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PL-14-1613Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226069 Permit Number: PL -7-14-1613 Scheduled Inspection Date: January 14, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: HESKIEL, RAOUL Work Classification: New Job Address: 9405 NE 9 Avenue Miami Shores, FL Project: <NONE> Phone Number Parcel Number 1132060010030 Contractor: TEMPERATURE SYSTEMS INC Phone: (954)370-7436 Building Department Comments INSTALL NEW BATH AS PER PLAN, REPLACE EXISTING BATH FIXTURES + KITCHEN SINK, Tank less EXISTING INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-216585. kitchen and lav Ef connection not to code GK Failed Correction L( Needed ❑ ,�-�- Re-inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 13, 2015 For Inspections please call: (305)762-4949 Page 15 of 28 Miami Shores Village r-,�,,� Building Department JUL. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 B INSPECTION LiNE PHONE NUMBER: (305) 762-4949 FBC 201 2 BUILDING Master Permit No. _ ! , PERMI APPLICATION Sub Permit NoM— ❑BU ING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � �-{� Clp CONTRACTOR DRAWINGS !OB ADDRESS: �. J V hY V City: Miami Shores County: Miami Dade Zig): Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple FFE: Address:— City: -Lj N d,r � i .�'� tz-C State: CL zip: s� h9cl Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: City: DM t � State: t 1 M Zip: Qualifier Name: Phone#: State Certification or Registration #: (. t"� Jr' Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ o O C7 Spuare/Unear Footage of Work: Q5 Type of Work: ❑ Addition ❑ Alterationh f ❑ New F-1 Repair/Replace 1:1 Demolition Description of Work: 4htASI 0"t �k�� S 96-r �)Ptjy l 'Rdlk--� F.-Ixslyittd N�4k � Illw`tr S �i. L -i4 cL &Art r-"-iS)s4,0Lq Specify color of color thru tile: Submittal Fee $E20 -(b Permit Fee $ ' "5N CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $, Training/Eduation Fee $ Structural Reviews $ _ (Revisedo2/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ t'l ) ark. Bonding Company's Name (if applicable) Bonding Company's Address Ctty State Zip 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 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 iss d. in the absence of such posted notice, the Inspection will not be approved and reinspection fee will be charged. Signature Signature WNER or AGENT CONTRACTO The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of '~ubi 020 , by �_ day oofe S .20 by ' C` o is personally known to S�J� ` '°`'�r� who is personally known to p Y (''� pe Y me or who has produced � as me or who has produced 0 L. as identification and who did ke an oath. identification and who did take an oath. ek,a�►1N11 `IIHI/�� NOTARY P C: �� Ap/, NOTARY PUBLIC:��Nulli►ur1rro�I�/// .� . <` Sign: % < " Sign: _ Print _— w' �: ��% % Print: = C. '• Seal: '�.°�' ...., Seal: \�.� P Nip ############################################################################################################ APPROVED BY �'�'!� Plans Examiner Zoning Structural Review Clerk (ReOwd02/24/2014) F 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA:ei t#;182-1618 Business Name: TEMPERATURE SYSTEMS INC ING/LWN SPRNKL/( • Business yp@:(pLUMBING CONTRACTOR) Owner Name: PAUL GREENBERG SCOTT Business Opened:0 6 / 0 3 / 2 0 0 8 Business Location: 13110 SW 8 ST 4tate/County/Cert/Reg:CFC1427652 Business Phone: DAVIE Exemption Code: Rooms Asea a Ines _ Professionals Numt�er of Machine• i or Yendtng justness _?n F . _ THIS RECEIPT MUST Be POSTED CONSPICUOUSL* 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: PAUL GREENBERG SCOTT 13110 SW 8 ST DAVIE, FL 33325 Receipt #13B-13-00000338 Paid 10/10/2013 29.70 }E trH�3~3r� , t i ' :T. :e + 0. VWME .3' t. .l�.i' /•" ' ,� � 'C fir" f- p �ry�.i? y �!�� }�� +�1 � �, /t`*s ib l ` II�DD��$ - � - �E��i�� AS`1��:�3Uf� B'i� iJ7�r:X-• Tax Amount Transfer Fee SF e' Fears Collection Cost Total Paid 27.00 0.005 0.00 29.70 Nay THIS RECEIPT MUST Be POSTED CONSPICUOUSL* 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: PAUL GREENBERG SCOTT 13110 SW 8 ST DAVIE, FL 33325 Receipt #13B-13-00000338 Paid 10/10/2013 29.70 }E trH�3~3r� , t i ' :T. :e + 0. VWME .3' t. .l�.i' /•" ' ,� � 'C fir" f- p �ry�.i? y �!�� }�� +�1 � �, /t`*s ib l ` II�DD��$ - � - �E��i�� AS`1��:�3Uf� B'i� iJ7�r:X-• 6 Adh J11" ArfAVATIOt qw CHWF FKAfAft0FFWM STATE OF FLORIDA DEPARTMENT OF FINANCIAL SEIM= DIVISION OF WORKERS! IWIWN CERTIFICATE OF ELECTION TO ISE EXEMPT FROM FLORIDA VJORIMW COMPENSATION LAW CCINSTRUCTION WOUBTRY E ' I WTU)N t This m m 0 m i *d the hOvkW bled bob* Ism **W tD be WmVW f(CM F*ft Vftd*W Compmellon low. EFFECTWEDATEt- 111V=3 EXPIRATION DATE- 11,M)2015 PERSON:. GREENBERG SCOTT p FEIN: 6500MM BUSINEW NAM AND ADDRESS: ERATURE. SYSTEMS INC 13110 SW 8TM ST DAVIE Ft. SCOPES OF BUSINESS OR TRADE* UCENSEI) FUMING HEATING, V84MATION. CONTRACTOR AIR-COMO pumm" to 4ftW"L M an dker twnww � -boa ON :==ll*ClwpW*WWUF-8,CWWcftscf U ftbeeNeMpt-o"" offtO, lisdt s fold on h netloe MNe ON 6=08PL PWS=ld ID ChIPW 44040M M, Naftes of 110 RNA ftbal I qpad oeralasms of stsottoq lobe womo "bo a*dio mmooftw. id my*mager ft am of the noUcmGrfie kwmK=of#w fie, adftanotar rmeoilfrs wo"meoft offt"com for baw4a aft falftoW 7M 0 pal i IdWtaeaaweetwvftvjwftft*§jft pe a- Hated on fte ol 'I too"" M**=Wo offits awn. 0F8*260VVC-,W CEWWATE OF PLEMCK TO BE DOW" REVOW 07-12 QUEff74Oft7 (836)413.IM CERTIFICATE OF LIABILITY INSURANCE I '1DA 4 AP2n A YYYY' 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the PRODUCER 313 Insurance Marketing Inc 10167 W Sunrise Blvd, 3rd Floor 31antation FL 33322 TEMPE-1 Temperature Systems Inc INSURER C: 13110 SW 8th St INSURER D: Davie FL 33325 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1014279936 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCECY NUM POLICY EFF CY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALuABILRY CLAIMS -MADE 1^ 1 OCCUR rMM44A 21114=14 14/2015 wnwIES EACHOCCURRENCE $1,009,000 D $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: poIJCY PRQ LOC PRODUCTS - COMPIOP AGG $1,000,000 $ AUTOMOBILE LU181LnY ANY AUTO ED ASCHHE�WLED �� NON -OWNED HIREDAUTOS AUTOS SINULETIMT— WMBINED Eat aoeident BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PROPE DAMAGE $ UMBREL A LUU3 EXCESS LLAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABIM YIN ANY PROPRIETOR/PAR� OFFICERAIEMBER EXCLUDED9 (Mandatory In NH) If yyesdescribe under DESCRIPTION ERATIONS below NIA I STA - I OTH- E.LEACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atlaeh ACORD 101, AddiUoral Remarks Schedule, If more spates Is required) Plumbing and HVAC Contractor. Miami Shores Village 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 _ . 6 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 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: CVL/7Gr% ''- �/ ql Signature: gzz— State of Florida ) County of Miami -Dade) Sworn to and subscribed before me this I i i r r rr,l day of c�l� , 20 l` By r / ••� (SEAL) _ Co � 0,e /!�� • As , Tvpe of Identification produced /0,. .......... •_ Fl 0 R "111111 11110 Contractor Print Name:` Signature: ��z State of Florida ) County of Miami -Dade ) { Sworn to and subscribed before me this day of e� VL.`�A 201-1By _ ^ G (SEAL) of Identification A _ %Z R10 A '��//IdllllllH