PL-16-1005 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-257459 Permit Number: PL-4-16-1102
Scheduled Inspection Date: June 01,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: WILSON,WARREN Work Classification: Addition/Alteration
Job Address:9942 NE 4 Avenue Road
Miami Shores, FL
Phone Number
Parcel Number 1132060171220
Project: <NONE>
Contractor: CASTELLON PLUMBING CORP Phone: 305-553-1490
Building Department Comments
Plumbing to convert 1 1/2 bath into 1 bath add new bath in Infractio Passed Comments
existing bedroom. INSPECTOR COMMENTS False
TO CANCEL PERMIT#PL06-2960
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
May 31,2016 For Inspections please call: (305)762-4949
Page 11 of 45
Miami Shores Village 1
Building Department AIRR252"'
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-89724
INSPECTION LINE PHONE NUMBER:(305)762-4949 � ��J
t Lvt��Rc�� FBC 201`
C7 Master Permit No.-R-�.I G 'l 0 0 S
PERMIT APPLICATION Sub Permit No. FUC " 1 62
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Q ' 1U ,
City:
CONTRACTOR DRAWINGS
JOB ADDRESS: l Z IVC-/L q/4y �/
City: Miami Shores County: Miami Dade Zip' 3 3 ( 3 l
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: —Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): LJ krr-kA (C . o- b"'?4 /- . W r 1'ro h Phone#: 3 ° 7 r�
Address: �� L Yeti p9u ad •
City: VJAcavi•., 5- ,ores State: rL- Zip: 3 3 3
Tenant/Lessee Name: Phone#:
Email: 1/j <_;C�'y+.
CONTRACTOR:Company Name: �f� 2, `�J�_�j�/206 Phone#:( 2AO.z S
Address: G� �� ,�dzf3 ip .S"/��
City: &d 4�;eg �S State: Zip: "916*
6
Qualifier Name: 6__1:Ra Ci Xe_
Q ��O 9 I" Phone#:)ZS
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ i 2.co . Gk) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: C_.,�`�Q jsan= -V6ci-o' \ 3:!k
as Ckm
Specify color of color thru tile: r
Submittal Fee$ Permit Fee$ :1 / CCF$ ! O CO/CC$
J7
Scanning Fee$ 01-3 Radon Fee$ '3 ' 5 9 DBPR$ Notary$ � r
Technology Fee$ , . 6o Training/Education Fee$ Double Fee$
Structural Reviews$ J� Bond$
TOTAL FEE NOW DUE$ 2L12 .07 ro
(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 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 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 KJOl^-,�.. �. //V Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
t 1 day of I'lrl-40 GH 20 t't by —71 _day of Z 20 Z� by
.,who is personally known to who is personally known to
me or who has produced - ��yR� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: IIIII�I�IIIII/jFJ/ NOTARY PUBLIC:
e�� ° Mr'•.�99� � n
Sign: _ ��:�% Sign: 0�
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Print: : ax 6 rn "�= Print: /J2/Z rcxAgbs
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Seal: Seal: o� Bc,
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MY COMMISSION AFF194734
81 6 69t.99�0��, EXPIRES:April 7,2019
ado°�o Banded Thro W Notary Services
************************************************************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
/ A
r
CASTELLON PLUMBING CORP.
9841 NW 130 St Hialeah Gardens, FL 33018
(786) 255-5195
April 21, 2016
State of Florida
Miami Dade County
Before me this day appeared Giraldo Castellon who, being duly sworn deposes
and says:
That he will be the only person working on the project located at 286 NE 99 Street
in Miami Shores, Florida 33138
Sworn to and subscribed before me this September 21, 2015.
t;1 X-
Notary Public
�pSpRY P(,B�
BEATW A.BURGOS
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�T'f * MY COMMISSION#FF 194A734
�P EXPIRES:A017,2019
�OF Fl.�+'P ThNBjet Notary Servkes
��� Miami shores Village
mu
Building Department
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.
Signature:)aw,
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this I day of M�Gt"l ,20
By Vv a�aa� W tl,�v,_) 011 tli ftersonally known to me or has produced
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Notary: ®� ;a
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