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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)