PL-15-894Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-233605 Permit Number: PL -4-15-894
Scheduled Inspection Date: April 30, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MAINADE, FRANK & KELARA Work Classification: Gas
Job Address: 925 NE 92 Street
Miami Shores, FL 33138 -
Project: <NONE>
Phone Number
Parcel Number 1132060060070
Contractor: UNIVERSAL PLUMBING CORP Phone: (305)887-3131
Building Department Comments
GAS Infractio Passed Comments
INSPECTOR COMMENTS False
April 29, 2015 For Inspections please call: (305)762-4949 Page 23 of 29
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
April 29, 2015 For Inspections please call: (305)762-4949 Page 23 of 29
0
e
Energy Multiservices, Corp.
7880 W 20 Ave. unit 42, Hialeah. FL 33016
Phone: (305) 362-2863 Facsimile: (305) 362-2864 Emergency Phone: (305) 796-2270
GAS DROP TEST
NAME:tt.�t��
ADDRESS: 9 2,�- Wr q 2, A
Mtr4"s Skbce-s• p=c- 32,12-73
Start Time: - cc
Starting Pressure: 43.0
Ending Pressure:
TEST DETAILS:
DATE:
End Time: 0
State License Number: 28607
Qualifier: Jimmy A. Calderon
Technician: ovVM C4,t O/-::
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
APR 16 2015
FBC 20
Master Permit No.
Sub Permit No. s—'
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING F-]MECHANICAL❑PUBLIC WORKS [:]CHANGE OF E] CANCELLATION [:]SHOP
i¢5 (-`PG , CONTRACTOR DRAWINGS
\ JOB ADDRESS:
_�:E:7 C(
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:
City
(Fee Simple Titleholder): Phone#:
Tenant/Lessee Name:
Email:
CONTRACTOR: Compan Name:���-� hone#:��61lP
Address:
City: �Yl Gq W State: f ��d>i/� �� Zip: 3� ® (
Qualifier Name-'/e&`��e/ Phone#: -_1�0.5 eSa GI(3all
State Certification or Registration #: L,-7!-6 �Z�a.2 W2 / Certificate of Competency #:
DESIGNER: Architect/Engineer:
one#:
Address: City: State: Zip:
Value of Work for this Permit: $ T430 = ® Square/Linear Foota of Work:
Type of Work: ❑ Addition ❑ Alteration I ew Repair/Replace Demolition
Description of Work: 4!ZAC�&, Oe
Specify color of color thru tile:
Submittal Fee $ Permit Fee $. /56, ;Z,*c CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $
3�s
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
E.
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
*rspeelQn wpl not be approved and a reinspection fee will be charged.
OWNER or AGENT
e" toregoing instrument w s acknowledged before me this
day of x e , 20 /S , by
®"Y o JA do—, who is personally known to
me or who has produced as
identification and who did take an oath.
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
-� day of ��/� ��,/ 20 45 , by
�Pe
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Print:
Seal:
Plans Examiner
Structural Review
Zoning
Clerk
;t�d��•y�OatN .•����
APPROVED BY
(Revised02/24/2014)
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
-� day of ��/� ��,/ 20 45 , by
�Pe
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Print:
Seal:
Plans Examiner
Structural Review
Zoning
Clerk
New Construction
Remodeling and Repair
Licensed & Insured
State certified plumbing contractor
Back Flow Preventer certification
Medical Gas Certification
PLUMBING & MECHANICAL
CFC -1428421 CMC -1250146
RESIDENTIAL ® COMMERCIAL® INDUSTRIAL
Tel 305-824-3131 Fax 305-824-3134 universalpms@gmail.com
Date: 0411512015
State of Florida
County of Miami
Before me this day personally appeared Michel Garcia, President of Universal Plumbing Corp
who ming duly sworn, deposes and says: That the only person working on the
Project Locates at: 925 NE 92 ST MIAMI 33137, is to Fran Mainale.
Print Name rd'a - --- -- ----- -
STATE OF FLORIDA COUNTY OF Clerk'
Sworn to and subsmibl Ped before me this dayoDE 20L,5
by
!��t
Personally known or I.D. (SEAL)
LOURDES MARIN
MY COMMISSION #FF009167
EXPIRES April 17, 2017
398-0153
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
777771
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 person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance co rage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BEL W YO AC OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
State of Florida
County of Miami -Dade s
� N
The foregoing was acknowledge before me this day of41?•) L , 20 1
By ,¢'� ► Iy who is personally known to me or has produced LU
c✓1G���"}��� as identification x
Notary: �CTr
rotes+' 1? ELLIOTSDM
SEAL: