PL-16-588 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-257580 Permit Number: PL-3-16-588
Scheduled Inspection Date:April 28,2016 Permit Type: Plumbing - Re ' entia
Inspector: Hernandez, Rafael
Inspection Typ :` o>�tgh
Owner: GROUP, LLC, ROCKSTREAM Work Classification: Addition/A
luniee'rucu re
Job Address.580 NW 113 Street "q -.a M-/
Miami Shores,FL 33168- Phone Number (305)788-8034
Parcel Number 1121360210810
Project: <NONE>
Contractor: LEROY WILKERSON PLUMBING LLC Phone: (954)927.4090
Building Department Comments
DISCONNECT/RECONNECT KITCHEN SINK. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 27,2016 For Inspections please call: (305)762-4848 Page 25 of 47
10050 N.E.2nd Avenue
Miami Shores,FL 33136-0000 Issue Date:4/25/2016 Expires: 10/22/2016
Phone: (305)795-2204 Fax. (305)756-8972
Pro ect Address Parcel No.. Tract No. Block No. Lot No. Section Township
580 113 Street 1121360210810
Miami Shores, FL 33168-
Owner Information Address Phone Cell
ROCKSTREAM INVESTMENTS GROUP, 15115 Street (305)799-8034
- MIAMI FL 33161-
15115 Street
MIAMI FL 33161-
Contractor(s) Phone Primary Contractor Required Inspections:
LEROY WILKERSON PLUMBING LLC (954)927-4090 Yes For Inspections call 1(866) 701-3365 ,
Inspection NR
Proposed Construction t Details Top"DISCONNECT/RECONNECT KITCHEN SINK. Valuation: $ 8`6.00 Final
Total Sq Feet: 0 Review Plumbing
Underground
Fees Due Amount Total Amt Paid Amt Due
CCF $0.60
DBPR Fee $2.25 $159.10 $159.10
DCA Fee $2.25
Education Surcharge $0.20
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS Applicant Copy
AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: p Nl
1. Construction activity is prohibited between the hours of 6:00pm and 7:00am and on Sundays and Holidays.
2. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
3. Final inspection of the work authorized by this permit Is required. A Certificate of Occupancy must be obtained prior to use and
occupancy of new buildings,structures and remodeling work.
This permitlplan review expires by time Iimitatlon and becomes null and void If the work authorized by the permit is not commenced within 180 days from the date of permit Issuance or if the permit
Is not obtained within 180 days from the date of plan submittal. This permit expires and becomes null and void If any work authorized by this permit is suspended or abandoned for 180
consecutive days or If no progressive work has been verified by a City building Inspector for a period of 180 consecutive days.
Monday,April 25,2016 1
iviidI1iii allUleb viiidge REC;
J Building Department g
..0 z
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 It-A
BUILDING Master Permit No.RC-15-2725
PERMIT APPLICATION Sub Permit No7� L (O`5b8
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
ME PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 580 NW 113th Street
City: Miami Shores County: Miami Dade Zio:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Rock stream Investments Group, LLC. Phone#:(305)799-8034
Address:
15 NE 115th Street
City:
Miami State: Florida Zip: 33161
�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:company Name: Leroy Wilkerson Pig LLC Phone#: (954)548-5815
Address: 27 NW 4th Ave.
City:
Dania Beach State: Florida Zip: 33004
Qualifier Name:
Leroy E. Wilkerson Phone#: (954)548-5815
State Certification or Registration#: RF11067527 Certificate of Competency#: 11P000508
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
fa____.l6�ir-t1j'lSSquare/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition
Description hen sink.
Specify colr ` u til
Submittal Fee$ Permit Fee CCF$ 0 " 60 CO/CC$
Scanning Fee$ .. b Radon Fee$_� DBPR$ Notary$
Technology Fee$ SO Training/Education Fee$ Double Fee$ 22
Structural Reviews$ JP Bond$
TOTAL FEE NOW DUE S 19`7 , 10
Bonding Company's Name(if applicable)
L f
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.
Signature Signature
W
OWNER rA CONTRACTOR
The foregoing instrument was cknotcgedbefore me this The fQoregoing instrument was a knowledged before me this
day of N 1� 20 16 ,by 1 day of � 20 16 ,by
Hemant Singh Leroy E. Wilkerson
.who is personally known to ,who is personally known to
me or who has produced �101id- ViNea as me or who has produced F1 <--7l(I. I I'C e-Mas
identification and who did take an oath. identification and who did take an oath.
NOT RY LIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: f
Seal: tSf w:w#uolagww00 my Cong11. If.4019
> to eIBIS'o94ad AWN ` WWROW Seal:
Y7W0 VNr11�fl19 I/WN °' s .
APPROVED BY 1-7—f Plans Examiner Zoning
Structural Review Clerk
L
Sg�REs
♦ ice•��a
j s Miami shores Village
Building Department
artment
10050 N.E.2nd Avenue
�iCpR�pP► 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 ACKNOWLE E THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. J
Signatur
Owner
State of Florida
County of Miami-Dade fl�
The foregoing was acknowledge before me this V da of M0 20 D
g g g Y � �•
By tiEM t�n!T who is personally known to me or has produced
`l Qla as identification.
Notary:
SEALlilm
EZrida2019
March 2, 2016
State of Florida
County of Miami-Dade
Before me this day personally appeared Leroy E.Wilkerson who,being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at:
580 NW 113th Street
Miami,Florida 33168
Sworn to (or affirmed) and subscribed before me this day of ma a Y0
`
2016,by
S' ature
Personally know
OR Produced Identification
Type of Identification Produced
Pjawl.
-f�IA�INNM•
bon no M9
Pri Stp Na f Notary
27 N.'VP. 4'6",L AL-W e>. w&xxAa. $®a.o1s,, FL. 33004
CTQB
Construction Trades Qualifying Board CERTIFICATE OF COMPETENCY
BUSINESS CERTIFICATE OF COMPETENCY •
11 P000508 °
A LEROY WILKERSON PLUMBING LLC
'LEROY WILKERSON
` D.B.A.:
WILKERSON LEROY E MASTER PLUMBER
Is certified under the provisions of Chapter 10 of Miami-Dade County LEROY W{LKERSON PLUMBING LLC
C#10-CMP-16554-X EXPIRES 08/31/2017
RICK SCOTT, GOVERNOR
STATE OF FLORIDA KEN LAWSON, SECRETARY
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
RF11067527 , �n
The PLUMBING CONTRACTOR
Named below HAS REGIS
Under the provTERED I f
isions of Chapter 489 FS.
Expiration date. AUG 31, 2017
(INDIVIDUAL MUST MEET A
ILICEREQUIREMENTS PRIOR O CONTRACT.INGSIN ANY AREA)
N
WILKERSON, LEROY E
MANUS _Vr 1iLEROY WILKERSON �.„
.. .
PL�1 � , SLC
5521 FLETCHER ST i a
HOLLYWOOD
FILO
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.k `5
ISSUED:
Net
TP Z
09/10/2015 �
- � � y -
DISPLAYAS R UIRED B`Y LAV1l'
SEQ# L1509100001466
r
r.
M uni ci pal Contractor's Tax lei pt
Miami-Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY MC
CC Na. 11 P000508
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
LEMYWUQRS0N PLUMBING LLC
DOING BUSINESS IN DADS OOUNW 7473378 SEPTEMBER 30, 2 016
Pursuant to County Code
Sac 10-24
OWNER TYPE OF BUSINESS
LERDY1MUKEIi90NPLUMBINGLLC PLUMBINGCONTR417OR PA YM ENT RECEIVED
BY TAX COLLECTOR
200.00 10/01/2015
0224-16-000020
Ties receipt is not valid in thefdlowing Municipalities:Avenkm Doral,Haleah,Key Biscayne,
SHEIK Miami Gardens,Miami Lakes,Palmetto Bay,Pinecrest,Sunny Isles Beach,Town of Culler Bay.
MIAM Forrnoreintomation.visitwww.rriarridada. /Axad1ector
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY LBT
6936091
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
LEROY WILKERSON PLUMBING RENEWAL SEPTEMBER 30, 2016
LLC 7211915 Must be displayed at place of business
DOING BUSINESS IN DADE Pursuant to County Code
COUNTY Chapter 9A-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
LEROY WILKERSON PLUMBING LLC 196 PLUMBING BY TAX COLLECTOR
CONTRACTOR 82.50 10/01/2015
Worker(s) 1 11P000508 0224-16-000020
This Local Business Trot Receipt only confirms payment of the Local Business Tex.The Receipt is Rd a license.
pemdt or a ceRRkation of the holder's gueUf edons,to do business.Holder must amply with any govemmeutal
m nongaaertma:stel reguiailory,laws and requirements which apply to the business.
The RECEIPT NO.above moat be displayed on all commercial vehicles-Miami-Dade Code Sao ga-276.
MIAM For more information,visit
r '
CERTIFICATE OF LIABILITY INSURANCE AATS(MMIDC
g.; , 6
THIS CERTIF' 'TE 18 ISSUED AS A MATTER OF INFOR TION ONLY AND CONFER$NO RIGHTS UPON THE CERTIFICATE HOLDER•1'H
CERT1FICATE'1:O . $NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND;OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TH1j,*0.♦tWICATE OF INSURANCE DOES NOTiOMSWUTE A CONTRACT BETWEEN THE ISSUING INSU�i(St AUTHORIZED
REPRESENT, IVE OR PRODUCER,AND THE CERTIFE!5 HOL13ML
M RTANYT: WeartIllicats nolle'Is an ADDITIONAL INSURED the pollcy([ea)must bd endorsed. IfSUBROIXATION IS WAIVED,rrblest to
the terms dnd s jp�one of the polity, In poades may require an end0ftowht. A statemwd on this a�Fcate does not aonforrights to the
aertiftcate tiold?e,.16i•J(eu of such endorsement(a)
PRODUCER
! J08@PFi BIiACClO I
J&J Insurance.Aas Bides i (9S4 883.55fi8 Na. WK 1174
7037-8 TN St. :
•�'t. � I Inst elisouthnet !
HoRymod,FL 33I1?4 I
Phone F8X 88893.1174 INSU ' ; SCOHTrSTUSR DALEAINSURANCE
E C®MPANY
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LEROY WILKER&ON PLUMBING LLC
27 NORTH 4TH AVE : !
FORT LA(1DEttDALE;""R_33312
INSURER F!
COVERAGES i.',;,":' CERTIMATE NUM REVISION NlUMRER:
THIS IsTO CER,�X THAT THI;POLICIES OF INSURANCE L18TE BEI.+DYIf HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE THE POLICY PERIOD
INDICATED, N9R W17li3TANDRNG ANY REQUIREMEIYf.TERM O CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
OERTIFH3ATIc ' ISSUED OR MAY PERTAIN,THE INStURAN E AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECTfM ALL THE TERMS,
EXCLUSIONS CONDITIONS OF SUCH POLICIES.LIMITS 8 NIAY HAVE BEEN REDUCED BY PAID CLAIMS. t
T1�PP9iDF IN8URANC6 ANEER Apagwy, LIMITS
acwR® CoMME5fC1111-1W6RAL LIABILrtY i ` 300=
100
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❑ ALL AWN®''> SCHEDULED I WaLY INJu (Per pefwa S
❑ AUTOS ;;k;:'' ❑ AVMS I HODII.Y INJUI@V(per maida*) $
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I1MR9110M OF 0,W. -TIONS/LDUATIONSI VI HOL65(ascan ACORD 1T.Adammrat Remarks sotreoate.If mwe spacers rega{redl r
PLUMBING COI�tRAGTOR ! {
CERTIFICATE 9111 DER CANCELLATION' r
SH9ULD ANY OFTHE ABOVE DE!'er.'RIBED PQuCI88 8E CANCELLED 8
MIAMI SI IOREB VILLAC3E THE EXPIRATION DATE TH�EOF■NOTICE WILL t DELMMD IN
100ACf.ORumm WITH THE POLICY PROVISIO&S,
:ME 2ND AVE
MIAMI,FL.33138 AUTHORIMD REPRES®dTATNE
:
�`;'.: JOSEPH BRACCIO
! IA 4 ACORD CO"RATION. All rights onrje&
ACORD Z5(Z0141Q9)t The ACORD name and b99 are reglsterail narks i f ACORD
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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 cerWies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 7242015 EXPIRATION DATE: 7232017
PERSON: WILKEJRSON LEROY E
FEM: 452088930
BUS94ESS NAME AND ADDRESS:
LEROY WILKERSON PLUMBING LLC
27 N.W.4TH AVE
DANIA BEACH FL 33004
SCOPES OF BUSINESS OR TRADE:
LICENSED PLUMBING
CONTRACTOR
Pmu�suaittoClia{Rer440.05(1q.FS.and6uoder�p"�eaapor�mwh0deftex pW*am9tad%Wter4y as ddecomwdWoft N
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0FS-F24)WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED OB-13 QUESTIONS?MID)413.1609