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PL-15-145( ,26Y/ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241792 Permit Number: PL -1-15-145 Scheduled Inspection Date: August 25, 2015 Inspector: Diaz, Osvaldo Owner: ALAN CORONADO, LISA AYUSO Job Address: 461 NE 101 Street Miami Shores, FL 33138-2448 Project <NONE> Contractor: DALE PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060170670 Phone: (786)663-1804 Building Department Comments 1 BATHROOM, WATER CLOSET SINK AND TUB Infractio Passed Comments INSPECTOR COMMENTS False Passed ,/ Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-226895. bt) August 24, 2015 For Inspections please call: (305)762-4949 Page 19 of 33 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: t--lco t .Arc -it to � �r BY: FBC 2010 s;d_.ro JAN 21 2015 Master Permit No. (ih Sub Permit No. FL/ S---1A-/S ❑ EXTENSION ❑RENEWAL ❑ REVISION ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: Occupancy Type: Load: Construction Type: Flood Zone: Zip: 3 3 1 0 is the Building Historically Designated: Yes NO OWNER: Name (Fee Simple Titleholder): lr /4~I -S BFE: FFE: r _ CD Phone#: 36f--V,3� 76 7 �� Address: \ t\ (- l 0 City: ✓ "W.- k g State: E' (` Zip: 5 i3 .°' Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 2-45- P N b ry O `1- CPhone#: Address: / 6-4. A) Ctd .S r J t/ /' -moi) a CiP--S �-� v re:/ birA City: State: ? � c..? he -09. Zip: 2s'/ 66 Qualifier Name: rig .i...0 7 w State Certification or Registration #: ? 2•7 Phone#: 7 gC `es, / e o ?. Certificate of Competency #: Cmc /' Z oe DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for thisermit: $ 3 a&Ort31 Square/Linear Footage of Work: State: Zip: L®® O - Type of Work: Addition ❑ Alteration 0 New 0 Repair/Replace Description of Work: c ���V•.'Zir0\ / C l l _ / 1 y k= T ❑ Demolition Specify color of color thru tile: Submittal Fee $ 1 Permit Fee $ 22S, Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 215' SC 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 reinspee#iegfee will be charged. JSignature OWNER or AGENT The foregoing instrument was acknowledged before,, me this day of? , 20 , by L. I ./�` �.' n , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: CA ctL '"°'% LAURA FARL Y 61 MY COMMISSION # EE53276 % p/ WIRES: March 16, 2015 1.800.3.Nermy 11. Nath Y Diems Assoc Co. Signature CONTRACTOR The foregoing instrument was acknowledged before me this 3 day of C' C T , 20 17 , by L iv, D g/ ✓� ' , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUB Sign: Print: Seal: ************************************************************ APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review LAURA F • ' EY MY COMMISSION # EE53276 157 EXPIRES: March 16, 2015 4 NOSY mat MOM CO 1-8003-N�ITAAB *** Zoning Clerk From: Responsive Inseastl Fax: (306) 621-9111 To: Fax: +1 (306) 756-8972 Page 2 of 2 01/21/2015 10:42 CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MM/DDIYYYY) 01/21/15 r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOESAIOT 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 1NSURER(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 f•'te :er m: arc : ontlitior:s o, the policy, certain policies may require an endorsement. A statement on this certificate does no: confer rights to the PRODUCER Responsive Insurance Agency Inc. 17845 NW 27th AVenoe Suite 'b' Miami, FL 33056 Phone (305) 621-9111 Fax (305) 621-9181 rINSURED _- Dale Plumbing Inc 1 154 NW 97th Street Miami, FL 33150 - COVERAGES 305 CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAY BE ISSUED INDICATED. NOTWITHSTANDING OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS ONTAC7 •- NAME: WESTERN WORLD INSURANCE COMPAhIY PHONE 305 621-x3111 •� F—AX I INC. No. Ext): ( ) j (A/�Nog (305) 621-9181 E-MAIL A^4RESS: clayion@responsivehlsulance.colli INSURERIS) AFFORDING COVERAGE NAIL 0 . INSURER A: WESTERN WORLD INSURANCE COMPANY INSURER B : • f i INSURER C: INSURER D : INSURER E: INSURER F: REVISION NUMBER: • EXCLUSIONS AND CONDITIONS OP'SUCt{ NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR A TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILI'T'Y 0 0 CLAIMS -MADE ® OCCUR GEN'L AGGREGATE LIMIT APPUESr�PER: El POUCY 2a F.3 LOC ADDLSUBRt INSR WVD POLICY NUMBER NPP1384308 PDIYYYY LMM/D) 07/27/2014 POLICY EXP IMM/DD/YYYY) LIMIT EACH OCCta2RE�VCE j DAMAGE TO NRE Fr — s s PREMISES (Ea.occurrence 07/27/2015 PERSONAL & ADV INJURY GENERAL AGGREGATE $ PRODUCTS - COMP/OP /GG MED EXP • (Any one person $ $ 300,000.00 50,000.00. J 5,000.0,0 $ 300,000.00 • .600,000.00 $ 300,000.00 I AUTOMOBILE LIABILrrY ❑ ANY AUTO D AUTOS NED ❑ PISMO AUTOS r• -ii AUTSCHEDULED LOS L NON -OWNED UMBRELLA LIAB ❑ OCCUR EXCESS LIAB 0 CLAIMS -MADE O DED ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y /N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Eyes, describe under DESCRIPTION OF OPERATIONS below COMBINacnidEDen SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per acclden $ .5 PROPERTY DAMAGE 1, ,Per accident) EACH OCCURRENCE AGGREGATE NIA DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CFC 1422087 Plumbing Contractor CERTIFICATE HOLDER O T TORY LIMIT .+o•-1 TY imms R TO EL EACH ACCIDENT $ E.L. DISEASE . EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 5 CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES , FL 33138 1 CFC -1422087 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE f�C'ttk'� faeklJzt3 • AC ORD 25 (2010/06)• QF ©1988-2010 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks ot ACCRD Miami Shores Viiiage 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.. Therefore, you may be personally liable for the worker compensation iniuries of any person allowed to work under this Permit.Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami -Dade The foregoing acknowledge befgre me this h ,20 (S. _ .. �e or has produced Notary\ SEAL: * p �N t, . lati1�Y PI 044 actor Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of , 20 By L.ir-s'i _.�� � tUttut, who is personally known ton \ �asR,�i�d as identification. 47,47 �®; J_= <2, ../ ''//n11111It0��` Notary SEAL: M.. . y 7C9 e) C.0 ii° 1=-e 0 e -5® AD,D12ers 4.41 10 --, !®! 27- a 14 /1 glig ie-_S' P4 t• t b £ '2_, r p .5>' 11TA0 D A -tel , '-b44,0 k; log • g L // A C.;C ) 42 7®.7 ®f 'D A PA0iY6 /Il1 a RNC- (ow Al &z J 1.-,/#? .S, ,6 �I I " - '7' ti_s--)-.--,t) e o 574-" 7'1c/ ? i A,1 77M. sj iv.t y e rue" 'p iso N) A jj,0 Lo ® e 0 N yo u ic i° , j % • A �e %,J® iTAJ& Ai A .S C 7• � 0 S�� vi.i,)b p rleci.-r c_®lis l'ifige-7 ®R 0 /sir eE-.13 a'- °77/6 S k; U.Ue -0 ° two 1e k -eel. vie:)".)r --,--7-10 pie,t-i., 1 A i a, , co ®R b/N ? ON 09 Ai-o e>c ecRe/ e'f✓ C <':' n -Psic7-0 11.s 77/4% p E-re/1( stt_cl, e pp 1 ct 6-iv c , '!oorko 6 r.p5 .-o vL= .z..v a cm, ( ¢ a'riv g 11_2014 2) F .- `-F z. w'c. 2.5-2 4.eve c ' i C A- - eif ► ki �r eoiv ..Z4x�',epr � Vrs'e2S 07- / Z 51"-tiL- 04- D lil l l ````���lal et��/' &' g-too I . \e : ;i.e...,:v t ' / 6 -SONS X41.. S =-acs I • ` • • E 06, szm •• - 'T!-t i S u' 3+7.y /� p z.o yS/ate io 10 is misst,s' z TO rig_ av, LINT N PAC- 44S ///// !/ f O,Ir141�oo, JEFF ATWATER CHIEF FINANCIAL OFFICEP STATE OF FLORID,, DEPARTP NT 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: 8/20/2014 PERSON: DAWKINS FEIN: 331118230 BUSINESS NAME AND ADDRESS: DALE PLUMBING IN:. 154 NW 97 ST MIAMI FL SCOPES OF BUSINESS OR TRAM. LICENSED PLUMBINZ CONTRACTOR 33150 EXPIRATION DATE: LINTON 8/19/201E 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 scion may .ot recover merits or compensation under this Chanter. Pursuant to Chanter 440 05M 2) F S Certificates of election to be exempt.. apply only within dm scope or the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05( 13i. F Notices of election to be exert and certificates of 4.rection to be exempt shall be subject to revocation if, at any time after the f,ng of the notice or a s. .ce of the certficeze, the person nzmect on the notice or • smticate no Ionoer meets the reauirements of the section for issi.ie. �ce of a °n+tom Ti -e ceoeitmerl ets.:3 -evoke a est tirmete at any time for (more of tP4e Person named on the certificate to meet the retraTemeMs 01 o s 1:FS-F2-D1NC-252 CERTIFICATE CF ELECTiON TO BE EXE.1P` REV SED 07-12 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS° COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE DATE: 8f2012014 PERSON: DAWIONS FEB,: 331118230 BUSINESS NAME AND ADDRESS: DALE PLUMBING INC 164NW97ST MIAMI EXPIRATION DATE: 8f 19/2016 LINTON FL 33160 SCOPES OF BUSINESS OR TRA QUESTIONS? (850)413-1605 IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporatton who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of electton to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S.. Notes of election to be exempt and certificates or election to be exeniot shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The deoarment shall revoke a certificate at any time for failure of the person named on the. certificate to meet the neauirements of this section. - LICENSED PLUMBING CONTRACTOR Kcal Busi n : Tax".. ` ,g pt M iamiODade County, State of Florida OTH1S IS NOT A BILL 0 DO NOT PAY 5835617 BUSINESS NAM EtLOCATION DALE PLUMBING INC 154 NW 97 ST MIAMI SHORES. FL 33150 OWNER DALE PLUMBING INC Wodcer(s) 1 RECEIPT NO RENEWAL 6084388 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC142708r EX PERES SEPTEMBER 30, 2015 Must be displayed al place of business Pursuant to County Code Chapter BA O Art. 9 8 10 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 07118/2014 0230-14-004965 This Local Business Tac Recetpt only coranrs payment of the local Business Tac. The ilsceipt is not a license, pemit,orsterna:anon°, the holder's qual locations, to do business. Holder ntslcalmly with any 9 or nongovernmental regatory laws and requirements which applytothe business The RB13PT NO alacme mat be displayed on all commercial vehicles t]Miarit3» axle Sec For mote irdam:dice( visit yoniY. ucriut 1 MENT OF='USINESS AND PROFESSIONAL REGULATION CONSTFkUCT)ON INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DAWKINS, LINTON HUGH DALE PLUMBING INC 154 NW 97TH ST MIAMI FL 33150 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day We work to improve the way we do business in order to serve you better. For information about our services, please log onto www myfloridalicense.com. There you can fled more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR CFC1427087 e PLUMBING CONTRACTOR med below IS CERTIFIED der the provisions of Chapter 489 FS. oiration date: AUG 31, 2016 DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ;., STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1427087 ISSUED: 08/27/2014 CERTIFIED PLUMBING CONTRACTOR DAWKINS, LINTON HUGH DALE PLUMBING INC IS CERTIFIED under the provisions of Ch.489 FS. E&ptrattan date . AUG 31. 2016 L1408270003228 KEN LAWSON, SECRETARY DAWKINS, LINTON HUGH DALE PLUMBING INC 164 NW 97TH ST MIAMI FL 33150 ISSUED: 08/27/2014 DISPLAYAS REQUIRED BY LAW SEQ # L1408270003228