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PL-13-1701Miami Shores Village U Buildingp De artmen - 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �7_ Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PRONE NUMBER: (305) 762.4919 IPTC 20 J BUILDING�-- 17D Per*,No. !3 PERMIT APPLICATION Master Permit No. (Oa4 Permit Type: PLUMBING JOB ADDRESS: - City: Miami Shores County- Miami Dade p' Foho/Parcel#: it — 320 (6 00 0 — Q6 IFO Is the Building Historically Designated: Yes OWNER: Name (Fee Simple 1►11R1►L9IM no NO Flood Zone:'R State: zip; CONTRACTOR: Company Name: 7@ A �`��c� ��i /✓c Phone#: (�� '�� 7 Address: / -13 ®® 45 W /,/,c? 5-T City: al -state: Zin: �•E r QualifierName: /J,4 State Certification or Registration #: d -P(2 ®fid 6 7 Certificate of Competency #: Contact Phone#: 4 —) -t�47 Email Address: DESIGNER: Architect/Engineer•. Phone#: Value of Work for this Permit: $ ��- Square/Linear Footage of Work: Type of Work: OAddress Alteration ONew ORepair/Replace Description of Work: �_) %— Submittal Fee $ Permit Fee $ OJO / S Ca - CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Doable Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ODemolition 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered 'to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatureq-1" Signature Owner or Agent Contractor The foregoing instrument was ac ow ed a efor s, The foregoing instrument was acknowledged before me this224 day of . Z . , 20 by day of v 20a by / c�� r w homes pq � 4y�now�n to me or who has produced who is erso y o me or who has produced identification and who did take an oath. as identification and who did take an oath. • ' % . 11 NOTARY PUBLIC: P take o�23 2p15 � Si s `+ Q g�0 Sl�� t �' Print: '- '" 5s p0 ��a� N°ta y Print: CIR, r de-- J C re r C (C4 e ac -h�J11 My Commission Expir off: Bor°' My Commission ExpirW,, -Pua1% 8A CA ADM Oi r«« MY COMMtS510N # EE 6" EXPIRES: February 19, 2011 Bended Thm Budgt"Sdt 7TedtzYda9e�'nF�iroY4cdt�Y4nY&�Y3e�ksY4t3e9t4takde&3e3:4a&&4e4e4e&9et43e4nYv4$ 9Ysk4ratoYaksT: aY4aaHe8eaYa4aY,t9YdrsTnYi4�/t�YakaY9t9eat�4r&&Br�Y�ke4de9edes:-�Y4ede�YeY4e�Y4e�hYtYdtde9a4rtYinhsTt4r�rktYsirale�F APPROVED BY/ ' 7 `o Plans Examiner Zoning Structural Review (Revised3/12/2012XRevised 07/10/07XRevised 06/10/2009)(Revised 3/15/09) Clerk Miami shores Vill'a'ge Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME:,,/, A- -r- E,urea Po 5 c� :7--A.> C BUSINESS ADDRESS: 1, X00 !&V --/—CITY STATE OT -ZIP CODE -0 f 7-( BUSINESS PHONE: (�®-tr) ��`��`�� FAX NUMBER CELL PHONE (%��) �� °( _247 QUALIFIER'S NAME: t4f d:2Gf Ti2 QUALIFIER'S LIC NUMBER: C- C3 4-& ? 7 E-MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV CERTIFICATE OF LIABILITY INSURANCE °0077M/�H31° '"' 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 flffq=ANT: Uthe carlifilowle holder Is an ADDITIONAL INSURED, the policy(les) must be endarsed N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement Asfatemmad on this certificate does not confer rights to the certificate holder In Neu of such s PRODUCER Express Insurance Services 13754 S.W. 84th St. ABalrti, FL 33183 Phone (305) 388-56M Fax (305) 386-0640 CONTACT PHONE RAX Me PRODUCER AFFORDING COVERAGE MAIC s INSURED YAT ENTERPRISES, INC 13300 SW 49 ST NwW, FL 33175 (305) 525-5843 INSURENA: CANOPIUS US INSURANCE, INC INSURER B: INSURER C : INSIUM D' DISURER E : F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:- THIS UMBER: 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 SUBdECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ngm—m In TYPEOFDURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. 10050 NE 2 AVE POLICY NUMBER POIJCYQF MIAMI SHORES, FL 33138 LIMB A GENERAL LUM31M ® COMMERCIAL GENERAL LIANU Y ❑ ❑ a AIMB-MADE ® OCCUR ❑ OUS00M2808 02/13pt013 0211=014MED EACH OCCURRENCE $ 1,000.000 S (Ea nommemal $ 100,000 EXP Wry one person) $ 5,000 PERSONAL & AOV INJURY $ 1 000.OD0 ❑ GENS. AGGREGATE LIMIT APPLIES PER: E1POLICY ❑ PRO"JET ❑ LOC GENERAL AGGREGATE $ 2,000.000 PRODUCTS - COMPIOP AM $ 1,000.000 $ AUTOYOBLE LIABUM ❑ ANY AUTO ❑ ALLOWNED AUTOS ❑ SCHEDUUMAUTOS ❑ HFUMAUTOS ❑ NOM-OWNEDAUTOS ❑ COMBINED SINGLE LIMIT $ ((Ea ate) BONY NAIRY (Pm Pte) $ BODILY INJURY (Per Bcddeful$ PROPERTY DAMAGE (Perecddent) $ $ $ UMBRELLA LIAR ❑ OCCUR ❑ ❑ OWESS LIAR El CIAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE RETENTION S $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABUM YIN A (dory in NH) 9MOMundw N OF OPERATIONSbebw N / A WC 13rATU orH E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ EJ-DISEASE-POLICYLIMITI $ DESCRIPTION OF OPERAT1O NSI LOCATIONS I VEUCLFS (Atli ACORD lei, AddWonal Remsrfu Sdwdsle, If mare space M required) CERTIFICATE HOLDER CANCELLATION ®1986-2008 ACORD CORPORATION. AN rights reserved. ACORD 25 (2009/x) QF The ACORD name mW logo are registered marks of ACORD SHOULD ANY OF TIE ABOVE DEED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZEDREPRESENTATIVE MIAMI SHORES, FL 33138 PATRICIA DUQUE ®1986-2008 ACORD CORPORATION. AN rights reserved. ACORD 25 (2009/x) QF The ACORD name mW logo are registered marks of ACORD Rft�f� d s a aJPAX RECEIPT 2fi�t 3 NPS}FIRST-CLASS STATE OF Ft-OPIDA U.S. POSTAGE I t sr. ExPiRr—s SEPT a :073 PAW k r 'JUST J?F D PLA SV AT PLACE OF EiJSIXES @�/��1�9�Ap�h.��1,�gFL�y9 . . • .. s43ci i�• .�. ,} 6 :� d k3d,: "4a •i k ti ,°�. dv i -i l 1i} PERK0 NO. 2 1 520024-1 THIS IS NOT A HIL- — Do woT PAY BUSINESS NIdMEIO VAT ENTER C I$ INC 15300 SW 49 ST 33175 LININ DAVE COUNTY OWNER VAT ENTERPRISES INC 156 MIYNA G CONTRACTOR TfM IS OMY A LOCAL . 6USD UMS TAX RECEIPT. iT DOES Mr THE HOLDER TO WPO�TTE ANY EXMM REillLATORY OR .. 7.OMM LAws OF TRE COFL M1 OR CITIES. NOR DOES TT EXEM-T TRE RENEWAL RECEIPT NO. 543460-0 STATE* CFC035677 WORKERR/S DO NOT FORWARD HOLDER FMM ANY OTHER PEROT OR UCEME YAT ENTERPRISES INC NOTA cERTTHMs Is CARLOS GARCIA PRES j EDsY LAW. 13300 SW 49 ST HOLDERS ctuauiacAw MIAMI FL 33175 PAYMENTRECEWED OCOONFIf TAX 07/24/2012 60060000035 / 17I/ttilfllij lttltt iJI /000075.00 322 SEE OTHER SIDE - STATE OF FLORIDA DSP OF BUSINESS AND PROFESSIONAL REGULATION INDUSTRr LICENSING BOARD (850) 487-1395 1940 NORTH MVNR0Z STREET I& SEE FL 32399-0783 pADRM, HIPOLITO G YAT ENTERPRISES INC 13300 SK 49 ST MIAMI FL 33175 .QrQranda#wW Wfth #= kmm you becoum one of the nep* one nuTion F=Whm Mmued by the Deparknent of &mlness and Rroftsdonal Reg"m our prabodonals and baskiesses range tom arcmkxft to yadd bmkem Aun bows to barbeclue reslaurarft and OW keep Florida's econmW stroM. -ZZWATE OF FLOJUDA CFC03567707/31/3? 110416005 Every day we work to love the way we do buskum in order to serve You better. For fidannaffon about our services. phme log onto wow-mYftrWAc9ns0-c0nL f IftPOLITO G duets and #0 MQUWkm #10t � mme you can SW mm kftmuftn about mw —, irim.-:krxsw 2= kApad V0% subscribe to ftpmtmd ears and learn atore aboutthe DdpartinerWshfflaffiffis. Chwam;dmat*oDopadmoitimlicermEnkim*.RegukftfzaMy We =,sW* sbm to serve you better sD that you can sem your cuskffm& Fkmia2ih142ii7 jrakda*m an YOE rmw Tlml* you for doing bre Honda, nd conc lmlpftatua date. DETACH HERE A OF FLORIDA STATE C 3 6 7'3 499 ps - Expiratimi- dates AUG .31. Y.2014i�'- -PADROWj,,-- 90 ZN AT 4221 9W 136�'ft 'V: SEW L12073102017 J Km LAWON -4- FL.. X3175 P-Etk Dig" REQUIRED tED BY LA .* * CERTIFICATE' OF ELECTION TO BE EXWT FROM FLOMOA WORKEW COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/15/2611 PERSON: PADRON FEIN: 650962036 BUSINESS NAME AND ADDRESS: YAT ENTERPRISES INC 13300 STs! 48 STREET MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED PLUMBING CONTRACTOR EXPIRATION DATE: 12/1412613 HIPOLITO WWMff Pmaaaat to ChapW 440 . 0914L F.S.. an afffm of a pmt w10 elects = ltom MIS cbapW by fafag a Cmtifieate of eledtne ander tills sectiax may MR recon" beaef0s or campannow amtar this diviner. Passant to Chapter 440_05112L F.S., Certificates of election to be Gump— GWy oaty Ww" tine scepe of oma hasmew or !rude limed an me anke of election to be exempt. Past to Chapier 440.09131 F.S., Natio of eteefm m be BUMP Bad COMICUM of electitat to be exempt awn be subject to wacadin if, at say fime after me fNi$g al so eatice ar the Issuance of oma catifief, the pmen named an do able or oa3liff�te no loagnt Ila regaltemeats of 0 fm isSMace of a camleate. The depatmnt $ban reaa s a certtiieeae d my acme for ferare of me h named an me cetiffisate to asst me requhe of ods secam QUESTIONS? (850) 413-1609 MMC -252 t ERVICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES opimm OF WORKERr CATION TION INDUSTRY GER TE OF ELECTION TO BE EXEMPT FROM FLEA COMPENSATION LAW 81ECTNE 12/15/2011 EXPIRATION DATE: PERSOr* HIPOLITO PADRON FEOtE OS0962036 BUS94ESS NAME AND ADDRESS: VAT 8 S WC 13300 SIV 49 STRIEEi NUUNt FL 33175 SCOPE OF BUSINESS OR TRADE: i- agumm Puns= COMRACTOR IMPORTANT F Pint to Chapter 440-05(14). F.S., an officer of a corporation who O elects exemption from ibis chapter by filing a certificate of election L under this section am not recover benefits or compensation umler this D 12/14/2013 Pursuant to Chapw 44(L05(12), M, Certifiicalm of election to be H exempt._ MV only Within the scope of the business or trade Usted on E the notice of election to be exempt _ R E Pursuant to Chapter 440-05(13), FS, Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time aft the fijeag of the notice or the issue of the certificate, the person named on the notice or certificate no Idler mee the recpsiremeents of this section for issuance of a certificate. The department shall revoke a c atiftaite at alhy tmhe for fm"Icre of the person named on the caroicate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE f Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Jr Y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-196133 Scheduled Inspection Date: September 17, 2013 Inspector: Diaz, Osvaldo Owner: WEBER, JENNIFER Job Address: 849 NE 92 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: YAT ENTERPRISE INC riunamg uepartment comments BATHROOM REMODEL Permit Number: PL -7-13-1701 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number INSPECTOR COMMENTS False 1132060050050 September 17, 2013 For Inspections please call: (305)762-4949 Page 13 of 39 Inspector Comments Passed E2, Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 17, 2013 For Inspections please call: (305)762-4949 Page 13 of 39