PL-14-904 fid^
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Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-211774 PermitNumber: PL-5-14-904
Scheduled Inspection Date: December 17,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: CADILLA,ARTURO Work Classification: Pool - Private
Job Address:841 NE 95 Street
Miami Shores, FL Phone Number
Parcel Number 1132060142940
Project: <NONE>
Contractor: R&I PLUMBING SERVICES CORP Phone: 305-823-6911
Building Department Comments
NEW SWIMMING POOL PLUMBING Infractio Passed Comments
INSPECTOR COMMENTS False
spector Comments
Passed EY
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 16,2015 For Inspections please call: (305)762-4949 Page 3 of 39
4�
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 cerliffes that the individual listed below has ekx:ted to be exempt from Florida Workers'Compensation law,
EFFECTIVE DATE: 4/3/2015 EXPIRATION DATE: 402017
PERSON: GUZMAN RENE
FEIN: 611433275
BUSINESS NAME AND ADDRESS:
R&I PLUMBING SERVICE CORP
7898 NW 174 TERRACE
HIALEAH FL 33015
SCOPES OF BUSINESS OR TRADE:
PLUMBING NOC AND
DRIVERS
Pursuant to Chaptsr 440.05(14),F.S an of loar of a corparadan arho elects exemption from We chapter by a cert tete of fiction LffKw dft section
_ y
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
. TATDF FLOfiIDA
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PLUMBING,SERVICES CORP �1n� $EPTEMB R 3%,2016-"Ji
7$98 PMl 134 1 `'` 532[3945 Must be dispt 111 a at place of basZness
ltU11 FL 3301'5 PursuarR county Gads
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DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/16/15
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 pollcy(ies)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 I CONTACT
NAME: JORGE CASTILLO
World Of Insurance Agency PHONE (305)231-1111 aC No): (305)231-0711
18600 NW 87 Ave Unit 113 E-MAIL woridofinsuran@att.net
Miami Lakes,FL 33015 INSURERS AFFORDING COVERAGE NAIC N
Phone (305)231-1111 Fax (305)231-0711 INSURERA: SECURITY UNDERWRITERS
INSURED INSURER B:
R&I PLUMBING SERVICE CORP INSURER C:
7898 NW 174 TARRACE INSURER D:
Miami Lakes,FI 33015 305 INSURER E:
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY DEFF POLICY EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00
RETED
F%,#] COMMERCIAL GENERAL LIABILITY PREMISESO a occurrence) $ 100,000.00
A
❑ ❑ CLAIMS-MADE F] 08/07/2015 08/07/2016 OCCUR 10203317 MED EXP(Any one person $ 5,000.00
❑ PERSONAL&ADV INJURY $ 1,000,000.00
❑ GENERAL AGGREGATE $ 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00
❑ POLICY ❑ JECTPRO- ❑ LOC DEDUTIBLE $ 500.00
AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT
Ea accident
❑ ANY AUTO BODILY INJURY(Per person) $
❑ ❑ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY(Per accident) $
❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
❑ AUTOS Per accident
❑ ❑ 1 $
❑ UMBRELLA LIAR ❑OCCUR
EACH OCCURRENCE $
❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $
❑ DED ❑ RETENTION$ $
WORKERS COMPENSATION1-1W YLIMIjS ❑OTH-
AND EMPLOYERS'LIABILITY Y/N ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? N/A
(Mandatory in NH) F-1 E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
license number:03p000074
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10050 NE 2ND Ave ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES FLORIDA 33138 AUTHORIZED REPRESENTATIVE
felicianoj@miamishorevillage.com
305-756-8972 JORGE CASTILLO
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD
Miami Shores Village cD
Building Department MAY 052014
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.8PP/L/ qo�
PERMIT APPLICATION Sub Permit No.pj
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE ❑ CANCELLATION ❑ SHOP
�yCONTRACTOR DRAWINGS
JOB ADDRESS: `� �I s`-
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): ' kk we CK- ST Phone#:
Address: ',�k vv_ %_ 51—
City: 441% 0.vr.► S i.,0 r'2. State: J_ Zip: 3 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: - v wl'1' Phone#: 3 O T- a-� Y �7
Address: :1,101 �W 1YY
City: N i 06�P_ State: rZip: 0
Qualifier Name: LekQ, Gy`L w•.Q..-% Phone#:
State Certification or Registration M 0 3 O O b O ?H Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 9,0 0o. Square/Linear Footage of Work:
Type of Work: ❑Addition t❑ Alteration New ❑ Repair/Replace ❑Demolition
Description of Work: N0
Specify color of color thru tile: ,y
Submittal Fee$ So'�� Permit Fee$ 9 30b 2*'W CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ F
TOTAL FEE NOW DISE$
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS,POOLS,FURNACES, BOILERS, HEATERS,TANKS and 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 commencementmust 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
Owner or Agent Contractor
The foregoing i strument was ackn wledged before me this Z(j_ The foregoing instrument was acknowledged before me this��
day of A.0204 by — t i I let day of�20&by ��+e (�✓�-waw
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUB IC' NOTARY PUBLI
Sign: Sign:
Print: -Z Print: vA."V _L•
My Commissio , . MARTINEZ My Com � OSVANY MARTINEZ
' :
•= MY COMMISSION#EE080681 ;A
MY COMMISSION#EE080681
EXPIRES April 04,2015 =;�; .••. '�' EXPIRES April 04,2015
iAOF FV
APPROVED BY '�y"15` Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/30/2009)(Revised 3/15/09)(Revised 7/10/2007)