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PL-15-2174 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242210 Permit Number: PL-8-15-2174 Scheduled Inspection Date: July 18, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: GAIQUI, MARITZA Work Classification: Addition/Alteration Job Address:1450 NE 101 Street Miami Shores, FL Phone Number Parcel Number 1132050240040 Project: <NONE> Contractor: SIXTY MINUTE SERVICE INC Phone: (954)263-5799 Building Department Comments REPLACING OLD PLUMBING FIXTURES WITH NEW 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. July 15,2016 For Inspections please call: (305)762-4949 Page 1 of 44 etr»if tUf?. PL-8•15-2'17 Miami Shores Village 1 lt7Tlf hype:P(E![liltrt - 61k(C� t9� ). 10050 N.E.2nd Avenue NE Wt�ci�aBS catjon; , itl�,n/Alt@ration "'"r' Miami Shores,FL 33138-0000 , I Felt ;A,PPROVED Phone: (305)795-2204 Isscte fete:9/812015 Expiration: 03!06/2016 Project Address Parcel Number Applicant 1450 NE 101 Street 1132050240040 NATASHA GAIQUI&MARITZA C Miami Shores, FL Block: Lot: Owner Information Address Phone Cell NATASHA GAIQUI&MARITZA GAIQUI& FIRST UNION PO BOX 40062/C MOORE --- - -- - JACKSONVILLE FL 32231-0062 Contractor(s) Phone Cell Phone $ 2,500.00 SIXTY MINUTE SERVICE INC (954)263-5799 Valuation: Total Sq Feet: 00 Type of Work:REPLACING OLD PLUMBING FIXTURES WIT Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PL-8-15-56853 DBPR Fee $3.38 08/25/2015 Credit Card $50.00 $420.56 DCA Fee $3.38 Education Surcharge $0.60 09/08/2015 Check*31004 $420.56 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $2.40 Work without Permit Fee $225.00 Total: $470.56 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 info tion is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abov na ed ontractor to do the work stated. September 08, 2015 Authorized Signature:Owner / Applicant (/)Co tractor / Agent ate Building Department Copy September 08,2015 1 c ' -�1 Miami Shores Village Building Department 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 20I� 1 S� BUILDING Master Permit No.VC ) 5 —1 q 2Z PERMIT APPLICATION Sub Permit No� B ILDING ELECTRIC ROOFING E] REVISION EXTENSION RENEWAL PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLIATION ❑ SHOP 1 l CONTRACTOR DRAWINGS JOB ADDRESS: l q6) �c- ICA S- 2&ez, City Miami Shores C J 1 ' County Miami Dade zip: Folio/Parcel#: j ! - 32-0 - C)LL i-r Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �r1'�-ZA. ftA,rp,� Phone#: 3015 5y-503 Address: C) V City:m �� . `�IaState• 16� Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: L4, 4 / 4.0 ' - Phone#: Address•.2//d City: Fl- State: Zip: Qualifier Name: /7� �ltd 1�—bcjG� Phone#: State Certification or Registration#: (. FC,��.7 /cjo� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$0SO Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New IDRepair/Replace ❑ Demolition U1,Description of Work: Q ,� C) -RC1 .U'U Specify color of color thru tile: Submittal Fee$ Permit Fee$ j`�' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ 2�I. D-3 Structura4 Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 but7ding 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 ceded 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 pprov d and a reinspection fee will be charged. Si Signature or AGENT CONTRACTOR e foregoing instru ent was acknowledged before me this The foregoing instru ent as acknowledged before me this day of 20 J' by day of 20_1�by ► ► A,A2G r,r. G�I .who is personally known to Ami (� C1 0 who is personally known to me or who has prod ced �(.nl� as me or who has produced as 0 YPUB" OF FLORIDA PUBLIC-STATE OF FLORIDA identification and wW'"'q1take an,� tf�� identification and who di �V' oathLori Madison Comni; aadisom Cor7mission#NOTARY PUBLI - Sion#EE129483 NOTARY PU UC: EE128483 ExFirns: _ , 015 aorin Aires: SER 08,201S Bo1NbkDTHRUA ATL.WTIC; )NDJNGCo.,1Xr Si n- ign• Print: ` ('F Com '4" Isol Ne,A Seal: hta+' eEE128g Seal: SEP 20� Q s; APPROVED BY � Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD y �, d CFC1428732 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 %* e FLOWERS,ANTONIO DEMETRIUS SIXTY MINUTE SERVICES INC 3110 N W 4TH COURT FORT LAUDERDALE FL 33311 ISSUED: 08/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408100002170 • BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,201S DBA:SIXTY MINUTE SERVICES INC Receipt#:182-253377 SPRNKL/CONTRACTOR Business Name: Business Type: (PLUMBING) Owner Name:ANTONIO FLOWERS Business Opened:01/10/2013 Business Location:3110 NW 4 CT State/County/Cert/Reg: CFC1428732 FT LAUDERDALE Exemption Code: Business Phone: 954 263-5799 Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 7.00 0.00 0.00 4.050.00 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: SIXTY MINUTE SERVICES INC Receipt #04B-14-00000870 3110 NW 4 CT Paid 11/06/2014 31.05 FT LAUDERDALE, FL 33311 2014 _ 2015 SRCWARD COUN"rYt ,-1 'AI ► t iU�C� -•• t��r�c�oT Keport Viewer Page 1 of 1 list d i} FMANCIAL STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW"* CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Flonda Workers'Compensation law. EFFECTIVE DATE: 2/5/2015 EXPIRATION DATE: 2/4!2017 PERSON: FLOWERS ANTONIO FEIN: 455265071 BUSINESS NAME AND ADDRESS: SIXTY MINUTE SERVICES INC 3110 NW 4TH COURT FORT LAUDERDALE FL 33311 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to ptapter 440.05(141.F.S.,en ot8oer of a caporatlon wtq elegy exemptlan fran this rh WW wMWtrt th recover beaelt�or eompensatlon urMer thw d7�lter.Pursuartt to Otapter 440.08(12).F.S..CertlHcetes of etecfiwt to be exem Scope ofthe buafne96 ar tratle Osteo on the rxttice of etectlon to be ex apter hWg a oerlltlm[e of eleetlon utMer ttFytls sectlon exempt arm certlOcetes oteteenon to oe exempt sne0 be suo)ea to rewxanon a.a�'Pura,em to cne�ter d40.�13).F.S..Notite6 of�ecUpbn to be the person nameH an the notMe a certlOcete no longer meets the repuiremen6 of puy�se�ja?he ing of the notlee or the ieweneo of the cariAcete. amrance as certlaeate.ma oapartrnertt snap revaxe a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413.1609 https://apps8.fldfs.com/crreportviewer/renortViPwpr a,,„,9,4.+--],.j-.--- - 07/31/2015 FRI 10: 42 FAX 636 779 0080 CUSTOMER SERVICE 0001/001 CERTIFICATE OF LIABILITY INSURANCE DATE07/31DlYYYY) 07/31/15 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(les)must tie endorsed. fl SUBROGATION IS WAIVED,su6Ject 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 CEACT ANGELA DENARY GOMEZ Morgan Insurance Group Inc P ONE 305)222-9001 IAIC.Noll:FAX 305)222-9006 13155 SW 42nd St#107 L ExQ* angels@morganinsgrp.com Miami,FL 33175 INSURERS AFFORDING COVERAGE MAIC 9 Phone (305)222-9001 Fax 305 222-9006INSURER A WESTERN WORLD COMPANY INSURED INSURER B: SIXTY MINUTE SERVICE INC INSURERC: 3110 NW 4TH CT 114SURER 0: Miami,FL 33175 (954)263-5799 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 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, IV AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L"TRR TYPE OF INSURANCE ADD UBRPo EFF POLICY EXP POLICY NUMBER LIMITS GENERAL LIABILITYEACH OCCURRENCE 1,000 OOO.00 D GE CU ® COMMERCIAL GENERAL LIABILITY RENTED $ 100,000.00 A O ElcwMs MADE R] OCCUR KVPKL-K MED EXP(Any one on $ 5,000.00 07/30/2015 07/30/2016 PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP10PAGG $ 1,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY MBINEO SINGLE LIMIT ❑ ANYAUTO ULED BODILY INJURY(Per pemon) $ ❑ AUTOS OWNED ❑ AUTOS BODILY INJURY(Per acddent $ ❑ HIREDAUTOS [:] AAUTO3WN� re P aY AMAGE $ El ❑ UMBRELLA LIAR [:]OCCUR EACH OCCURRENCE $ [-] EXCESS LWB ❑CLAtMS-MADE AGGREGATE $ El DED [:1RETENTION WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN E], C STATU- OTH- ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) H yyeass d MbNo under E.L.DISEASE-EA EMPLOYE $ DESGRIPTK)N OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Altech ACORD 101,Additional Remarks Schedule,If more space Is required) LIC#CFC1488732 ----CERTIFICATE-HOLDER --CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NQTiCE WILL BE DELIVERED IN 10050 NW 2ND AVE ACCORDANCE WITH THE POLICY PRpVISIONS. MIAMI,FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05)QF ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OR ♦ Big Miami shores Village Building Department �COR 10050 N.E.2nd Avenue 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. 7 U Signature::,4 —L---< State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 120 B tZA 0-57 CIA AA who is personally known to me or has produced as identification. Notary:WU& I- MERLE FITZGERALD TIN - i*.&E,MY COMM(SSION#EESS3624 ,?p " SEAL: F;p EXPIRES March 30,2017 ( 7)39M53 FWk13N0hr/9ffW=.=n Red Oaks shutter, Ind. Security&Hurricane Protection 6 Sales• Installations•Servoce Date: State of. ElZY6A County of. This form states that Antonio Flowers licensed plumbing contractor, will be the only person working on the plumbing project located at 1450 NE 101St St in Miami Shores. sW a rmed) and subscribed before me this��ay of 9 , 2015, Personally known Or Produced Identification Lc Type of Identification MERLE FMGERALD -'; •'S MY COMMISSION#EE883824 EXPIRES March 30,2017 396-0183 FW(kU ouryserAwcan Print, Type, or amp Name of Notary 221 S.W.S'Court• Pompano Beach, FL 33060 • Phone(954)782-9325 Fax(954)782-2890 2016-01-22 07:28 main fax 1 >> 1 800 685 7530 P 2/2 BROWARD COUNTY LOCAL BUSINES$ TAX RECEIPT 1115 S. Andrewsf"4vc, Yam. A-100, Ft, Lauderdale, FL 33301-1895^954"^83 -4000 VALID OCTOSER 112016 THROUGH $11PTEMBORM2018 SEA. Receipt iii Business Ntt :�IXTY t�,t:teut R 89fivTom� TNC Ea+s�t;`r��Type., tyi�i�� taw� `�8'l�t�i��1�;r3t�',G 1gA1 :41 tt t,t. t�rasa�i Ear iii iss+ ati . s��t� NW 9 CT Gt81*1C*U"tY/C-0fVR"' CIFC1426732 k1141 IAvugiiuAta� 8usinmiaheme,9.54 2o-s799 EXOMP00n Code. '� � t4��te�i5�tr1,�► i�r�sret��n�itt Tim Aftwuml Ytanafw Far" t� F. t a_ . i�rtat ptiat Yeatm a..n Cost Tf201 1S s Si FS p. wex THIS RECEIPT"MUST ME POSTED CONSPICUOU LY IN YOUR rLACM OF BUSINESS THIS MOWS A TAX R9001pr TWO 18Z is 111Vi64 lit 11110 WiWage bf doing buaftes+t 01n ftwal county rand t$ W-COWWXY In nature, You moist mew all county andtor tiP unidpalty pttarttrit W14EN VAUDAT90 ON WON rMIMM& G. TWA GUSIAM Tax Rscelp4 mkiatt to tramfa�whesi tho buoinvas is said, bt invg.s nome has chfilload of you have moved #tu busitiolfa Jacaftn:ThIg m*49 dcrat Act Indleate tett tide businen%to lop!ot that it is its WWOSA46 With 818te or RMI Ims and r tttgtiong, �66Ai�Qi��A�tdr .ek W 01 tt`i° $'siLaABft X9.06 2016 . 2016