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PL-14-1911 le- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218896 Permit Number: PL-9-14-1911 Scheduled Inspection Date: June 02, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , Work Classification: Repair Job Address: 140 NW 102 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010220100 Project: <NONE> Contractor: CAPOTE PLUMBING CORP Phone: (305)588-9917 Building Department Comments CHANGE SINK, CONNECT WASTE AND WATER LINE, Infractio Passed Comments RECONNECT WASHING MACHINE. INSPECTOR COMMENTS False nspector Comments Passed Eg/ Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 01, 2015 For Inspections please call: (305)762-4949 Page 3 of 38 s Miami Shores Village . Building Department str �U, 4 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Bair, Tel: (305)795-2204 Fax:(305)756-8972 - -_-_- INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. �1 L - ly— (`3� PERMIT APPLICATION Sub Permit No. i A 14-" n ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL (PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ILA o umi it) ? ST City: Miami Shores County: Miami Dade Zip: 33 ISO Folio/Parcel#: It -3/O( - 0 2 2 -0(b© Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):Tl k a rdMe�- %bQD ILC_Phone#: 964-Cf/ <<1OO Address: 2- TOO w Gc pyep- S CyaeK Md. SU�nE F1 City: oia. - L&uPA P,1>ALe State: tel_ zip:'„ 3301 Tenant/Lessee Name: Phone#: Email: /? ) Q CONTRACTOR:Company Name: aWIX9 Phone#: C2_o, -5 Address: 0/ SC-0 City: State: /-L Zip:: Qualifier Name: D Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ O(0 Square/Linear Footage of Work: ZO LT Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: C HQ 1-0'q,2 5��fC; L o,e c / lyo_5V A,oj ct-'ale r Lr o-*'Q_ ,a1tr11.rrfyi Specify c r�lif�ee�{e� hr�rik�r „G►, Inc ; Submittal F $ / Permit Fee$ y �� '' C 42% Scanning Fee$ t Radon Fee$ Notary$ J Technology Fee$ Training/Education Fee$ G v Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) a y 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..... `s OWNER'S AFFIDAVIT: 1 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. 0 "WARNINd T610WNER: 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 conditign,to the;ssuance of a building permif with qn,estimated wiue exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brachure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the tecorded notice of coihrh'ence-Afit must be posteh•arthe 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 Signature X OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before mp this The foregoing instrument was acknowledged before me this L day of f 7 20 h by day of d 20 % by ��l'pNh rci'j2✓ who is personally known to ( �/I YiaY ��"'f )-e who is personally known to me or who has produced LAAA-1,4s me or who has produced ✓i'c.u�C f C2 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: l' Print: -,Print: Seal ALEX FIERCE Seal: • Mohry�ONc.Sbte of Florida comm.Ems=Oof `. 30,2016 o,Pa�°�a,;.,� LIANNYS CAPOTE *************** # * A3T * ************** .6Aoterg*%b"*sWAIM"W F+IMi03 ********** My Comm.Expires May 26,2018 Commission #FF 126262 APPROVED BY ( J /d-6-/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) t- a IAt c yr rLwru&j#► DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 �;APOTE,OMAR CAPOTE PLUMBING CORP 3811 SW 7TH STREET MIAMI FL 33144 Congre#utabons! With this icwm you one of the mmoy —-- one mi8ion Florid k ensed by the Department of Business and Profesakmd RegulafiwL Our pliofeseuxuds and businesses range STATE OF FLORIDA from and iteds to yad►t brokers,from boom to bwWque reMWa rds, DEPARTMENT OF BUSINESS AND and they keep Florida's eaariomy strong. }= _ PROFESSIONAL REGULATION Every day we worts to imprum the way we do business in order to CFC1427737 ISSUED: 05129/2014 serve you better. For mformabori about our SBPJMM please 109 Oft wywv_mynotidal_r com_ There you can find mom irdorrnafim CERTIFIED PLUMBING CONTRACTOR about our visions and the regulations that invact you,subscribe CAPOTE,OMAR to department newsletters and learn mwe about the Departments CAPOTE PLUMBING COR.a inlflatives. Oix mission at the DepaftIent is:License Efficiently.Regulade Fairly. We constandy stride too 6erY9 oou better so VIM you can Serve your customem kyou for dOir{g buskmm in Fiorld2, IS CERTIFIED under the proviaiona of Cn.aea F&. and congrdhJlati0r13 On your new ! EmiraUan date.AUG 31.2016 111725 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUC710M INDUSTRY LICENSING BOARD C142773 ?tie PLUMBING CONTRACTOR Tamed below IS CERTIFIED Under the provisions of Chapter 489 I=S. Expiration date: AUG 31,2616 CAPOTE, OMAR �4 CAPOTE PLUMBING CORP 8811 SW 7TH STREE T MIAMI FL 33144 HUED: 0 ,014, DISPLAY AS REQUIRED BY LAW SEQ# L14 1725 Local Business Tax eco" miami-DaCw County, Staw of forif THIS 6 NOTA OLL — DO NOTPAY 5295927 k,= BT ) era a .T— OEM="amEKf�IRES 6811 �am � SEPTEMBER 3Q. 301,5 uaMR331" mmt be *sofa Pumum M to axmig code G1>vW 8A—AR.9&10 OWUM Sm TUB OF Btmomm CAPOTE PUMBING CORP 196 PUUMBM CONTRACTOR � wodw(5) I CFC1427737 TAX COUBCTOR $45.00 08/11/2014 CR@RCARD-14-037.204 7ikLaoMB �� t�TOsl�eddiieNeTattHb ko is pe��IGsao�ABaMkw�flb tor6aekeOL■oiserwrtas�l► ani regnipwtbxa st�ilepawa1Miwk�p the�TNa r�e�tbiw s�e�W rr�kle�-laroi-tints 0oi�Secee.Z78. foraweeiw�we6r,abit '- ACORN® CERTIFICATE OF LIABILITY INSURANCE �_ DATE$i28/144/'r'r' PRODUCER Florida Bankers Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 7278 SW 8 Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)266-6493 Fax (305)262-0679 INSURERS AFFORDING COVERAGE NAIC# INSURED CAPOTE PLUMBING CORP. INSURER A: APPALACHIAN UNDERWRITERS INS 6811 SW 7 Street INSURER B: MIAMI, FL 33144 INSURER C: (305)266-3618 INSURER D: --- L_ INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD _ DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 d❑COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 CPP 0012250-00 02/19/14 02/19/15 PREMISES Ea occurence ❑❑ CLAIMS MADE ❑d OCCUR MED EXP(Any one person) 5,000.00 A ❑ ❑ PERSONAL&ADV INJURY 1,000,000,00 ❑ GENERAL AGGREGATE 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1,000,000.00 POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS ❑ El SCHEDULED AUTOS BODILY Dps person) ❑ HIRED AUTOS ❑ BODILY INJURY NON OWNED AUTOS (Per accident) ❑ --- PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND El WC STATU- F] OTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE SPECIAL PROVISIONS_below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CFC1427737 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL VILLAGE MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPARTMENT THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2 AVE OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES , FLORIDA 33138 AUTHORIZED REPRESENTATIVE : a - - nZf.tmp ACORD 25(2001/08)QF ©ACORD CORPORATION 1988 729r�Df4 ReowtVWAL- �. u,1 ( 1009E 1 i � I PLEASE CUF OUT CARD BELOYN AND RETAIN FOR FUTURE RACE ------7-z..-------------------------------------------T-- --------- - - -----;---------------- -------srw3i`�---------------------- ' STATEOFRMMA i _ Pd acmger 1�q,P :ted ke oft opQ.eu. i app , �tlseo�atiamDeelt�rBa6d MWOF orammoFwoRKE • .L mpEmSATwm - - F oaspesffiweAsYisd6Ws ;Q PSWAMI-Q�r14 FS.,csrfrl.of ft IpI�1 { C mxwwsm&pTm 4esegt- 9aaugedtlrEu4ematrade ' ' 't. Ra6edmRs de�oDffiORmyt i t>3HMrwi OF0EC808WWZU P7FAOYMcom �D {; : p- w ; Puaastbd�ptrlNdFS gaf�dderSmb6e I ; EFFFCRVE OA7� 7MRMa E74•RK�II ORS 7nM2 8 a badwSedeKsd � mit dd�s �H arf5srase.dL.mfidrRpeoat,ffindme,�cB m.. i oac aParE aw+ 'E � ea ries ,edrmd� s� 2625Mt1 _ :R as aaYrifair crinpwmromdcnft iBUSINESS MIRE AM :E atNalsbswtllr[a�{ma6 d4isaS� Gr'd1E PLtAIBIN6 CORP i 8611 SYR 7 Si 1RJr FL 33W � i SCOPES OF BUSlIESS OR IRA s LICENSED PLUMMG PLUUiBINGROG AND ' CONTRACTOR DRIVERS ---------------------------------------------------------------------------------------------------------------'t-------- OFS*2-DV W-=CE"B"'E OF ELEC M 70 BE E)EAWT P"S®07-12 CLEWHOM-5-(859)413-1608 i r man ,p„ Miami Shores Village Building Department [pRmi► 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 ffill-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 RMon 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 Contractor Print Name: UJ Print Name: QT�. Signature: Signature: State of Florida) Sta ) County of Miami-Dade) County f Mi - ade) Z Sworn to and subscribed before me this 01- Swom to an fore s day of ,20!,4. day of S t , B .1 tv Notary Public State of Florida By Melissa Urrego p�% Q My Commission FF 124834 Notary Public.-State of Florrdg (S ? o Ex ire-05/20/2018 Typ Id o Iden Commission N EE 182641 Bonded Through National Notary Assn.