PL-15-1126 �qr
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(305)756-8972
Inspection Number. INSP-234573 Permit Number. PL-5-15-1126
Scheduled Inspection Date: May 05,2016 Permit Type: Plumbing- Residential
Inspector: Hernandez,Rafael
Inspection Type: Final
Owner. SUB LLC,SRP TRS Work Classification: Addition/Alteration
Job Address:10540 NE 2 Place
Miami Shores, FL 33138-
Phone Number (854)671-1400
Parcel Number 1122310130540
Project <NONE>
Contractor CAPOTE PLUMBING CORP Phone:(305)588-9917
Building Department Comments
PLUMBING FOR KITCHEN AND BATH REMODELING Infrecdo Passed Comments
INSPECTOR COMMENTS Felse
Inspector Comments
Passed
Failed D
Correction a
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee Is paid
u__.w• ww w For Inspections please call.(305)762-4949 M---A-s•w
� F
i
Miami Shores Village E I•L =.
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiratio
n: 11/2312015
Project Address Parcel Number Applicant
10540 NE 2 Place 1122310130540
SRP TRS SUB LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
SRP TRS SUB LLC FL (954)671-1400
Contractor(s) Phone Cell Phone Valuation: $4,000.00
CAPOTE PLUMBING CORP (305)588-9917 Total Sq Feet: 0
Type of Work:PLUMBING FOR KITCHEN AND BATH REMOD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Top Out
Bond Retum: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2. 00 Invoice# PL-5-15-55529
DBPR Fee $2.25
DCA Fee $2.25 05/27/2015 Check#:7128 $183.90 $0.00
Education Surcharge $0.80
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $163.90
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. Futhermore,I authorize the above-named contractor to do the work stated.
May 27,2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 27,2015 1
Miami Shores Village REC IVFD
` Building Department MAYAS 205
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 2013
BUILDING Master Permit No. — S
PERMIT APPLICATION Sub Permit No S'
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I n s g® VE Z ild PIACI
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: l l- O'a 3 I- 01 3- 0 5 y fl is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
SKfl TSS
OWNER:Name(Fee Simple Titleholder): Phone#:
Address: 2AW weft Q/Pyr SS 02tEAfItZ Rol #L //18
City:_ R_7- tAL�49AR-OSE State: —Zip: 333a�
Tenant/Lessee Name: Phone#:
Email: p
CONTRACTOR:Company Name: C.� �'O/, P�U/n�NZ Phone#: rw5)5- f g f/rl
Address: �d �� Al �-
City: bb&AU State: Ic=l�t Zip:
Qualifier Name: <!f�Aos 716 Phone#: -ao 5" �^ /7
State Certification or Registration#:�� /5� ��3'�_Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State:_Zip:
Value of Work for this Permit:$ 00,0 Square/Unear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: k'JcA PnKxl7 ( M O _ �`'UM�e>i iy�
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$
TOTAL FEE NOW DUE$ �0,1 4
(Revised02/24/2014)
163. 1'b
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: 1 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 certdfed 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 to a absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature�r
OWNAGENT CONTRACTOR
The foregoing in enf was ackn ledged before me this The foregoing instrument was acknowledged before me this
1 day of 3 ,20 )5,_,bydcof4
ay of__ � S� ,20 /6— ,by
F GtUm ,who . ersonally known �, ,who is personally known to
e--
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: NOTARY PUBLIC:
g�� se Chuay
Sign•I v Sign: CSN ; FF178M
Print: Print: '� Y.COM
Seal: ,�.��YP�,,, NADINEAUSTERFIELD Seal:
i°* a Notary Pubiic-State of Florida
•: * =My Commission Expires Nov 7,2017
Commission#FF 55651
s*sss**sssssss siu��k(�`*sss*s * ********ss****s*s*s*sssss*sss*s**s*•***s*****ss*s**********s*a
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RwbeM2/24/2D14)
CERTIFICATE OF LIABILITY INSURANCE x=31
PRODUCER Florida BankWS Insufarma TM CS11101111WATE 18 E81M AS A MATTER OF 114POWMIM
7278 SW 8 Sfceat ONLY AND NO RNKM UPON TM CERTIFICATE
NO11011.TM CERTPICATE DOES NOT A11118DID,EIITC-itiD OR
M nti.FL 33144
Platy(305)2064M Fax(305)282-0879 AFFORONG COVElitAGE NAS•
INSURED CAPOTE PLUMBING CORP.
ACCIQ)ENT INSURANCE COMPANY
8511 SW T sbw INSURERS:
MAIM.Fl 33144 INSURERD.
(305)288-M18
SEB INSURER F.
THE POLICIES OF INSURANCE LISTED HAVE SEEN MSI TO THE INIKARIED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY SIT,TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE MSUED OF
MAY PERTALr1.THE B/MRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT TO ALL THE TERMS.EXCE.USIONSAND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM
AM LMAM TYP@OPBMURANCE POLNCYNiUFA= �� LBEflI
OBOMAL LlABLITY EACH OCA 1,000,000.w
12COMMEIN3ALGENEIIALLIABILITY CPP 001225041 02119115 04h9V18 100*000•00
❑❑CLAIMS MADE ®OCCUR M D EW WW ane Peel 51000.00
A p ❑ PERSONAL&ADV INJURY 1,000.000.00
❑ GENERALAGGREGATE 1000,000.00
(ENPLAGGREGATE LIYIITAPPLIES PER ACES-COUPWOPAG3G 1,000,000.00
®POLICY ❑PROJECT ❑Loc
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
❑ ANYAUTO ISOaa*1
ALL OWNED AUTOS BOIDILY ,
❑ SCHEDULEDAUT40S
HIREDAUTOS BODILY BLIURN
NON OWNED AUTOS pwac ftm
❑ PROPERTY OAMIAtEE
GARAGE LIABILITY AUTOONLY-FAACCIIDENT
❑ ❑ ANYAUTO OTHER THAN EAACC
0 AUTO ONLY:. AGO
ry EACH OCCURRENCE
Q ❑ OCCUR ❑CLAIMS MADE AGGREGATE
❑ aemc u
❑ RETENTION S
WORIKERSCOMPSIMIMAND EMPLOY®f!P LIABLIT1r A
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT
OFFICER/ME NBER EXCLUDED? E.L.DISEASE-ESL EMPLOYEE
Nv desorIe�der
SPECIALPROVISIONShftw El DISEASE-POLICY LMT
OTHER
OESCAMI OFOPBRATIO/MILOCATi01EI IBMUMM =BY /8EW4.PRO11UM
CFC 1427737.CapM Plumbing Corp
CBRTllwATE HOUXER CANCQ.tATM
SNWULOANYOFTIMA MU M:BEECANCEUM TIE
WM"MDA'MMMW.WMMWMOUMWMMLENMVORTOOM
MIAMI SKIM BJH DEPA nWff 30 DAYS WIBTIEi N vX:e To TIM C®IIfrICATE NOLOEEEI waw To
T�0-ft.BUT PASTo00SOSIWLage=NoOSLIO "M ORUMMJIY
10050NE2AVE AN
OPYNBEOIMONTIMBAR.QSA8MNMCR fTAT1VE.
MIAMI SHORES,FL 33138
AUfHOIRIMASPIRMSMATIVE
808 888.2172 1 & -
ACIORD 25 OMAN)GF MACORD C ATGt11888
IMPORTANT
If the c artiflcate holder is an ADDITIONAL INSURED,the pokAles)must be endorsed. A statement on this
certificate does not confer rights to the cerWicate holder In lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the
Issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or
negatively amend,extend or after the coverage afforded by the policies listed thereon.
AMMMI r=uMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (306)795.2204
Fax: (305)756.8972
Notice to Owner- Workers' Compensation Insurance ExernCbon
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 caw of
an LLC,a statement attesting to the minimum 10 percent ownership,
2. The officer is fisted 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 conuactor'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: --S4
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of L)_,45
ByLri-r1!!i E!�k�v who is
,%'APisa.,"tityliliNADINE AUSTERFIELD
as identif!
Notary Public-State of Florida
My Commission Expires Nov 7.2017
Notary: bbj.,A a Commission#FF 55651
I tit
SEAL:
Capote Plumbing Corporation
6811 SW 7 ST MAW FL 33144
305-588-9917
License#CFC1427737
Before me this day personally appeared Omar Capote who being duly sworn,deposes and says:
That he or she will be the only person working on the project located at: 4voe (fvV746
10540 NE 2nd Plaice
Miami Shores,FL
Sworn to affirmed and subscribed before me this its-of Ajgx�l 2015 b (/ 4
( ) Y ,Aa,O.
Personally Known_,,X
Or Produced ID
Type of identification produced
,,op. Jose May
a k =MOOR
KN&
WFM$:k9116t1 W 20,2M$
svv.4FiiK�+`�OF WWW.AARONNO Y.COM
Print,Type or S Name of Nota
3 Miami Shores Village
Building Department CF-TVI--)
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 OCT 14 2015
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-490
--
BUILDING Master Permit No.JZ�
PERMIT APPLICATION Sub Permit No.PZ % .�- //Z�
(BUILDING ❑ ELECTRIC ❑ ROOFING Qg REVISION ❑EXTENSION ❑RENEWAL
(PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
//�� /�/CONTRACT R DRAWINGS
,OBADDRESS: 106-00 � ?� / z ',4a kfs
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): C,.IR P IIRS Sc.h 11C. Phone#: S�I -c')3'(` S5 I C
r
Address: o��DU W of-ss Qre,el� f�a lel I Q
City: 'R ��� C.� State: r(. Zip: 333D-C\
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: !u �J Phone#:
Address: yy h�is of A� 7-
City State: rlA'' Zip:
Qualifier Name: /??QA Phone#:
State Certification or Registration#: C.&Ze—•'/9/f7 73'J Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �{�,� ware/Linear Footage of Work
Type of Work: ❑ Addition \ Alteration I❑ New ❑ Repair/Repiace F-1Demolition
Description of Work .aS��f' I GN t4er d
Specify color of color thru tile.-
Submittal
ile:Submittal Fee$ Permit Fee$ 16CI -Zr CCF$ CO/CC$
Ar
Scanning Fee$ Radon Fee$ DBPR$ Notary$
TechrrokW Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 10 �✓
(Rw6ed02/24/2014)
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. 1 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$25(x, 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
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I c'� day of .206 .by day of d_V/R'l.. .20 ed"` .by
"rti IS rr .who Kjersonally known t ?�. ,who e�r~�known
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did takoath. joss Ch Uay
NOTARY PUBLIC: NOTARY PUBLIC: COMMISSION # FF178270
EXPIRES:November 20,2018
www.AARONNOTARY.COM
Sign:, q, Sign
Print: Print:
7O;{yY PU"c..
Seal: Notary Public-SN�7,2017 Seal'
•` ;a, My Cemr�ission Expires FF 55651 .
OF
Commission#
APPROVED BY c)- Plans Examiner Zoning
1
Structural Review Clerk
(Rcv1sed02/24/2014)