PL-14-143Miami 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
Permit Type: PLUMBING
JOB ADDRESS: 131 /0 -vi- 1lb'",S '.
rvffo--
Permit No.
Master Permit No.
City: Miami Shores County- Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
Zone:
JAN. 2 7
L- f `J ,1`t 3
OWNER: Name (Fee Simple Titleholder):. Lc/e,,kV
Address:
y WS6 N
city: 114ba h State: G Zip:.?3.o/d
Tenant/Lessee Name: Phonek -
Email:
CONTRACTOR: Company Name: F—F
Address: d f 7 N - tV - /S"Z -Ove-
City:!
ve-
City:
Qualifier Name:
Fe.;
State Certification or Registration #: CFC l5(Z 8 Z Zr Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ RX - 06 Square/Linear Footage of Work:
Type of Work: ❑Address OAlteration ONew 01air/R lace - ODemolition
1+c ��GwEh na,, ho� �a^E�1ro , �.pvd4ft,
Description pf Work: � s4A l �t r:P_u+ :' {4A_a - 12 MOU C a,^ !R e 't
•. .
4"t A l ( -Nltit 344! C.
Submittal Fee $ Permit Fee $ 7. L'S• 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
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 comme ent ust be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In e b n of such posted,�#�
inspection will not be approved and a reinspection fee will be charged.
4? Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this /
day of .22 ,20/,by/Z/GGi4ra/ %1��&tezTrt ,
who ' ersonally kno to me or who has produced
As identification and who did take an oath.
The foregoing instrument was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
APPROVED BY L d 16y Plans Examiner Zoning
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
OP ID: LO
A1'p CERTIFICATE OF LIABILITY INSURANCE
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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 BETWEEN THE ISSUING INSURER(S), AUTHOR®
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the poticKws) muni be endomed. If SUBROGATION IS WAIVED, subject tD
the terms and conditions of the policy, certain policies may require an endomemem. A statement on this cartificate does not confer rights to the
I:= ficate holder In lieu of such 2ggorsemi s .
PRODS Phone: 306444-2324CONTACT
MDW Insurance Group Inc
362 Minorca Ave Fax: 305-444-A9
PHONEFU
Eft
Conal Gables, FL 33134
MDW Insurance - House
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CUMMID& EFDES-1
aFFORDM COVBtAGE NAIc e
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INS,r�D EF Design & Construction, Inc
287 NW 152nd Ave
Pembroke Pines, FL 33028
IsuRMA-Accident Insurance Company
INSURER B
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X Ct ERciAL GENERAL I ABILITY
i CLAS tAADE XX OCCUR
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INSURER D
CPP000511101
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MED EXP am $ 5,004
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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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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MED EXP am $ 5,004
PERSONALS ADV INJURY $ 11000,
X BLANKET ADDTL INS
GENERAL AGGREGATE E 2,0W,
PRODUCTS - COMPIOP AM $ 2,000,00(
GEM& AGGREGATE LW APPLIES PER:
17 POLICY PRO --7 ismLOCI
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$
AUTGAIMI
.E LIABILITY
ANY AUTO
COYIBNED SINGLE Uwr
(Ea BMWWd)
BODILY INJURY (Per pion) ' $
ALL OWNED AUTOS
j
80DIL,Y INJURY fP� ax1tI $ —�
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SCHEDULED AUTOS
HIRED AUTOS
!
PROPERTY DAMAGE $
(Pew as rA)
$
NON -OWNED AUTOS
!
$
UrrBRELtA UABHoc
CUR
EACH OCCURRENCE $
EXCESS LIAR
CLAIMS -MADE
AGGREGATE $
DEDUCTU LE
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$
YHORKERS COMPIUMMONWC
STATU- OTH-
AND EMPLOYM LIABILITYOM
ANY PROPRIETORIPARTIVE Y / N
OFFICERIMEMBER EXCLUDED?
N f A
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EL DISEASE - EA EMPLOYEE $
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F -.L DISEASE - POLICY LIMIT $
N OF OPERATIONS betpw
DESCRIPTION OF OPERATE I LOCATIONS I VEHICLES (AVaeh ACORD 101, AdOtlonal Remm1m S4 N mole e N regWfed)
GENERAL CONTRACTOR
M"I SHORES VILLAGE
10050 NE 24d Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
I IN i 11111
019tlt1-2009 ACORD CORPORATION. AM rights reserved.
ACORD 26 (2009109) The ACORD now and logo are registered marks of ACORD
05-07-2013
JEFF ATWATER 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: 04/24/2013
PERSON: FAJARDO
FEIN: 270946010
BUSINESS NAME AND ADDRESS:
EF DESIGN & CONSTRUCTION INC
297 NW 152 AVE
PEMBROKE PINES FL 33028
SCOPES OF BUSINESS OR TRADE:
1- LICENSED GENERAL CONTRACTOR
EXPIRATION DATE: 04/24/2015
EDGAR M
2- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT. 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 440.05021, F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed 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 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.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609
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SEC -r*PE OP BUSINESIi PAYMHNT R8t3E
196 PLUMBJKa,,COOTMCI'Qfl Y TAX Ift
COAC
CFC1428Z9i µ{ , a '75.00 03f 10/
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eipt only aonfinusof dt toml Busidesa Tax. The 11001pt is not a license "
he boldwi qualiticaatlo�to Flak 1plsiaoss. Holdor must cpmpt� y th soft governmental or
laws ad requirements whichdppijrtotpe busino$&
to must be displeyed4s oilcommeiCial vebici lNt�t- td0 ode Sec Nom' r a
br more fntormation yi�www miemidade arovp�l�at Y
k
THIS DOCUMIENT
HAS A COLORED BACKGROUND - MICROPRINTING LINENIARK7' PATENTED PAPER
'LP#62493117
STATE OF FLORIDA
DEPARTMENT.10F.BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
$EQ#L12080600981
LICENSE NBR-,
0.8 .06 20I2 6
lCFC14*29221-'l'
TTMRINd -.CONTRACTOR
Ni ed below -IS CEttiFtEb
-trzider the provisions
of Chapto wl-`3*ssw'y&.
Expiration date: AUG
3 1 2 0 14 S
N
ld
FAJARDO EDGAR.MANUEL.
EF DESIGN "&.-CONSTRUCTION, INC-, Al"
297 NW 152 AVE
HOLLYWOOD
FL -33028
RICK SCOTT
KEN LAWSON
"GOVERNOR
SECRETARY
DISPLAY AS REQUIRED BY LAW
4
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-208844 Permit Number: PL -1-14-143
Scheduled Inspection Date: March 26, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address: 131 NW 110 Street
Miami Shores, FL 33168- Phone Number (305)219-8267
Parcel Number 1121360030540
Project: <NONE>
Contractor: EF DESIGN & CONSTRUCTION Phone: (305)409-4581
Building Department Comments
KITCHEN AND 1 BATH RENOVATION
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-206191. W/C TO FAR OFF
I I WALL
KITCHEN DRAIN NOT PROPERLY CONNECTED
LAV Accordion FITTINGS NOT APPROVED LEDGES NOT ALLOWED
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 25, 2014 For Inspections please call: (305)762-4949 Page 17 of 40
°w
p
o
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-208844 Permit Number: PL -1-14-143
Scheduled Inspection Date: March 26, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address: 131 NW 110 Street
Miami Shores, FL 33168- Phone Number (305)219-8267
Parcel Number 1121360030540
Project: <NONE>
Contractor: EF DESIGN & CONSTRUCTION Phone: (305)409-4581
Building Department Comments
KITCHEN AND 1 BATH RENOVATION
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-206191. W/C TO FAR OFF
I I WALL
KITCHEN DRAIN NOT PROPERLY CONNECTED
LAV Accordion FITTINGS NOT APPROVED LEDGES NOT ALLOWED
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 25, 2014 For Inspections please call: (305)762-4949 Page 17 of 40