PL-14-2007 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-219642 Permit Number: PL-9-14-2007
Scheduled Inspection Date: March 24,2015 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: TRAVELS&RENTALS CORP,TRAVELS Work Classification: Addition/Alteration
4 0MJ1rAI Q/`noo
Job Address:37 NW 108 Street
Miami Shores, FL 33168- Phone Number
(305)538-8105
Parcel Number 1121360110290
Project: <NONE>
Contractor: AT QUALITY PLUMBING INC Phone: (786)2584564
Building Department Comments
Infractio Passed Comments
INTERIOR REMODEL INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
L March 23,2015 For Inspections please call: (305)762-4949 Page 5 of 52
1
' f
Miami Shores Village IZECFTN-7
T
Building Department SEP.
15 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: I
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 200
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.P/ A�
❑ UILDING [-_jELECTRIC E] ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
A�
U)
W1 �r CONTRACTOR DRAWINGS
JOB AD �AJ Oo
City: Miami Shores cage
Miami Dade Zip: 333
Folio/Parcel#: ".24 I- Qa7Is the Building Historically Designated:Yes NO
Occupancy Type:Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:, ame(Fee Simple Titleholder): 'r4P AO t S P FA)JA LS GV aT Phone#:
ddress: 13 01 S-CLL 1 A S A u F 13
33/
3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: ' Phone#: �C�
Address: i!�2�z_fl V iW ��� �
City: T, /r,�,k State >3 ge l
Qualifier Name: 466FJlIl S / G Phone#: "496 -'as es'695,_1
State Certification or Registration#: ���� � "? 2(� 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 [1 Alteration ❑ New ❑ Repair/Replace) ❑ Demolition
Description of Work: G46W?-'
Specify color of color thru tile:
Submittal Fee$ I Permit Fee$ 2Z5- x CCF 0 CO/CC$ (79
Scanning Fee$ '� Radon Fee$ - 3� DBPR$ .3 X Notary$
Technology Fee$ ` �S� Training/Educatlon Fee$ G �ry' Double Fee$�5?
Structural Reviews$ Bond$ 0
TOTAL FEE NOW DUE$0 2 • �o
(Revised02/24/2014)
41
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.
ignature Signature 6�0v��
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before m is The foregoing instrument was acknowledged before me this
'C _day of 20 ,by day of� ��� ,20 1 C/ ,by
4/1WR ffX0ATbQ QW ,who is personally known to TF"r ,who is personally known to
me or who has producecga/3S-VSyd-4g-9:53'"o as me or who has producedl�LdOGT�dPO'-00,0 W070as
identification and who did take an oath. identification nd who did take an oath.
NOTARY PUBLIC: NOTARY P UC: �1N1�N�rL-
�1h/11
��. r
Sign: Sign: �: �Jsi`127' 9�
Print: V19itJ®� Print: = o•� •
Seal: Seal: �Oj••'I'•,a 8br10\�
PrDBY
ublic State of Florida /��'�i9y s�•Pub je•• i \�\\
blo l iau itaN �/
APPPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-4783
TEJERA,ALEXIS
AT QUALITY PLUMBING INC
6055 W 19TH AVE
APT#320
HIALEAH FL 33012
,E�ictnst-With you one o#-th�.r�arly . .,. ,..; _
one me Furl by Oaparter►ent of f3usiness and
P
Regtelatn Om lonals and busses range STATE OF FLORIDA
from to yacht txca ,from boxers to ue r taurartts.
DEPARTMENT-QF s" BUSINESS AND
and they 1=torida`s strong. n PRQFESS
!' TIO !
Every day we work to i(pprove the way we do business In order to CFC142 0 OV01A 01
serve you.nbetter" For i a about our services,please log onto
ye you can find mom InformationCERTIFI P U Gq
about our d ' that impact you,subscribe 6EJERA, I:E3S
to d n hers an learn more about the s AT t�UAI.ITY P1 I INC
initia
Our mlsision at the Depertrnent is;License Efficiently,ntly,R ate Fairly.
We co a to you so that you can serve your
customers. you for doing business in Florida, is CERTIFIED under the provisions of oh.489 M
and congratulations on your now liter I Ewbom doe;e60 st.tee L144MOOM266
DETACH HERE
RICK SCOT T,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
mn
�.
CFCt42
The PLUMBING CONTRACTOR
Narvd below IS CERTIFIED
Un . Ions of Chapter 489 FS. _
Expiration date. AUG 31,2016
iR
TEJERA,ALEXIS
AT QUAL .;; ...PLUMBING
6055 W 19TH AVE
APT*320
HIALEAH FL 33012
r
gt1�,�s
Into IL Miami Shores Village
Building Department
�ZORtDA 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`ofthe 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
I 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 fora period of two years or until a
voluntary revocation is filed or the exemption is revoked by theVvision.
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 ma+y be
2raQnally liable for the worker gQMRWSLon injuries of any persgn allgw_W to work under this p=it. 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.
A ontract r
Print Print N 'f
Signature: ( in Signa
State of Florida) State of Florida)
County of Miami-Dade) County of-Aami-Dade)
Sworn to.and subsoribi'd-Sefore me this � Sworn tq and subscribed before me this
day of SeP
r - .20 day of ,20_Z�( .
Wo
( il rodkcecl
• of ftgL
• on ,.
.....� ��, � V, �, . .:
IMPOKrANT:If the certificate holdW is an A tN770WA1)S�URf,O,the pa(icy(ies)must t e fOrsed,tP SUr tOC�ATtCtt !8 WA(VED>sum
the terms and condWolt of the policy,certaln Policies May require an endorsement.A statement on this certificate dosis not confer rlgbW to the
r
ee Mate holder In lieu of such endorssmengs).
PROW4M Y.udards Muniz
Opfim insurance Solubans,Inc (305)2259550 . (306)225-9$61
14750 SW 26 Street..Ste-103 Yudmlls Ptionlnsurancesolutlorlls.eom
Miami,FL 33105 INTI g AFFORDING COVERAGE >r
Phw* EN 2254,550 FaX 225-96x1 INSURER A. Al and Ins Cc
IISUR6D INSURERS:
A.T.Ouality Plumbing Me Itis RER C:
6036 W 19 Ave*=
Hialeah,FL 33012 (M)258.4384 RER E:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IS 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.
it TYPE OF INSURANCE ADM BUSA
pGY NE%P LIMITS
GENEW L IAN ITY LAM EACH OCCURRENCE I g 500,000.00
® COMMERCIAL GENERAL LIABILITYE r RED
RNMISESrten ) $ 100,000.00
A ❑ ❑ CLAIM"ADE ® OCCUR 0513484 MEO EXP( 0M pwwn) S 5,000.00
❑ 05/03/2014 06103/2015 PERSONAL 8 ADV INJURY 3 600,()00.00
❑ GENERAL AGGREGATE S 1.000,000.00
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 1,000,0W.00
❑M= ❑ ❑ LOC Included S
AUTgM�B11ELNAtrri LIMIT
�.�' nt
❑ ANY AUTO BODILY INJURY(Per Person) -II
❑ NI:A ❑ SCHEDULED i BODILY INJURY(Per acddeM) g
❑ HIREDAUTOS Cj A%"EO PR, E Cf)AMAGF $
g
❑ UMSAELLA LIAB ❑OCCUR EACH OCCURRENCE s
EXCESS LIAR C(, MS•MADE AGGREGATE g
D ON sg
WOIKERSC V*N W STAT OTH-
ANDEMPLOV L ITY YIN
ANY PRCPRIETORIPARTN£R!£XECUTIVE E.L.EACH ACCIDENT li
OPFICERIMEMBER EXCLUDED? NIA
In NH) E.L.DISEASE•EA EMPLOYE $
X IP RA betoaa E.L.DISEASE-POLICY I WIT $
069CRIPT*N OF OPERATMSI LOCATIONS I VEHICLES(Aita¢h ACORD 101,AddMtonW Rea ft Schedule,M more spm IS regi!red)
PIUmbM Commercial and Residential
CERTIFICATE BOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Miami Shores THE E1PIRATI1001 DATE THEREOF,NOTICE WILL BE DELIVERED IN
tOM NE 2 Avenue ACCORDANCE MTN THE POLICY PROVISKM.
Miami Shores,FL 33138 AUTHoRIZED RdWRESiNTATINE
3tueemu..an> s
Q IM-2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010108)OF The ACORD name and
logo,are registered marks of ACORD
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7431 t10 . as;st na �sp�avea
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6{ty5;t�19 AVE�. Pursuarftttz C+at»tt'Code
}{ F!Ft 33(112` Chapter
�EC.1 YPIB pp 8td�3�E8 ' PAYAaOW REC&iVBD
owe 198 pLUMBING CO
ACT 1R ax sAx Ctau ecroa�
A7 t1 pWM$ING NUC CM1428M 5.{N3 07J23/2014
pMAP -1 A-029623
WOKICET�s� 1
of `laaal6asietssaTax.'fia isr+otalie�tser
Tkis t gusiaesstaa: ����siaesa.Haider aa4'8 .
,; a ►� t 3 tah , ra at sao s - s.
ar t vahielas-,��11a
Trore'ta1®ro+atiaa.
This certifies that the individual listed below has elected to be exempt from Florida Workers`Compensation law.
• EFFECTIVE DATE: 5131/2013 EXPIRATION DATE: 513912015
PERSON: TEJERA ALEXIS
FEIN: 46140649,9
BUSINESS NAME AND DRESS:
AT QUALITY PLUMBING INC
6055 WEST 19 AVE#320
HIALEAH FL 33012
SCOPES OF BUSINESS OR E:
PLUMBING NOC AND
DRIVERS
'ant 10 Chapter 440.05(14),F.S.,an officer Of a corporaffoil%to exam
not recover benefits or compensation comer the��ter.Purstmnt to r �frmn this tapter by�n9 a oeriifioate of election under this section may
of the business or trade listed on the notice of steam to be exanpt. Otaptett�05(12),F.S..Certificates of election to be exempt..,apply only Win the scope
election to be exempt shall be subject to revocation if,at any time af#er'tsu fiaptheter 44notice0.06(13).F.S.,Notices of election to be exempt and certificates of
certlilcate,no lonoer meets Perm named on the Ceitifl�te ftregUiof ws section ntS �Of certificate.The department shag revoke as Wilfica� tissuance of the certificate,ft named annoCrc�or
the
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12
QUESTIONS?{850}493-18fl9