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PL-14-1610 (2)11 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216577 Scheduled Inspection Date: August 12, 2014 Inspector: Diaz, Osvaldo Owner: HALLORAN, THOMAS Job Address: 451 NE 91 Street Miami Shores, FL Project: <NONE> Permit Number: PL -7-14-1610 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Sprinkler System Phone Number Parcel Number 1132060140130 Contractor: BEACHSIDE PLUMBING INC Phone: (954)444-9646 13uilaing Department comments INSTALL SPRINKLER SYSTEM INSPECTOR COMMENTS False rescheduled by ouie for next tuesday not ready on thursday Z Inspector Comments Passed rescheduled by ozzie for next tuesdaynot ready on thursday Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 11, 2014 For Inspections please call: (305)762-4949 Page 15 of 39 BUILDING PERMIT APPLICATION Miami Shores Village PIEC Building Department JUL 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY' INSPECTION LINE PHONE NUMBER: (305) 762-4949 Fk'20 �p Master Permit No ' Q p L) Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 451 N.E 91 st STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-0130 Is the Building Historically Designated: Yes NO Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Thomas & Erin Halloran Phone#: 352-262-3193 Address:451 N.E 91st STREET City: Miami Shores state: Florida Zp: 33138 Tenant/Lessee Name: Thomas & Erin Halloran Phone#.352-262-3193 Email: CONTRACTOR: Company Name: 'Beachside Plumbing INC. Address: 2650 N.E. 91st STREET Cit,. Pompano Beach state: Florida up: 33064 Vincent J Kortabani �� Qualifier Name: Phon State Certification or Registration #: CFC1425746 Certificate of Competency#: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: 5 2,465.00 Souare/Linear Footme of Work: Type of Work: ❑ Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ / 56. � CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ SO 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 $250, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatures/iii Signature P- -- OWNER or AGENT COL69 ACTOR The foregoing instrument was acknowledged before me this 22 day of JUIy . 20 14 _____,by Erin M Halloran , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign• M , Jamie Jc The foregoing instrument was acknowledged before me this 22 day of JUIy .20 14 __,by Vincent J Kortabani , who is personally known to as me or who has produced identification and who did take an oath. I;;1'1Y;J!fA 01:11110; Seal: a° JAMEJONES Seal: W COMM#SSION # FF A0M EXPIRES:Apdl 1, 2017 Bonded Tim, Nater] Pubo urdewurbm saoee�r+Rss+b►�:$��:�k+ea<is& �ea��+say+Ps��rs+ess�ss�swaa�*�esses�x��*+� APPROVED BYy—(� Plans Examiner (Rev1sed02/24/2014) JPAE Jti7NES W COWIMION & FF MM EXPIRES: AprU 1,21017 BMW 7ft Nowy bft underowors as Zoning Structural Review Clerk V6255421 STATE OF FLORIDA gg 883g,,E� pp ggS DEPARTME NSTRUCTI,N�iNDLiSTRYRLIHPTINN�LSOAR�LATION C SEW L12080801446 08 ..08 2012 128011436 " CFC142S746- The PLUMBING'CONTRACTOR Na Med below ..IS CERTIFIED Under the -provision® of Chapt®r.:489 FB. Expiration state: AUG 310 2014 KORTABANI, VINCENT JOHN BEACHSZDE PLUMBING -INC 2650 N.E. 9TH TERRACE POMPANO BEACH FL 33064 RICV:SCOTT KEN LAWSON GOVERNOR SECRETARY A.autmv _......,_........___..._._...___w__.._....___._..._....�._.__. 0 i 'i 10 e yh DF%VrWV %1r%Lt %0'%~ t 1 -t t-rmsa-tar-%F1 IS • 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA:BEACHSIDE PLUMBING INC Business Name. Owner Name: VINCENT JOHN KORTABANI Business Location: 2650 NE 9 TERR POMPANO BEACH Business Phone: 954-946-1764 Receipt#:PLU -1305 NG/LWN SPRNKL/ Business Type: (CERTIFIED PLUMBING Business Opened: 0 7 / 0 5 / 2 0 0 2 State/County/CertlReg: CFC 14 2 5 7 4 6 Exemption Code: Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vendina Tvoe: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 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 VALIDATED and zoning requirements. This Business Tax Receipt must be transferred 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 with State or local laws and regulations. Mailing Address: VINCENT JOHN KORTABANI Receipt #OIC -12-00014622 2650 NE 9 TERR Paid 09/27/2013 27.00 POMPANO BEACH, FL 33064 2013 -2014 t 07-31-2012 JEFF ATWATfR STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 10/07/2012 EXPIRATION DATE: 1010712014 PERSON: KORTABANI FEIR- 113844452 BUSINESS NAME AND ADDRESS: BEACHSIDE PLUMBING INC 2650 NE 8TH TERR POMPANO BCH FL 33084 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING NOC AND DRIVERS VINCENT J IMPORTANT: Purcuoal to Chapter 440 . 05114), F.B., an officer of a corpotetion who elects exemption from this chapter by filing a certificate oh election under this setilan may act recover benefits or compensation under this chapter. Pursuant to Chapter 440,05112), F.S., Certificates of election to be exempt... apply only 011111101 the scope of The business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440,051111), F.B., Notices of election to be exempt and certificates of election to be exempt shell be subject to revocation if, at any time alter the filing of the notice or the Issuance of the eertflicate, the person named on the nonce or certificele no longer meets the requirements of this section for Issuance of a certificate. The department shell revoke a certificate at any time for failure of the person named on the certificate to most the requirements of this section. QUESTIONS (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 , Miami shores V 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. Owner Print Name: Fy— I' ■ I� • '[� State of Florida) County of Miami -Dade ) Sworn to bscribed before me this day of.u. ,, MYCOMMISSIONtmM Contractor State of Florida ) County of Miami -Dade ) Sworn to and ubscribe day of of Identscation produced &" � Yype of Identification —WCMUSSION 9 FF 004 3 EXPIRES: April 1, 2017 ftMod ihru Notary POW Undwwrh a From:Global Insurance Services Inc. 5614519825 07/24/2014 16:32 #696 P.001/001 ��---� 13EACPW OP W. VL A`ORt7' CERTIFICATE OF LIABILITY INSURANCE 07MUM4 TFC CERTIFMTE 18 f88tMD AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGM UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFMATNVEN.Y OR NATIVE! Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON871TUTL A CONTRACT BETWEEN THE ISSLgNG INSURER(81, AUTHORMb �fTATII� OR PRODUCER, AND THE CERTIFICATE HOLDER E UNMANT: N Go cWtIfiraft hakler Is an ADDITIONAL USD, fO P09VJPMO MUd b9 611110YOS& H SINBROGATION IS WAIVED, eW*d to the fffIMtIS and MXMMU of the POf76 welsh" POWMI M@Y rRICIU1110 8D Wktonenwt A StaWmint on thb owifflimb toes not ecaw MWft to the pertmoo komerfn Nee orsuch c I 2mv�s. I= Bohm C namrdaN LNn� --- --- ---- soul= MUMUM MMMIM Inc. 2060 NNE 9th TerrM Pompano Beach, FL 33004 ACOR1D 25 CM40H) The ACORD nams wd k" are IB Mid maift of ACORD L. • �" L '. Eti �: .- 14.' i- -•:k sr� .. 1 � e: ., :,��. .c:, ❑� . 1�=. �-�_�■ , Imo) :.• •�' -'.� ,� 7 r.�. 7i- �;.i �- x", . " �...,._ ... ., - tti ;.lr=, �► ,. p i,>, oi ^; - -'iiz: - ��'■ w'7'!.I_7,fat •r+-'-� • . f,N ❑`i,. a.r,. � tM: .'i -.' 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