PL-14-1033 (2)Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-212739
Scheduled Inspection Date: August 27, 2014
Inspector: Diaz, Osvaldo
Owner: CASTANEDA, DAVID & KARA
Job Address: 9525 NW 1 Court
Miami Shores, FL
Project: <NONE>
Contractor: CENTRAL IRRIGATION INC
comments
I
Permit Number: PL -5-14-1033
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (786)281-1825
Parcel Number 1131010240300
Phone: (305)255-5090
INSTALL LAWN SPRINKLER SYSTEM 4 ZONES 45 ' False
HEADS AND EXISTING PUMP AND WELL INSPECTOR COMMENTS False
� Inspector Comments
Passed F/I
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 26, 2014 For Inspections please call: (305)762-4949 Page 3 of 14
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Master Permit No.
MAY 20 2014
FBC 20 tO
Sub Permit No. -Pu —' (CO
❑BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLICWORKS
❑ CHANGE
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: /SZ,5' &W I GT tbL h j fygj�S Ak - 33i-rc)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: &_ Q/ - 024 - Conn Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ V/ r'^i � A LAMW &EDA Phone#:
Address: X1525 Nw ! Cf
City: N/Awj/ State: G�Zip: 33/s
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: cz& �A/ Ziy C - Phone#: 3e3 - ZSS - So 10
Address: e, O 1wX mzs i
City: -%7 i State: Zip: 33 / 9_
Qualifier Name: _4ezla s LA&4a ;y Phone#: _,ro t' - 6VT -oalS
State Certification or Registration #: 926a, I q zk36s— Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address
City:
State: Zip:
Value of Work for this Permit: $ 9400* Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
FE
Description of Work: 7j:NS?s4« 1%)44W EaPZjUX CGZ 20M"&5 _ yr #eAdi-
PYi5AN�04i0i IIIP11
Specify color of color thru tile:
Submittal Fee $ �v ��'
Permit Fee $ �� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ It K� 3 0
Bonding 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 ntt eapproveid and a reiriapection fee will be charged.
The foregoing instrument was acknow dged before me this.
day of 20 by VAN 1Q Com) -' VA
who is pers nally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
My Commission Expires
Signature
Contractor
The foregoing instrument was acknowledged before me thi
day of /kA--( , 20N by GA-eZ4-0-3 VIC%ZI A
who is personally known to me or who has produced fes— Ir:�>
as identification and who did take an oath.
�k�k*+k�kMffi�kMe�ie�ie�k�kakak�k�k�k�k�k�k�k�k�k�k�kffi�RIleak*ii�kak�k�k*��k�k4*�k�k**�k�k�k�ki�k*�k�k�k�k�k�k+k�k�k�k�k�hffi�k�kM�k�k�k�k�R�k*�k4�k�k&�kffi4�k�k&�k�k�k�kM�k�k&�k*�k�k�k�k�kak�k*�k�k
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
NOTARY PUBLIC: �� ' Arl,
Sign. _
c
r
Print: '. /j� Pin °!
_
My Commission Expires:ORi®A'°
///j1/111111111\
�k�k*+k�kMffi�kMe�ie�ie�k�kakak�k�k�k�k�k�k�k�k�k�k�kffi�RIleak*ii�kak�k�k*��k�k4*�k�k**�k�k�k�ki�k*�k�k�k�k�k�k+k�k�k�k�k�hffi�k�kM�k�k�k�k�R�k*�k4�k�k&�kffi4�k�k&�k�k�k�kM�k�k&�k*�k�k�k�k�kak�k*�k�k
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
FROM :VICTORIA CONSTRUCTION FAX NO. :305 255 5090
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOTA BILL - DO NOT PAY
6748793
May. 18 2014 07:18PM P2
LBT
Musumnst; NAmr;AmcAT1aN RECEIPT No. EXPIRES
CENTRAL IRRIGATION INC RIINMAL SEPTEMBER 30, 2014
8975 SW 198 TERR 7022197 Must be displayed at place of business
MIAMI FL 33157 Pursuant to County Code
Chapter SA- An. 9 & 10
OWNIER sx4c. TYPE OF. BUSINESS
CENMfiAL IRRIGATION INC 196 PLUMBING CONTRACTOR PAYmr;mT RECEIVED
Worker(5) I CFC1428365 HY TAX MLLECTOR
$75.00 09/06/2013
TXHS1-13-057028
This Local Business Tax Receipt onty confirm paymaM Of the Local Business Tax. The Receipt is not a license,
permit ar a certilkadon of the holder's qualification. to do buslness. Holder must comply with any governmental or
nongovernmental regulatory laws and requirements which apply to the buaimavx.
The RECEIPt NO, above mast he displayed an all commercial vehicles -Miami-Ueda Coda Sac 8"76.
For more information v{sit vaww.miamidaga aavkalmellerxor
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL 04RVt=
DIWtS10N OF WORKERS' COMPENSATION
CONSTRUCTION I1JI ISTRY
CERTIFICAIV OF ELEC-n N TO BE EXEMP'C FROM FLORIDA
WORKERS COMPENSATION LAW I '
F-FFECTIVE 02/22/2019 EXPIRATION DATE: 02/22/2015
PERSON: CARLOS M VICTORIA
FEIN: 208235868
BUSINESS NAME AND ADDRESS:
CENTRAL IRRIGATION INC
9974 SW 199 TERR
MIAMI, FL 33157
SCOPE OF BUSINESS OR TRADE:
1- AUTOMATIC SPRhWaR INSTALLATI 2- PLUMalRa NOC AND DRIVERS
f �:S7` TE 0#
6L Tb
! PROFm
CFC142 83 6.5,:
I .... /128027992
I CT09
wader 't he rixiairana 'q.cR; 419
y' fi1'itAoa ..Z. ALier.>3:zR;:'''2E%]:• L72`ra13,:03111479
05/19/2014 09:26 305-220-2263 EUI PAGE 01/01
AI �'� CERTIFICATE OF LIABILITY' INSURANCE °Ai1s� oia "
THIS CERTIFICATE IS ISSUED AS A MATTER 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 RM WEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE: OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. If SUSIAOGATION IS-W-AIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not carter rights to the
certlflcaie holder In lieu of such endorsement( s).
PRODUCER (306)220-2280 E JAIME C. QRDONEZ
Eastern United Insurance PHONE W,(306)220-2260 W. A" Na.(30-S)220-2263
JAIME,CARLOS ORDONEZ A-196817 "-�, JCORDONEZN£ASTERHUNITEDINS.COM
176 Fontainebleau Blvd,
Suite 2A-1 MU s AMP Mho COVERAmE NAIO #
Miami. FL 33172 LNSVR9R A : SCOTTSDALE INSURANCE COMPANY 41297
INSURED CENTRAL I RR I OAT I ON INC INSURER 0
8975 SW 198 TERRACE iNSURER 0,
MIAMI, FL 33157 INSURER D:
(306)265-5090 Ext. INSURER 9.
COVERAGES CERTIFICATE NUMBER: REVISION Numahm:
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 TEAMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TWE OF INSURANCE
VAM
POLICY Human
&UAM
POMM0Y
LMITS
QAd6ReL 6IA81IJ Y
EACH OCCURRENCE ® 1.000.000
E a weur $ 5D 000
EXP tAny 011e parson S 5,000
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX -1 OCCUAMED
PERSONAL a ADV INJURY $ 1,000,000
A
N
CPS1926880
02/26/14
02/26/15
GENERAL AGGREGATE $ 000 000
GEML AGGREGATE LIMIT UES PER
PRO UCTs - COMP/OP ADG S 1,000,000
)� POLICY PRO. LOC
S
AUTOMOBILE UASILITY
COMBI E OUR- LIMIT
a aaokie t
BOLALY INJURY (Par poreen) B
ANY AUTO
ALL CIVINED AUTOS Au7OSULEO
AUTOS AUTO ��
BODILY INJURY (Par awkktnl) 0HIRED
o PE C g
$
VUBRM L A LIAR OCCUR
EAEH OCCURRENCE 6
AGGREGATE $
EXCESS LIAR CLAIM&MADE
13ED i I RETENTIONS
>8
WORIGIRS COMPENSA710N
WC "TATO- GTH•
AND EMPLOYERS' LIABILITYEEL
ANY PROPRIETOR/PARTNER(EXECUTIIIF
OFRCEF MEMBER EXCLUDED7 ��
(Mandatory In NH)
nyes� daaarlba unser
DESCRIPTION O OPERATIONe bulaw
N I A
LL. EACtI ACCIDENT $
E.L. DISEASE - EA EMPLO $
EL DISEASE • POLICY UMITI S
A
ERRORS 8 OMISSIONS
IN TRANSIT POLLUTION
PEST ICIDES/RERBICIDE
N
EACH OCCURRENCE 1,000,000
GENERAL AGGREGATE 2,000,000
DESCRIPTION OF OPERATION/ LOCATIONS! VEWICLES (Attach ACORO 101, Add►danal Remarks Schadulo, M nme specs W required)
IRRIGATION SYSTEMS INSTALLATION, SALES AND REPAIR.
v¢n�
MIAMI SHORES VILLAGE
10050 HE 2 AVE.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NCITICE WILL BE IDELIVOMM IN
ACCORDANCE WITH TME POLICY PBOICSIONS.
MIAMI SHORES FL 33138
(305)756-8972 Ext. AUTHORIZED REPRESENTATME
BUILDING DEPARTMENT 10
®1
ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD
Miami shores Village
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, youmaybe
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.
Owner
Print Name: 7
Signature:
State of Florida )
County of -
Sworn to d e � Fl
day Of M Cag F 082753
w Expires 0111 18
By /GG`
(SEAL)
Contractor
Print Name: ei9 Wei V1
Signature: '�'�►�
State of Florida)
County of Miami -Dade) ��`� c� .•• ''%
Sworn to and subscribed be ���s�
day of
_ C>
By -� � �`'•nj
(SEAL) i��is,�s �� • ..... \``e�`�
Type of Identification produced -111>11y, 11
FROM :VICTORIA CONSTRUCTION
FAX NO. :305 255 5090 May. 19 2014 12:21PM P1
'61r15•CERnFtCATE is ISSUED -AS A MAMR oP.WFC.�MijCliy'p il.Y
Cf~ MFfoJ 'M-VOE3 NOT'AMWATWkLY OR N&x4Mfty AmEm,
SMOW.. THM CEMWICATE CF O SMAN= DOES HOT CDHS7i'FtiTE
RlrPi sWArAWvE- oR'PROADUcjR Ato TW.cmnMATS tiO#. M
t1ilPOiiTANT: Ehe•'certifio hoS r -h- zits AUNT016Z WSa1*W,
am larmv and corumom of as poiiay, cermirk p0.0cws ftr/ require a"
osrtiificaiie fieid@r 1n q®u 77d'SU7rts eradors�r�s?
(=5)220-=g .
fAste*m United •Insurance
JAIME GR1aLoslo1lAom A-19"17
175 Fat(tdimbleak Sled,
Suite 21147
CENTW IRRISATIGt INC
82x5 mf 198 'FEMME
141ARL FL 38t67
(105)251 -SONG Ext.
O
N 'COWERS .. MQUPON TlW 0WMF=1V HOU=. TWS
' A
%XnM ORLTER THE COVERACK AFFOPMW 13r *7M AOUmn
Q
commar commasvrwm 33.1E Wstnm 1t+iSiBAORM AUIMORMD
P0111p9102) 7nusnt be ems. ' i1• SUM A'61®11i'15 t1 RVEQ, subjsai to
andmment Jit statement an this cer000to d=m not aonter rights to Um
E,JAr C. 0i
x2280 Ext.
ti umc
SDALE 3
...
dti53i UVE COMFAW +11291
D.,
'7{.15E1107:37 B
TH SiS TO CEWIFY.I AT THE POUGM OF WSUfbWE VMD SELOW HAVE OEM PSSWED TO THS-MISURF.o NOAWD-AWVE FOR THE POUCY PERIOD
' (NOICA790 • NOTWffHSTA1 MNG ANY.RWUI Ar% T€Fm o>; comnvm of mY corm=T CR•oTmeFi Docu l mr r rr" REspwr ro wi-=H Tms
CERT6FlC1dTE MAY 13EMUBD OR MAY PERTAOk Tf�'(�+$SR[FdA M AMORD!M BY THE POLICIES i'?J=^.a AS � HE WJN IS SLSWECT TO AM THE'TERN(S.
EJCCLU9►ON5 dtW CMDFiWNS OF SL CH PWO185L UWTS S3•It?1AFPf MAY "AVE 8EE'N'Ri:.W9D By PAID CL IM$.
rm cw mUmmm s3'piaG! R P Lam
A
X o1,aA� Ai +aem rry
c��' � occur
K
C1'S3$2A3g13O
OEl 14
G2/2&J15
EACH OCCLffRRENM 8 1 • G fl '
,. s.0,000
,� %XA ore � •� 5 otYO.
AHRSMALaADV KPAY $ 1 tN74,Ei0D
�eNeflAL s 2 96S Ro
73 LAeBRarE its At9S c+Ea
' Polley ` 40G•
t+avtu>Lr$-pOMPIOA AUS $ i QSO.SDO
S
AHT*60f3tAA UAWLWV
ANY Al7r(3• '
'AA ULW N W AMS
HAW AUMS
on '
BODILY IN.1m Ohl Pwf wo $ .
B=LY Mmy (Ami 4m,&fn) $
04E
Uees
EXCESSi6AB
Oma.•
s aOCOMMONCs s'
!2"EGA S.
WOA)tM ATI=
ALP0 E�7PLflY ' UA0& ip Y111
PAOPAiEToRtPAR7'HEROMMMk/
�Fl�R+FAf3lA EXCLVGFA? t. r
Wo da'net"mnrt7ar
Galmvr
A
'
-Imml lox
EL. l.AGCIDz`luT £in .
ML DISFAS - 04 WK
EL.DiS£Ass• E2poeu7iBri S•
•A
own. & oNl$slon. •
IN TRAWT PILOTI(*
PWIC10ES1"ICIDE
A:AO$ OCC1iRfPi�E 6,x',500
GENERAL AME46A' E 2,000.000
LESClztrt7CRl12F QP�i►:iot7Sl 1:OCAii�l1lEHICLE6 �p�teACORD 397. oaf SSomathw 7lebteQse4e, st ia�'e a (� �4��
1111H ATION SYSTE11S INTALI.ATION, SALES•A66D• REPAIR,
MIAK1' SH0JE*� VILLAGE
10M A.E 2 HL
MIAMI' MORES FL 33'!38
(3t�.5,�TvB-8972 Eict.
RUILDIN DEPARTMEN'i'
664 UW MY OF T14E AWWE ilE9OMED POLME$ SE CANCELLM BEFORE
TM EUMA'it U 04TE TW—CWW, MOMS WILL SE I2E MMW 1N
ACMADARM WffH -TM POL'•1QY' NS.:
Act ?R' (2Q1t?! 7Me ACORQ 7181rI�:1ld logo ere M6716bored narks ot'It1rORt3
Miami shores Village
Building Department
10050 N.E.2nd Avenue
.Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
Whereas, (owner) hereinafter referred to as the owner of
the following described property (address): 1 01Y CoI,I t I11Nhi S)A��
3b'1��
Legal Description Lot Block_ Subdivision
Folio # 31SkoI0,7 LO I> ()V
Requests permission to install (describe work):
Within the public right Of way Of (address) S Z -S 1.�T cAQiC lAhrA% A';:A,b
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of
way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any
and all liability, which may rise by virtue of permitting the installation of these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s)
to be removed and a lien being placed on the property and/or assessed against the Owner for all costs
incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land
and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until
such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County,
Florida by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE or
SIGNED, SEALED, AND D LIVERED in the presence of:
vsor nr, Notary Public State of Florida
�^ Joanna M Feliciano
My Commission FF 082783
A E Ores 0111212018
2