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PL-14-1154Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216984 Scheduled Inspection Date: September 04, 2014 Inspector: Diaz, Osvaldo Owner: CANOBBIO, GIANMARIO & ZOE Job Address: 142 NW 99 Street Miami Shores, FL Project: <NONE> Contractor: ELECTRICAL MASTERS INC comments REPLACE HOT WATER HEATER Passed Fail Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Permit Number: PL -6-14-1154 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)989-8415 Parcel Number 1131010240040 Phone: 305-265-7996 INSPECTOR COMMENTS False Inspector Comments CREATED AS REINSPECTION FOR INSP-213546. MIN SUPPLY TO WATER HEATER 3/4" September 03, 2014 For Inspections please call: (305)762-4949 Page 10 of 26 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 BUILDING Master Permit No. JUN _0 4 2014 FBC 20 l (_�!N PERMIT APPLICATION Sub Permit No. R_'1 H ` I I� ❑BUI ING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E] RENEWAL [� UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP NNTTRACTOR DRAWINGS y 7�/CO" /C/,Oz" i JOB ADDRESS: �! / � � City: Miami Shores County: Miami Dade Zip: 3 i / [Z) Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Csf 2) Phone#: Address: y City: % ��i 1, j State: / Zip: T Tenant/Lessee Name: Phone#: Email: % CONTRACTOR: /� Address-,--) (✓ City: L f State: zip: �/ Qualifier Name: /� �1 Phone#: 22� State Certification or Registration #: �"� r Ca d rtificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ;2 �G Square/Linear Footage of Work: Type of Work: ❑ Addition_ ❑ Alteration ❑ New Repairf Replace ❑ Demolition„ Na Description of Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ CCF $ CO/CC $. DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ 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 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 $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 osted at the job site for the first inspection which occurs seven (7) days after the building permit is ' ued. In the absence such osted notice, the inspection will not be approved -and a reinspection ill be charged. 0 Signature Sign ure OWNER or AGENT CONTRACTO The foregoing instrument was acknowledged before me this a®fh day of /� //A9� , 20 / 14 , by �i'9NI"09R/o C.2"MiD o is personally known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this ru day of 00 -NE; , 20 by WA, wh is personally knowrn� me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Sign: Sign: Print: ec/i� sa sJ tom' Print: Seal: s.ti, NA7FULLIP8ANCM Seal: �TWWESANg a W COM=I0N #lXW179 MY N 19979 iVIRES: AUIN 07, 2014 tF.B: NN1107, 2094 t�arph let State Insurance d 1st Siafls Incur APPROVED BY ,� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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, you may be personallv liable for the worker compensation iniuries of anv 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: C 1110 Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before day of , ?! M (SEAL) Tvt)e of Contractor Print State of Flo' ) County of M ami -D de ) Sworn to and subscribed befc day of 1��_ JUN 07 JEFF ATWATER CHIEF FINANCIAL OFFICER * * 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' Comoensatinn lauv EFFECTIVE DATE: 11/1/2013 PERSON: WHITAKER FEIN: 270477023 BUSINESS NAME AND ADDRESS: G WHITAKER INC 400 N.E. 20 STREET, APT. BOCA RATON FL SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR 33431 EXPIRATION DATE: 11/1/2015 GRADY L 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 440.05(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 any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 �u t�lKuc 11c?N INDUSTRY LICENSING $OARD SEQ# L12071701111 07Z17/2..012 2012 12003,0964'. Q*-—0225i4Err` k MAI a : The PLUMBING CONTRACTOR Named below IS CE:I2TIF`IEI? Under the provi j.*,aTns oF Expiration date. AUG 31, 2.0 f w ✓: f' WHITAKER, GRADY L r G WHITAKER INC 400 NE 20 ST APT 104D�$_'�� !, r; BOCA RATON FL 33431 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED'BY LAW 0 A N N r. M, G A N N O lei P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel (561) 355-2264 s aom„ f'a1t,,, s,.•.,,;, County 400 NE 20TH ST APT 104D Serving ✓ u. BOCA RL%TON, FL 33431-8159 T'TPE OFBUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AMT PAID BILI. u 23-0069 PLUMBNr, CANTRACTO;: WhITAKER GRAOv CFCO22546 . 1313,1370342-07/11/13 $27 50 8;6183780 This aucumeni is valla only when recelpled by the Tax Collector's Office G WHITAKER INC G WlilTAKER ;NC 400 NE 20TH ST APT D104 BOCA RATON FL 33431-8117 II� „ �,1��1111��11�1111 STATE OF FLORIDA PALM BEACH COUNTY 2013/2014 LOCAL BUSINESS TAX RECEIPT LBTR Number: 201006054 EXPIRES: SEPTEMBER 30, 2014 This receipt grants the privilege of engaginy in ul managing any business profession or occupat un within its jurisdiction and MUST be conspicuously displayed at the place of business and in sued a manner as to he o;r:n to the view of the public: 06/03/2014 12:32 18504827042 TODD-DORROH INS. PAGE 01/01 1 Ur 16J: � ^` Mcjr CERTIFICATE OF LIABILITY INSURANCE °Or*/012014 ' GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 06/03/2094 ' 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 13Y THE POLICIES BELOW. T141S 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 polioy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons of the policy, certain policies may require an endorsement, A statement an this certificate does not confer rights to the Certificate holder in lieu of such endorsemen s . PRODUCER Todd-DoFroh Insurance, Inc. 4388 Clinton SL CONTACT NAME: PHnNE FA/C No Marianna, FL 324460 Francine Todd Lam. GWHIT-1 -- INSURED G. WHITAKER INC 400 N.E. 20TH ST APT 0904 BOCA RATON, FL 33432 INSURERS AFFORDING COVERAO NAIL# INSURER A; LLOYDS OF LONDON FN3UFMR B: INSURER C : INSURER 1) INSURERE! INSURER r.. mr-VIO innumomm: 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. g 1 1TRRTYPE OF INSURANCE1J EFFPOLICY POLICY NUMBER MEAD M/D %LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CIBFLOODO076 02/10/2094 ' Ox/10/2015wmdg EACH OCCURRENCE $ 9,000,00 t6 PREMISES 6e00rarlee g 100,00 MED EXP (Any ono person) $ 90,06 PeRSONAL a ADV INJURY S 1,000,00 -- GENERAL AGGREGATE $ 2,000,0 GEN -L AGGREGATE LIMIT APPLIES PER POLICY PJECT RO LOC PRODUCTS -COMP/OP A130 B ZrOOO,OO $ AUTOMOIRLE LIAB[Uw ANY AUTO COMBINED SINGLE LIMIT $ (Es a=Wj;nt) ALL OWNED AUTOS 80014Y INJURY (Per pefum) $ BODILY INJURY (Per acdderd) S SCHEDULED AUTOS PROPERTY DAMAGE S (PER ACCIDENT) HIRED AUTOS NON -OWNED AUTOS S $ UMBRELLA LIAR EXCESS LIAR OCOUR CLAIMS MADE N / A EACH OCCURRENCE $ AGGREGATE S DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND C MFLOYCRC s1Aon nYANY OffiCEFUMEMSERR EXCLUDED? I Y� (Mandatory in NH) If Yes deedfiee Under DESORIPTION or OFORAT10N5 peUw S WC A�Lr TORY LIMITS ER _ E.L EACH ACCIDENT 1- DISEASE - EA EMPLOYEE $ GL. DIGCACC - r+OLICY L1MFT 6 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUW ACORD 101, AddlBonat Remadte 909dute, 1frnom apaca Is ruqukud) Fax - 305.756.8972 C1rCO22540 r9TMRI1%ATC Un1 rfCb MIASWOR MIAMI SHORES VILLAGE 90050 N.E. SECOND AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE LMTH THE POLICY PROVISIONS- AUTNORtZED Francine lyo+s-Auu9 Acic7KU CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD