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PL-14-2063 Ir . 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax.(305)756-8972 Inspection Number. INSP-220117 Permit Number. PL-9-14-2063 Scheduled Inspection Date: February 29,2016 Permit Type: Plumbing-Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner. MARIELA B ROVITO JTRS,AMINE Work Classification: Addition/Alteration Job Address:9400 N BAYSHORE Drive Miami Shores,FL 33138- Phone Number (305)992-6776 Parcel Number 1132050100110 Project: <NONE> Contractor: SKYLA PLUMBING INC Phone. (954)773-5323 Building Department Comments RELOCATE KITCHEN SINK TO NEW LOCATION Infractio ments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction D Needed Re-inspection Fee No Additional Inspections can be scheduled unci re-inspecdon fee is paid February 26,2016 For Inspections please call:(305)7624849 Page 2 of 60 • , . Miami Shores Village ; �������� Building Department !.� ��EP 2 2 14 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 i S Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 201,17 BUILDING Permit No. 1.1�—"` 3 PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: q go c? c5cyj!�& 3AX�HO 2e P/Z City: Miami Shores County: Miami Dade Folio/Parcel#: //-3,205 -010 -0//0 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): A'A N 000 GACA U Phone#: Address: 9 le®0 `J O U 7W ►3,a,cS�o�£ DiZ City: Jv\i AM. . Aeog& State: Zip: 39 1$ O Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company n Co PanY Name: L �r (V — � t IJP Phone#: iaq- Address•c O oO tr k S-7- w City: State:, Zip: 3� QualifierName: S A '`V g( Phone#• .3,ar--;�Io :f State Certification or Registration#: i qa 9-0 4-/ Certificate of Competency#: Contact Phone#:'3cS-_4?V_ J!? mail Address: L-VA `PGUM C_\11,C- a/yt DESIGNER:Architect/Engineen / Phone#: Value of Work for this Permit:$_ o o Square/Linear Footage of Work: Type of Work: DAddress teration ONew ORepair/Replace ODemolition Description b Woirk �'� _ k Y�rfl S%�✓� -�v �irull_ 6 -C71 O/y. C llukllp Submittal Fee$ Permit Fee$. xf CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ c TOTAL FEE NOW DUE$ J• 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. 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 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. Si tore . Signa Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was Ia/cknowledged before me this v�(O day of ,20�,by (c, 1Q6.,y---� day of� ,20 ZS�by L ZeW. who is perso ly known to me or who has produced who is personally known to me Qr who has produced As identification and who did take an oath. as identification and who did take an oath. Lori C. NoMs NOTARY PUBLIC: =_�`• �. COMMISSION#EE218753 NOTARY PUBLIC: 9 ", EXPIRES:AUG.05,2016 •4�OFpO`C WWW.ANRONNOTARY.com — Sign: Sign: Print: 6 Print: r- vLAa u Z My Commission Expires: My Co t 8. X 'fir MUSSION:EE 066673EXPIRES Jane 22,2015 rte,. BaeaedTMuNotryPub5cU*Mbm andFalraR�rdrsYdednira4dFdrdade�4aYFasre4t4r�inkaRsk�TnhsYdnY,t&inrandnkilr�irdr4idasYtk+trwdra�a3raYtkdnYdtdFav4aakdasY3nk&st4rirrTasYSYaYfr�Tr&�lrdednY�fea4anYsk+Y3rfe4nirfa*sY,tskieaYaYdnkie&�Tr&a4�kar4n4�YsY APPROVED BY 1`� Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012XRevised 07/10/07XRmised 06/102009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MCDONALD, SAMUEL SKYLA PLUMBING INC 13143 NE 3RD AVE NORTH MIAMI FL 33161 Congratulations! With this license you become one of the nearly illion Floridians licensed b T y the Department of Business and -- one m Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTTAF, OF BUSINESS AND and they keep Florida's economy strong. PROFESI REGULATION Every day we work to improve the way we do business in order to ? CFC1427071 F �` 07f03/2014 serve you better. For information about our services,please log onto www.myfloridalleense.com. There you can find more information `: CERTIFIED P ,A t Tf R about our divisions and the regulations that impact you,subscribe , MCDONAL D, _ to department newsletters and learn more about the Department's SKYLAPLUMB. initiatives. : Our mission at the Department is:License Efficiently,Regulate Fairly. We co r�r stave to serve you better so that you can serve your customen�rs. Thank you=business business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! :^��� are L407 ' DETACH HERE ......_............. RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �CFC1427071 The PLUMBING CONTRACTOR _ ` . Named below.IS CERTIFIED Under the provisions_of Chapter 489 FS. Expiration date: AUG 31,2018 MCDONALD,SAMUEL . ft SKYLA PLUMBING INC1.3143 NE 3R�?�4VE,. � NORTH MIAMI ' 13161 V IBM ... '.. .w+ _S +,bs,-aa. T� � �•i. ems^ 4 �. d � ISSUED: 0710312014 DISPLAY AS REQUIRED BY LAW SEQ# L1407030000967 Ate_ CERTIFICATE OF LIABILITY INSURANCE __ _' DATE 8`/2s ' ODPRODPR UCER Annette Willis Insurance - - 'THIS CERTIFICATE IS ISSUED AS A MATTER OF iNfORMATION ONLY AND CONFERS NO RIGHTS UPON THE RTIFICATE f 4759 N.W.183rd St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33055 ;_- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)625-8131 Fax (305)625-3694 INSURERS AFFORDING COVERAGE - NAIC# INSURER A: ARCH SPECIALTY [INSURED SKYLA PLUMBING INC rINSURER B: A_ 3315NW 213 TERRACE INSURER C: MIAMI FL 33056 �---- -- — -- - - - ---- INSUI RER 0_._-- { INSURER E: t COVERAGES 1 INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING y 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 I POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID (CLAIMS. __,-___ _.___.- -_--_-- -_---- -----; E NSR AWL TYPE OF INSURANCE ( POLICY NUMBER-- 1�pp;kM/p�I-p t pmi N LIMITS - - - - - -- t GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 DAMAGE TO F2ENTED ®COMMERCIAL GENERAL LIABILITY AGL0016287-00. 08/08/14 ? 08/08/15 PREMISES(Ea oc ,Wcc L- _$100'000.00 ❑❑ CLAIMS MADE W! OCCUR 1 MED EXP(Arty one person) - — $5 000.00 1A 4 ! PERSONAL&ADV INJURY $1,000,000.00 I I- GENERAL AGGREGATE $21000,000.00; ;PRODUCTS=COMP/OP AGG $2,000,000-00 GEN'LAGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑PROJECT 7 LOC i AUTOMOBILE LIABILITY ! 'COMBINED SINGLE LIMIT ❑ i i (Ea accident) ANYAUTO ❑ ALL OWNED AUTOS i I ! BODILY INJURY k B I ❑ ❑ SCHEDULED AUTOS (Per person) __T___ ----- ❑ HIRED AUTOS { ! BODILY INJURY { {[� NON OWNED AUTOS ! (Per accident) - j PROPERTY DAMAGE Per accident I i I GARAGE LIABILITY S i AUTO ONLY-EA ACCIDENT C ! !❑ ANY AUTO j { j OTHER THAN EA ACC I i AUTO ONLY: AGG - ! OCCURRENCE EXCESSIUMBRELLA LIABILITY ! j AGGREGATE ❑ I❑ OCCUR L CLAMS MADE ID 4 { ❑ DEDUCTIBLE _- J RETENTION $ ' — -- - -- -- - - !WORKERS COMPENSATION AND 7---- WC STA dTH {EMPLOYFJ2S'LIABILITY _ _TQ(,Y-LN4 E ,ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT { OFFICER/MEMBER EXCLUDED? _ - DISEASE-EA EMPLOYEE; _. __-_ ---_ -- -- - - _ {If yes.describe under f ` ;E.L.. 4 (SPECIAL PROVISIONS below 1 j E.L.DISEASE-POLICY LIMIT -- (F � OTHER I � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS (PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION �f - fSHOULD ANY OF THE ABOV SCRIBEDF16UCIES BE CANCELLED BEFORE THE EXPIRATION DATE THE ,THE ISSU G INSURER VMIL VOR TO MAIL MIAMI SHORES VILLAGE ! 30 DAYS WR N NOTICE T E CERTIFIC ER NAMED TO f THE LEFT,BUT F URE TO DO SHALL IMPO BLIGATION OR LIABILITY I BUILDING DEPARTMENT ! OF ANY KIND THE(NSU R,ITS G REPRESENTATIVES. f 10050 NE 2 AVE - ----- - -- - MIAMI SHORE FL 33138 AUTHo DRE E k ACORD 26(2401108)QF ©ACORD CORPORATION 1988 J , a Miami Shores Village Building Department 1ti1t11S�" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)758.8972 Notice to Owner — workers' Compensation Insurance Ekemption 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 - I. 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. o 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 revokedby the Division. 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 may be personally liable for the worker compensation injuries of any person allowed to work under this permit 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. 0%per Contractor Print Name: / Print Names.SAMU JV C Signature: jL rl! _ IZ VL Signat State of Florida) State of Florida} County of Miami-Dade} .lk, County of Miami-Dade) Sworn t d subscribed before me this Sworn to and sub 'bed before me day of ,20�. day of ,20„L_ By �6(-A Pro By (SEAL) WIFA MY COMAtiSSION i EE 066M (SEAL) EXPIRES:June 22,2015 T of Identifica Type of Id �• MY COMMISSION#FF03IMS ►�` '°r EXPIRES June 25,21)17 (407)38&0183 FbridalloterySenvicecom BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 116S.Andrews Ave., Rm.A 100, Ft. Lauderdale,FL. 33301-1895-954-831-4 W` VAUD OCTOBER 1,2014 THROUGH SEPTEMBER 3o,2015 t3aA: Receipf#:P?L NG9L�fM SP1aM/CONTRACTOR Business Name:SKYLA PLUMBING INC SUSirla"Type:(CERT PLUMB'IM CONTRACTOR) Owner Namw.sA=L Mc Domes Business Opened:10/23/2007 Buelne"LoCatdon:2230 POLK ST 20 St"County11C"Req:CFC1427071 HOLLYWOOD Exemption Code. BtWneW Ph0nef9S4-642-6473 Rooms Seats Employees Machines Professionals 1 For Verging business Only MumberofMachine : Venda ngg Type: Tax Anmunt Transfer Fee I NSF Fes Penalty Prior Years Cclledion Cost TOW Paid 27.00 3.00 0.00 0.00 0.00 04.0 3dt.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS SECOMM A=TAX RECEIPT This tan is levied for the privilege.of doing business within Braward County and is non-regulatory in nature.You must most alt County endtcr Municipality planning WHEN VALIDATED and zoning requirements.Thle Business Tan Rscelpt must be transferred when the business is saki, business name has ganged or you have moved the busks location.Ttds receipt does not indicate that tate business is legal or that it is in compliance with Nate or kKW laws and regulations. tilling Adds: SAMM MCDONALD Receipt #30A-13-00013275 2230 POLK ST #20 Paid 09/25/2014 30.00 HOLLYWOOD, FL 33020 2014 - 2015