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PL-15-1272 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243429 Permit Number: PL-5-15-1272 Scheduled Inspection Date: September 15, 2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: GOLD JTRS, CAROLINE Work Classification: Addition/Alteration Job Address:803 NE 99 Street Miami Shores, FL Phone Number Parcel Number 1132060340090 Project: <NONE> Contractor: ECO 1 PLUMBING LLC Phone: (786)281-6355 Building Department Comments REMOVE& REPLACE WATER CLOSET, SHOWER HEAD, Infractio Passed Comments VANITY SINK AND FAUCET IN 1 BATHROOM INSPECTOR COMMENTS False Inspector Comments Passed Failed ✓� 'C Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 14,2016 For Inspections please call: (305)7624949 Page 52 of 56 1272 N,.1 �t Miami Shores Village 0116 u1Min "R+ idm0a[ 10050 N.E.2nd Avenue NE Itl/etrlcOa�l�iCalrc�rt �dMcntAltaratiarlr r�Miami Shores, FL 33138-0000 rerrtlfttil AP ED "4ENre �r` Phone: (305)795-2204 Expiration: 02/0112016 Project Address Parcel Number Applicant 803 NE 99 Street 1132060340090 CAROLINE GOLD JTRS Miami Shores, FL Block: Lot: Owner Information Address Phone Cell LCAROLINE GOLD JTRS 803 NE 99 Street FL 803 NE 99 Street FL Contractor(s) Phone Cell Phone Valuation: $ 300.00 ECO 1 PLUMBING LLC (786)281-6355 Total Sq Feet: p Type of Work:REMOVE&REPLACE WATER CLOSET,SHOW Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-5-15-55734 DBPR Fee $2.25 08/05/2015 Credit Card $ 109.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 05/27/2015 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-nam ntractor to-do the work stated. August 05, 2015 Authorized Signature:Owner / Applicant / tr t r / Agent Date Building Department Copy August 05, 2015 1 Miami Shores Village Building Department MAY 2 7 ?015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. /—I 0 �� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION 0 EXTENSION ❑RENEWAL [XPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 803 NE 99 Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 1132060340090 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Caroline Gold Phone#: Address: 803 NE 99 Street City: Miami Shores State: FL Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Eco 1 Plumping Phone#: 786-281-6355 Address: 247 SW 8 Street #178 City: Miami State: FL Zip: 33130 Qualifier Name: Norberto Borgeat Phone#: State Certification or Registration#: CFC1428373 Certificate of Competency#: DESIGNER:Architect/Engineer: Nva Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: In order to solve case #10-14-13230 1 R A i I H OP,�rn Specify color of color thru tile: Submittal Fee$ Permit Fee$ ` y CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ f (Revised02/24/2014) EC01 PLUMBING Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) i Mortgage Lender's Address City tate 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. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 'AJ' o _ Signature_ OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -� day of 20 , by VVM day of—Miw 20 I by C 1 ) 6P 6900, ho is ersonally known o or i,1 who is personally known to me or who has produced as me or who has produced d r I�Y lit-'i V6(—# as �5W�5—4661 0--40-1'd516- identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: &av-9Z Print: S �-� Print: iq 7ZAn4k7r4L Seal: ; 's' ROSALYN MONTENEGRO Seal: .slyMy •.,,� COMM1331pN 8 EE1658ppNa1up POW•Bhb of PA*4*0 i01fi� EXPIRES February p2,2019 E MY COM.EW M Ave 1.2016 (�In7)39S- APPROVED BY �� ---u-! S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) S�ORFs G logo Village Miami shores ZOR Building Department __._rtII05IINE 2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. r COPY OF LOCAL BUSINESS TAX RECEIPT C. _COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE 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 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: ECO1 PLUMBING BUSINESS ADDRESS: 247 SW 8 ST.#178 CITY MIAMI STATE FL 33130 ZIP BUSINESS PHONE: ( 786 ) 281-6355 FAX NUMBER ( ) CELL PHONE ( ) QUALIFIER'S NAME: NORBERTO BORGEAT QUALIFIER'S LIC NUMBER: CFC1428373 _ : .g. . . � `"` � :' .; ,.,,. �; � ' � ¢.. NATE OF FLORIDA E DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION f'4 =t w CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BORGEAT NORBERTO F ECO 1 PLUMBING LLC 247 SW STH STREET#178 MIAMI FL 33130 Congratula#ions! With this liceae you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range : STATE OF FLORIDA cm arc+i;ects to yacht brokers,Srom boxers to barbeque restaurants. H44I DEPARTMENT OF BUSINESS AND and'hey Beep F"crida's economy strong. PROFESSIONAL REGULATION =very day we work to improve the way vie do business in order to CFC1428373 ISSUED: 07101/2014 serve you better. For information about our services.please log onto www.myfloridalicense.com. There you can find more information CERTIFIED'PLUMBING CONTRACTOR about our divisions and the regulations that impact you,subscribe. BORGEAT NORBERTO F to department nmvsletters and learn more about the Department's EGO 1 PLUMBING LLC initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Cha89 Fs,. and congratulations on your new license! Expeas-n d" AUC-31.201.5 "a97010p°" a DETACH HERE I RICK SCOT,GOVERNOR KEN t,AWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1428373 � r The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 \ v 0 � 0 BORGEAT, NORBERTO F i ECO 1 PLUMBING LLC - 247 SW STH STREET#178 'MIAMI FL 33130 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6761978 [L RTJ BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ECO I PLUMBING LLC RENEWAL SEPTEMBER 30, 2015 247 SW 8 ST 178 7035377 MIAMI FL 33130 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS ECO 1 PLUMBING LLC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC1428373 By TAX COLLECTOR Worker(s) 1 $45.00 08/04/2014 0HECK21-14-042280 This local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, Pemtit,ora certification of the holders qualifications,to do business. Holder must comply with any govermxentel 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 6a-276. For more information,visit�p�v miamidade aor/t xcollecter C ACCOIR0CERTIFICATE OF LIABILITY INSURANCE DATE15 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: Ifthe certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 CONTACT LUDYSBEL PEREZ Best Option Insurance Brokers,Inc PH (305)859-7303 FaxWC No- (866)910 0983 3400 Coral Way Suite 500 L ludysperezfgmall.com Coral Gables,FL 33145 INSURERM AFFORDING COVERAGE NAIC s Phone (305)8W7303 Fax (866)910-0983 INSURER A. GIC UNDERWRITERS INSURED INSVRER B ECO 1 PLUMBING LLC INSURER C: 247 SW 8th Street APT.176 INSURER D: MIAMI,FL 33130- (786)281-6355 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. LTR TYPE OF INSURANCE WWVD UB POLICY NUMBER MMIDDIYYYY OLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DA AGE ES RENTED ccwrence S 100,000.00 ❑ ❑ CLAIMS-MADE ® OCCUR 0185FL00042892 MED EXP(Any one person) S 5,000.00 A rN N 02!17/2015 02117/2016 ❑ PERSONAL anw INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GERL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000.00 ❑ POLICY ❑ PRO- L] OC S AUTOM0130.E LIABILITY COMBINED SINGLE LIMIT Ea ecddeN ANYAUTO BODILY INJURY(Per person) $ ❑ ALL UT OWNED ❑ U�L£D BODILY IINJJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTOS NED Per�acc{dent AMAGE $ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE S ❑ EXCESS LIAR ❑CLAMS-MADE AGGREGATE S ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑WC STAID- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRETDRIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICERMEMB£R EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Cyeq describe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space ie required) LIC.CFC 1428373. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building Depariment THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010106)QF The ACORD name and logo are registered marks of ACORD JEFF A7WATER 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: 1/8/2015 EXPIRATION DATE. 1!7/2017 PERSON: BORGEAT NORBERTO F FEIN: 274477346 BUSINESS NAME AND ADDRESS: ECO 1 PLUMBING LLC 247 SW 8TH ST# 178 MIAMI FL 33130 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-172-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTION Scanned by CamScanner EC01 PLUMBING 247 SW 8' Street #178 Miami, FL 33130 Date: MAY 21 2015 State of IFp Ab,, County of -_bN�,p Before me this day personally appeared lY0e-.,W'id &Owho, being duly sworn, deposes and says: /-? That he or she will be the only person working on the project located at: 3 NLRRT4SVrt-S ,rYI mvvn i SJnrY�es FL- Sworn LSworn to (or affirmed) and subscribed before me this 2 day of H&V 201 J by NAY be-rh p n wwt Personally know OR Produced Identification P)We -�D�D"jtJq- '0151-0 Type of Identification Produced PJ- If i 0';Z- Print, ype or Stamp Name of Notary Eo AD ZANI6RAN0Notary Public-Silo of Florida My Comm.Expiry Aub 2,2018 Commbsion#�EE 221961 �SHORES D� MAY 11 2015 ,a„ Miami shores Village "C&N -�� Building Department �0R1Dp` 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 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. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ' Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of Gtr 20 i ) . By C Fv o \- A e. C)p 1 who is personally known to me or has produced rs6"C11 I kA1L 0, as identification. Notary: SEAL: ; :P � BRIGrM PARIENTE •~ MY COMMIUION*EE157420 • • EXPIRES January 05.2016 (407)3W4193