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PL-16-1216 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)785-2204 Fax:(305)756-$972 Inspection Number. INSP-258236 Permit Number: PL-5-16-1216 Scheduled Inspection Date:June 06,2016 Permit Type: Plumbing-Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner: , Work Classification: Sprinkler System Job Address:1032 NE 88 Street Miami Shores,FL 33136- Phone Number Parcel Number 1132050180320 Project <NONE> Contractor CENTRAL IRRIGATION INC Phone:(305)255-5080 Building Department Comments INSTALL LAWN SPRINKLER SYSTEM ON EXISTING 1ft mme s WELL. 5 ZONES,51 SPRINKLER HEADS. INSPECTOR COMMENTS Faye Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee Is paid. Miami Shores Village 10050 N.E.2nd Avenue NE ,r= ' Miami Shores,FL 33138-0000 fi Phone: (305)795-2204 Expiration: 11/07/2016 Project Address Parcel Number Applicant 1032 NE 98 Street 1132050180320 1032 NE 98TH HOLDINGS LLC Miami Shores, FL 33138- Block: Lot: Owner information Address Phone Cell 1032 NE 98TH HOLDINGS LLC 800 CORPORATE Drive FT.LAUDERDALE FL 33334- 800 CORPORATE Drive FT.LAUDERDALE FL 33334- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 CENTRAL IRRIGATION INC (305)255-5090 (305)505-0019 ,.�.�.�...__._�_�...._..__ ,. ...�...e -�_..�.:.�.....�, Total Sq Feet: 0 Type of Work:INSTALL LAWN SPRINKLER SYSTEM ON EX Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return Underground Sprinkler Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PL-5-16-59666 DBPR Fee $2.25 05/11/2016 Credit Card $118.30 $50.00 DCA Fee $2.25 Education Surcharge $0.60 05/05/2016 Credit Card $50.00 $0.00 Permit F $150.00 Scanninq.Fpe $9.00 Technolo t,Fee $2.40 Total: $168.30 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 t4ereto 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 forELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS>AFFIDA T: I certify that all the fo of information is accurate and that all work will be done in compliance with all applicable laws regulating construction;and o n Futhe Imho' t bove-named contractor to do the work stated. May 11,2016 o S re er / #plicant / Contractor / Agent Date Building Department Copy May 11,2016 1 Miami Shores Village CEIVEIENP ' Building Department M 0 5 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Bim' Tel:(305)795-2204 Fax:(305)756-8972 J 1 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 f q BUILDING (waster Permit No_B=k 6`_ 12-(ro PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ©PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1032 NE 98 St. City: Miami Shores County: Miami Dade Zia: Folio/Parcel#:11-3205-018-0320 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1032 NE 98th Holding LLC Phone#:970-379-9730 Address:800 Corporate Dr. #208 City: Ft-Lauderdale State: FL Zip: 33334 Tenant/Lessee Name: Phone#: Email: sluyterconstruction@gmail.com CONTRACTOR:Company Name: Central Irrigation Inc. Phone#: 305-255-5090 Address: P.O Box 970251 City. Miami state: FL Zip: 33197 Qualifier Name: Carlos Victoria Phone#: 305-505-0019 State Certification or Registration#: CFC-1428365 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$2,400.00 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration M New ❑ Repair/Replace ❑ Demolition Description of Work: Install lawn sprinkler system on existing well. $zones, 51 sprinkler heads. Specify color �—o-pf�color thru tile: Submittal Fee$ �V " Permit Fee$ �`! CCF$ E�O CO/CC$ _ Scanning Fee$ Radon fee$ Z? DBPR$ c`3 Notary$ Technology Fee$ ® Training/Educatlon Fee$ ®' 60 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Rev1sed02/24/2M4) • 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 fast 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. .V,— ^ .� Signature Signature •T OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this *&X& ���-' day of 20 (Ca ,by � day of 20 J by *&X&M J13�Ln ,�_,who is personally known to "1rf-2 NJ 1 c-'tiY 161,who is personally known 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 oath. NOTARY PUBLIC: NOTAR UBLI Sign; Sign. Print: Print: Seal: PATFIA SD Seal: �� Heger Mulroney "X $w '�J ..,' l:> Novsrhbe►1,2018 �c xs C[.OWNISSI #FFFMF1252,2,pp7 4.,N.' eea�alluu(uemy Pues�:bldmMAh�u WWWAARONNCOTTARY.001a APPROVED BY J s Plans Examiner Zoning Structural Review Clerk (RewsedM/24/2M) 'c �R- M-niffinaw"CERTIFICATE OF LIABILITY INSURANCE M/ THIS CENTIFICATEIS 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 cmtlficate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terns 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 Hou of such endorsement(eJ PRoOucER (305)220-2260 ACT JAIME C. ORDONEZ Eastern United Insurance PHONE 305 220-2260 Ext. Pax .(305)220-2263 JAIME CARLOS ORDONEZ A-196'817 JCORDONEZOEASTERNUNITEDINS.COM 175 Fontainebleau Blvd. ADDRM- Suite 2A-1 AFPORDINQ COVERAGE NAIL 0 Miami, FL 33172 INSURER A:SCOTTSDALE INSURANCE COMPANY 41297 NEED CENTRAL IRRIGATION INC INSURERS: 8975 SW 198 TERRACE IBURERC: MIAMI, FL 33157 HERD: (305)255-5090 Ext. E: I SURER 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 REOUIREMENT,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 LTR TYPE OF INSURANCE A� POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 DAMAGE TO Km I ho X COMMERM&GENERAL LIABILITY PREMISES $ 501000 CLAIMS-MADE a OCCUR MED EXP are rmm) S 5,000 A N CPS2363736 02/26/16 02/26/17 PERSONAL&ADvINJURY s 1,000 000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 X I POLICY spa Loc S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY NAM(Per person) S ALL OWNED SCHEDULED 130DILY INJURY(Per aura) $ AUTOS AUTOS HIRED AUTOS AUTOS PROPERTY DAMAGE S S uM�tELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAINs-MADE AGGREGATE s DED I I RETENTION S WIORXERS COMPENBAMON WC STATIU. _ITS EB AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTiVE❑ N!A E.L.EACH ACCIDENT $ OFFICERJMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ a�s dearxlre ur�r DE�I'TION OF OPERATIONS below I I i E.L.DISEASE-POLICY LIMIT i S ERRORS & OMISSIONS EACH OCCURRENCE 1,000,000 A IN TRANSIT POLLUTION N CPS2363736 02/26/16 02/26/17 GENERAL AGGREGATE 2,000,000 PESTICIDES/HERBICIDE DEMCF1113' N OF OPM7 /LOCATIONS I VEHICLES(Attach ACORD 101, Remarks sohedule,N more apace is roque IRRIGATION SYSTEMS INSTALLATION, SALES AND REPAIR AND PLUMBING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION M I ALL I SHORES VILLAGE 10050 NE 2 AVE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIMI SHORES FL 33138 (305)756-8972 Ext. AUTHORUNDREPRESENTATM BUILDING DEPARTMENT L7414fe C 01404m, ®1 9OB-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010W The ACORD name and logo are registered marks of ACORD R . 1,- Miami shores Village INII Building Department %7w.v_2AF—_W6nom' 10050 N.E.2nd Avenue 4P AITVS to Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption mr, 2_1 12 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. 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 -4� day of Vux.,.. 20j&–. J By AA&WL NAUJsn�� who is personally known to me or has produced as identification. ?I/, Heater mulrolq Notary: L rt ComMSSI(IM#FF125W SEAL: F_yz,AEs- m4 21, 2019 W .:.AkA0.NN0TARY.00M CENTRAI ATI® . we P.O Box 970251 Miami,F133197-0251 State Lic:CFC1429365 PhonelFax:(305)255-5090 Email:carloscentmUrrigation@gmail.com www.Central-Irrigation.com Date: S/&A/t G State Of. L„. County of: �d as Before me this day personally appeared C-0,60S V%C0 60� who,being duly sworn, deposes and say: That he or she will be the only person working on the project located at: 1032 NE 98 St. Miami Shores Fl. Sworn to(Or affirmed) and subscribed before me this.- of .2Q-1(sL,by t.:aa.'. r'►Cts ¢�,f�• Hcauhcf MUIro Personally Know FF125227 .c ;► EX M May 21, MIS Or produced identification gwW,AA110lIMQTAp11.GaM Type of identification produced. Print,type or stamp nam, of Notary. s greenreturn SMART j 3 Wg'a an WaterSense ���sru arroN �® P � assannnue,- W".CENTRAL-1 RRIGATI ON-COM