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PL-14-1935y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-89720 Inspection Number: INSP-219080 Permit Number: PL -9-14-1935 Scheduled Inspection Date: December 30, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: VEJDANI, RAMIN & BETHANEY Work Classification: Repair Job Address: 665 NE 97 Street Miami Shores, FL Phone Number 3051758-9375 Parcel Number 1132060171910 Project: <NONE> Contractor: ATLAS GENERAL CONTRACTOR Phone: (786)346-5711 Building Department Comments REPLACEMENT SINK INSTALLATION (ICE MAKER, NOT Infractio Passed Comments RELOCATION) I INSPECTOR COMMENTS False Passed EZ Inspector Comments Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 29, 2014 For Inspections please call: (305)762-4949 Page 2 of 32 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 C PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING SE 5 2014 FBC 20 c� Master Permit No. Sub Permit No. ❑ REVISION F-1 EXTENSION ❑RENEWAL ❑■ PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 665 NE 97th ST City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: 11 -3206-017-1910 Is the Building Historically Designated: Yes NO NO Occupancy Type: Home Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Bethaney R. Vejdani Phone#:305-582-9917 Address:665 NE 97th ST City. Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Atlas General Contractor Phone#: 786-346-5711 Address: 16266 SW 97 TER City. Miami State: Florida Qualifier Name: Marcel Perez Phone State Certification or Registration #: CFC1427636 Certificate of Competency #: DESIGNER: Architect/Engineer: 33196 786-346-5711 Address: 0 .4City: State i Value of Work for this Permit: $ boo. Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration ❑ New IN Repair/Replace Work: Specify color of color thru tile:. Zip: ❑ Demolition Submittal Fee $ �'O -CD Permit Fee $ } "� CCF $ 0 cc CO/CC $ Scanning Fee $ Radon Fee $ c DBPR $ a5 Notary $ S` Technology Fee $__ Training/Education Fee $ a P-3 Double Fee $ (29 Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ Lhl Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 (7J, 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 OWNER or AGENT The foregoing instrument was acknowledged before me this dayof 20 /�, by who is personally known to me or who has p duced as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument w s acknowledged before me this _.? day of 20, by who is personally known to me or who has produced P(GZ0-540-5+-6 # ^b as identification and who did take an oath. NOTARY PUBLIC: Sign: - Sign:_ Print: �i� . c. / c Print: Seal:,. JORGE R MAILLO Seal: MY COMMISSION # EE122711 EXPIRES August 16, 2015 APPROVED BY �'J l Plans Examiner Structural Review (Revised02/24/2014) JORGE R MAILLO MY COMMISSION # EE122711 EXPIRES August 16, 2015 Zoning Clerk 9/2/2014 Licensing Portal - License Search 6:27:33 AM 9/212014 Data Contained In Search Results Is Current As Of 09/02/2014 06:25 AM. Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Name Certified Plumbing ATLAS GEjjERAL-r,0AjRArJQRS Contractor Cr.`,_ Name License Type Number/ Rant CFC1427636 DBA Cert Plumbing Main Address*: 16266 SW 97 TERRACE MIAMI, FL 33196 Mailing Address*: 16266 S.W. 97 TER MIAMI, FL 33196 Certified General DBA ContractorP_ Main Address*: 16266 SW 97 TERRACE MIAMI, FL 33196 Construction Business AILA Primary Information Main Address*: 16266 SW 97 TER MIAMI, FL 33196 Status/Expires Current, Active 08/31/2016 CGC1519118 Current, Active Cert General 08/31/2016 Business Current Info * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. 1940 North Man= S r _ _t, TaHahas ee t 323 9 :: Ernail: beds carercontact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO emp€oyer. y�# Under Florida taw, email addresses are public records. If you do not want your email address released in response to a public - records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1.395, *Pursuant to Section 455.275(1.), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. rhe emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our ClaUtaL455 page to determine ;f you are affected by this change. AAA eid ` 12-10-2012 JEFF AT"WATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL. SERVICES DIVISION OF WORKS 5` COMPENSATION N * * CERTIFICATE OF ELECTION TO BE EXEMPT PO FLORIDA WORKERS COMPENSATION LAW This certifies that the individual listed below has elected to cw exempt from F1'!' da tAf ;' yrs° Corri lertsatiftft lave. DATE:EFFECTIVE # ? iw iYi BUSINJESS NAME AND ADDRESS: ATLAS GENERAL CONTRACTORS CORP 11626111 Sit 97 TER MIAMI FL 33196 SCOPES OF BUSINESS 01 TRADE: 1- PLUMBING N OC AM ORIVf RS 12- LICENSED GENERALIPUAC 6 WIPWANT. Por3aait to Chapter 440 . 85(14), r.5., to officer of a rofporOnaii, arta .13 "1" ers pt+oe from ibis ^atxtor py .."ag a .eniticafa of election Widertkis sectifna any oaf feco sr #raoetitte at un#et ibis =;ha}yier, eurruant to chlow ac" 3s&t , F>5., tel-Vfica"r1 Eif ea,e rXotficf< ,apply 4oly within the scope of the bosiaess Of trade fisiad an the notice of ofediea to dxe exempt. Persatent to bheptar 440,0501, z.5., kalies fid ; irietior to he aneaapt "4 cattfficettes of election is he exempt %belt be sabiret to reivoaetioa if, at nay time attar the kitiog of the rotaee ar 144 issuance of the rami!"true, fqe pitied maned oa the mice or eartitlaate as lis"of fneets the reieitemosta of this section, ter i%aiieface of s cnrfiticato. The amatiftemit uiaK re -oke I €erf;ffsaie ss any t€ear for failure i1 me person a " "a certificate to meet the ragearaoants of this &action_ lI1fEST1OStS7 I51 413'160 DDC-252 CERTIFICATE OF ELECTION TO RE EXEMPT PT REViSEO 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAINFCD? FUTURE REFERENCE STAiE OF FLORIDAIMPORTANT ---- ff�TAIdT MERIT F fAt ICES OFKERS Ctr Por Chaote,, I � Oil',, i is Euv 'ERUCTION ISS` RY O ant to ,3 , ar o€fecer of a corpor on whot , � etects e�errtptta,t srn osis "" ter by filing a certificate of electionCERTIFICATE OF fEk. i Til tEtP'TFROMFLORIDA L nder this Section iia }roof r. over oenefitS or comp nation underthis �KE:Ft'a' C NSATK i LAW i Ater. EFFECTIVE: 12/10/2012 EXPIRATION DATE: '12/10/2014aur;t nt to Chapter' <�C� i 1d 11l�,. --S- '.ertificates of election to be PERSON: MARCEL PEREZ H eAefnpi— apply only witato the scow of the business or trade lister! on FEIN 2707404 E t"e novice of eseCtmn to be - refrot. BUSINESS LANAE AND ADMES& E Pursuam -to Cra %ter i4u )hOAIK ��S- Notices of election to i ATLAS GEWPAL CONTRAVORS veOAP and certificates of election P. je t. ,.irrno %*1 be subject to revocation °6266 SW 97 TER � tf, at any bi-te aft,;' th4 'd . q i# fl'.ar notice or the issuance of tha MlAW, Ft 33155 i` fic ta, ehe Aet.x o riatnet f t`€e !€O%tce or certificate no lo"is t t: requirements o' `his ,ec`.,;; for ssuafce of a certificate The �,-rt,rfent $hful reg*e a ce-ificare at any time for faiture of ttse SCONE OF BUSINESS C TRAOEU oersoft named on tt certificate to 'meet the requirements of this I- PLLdMBAIs NOC AND DRIVERS 2- ':!CERSED cWNERAt..�.�:ft3�ii.��;g;�t?- QJESTIS� d135l 41-ISCt WT VERE Carry bottom a portion e s xi 5t!is logo mail" Miami shores V Building Department �OR1Dp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers$ 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 L 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, ou maybe personallyliable for the worker com ensation injuries of an 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. Print Name: Print Name. aY Signature-='�--". ' f x < c 0 z 3 Signature:riami-Dade) 3'z3mState of FloridajET County of Miami-Dade) g„ ff: vmT m9 oun y o Sworn to and subscribed before me this ® C ”. c – Sworn to and subscribed before me this 0 -4 N T day of 201q, N m day of 20 /�. By ' � W $y,' 7 ® y� ' 'RIRES Se ; • r , 11, 2016 (SEAL) it l 6�L1 (SE AF:;t ate.. r t . Type of Identscation produced - 4-- ,� u T e of Identification produced L P 60,)_0 -'540—tf A� '� CERTIFICATE OF LIABILITY INSURANCE DATE 1"YYY' 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. IMPORTANT: ff the certificate holder is an ADDtTtONAL INSURED, the poiicy(ies) must be endorsed If SUBROGATRaN IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statemevd on this certificate does not confer rfgMs to the certificate holder in lieu of such endorsement(s). PRODUCER _--- _ -- CONTACT NAME: Best Quality Insurance Group Lic PHONE FAX Mto..tFxt) (305)597-7787_ Im, Nor (305)691-6477 8181 N.W. 36nd Street, Suite #1010_ 6esodua�►tY!!±surance�9ru_com Doral, FL 33166 INSURER(S) AFFORDING COVERAGE NAIL S Phone (305)597-7787 — _ Fax (305)597-6477INSURER A : UNITED STATED LIABILITY INSURANCE COMPANY ............ INSURED INSURER 8: _. Atlas General Contractor Corp INSURER C : 16266 SW 97 Ter INSURER D.; MIAMI, FL 33196- (786) 587-2235 wsuREit tt : _. __.. INSURER F: — _ - COVERAGES _ CERTIFICATE NUMBER: _ _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABOVE FOR THE PCXICY PERIOD I INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 REDUCEDBY PAID CLAIMS. INSR ADDL WBR - _ _TYPE OF INSURANCE POLICY EFF ppppLLICCY EXP ,IK�.WVD;__ POLiCYNUMBER_— MM/DD/YYY11;(MAtIDWYYY1J/ ; ,- LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 _ © COMMERCIAL GENERAL LulelLm ATO Wiz. ..-. $ 100,000.00 A 11 CLANS-MADEEl © OCCUR CL -1642547 MSO EXP (My me Person)$ 5,000.00❑ 03/07/2014 03/07/2015 - - _ Pff=! AL S ADV INJURY S 100,000.00 i GENERAL AGGREGATE $ 1,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: PROD=$ - COMP/OP AM $ 1,004.000.00 ❑ POLICY ❑ JEOT Loc $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ❑ - ANYAUTO BODILY K)URY (Per perem) $ ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS BODILY INJURY (Per ecddent) S ❑ HIREDAUTOS ❑ "ONIAUTOS NED PROPER $ ❑ ❑ (Per a l $ - UMBRELLA LIAR ❑OCCUR — , - EACH OCCURREDICE $ - - ❑ EXCESS UAB ❑ CLAIMS MADE AGGREGATE :. ❑ DED CJ_ RETENTION$ - - -. WORKERS COMPENSATION WC STATU- OTI-I.' AND EMPLOYERS' LIABILITY YIN ❑ TORY LIMITS ❑ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A - _ (Mandatory ew in NH) describe andel E.L.DISEASE - EA EMPLOYEE S I "�`. ._. - - -- -'. DESCRIPTION OF OPERATIONS bekya EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addllonal Remarks Schedule, S more space is rwpdmM PLUMBING CONTRACTOR LIC# CFC1427636 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG. DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED RE. 4WSENTATNE ` 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACOR9 name and logo are registered marks of ACORD