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PLC-14-2135 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238192 Permit Number: PLC-9-14-2135 Scheduled Inspection Date:August 20,2015 Permit Type: Plumbing-Commercial Inspector: Diaz,Osvaldo Inspection Type: Final Owner Work Classification: Addition/Alteration Job Address:9501 NE 2 Avenue Miami Shores, FL 33138- Phone Number (305)756-3711 Project: <NONE> Parcel Number 1132060133920 Contractor: CASTELLON PLUMBING CORP Phone: 305-5534490 Building Department Comments 2 FULL ADA BATHROOM, 1 D FOUNTAIN 1 WATER Infractso Passed Comments HEATER 1 MOP SINK INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-220631.ACCESSIBLE Ed SHOWER NOT TO CODE NEED BENCH, HAND HELD AND MAY NOT HAVE CURB HIGHER THAN 1l2 Failed ❑ WATER CLOSET SHALL BE 16-18 INCHES FROM WALL GROUT FLOOR DRAINS Correction Needed Re-Inspection ❑ �-1 S Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 19,2015 For Inspections please call: (305)762-4949 Page 11 of 41 Miami Shores Village [SEP ,ry_,— Building Department n 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No0-0--- PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER:Name(Fee Simple Titleholder):�qI".!W A.Z 2f�/ ,e .- Phone#: Address: -�r3) ty 14yz City: M 1-711, S State: fi�-- Zip: 1}�13 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: �� ,AZ 44: 2 4 City: Miami Shores County: Miami Dade Zip: 4�3 l Folio/Parcel#: 1 1— _32-6 (0-03— 3`i 10 Is the Building Historically Designated:Yes NO %� Flood Zone: CONTRACTOR:Company Name: 4(jN!j= P /l7 A Ig Phone#:AP Address:_e R 5// �,/ City: �� ylie ea State / �l Zip: Qualifier Name: //L, r(��t_C'7�P�/�i,.c Phone#:67P-4 2 z,, State Certification or Registration#: C- (�L/� �Certificate of Competency#: Contact Phone#: � �� Email Address: C-42 S, /�� DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$_ Square/Linear Footage of Work: Type of Work: OAddress UAlteration ONew ORepair/Replace ODemolition Description of Work: / r Submittal Fee$ Permit Fee$ d �� ' CCF$ CO/CC$ Scanning Fee$ 01 Radon Fee$ DB`PR$ Bond$ Notary$ 0 Training/Education Fee$�20 Technology Fee$ 1 Double Fee$_ Structural Review$ TOTAL FEE NOW DUE$ • 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 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this a O The foregoing instrument was acknowledged before me this I--- day of ,20 ll U,by -j g' tic day of ��/`� 0 LI,by�iew�ln�� who is rsonally known to a 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: Print: -16 rqa.. Print: . '' —IZZ - 15 u e-67as My Commissio My Commission ExpiretaY Pale, BEA7AQA BURGOS .,� n .�. y°°a * IN COMMISSION#EE 052014 ISRZGARCIANotary Pubrida �r c! EXPIRES:April 7,2015 a Bonded Tien Bu%d8 x Commis APPROVED BY lans Examiner Zoning /o —/-/`9 Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ■ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 323€9-0783 CASTELLON,GIRALDO CASTELLON PLUMBING CORP 9841 NW 130 ST. HIALEAH GARDENS FL 33018 Congratulations] With this license ydu become ons of the nearly one million Floridians licensed by the Department of Business and Professional Regulation Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to.barbsque restaurants, DEPARTMENT OF BUSINESS AND and they-keeep Florida's economy strong. PROFESSIQNAL REGULATION Every day we worts to improve the way we da business in.order to CFC019059 19SU€13 Q5/29 o14 serve yoct better. For information about our services,please log onto arww.myfl 4dalicense COW There you can find more information CERTIFIED PL C©NT TOR about our divisions and the regulations that impact you,.subscribe CASTELLON,til - to pwarbivent newsletters and team more about the Department's CASTELLON P initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. We Constantly Strive to serve you better so that you Can serve your IS CERTIFIED under the provision$.of ChASS FS. Customers. Thank you for doing business in Florida, eq*w on .AUG31,=6 L14052MM1728 and congratulations on your new license] , DETACH HERE RICK SCOT?,GOVERNOR KEEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD W01125901u,Kim CFCoiwo The PLUMBING CONTRACTOR Named.below IS CERTIFIED Under tire.provisions of Chapter 489 FS. Expiration date: AUG 31,2016 0 CASTELLON,GIRALDO CASTELLON PLUMBING CORP 9841 NW 130 ST. HIALEAH GARDENS FL 33018 ----. ... ....,.�...,.r..-er na I w1Ai ccn H 1 1df1fi?Qni3n17 R ■ 1UU�u1 Local Business Tax Receipt Miami-Dade County, State of Florida- -T,Hl$ IS NOTA BILL - DO NOT PAY L El 466748 S"NESS NAMEMOCATION RECE11"NO. EXPIRES CASMUON PLUMBING CORP RENEWAL SEPTEM R 30, 2016 9841 NW 130 ST 468748 Must be displayed at place of business HKEAH GARDENS FL 33018 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED CASTELLON PLUMBING CORP 196 PLUMBING CONTRACTOR BY TAX CQU.ECTOR Worker(s) 10 CFC019059 $45.00 08/07/2014 CHECK21-x-14-0451 93 This Local Business Tax Nocelpt only confirms payment of the Local BusinossTax The lloce is t. R 44 pe mk or a certificatlon of The holder's qualifications,to do business. Holder mat-campty or nongovernmental regulatory laws and toquirements which apply to the bush The RECEIPT NO.above must be displayed on aft commercial velilo — For more informationviskmongalln CERTIFICATE OF LIABILITY INSURANCE 1 0124113 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER NO RIGHT'S 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 ISSU04G INSURER(St AUTHORIZED REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. WP ORTANT,If the certlRcate holder[son ADDITIONAL INSURED,the y(les)must be endorsed. BSUBROGATI0N IS WAIVED,sW#ect to the.ternw antl condtflons of the policy,certain policies may requIre.an oralcrawment A statement on thiscertiftcala does imot cw4ar rigida tothe csrdtleate holder In flu of such ends}. PRODUCER Mcr Ffmt Class InSurance Market PHONe (305)141=2997 (305_ 1-6443 4101 NIM 9th Street AWL& rear .C= Miami,FL 33126 I AFPOROM CON� NAS 1a Phone WS)441-2947 Fox 1-6+443 IMIURERA: WILSHIREINSURANCECOMAPNY R=RED INSURER 8: CASTELLON PLUMBING CORP OMRER C: 9841 NW 130 ST 1 INSURER D HIALEAH GARDENS,FL 33018 1 RM I RERF. 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. NOTUVITHSTANDIlsIG ANY REQUIREMENT,TERRA OR CONDITION OFF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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 TYPE OF INSURAPt M POLICY BER YYM � � LIMITS 09NERALLIABNJTY EACH OCCURREICE s 1000,000.00 COMMERCIAL GM&RAL LIABILITYDAMAGE TO PREMISES(Ea RENTED $ 1Q0,0 e rwel 00,00 ❑ ❑ CLAbwsAvmE_ ® OCCUR01028513 MED(A ori pawn) s 5000.00 A ❑ N 10)29!2013 90/39!2014 PE�Rsom&AWm6 w $ 1;000,00D.00 ❑ i GENERALAGGREGATE $ 200,000.00 GEMLAMREGATE LIMITAPPL ES PER: PRODUCTS-COhAPioP Aw l$ 2,000,000.00 11 POLICY ❑ PR ❑ LOC I $ AUTOMOBILELIABILITY ! SINGLE LIMIT ❑ ANY AUTO ( BODILY INJURY(Per Parson) $ ❑ AUTOS El D A$uToDs�D N BODILY Y WJU (Per aodd�t $ E] IiIREOAUTOS Q AUTOS $ ❑ UMERELLA AS ❑OCCUR I EACH OCCURRENCE $ ❑ Exch LIn6 ❑CLAAADE ' I AGGREGATE $ MO _E1 RETENTIONS ` i WOE COMPENSATION I STATU oTH- ANDEMPLOYEWLIABiLITY YIN ❑ PROPRIETORIPCUThiF N./A i I EL EACH ACCENT $ j y�,�R�asu8se r 1 1 E.L DISEASE-EA EA1PtOYEE$' OESCOF OPERATIONS balsa E.L.DISEASE-POLICYLwrl $ N ! TION Or OPERATIONSI LOCATIONS I VEN ICLES 00wh ACORD 101,Adder Re naft Skhed:de,U!rale space Is required) PLUMING CONTRACTOR i I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF EL PORTAL THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 500 NE 87 STREET ACCORDANCE WITH THE POLICYPROVI8ION8. EL PORTAL FL 33138 p i 198(1.2010 ACORD CORPORATION. AD rights mserved. ACORD 25(2010"OF The ACORD name and logo are regislerecl marks of ACORD 1W3 FiepartVfer e qw saffimG=piwc M, -ftar> s1lmWtls.fmdht"VmWblAm electedb•bee R W�xloets'Comp n ►- IUMM311111©NNM7L 11222018 P0>miilt crdmum ORKM tIswiffew ft 'Mains 1 It1 MW 130$t: �#3i1 Fl- 3M8 01l1'Ali� FLUMOM am •e,�aard�t.� ••r 7 r• �� a�o w�ie�.•ati _-i�mftrwndri. sirr+as.� �aRttoeemtz Ct ? ta-teo9 QXIIf#lI... 12 n .... o�.� Miami shores Village Building Department �OR10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption I El 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. 'fOwner Contractor Print Name: y t �' Print Name: L9>4p_ I IWIe ;r'S uio e Signature: ms's i Signature: ' State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Swo � o e 's 2 Sworn t and subscribed before me this day, 6'• 0 day of , ,•r. . GARCtA-* otarf kW1 State of Florida �O�P"�°bel% I RAE GARCIA BY -" Coin By +�•�+ `*�' � � Icate of Florida ' Commission#EE 77863 ;, •o� y comm.ExpiresJul most%(SE (SEAL %,',;o�l�o •'• Commission#EE 77863 Type of Identification produced Type cn n ro u