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PL-13-1027 2__ 1 S Y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219817 Permit Number: PL-5-13-1027 Scheduled Inspection Date: March 10, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: POLLEY, RUTH Work Classification: Addition/Alteration Job Address:935 NE 95 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060143110 Project: <NONE> Contractor: D&D PLUMBING CORP Phone: (305)979-0516 Building Department Comments INSTALL NEW KITCHEN SINK, DISHWASHER, ICE AND Infractio Passed Comments MOVE GAS LINE INSPECTOR COMMENTS False 09/12/2014- renew as per ismael Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-191239. no answer at residence Failed 3 � Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 09, 2015 For Inspections please call: (305)762-4949 Page 4 of 29 Miami Shores Village g p Building Department v m 2j 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 I Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 200 BUILDING Permit No. FLi 3 PERMIT APPLICATION Master Permit No. /Z —/5'-y0 Permit Type: PLUMBING JOB ADDRESS: MEI S T-e--jT City: Miami Shores County: Miami Dade Zip:,�3/3 Folio/Parcel#: 11 J 2206 0/`K-Y IZ O Is the Building Historically Designated: Yes CNO Flood Zone: OWNER:Name(Fee Simple Titleholder): u' 4 e GNch Phone#:3L�--Sa,- /2 Address: (?3; /)G 9.S-f1, ST cr,. City: / S' 'Zyz -i" State: Zip: . /3� Tenant/Lessee Name: 00(),40 Phone#:Z`' Email: CONTRACTOR: Company Name:Dar-D Phone#: 30J -9/n— 05-16' Address: 3/'f! (.) /9' City: w!i.4 wi i State: Zip: 33/e-i Qualifier Name: 0/q U t J 0-rq Phone#: State Certification or Registration#: 15/2 (/ 72 Certificate of Competency#: Contact Phone#: S,4"-7 -C- Email Address: /SAX DESIGNER: Architect/Engineer:_ �.z l�I G /�. +lc �Y' <� Phone#:30's--3 5-6 C2( Value'of Work for this Permit: $�`�OoC� Square/Linear Footage of Work: Type of Work: gIAddress ❑Alteration blew epai" r eplace ❑Demolition Description of Work: ZA- S L-9!l N z w i<< +c Izef Submittal Fee$ Permit Fee$ �7 Q CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) i Bonding Company's Address l j 14 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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. Int absence o �strL�r�posted notice, the inspection will not be approved and a reinspection fee will be charged. -- 7 Signature �� Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this/y The foregoing instrument was acknowledged before me this r�� III " day off-jf1204– by�il 7�)�N day of _ ..._.- ,.20 1 ,by �1� �a� who is personally known to me or who has produced ` who is_personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC / Sign: Sign: —' P��Ue,�,, SHELLIE L.FULFORD OF da print: 60MM�SS10Ni1 11e Zp13 Print: ��1�11/ "y° loos My Commission Expires: My Comm.Expires Feb 28,2017 My Commission Expires: .,.....q Ee St Commission 8 EE 849356 • /,AAPPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ,d 114 n zn� CERTIFICATE OF LIABILITY INSURANCE DATE 0/03/i2YVY, �.r� 10/03/12 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(iss)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 i certificate holder In lieu of such endomemerd(s). PRODUCER CONTACT Luca Estrella NAME: - .. _ Accurate PHONE (305)226-8727 FAX (305)226-8767 _EJA��o...EXU__ —-- — (A/C,No): — _ 8300 West Flagler Suite 114 ADOREss _- luciaestrelia@bellsouth.net Miami,FL 33144 -__ INSURERS)AFFORDING COVERAGE NAIC 4 Phone (305)226-8727 Fax (305)226-8767 INSURER A:-.-Accident insurance Comp INSURED INSURERS: D&D Plumbing Corp INSURER C: 3271 NW 6 Street INSURER D: Miami,FL 33125- (305)979-0516suRER E_' INSURER F: --- ----------- r 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. _ )N ADDLSUBR, POLICY EFF POLICY EXP I LTR_ TYPE OF INSURANCE tNSR,WVD: POLICY NUMBER_ (MWDD/YYYY_).-M) LIMITS GENERAL LIABILITY ' EACH OCCURRENCE _ $ 1,000,000.00 DAMAGE TO RENTED — -{ COMMERCIAL GENERAL LIABILITY 1 i PREMISES(Ea occune ics) $ 5,000.00 CLAIMS-MADE OCCUR CPP0005623 �Ep_ExP(Any ane Person) $ 00,000.00 1 _ A Y Y 09/2$/2012 09/28/20131 PERSONAL-ADV INJURY S 1,000,000.00 GENERAL AGGREGATE S 1,000,000.00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG _S 1,000,000.00 __ -_ POLICY PES L-. LOC _ $ - AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT _iEa accidentl ANY AUTO I BODILY INJURY(Per person) S , AUTOS I SCHEDULED BODILY INJURY(Per accidem) $ — _ ALL OWNED AUTOS -.. HIREDAUTOS j- NON-OWNED AUTOS denO PROPERTY DAMAGE l er acciS UMBRELLALIAS OCCUR j i EACH OCCURRENCE - EXCESS LIAR-...--_-- CLAIMS-MADE AGGREGATE S AND EMPLOYERS'LIABILITY YIN j ---- -� _ — $ — — — - C STATU- WORK RS COMPENSATIONS ? - ,� .JQRY LItAITS r�ERH . ANY PROPRIETOR/PARTNEPJEXECUTIVE E.L.EACH ACCIDENT Is OFFICERIMEMBER EXCLUDED? N!A (Mandatory in NH) E L.DISEASE-EA EMPLOYE S II yes describe under - - DESCRIPTION OF OPERATIONS below _ { E L DISEASE:POLICY LIMIT i DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Certificate holder is listed as additional name insured. I I ------—----- --- ------------------- — . . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shore Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue i Miami Shores, Florida 33138 1 AUTHORIZED R E Lucia Estrella j —. — --- - CORPORATION. All rights reserved. ACORD 26(2010/05)QF The ACORD name and logo are registered marks of ACORD MIA FIRST-CLASS U.S.POSTAGE PAID MIAMI,FL z PERMIT NO.231 526858-6 THIS IS NOT A.BILL-DO NOT PAY RENEWAL BU (NESS NAP L2CATION REC fPT No. 550548-3 8 D P��MBING CORP STATE# FC1426173 3145 SW 19 ST 33145 MIAMI OWNDE& D PLUMBING CORP sec196eVLBdABe1 NG CONTRACTOR WORKEi/S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY REGUOR ZONINIG NG LAWS�OFR THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT DR LICENSE D & D PLUMBING CORP REQUIRED BY LAW.THIS IS THE HOLDERNOT A 'S •ICA DAVID DIAZ PRES TIONS. 3145 SW 19 ST PAYMENT RECEIVED MIAMITFL 33145 MIAMI-DADE COUNTY TAX COLLECTOR: 08/13/2012 j 00004560001 1111111 fill 111111111111111f1111111111111111111111111111114171 SEE OTHER SIDE THIS DOCUMENT • •• r BACKGROUND ••• r PAPER kC# 6 2 6 2 8 0 7 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L12081100635 - LICENSE NBR 108/11/20121128037011 CFC1426173 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter ,#85. FS. Expiration date: AUG 31, 2014 DIAZ,,"DAVID D & D PLUMBING CORP 3145 SW 19TH STREET MIAMI FL 33145-1927 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 1 01-30-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 03/22/2012 EXPIRATION DATE: 03/22/2014 PERSON: DIAZ DAVID FEIN: 200604412 BUSINESS NAME AND ADDRESS: D & D PLUMBING CORP 3271 N W e STREET MIAMI FL 33125 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING NOC AND DRIVERS IMPORTANT: Pursuant to Chapter 440 . 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112►, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to 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. QUESTIONS? (850) 413-16 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRYr elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW ``��'�` D chapter. EFFECTIVE: 03/22/2012 EXPIRATION DATE: 03/22/2014 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: DAVID DIAZ H exempt.. apply only within the scope of the business or trade listed on FEIN: 200604412 E the notice of election to be exempt. R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt D & D PLUMBING CORP and certificates of election to be exempt Shall be subject to revocation 3271 N W 6 STREET If, at any time after the filing of the notice or the issuance of the MIAMI, FL 33125 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 SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- PLUMBING NOC AND DRIVERS section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11