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PL-13-700Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-196360 Permit Number: PL -4-13-700 Scheduled Inspection Date: August 15, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Owner: BAKER, GOLDIE Job Address: 9510 NW 1 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: SAGE PLUMBING INC comments Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1131010240260 Phone: (954)214-3961 RENOVATE TWO BATHROOMS AND KTICHEN INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-196274. CREATED AS REINSPECTION FOR INSP-188920. NO ACCESS NO ONE AT RESIDENCE 7/30/2013 Failed ❑ FBCP706-APV.FITTINGS REQUIRED FOR CONNECTION OF SINK STRAP DM/ HOSE FBCP305- CAUCK AND GROUT TOILET AND FIXTURES 8/1/13 Correction ❑ Needed Re -Inspection ❑-�-� Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 14, 2013 For Inspections please call: (305)762-4949 Page 21 of 46 Miami 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 �P OR 00 �a FBC 201 Permit No. Master Permit No.y-, l �� JOB ADDRESS: A r(O MJ I Ir *— City: Miami Shores County: Miami Dade Zip: Foho/Parcel#: ( I —'1510f -02d -02400 Is the Building Historically Designated: Yes OWNER: Name (Fee Simple NO ) Flood Zone: City: Al L, UX,% State: Zip: 900O %q Tenant/Lessee Nam -`e. Phone#: Email: CONTRACTOR: Company Name: 5; 6 Ar=ev W4j411, Zf/oiG Phone#: qC-j!�_ AIV- 3 Address: `R&i;-Yu g, 24 u L City: it m 0,06kPZA-I L c' Stater Zip: 7, 3 Qualifier Name: YYL i Cl- 14 e4. % A P z Phone#: g s:�-Uy- 3 State Certification or Registration #: G dL-a J ej 16ejVn Certificate of Competency #: Contact Phone#: m;61_Em4Address: C ® I= ll G (-,;w A i a.,& A so &X11s .i? c-7 DESIGNER: Architect/Engineer.. Phone#: Value of Work for thisPermit: $ 1// -Square/Linear..Footuge of Work: Type of Work. ,❑Address J ►alteration ' ONew` Cpair/Replace ❑Demolition iDescriptionofWoik: _ A,,6vts�tl P��C ��u%�, _ �, �/�-�T�t f-,� e,TA7®, ka r®y z:-yf t Lf ry 6 A a., At ri s l -C jQR'3/ry i�I �`h/ T I-l4rk-t�' OA- 7 fi AA f, &a Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ �� °'Tj 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�`d____2�',//`� Owne r Agent Contractor The foregoing instrument was acknowledged before m this The foregoinj instrument was acknowledged before me this day of fI , 20, by day of '' , 20 ()L, ��by PZ who is personally known to me o ho ilas pro ud 1Vo�i who is personally known to me or who hasauced �.; CGySi As identification and who did take an oath. 011 00f (ACAy i(- as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: it /� a•`StF!r?ii'•, Yuliesy Arias Sign:voit cp `�ttl`Y? Yuliesy Arias 4606565 Print: z�' ml�"EXp1i:ES: NOV.14,2015 Print: -'EXPIRES: NOV. 14,2015 My Commission Expires: N00�/Y/,Vfr --1, N�� www�ROtrNOTMY,com My Commission Expires: PIMP Y J&t- r - APPROVED BY ` % Plans Examiner Zoning Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B.y 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 JEITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT 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 WORKERS 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: Sh�&e 1��� ►Rr�z C�� BUSINESS ADDRESS: 106r rycw- —CITY po?laa P m c -r STATE FL- ZIP CODE 3 3, © 2-op BUSINESS PHONE: ( ) ) r q, 3 o& FAX NUMBER 19 0L1�'.& F CELL PHONE ( )A/� QUALIFIER'S NAME: ^),Yl i C /4 EL, TA 66 - QUALIFIER'S LIC NUMBER: /.�e 14, 0 S' E-MAIL ADDRESS (IF APPLICABLE): Sk dof PL jmRrwZ 40 A LS 0 clt� - Created on 3119109 BY MLDV I RV 3126(09 MLDV 1 RV 6127111 AS 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Receipt #:182 -1273 Business Name: SAGE PLUMBING INC Business Type: PLUMBING/LWN SPF (PLUMBING CONTR) Owner Name: MICHAEL SAGE Business Opened:ll/17/2000 Business Location: 1865 NW 76 WAY Sj3te/Cppnty/COrtfROg•CFC1426059 PEMBROKE PINES Exemption Code: Business Phone: 954-214-3961 Rooms 'ems Employees Machines Professionals 2 For Vending Business Only Ntltfllar of Man_hinn�c- ••---'°-- �-•--- I Tax Amount Transfer Fee NSF Fee Penalty ..r, .sr... Prior Years Colteciton Cost Total Paid 27-00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MICHAEL SAGE ReceiptbSA-11-00010825 1865 NW 76 WAY Paid 08/08/2012 27.00 PEMBROKE PINES, FL 33024 2012 -2013 02-a1-2012 .JEFF ATWATER STATE OF FLORIDA CHI9F FINANC AL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OP 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: 02!01/2012 PERSON: SAGE FEIN: 650796588 BUSINESS NAME AND ADDRESS: SAGE PLYING INC 1865 NN 78TH WAY HOLLYWOOD FL 33024 SCOPES OF BUSINESS OR TRADE 1- PLUMBING EXPIRATION DATE.' 01131/2014 MICHEL iAA RTANT: Pursuant to Chapter 440 . 0504}, F.S., an officer of a corporation who elects exeaption from this mer by filing a certificate of election under this section may nat recover benefits OF compensation ander this chapter. Porsoaat to Chapm 440.0502) F.S. Certificates of election to be exempt.— apply only within the scope of the basiaess or trade listed an the aatfce of election to be exempt. Pets to chapter 440.0503) F.S. Notices of election to be exempt and certificates of election to be exempt skull be subject to reaeration ff. at eny time after the filing of the notice or the issuance of the certificate, the person named an the notice or certificate no looger meats the requirements of this section for issuance of a eertNfe:zte. The department shall revoke a certificate at any time for failure of the person aamed an the certificate to meet the requirements of this section QUESTIONS? (850) 413-160S OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FiNAHGIAL SERACES DIVISION OF WORKERS' C01943MTION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTIOAtT01E ExIMWT FROM FLORIDA WGRKEW CON949MTION LAW 9 EFFECTIVE 02/01/2012 EXPIRATION DATE: 01/31/2014 PERSON MICHEL SAGE FEiNN 650796588 BUSINESS NAME AND AMRESS: SAGE PLUMBUM INC 1865 NW 78TH WAY HOLLYWOOD, FL 33024 SCOPE OF BUSINESS OR TRADE 1- PLtMiNG IMPORTANT F Pervient to Charter 440.05(14), F.S, n o� of a corporation who elects exemption from this cher by filing a certificate of election L under this section may not recover benefits or compensation angler this D dwtw. Pursuant to Ctnagter 440.05(121; F.S. Certificates of election to be H exempt-. fly only wititin the scope of the bWwss br tree listed on E ttte notice of election to be exempt R E Puratt t6 Citepter 444.05{131, F.S., Notices of election to be exempt and certificates of .election to be exempt shall tie suixject to revocation if, at any time after the filing of the notice or the isstance of the certiftcft the person named on the notice. or.certificate no longer meats the repiremem of this section for issuance of a. -certificate. The departnim shall revoke a certificate at any tme for- faiNire of the person named on the car ificate to meet tm regniramettts of this section. k7 � QUESTIONS? (850) 413-1609 * Carry bottom* portion on the job, keep u PW Portion for your records. OWC-252 CERTIFfCATE OF ELECTION TO BE E10.WT REVISED 01-11 04/02/13 03:36PH Cover All Insurance 9549350266 P.01 ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDONYM 0410212013 PRODUCER COVER ALL INSURANCE 5800 W.ATLANTIC BLVD. MARGATE, FL.33063 PHONE # MN 956.0006 FAX # 9564M THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED SAGE PLUMBING INC. 1865 NW 76TH WAY PEMBROKE PINES, FL, 33024 FAX# PR 987.3168 mugeg a MID-CONTINENT CASUALTY COMPANY INSURER a.,• PROGRESSIVE INSURANCE COMPANY INSURER C: R R a INSURER E: L;[ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A RALLIABILITY X Canna,> Rcwl cEN LIABILITY CLAIMS MADE I X OCCUR POLICY NUhTBER POLICY EFFECTNE POLICY EXPIRA 01111/2014 LIMITS 04GL00086M 01!11!2013 OCtx3RRENCE$1,000040 E TO RENTED $I00,000 MEd EXP ori 000 PERSONAL & ADV 1000 000 N AGGRE TE MAN EIIL AGGREGATE LIMIT APPLIES PER: X CY PRO PRODUCTS - COMPIOP AGO 666 Qali B X OBILE LIABILITY ANY Auro ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 08469002.1 0310112013 0.110112014 COMBINED SINGLE LIMIT (Ee) $'�0 BODILY INJURY (PerP) $ B=Y INJURY (P ) $ PROPERTYDAMAGE $ (Per aoddent GARAGE LIABILITY ANY AUTO Y -EA EENT $ OTHER THAN AUTO ONLY: AGG $ EIC MMOM I A LMBILRY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION EACHOCURRENCE AGGREGATE WORKERS COMPEN$AIM AND EMPLOYERS' LIABILITY ANYPMR OFFICERRdEMBER EXCLUDED? I descoe ordw O FTJHL EACH ACCIDENT E.(.. DISEASE • EA EMPLOYEE E.L. DISEASE • POLICY LETT OTNER DESCRIPTION OF OPERATIONS I LOCATIONSI YEHX:LES I EXCLUSUM ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PLUMBING RESIDENTIAL & COMMERCIAL 1 SEWER MAINS OR CONNECTIONS CONSTRUCTION MIAIVI SHORES VILLAGE BUILDING DEPT. 10050 HE 2ND AVE. MIAMI SHORES VILLAGE, FL 33138 SHOULDANYOFUEASMDESCRMWPOUMSUCANCEUEDBERMTHEEXPMIM DATE THEREOF. THE ISSUING INSIOM WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETO Tw C@ '11 ATE HOLDER NAMED BUT FAILM TODD 90 SHALL IMPOSE NO CIUM4{LIA UTY OF ANY tMAIMN THE MMM R8 AOEHTS OR SAGE, MICREL SAGE PLUMBING INC 1865 NW 76 WAY PEMBROKE PINES FL 33024 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. 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. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's Initiatives. Our mission at the Department is: Ucense Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business In Florida, and congratulations on your new licensed DETACH HERE cf�fo- b�b t ' �N SES L1206010086 KRN LAWSON SECRETARY ti r the �3vi aic o ri ap - A. 3xpirati6n 'date: AUG- 3;12014 1ti a ._J.aty �• kk- �,. tz JSAGE Pte. X -N 18 6 5 NN .: 7 6 : PEMBROKE PINES FL 33024 ( x JA. 1 °• / i i y LJ g P ' � ' S, \ A 2 s $ .. 4. iw� S � / •6 'S � .88' s, _ •h x [,'y^��{*•' ,ry�RR�«s b t� �-,J .0 3 I � �f A �i{y� f;M10R Df8PL-A- "AS REQUIRED 'F3Yx-LAW �N SES L1206010086 KRN LAWSON SECRETARY