,-- ) )14 -- .P rte, A , _.
A
Submittal Fee $ 50 j� o Permit Fee $ �% U d/ CCF $ CO /CC $
Scanning Fee $ U' Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ I. I l.l-
L
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 ' f a reinspection fee will be charged.
1 ,
Signature / Signature
Owner or Agent Contractor
The foregoing i i trument was acknowledged before me this f The foregoing instrument was acknowledged before me thi
day of t . ' 20 ., by , day of 144( , 20' LI , by U':(.14 $
who is rsonall ka to me or who has produced who i rsonally know me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: kevViSSei 140046 MELISSA MORALES
;44 4 MY COMMIS IOiv a EE'i83210
EXPIRES January 24, 2016
(407)918-0169 FbAdeN0 ySsviosoan
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires
(407)319.0169
MELISSA MORALES
MY • MISSION 8 EE183210
EXPIRES January 24, 2018
* * * * * * * * * * * * ***** ** *** ** * * ** ****** ***** ** ** **x **** *** *a ***** * say * ********** *********** e*** ** ** * *** ***********
$ - /`-i Plans Examiner Zoning
APPROVED BY
Structural Review
(Revised3 /1212012)(Revised 07110107)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
THIS DOCUMENT HAS A COLORED BACKGROUND MIC':
STATE OF FLORIDA
DEPARTMENT OF BUSINESS PROFESSIONiL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SECS L12071701107
PRINTING • LINEMARK`' PATENTED PAPER
6205 .'
1:28011540
ICE 1BR
CFC0550
IN#g CONTACTOR
Named below IS CERTIFIED
Under the provisions of Chaptet,
Expiration date: AUG 31, 2014i1
OY
11TH U NG & BOILER CO • ,
7815 SW MIAMI FL 33156
PLAY AS REQUIRED BY LAW
KEN LAWSON
SECRETARY
0510212014 10:56 gAXj
CERTIFICATE OF LIABILITY INSURANCE DA g40000AT
P.0011001
PRODUCER Excellence Insurance Agency
3801 SW 107 Avenue
Miami, FL 33165
Phone (3(15)228 -3910 Fax (305)226.3997
INSURED Roy Valdes Contracting Services, Inc DOA
Radiant Plumbing and Boller Co,
7815 SW 118 ST
MIamI FL 33156
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLIO BE OW
INSURERS AFFORDING COVERAGE NAIC 0
INSURER A: Granada Insurance Comm
INSURER B;
18870
INSURER C:
INSURER D:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWrrH$TANDIP4G
ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN. THE WSURANCE AFFORDEI BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS.
Jam, TYPE OF INSURANCE POLICY NUMBER EXPIRATION LIMITS
GENERAL UABR.ITY
E COAmeRCIAL GENERAL LIABILIY
❑Q CLAINE MADE ® OCCUR
0
0
GEN'L AGGREGATE LIMIT APPLIES PER:
Q POLICY ® PROJECT 5a LOC
0185FL00037407
08I03!2013
08/03/2014
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALL OWNED AUTOS
❑ SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON OWNED AUTOS
Q
GARAGE LIABILITY
❑ ANY AUTO
❑
EXCESS / UMBRELLA LIABILITY
❑ OCCUR ❑ CLAIMS MADE
I_1 DEDUCTIBLE
❑ RErENT1ON S
EACH OCCURRENCE
DAMAGE TO RENTE'LF---
PREMISES (Ea occurrence)
MED EXP (Any one parson)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS. =MOP AGO
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000.000
COMBINED SINGLE L00T
(Ea n5
BODILY INJURY
(Per peraan)
BODILY INJURY
(Par acOlden)
PROPERTY DAMAGE
AUTO ONLY - EAACCIDENT
WORimits COMPENSATION AND
LOVERS' UABILITY
ANY PROPRIETOR I PARTNER I EXECUTIVEYW
OFFICER I MEMBER EXCLUDED? Y
q� In NH)
SPEoPROVI$ under mew
OTHER
OTHER THAN EA ACC
AUTO ONLY: AGO
EACH OCCURRENCE
AGGREGATE
DTs TA`TU- l W.
EL EACH ACCIDENT
EL DISEASE - EA EMPLOYEE
E.L. DISEASE - POUCY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS rvEHICLES I EXCLUSIONS ADDED BY ENDORSENBisrr I SPECIAL PROVISIONS
PLUMBING CONTRACTOR
CER11FICATE HOLDER
CANCELLATION
Miami Shores Village
10050 Northeast 2nd Avenue
Miami, FL 33138
I Fax 305.758.8972
ACORD 26 (2009101) QF
1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD name and loge are registered marks Of ACORD
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SE:RVICE:S
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.
10-12-2012
EFFECTIVE DATE:
PERSON:
FEIN:
10/12/2012 EXPIRATION DATE: 10112/2014
VALDES ROY
650347482
BUSINESS NAME AND ADDRESS:
ROY VALDES CONTRACTING SERVICES INC
7815 SW 118 ST
MIAMI FL 33158
SCOPES OF BUSINESS OR TRADE:
1- HEATING, VENTILATION, AIR -COND
IMPOOT4NT Pursuant in Chapter 440 _ 05114). F.S., an officer of a corporation who elect: exempla from tars chapter by filing a certificate of election under this
section may riot recover benefits or eomlensmioa Bader this chapter. Purest to Chapter 440.(15{17), F.S., Cettiftcates of election in be exempt... apply only within the
scope of the business or trade irsled on the notice of election to be exempt. Pursue to Chapter 440.05{13). f.S., Notices of election to be esemi and certificates of
election to be exempt shall be subject to revocation if, at any time alter the filing of No notice or the issuance of the cerdiltate, the parson named on the notice or
certificate no longer meets the ragairemeots of this sectioe for issaeece of a certtlicata. The department shall revoke a certificate al ray time for failure of the person
Maned en the certificate to meet the requirements of this section.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0.1 -11
aUESTIONS7 (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
CEFMFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS COMPENSATION LAW
EFFECTIVE 10/12/2012
PERSON: ROY VALDES
FEIN 850347482
BUSINESS NAME AND ADDRESS:
ROY VALDES CoNTRACTINO SERVICES NC
7815 SW 118 ST
MIAfM, R 33195
EXPIRATION DATE: 10/12/2014
SCOPE OF BUSINESS OR TRADE
1 HEA77NG. VENT LATION. Alit-COK)
IMPORTANT
OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
1- under this section may not recover benefits or compensation under this
D chanter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt_ apply only wittin tint scope of the business or trade listed on
E the notice of election to be exempt
EPursuant to Chapter 440.05(13), E.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 named on the certificate to meet the requirements of this
section.
CUT HERE
QUESTIONS? (850) 413-1609
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
v
£96ZLL690£
£96Zl.L690£
d80 :17017 L 9Z len
3/2512014 2014 details - Business Tax Account RADIANT PLUMBING & BOILER CO - Tad* - Miani-Dade CountyTaxCellectiT
Tax Collector Horne Search Reports Shopping Cart
When entering your name and address on the payment form, please do not enter any special characters such as #. or
2014 Details — Business Tax Account RADIANT PLUMBING & BOILER CO
Business Tax Account #5393889
la Account details 81 Account history
2014 2013 2012 2011 2010
Paid
Paid
Account number: 5393889
Business start date: 08/01/2004
Business address: RADIANT PLUMBING & BOILER CO
7815 SW 118 ST
PINECR1EST, FL 33156
Physical business location: PINECREST
Receipts hid Occupations
Paid
Paid
Paid
Ow ner(s): VALDES ROY CONTRACTING
SERVS INC
PO BOX 565273
MAK FL 33256
Mailing address: VALDES ROY CONTRACTING
SEWS INC
ROY VALDES FIRES
PO BOX 565273
MA K FL 33256
Flags: Home Business
Print account application
(PDF)
Receipt 5532592
Paid 2013-10-01 $49.50
Contracting 10/01/2013— NAICS code: Receipt #CREUTCARD-14-000157
PLUMBING 09/30/2014 23822
CONTRACTOR Units: 7
Additional documentation required: CFC054880 State/County License or Certificate
IE Print this
bill
hapiliwairmiankbde.caunly-taxes.ccrnipublicibusiness tax/a:counts/5393889
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204 `
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case
of an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. '
Print Name:
Signature:
• per
AllaPAadi
,a
State of Florida )
County of Miami -Dade )
Sworn subscribed before
day of , 20
By ®SR\ 1 ✓ \ :e
Ia,
CL
(SEAL)
Type of Ident
cation pr. diked
DIE
Print Nam
Co
tr
Signature: '- l Q�
State of Florida )
County of Miami -Dade )
Sworn . subscribed before
day of .J
, 20
By
(SE
Type o
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en ' . cation produce
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