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DEMO-15-1330 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235933 Permit Number: DEMO-6-15-1330 Scheduled Inspection Date: August 18,2015 Permit Type: Demolition Inspector: Diaz, Osvaldo Inspection Type: Final Owner: Work Classification: Plumbing Job Address: 1151 NE 99 Street Miami Shores, FL 33138- Phone Number (786)253-2869 Project: <NONE> Parcel Number 1132050180070 Contractor: BGL PLUMBING CONTRACTORS, LLC Phone: (786)367-1932 Building Department Comments CAP WATER LINES Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments PassedEy Failed Correction ISS Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 17,2015 For Inspections please call: (305)762-4949 Page 15 of 38 P�u J 6 Co N�� c Ts DEH Miami Shores Village LOUII 3o5 -75G ,q 22 RECRIM D Building Department "oN1Qu65' Wb -2Z3 zk&q JUN 0 2 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 10 BUILDING Master Permit No.DEQ2 o� "'! 32o ) PERMIT APPLICATION Sub Permit NoII224j /3,90 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1151 N E 99 ST Cid: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3205-018-0070 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name(Fee Simple Titleholder): S////1�7/4' Phone#: ��J •� � - Address: /V C;1 S i 7 City: State: Zip: � Tenant/Lessee Name: Phone#: Email: 5 /-/,- �'�!/�- ✓ -'Tib /h"jp-7 4- C".-'� CONTRACTOR:Company Name: BGL Plumbing Contractors, LLC Phone#: 786-367-1932 Address: 2340 Overbrook St City: Miami state: FI Zip: 33133 Qualifier Name: Giancarlo Perez Phone#: 786-367-1932 State Certification or Registration#: CFC1429167 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 ❑■ Demolition Description of Work: 64 1-12 T&�74— ,( Specify color of color thru tile: Submittal Fee$ Permit Fee$ BUU CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 1' C> (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 ft t in on which occurs seven 7) da r the building permit is issued. In the absence of such posted notice, the inspection i not b approved and a rei sp cti fee w 1 be charged. Signatur Signature. OWN R or AGENT t CONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I day of cJ��` 20 by / day of M 20 /j by who issons y c o who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: �� NOTARY PUBLIC: r Sign: _ Sign: Print: �G�, s = Print: Seal: I My COMMISSION#FF188215 ,C \. Seal: 30,2019 EXPIRES:Ja=uy APPROVED BY t L/S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Is SNORES "Cf logo Miami shores Village eN o Building Department ORIDA 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. X COPY OF QUALIFIER'S STATE LICENCES B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE* D. X COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor 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 form and Contractor 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: BGL Plumbing Contractors, LLC BUSINESS ADDRESS: 2340 Overbrook St CITY Miami STATE FI Zip 33133 BUSINESS PHONE: J86 ) 367-1932 FAX NUMBER J56 703-9669 CELL PHONE(786 ) 367-1932 QUALIFIER'S NAME: Giancarlo Perez QUALIFIER'S LIC NUMBER: CFC 1429167 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC 1429167 ISSUED: 11/03/201 CERTIFIED PLUMBING CONTRACTOR O PEREZ,GIANCARLO DI BGL PLUMBING CONTRACTORS,LLC IS CERTIFIED under the provisio f .489 FS. Expiration date AUG 31,2018 L7411030000802 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7177732 \. LBTJ BUSINESS NAME/LOCATION &RECEIPT NO. EXPIRES BGL PLUMBING CONTRACTORKOI NEW BUSINESS SEPTEMBER 30, 2015 LLC V 7457785 2340 OVERBROOK ST Must be displayed at place of business Pursuant to County Code MIAMI, FL 33133 Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED BGL PLUMBING CONTRACTORS LLC 196 PLUMBING BY TAX COLLECTOR C/O GIANCARLO DI PEREZ MGR CONTRACTOR 45.00 11/05/2014 Worker(s) 1 CFC1429167 0224-15-000455 This Local Business Tax Receipt only confirms payment of the Local Business Tex.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Se-276. ®D For more information,visit wwwmiamidade.ggyancollector CERTIFICATE OF INSURANCE I ISSUE DATE 5/19/2015 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 INSURER(S)AFFORDING COVERAGE Northeast Agencies, Inc. INSURER A: Western World Insurance Company 6467 Main Street-Suite 104 Williamsville, NY 14221 INSURER B: N/A INSURED INSURER C: BGL Plumbing Contractors LLC INSURER D: PO Box 441170 Miami, FL 33144 INSURER E: N/A COVERAGES 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. INSR TYPE OF POLICY POLICY POLICY LIMITS LTR INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE A GENERAL LIABILITY NPP1391301 9/22/2014 9/22/2015 GENERAL AGGREGATE 2,000,000 PRODUCTS-COM/OP AGG. 1,000,000 PERSONAL&ADV.INJURY 1,000,000 EACH OCCURRENCE 1,000,000 DAMAGE PREM RENTED TO YOU 100,000 MED EXPENSE(Any one person) 5,000 B PERSONAL LIABILITY COMBINED SINGLE LIMIT MEDICAL PAYMENTS TO OTHERS C EXCESS LIABILITY EACH OCCURRENCE AGGREGATE D E PROPERTY BUILDING CONTENTS BUSINESS INCOME THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER. SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. DESCRIPTION OF OPERATIONS/SPECIALTY ITEMS Plumbing commercial&industrial,Plumbing residential or domestic SURPLUS LINES AGENT VIRGINIA CLANCY LICENSE#A206695 13577 FEATHERSOUND DRIVE PO BOX 17069 CLEARWATER,FLORIDA 33762 CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED SIGNATURE Miami Shores, FL 33138 we 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: 11/7/2014 EXPIRATION DATE: 11/6/2016 PERSON: PEREZ GIANCARLO D FEIN: 471858080 BUSINESS NAME AND ADDRESS: BGL PLUMBING CONTRACTORS LLC 8228 SW 5 STREET MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),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 440.05(12),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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 BGL Plumbing Contractors, LLC 2340 Overbrook Street Miami, FL 33133 ----------------------------------------------------------------------------------------------------------------------------------- Date: June 1,2015 State of Florida County of Miami-Dade Before me this day personally appeared Giancarlo Perez who,being duly sworn,deposes and says: That he will be the only person working on the project located at 1151 NE 99 Street, Miami Shores, FL 33138. Affirmed and subscribed before me this 1st day of June, 2015 by Produced identification Type of Identification Produced: a - 1_2i Print,Type or StamiD Name of Notary --gyp BRENDA TABRAUE Notary Public-State of Florida � r My Comm.EaPbU Jul 11.2018 Commission#FF 108597 ansa ♦SNoRFs Grt t�s .,, ,,,,;" Miami shores Village Building Department ORIDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption ON 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 coverage from the contractor's company for day labor,part-time employees or subcontractors. BYSIGN BELOW YOU ACKNOWL DGE T T YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: (A-p— wner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 70 day of 120 / By %`' 07ytif who is personally known to me or has produced ication. Notary:�� _ o . u- '� SEAL: =in�`a o � G, •�AQ-_