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PL-15-1271 �f Perm r � ��'" 4 271 w �sKd`Vy.0 Miami Shores Village DIY y )� Hat: 10050 N.E.2nd Avenue NE P�er �� :. Wc�rtct;les��at€r� �iti��Alteotjr�nMiami Shores,FL 33138-0000 � � Phone: (305)795-2204 i t7Yt>$ tS 'PROVED �ZNORW4' ..... , Issue tart :6126 {2015 Expiration: 12123/2015 Project Address Parcel Number Applicant 640 NE 101 Street 1132060172090 Miami Shores, FL 33138-2468 Block: Lot: LOIS WEISMANTLE Owner Information Address Phone Cell LOIS WEISMANTLE 640 NE 101 Street (305)467-5342 MIAMI SHORES FL 33138- 640 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 650.00 ALL COUNTY PLUMBING CONTRACT (954)328-9122 Total Sq Feet: p Type of Work:REPLACING SINK AND ICE MAKER 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 $0.80 Invoice# PL-5-15-55730 DBPR Fee $2.25 DCA Fee $2 25 05/27/2015 Check#:1983 $50.00 $109.10 Education Surcharge $0.20 06/26/2015 Check#:1989 $ 109.10 $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,MECHANICiii5 S,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: rtify that all the ore ate and that all work will be done in compliance with all applicable laws regulating construction and zonin F thermore,I auth rize tor to do the work stated. June 26, 2015 Authorized Snature:Owner /UWtnt / Contractor / Agent Date Building D1partment Copy June 26,2015 1 Is bq Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235521 Permit Number: PL-5-1 -1271 Scheduled Inspection Date: September 22,2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: WEISMANTLE,LOIS Work Classification: Addition/Alteration Job Address:640 NE 101 Street Miami Shores, FL 33138-2468 Phone Number (305)467-5342 Project: <NONE> Parcel Number 1132060172090 Contractor: ALL COUNTY PLUMBING CONTRACTORS INC Phone:(954)328-9122 Building Department Comments REPLACING SINK AND ICE MAKER Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-inspection Fee L No Additional Inspections can be scheduled until re-inspection fee is paid. September 21,2015 For Inspections please call: (305)762-4949 Page 3 of 44 Miami Shores Village Building Department MAY 17 MIS 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 13y--- INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC M6 BUILDING Master Permit No. yk� PERMIT APPLICATION Sub Permit NoTL ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING F-1MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: E 0", 5�f City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: p t)f Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder) L :&tVy_��V.� �(� S,Whone#: 3DS`js�. 299®) . Address: 6A-0 W E 1®1 S- pp City: 11 a 1-$ State: Zip: -,2N Tenant/Lessee Name: Phone#: Email: vi ► o CONTRACTOR:Company Name:_ _ Phone#: Address: City: �j c r1¢CSI k e� ECL State: (L Zip: 3-6 `1 Qualifier Name: w C \� a' 0aoI0Q4e Vj s 'Qj 0 Q 15S ZW_Q Phone#: SSk—, �. ��► State Certification or Registration#: C_V�C, ®'�) !10% S 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:—_ _��k(DLI�A. \fk NC CL XJA "C'ey.c� V"'e V Specify color of color thru tile: Submittal Fee$ Permit Fee$ Of ISO, CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �—a (Revised02/24/2014) I 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. 1 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 low 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 ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature_ 1 Signatur `� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The Joregoing instrument was acknowledged before me this 1 I,'day of nla�z ,20 /S�—,by "/ day of `V 20 4 by __,who is personally known to 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: Sign: Sign: Print: (✓� rt-D Print: Q. YL J Seal: Seal: �auunq `,�joi y Piiei:Notary DOUGLAS MARIANO DOUGLAS MARIANO Notary Public.State of Florida � Public-State of Florida My Comm.*E�xkIre "; Con�It�{`IIPliS100 FF 046776 .,,nwu ommission#FF 046776 APPROVED BY flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 .g WS1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 WOESSNER,WILLIAM W ALL COUNTY PLUMBING CONTRACTORS INC PO BOX 13098 PORT EVERGLADES FL 33316 Congratulations! With this license 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 from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. p" PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC039956 ISSUED: 08/12/2014 serve you better. For information about our services,please log onto www.m yflorldallcense.com. There you can find more Information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you,subscribe MESSNER,WILLIAM'W to department newsletters and learn more about the Department's ALLCOUNTYR t7 BING CO, CTORS IN initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. _ r-�----� 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 Ch.489 FS. and congratulations on your new licensel Expbatian date:AUG 31,2D1s L1408120MIS DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD y a: TFC03959 �. s•, The PLUMBING CONTRACTOR Named below IS CERTIFIED �a Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 WOESSNER,WILLIAM W.. ALL COUNTY PLUMBING-CONTRACTORS INC_ 1870 NE 207 STREET� --' R IC NORTH MIAMI BEACH FL 33179 0 1e011CM net4')Mn4e niQoi Av AQ P=tni iipr-n RY I AW Sr-nit I iAmi9tinn9n1R i SROWARD COUNTY LOCAL BUSINESS TAX RECEIPT " 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 i DBA:ALL COUNTY PLUMBING CONTRACTORS Receipte:PL�iNO3LWN SPRNKL/CONTRACTOR Business Name:INc Business Tye:(PLUMBING CONTRACTOR) Owner Name:WILLIAM W WOESSNER Business Opened:11/19/1991 Business Location:701 N E 1 AVENUE Stat0/C0unti//CelrtfReg:CFC039956 POMPANO BEACH Exemption Code: Business Phone:954-796-6124 Rooms seats Employees Machines Professionals 1 ' For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee I NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 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: WILLIAM W WOESSNER Receipt #30A-13-00013382 PO BOX 13098 Paid 09/30/2014 27.00 PORT EVERGLADES, FL 33316 i 2014 - 2015 -A 0' CERTIFICATE OF LIA13ILITY INSURANCE • i 1134/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANn CONFERS NO RIGHTS UPON THE CERTIFICATE 1401DF.R.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NFGATIVFI.Y AMEND,FXTFND OR ALTER THF COVFRAGC AFFORDED BY THE POLICIES BELOW. INS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCK AND THE CERTIFICATE HOLDER. IMPORTANT: If the cortiticste holders an AD-01TIOIAL MUM,thy po Mss)must Fe endorsed. i SUBROWONV ,subject to the toms and condlMons ofthe poky,cortahl polklas may roqulra on ondorsoment.A statwont on this certificate does not confer rights to the aordfltab holder in Eau of such ondolxornonl s. k PROMER -WANGEL T.CA6TR0 SOUTH PL COMMERCIAL INSURANCE PLANNERS OIL 306 819-8616 ga04�a+9 aaa� i 16166 NW 77TH AVENUE#1004 ai►a�eu MIAMI LAKES FL 33014 w®UeA A ACCIDENT INSURANCE COMPANY 11673 INSURER 0 ALL COUNTY PLUMBING CONTRACTORS ING 140 NE 214TH STREET t MIAMI FL 33179 IITewIaR P: ; COVF.RAGrg Cf RTIFICATE NUMBER: REVISION NUMBER: THIS 16 TO CERTIFY TFD4T TILE POLICIES OF INSJRANl;E LINED dLLUSN HAVE U&N `LSU 10 1 HL ASU&U NAMLUAW-O&DUH I HI:i'GIJG'r 11044 INLNCA i Lo. NOIWI I F IS IANUING ANY ReQUHLMENT,TERM OR CCNt11TION or ANY CONTRACT OR OTHER DOCUMENT W"RFgW-GT TO WHICH 7HIS CERTIFICATE MAY Mil-ISSUM VIR MAY PFRTAIN,TI IP imAir cr AFroRDrD nY ric PtM.If:1E.",DCSCRIUM HEREIN IS SUDJCCT TO ALL TI IC TEPM"u, t=XCL1.150N AND CONNTIMS QF sow PALiCirs.LIA71TS SI MILAN MAY HAVE DCCN nrDUCCD DY PAID CLAIMS, NM 1VK OF ROURANCt A® UVR PDLX:Y[Fg }1LY eXP DIMS CENERAL LUISIUTY �Ataluu usatrNta _ ;1,DOO,000 o>, 6C rti RSO -100,000 A X rd110J R(su r'�FNFRAI I M I"y '�" i ICLAIM00AOE U06ZJR CPP001718800 1110=14 11IM&KA01S r�nEx�r moprao,Lf.5.w0. f =.1 000 P tiEN0RA4 AUGIgFGATE s2.000.000 LAIG3n Liner ,IrBPPR PROn,.f S (•cMMI'MIS 12,000,000 X cr P' a 1 AUTOWGU LNUMUTT 9QA1LE LRp l A%Y AUTO i 80611Y 1H pXtY lib,Pct ma,) 5 &trlia7AlkU AU�kG R�Iti Y1tLHIRYiaurnrn#u t► 3 IRI�DAU GS Nd}:i QW..4 0 MHtwmIlen4Iik 3 t AUA'Ob 9 ' UDaRELL.ALMbMd:IXI � IAt;ll(d:7,:URKh.Wx. � � rIKern LIAII U AM%N&W S NIOIilQsRB COgI'�ld,ATIgN «i ' 'I O �ANDE9MC1YERgLWE1KPir YIN ANY M9gt It%IJAK1NrXkXtt�JIP.% I RSA FI AC AQ411?IT (IFFl t4"EX1lUIIE D? �.J (,AarrYto y hr NNj F 4_.C>EA:_FA PMM 15Y1=F 1 1 e ti�JuasUuuwA� rr a 1 I'M ' •HKICY 1*411 DUCFPTIOt1 OF U'ERAITi)NS:LDCATWNV$VEH74US WicnAGU IJ 101,AdMand Rawmt SetAods,A more spus■roquirt4) PLUMBING CONTRACTOR , state lic # cfco39956 CERTIFICATE BOLDER CANCELLATION i MIAMI SHORES VILLAGE RHOUI.D ANY OF TNS ABOVE DIMMED POLICIES BE CANCELLED BEFORE THE EXPIRAMM DATE THEREOF, NOTICE WILL D@ DELIVERED IN i BUILDING DEPARTMENT ACCORDANCE&V,'RH THE POLICY PROVISIONS. ; 10080 NE 2ND AVENUE MIAMI,FL 33138 AUIHUftkWRhWI:1kNIAIwI'ALACHIAk <DAWip UNDWNRITE?RS INC 01988.2010 ACORD CORPORATION. AN right reserved. AOOkU 26(2010106) Tim ACORD name and logo aro roglstemd"wks of ACORD r JEFF ATWATER CHS FMMCiAL 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 E)(EMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4125/2015 EXPIRATION DATE: 4/24/2017 PERSON: WOESSNER WILLIAM FEIN: 651117368 BUSINESS NAME AND ADDRESS: i ALL COUNTY PLUMBING CONTRACTORS INC PO BOX 13098 i PORT EVERGLADES FL 33316 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS r 1 Pursuant to Chapter 440.05(14),F.S..an oftfter of a corporation who elects mternpiion from tht chapter by ting a cerffi ate of elecdon under ids sediort may not recover bensfits or c mpensadurh under this chapter.Pursuant to Chapter 440.05(121 F.S.,CWAcM=of election to be exempt..apply only wMft the scope of the bust n3ss or trade now on the notice of election to be exempt.Pursuant to Chapter 44o.o5(13),F.S..Wo&as of election to be MmPt and oerdflrates of election to be wcehnpt shall be subject to revocation H,at arty time atter the ffimg of the notice or the issuance of the cermcate, the person named on the nalica or eertiflcate no"ar meets the reouirements of this section tar issuance of a cer0oate.The depart nardstall revoke a DFS•F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1608 { ALL COUNTY PLUMBING CONTRACTORS INC. PO BOX 13098 FT.LAUDERDALE,FL 33316 STATE CERT OCPC039956 DATE: COUNTY OF D STATE OF /2 / D A BEFORE ME THIS DAY PERSONALLY APPEARED ,��/�/df / If 55fL-WHO, BEING DULY SWORN,DEPOSES AND SAYS: THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: SWORN"TO (OR AFFIRME C ED BEFORE ME THIS RC?, DAY OF ..fnqJ 20 BY PERSONALLY KNOW OR PRODUCED ID_____ YPE OF ID ODUCEDL - #aY Notary MARIANO ZVP) Notary Public-State o1 Florida *;E-My comm.Expires Aug 27,2017 :ter s o� ,n 1 commission#FF 046776 �y V 4uUN PRINT,OR TYPE NAME OF NOTARY V7 REs ' also q,..M Miami Shores Village `47%Vr2t�ToWd$' Building Department 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(id_ day of G� ,20 By _ \ J r, r who is personally known to me or has produced as ide DOUGLAS MARIANO J�4ppY P�B'�y Notary: '��•� : Notary Public-State of Florida My Comm.Expires Aug 27,2017 SEAL: Commission#FF 046776