PL-13-1866Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 A U G 1
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 `
FBC 20'L")
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
Permit No.
Master Permit No.?L 1-3 --i 8-(0
JOB ADDRESS: �� t)c %i %
City: Miami Shores County: Miami Dade
Folio/Parcel#: 11-3101-020-00W
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
AAdre_ac- f /,R k nDc—, cet-s f"
City: V V I ( G4S"A l
Tenant/Lessee Name:
Email:
c V -e- S- State:
NO Flood Zone:
e s- Phone#: �3 V�- qQ -L -q -163
-3,"-3 i 3
CONTRACTOR: Company Name: &Ji) Cg 1' 10►*3 � ( ° X " Phone#:
Address: 6Wz?i 72 �X
City: ���� `- State: - Zip:33r
Qualifier Name: aPhone#:
State Certification or Registration #:da ICIL2B 454Certificate of Competency #: A/46
,, ,,��� ����
Contact Phone#: -65Z) Email Address: fi�7tx PL s�rl� ��6 Q-& W7
DESIGNER: Architect/Engineer. Phone#:
Value of Work for this Permit: $ Ivo Square/Linear Zepair/Rcplace
of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Demolition
Submittal Fee $s Permit Fee $ f SQ, 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 c mencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issu the absence of such posted notice, the
inspection will not be approv d a reinspection fee will be charged.
Signature - Signature
r or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 q, by PC0 � L > Gc�' day of , 201% , by A4�� k4z� , 1(2;7—
who is
am'whoois personally known to jgQine or who has produced PL- US�who is personally known to me or who has produced
and who did take an oath. as identification and who did take an oath.
NOTARY PUB C:
\``\\����t��i ii�i�i/i
NOTARY PUBLIC:
Sign:
=
Sign:
Print:
OXNO���� 3-
Print:_
��1���� ,eQ
My Commission Expires:.
sa,4a'�����
My Commission Expires:
lmnni�n
APPROVED BY r -I S! Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009XRevised 3/15/09)
Zoning
Clerk
AC#w 6.17.8 2.: S.,:
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P I f PLUMBTN 6
Xa# CEI T--
IFIND
E 31, 201 #1
Under thb,, provisions of:"..' h
Expiration date: AUG
4
5162 SW' 5 TERRA
MIAMI FL 3 313 4 r.
SCR S,
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b1s*PLAY'AS RF-OUIREb-13 LAW
SEQ#L12062900198
KEN LAWSON
SECRETARY
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Locai ftsi ess.TaX Receipt
Miami -Dade County, State of Florida
THIS IS NOT A BILL— DO NOT PAY
7!009M
UUM11" NA11 WLOCATION RHCEIPT No.
ROTO TECH PLUMBING INC RENEWAL
5162SW 5 TER 7284532
MIAMI FL 33134
r
"_,L_BT
EXPIRES
SEPTEMBER 30, 2014
Must be displayed at place of business
Pursuant to County Code
Chapter SA — Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS
196 PWMBING CONTRACTOR PAYMENT RECEIVED
ROTO TECH PWMBING INC 13Y TAX COLLECTOR 1 CFC1428640 $45.00 07/08/2013
DG61-13-013934
Tial Coat! BosinessTax Receipt o* 00II&DIS P10101dafthe Local BUsiuess Tea. The Receipt is Rd a ram,
perms ora �iNtm althe rider a qwM to do basooss. Robber most comply wkb my gor�aa�tai or
iequmew laws aad wbioh apply to the bashmm
The RECEIPT AIO. above wolke diopbr}ed an all commercial voldoles - Miami -Dada Code Sec Ba -M
For more iNor an. aisle
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(� SEE OTHER S@E
From: 08/13/2013 12:43 #604 P.0011001
CERTIFICATE OF LIABILITY INSURANCE °A o�1s11'
THIS CERIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO kid 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 ISSUBNG INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: Nthe certt8eate holder Is an ADDITIONAL INSURED, the poitry(►es) must be endorsed. If SUBROGATION IS WAWED, "ad to
the terns and conditions of the po ft, certain policies may re"I a an andorsement. A statement on this certificate does not confer rW is to Ute
certilloste holder in Ileu of such sndorsmnsngs).
.— .__. ___.«. _......._. :
PRfUCER CONTAL't
- _ Luda Esbetla - -•-- --.... _ ..
AJU
Accurate _PHONE (3(?51228-8727 - �305�226.0787.
8300 West Floglm Suite 114 AQGIREBS: Bucleamla@belsartl im
Miami, FL 33144 --- - INSust} A�ORoe►o cay�AGe _. --- - Nuc r
Phone _L305)226-8727 Fax (305)226.8767 : - _ _ _ .. .A : • _ Gtarlada irts�rance Company
Roto -Tech Plumbing Inc INSURER
5182 SW 5 Tarr _INSUAERD;. __-...----....... ----• -
Miami, FL 33134-
- ..... _.... ... ....... _ _ .. - - --- .._....._ _....._..._...__._.. INSURER F:
COVERAGES _
CERTIFICATE NUMBER: REVISION NUMBER:
THIS
HS TO CERTIFYTHATTHE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOIi THE POLICY PERIL - -
INDICATED. NOTWITMSTANDIING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THUS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN B SUBJECT TO ALL. THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS.
- ADOLSUBR POL ISEX
t - TYPE OF INSURANCE - IMSR IIID_-._ PDL�Y NUMBER __._"_• _, URdTB
GENERAL LIABILITY IACHICE 2,00,000.0(1
DATO REP}fiEd'
® COMMERCIAL GENERAL LIA91irfY _?R.PN9£Lfa»IenP .s 100,000_.00
A ❑ ❑ CLAWAIIADE ® OCCUR : CISA004578787 06/252013 06252014 MED EXP (Any w:e Persons
❑ . __ _ _ _ -- - _ _-.. _. PERSONAL a ArnriHW!tr S 2.000,000.00
❑---•-•-----.._____--
GENERAL 2,000,000.00
OEN'LAGGREGATE LIMIT APPLIES PER: I PRODUCTS-compiQPAQs' s 2,000,000.00-
: — — _.. — — ... _
__6d Paucw 0 F [� �oC .. .:. s
_............_...._.... - --- _........
AUTOMOBILE LIABILITYe4gden111wOi
❑ ANY AUTO BODILY MARY (Per parson) $
[3 ALL AUTOS C]AUTOSULEO BODILY INJURY (Per acetdwq S
❑ HIREDAUTOS ❑ A O� g' �[q_ .._..._ __...S . . _.._ .. __ . .
❑ UMBRELLA LIAS ❑ OCCUR
_DEXCESS LU18
�••�_ .............`..._� CLAIINS-AIDE ACiORECiATE S
4 1...�_ RETENTIONS -- -
tYDdtKEAS COMPENSATION _� S4BY11AgT . Q .......
ANO EMPLOYERS' LIAIMM YIN . — .._.. . _ ....
OTH
ANY pROPR�TOR(PARTNERIEMUTNE _ELL EACH ACCIDENT S
OF'FICERIMBABER EXCLUDED? - NIA
(01 -da" In MIQ _.:; E L DISEASE - EA EMPLOYEE S_ -
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•_ �N��ERATIQAIS1�v.._ ..._._ ..._---• • -•-_-- ----------.._.__..,. _ ..._...:.E.L.�ISFASE. _f�LlCr�fNOT• S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remazks Schedule, I MOM Space k4 required)
Certificate holds ris listed as addiltonai name insured.
CERTIFICATE HOLDER
Miami Shore Village Hail
10050 NE 2 AVE
Miami Shores, FL
305-290-7347
ACORD 25 (2010105) 4F
CANCELLATION
SHOULD ANY OF THE ABOVE POLI :IES BE CANCELLED BEFORE
THE EXPIRATION DATE TH O C L BE DELIVERED IN
ACCORDANCE WITH THE R
AUTHORIZED REPRESENTATIVE
Lucia Estrella
®1988.2010 ACORD CORPORATION. An rights reserved.
The ACORD name and logo are registered marks of ACORD
" . •
JEFF ATWATER
CHIEF FINANCIAL OFFICER
989"
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
07-11-2012
* * 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.
t
EFFECTIVE DATE: 07/09/2012
PERSON: RAMIREZ
FEIN: 455408881
BUSINESS NAME AND ADDRESS:
I' ROTO TECH PLUMBING INC
5162 SW 5 TERRA
MIAMI FL 33134
I
SCOPES OF BUSINESS OR TRADE:
1- PLUMBING NBC AND DRIVERS
EXPIRATION DATE: 07/09/2014
ARMANDO J
2- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT. Pursuant to Chapter 440 . (15(14), F.S., as officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this
section may not recover benefits or compensation ander this chapter. Pursuant to Chapter 440.05(12), 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 nay 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) 413-16(
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORI(EIW COMPENSATION
CONSTRUCTION INMISTRY
CERTIFICATE OF ELECTION TO BE
I WORKERS' COMPENSATION LAW EXEMPT FROM FLORIDA .6
EFFECTIVE 07/09/2012 EXPIRATION DATE: 07/09/2014
PERSON ARMANDO J RAMIREZ
FEIN 455408881
BUSINESS NAW AND ADDRESS:
ROTO TECH PLUMBING INC
5162 SW 5 TERRA
MIAMk FL 33134
11
0
SCOPE OF BUSINESS OR TRADE
1- PLUMBING NOC AND DRIVERS 2- CERTIFIED PLUMBING CONTRACTOR
IMPORTANT
QPursuant to Chapter 440.05(14); F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt
E 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 ofthe
person named on the certificate to meet the requirements of this
section.
(WESTIONS? (850) 413-1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11