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PL-14-873Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-213502 Permit Number: PL -4-14-873 Scheduled Inspection Date: July 01, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: MOORE, REBECCA Work Classification: Addition/Alteration Job Address: 9118 NE 5 Avenue Miami Shores, FL Project: <NONE> Contractor: CASTELLON PLUMBING CORP Building Department Comments Phone Number Parcel Number 1132060140010 Phone: 305-553-1490 REPLACE KITCHEN SINK, DISH & DISPOSAL. RELOCATE I Intractio Passed comments WASHING MACHINE, ICE MAKER LINE AND WATER INSPECTOR COMMENTS False HEATER June 30, 2014 For Inspections please call: (305)762.4949 Page 6 of 22 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-213267. Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 30, 2014 For Inspections please call: (305)762.4949 Page 6 of 22 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 APIA 8 0 014 FBC 2(�I � Master Permit No. i) Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [-]CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: Ct I 1 N U S4 -k A t,, -e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I " 3 CA I L4 - 0G 1 V Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):?, LIL Y%Jonce �� F /C y1P1efk Ind Phone#: jjq Address: -ug NG Syh AK p City: M', &vyr ► ka1 re-& —State: F L Zip: SS l t1 Tenant/Lessee Name: Phone#: Email: �'p-o6D CONTRACTOR�C}ompan/y Name: "! Address: .0 el -I A City: Qualifier Name: XW.'? ,?.Ds-S-sT,,5-- t� �- f � �--. �-S -State: � /,q. //Z''ip: `."'3 � O ( i 214 L b 0 (f!ft'T�ti1—®14 Phone#4_�86) 2 -SS- S-1 L� State Certification or Registration #: C.; M U f �Z ®tea I Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: 10® State: Zip: Value of Work for this Permit: $7. 9,0& Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 5� Repair/Replace ❑ Demolition DescriptionLi€`/5 ,I i . t/'' rte✓ ! !,� :rl J, I / I. f Ir L c ii . i t /,/, L / :lopice, 1 lW WA 17. JM,i Snecifii color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary Radon Fee $ DBPR $ Bond Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 6 3 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 not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this �� The foregoing instrument was acknowledged before me �� this day of `c 201-4 , by i�(�LL day of 20 Ly, by G; m I ck C ,� St� 7 404 who is personally known to me or who has produced ' 1(9 who is personally known to me or who has produced NOTARY PUBLIC: As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: a u...... \\\, Sign: .9 ' �1 Sign: _ Print: ' o r q - Print: My Commission Expires: 0 -" a `�: CIO My Commission Expires: t A11�A. �'%, �/ '' • • • • ' �� EXPIRES: AprI17, 2015 \��` Nrdw 1iBUW SWAM N��kK��kN�ffi�k&�R�k�k9effi&*�k9�&�k�k�k�k�kakffi�k�k�6�4�k�k*�k�I��RIkak�kK�ek�k�k�k*N��k�k*�k�k+l��k�k�k�k�k�k�k�k+b�k�k�kak�NN��k�k�kd��kakak4�kilt�k�N�k�k�kak*�k�ksk�b�F�k�k�k�k�k�k�k*�k&�k�ka6*�k�kfle* 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) '°� CERTIFICATE OF LIABILITY INSURANCE i DATE(MAt/DDNYYY) 10/24/13 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: First Class Insurance Market PHONE{305)441-2997 ; FAX , ; (305)441-8443 4101 NW 9th Street annRess; fcimc@aol.com Miami, FL 33125 _ INSURER(S) AFFORDING COVERAGE NAIC # Phone (305)441-2997 Fax (305)441-6443 INSURERA: WILSHIRE INSURANCE COMAPNY ,INSURED CASTELLON PLUMBING CORP 9841 NW 130 ST HIALEAH GARDENS,FL 33018 r_ q _ INSURER E : INSURER F: COVERAGES _ _ 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDLSUBR OLICY EFF POLICY ExP LIMI r3 INSR' WVD _ POLICY NUMBER IMPMIDDW IMM/DDIYYYY)' GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES (Ea occurrencsl $ A ❑ ❑ CLAIMS -MADE 0 OCCUR01028513 MED EXP (Any one person) ! $ 5,000.00 ❑ N 10/29/2013'10/29/2014 PERSONAL a ADV INJURY $ 1,000,000.00 ❑ 1 GENERAL AGGREGATE 1 $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG', $ 2,000,000.00 ❑ POLICY ❑ JJECT ❑ LOC $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOOWNED ❑ AUTOSULED ❑ HIREDAUTOS ❑ AUTOSWNED BODILY INJURY (Per person) j $ BODILY INJURY (Per accident) $ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ —� ❑ EXCESS LIAS ❑ CLAIMS -MADE AGGREGATE $ ❑ DED ❑ RETENTION$ _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES,FL 33138 ACORD 25 (2010105) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10 ACORD CORPORATION. Ali rights reserved. name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395. •a 1940 NORTH MONROE STREET 32399-0783 TALLAHASSEE FL CASTELLON, GIRALDO CASTELLON PLUMBING 9841 NW 130 ST. HIALEAH GARDENS CORP FL 33018 sT oFow4 AC# EL49::.L� Congratulations! With this license you become one of the nearly one million DEg TlI T t F :$IISINE38: AND Floridians licensed by the Department of Business and Professional Regulation. , PRO)SSREGIILATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CFC01959 0530/12 110404692 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.myfloridalicense.com. ' . <CERTIFI: pBb>l4BINE CONTACTOR There you can find more Information about our divisions and the regulations that CASTE%ION� CIBAI f: impact you, subscribe to department newsletters and team more about the ` CAS £SLLOW ` P100 CORP Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CBRTMED under the provie9.one of Ee►.4 s 9 ss Thank you for doing business in Florida, and congratulations on your new licensel s�pirsesa� fate.: AVG 31, 2014 L3205- 03.066 L`' DETACH HERE lei 3! AC#6144918 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEWL12053001066 5/30/20121110404692 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Expiration date: AUG 31, 19059 Chapter 489 FS. 2014 CASTELLON, GIRALDO CASTELLON PLUMBING CORP 9841 NW 130 ST. HIALEAH GARDENS FL 33018 RICK SCOTT GOVERNOR n1SPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 000797 . . 40 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL — DO NOT PAY 4" 748 BUSINESS NAME/LOCATiON QSTELLON PLUMBING CORP 9641 NW 130 ST HWBW GARDENS FL 33818 RECEIP' NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 4W748 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED CAMLLON PLUMBING CORP 196 "WNIBING CONTRACTOR BY TAX COLLECTOR Worker(s) 10 CF69059 $45.00 07/02/2013 FPPU07-13--M1200 This Lad Business Tax Receipt only confhms� of the Local Business Tax. The Receipt is not a license, pumit. or a cerldicadon of the holder's qual to do business. Holder mind comply with any governmental or ;' n►1 l regtdetory laws and requiremeras which apply to the business. The RECEIPT N0. above aaaH* displayed on all commercial vehicltu — a t odq.. e ¢ H For mere iaformation. visit www.miamidade.au;r.; Report Viewer =/1 100% * * CERTIFICATE OF FLECTION TO BE EXEMPT FiOIM FLORIDA W ORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensaiion law. EFFECTIVE DATE 11222013 EXPIRATION DATE 11222015 PERSON: CASTELLON GIRALDO FEIN: 591676886 BUSINESS NAME AND ADDRESS: CASTELLON PLUMBING CORP 9841 NW 130 ST. HIALEAH GARDENS FL 33018 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Cr DFS•F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (&50)113-1609 htMJ/apps8.fldfs-=WcrreporNewer/reportVewer.aspXtdatEF=kMVinc9D7Q3gH6TER6eP1KMZ%ZSz*ekeESdWv4NPOPN42XeirDRGXWVIxH... 112