PL-14-16170
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216613 Permit Number: PL -7-14-1617
Scheduled Inspection Date: November 06, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: , KALYANI VENTURES, LLC Work Classification: Addition/Alteration
Job Address: 30 NW 92 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1131010170210
Project: <NONE>
Contractor: DPAUL PLUMBING INC Phone: (305)332-1402
Building Department Comments
INSTALL NEW BATH TUB, SINK AND TOILET Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed El/
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 05, 2014 For Inspections please call: (305)762-4949 Page 6 of 35
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
JUL 2 5 2014
FBC 20 fD
BUILDING Master Permit No.,&
PERMIT APPLICATION Sub Permit No.
-Pz
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS:
DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE�'
OWNER: Name (Fee Simple Titleholder): r 7z7946 Phone#:or a `90
Address::, I ®o
4
City: % State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: / 6 _,- ,
Add
City
Qua
State Certification or Registration M ej!�C / Certificate of Competency M
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $ rev. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $�' Permit Fee $ ' y CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
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 posted at the job site
for the first inspection which occurs seven (7) days after the building permit is i ed. in a absence of such�osted notice, the
inspection will not be approved and a reinspection fee will be charged. ,
IL;Signature W 4"lam
OWNER or AGENT
The foregoing instru ent was acknowledged before me this
day a- illo 20 , by
f) pg/'t�'7�Gvho is personally known to
me or who has produced�� ��
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 �J by
.��In u-1 /�,�whho is personally known to
me or who has produced ".
identification and who did take an oath.
NOTARY PUBLIC:
Notary Public State of MOMS
408nna M Feliciano
My Commission FF 082753
Expires 0 111 2120 1 8 _ y a
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Ate` :: iii14
Tm ciumcA-m is issuitt , iio6ukim ONLY AND COMERS..NO S UPON
THE A H LDEf
€� CAIV DOM NOT $�( AfFM AT y �Q#.3yY OR E �p9 ELY AMEND, �y�EXTEyAp6D OR ALTER g� o THE
' 13Sq;yAF M;• E �l THE
gap
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305-692-9212 306-6924233 F'A �T :t
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GRANADA INSURANCE COWAW.. _
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1710 NE 139
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MIAM33481THIS IS TO CERT!" THAT T31 POLIOWS OF HAVE SEEN ZS UFD TO THE SURD NAkEC) Aim FOR THE POLICY PER.109
INDICATED. NOTW THS'T.A X ANY' PSOUREMEW, TERM OR CfSMITION OF AMY CONTRACT OR OTHER DOCUMEW WITH REWE£T TO Slid c" THIS
Owty TE MAY:.BE ISSUED? I OR MAY PERTAK TRAWE AFFORDED . R THE POLIGWS DESGIBED HEREIN IS Si BJECT TO ALL THE TEPA <
h GLUSMS i IWiTIt� OF SUCH POU Se LIMITS ZKOM MAY HAVE 9FEN REDUCED BY PAID CLAWS.
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PLUMBING COMACTOR CFC-14 #1428259
.CtRTIFICATE HOLDER
.. CANCEW:LTM
WAMj SHORES VILLAGE BUILD DEPT
IW f100502NDAVE. SHOULD Ta L rA A NCELLED H r
MIAM1,15 ORES FL 3313 :
FAX 105-756-48672 AtrMO ai ATWL
W KENNEDY
0 3 ACO . All rigIft asome&
A,COREY M d 9p Tho ACQJW rwame and s are rogistefed marks o3 ACORD
Report Viewer
MIAMI FL 33181
SCOPES OF BUSINESS OR TRADE:
PLUMBING NOC AND
DRIVERS
Page 1 of 1
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JEFF A,WAIER
s_yM„r`
CHIEF FINANCIAL CFFIM
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
•' CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENS�TION
LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has
elected to be exempt from Florida Workers' Compensation)
law.
EFFECTIVE DATE: 5/29!2013
EXPIRATION DATE: 5292015
PERSON: PAUL
DECINOS
FEIN: 272606776
BUSINESS NAME AND ADDRESS:
DPAUL PLUMBING INC
1710 NE 139 ST
MIAMI FL 33181
SCOPES OF BUSINESS OR TRADE:
PLUMBING NOC AND
DRIVERS
Page 1 of 1
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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
personally liable for the worker compensation iniuries of any 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.
�1 Owner Contr ctor
Print Name: `,
/V® 6 /t- Print Name:
Signature: Signa. ,
mcc z
-H
State of Florida) 3 d State of Florida
County of Miami -Dade) 3 g County of Miami -Dade)
dayto d scribed befor2eo �s �„ g Sworn to subscribed before m
Y a / o 9 day of , 20
By_ffa— 6) 5. <, is a B
(SE)L) (SEAL)(�
T e of entification produced Type of Identification produced