Loading...
PL-16-3286 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-273471 Permit Number: PL-12-16-3286 Inspection Date: December 21,2016 Permit Type: Plumbing- Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: COIRIN,CATHERINE Work Classification: Repair Job Address:140 NE 104 Street Miami Shores, FL 33138- Phone Number (305)733-2037 Parcel Number 1121360130770 Project: <NONE> Contractor: CANCIO GROUP LLC Phone: (305)525-5439 Building Department Comments REPLACE PVC PIPE WASTE Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed I V1 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid L 24 s ° 1 Miami Shores Village ti Pklfy ejaw 10050 N.E.2nd Avenue NEj"O�fer Miami Shores,FL 33138-0000 Phone: (305)795-2204 � z�' + �&g Expiration: f04I201? Project Address Parcel Number Applicant 140 NE 104 Street 1121360130770 CATHERINE COIRIN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CATHERINE COIRIN 1042 N EL CAMINO REAL (305)733-2037 ENCINITAS CA 92024- 1042 N EL CAMINO REAL ENCINITAS CA 92024- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 CANCIO GROUP LLC (305)525-5439 _._ _._... _. . :._._n .. .... . Total Sq Feet: 60 Type of Work:REPLACE PVC PIPE WASTE Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Review Plumbing Classification:Residential Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# PL-12-16-62258 $2.25 12/06/2016 Credit Card $ 163.90 $0.00 DCA Fee $2,25 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 AFFIDAVI ify hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z in Futi e I authorize the above-named contractor to do the work stated. December 06,2016 Authorized Signa e:Owner 0 Applicant / Contractor / Agent Date Building Department Copy December 06,2016 1 ®. 00- &- Miami Shores Village 7DEC ��o�s��� Building Department rkx 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ,y. Tel:(305)795-2204 Fax:(305)756-8972 `�� INSPECTION UNE PHONE NUMBER:(305)762-4949 � �` I=BC 201'-(B V I LD G Master Permit No.-pu(, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL VPLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP �•-� ry t Cr NTRACTOR DRAWINGS JOB ADDRESS: �7 J�C� l� ���`4 � City: Miami Shores County: Miami Dade Zia - : !�)/� Folio/Parcel#A I Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: 7 c-3,0 b—) Address: !1 �J f`�� /1�^r 1— City:��l �1���' State• CIA Zip: q Tenant/Lessee Nme: Phone#: Email: � _k7 k7\\M e., CONTRACTOR:Company Name: \ ,6Phone#:,_.�..r Jam- &_55 Address: n ,"Si City: M N Okfy1 I State: , Zip: 4 Qualifier Name:Geoc�x� l�C✓�'�--�I Phone#:,�-- zs- 2-5 q State Certification or Registration#�� . 1 U1� �"t`��' Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: r� c� f �� Value of Work for this Permit:$ L �w / Square/Linear Footage of Work: �w Type of Work: ❑ Addition\,❑ Alteration ❑ New epair/Replace [I Demolition Description of Work: `�` � ^ Specify color of color thru tile: Submittal Fee$ Permit Fee$ A CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 42 (Rev1sed02/24/2014) 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before Mme this The foregoing instrument was acknowledged before me this daay�of � 1 20 �y/ ,by day of Ciao— ,20 1 � " by wos personally known to (�,e®rte cal-)C—who is ersonall own to me or who has produced—(-05(D-4(D-4 a"}-?Q5)?aP me or who has produced as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: 1 NOTAR PUBLI SIn: n Sign: Prin l Print: Seal: ARMNEDIR Seal: �' �#?p Commi81an 0 FF CainA90126,2018, Fxplrn April 26,2019 tomsp�+ e�retiwT,ei,ou� eeeoou�o+r e�'fl°""°' APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Cancio Group, LLC 6619 S Dixie Hwy#173 Miami, F133143 CGC1512105 Affidavit and Contract December 1, 2016 State of Florida County of Miami-Dade Before me this day personally appeared George Cancio who, being duly swom, deposes and says: That he will be the only person working on the project located at 140 NE 104 Street. i X JL_ George Can i Swom to (or affirmed) and subscribed before me this 1st day of December, 2016, by Pegrg Cancio Who is pe ally known to me. (Stamp) Notary Signature-Arlene Dia ARLENE DI14Z Contract: ' ` EDOxpire H 28,2018 Property Address: 140 NE 104 Street Folio 11-2136-013-0770 Plumbing -Replace PVC 4" pipe about 60 ft long $4,000.00 Total for remodeling -$4,000.00 X George Candid Miami shores Village Building Department e,eo� 10050 N.E.2nd Avenue ��OR1Dpc 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 it L 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 hmite d 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,Nflami 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 W YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this� {�_day of L 20� By&� 1 l 1�� who is personally known to me or has produced _-?y' 0 'i"cation. ill 11111" N �AQ-g,�R�L}_�NE DIg� `R• '��_v�28, SEAL: Bwnm,norF ,nr „aa+a Scanned by CamScanner DATE(MM/DD/YY) t CERTIFICATE OF LIABILITY INSURANCE 11/15/16 PRODUCER Florida Bankers Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 7278 SW 8 Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)266-6493 Fax (305)262-0679 INSURERS AFFORDING COVERAGE NAIC# INSURED CANCIO GROUP,LLC INSURERA: ESSEX INSURANCE COMPANY 6619 S Dixie Hwy#173 INSURER B:INSURER C: MIAMI, FL 33143- INSURER D: (305) 525-5439 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE M/DDIYYYY DATE M/DD GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 ©COMMERCIAL GENERAL LIABILITY 3EG6314 08/19/2016 08/19/2017 PREMISES GE ea occurrence)RENTED 100.000.00 ❑❑ CLAIMS MADE © OCCUR MED EXP(Any one person) 5.000.00 A ❑ ❑ PERSONAL&ADV INJURY 1,000.000.00 ❑ GENERAL AGGREGATE 2,000.000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1,000.000.00 0 POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS ❑ BODILY INJURY NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ W C STATU- ❑ OTH- EMPLOYERS'LIABILITY Y/N T LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE IfyECIAL PROVISIONS below es,describe under SPE.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CFC1427458 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL VILLAGE OF MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPARMENT THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2 AVE OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES, FL.33138 AUTHORIZED REPRESENTATIVE ACORD 25(2009/01)OF ©1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 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 certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4/28/2015 EXPIRATION DATE: 4/27/2017 PERSON: CANCIO GEORGE L FEIN: 208588438 BUSINESS NAME AND ADDRESS: CANCIO GROUP LLC 6619 S.DIXIE HWY#173 MIAMI FL 33143 SCOPES OF BUSINESS OR TRADE: UNDERGROUND UTILITIES MECHANICAL CONTRACT LICENSED GENERAL LICENSED PLUMBING CONTRACTOR CONTRACTOR LICENSED ROOFING LICENSED ELECTRICAL SWIMMING POOL SOLAR CONTRACTOR CONTRACTOR CONTRACTOR CONSTRUCTION-NOT Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefts or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Cerbflcdn of election to be exempt..apply only within the scope of the business or trade listed on the notes of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exampt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the nodes or the issuance of the cariffMste,the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a certlflcate at t1F.S-F7-rtwf:-9F9 f:FRTIFlrATF OF Fl Fr^.TION TO RF FXFMPT RFVIRFn Min 01 IFRTIONR91R.5t1141A-1R11Q Cowl Aeat Business Tax, :RcFIT !Miami-Dade County, State of Florida THIS IS NOT A BILL-GCI NOT PAY 6084735 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRE CANCIQ GROUP LLC RENEWAL SEPTEMBER 30, 17 6619 S DIXIE HWY 173 6534276 Must be displayed at piace'at busing MIAMI R.33143 Pursuant to County Cade Chapter$A--Art.9 itt OWNER SEC.TYPE OF BUSINESS ` CANCIt GRC+UP LLC 196 PLUMBING CONTRACTOR PAYMENT R�lilO; FC14274 BY TAX CCOL�.t�t1�: N 07 GRED f This Local Business Tax Receipt only coAmns payment of the Local Business Tam The Receipt is not a luu pennit,or a certification of the holdersalalificationa.to do bufdnes: Holder must comply with any goaerenl ml" or angovernmental regulatory laves an+ r$quirements which appy to the business. The RECEIPT NO.-above must be dl*ayed on aR commercial`vehicles-Utanri-0*deCode Sec ft-ii For mare Inknuation.visite miamidade lWexce Scanned by CamScanner STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CANCIO,GEORGE L CANCIO GROUP LLC 6019 SOUTH DIXIE HIGHWAY#173 MIAMI FL 33143 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. �' PROFESSIOAIAL REGULATION Every day we work to improve the waywe do business in order CFC1427458 ISSUED 07/04/2016 to serve you better. For information aut our services,please log onto www.myforidalleense.com. There you can find more CERTIFIED.PL6kf5IN0CONTRACTOR information about our divisions and the regulations that impact CANCIO,GEORGIr R you,subscribe to department newsletters and learn more about CANCIO GROUP CLC the Department's initiatives. r Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can IS.CERTIFiED under the provisions of Ch.488 FS " serve your customers. Thank you for doing business in Florida, usoraaaoora, and congratulations on your new licensel fin*stM, AW 31,,201,8, DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA ' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC142745$ The PLUMBING CONTRACTOR �A Named below IS CERTIFIED Under the pravlslons of Chapter 489 FS Expiration date: AUG 31,2018 Nil" a s ' CANCIO..GEORGE L -- , //CANCIO GROUP LLC _.661.0-SOUTH-DIXIE MIAMI.. FL3S1A -a'o�� . - ::• .a' _ � €,y Vit. - .e:a ..+- ., #y, ,... ;-`, �� „_ -d,+.�k...s.............'h-�..4..h x�&.<�'k:.«`�..�. ISSUE13: 07/00016 DISPLAY AS REQUIRED BY LAW SEQ# 1.1807040001583 Scanned by CamScanner .x� YeFALk -_ ATION S + t acs Ts =+ • +DEQ BYtd AAE •• 4.,Y. .3+....,;. £k7.r �.,, •�� _r_d4;rf'ar1§,w'%r� r'1.1d`. c � _ _._ rix0c r .f - fp! -..rjr 'S.� Y d .,,.. _.�,. :. r� ti��E._,r,:: . ; � � �. � , . �< • . t _ .�- Vit:. '�. _ � ..�- i�.?=r a a :a:,.; i�: i;? 4 1- a t >�� �.,�: :'d• - as t �y �� �','k a f v<i -.e .� „T �,ty�_. _ � •. ': Pmt F .... .... '•- w3 ur r .•;'� nW:' x:;T rf i. -'"� mss`:' s.R.. �..• �.. l .1`: ..:.::.+.: ...w: dF. � u.�..r........: ,: x.R iv..:. i' '.'-,e+'Y..wi .vA .airA <x '�,:.,. •..�' �'.. .. �%�a .# :'.S' ....xx-,r: x _. -ra.. ,,, ate. ,-..-., ,..,..._,Y t ,. .•r, „a.,.., .,'.,». nz.':;:. '��'' ,. .:,;...,, .•I w ,.<,,,, ,. �€:.� ±;� � '�;; '�g _ .,,.-.. Kt .,,:,;r,�,. :.,,.w .....Vii., .. Er: s 4 _�'n h,.,. - it,.«;' v , s.,<3.u•. _;-. .., .. ,:t:.. . �. .fes, ,. ;i.." —^bt;';.r r.�sc '.: 'iii, 3 ...: ,.a.: .. :,.t t ,. .::�,,.. -. .. .':. x T✓ �'r„"' k ^"�.,: �.7Ea.;.:; ? ....,<}�. :'§z ....•.:._... .',k<'f .4 .,..x. .:..- ¢.a.,.d.,,«�-., :,.1,,< � - r ..-br'�"'s'•- m t .}�. "?;3 ;�' ';;t Q•-a�:'..' ,rz;�' �� r¢€ ,r * ''�` �- ra � .1{�+�'tAr ��Y7.�$� d,1c.:3A1n. 7�,. '¢•. F�.,.,e ?. .Y Skil .b a 9i=a,3,q,ux,. ����� ��5 1 ;c ,rP(:. ;-� �R d". C a � � 5 a:.. :, a.. ... �„” :.�, -, vx,.: •,. �.. :.+: „-.a'!. a' ll�. - '��� � `�.., .`'%Ylwt-: ek. ,r .e_u•:54+.;.(�'.. 1�a's' u,v � "�•,!a'Sl'.a.,: F ..,. .. ..� e{ `�"'e+ '." ..yx...:.> +,,._, r.:• �. .� ear �... ;: �' :r �T'�`c' __ w�,. ,...., ....-r, ., , a. :,.�,r,-. - p .,.� All - �+ ' - '�Pjt..„a w Ke,�`a�.b u .,'�.. >s 4 _ � �'.•... ',� } ...xs+E N t ..A:�l ..C7 f' �.y{�^��� a .._ ^' �• ix..� � � ... i .a 3y P.. .,:. 1i •�.. ';A d i, ��W�xL, WSJ• A L Esc •'.•`s Y.`?, -.. -'�' �� t `l?d. �+}, Y �_.l,-t M � r � � �•�F+gL°F'S ��C _ d. 54Q Lh.x':, s4MTf ?:5='+.. .� y 4