The URL can be used to link to this page

DEMO-15-753 'Z)wa� Inspection Worksheet Miami Shores Village 6 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-231498 Permit Number: DEMO-4-15-753 Inspection Date: July 30, 2015 Permit Type: Demolition Inspector: Diaz, Osvaldo Inspection Type: Final Owner: TAVARES, TIERES Work Classification: Plumbing Job Address: 10050 NE 12 Avenue Miami Shores, FL Phone Number (305)244-2356 Parcel Number 1132050190370 Project: <NONE> Contractor: MILLENNIUM PLUMBING LLC Phone: (561)674-7727 Building Department Comments CAP ALL WATER AND DRAIN FOR PROTECTION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments PassedE:4/ P-;-' Failed r\L Correction ❑ Needed � 3d Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 July 29, 2015 Page 1 of 1 Miami Shores Village Building Department APR 0 H 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 -=_ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. 1X—TA0- PERMIT APPLICATION Sub Permit NO.LFT\.Q ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP f CONTRACTOR DRAWINGS JOB ADDRESS: /00,5-T) /(7 t" 12- AU City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: 1./ .3 2 K),,�- - 193 j^0 Is the Building Historically Designated:Yes NO Occupancy Type:�L Load: Construction Type: Flood Zone: BFE: FFE: �2J-)AIFP '//v/Y OWNER:Name(Fee Simple Titleholder): ,(), /ON 17 41 r-- is 4PUS/Phone#: Address: 16C / All 6 /2 6A A ' City: /I�1 i State: G. Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 4j / /I r-d/ q/ 1 c) Phone#: Address: / City: r��t'i1 State: A-G Zip: Qualifier Name:l 1�f1`,1/� C r ,s Phone#: State Certification or Registration#: G z Z .`j 3 3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ETIDemolition Description of Work: -Z ezz �22 `�R,/ 1 4 1 la2 Q f?r7o�C--'/4�LJ _ Specify color of color thru tile: rr � Submittal Fee$s" ) y�� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ S9 an (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature " , _� Signat !�11 �✓%c OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Q� day of 2(L 20 (� by �day of A44Eh r. 4A 20¢) f L_,by tAAl yo L .(Ir o��,wh1o�i-s-personally known to fit'=F� c/ Si// fes.who is personally known to me or who has produced F(.� �►CQ- UM�as me or who has produced as identification and who did take an oath. identification and who did I ,.•Nt"1w SILVAIR DACUNHA NOTARY PUBLIC: NOTARY PUBLIC: ;.••�"•:'.. Commission#►FF 170061 >: '• �= MY Commission Expires ''•� �A� October 20, 2018 'y ani NI14NN� Sign: Sign: i 4 _ Print: Print:11#61CC4 Seal: , Seal: �� 7 /A/ dee. Notary Public State of Florida `(�. Sindia Alvarez My Commission FF 156750 pr i< Expires 09/03/2018 / S APPROVED BY Plans Examiner Zoning 3 Structural Review Clerk (Revised02/24/2014) gt1ORE' ♦� 9aa n Eggs .....l" Miami Shores Village Building Department RNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. /COPY OF QUALIFIER'S STATE LICENCES B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE' D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: MIL- LC N 411 U M T BUSINESS ADDRESS: /C 7q CITY CfR F/C-L STATE-0,ZIP BUSINESS PHONE: � FAX NUMBER(� CELL PHONE ZIP /C `Y' QUALIFIER'S NAME: JI–C—F F R C .`_�i VAl QUALIFIER'S LIC NUMBER: C, F<:L y Z Z 503 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1427397 ISSUED: 0710712014 CERTIFIED PLUMBING CONTRACTOR SIVALLS, JEFF RE'y L MILLENNIUM PLUMBING, LLC IS CERTIFIED under the provisions of Ch-489 FS. i 1%date : ANUG 31.2M6 Lumm ann esB . Scanned by CamScanner A N N F All. G A N N O N P O Box 33S3 wtst POIM Beath FL 33402.3353 ••LOCATlO AT" 0 CONSTITUTIONAL TAX CotIECTOR www ooctax COM Tel (5611355.2264 11133 MODEL CIR E S.n•w.X('rine Fire.1,t uunly BOCA RATON,FL 33428 Serving Vou T"s OFeus.4css OWNIA nlcNrT wa,%If PAID AMT PAID ski.4 2}MMKuWs*4c01rT%ACTO1% srrAi\fJiitalvl LiC14T»► 11413e1173 47710 a101f17e31 This doc~is vara only when recee►ted by the Tax CanecWS Office STATE OF FLORIDA PALM BEACH COUNTY 2014/2015 LOCAL BUSINESS TAX RECEIPT 1 MILLENNIUM PLUMBING LLC LBTR Number: 201489797 I MILLENNIUM PLUMBING LLC EXPIRES: SEPTEMBER 30,2016 11133 MODEL CIR E BOLA RATON,FL 33428 This recap grant$"pnvltepe Of ertgagaq In Or 1111erei{•rlerlaeleIle Ie maoag"anyOusnaaprdeeetonaoccupation wllhin its junsdiaan ane"T to oaNptsuOU* displayed at the pace of butwta$NO In suet A Mnnner as to be oven to Nu view of the wbuC it 1 I i i f MDear Business Owner: Your new local business lax receipt Is on the reverso side Verily this rilormahon and dlsolay It conspicuously e1 your place of business.ODM to the view of me pudic. This receipt,Is In addition to and not In lieu of any license or receipt required by taw or city ordinance and Is subject to regulations of zoning. health and any other lawful authority(County Ordinance Number 17.17) • Receipts may be transferred to a new owner when evidence of a sale Is provided,the original receipt must IM 6txfendered and a transfer tee Is required. • Rettsipls may be transferred to a new location when proof of zoning approval Is provided,the original 10100101 must be surrendered and a transfer lee is required. • A business name change requires a new Local Business Tax Receipt.Therefore a new LOCAL BUSINESS TAX APPLICATION, (PBCTC FORM 165),proof of business name change registration with the state and proper fees would be required. This re"expires on September 30,2015.Renewal notices are sent at the enc!of June.11 you do not receive a notice by the and of July. please contact our office. 1 hope you have a successful year. a," Yh. 11&4vx� I Constitutional Tax Collector.Serving Palm Beach County e 1 Scanned by CamScanner A� � DATE(MMIDD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 03/31/15 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(ies)must be endorsed. If 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PAULO SILVA. Express Service Insurance Agency PHONE 954 943-7900 -FAX 954 943-1810 (A/C,No,.Ex�: ( ) (AIC,No):----( ) 900 E.Atlantic Blvd.#10 ADDRESS: paulo@express4u.net auto�ex ress4u.net . p Pompano Beach, FL 33060 INSURER(S)AFFORDING COVERAGE NAIL# Phone (954)943-7900 Fax (954)943-1810 NSURERA: Maxum Indeminity Ins INSURED INSURER B: MILLENNIUM PLUMBING, LLC INSURER C'. 11133 MODEL CIRCLE EAST INSURER D: Boca Raton, FL 33428 (561)305-7323 INSURER E_: INSURER F: COVERAGES 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 REI DUCED BY PAID CLAIMS. ADDEXP ILTR.- TYPE OF INSURANCE NSRLISWVD. POLICY NUMBER IMM/DDY/YYYY) (MEFF M DDY/YYYY) _ _ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 00,000.00 PREMISES Ea occurrence) $ ❑ ❑ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000.00 A Y Y BDG007909201 02/07/2015 1 02/07/2016 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG:.$ _2,000,000.00 POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED❑ AUTOS AUTOS BODILY INJURY(Per accident) $❑ r. - ---- --. NON-OWNED PROPERTY DAMAGE ❑ HIREDAUTOS ❑ AUTOS _(Per accident) ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ - - -- ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED- ❑ RETENTION$ - - -- - - $WORKERS COMPENSATION WC STATU- - AND EMPLOYERS'LIABILITY Y/N ❑ TORY LIMITS ❑_ERH -_ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? i N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ if yes describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT! $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) QUALIFIER'S LIC NUMBER CFC 022533 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE FAX 305 756 8972 a ---- `� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD JEFF ATWATER , CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION '•CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW • i CONSTRUCTION INDUSTRY EXEMPTION TMs certifies Ihst the indiwdual fisted below has elected to be exemot Irom Fbnda Workers'Compensabon low. EFFECTIVE DATE: 214/2014 EXPIRATION DATE: 2/4/2018 PERSON: SIVALLS JEFFREY L FEIN: 320421731 BUSINESS NAME AND ADDRESS: MILLENNIUM PLUMBING LLC 11133 MODEL CIRCLE EAST BOCA RATON FL 33428 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING t:fNdTRACTOR . w.,•ow�xa Glwaar aao osteal,F E.,ne aFas a�aaeFaaxM wew aws.+«www rows e>N awe.►7�^Y•e«eaerr d wartaee eH�Y wu e>tHwe .Vp nn Wooer Mrrkt o.a01e�e1tMOq enWr Ns dray PvrwM a CmOeK aa0;�12�f.5.CatMaww d.ae�on a M wwN.•+elMs!a"h w`n e>r MtaM d M awr�ws a YeN was an eir nI C d 6%~a M p Pirrima a Chm0w MO 06(1 TI.F.S..MAoq d a.arA a N Stew"w nrrkam of.l.or on 10 be e>rnee~to erAl.a a po"a~r,at wy rM AV to r'q d ow nares or M rneer.w 4100 swim. rr OM�OP nnend at M rob a eyeMenb ro eoegev rwr��prn>rMer.a M ewam b eMeewo.d.eewfArMw TM a�pewerr ael/eawr• r),S-F24YWC-252 CFRTPICATE OF ELECTION TO BE EXEMPT#"$ED 07.12 CUEST10669(Mroµt3.11M } t Scanned by CamScanner SNoRFs Grt t NC Miami Shores Village 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 4.2 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 oject.In these circumstances,Miami Shores Village does not require verification of workers' compensatio ance erage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING B OW O ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 11211 1 I 20 1 By 1 C- 611= 5 A who is personally known to me or has produced �s�dentification. Notary: (,w2 � J � SEAL: *�;�.,y SI TV DAC7xpir Commission k FF My Commission c o er 20, 2018 11 Millennium Plumbing Services 1502 SE 10"'St Deerfield Beach-FL-33441 Phone: cell(954)709-1094 April 1, 2015 State of Florida Before me this day personally appeared Jeffrey Sivalls who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 10050 NE 12 AVE Sworn to (or affirmed) and subscribed before me this /s day of �P 1 , 20 05, by �e�F�rY S;vails Personally Know ��I OR Produced Identification Type of Identification s Commission 0 FF 170061 My Commission Expires October 20, 2018 Print, Type or Stamp Name of Notary