DEMO-15-5280 _ 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231580 Permit Number: DEMO -3-15-528
Scheduled Inspection Date: April 07, 2015 Permit Type: Demolition
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: CONTESSA, MICHELE Work Classification: Plumbing
Job Address: 9220 NE 2 Avenue
Miami Shores, FL Phone Number (305)761-5243
Parcel Number 1132060133060
Project: <NONE>
Contractor: ARNIELLA CONTRACTORS CORP Phone: (786)597-8621
Department Comments
REMOVE PLUMBING FIXTURES AND CAP EXISTING inrracuv rassea comments
PLUMBING 1 BATHROOM AND KITCHEN INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-229892. not ready cap all open
ends
Felled
Correction 0 e, �V
Needed
l
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
April 06, 2015 For Inspections please call: (305)762-4949 Page 39 of 63
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: (30S) 762-4949
MAR 112015
�BY'-
FBC 20VD
BUILDING Master Permit No. PE/4o • Z - 15 3'JI
PERMIT APPLICATION Sub Permit NoVom®I576!5
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
[�apLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
j CONTRACTOR DRAWINGS
JOB ADDRESS: �a N �� A:2g .
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: _
OWNER: Name (Fee Simple Titleholder): �A e k ie _ Q: �4 Phone#:
Address: O;E 'vs- d Ana _mit
City: IA1AA wM State: V 1—_ QA Y-71 /A Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: . ,,✓l ��l(4 CV/ 7_h,4CS'6W , CA!/ p Phone#: �rw -S 9 " rgll
Address:�`��
City: on Statq: C� Zip: 1
Quali
State Certification or Registration #: Certificate of Competency #:
DESIGNEAi Arch)tect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for _this -Permit: $ O.00 Square/Linear Footage of Work:
Type of Work: ❑ 'Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
'Description of .Work. int M y `x �C \ kA
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $ _
J
CCF $ CO/CC $
Training/Education Fee $
DBPR $
Notary
$
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 4 • Co
re -n 1'e l ��
l �� C �® �,
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 comm cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. 1 e absence of such posted notice, the
inspection will no�appro�ed%and a reinspection fee will be charged.
YYF �°
F L CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�1 day of M BIZ.. 20 , by / / day of 4 A -&C4 .20 j� 657- by
On'�5A, who is personally known to 406AN ^X D 4UtC'/�l4who is personallylaiawn to
me or who has produced UCC N !�Eas me or who has produced FG • Q L •
identification and who did take an oath. identification and who did take an oath. a: ��pme► is
NOTARY PUBLIC: NOTARY PUBLIC:
• 9FF 1 •
Sign: Sign: 1 �/• ••.. .•• \�\�
Print: Print: Z /u �6 Q. VJ/`r er
Seal: c40P& Notary Public State of Florida Seal:
a Sindia Alvarez
X4My Commission FF 156750
d Epinal 0910312018
APPROVED BY 3 .` 1—r; Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
-
Notice to Owner - Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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 and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only erson allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers come ation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SI 'NIN LOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this f day of , 20 (�
ByM 10
,+Ai_L& N who is personally known to me or has produced
=L-- �z(e_ � as identification.
Notary:
SEAL: Fey Notary Publ� 3+?te of Florida
Shidia Aware=
My COMMi ry . : r 158780
Expirps ,y " ,
lix—
"O"` ` CERTIFICATE OF LIABILITY INSURANCE
DATE03/1.13/1.1D/YYYY) —
TYPE OF INSURANCE
0 f15
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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to i
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Hades Insurance Corp.
210 SW 107th Avenue
Miami, FL 33174
Phone 305)552-0038 Fax 305)221-3810
CNEACT Blanca L LaceyO
No. , (305)552-0038 _ c No : 1305)552-0701 T_
' D L hadasins@sttnet
INSURERS AFFORDING COVERAGE NAZCA
INSURER A: GRANADA INSURANCE COMPANY 09730
INSURED
INSURERS:
NSORERC:
Arnieila, Contractors Corp (11339)
INSURER D :
5671 SW 129 PI
INSURER E :
MIAMI, FL 33183 (786) 597-8621
PERSONAL&ADV INJURY $ 1,000,000.00 I
❑
INSURER F:
L-Vvctwuea CERTIFICATE NUMBER: REVISION NUMBER:
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.
ILTR
TYPE OF INSURANCE
ADD
UBR
POLICY NUMBER
POLI E F
M D
POLICY EXP
MM/D
LIMITS
A
GENERAL LIABILITY
U COMMERCIAL GENERAL LIABILITY
❑ D CLAIMS -MADE Q OCCUR
F]Y
0184FL00031991
01/06/2015
01/06/2016
EACH OCCURRENCE $ 1,000,000.00
O AGE TO RENTED 100 OOO.00
PREAffiggS Me occurrence $ —
MED EXP An am person) $ 5,000.00 II
PERSONAL&ADV INJURY $ 1,000,000.00 I
❑
GEN ERALAGGREGATE $ 2,000,000.00
GEt?L AGGREGATE LIMIT APPLIES PER.
❑ POLICY ❑ M ❑ LOC
PRODUCTS - COMPIOP AGG $ 1,000,000.00
--i
$
AUTOMOBILE LIABILITYE
❑ ANY AUTO
❑ AUTOS ED ❑ SCHEDULED
AUT ED
❑ HIRED AUTOS ❑g
El
❑ UMBRELLA LIAB ❑ OCCUR
❑7.
EXCESS LIAR ❑ CLAIMS -MADE
MMcB IN D , antSINGLE LIMB
_
BODILY INJURY (Per person) $
BODILY INJURY (Per strident $
ROPFJ2dY AMAGE $ �—
EACH OCCURRENCE $
AGGREGATE $
❑ DEO ❑ RETENTION$
_
$ W
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTNE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) D
If yes deemlbe under
DESCRIPTION OF OPERATIONS below
N I A
❑ WC STATU- ❑ OTH-
Tt)RY LIMITS
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYER $
E.L. DISEASE -POLICY LIMIT $
1
LnztK;KIPT1VW OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
PLUMBER CONTRACTOR
CFC 1428118
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORE VILLAGE
10050 NE 2ND AVE
MIAMI SHORES FL 33138
LICENSES NUMBER
CFC1428118
ACORD 25 (2010/06) QF
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
BLANCA L LACAYO
®1988-2010 ACORD CORPORATION. All rights reserved:
The ACORD name and logo are registered marks of ACORD
Report Viewer
dR a I W d=/ 1 A H I locale .
JEFF ATWATER
CHIEF FINANCIAL OFFICER
p,
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF 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: 2/6/2015 EXPIRATION DATE: 2/5/2017
PERSON: ARNIELLA BERNARDO
FEIN: 205784017
BUSINESS NAME AND ADDRESS:
ARNIELLA CONTRACTORS CORP
5671 SW 128 PL
MIAMI FL 33183
SCOPES OF BUSINESS OR TRADE:
LICENSED BUILDING LICENSED PLUMBING
CONTRACTOR CONTRACTOR
F.S., an officer of a
remotion under this
exempt end certlff es of election to be exempt shsg be subject to
the person named on the notice or cerbflcete no longer meets the n
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13
8grg a cerMcete of election under this section
ates of elecdon to be exempt.. 000ly only
QUESTIONS? (850)413-1809
Page 1 of 1
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION,,dNDUSTRY LICENSING BOARD _
The ILUMBING OONTRACTOR" ;
INa% d�beiow_ IS CERTIFIC r.
`_U dgr jhe. prov'tsfions .of Chapter 489T"S. -
€?cptr�tion-die:
y - x M-L-a-4�RRR VARDO t
�1#l�
A2QN2�4C
' .� ems" .a �s . � _. ._ "� v �,�^ .. ,.� x_. _. , __ .�, •�,.
ISSUED: 07/31/2014
DISPLAY AS REQUIRED BY LAW
■
SEQ # L1407310001735
u
ARN I ELLA CONTRACTOR.
5671 SW 129th PL, Miami, Florida. 33183
arniellacontractor a-yahoo.com
Ph: (786) 597 8621
State of Florida
County of Dade; Miami shores Village Building Department
Before me this day personally 03/12/2015 who, being duly sworn, deposes and says :
Me Bernardo Arniella is the only person working under this permit
Swornto (or affirmed) and subscribed before this _qday of,20%by
Qrs:o: jy�kno
OR Produced Identifications
or stamp Name of Notary
��z,110 -37S7 ;24-