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PL-15-1319 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235892 Permit Number: PL-6-15-1319 Scheduled Inspection Date: July 21, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: ENGEL, JERRY AND SARAH Work Classification: New Job Address:351 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122310130290 Project: <NONE> Contractor: EDWARD ROJAS PLUMBING CORP Phone: (305)944-6788 Building Department Comments RE PIPE WATER LINE Infractio Passed Comments INSPECTOR COMMENTS False TO CLOSE PERMIT#PL07-1679 spector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 20, 2015 For Inspections please call: (305)762-4949 Page 11 of 39 SnoRFs Miami Shores T Village t�rmit Plt! bin, - erg! �.� 9 Yl�e # 10050 N.E.2nd Avenue NE WtrOVE tfktssircatio ; Miami Shores,FL 33138-0000 F .APR erm eta - �E=moo` Phone: (305)795-2204 FCOAiUF' 7l17/2015 Expiration: 01/17/2016 Project Address Parcel Number Applicant �_. _.� ......_. ...... ............... 351 NE 105 Street 1122310130290 JERRY AND SARAH ENGEL Miami Shores, FL Block: Lot: Owner Information AddressPhone Cell JERRY AND SARAH ENGEL 351 NE 105 Street � . MIAMI SHORES FL 33138- 351 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone i $ 2 500.00 LTotal tion: EDWARD ROJAS PLUMBING CORP (305)944-6788 Sq Feet: 0 Type of Work:RE PIPE WATER LINE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Water Main Classification:Residential Scanning:3 Final Review Plumbing Underground Fees Due LAmoUnt Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee $2 80 Invoice# PL-6-15-55794 DCA Fee $2 70 07/17/2015 Cash $ 199.20 $0.00 Education Surcharge $0.60 Permit Fee $180.00 Scanning Fee $9.00 Technology Fee $2.40 Total: 99.20 i In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either m m ent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL,WINDOWS, DOO FING nd SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information i ate d hat I work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-name ctor o d t wgrk st Q July 17, 2015 Authorized Signature:Owner / Applicant / tractor / A ent Date Building Department Copy July 17, 2015 1 Miz mi Shores Village Building Department �cr�`Tr�� 2ot5 10050 N.E.2nd Avenue,Miami Shores, Florida 33138JUN \� Tel:(305)795-2204 Fax:(305)756-8972 B�. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2O _o L BUILDING Master Permit No. y- IG— 13t PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL VP LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: city Miami Shores County: Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: /�BFE: FFE: OWNER: Name(Fee Simple Titleholder): 155J9 !tel n �',�-e E' f.Q x'02" e#:' Address: 20 '57— City: __.,City: (322 State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �^ /,�S Phone#:_-10 L/y.(o 7 O Address: ?\J C 1 S / City: tv-Q- -state: Imo ' Zip: -37161 Qualifier Name: ctL't Phone#: 9f State Certification or Registration#: c Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Ed Alteration ❑ New 1:1air/Re lace Re p p ❑ Demolition Description of Work: 2 2 '12I L YUt �C o Specify color of color thru tile: Submittal Fee$ Permit Fee$ C $ C0,1q,..-,-L Scanning Fee$ Radon Fee$ D P $ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$1 • (Revised02/24/2014) R _ 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. /n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRA TOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —XJ It day of 20 15by �� day of M 120 by C°t4op-C1 gnGl who is personally known to it �0 ��FI� who is personally known to me or who has produced as me or who has produced TL 7� `Q as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 0 Sign: Print: L �C"L,-e Print: Seal: giSeal: G`�` °B`�i ANA L BALLOVERAS IpV"W_ Notary Public State of Florida • Notary Public-State of Florida `t` Sindia Alvarez ' 6 My Commission FF 156750 ,� a,; My Comm.Expires Sep 23 2017 a�d� Expims 09103/2016 APPROVED BY - f S Plans Examiner Zoning C Structural Review Clerk (Revised02/24/2014) acs STATE OF FLORIDA ¢ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION C FC049431 ISSUED: 08/05/2014 CERTIFIED PLUMBING CONTRACTOR ROJAS, EDWARDO EDWARD ROJAS PLUMBING CORP IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31,2016 L1408050001639 1 Local Business Tax Receipt Miamade Cciunty, Sate o Florida - 0 s ria B I! NOT PAY,,. 5175658 BU$INE$$iNAME/LOCATI111 RECEIPT NO. .� E'DWAR�ROJAS-PLUMBING EXPIIIES coRP "2 SEPTEMBER 30,2015 860 NE 11 ST**** 50 Muat be diaplaV0 at place qF husn+e� , ?ursuant to COuTty Code BISCJ�YNE PARK,F� =13181 E' Chapter 8A Art 9&10 f OWNER $EC TYPE OF BUSINESS, t OWNEI RDriAS PLILIMBING COMP PA1fIlAEtyi ]RECEIVED X86 'PLfMA61 4 _ � 1 X COL48CTQR CONTRACTOR 45 00 07/18/2014 Worker(s) 1 CFC049431 0224-14-006140 This local Business Tex Receipt only confirms paymmK the Local Business Tea.The Receipt is puts license, permit,or a carji6cadon of the hobim's qualifications,to do business.Holder muf cOmplT With enc governmental or ntingovernmemal regulatory biis and requiremesttwhich apply to the bias s. The RECEIPT,N ove must be displayed onall commercialvehicles iuliami-Fade Code See 8a-216. MIMM ® FernteMiniormationYtsitVvWvv midadagavhszcollector 0610112015 12:13 TAX) P.0011001 CERTIFICATE OF LIABILITY INSURANCE DATI06101/15 Y) O6/01/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED ,REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tho certificate holder Is an ADDITIONAL INSURED,the polley(los)must be endorsed. If SUBROGATION IS WAIVED,aubJeotto the terms and condltlone of the policy,certain policies may require an endorsement. A statement on thie certlfloate doe$not confer rights to the certificate holder in lieu of such endorsomont(s). PRODUCER CONTACT NAME: Lucia Estrella Accurate PH NE (305)226-8727 FM Ne; (305)228-8767 8300 West Flaglar Suite 114 th,nat Miami,FL 33144 INSURER(S)AFFORDING COVERAGE NAIC d Phone (305)226-8727 Fax (305)226-8767 INSURER A: Grenada Insurance Co. INSURED INSURER B: Edward Rojas Plumbing Corp INSURERC: 880 NE 111 St INSURER V. Biscayne Park,FL 33161- 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 REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYY1 (MMtDDrfYYy1 LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 •1,000,000.00 © COMMERCIAL GENERAL LIABILITY Y PREMISES(EsERENTED nee i 100,000.00 A [IICLAIMS-MADE OCCUR 0185FL00051045 08/08!2014 08/08/2015 MED EXP(Any one erson a 5,000.00 PERSONAL&ADV INJURY s 1,000,000.00 ❑ GENERAL AGGREGATE s 1,000,000.00 OEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 1,()00,()00.00 ® POLICY El jFFT PRO- ❑ LOC S AUTOMOBILE LIABILITY ARINED INGLE LIMIT ❑ ANY AUTO BODILY INJURY(Par person) S ❑ ALL OWNED BCHEDULEO AUTOS ❑ AUT08 BODILY INJURY(Par accident 3 E] HIRED AUTOS ❑ '0"'N ED PJiOPER77Y AMAGE ❑ ❑ oraMent 3 - - s ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE L EXCESS UAB ❑CLAIMS-MADE A013REGATF $ ❑ DED RETENTION -• WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N ❑W TAT EJTM. ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑NIA E.L.EACH ACCIDENT ti (fMyyendetory be un) E.L.DISEASE-9A EMPLOYE 5 IgE6(:RIIPTTIION OF OPERATIONS bopw EL DISEASE.POLICY LIMIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addltienai Remarks Schedule,If mere apace Is requwso) CSC049431 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE City of Miami Shores Building Department THE EXPIRATION DATE THEREOF OVE C CEWED PWILL BE DELIVEROLICIES BE ED IN BEFORE 10050 NE 2nd Ave ACCORDANCE WITH THE PO o SIONS. Miami Shores,FL 33168 7AUTH0:PJZEDREPRESENTATIV305-755-8972 ia a ACORD 26(2010105)OF ®1988 010 A R RPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Report Viewer Page 1 of 1 m 4 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 CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 7/12/2013 EXPIRATION DATE: 7/12/2015 PERSON: ROJAS EDWARDO 1 _FEIN:. 453073611 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP - 800 NE 111 STREET BISCAYNE PARK FL 33161 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuantto Chapter 440.05(14),F.S.,an omcer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation underthis chapter.Pursuantto Chapter440 05(12),F.S.,Certificates of election to be exempt..apply onlywithin the scope of the business or trade listed on the notice of election to be exempt.Pursuantto Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 I https:Happs8.fldfs.com/crreportviewer/reportV iewer.aspx?data=kdvpginc9D7Q3gH6TER6... 7/12/2013 Edward Rojas CFC-049431 Plumbing I Complete Plumbing Services Hi Speed Water Jetting 24 Hour Service Licensed,Bonded&Insured One Call Do it All 786.443.9846 E-mail:eddie.rojas@hotmail.com We are now accepting Insurance Claims it