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PL-15-81 Z4 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226491 Permit Number: PL-1-15-81 Scheduled Inspection Date:July 21, 2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: RANDLE,JULIA Work Classification: Addition/Alteration Job Address:285 NE 103 Street Miami Shores, FL 33138-2430 Phone Number Parcel Number 1121360130440 Project: <NONE> Contractor: MIAMI PLUMBING &SOLAR HEATING Phone: (305)835-8008 Building Department Comments WATER HEATER AND KITCHEN SINK Infractio Passed Comments INSPECTOR COMMENTS False Inspector 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 4 of 39 Miami Shores Village LBy _'A ED Building Department 14 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 331380,— Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No. r �� PERMIT APPLICATION Sub Permit No. PLJ ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ©p'CUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP i CONTRACTOR DRAWINGS JOB ADDRESS:��5_ls� E ` Q City: Miami Shores County: Miami Dade Zip: t�� Folio/Parcel#: t 1.� -0 nq!40 Is the Building Historically Designated:Yes NO Occupancy Type:red,_ Load: Construction Type: Flood Zone:\,�C) BFE: FFE: OWNER: Name(Fee Simple Titleholder): ' Phone#: " 7 Address: 1_0 E D? City: l-`-10-yv-\ 1 Ott t� State: :PL— Zip: Tenant/Lessee Name: ��) !� Phone#: Email: CONTRACTOR:Company Name: a 40 j t/ �t��✓done#: U' y AV Address: -7(7 f City: / State: / Zip: Qualifier Name: • P?7/Frp/� Phone#: State Certification or Re istration#: C/ 0� Certificate of Com eten #: E P cY DESIGNER:Architect/Engineer: � C_C�� ) C e— Phone#: O (o Address: 3 `Z -k- Ci M► S ate:('--L Zip: Value of Work for this Permit:$ c r Square/Linear Footage of Work: Type of Work: ❑ Additiionn� ❑ Alteratio ❑ New Repair/Replace, ❑ Demolition Description of Work: K �� '/ �� f Specify color of color thru tile: Submittal Fee$ Permit Fee$ r �• ry CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ e �� (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. 1 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. Signat Signatur -i �e�AC�Z9�'� OWNER or AGENT CONTRACTOR The ng instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 �by day o � 20 /.� , by who is personally known to G � rho is personally known to me or who has producedg5__�(43 6/62r-)- s me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: _ Si n: nt: Seal: Joanna M Feliciano Seal: rot ®yam Notary Public State of Florida .c 0 P& Notary Public State of Florida o Expires01/12/2018 Joanna M Feliciano ®` Commission FF 082753 oFp►o� Expires 01/12/2018 "�, ova My Commission FF 082753 �oyy�o� Expires 01/12/2018 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 01/13/2015 12:12PM 786-5182899 ESTRELLA INSURANCE PAGE 01/01 ' , CERTIFICATE OF LIABILITY INSURANCE DATE(mMIDDiYYYY) O1/1212DIS 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,ANP THE CERTIFICATE HOLDER. IMPORTANT: If the cetificate Holder is an ADDITIONAL INSLW=,the poitcy(ies)must be endorsed. N SUBROGATION IS WAIVED,Subject tC the terms and condtions of the policy,certain policies may require an endorsement A statement on this cerdficate does not confer fights to the cerflftcate holder in Kau of such endorsement(s). PRODUCER NAM ACT IGIPSY DE LA PAZ Estrella Insurance 187 P Nluo (78$}51&2898 F Na; 861&2899 9500 NW 27 Ave E-M GIP SY.DFIAPAZOES rREWUN3URANCE.COM Miami,FL 33147 INSURER AFFORDING OOV@RAGR NAIL S Phone 8).518-2885 Fax {786 1&2899 I INSURER A. WESTERN WORLD INSURANCE Co INSURED INSURER EI; MIAMI PLUMBING&SOLAR HEATING,INC INSuRERc:' 2170 NW 95TH STREFT INSURE D: INSURER E: KAMI,F1,33147 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 AJ30VE 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. I�TRR TYPE OF INSURANCE ADDL BR POLL EFF POLICY AP LIMITS I 1001.102Y NUMBER (MMOO- M GENERAL LIABILITY EACH vcCuRRENCE f 1 b0,Ob0.00 a COMMERCIAL GENERAL LIABILITY PREMGSES R occu1111 $ 100,000.00 ❑ C] CLAIMS-MADE © OCCUR MED 0'(P(An one pa,son) S 6=00A ' El PERSONAL 01 M/2015 01109/201fi PERSONAL&ADV INJURY $ 100,V00,00 D GENERALAGGRE.GATE $ GEML AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ ❑ POLICY ❑ PRO- ❑ LOC S AUTOMOBILE LIABILITY N TWTdT SINGLE LIMIT accenl ❑ ANY AUTO BODILY INJURY(Pet pemn) $ ❑ ALL AUTOS OWNED ❑ SUCTHWUI-M BODILY INJURY(Per gccident) S ❑ HIRED AUTOS ❑ ql psi er acc M $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE S ❑ EXCESS UAB 0 CLAIMS-MADE ASGFWGATE $ ❑ DID ❑ RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERRW LIABILITY Y/N ANY PROPRIEr"OR/PARTN EL EACH ACCIDENT $ OFFICEWMSMBSR 2XcLUDED? NIA (Mandatary In NH) E.L,DISEASE-EA EMPLOYE S If yes,dow1be under DESCRIPTION OF OPERATIONS below i"L DISEASE-POLICY UMTf $ OMRIPMON OF OPERATIONS I LOCATIONS/VF.HIOM(Attach ACRD 101,Addinanal Rumarks Schedule,if mere space Is requiYG9) CFC 045984 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL,33138 AUTHOWED REP094TIVE ®1988 2014 ACORD CORPORATION. All riglits reserved. ACORD 28(2014/01)QF The ACORD narne and logo ere registered marks of ACORD 001256 Local Business Tax Recaipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DONOT PAY LBT 2023760 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES MIAMI PLUMBING&SOLAR HEATING RENEWAL SEPTEMBER 30, 2015 2170 NW 95 ST 2131682 Must be displayed at place of business MIAMI FL 33147 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS GEORGE KITZMILLER 196 PLUMBING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR Worker(s) 10 CFC045984 $75.00 09/10/2014 CHECK21-14-066402 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder meet comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276. For more information,visit www miamidade.novhaxl;9Hocbr Report Viewer Page 1 of 1 '� }�... { 1 125%"_...,I 4 i PLEASE CUT{dU1�CAR0 gLOWAND t t 2t:t AtN..FOI t USE Rtrt ERIA IC ~STATE OF PLORIOA tm�t an�ar aa�tt�liaj.F.s;an wa�r�so�nw�aon iip curate tlmthamrdps'aFapter hgfilmg aserbaoata of f DEPARTMENT OF FINANCIAL 60060t . r�t�n.un�e3>�a mavnmrecoverWane or . E DIVISION OF WORKERS COIIAPENSATION1 ' -� �' P fANgegrFtlo�h4pt@t44a t�;Fs,eeenne�teet#m,.sttr d r CONSTRUCTION INOUSTRYEXERRt?'C N GI twex�mt tY Nyq�theuraoetttrevusiingaova�e '; (+ .&§tedotittst3natl4eWUteab6tttabaexompi '. . C@ATiPY.AlHotraL77cooN A'Ott7%aM14PT RR004RL4FN9A D '"Pusaaat4k ^•, A+70 at�ta PB.,IVatxesmete�eAWhB WORtaQe't0VASNBATIAM LAW -_ E o?anro4Rto Of'eF9 �be oxmnpt sAan be, 1 aRReottveOAT& iYN16ra 67¢96Ati0atUyT6: �veatQ: spDlaottO rNateeytarBaQerfbebaftd n", I't to tsaaaaceatttm oeT4dae ,t 10 Oum vaaynots the fBRBiuP: M78LVLL8R OPORGB E ,rtetiCO ot>�gt4(Ori�bT qte reNttN'amehta9ttvig '840='aaaco nt aorr. .' 'm' ; sat atmn revoke Rant. ssm .a. Rt@ `4a tanPl9t)sB4reof" 9areoAeamettCnU+a E dteto94ketnenlaafletaaar ` BUSINESS NAME AND A0MSS. � } MIAMI PLUMBING&SOLAR t1EATINS 04. 2170 NW SM STREET i 0Sh4MlFL X3147 t SCOPES Of BUSINESS OR TRADE MACHINERY OR P#UMBtNt3 h1OC ANO EQUIPMENT trRECTIO,: pltiltEl25 I L..:r......._w .. `: :.7. ." .` ....ar+w...� '...+...r..r-�r.«....:..rr...s..+v:«�..�••^w'.'•""^ OFS F2-OWC-262 CERTIFICATE QF ELECT{AN TO BE t�CC-.MPT R YISEO 07 17,,, " OUESTIONS7 i830Ni13 7B0S r; i Fr a. a z r, t aCrX9riats=krivnoinc,QD7O3gl46TER6... 7/17/2013 + i n Miami s Village am Building Department �pR�pA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption v 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.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_person 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 �aNSo�® Contractor Print Name: ® Print Name: Signature `n z Signature- 0 ignature~' 0°30', Stat f Flo ' ) N 0 �, State of Florida) _N County of Miami-Dade) a T County of Miami-Dade) N _ Sworn tj and subscribed before meth s %o o Sworn tq and subscribed before me thi of W day of ,201 . w S. day of p r ,20 Y N B m ►~� By � (SEAL) AI,) T entffication produced P Typ entification produced