PL-15-1903 t
! Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 Io Z_
Inspection Number: INSP-240148 Permit Number: PL-7-15-1903
Scheduled Inspection Date: September 29, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: BROWN, BRUCE Work Classification: Addition/Alteration
Job Address:402 NE 95 Street
Miami Shores, FL 33138- Phone Number (305)758-1303
Parcel Number 1132060140470
Project: <NONE>
Contractor: VLADIMIR PLUMBING & GAS INC Phone: (954)213-7129
Building Department Comments
1 BATHROOM REMODEL REPLACE TOILET AND VALVE infractio Passed Comments
OF LAVATORY INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 28, 2015 For Inspections please call: (305)762-4949 Page 9 of 44
Miami Shores Village y ROM
10050 N.E.2nd Avenue NE hit �
Miami Shores,FL 33138-0000 \� \ IN
3 3 f \� - � •'.
Phone: (305)795-2204
FioRiaP �\ � 3
Expiration: 02114/2016
Project Address Parcel Number Applicant
402 NE 95 Street 1132060140470
BRUCE BROWN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
BRUCE BROWN 402 NE 95 Street (305)758-1303
MIAMI SHORES FL 33138-2730
Contractor(s) Phone Cell Phone Valuation: $ 700.00
VLADIMIR PLUMBING&GAS INC (954)213-7129 Total Sq Feet: 00
Type of Work: 1 BATHROOM REMODEL REPLACE TOILET A Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-7-15-56512
DBPR Fee $2.25 07/29/2015 Cash $50.00 $ 115.10
DCA Fee $2.25
Education Surcharge $0.20 08/18/2015 Credit Card $ 115.10 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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-named contractor to do the work stated.
5e V Q-,4'eX1-N I aA-�e v� August 18, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent uate
Building Department Copy
August 18, 2015 1
Miami Shores Village
7JUL
CETVFD
Building Department 29 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax: (305)756-8972 P'Y'
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2019
BUILDING Master Permit Nok
PERMIT APPLICATION Sub Permit No. / S — 3
BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:�!^�� ��5_22 �. =
City: Miami Shores County: Miami Dade Zip: �1�
Folio/Parcel#: /1-3oR66 nol ql""i2�J� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �/
OWNER: Name(Fee Simple Titleholder): lJ — UL�J Phone#: f�� ,Z/
Address: 495- h
City:„i��/��i' ���U/P/—"J State: iu Zip:
Tenant/Lessee Name: Phone#:
Email: *,� G n
CONTRACTOR:Company Name: y 101 'f A)m ti �'G Phone#:oS / ' Ei / 2�
Address:
City: t}-1D l L,•g Sttat_e^: Zip:
1�9 J �
Qualifier Name: y ht��C�'l i t� y �D V ( moi Phone#:
State Certification or Registration#: Co S 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ WO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ire)1 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ k b` K
(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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencer0ent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature -- f–
Signature�WI
r`
NE �oiAGE➢ T CONTRACTOR
The fo ng instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of `� 20 by ;;�-7 day of - .0 20 by
who is personally known to 1/� w��' - who is personally known to
me or who has produced rt– 7>:2%1Qr-< as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: ��iiiiii� «� NOTARY PUBLIC:
✓;
Sign: 61 Sign:
Print: - Print: ,,. '�' "'# * SERGUEIKA7AK�5240
Seal: C;> �'J' `"' Seal: * * EXPIAE� N�rySer*"
y 7TE OF F�
APPROVED BY vPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
i, 100
JEFF AJWATER STATE OF FLORDA
CHIEF FINMICl/L OFFICER
DEPIIRTWA3ff OF FINANCIAL SERVICES '
DIVISION OF WORKERS'COMPENSATION
••CERTIFICATE OF ELEMON TO BE EXEMPT FROM FLORDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has eieCled 10 be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE- 2/32014 EXPIRATION DATE 2132016
PERSON: RANKOViC V-ADIMIR
FEN: 010805060
BUSINESS NAME AND ADDRESS:
M-ADIM IR PLUMBING&GAS INC
1925 THOMAS STREE
HOLLYWOOD FL 33020
SCOPES OF BUSMIESS OR TRADE
LICENSED PLUMBING
CONTRACTOR
PvaaitoCWm440.0$W.F.Smdkwdaeupom+Mdeaisemp4mlraaM+ � ➢am'fioeeddaimudrMsxfm
marrancowbelts aemVe a"10da dila.PseasatbC1�le 44005(1P1.F�-a.s.w�ddsimsoeeeswp.-spr�r
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a adcaa(ura ddadimbbee "bast9WbraboilwkdagfesdM 1eYnpdMnslmvMissacedMurYfcaift.
Ore peam na�edm lr nuYos ar cerNolero lags aes4 M nqiramels dUh saAos for btiaanosd a ca56carti TlydRnrb�I dr0 rar4 a `
DFS-F2-DWC-252 CERTIFICATE OF ELECTION To BE EMIPT REVISED 07-12 OUESTIONS7(850013.1609
STATE OF FLORIDA
DEPARTMENT-OF BUSINESS AND ;.f
PROFErdGULATION
CFC057186 -. 09/29/2014
CERTIFIED PLd._ Q! cR
RANKOVIC.
VLADIMIR PLGORSDIC
IS CERTIFIED under the provisions of Lh_489�FS.
EtVio6mldms:ALIG31.2016
BROWARD COUNTY LOCAL BUSINBSS TAX RtUlo` r j
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000
VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015
DBA: Receipt#:PLt MB NG/LWN SPRNKL/CONTRACTOR
Business Name:VLADIMIR PLUMBING & GAS INC Business Type:Y (PLUMBING CONTRACTOR)
Owner Name:VLADIMIR RANKOVIC Business Opened:02/25/1999
Business Location:3121 NW 47 TER BLDG 4 APT 204 State/County/Cert/Reg:CFC057186
LAUDERDALE LAKES Exemption Code:
Business Phone: 954-927-9926
Rooms Seats Employees Machines Professionals
1
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 0.00 0.00 2.70 1 0.00 0.00 29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location.This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
VLADIMIR RANKOVIC Receipt #30A-14-00000070
3121 NW 47 TER BLDG 4 APT Paid 10/02/2014 29.70
204
LAUDERDALE LAKES, FL
33319
2014 - 2015
Fax:.(305)756-6872
.�►rv�� CERTIFICATE OF LIABILITY INSURANCE "mom mor"
7 malas
THIS CMIFN:ATE 18 ISSUED AS A MATTER OF P CATION ONLY AND CONIMU NO IR QM UPON THE CMIOWATE HOLDER.THIS
CERTIFICATE DOES NOT AFF111WATWLY OR NEGATIVELY AMEND,WMM OR ALTER'IHE COVERAGE AFFORDED BY THE POJCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOM NOT CONSTITUTE A cowmACT 86ram-am ISsum mamm AUTHoRmD
REPRESENTATIVE OR PRODUCER,AND THE cERTIRCATE maLmR.
NUMWAMI. WON wee holder is an ADon UMAL NNSURED`the poiciomml nmt be eomm=d If SU8ROGATION IS WANED,,vWect to
the temis and coa W-m at the poft,oertm PoQde:mW mv*.=wWw= W1L A ton oris c"Vicate dam tut confer roue to dw
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PROMMIR Monica Mendez
Finney UMmnce Corpofadon et&WOM 3 ase .ezos
5601 Sheridet Street
Hollywood,FL 33021
NAIL
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Vladh10t Plumbing&Gmm Inc c.
2306 Van Sur+eft ApL1 p.
Hollywood,FL 33020 13:
F•
COVERAM CERTIFICATE HLOA13M 60080009.9 REVisam NUMBED 2
THIS is TO CERTIFYTHAT IF E Pout Es OF INsuRANcE L.ISTID BLLOW HAVE!LEEN{ TO THE iI3URED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWIT?N6TAbDNGANY REQUtRHJENt TUI OR OONOWIM OF ANY OONTNAI'•I OR OTNM DOOAMTI WITH IAIMPECT TO WHDH THIS
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D0011110NB AND COINDLno.us OF SUCH POLIOS,LIMITS S WMAI MAY HAVE BEEN MWED BY PAD CLANS
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CER77FICATE HOUNW. CANCd t.ATiON
SHOULD ANY OF THE/MQVB DESCrOW POJ "eE CANCE LM ewoM
civ of Illlenti Shones TW EXP"TION DALEVIWMF.NOTICE VXL.BE oftriu D iN
10050 NE 2nd Avenue ACCOOWAM imm Too Pom"PRAIVUbam
111 b1W Shares,R-33138
.Reree�Irr�TA�
ACuMp SS(ZOT4f01) The ACORQ n0sm and ®1laB,2014 ACOI�CORPORATION. Aq rights rasarMad.
�°ate d nlstks of ACORD
Printed by MIM on July 28,2015 at 01:20PM
Date: July 29th, 2015
Vladimir Plumbing&Gas, Inc.
CFC 057186
1925 Thomas St hollywood FI 33020
Ph 9S4-213-7129
State of Florida
County of Broward
Before me this day personally apperead Vladimir Rankovic who, being duly sworn, deposes and
says that he or she will be the only person working on the project located at 402 NE 95TH ST
MIAMI SHORES, FL 33138.
Sworn to (or affirmed) and subscribed before me this 29th day of July, 2016, by Vladimir
Rankovic.
Personally known
OR Produced identification la J-860-50-A-3-0
Type of Identification Produced � MIHAELA STOICA
•y
•'= MY COMMISSIONS EE200Wi
'''•fi• EXPIRES Jure 17.2016
Print,Type or Stamp name of Notary
,,5�►ORFS D�
Irl iami Shores Village
mail
Building Department
ORIDA 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' coverage req p g p requires Workers' Compensation insurance 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 i£
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:
wn r
State of Florida
County of Miami-Dade
J
The foregoing was acknowledge before me this day of SU C ( 20 G—
B j�iUC�/� �`Lc���l' \\�����t�� �iurrrrr�i
y �yera v�f�cq�is personally known to me or has produced
............
es
catiod-_
r _
Notary:
SEAL: