PL-14-1250Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-214177
Scheduled Inspection Date: November 06, 2014
Inspector: Diaz, Osvaldo
Owner: CLEEK, RONALD
Job Address: 882 NE 97 Street
Miami Shores, FL
Project:
Contractor:
<NONE>
CASTELLON PLUMBING CORP
sunaing uepartment comments
REPLACE FIXTURES AS PER PLANS
Permit Number: PL -6-14-1250
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction l
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
1132060142700
Phone: 305-553-1490
November 05, 2014 For Inspections please call: (305)762-4949 Page 4 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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
JUN 18 2014
FBC /2,010
Master Permit No.A(l_ /`7 /
Sub Permit No.�l " /,z<_r'j^
❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: e a (VAE
Folio/Parcel#: - ! 3Q 0 1 'y ) 76 I Is the Building Historically Designated: Yes NO K'
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder))
Arlrlracc• 5�- 1 im,Q Aj f"
Construction Type: Flood Zone:
rJA N4CA i5,Q%11 C kif
4—
BFE: FFE:
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City: j% A t SA 6 R&__S'State: ''l zip:ZR 3
Tenant/Lessee Name: fkj 6 Phone#:
Email:
CONTRACTOR: Company Name: /_/
Phone#:
Address
City: y /w%ioState: ��% Zip:
Qualifier Name:
State Certification or Registration #: eCz 01-74,51-49 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of Work for this Permit: $ ' 0 0 Square/Linear Footage of Work:
Type of Work:. ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Zip:
❑ Demolition
-JITYe -
Specify color of color thru tile:
Submittal Fee $_
Scanning Fee $ _
Technology Fee $_
Structural Reviews
(Revised02/24/2014)
Permit Fee $ L25 +^•7 CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Training/Education Fee $
Double Fee $
Bond $ n
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage L'ender'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 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature4Tv . ri
�IL�/><I4�•T1TC1����
Theforegoinginstrument was acknowledged before me this
day of M 4>f -T' , 20 , by
who is personally known to
me or who has produced— 1 as
identification and who did take an oath.
NOTARY PUBLIC:
Sien:
Print:
1
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
C;�'l day of 20 % . by
(Gi 2441» QftR9-Lv�-rJ, who is personally known to {�
me or who has produced ylo0J A as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: Seal: &0 Rug
BFATRIZ A. BURMS
/�����►►n►nim��`���` * * W11MMISSION111152014
EXPIRES: April 7, 2015
N'grF oc�°` Bonded Thm Wig Nplery 60to
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReAsed02/24/2014)
Flal�bll
5'�';aOc.RES
all DO"
�tORID�
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, youmaybe
personally liable for the worker cMensation injuries 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.
Owner/
Print Name: no./u/j A/ Cl'
Signature: a::!:�
7-3
State of Florida )
County of Miami -Dade )
Sworn to Vnd subscribed before me this
day of �_ , 20 / IJ
By
d NOWY Public State of Pla ida
Contractor
Print Name: G'.*R,t 71&144 6 n!
Signature:
State of Florida )
County of Miami -Dade) n
Sworn t d subscribed before me/
day of , 20
0
Of