PL-16-1265 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-258615 Permit Number: PL-5-16-1265
Scheduled Inspection Date: August 23,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: LIBONATTI,ALEJANDRA Work Classification: Addition/Alteration
Job Address:689 NE 92 Street 11-G
Miami Shores, FL Phone Number
Parcel Number 1132060430270
Project: <NONE>
Contractor: DECONEX INC Phone: (305)817-8777
Building Department Comments
NEW ROUGH AND FINISH PLUMBING FOR BATHROOM Infractio Passed Comments
AND KITCHEN. REPLACE FIXTURES, HOSES AND INSPECTOR COMMENTS False
VALVES.
Inspector Comments
Passed 5�1
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
August 22,2016 For Inspections please call: (305)762-4949 Page 8 of 36
,gtt ,mS g Miami Shores Village t P� j11113
10050 N.E.2nd Avenue NE �� „
9 p
•"• "� Miami Shores,FL 33138-0000I'll r1i
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Phone: (305)795-2204 s \� A
t4?f 19%' 4 y
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x /�1E3 Expiration: 1 04/2 1
Project Address Parcel Number Applicant
689 NE 92 Street Number: 11-G 1132060430270
ALEJANDRA LIBONATTI
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
ALEJANDRA LIBONATTI 10401 NE 6 AVE
MIAMI SHORES FL 33138-2048
Contractor(s) Phone Cell Phone Valuation: $ 850.00
DECONEX INC (305)817-8777 Total Sq Feet: 0
Type of Work:NEW ROUGH AND FINISH PLUMBING FOR B Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-5-16-69730
DBPR Fee $2.25 06/07/2016 Credit Card $ 164.10 $0.00
DCA Fee $2.25
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $164.10
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.
i June 07,2016
Authori d Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 07,2016 1
RECRIVgM7
Miami Shores Village Y 11 2816
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 201`I
BUILDING Master Permit No. zo_((O- Pjg--�
PERMIT APPLICATION Sub Permit No.a(( — 12-6 J
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�,/ CONTRACTOR DRAWINGS
JOB ADDRESS: �C'91 /Vr%� ���`�c5f reef I/- C
City: Miami Shores �! County: Miami Dade Zip: 3 i 3
Folio/Parcel#: //- 3 206 —0 ! - 01-170 Is the Building Historically Designated:Yes NO )e
Occupancy Type: pfffi Load: nl/ Construction Type: Flood Zone: y//A BFE: N FFE:-V/A
OWNER:Name(Fee Simple Titleholder): _T C��1era4Ij�i�}I0��C Phone#: S-- 7/3 "(257'T'
Address: 64?5. Ale 92 S' 5,lree-t
City: !1 .ten j S holes State: Ei zip: 3313 Y
Tenant/Lessee Name: I / Phone#: A)/A
Email: alQ�1 bto L:.�4hcw com
l7 _ .
CONTRACTOR:Company Name: JHe C O A/e> 1KG Phone#: 3o5-- 3-777
Address: 2217 (31R(> R d AP7
City: Copvg& & r.r S State:ted/ zip: 3319
Qualifier Name: _T6 HA1 A D AL,1 P Phone#: 3057 - 8 )7-9377
State Certification or Registration#: CF6 /zai-2--r��t/ Certificate of Competency#:
DESIGNER:Architect/Engineer: 14 V► 4V'' /Z 4 cc' Phone#: ®S -28L -v®CSS
Address: )SDO SW I s± City: rl elm f State: rl_Zip: 331
Value of Work for this Permit: Square/Linear Footage of Work: -151 L04.0e'-b K
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑l -Demolition
Description of Work: Alew WgZa
yfs , hoses f x(1(5
Specify color of color thru tile: N A
Submittal Fee$ Permit Fee$ (/ CCF$ ® GC) CO/CC$
Scanning Fee$ Radon Fee$ C_ DBPR$ Notary$
Technology Fee$ ® Training/Education Fee$ 0 a® Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I `f d
(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 Signature
W or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of DrI 20 by day of /%pxf L 201,by
����,.�
1��C� YC3 "r"` no is personally known to -10Hd/ �(//9 who is personally known to
me or who has produced Q ' 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:
S, Sign:
�i pAy A; GABRIEL REYES
Print: .J �Y) Print: 4°
I MCA N11 11010N I IT wr�--
Seal: Seal: �, 4 11,22017�AIL °R `0 ! BEXPIRES: 1*N0Wysrve
41AN 00 1111M FROM
�taomm. �
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
e SNoREs 61
... .....� Miami Shores Village
Building Department
��ORIDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY F LQ OCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
Workers Compensa ion RUR have NOTI TO-DOWN form and Contractor ffA it davit
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICAT OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINES RECEIPT
C. COPY OF STATE REGISTERE ONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE T NER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify theescri'ti
BUSINESS NAME: C' 0 C '
BUSINESS ADDRESS: 0- r IQCITY cot"4 A4TkATE-,L-7ZIP
BUSINESS PHONE: FAX NUMBER�)
CELL PHONE C ) QUALIFIER'S NAME:7 ��7 vn en
QUALIFIER'S LIC NUMBER: Z 3141/
STATE OF FLORIDA
DEPARTMENT OF 9=NM AND pROFESSIONAL REGULAT N
CONSTRUCTION INDUSTRY LICENSING BOARD
1840 NORTH MONROE STREET (854)487-1395
TALLAHASSEE FL 32389-0783
J
DAVID JOHN A
2D 7 BlRp IROD
NC
CORAL GABLES FL,33'146
one mfelon B b offt near* ;
Penal Regulation. tlru Depanami
OfBus eras
fe ���� ushumses range
Fl �m s two 6arbt to D ASTATE OF �BUSINESS
E+►�I+�S►we work to PPFE
RLATION
to serve semkos
busirs 1n order CFC142 =g P
in oY� For °ttrt�tdmcna � %. I14�l04/2Q1 fi
There CERTIFlEp
N
OSu to and it � DAVID..OHN - �'� 000
.« r,
ePerbnerrt's DECONEX IMG
oyon�syftta�o.. strive to b:UCOM�#W ym can
A17Li
and con8�on Y=row ummal In Fiorlrla, s CERTf A under the p"revlsfona.Ot ChAU FS_
F.�aaii�ata: 31,Z0i8 LTW�ROpppg�.
DETACH HERE
RICK SCOTT,GOVERNOR
KM LAVyVW SECRETARY
STATE OF FLORIDA
DEPARTMW OF BUSINESS AND PROFESSIONAL 1:tMf.A-IM
CONSTRUCTION INDUSTRY UCENMM BOARD
"CFCI42823t
The PLUMBING CONTRACTOR
Named below IS CERPRED T
Under the provkdDm of ChgAsr489 FS.
Exphation : AUG 31,2016
.'•
DE DCONE A
247 BIRD ROAD imi
ISSUED.
t8 DISPLAYAS REQUlRD .
WQ Oft
`j
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY LBT
7062177
BUSINESS NAMIULOCATION RECEIPT NO. EXPIRES
DECONEX INC RENEWAL SEPTEMBER 30, 2016
9092 NW S RIVER DR STE 51 7339815 Must be displayed at place of business
MEDLEY,FL 33142 Pursuant to County Coda
Chapter BA-Art 9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
DECONEX INC 196 PLUMBING BY TAX COLLECTOR
C/O DAVID JOHN A CONTRACTOR
45.00 07/31/2015
Worker(s) 3 CFC1428231 0221-15-007229
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt Is not a license,
permit or a ceriigcation of the holder's qualf1loadons,to do business.Holder must comply with my governmental
or nongovermme►ial regulatory laws and requiremants which apply to the business.
Illyffik The RECEIPT No.shove must be displayed on all commercial vehicles-Miami-Dade Code Sec go-M.
For more information,visit www miamidedegovhsxoollector
e
DATE
A4C+o`� , CERTIFICATE OF LIABILITY INSURANCE 04/20/M/DDKYY1�
04/20/16
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 policy(les)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 CONTACT MARTA ALONSO
Florida Bankers Insurance PHONE (305)266-6493- � No): (305)262-0679
7278 SW 8 StreetD L MARTA@FLORIDABANKERSINSURANCE.COM
Miami,FL 33144 PRODUCER
CUSTOMER ID A
Phone (305)266-6493 Fax (305)262-0679 INSURERS AFFORDING COVERAGE MAIC#
INSURED INSURER A: WESTERN WORLD INSURANCE COMPANY
DECONEX INC INSURER B:
233 MADEIRA AVE STE#2 INSURER C:
CORAL GABLES,FL.33134 INSURER D
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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I SR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP
INR WVD POLICY NUMBER MM/DD M/DD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 500,000.00
COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED
occurrence
PREMISESS 100,000.00
$
❑ ❑ CLAIMS-MADE W] OCCUR B#1501181 MED FRCP(Any one person) $ 5,000.00
A ❑ N N 07!30/2015 07/30/2016 PERSONAL&ADV INJURY $ 500,000.00
❑ GENERAL AGGREGATE $ 500,000.00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000,000.00
O POLICY ❑ PE OT- ❑ LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
❑ ANY AUTO (Ea accident)
BODILY INJURY(Per person) $
F-] ALL OWNED AUTOS BODILY INJURY(Per accident) $
F-1 SCHEDULED AUTOS
❑ PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
❑ NON-OWNED AUTOS $
❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $
❑ EXCESS LIAB ❑ CLAIMS-MADE AGGREGATE $
❑ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATIONWC STA OTH-
AND EMPLOYERS'LIABILITY Y/N TRY LIM E
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBEREXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
If yyes describe under
DESGrRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required)
L#CFC1428231
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
CITY OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING&ZONING
10050 NE 2 AVE AUTHORIZED REPRESENTATIVE
MIAMI SHORES,FL.33138
@ 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09)OF The ACORD name and logo are registered marks of ACORD
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DECONEX INC.
State Licensed Plumbing Contractors
247 Bird Road, Coral Gables, FL. 33146
CFC 1428231
27 April, 2016
State of Florida
County of. Dade
Before me this day personally appeared DAVID JOHN who, being duly sworn, deposes and says:
That he or she will be the only person working on the project located at: 689 NE 92nd Street
Miami Shores,F133138
Sworn to (or affirmed) and subscribed before me this 20 day of April, 2016 by:
David John
.y
Personally Know
`/
OR Produced Identification
Type of Identification Produ
YP
MY CO FF
MI EYEI FF;81
s f� `ate 07079
EXPIRES: WWI 11,2017
For noa Bonded 1bfU Budget Notary Services
Print, Type or Stamp Name of Notary
• ,5t10REy� A,l Miami
shores Village
l"' n"'M Building Department
.�"
10050 N.E.2nd Avenue
LORiDA 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: �! ��>e
State of Flo da
County of Miami-Dade ��n
The foregoing was acknowledge before me this day of CI V 20
By �I�� IN p` D who is personally known to me or has produced
as idenl OnAR41
• i
Notary: 9 Mma,M/s'• csi
• Q�g`rio`��„
SEAL: N�":�'?
r 9 �
FLO