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PL-15-3097 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249373 PermitNumber: PL-12-15-3097 Scheduled Inspection Date: March 24,2016 Permit Type: Plumbing - Residential Inspector. Hernandez, Rafael Inspection Type: Final Owner. PERAGALLO,DINO&IRENE Work Classification: Addition/Alteration Job Address:55 NE 97 Street Miami Shores, FL 33138- Phone Number (305)995-5224 Parcel Number 1132060130990 Project: <NONE> Contractor: UNLIMITED PLUMBING TECHNOLOGY CORP Phone: (954)624-5827 Building Department Comments KITCHEN RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed L Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 23,2016 For Inspections please call: (305)762.4949 Page 6 of 36 Miami Shores Village ' " 10050 N.E.2nd Avenue NE z Miami Shores,FL 33138-0000 k ,y. Phone: (305)795-2204 i. JAR Expiration: 06/26/2016 3a � ', vv �• i 3a Project Address Parcel Number Applicant 55 NE 97 Street 1132060130990 DINO&IRENE PERAGALLO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DINO&IRENE PERAGALLO 55 NE 97 Street (305)995-5224 MIAMI SHORES FL 33138- 55 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $4,000.00 UNLIMITED PLUMBING TECHNOLOG`T(954)624-5827 9 y y Total Sq Feet: 00 Type of Work:KITCHEN RENOVATION Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# PL-12-15-58050 DBPR Fee $2.25 12/15/2015 Credit Card $50.00 $119.90 DCA Fee $2.25 Education Surcharge $0.80 12/29/2015 Credit Card $119.90 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $169.90 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. Futhenmore,I authorize the above-named contractor to do the work stated. December 29,2015 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy December 29,2015 1 Miami Shores Village DEQ 15 2015 Building Department BY: 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. V C' //' is- R`l PERMIT APPLICATION Sub Permit No.P4 4y--- ��L-94 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS t�V JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: �3l 3J Folio/Parcel#: i</3 as 6 a 3 8,"o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: / FFE: OWNER:Name(Fee Simple Titleholder): 'J(Ny �tr f!61 L- G Phone#: -7 '2 �— Address: l� City: 1"\�w Sh�`� State: Zip: 3313e Tenant/Lessee Name: Phone#: Email: � r CONTRACTOR:Company Name: t &(&!l1a2�4�Phone#:&e Z Address: O .Q 2 City: o ��_Stato: f i.. Z1p: .3.3�� Qualifier Name: K7o Phone#: �6�9/—Sg2 State Certification or Registration#: ^ / Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: Clty: State: Zip: Value of Work for this Permit:$ } Square/Linear Footage of Work: Type of Work: ❑ Addition IfS Alteration ❑ New ❑ Repair/Replace ❑ Demolition don Desaipof Work: IV[TWA �n 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$ q TOTAL FEE NOW DUE$ (Revised02/24/2014) 7 Bonding Company s Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Nance(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 certifFed 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 nce of such posted notice, the Inspection will not be approved and a reinspection fee will be charged. S*Wu-dmrb Signature WNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this r I day of 20 I S .by da of � 202- by who is personally know 121AJ SOV 446o is personally kno 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 o NOTARY 7PJ08LLQZ 400411111110 NOTARY PU y .........,e-•O �i M S ��� .;�GOMpS-t� �'�'t► �� ign: Print: r �. T4 j'. �� to v S C7 (e4A to M tp Ve r Seal. �° C f YAAKOV KOPFSTEIN :��•t�• �frjg ��° ,,: Seal: ,�� 'X, OA. .....�p''� • Notary Public-State of Florida My Comm.Expires May 13.2017 assssssssssssssssssassssssssssssss�5tssaas�sass:::::::saaasasaaasasasaasss sss6fs #�113�ds APPROVED BY ( f L /�'�S Plans Examiner Zoning Structural Review Cleric (Revised02/24/2014) mail am Miami shores Village Building Department 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. ■eeeees000eeroeooeeeeeoo■ ■■ ■■oeeeeeeoeeeeoeeee000ee0000eeeeoeeeeeeooeeoeooeeeeeeeeeeeeo BUSINESS NAME: 4 2�� BUSINESS ADDRESS:_ ge < AA)- 40 Tia CITY e o STATE33'c7 ZIP 2� BUSINESS PHONE: � � FAX NUMBER f CELL PHONE(%Y) ICLL SZ2�9- QUALIFIER'S NAME: e -! �w QUALIFIER'S LIC NUMBER: rl-:*C 4 RICK SCOTTs`-GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL,REGULATION CONSTRUCT".INDUSTRY LICENSING BOARD } 3# t ( 00Ct�129o20 The PLUMBING CONTRACTOR" y Named bejc IS CERTIFIEfy provisions of Olzapte �' Under the 2QQ AUG 31, , ME wl Ex{uraboncte. 1f t fM v a ' 6 ZU Ba, wu xwT :YC3� O _WNLIMITED 1 NWA ISSUED: 07/23/2014 DISPLAY AS REQUIRED BY LAW SEQ s L140723WO1258 , ACOOR CERTIFICATE OF LIABILITY INSURANCE DATE(MMtDDtYYYY) 12/14/2015 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 pol(cy(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: Armando Silva MAX Insurance Comer acNN . 305-642-1885 1(AIC No): (305)722-2799 3680 NW 11s ��REss: icg@insurancecomergroup.com INSURER(S)AFFORDING COVERAGE NAIC S Miami FL 33125 INSURERA: GRANADA INSURANCE COMPANY INSURED INSURER 8: Ascendant Commercial Insurance Unlimited Plumbing Technology,Inc. Uc.#CFC1429020 INSURER C: 2351 NW 66 Avenue INSURER 0: INSURER E: Miami FL 33024 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 ADDLISWVD UER POUCY NUMBER MPOLICYD EFF MMMPOLICY EXP UMrr3 LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEIT___ CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 0185FL00052993 09/23/2015 09/23/2016 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY DEPC D LOC PRODUCTS-COMP/OP AGG $ O OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 10,000 B ALL OWNED X SCHEDULED CA-39033-0 09/17/2015 09/17/2016 BODILY INJURY(Per accident) $ 20,000 AUTOS NON-OWNED PROPERTY DAMAGE $ 10,000 HIRED AUTOS AUTOS Per acddant UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yesdescribe under DESCRIPTION OF OPERATIONS Mow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) (B) 2015 FORD TRANSIT-250 CARGO 1 FTNR2CM7FM93263 7 L GAG/ C rC I l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE ARMANDO SILVA MIAMI SHORES FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100,Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: LIMITED PLUMBING TECHNOLOGY CORP Receipt#:PLUMBING/LWN SPRNKL/CONTRAC R Business Name: Business Type: Owner Name:SANTOYO REN IEL Business Opened:07/30/2014 Business Location:641 NW 70 TERR State/County/CertJRe9:CFC1429020 HOLLYWOOD Exemption Code: Business Phone: Rooms Seats Employees mactNnes Professional 1 For VendhV ohms Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penally Prior Years Collection Cost Total POW 27.00 3.001 0.00 0.00 1 0.00 1 0.00 29.70 i 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 ganged 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: UNLIMITED PLUMBING TECHNOLOGY CORP Receipt p10B-14-00009243 641 NW 70 TERR Paid 07/17/2015 29.70 HOLLYWOOD, FL 33024 2015 - 2016 � r • JEFFAIMTOt CHIEFFHAANCIALOFRCISR STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF VuoMMW COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW•: CONSIRUCTION INDUSTRY EXEMPTION This cues OW the kdvi"listed below has elected to be exert twn Flwlda workers Cwensa*m law. EFFECTIVE DATE: 718=14 EXPIRATION DATE: 717/2018 PERSON: SANTOYO RENIEL SR FEIN:. 452843751 ISUMPlESS NAME AND ADDRESS: UNLIlMlTED PLUMBING TECH► UN1.11MITED PLUMBING TECHI, 2351 NINGS AVE HOLLYWOOD FL 33024 SCOPES OF BUSINESS OR TRADE:- LICENSED RADE:LKS PLUMBING CONTRACTOR Pmmu&tRbCbl44UM4F.&.anoftwrofaaot101160 who sbtabtsmnoftahm Gbdw#wbyftg amomaofskotionundwofteaftnmap nd ,,,,tier' Ill"OfcOrfilleneationundwft,ftli, Pwom t to t 44MIA FA. at Lo be wmv*L_g**O*vA bt ft l g qpe of6tebueimsorb &Ildedanoten000eofekxftnfnbestat P Eo Cha*r4dltMaF.&.t aatebo&mtobee and of eYsdlonbbemoempt shagMstdbresa t stanyotoaibxotsoHtgofotsmoosorotebwmmcfote otapmmtt artotenoosor oet0oals+wkttg4tttots afodssecooniorbtnosoFao .ThsdeparhrRt�otasa ata±tynetoreec#ote pmtataanaeosdants- to rind itre**enwxftof#&s t. CERTIFICATE OF ELECTK)N TO IE EXEMPT REVIW 0712 QLIE8TIMM(850)413-"W r o Unlimited Plumbing Technology Corp License#CFC 1459020 641 NE 70th Terrace, Hollywood, FL 33024 954-624-5827 Date: `W 14 o-b 15 State of:el-,�& County of: Before me this day personally appeared ���Ci U�0 who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Sworn to (or affirmed) and subscribed before me this —1 day of 20 �� , by ���e1 uc� rsonally know OR Produced Identification mod F <ARY r'Ug i- YAAKOV KOPFSTEIN T e of Id � kation Produc Notary Public-state of Florida cMy Comm.Expires May 13,2017 ,�oF;0.9.` Commission#FF 0177 unu Print,Type or Stamp name of Notary 1 -R Ran Miami shores Village 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 ib t 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 day of 61 20 B s personally kno r has produced A04 0 —V -4 .4 '00M X SEA OA