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PL-15-2247 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242770 Permit Number: PL-9-15-2247 Scheduled Inspection Date: December 15, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , Work Classification: Addition/Alteration Job Address:101 NW 108 Street Miami Shores, FL 33168-4312 Phone Number Parcel Number 1121360100320 Project: <NONE> Contractor: DIAL PLUMBING CORP Phone: (305)221-8569 Building Department Comments BATHROOM REMODEL TO CLOSE OUT EXPIRED Infractio Passed Comments PERMIT INSPECTOR COMMENTS False Spector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 14,2015 For Inspections please call: (305)762-4949 Page 11 of 43 W � vo 4 Miami Shores Village QI7 �jF !1j0tt9nt 10050 N.E.2nd Avenue NW M +0 t "n*Addit "'• Miami Shores,FL 33138-0000 P, StdttWAPPl O Phone: (305)795-2204 �toxzoA > , ,f ., Expiration: 04/12/2016 Project Address Parcel Number Applicant 101 NW 108 Street 1121360100320 FEDERAL NATIONAL MORTGAC Miami Shores, FL 33168-4312 Block: Lot: Owner information Address Phone Cell ['�FE!DERAL NATIONAL MORTGAGE PO BOX 650043 DALLAS TX 75265- PO BOX 650043 DALLAS TX 75265- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 DIAL PLUMBING CORP (305)221-8569 (786)412-6720 Total Sq Feet: 00 Type of Work:BATHROOM REMODEL TO CLOSE OUT EXPIR Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return: Top OutFinal Classification:Residential Scanning:3 Review Plumbing Underground Fees Due AmountPay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee InvO'tCe# PL-9-15-56936 $2.25 09/02/2015 Check#:13911 $50.00 $115.10 DCA Fee $2.25 Education Surcharge $0.20 10/15/2015 Check#:14112 $ 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 a thorize the above-named contractor to do the work stated. October 15, 2015 Authorized gnature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 15,2015 1 'x CEIVED Miami Shores Village SEP 02 2015 I� Building Department 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.��l' PERMIT APPLICATION Sub Permit NoP BUILDING ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL WflPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 101 Northwest 108th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-010-0320 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Federal National Mortgage Association Phone#:305-267-7777 Address:P.O. BOX 650043 City: DALLAS State: TEXAS Zip: 75265 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: \3 nl�wk, Phone#: Address: City: State: \ Zip: Qualifier Name: `� ��, lb �� ` ®�, Phone#: State Certification or Registration#: 4 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: -VO�C0'e)tiI%0 v l"-de 1 -�G c ^ ✓ L C - r5 Specify color of color thru tile: Submittal Fee$ Permit Fee$ 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) 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 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. t Signaturey_ � � I S Signature y OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 14 day of P L— - _�-Ir 20 6S by 161 day of + 20 l IS7 by ,who is personally known to F�c, rn14 [—p n+e,60 gwho is personally known to me or who has produced -7 Y- 'off as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOT P LIC: NOTARY PUBLIC: S n: Sign Prin Print: Pa—+r- c I d p e p-�� Seal: Seal: ASNA MILES `" '"" PATRICIA ELENA CEPERO MyCOMMI[SOonEx� ,` .�`�= Commission#EE 141550 MOO 9,2019 �,,�s,r� My Commission Expires ***** **** ************************* *********************** •.""e.,..***"Y0is ********* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SORES .•. •....� Miami Shores Village Building Department Fh1'BS tN 6� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. 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 form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE 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 form and Contractor 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: BUSINESS ADDRESS:���� �gZQ�cS'� CITY STATE ZIP BUSINESS PHONE:SOS)��( as(L FAX NUMB __) SP CC CELL PHONE( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER:�� From: To:3057568972 10/14/2015 23:51 #299 P.004/005 F w M s „ •moi From: To:3057568972 10/14/2015 23:50 #299 P.002/005 r ' oas�i u6icipal Centractoes ecei t Miami—Dade County, * State' of Florida THIS '4' NOTA BILL - DO NOT PAY ;000014319 Mc j 1 i susuua�ss NAa�enocaTtont RecPr>+so. EXPIRES DIAL PLUMONO CORK 747011410 9940.CORAL.WAY SEP'T'EMBER 30, 2016 i MIAMI FL 33165 { � Pursuant to County Code SoC IC-24 OWNER t' 1. one.TYPE OF 4usms" } i DIAL PWM8ING CORP PLUMBING CONTRACTOR ! PAYMHNT RROAM6 cotmog0) .1 j 1 X 1 0 014318 i. tt TAX COLLECTOR i POD=08/11/2015' � FP, UV-3--41"19421 •. � ...._... .,'mac . . ..: .. ..._,,, ' 1 N ocal : sin�ss '�x ec�ipt s Miami;Daae Coynty, State of Florida s I TM IS .NOTA BILL -.p0 NOTPAY 100488 9USam" S NAPANAOC.►T,QH DIAL PLU .';EXPIRES AABiNG CORP RBNEN►pL ' 9940 CORAL WAY SEPTEMBER"$�, 201 a MIAMI FL 33165 10Q4888 .,Mu8tb9.dfsplWsd et platy of•businese 1 Pursuant to County Code . I ChaptsrBA-Art 9&10 • � r ,.��-�G'�:tfRP .. . '� •�� ..�+:eEt>tptt .� '� 11�iC3'CCf11'FA7�C1' EY T� { Workers) • 10 - 000014319. GotLEeTOR $75.00 08/11/2015 FPPU03-15-01.9421 'tilts Loeel 8uetease Tmc tnnyt eonRm�e PaYmeartottJuf Local Besiness7ax.The flacsJpt M Rot s 9casse, i i �psimit at a oatttRoatlan o!S� r�qna ,to do 6�t ��r�,00�a9FIrwRA auygrrm�rosttil i I aan9��entat�?+dednYaadragairasusTs wblab The RECEIFr IIlO,a6ave mtuthe dJepleq�t ae eM atltiwsRdel vehid�-Mlaunl-Bede"sea 6e"& f ' � .. ..... ._.. . 1'4rgra7alsfomt!a2ion,aditt j s t s I { A°'R® CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD 5rn / / 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: If the certificate holder is an ADDITIONAL INSURED, the policy(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 NAME CT Barbra Gonzalez Rodriguez Tadeo Insurance Agency Inc PHONE : (305)553-1760 ac No; (305)553-1762 9120 SW 40 St E-MAILADDRESS: tadeoinsurance@Iive.com INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33165 INSURER A: GRANADA INSURANCE COMPANY 16870 INSURED INSURER B Dial Plumbing Corp INSURER C: 9940 Sw 22 St INSURER D: INSURER E: Miami FL 33165 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM D MM DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED PREMISESS Ea occurrence) $ $100,000 CLAIMS-MADE ElOCCUR MED EXP(Any one person) $ $5,000 A 0185FL00061941 -1 08/15/2014 08/15/2015 PERSONAL&ADV INJURY $ $1,000,000 GENERAL AGGREGATE $ $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ $0 X1 POLICYLI PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N T Y LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Plumbing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE q* ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER 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: 10/27/2013 EXPIRATION DATE: 10/27/2015 PERSON: FONTEBOA FRANCISCO A FEIN: 592248413 BUSINESS NAME AND ADDRESS: DIAL PLUMBING CORP 9940 SW 22 STREET MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 g- Corporation . Plumbing August 27, 2015 State of Florida County of Dade Before me this day personally appeared Francisco Fonteboa, owner of Dial Plumbing Corp., who, being duly sworn, deposes and says: that he will be the only person working on the project located at 101 NW 108 Street, Miami Shores, Florida 33150. Sworn to and subscribed before me this 27th day of August, 2015 by Francisco Fonteboa, personally known by me. Francisco Fonteboa, res. Dial Plumbing Corporation PATRIMA ELENA CEPERO Patricia E. Cepero **, ,a Commission#EE 141550 My Commission Expires Notary Public, State o November 14, 2015 9940 Southwest 22nd Street Miami, FL. 33165 (305) 221-8569 5thRE'Smill y o'googol" Miami shores Village ��- v Building Department �tORt[DA 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,.vnm-,-;tea 'T;-' -+ 3 County of Miemi-� The foregoing was acknowledge before me this �5 day of �� S ,20 I . By r (- , who is personally known to me or has produced �— as identification. Not Y� : 11%G-. JOHN R HODACK MY COMMISSION EXPIRES SEAL: p1; •�� AprO 14,2016 FEDERAL ROME LOAN MORTGAGE CORPORATION CERTIFICATE OF APPOINTMENT AND AUTHORITY Pursuant to the authority vested in me by the Divisional Delegation of Authorities Certificate, Section VII,Le 1, I hereby appoint ELVABETT3 PARSONS as Assistant Treasurer of the Federal Home Loan Mortgage Corporation (Freddie Mac) for the sole purpose of executing the documents regarding real properties which are foreclosed or real property acquired by other means and assigned to REO for disposition,including,but not limited to,the following: Marked if >attltoritles Author4 is beta need Execute any and all documents required in connection with the disposition of such property,including,but not limited to,listing agreements and any and all disposition expenses or documents associated with the listing of a property to be sold individually Negotiate and approve REO property sales contracts,sign settlement statements,and any and all documents associated with the closing of such property,whether sold individually or in a Bulk REO sales transaction,seller financing and assumptions,and limited Powers of Attorney to execute any and al I documents necessary to convey the property,transfer property by deed,transfer bulk REO properties by deed Approve REO auction and outsourcing agreements Execute agreements and claims and other necessary documents for recovery of funds associated with Single Family REO Approve property management agreements and rental agreements; Execute Deeds to transfer or donate properties to outside organizations Authorize expenditures related to the repair,preservation and maintenance of a REO property, including,but not limited to Permit Approvals and Notices of Commencement Any previous appointment is hereby revoked and replaced by this appointment, which shall become effective as of the date shown below and shall continue in full force and effect unless modified or revoked;provided that,this appointment and authority shall terminate upon the termination of the appointee's employment by Freddie Mac. This authority shall not be redelegated. lam(,k��4 — Ali is Myara Senior Vice President&Principal Deputy General Date: June 30,2015 Counsel—Corporate Governance Commonwealth of Virginia,County of Fairfax Sworn and subscribed to before me this 30"'day of June 2015. LW=WOMB Oro 1W ida =FUKW OF thor