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PL-15-2529 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-244932 Permit Number: PL-10-15-2529 Scheduled Inspection Date:January 05,2016 Permit Type: Plumbing -Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner: SANCHEZ,VAL Work Classification: Addition/Alteration Job Address:101 NW 102 Street Miami Shores,FL 33150- Phone Number (305)962-9175 Parcel Number 1131010220050 Project: <NONE> Contractor: MPS OF MIAMI INC Phone:(305)627-0199 Building Department Comments RELOCATE 1 TOILET 1 LAV AND REST SET. 1 TUB 1 infractlo Passed Comments KITCHEN SINK INSPECTOR COMMENTS False Inspector Comments Passed lz� Failed a (� Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid January 04,2016 For Inspections please call: (305)762-4949 Page 13 of 45 Pert t o IPL �1 01"4""' Miami Shores Village �� >itrt712tflt�� D ( 10050 N.E.2nd Avenue NW � {�/ f�rr}}y� (gyp Ne n/ =ft Mio •• Miami Shores,FL 33138-0000 ' It - °ties �Phone: (305)795-2204 ;,�, a t>� a APPROVE rtt� S D Al��toxcu�► � r IssusJ�ate. 12/10�1; Expiration: 0 /07/ 016 Project Address Parcel Number Applicant 101 NW 102 Street 1131010220050 Miami Shores, FL 33150- Block: Lot: VAL SANCHEZ, LLC Owner Information Address Phone Cell VAL SANCHEZ, LLC 3125 SW 80 Avenue (305)962-9175 MIAMI FL 33150- 3125 SW 80 Avenue MIAMI FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 MPS OF MIAMI INC (305)627-0199 (786)256-4690 _,...._... ..... _.._ ,._. .._:. ....._ _..._. ,__ ,..... _ .,._.. ..,.... Total Sq Feet: 00 Type of Work:RELOCATE 1 TOILET 1 LAV AND REST SE 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 $1.80 Invoice# PL-10-15-57321 DBPR Fee $3.38 10/05/2015 Check#:7725 $50.00 $195.56 DCA Fee $3.38 Education Surcharge $0.60 12/10/2015 Credit Card $ 195.56 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $245.56 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work d by e' m elf, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL, DOOR ,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all �/oref ormation is a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermor auBove tractor to do the work stated. December 10, 2015 Authorized Sig ure: A plicant / Contractor / Agent Date Building Department Copy December 10,2015 1 Miami Shores VillageP-TvR- Building Department ocr 0 5 2095 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY. Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 201Y BUILDING Permit No. F/ ��✓' �� PERMIT APPLICATION Master Permit No.Pct -01 - 1 C_� Permit Type: Electrical JOB ADDRESS: P 0 I `)\N I a City: Miami Shores County: Miami Dade Zip: Folio/Parcelk Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):�Q Phone# Address: 3 1 2� City: l_A %C State: T-L Zip: J 1 Tenant/Lessee Name: Phonek Email: CONTRACTOR:Company Name: C �� r� Address1l]7� � E 11�old City: �C�1f2�, �-1 State: C Zip:_�-160 l Qualifier Name: — 1 Ci C4)(Y Phone#:36'� State Certification or Registration#: V=C I�_ta �1 Certificate of Competency#: Contact Phone#: Email Address:rYN PS Cl& �-'t , 0i L '' a" 011."1 0- ( . 0 c DESIGNER:Architect/Engineer: Phonek Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address *Iteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Kef 00 a-I e 4-z, / e,�- 1, 1 �-� (nu , 7 4z--,, /e Submittal Fee Permit Fee$ Z ZS �'v CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 9 5 °k Bonding Company's Name(if applicable) Bom ing Comlmny'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 whic os� 7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ro and a reins ction fee will be charged. Signature Signature Ownervf Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20�J,; y 1/l �� g day of�-�- ,20��,by L9 C'I who is personally known to me or who has produced who i gers� onally known to me r who has produced �C—=As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 4V*A-1 Prin . Print: 0i ag A E Notary Public State of Florida �a e�� Notary Public-State 01 FIOf� My Commis o� saoanna M Feliciano M Commission Expires: - `• My Commission FF 082753 y p •'_ Commission i FF 212217 FORta Expires 01/12/2018yrO� �Aa My Comm.Expires Mar 22,2019 �� .°;;t• Bor ed through National Notary Ano. xx�mxm�x��xxx�a�m��a�xx�xxx�x��u��xx�xxx�a��xxx�:xxx�x��x��xx:x�a��rxxx:xnx��xxx�xnxxxxx�a�xxxxxx�xxx�xxx APPROVED BY //'/�'/� Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) AUG-26-2015 14:57 From:MPS To:3057569972 Pa9e•1,'5 `5t�►0•�S IV FS Miami Shores Village OR wilding Department 1 050 N.E.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.--JZCOPY OF QUALIFIER'S STATE LICENCES B._L X 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 C mtractor 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 ntractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLO 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 num r. BUSINESS NAME: Am ; v1 'CITY ' BUSINESS ADDRESS: dQ d 1 f�C� 1 STATE BUSINESS PHONE: ( c� ` ) G' FAX NUMBER o r CELL PHONE-(?(O0 (�GjO QUALIFIER'S NAME: L f �--E QUALIFIER'S LIC NUMBER: F C-- 1 Cj AUCs-26-EAJ15 14:57 From:MPS To:3057568972 Pa9e:2,5 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIO CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-13.95 w, 19 .0 NORTH MONROE STREET TALLAHASSEE FL 323990783 MASSANET, MAYKEL M P S OF MIAMI INC 7561 WEST 29 WAY HIALEAH FL 33018 Congratulutions! 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 OF ORIDA from architects to yacht brokers,from boxers to barbeque restaurants, STATE TE !a, •Q.F.BUSINESS AND and they keep Florida's economy strong. {: PROFS I� US INESS Every day we worts to improve the way we do business in order to CFC1426700 Q' s E/19/2014 serve you better. For information about our services,please log onto �.ss " -_•; tW1W.-•-. r www.myfloriftlicense.com. There you can find more information Y CRTFFII*D PIl3eR about our divisions and the regulations that impact you,subscribe �;�_ Y__:••....*�• to department newsletters and team more about the Department's `, MASSANI_7; initiatives. M P S OF drAIAI .;;';a«fir•:< '> Our mission at the Depa,tment 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, JS;CERTINEW'under the previsions of Ch.489 FS. and congratulations on your new license! '" •EIi W l eat® AUG 31,2916 1,1408190600837 DETACH HERE AUCs-26-2015 14:58 From:MPS To:3057568972 Pa9e:4-15 DATE IMMIDDlW" CERTIFICATE OF LIABILITY INSURANCE os/zslzo,s f 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 NSURER(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 SUBROGAI ION 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 andorsem 5. GO MT, Cec2 Gonzwm PRotw R Latin American Mutual Insurance PHONE 305-642-7515 FAx o 305 12-7518 PO BOX 361088IA=-N6-EAh -ram-49MR9.L-—limia-i—nCORUI.Com Miami FL 33135 1N5U S AFFORDIN6COYERAGE N=0 INSURER A:ENDURANCE AMERICAN SPE MALTY INS.0 INSURED MPS OF MIAMI INC DIsuRER a 7581 WEST 29TH WAY INSURER C: HIALEAH FL 33018 INSURM 9, INSURM E INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION Nt MBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPEOFINSURANCE analI�MqjqMm POliCYNUMBER D EFF POLILYE1tP L mns 1101 COMMERCIALGENERAL LIABILITYLi EACH OCCURRE E $1,000,000 A CLAILS"At2 LTJ OCCUR DAMAGE TO R PREMISES Ea 3100,000 $5=DED CBC2000028100 02/04/2015 02/04/2016MEp AO INJ R GATE P/QP( ) $ 6,000 PERSONALSURY $ 1,000,000 POTHRR. 'L AGOREGATE LIMIT APPLIES PER: GENERAL AG(i $2,000+0(JO POLICY 1:1JE EDLOC PRODUCTS-Co P AM S2,000,000 S AUTOMOBILE LUUMMYLi tE M eD 5IN E NMi $ ANY AUTO BODILY INJURY Perso) S ALL OYVIIED SCHEDULED AUTOS AUTOS BODILY INJURY 8roaddwd) S WREDAUTOS NON-OWNED PERTY GE S UMBRELLA LIAR OCCUR EACH OCCURR CE S EXCESS LIAM CLAIMS-MADE AGGREGATE $ DED RETENTION $ WCRKOM COMPENSATION AND EMPJ,OTErtSLIABILITY YIN ST TUTE ER ANY PROPRIETOR;PARTNERlEXECVnve EIEACHACCI FM S M.=UERgcCWt7m7 MIA t! gg,dg�lShg uridd?1 AL DISEASE- EMPLOYE S DESCRtPT10N OF OPERATIONS tkelo+Y EL DISEASE- IOY LIMIT $ DESORPTION OF OPERATIONS/LOCAT1eNs/vEHtCLEs(ACORD 101.AddWcrdkI ROrMtks Smbedale,may be gl{g~iy mm ipgag io mq:d®d) PLUMBING DOORS INSTALLATION CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUIDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED Po tCIES BE CANCELLED 13EFORE 10051)NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTt E Wfl L BE DELIVERED 1St MIAMI SHORES FL 33138 ACCORDANCE VAT14 THE POLICY PROVISION AUTHOMIED Fd FRESENTAmrt C CILIA GONZALEZ A307480 01888 2014 ACORD CORPO TION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD PradU"d VWng Poring Boss VY&b BORMre.www Fomt69os%com;7 tnfpressWe PubGSIIMq 806.208-1077 002800 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 7187393 BUSINESS NAME/LOCATION SANCHEZ VAL LLC RENERECEIPT No. EXPIRES 7468 1800 PURDYAVE APT 1403 AL SEPTEMBER 30, 2016 MIAMI BEACH FL 33139 7468386 Must be displayed at place of business Pursuant to County Code Chapter SA—Art.9&10 OWNER SEC.TYPE OF BUSINESS SANCHEZ VAL LLC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED Worker(s) CGC1521594 BY TAX COLLECTOR $45.00 09/14/2015 CHECK21-15-127081 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, Permit or a certification of the holders qualifications,to do business. Holder must comply with any gove cause, l or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above most be displayed on all commercial vehicles—Miami—Dade Cade Sec Ba-276. For more information,visit lmww miamidade aov&axcollector AUCs-26-2015 14:58 From:MPS To:3057568972 Pase:5/5 JEFF ATiNATFJ2 CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION R R CERTIFICATE OF ELECnON To BE EXEMPT FROM FLORIDA WORKERS'coMPENSAnoN Lw CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 3/6/2015 EXPIRATION DATE: 3/5/2017 PERSON: MASSANET MAYKEL FEIN: 223865236 BUSINESS NAME AND ADDRESS: M P S OF MIAMI INC 7955 W 28 AVE HIALEAH FL 33016 SCOPES OF BUSINESS OR TRADE: MACHINERY OR PLUMBING NOC AND EQUIPMENT ERECTIO DRIVERS Pursuant to Chapter 440,0504),F S,an officer of a aorpmO-who elms exemption*am this der by lilif+g a cmalceta of eiecson under this may not'"r b9n6Tds or Compensation undo alis Chapter.Pcuauarcl t0 CAapter440.05(12).F.S.,Certificates d efearm to be exempt...apply only . the snipe of ffte business w trade listed oh the notion of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notions or eltrviion to be exempt d ewes of election to be exempt shall be subject to revocc st on If,at any tan®after the rang of the notice ar the of the certificate,the person named on the notice or e�rtmc;de no longer meets the requifomgtrts of this seotiocr for:� Of a certificate.The d spsrtrnerC sttatl revokg a Certdr-M DFS-172-DVNC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUE ONS?(850)413-1609 51�oR ms`s l` shores Village I iami ones 1..,.� M Building Department �lOR10050 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 comany for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE TH YOU VE 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 / ,20 By_ \\ who is personally known to me or has produced .[JL as identification. Notary: WMMIRWA -* :. W COMMISSION#FF 100402 SEAL: s d= EXPIRES:March 28,2018 '�..... .` 80^#ed Ttn NotaY Pubpc Undernrkere .00 "S 0 Prumbing Of W iami Pe CFC 1426700 W 28 AVE, HIALEAH FL. 33016 PH: (305) 627-0199 FAX: (786) 362-5348 August 26,2015 State of fi o}-k c C� County of V , L E' Before me this day personally appeared�-( (_1 1(,-j ho,being duly sworn,deposes and says: That he will be the only persom working on the ioject located at: Maykel Massanet signature Sworn to(or affirmed)and subscribed before me this day of 1�i C -1, ,20 c,t 1 , Personally known or Rroduced identification Print, or Amp name of notary. "•.,, MARS PONCE Notary Pablo-State d FWW • Com ossm N FF 214217 My Cow.E*n Mar 39.201 solM�d N- IIMMMAM 001136 � 40= � oun Of 10" , .. NOT A 9tLt" IT EXPIRE 2016 { OE MIAME INC '' 'Must dis iaYed at, ts�t business 75f tW 29 WAY Pursuant to CourAY COrte � Q CWW BA.--Af" SEC.'t"vpe OF S4affiItW%$ PAYMENT RECOVEt3 OtAi iEft 196 ?413A EI{Plta. �4�"k Cr 0F1 BY SAX CQLLECTOf4 MPS 0f MIAMI INC CFC142,9700 $45.00 08/07/2015 vUrS} 3CHECK2 t- 3 -15-112590 0*4 Lanai ausioess Tax.The Renew is not a license, Ttsli�locol Bosiasse Race�Y ovotirms PBYm t Holdermost"WIV Wo any 9osfatnmantsi' vetn'rtificidion,Of the nW rregsdsi taws ead requirataards � to the Itaslq a , t ti HEGEtP1 N0.ahave must ba rNspEaved an all cammeroiat vehicles-t44tardi»ltado. Sen � For nIM wormation,mm avu»v mid