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PL-12-13871 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 -9em Inspection Number: INSP- 176333 Permit Number: PLC -7 -12 -1387 Scheduled Inspection Date: November 05, 2012 Inspector: Hernandez, Rafael Owner: Job Address: 10500 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300010500 Contractor: R&I PLUMBING SERVICES CORP Phone: 305 -823 -6911 Building Department Comments NEW SINK AND BATHROOM REMODEL IN EMPLOYESS LOUNGE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comm =ants November 02, 2012 For Inspections please call: (305)762 -4949 Page 6of37 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. — _ 3 Master Permit No. CCI ---*D3 RECEIVED JUL 24 PERMIT APPLICATION FBC20 Permit Type: PLUMBING -- Name (Fee Simple Titleholde) Phone#: Address: / 05- 0 0 0, 4 e, /' City: Vi? f.4 5, - & 45 State: �. p ty' � Zip: � � � 6 Tenant/Lessee Name: Phone*: Email: a JOB ADDRESS: 0 �� /C� / VA Zip: r5 ( 3 41 City: Miami Shores County: " Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: te KY P 64 ii i4/ $fL Phone# :505 :" Sr-Z / 7 Address: "7111 Alai / e ' .�1,6 c...0_, . City: 6 'A [ // _ State: P' Qualifier Name: gask 6 L'Z. / i 4 g Phone*: s3e!"- ^ V- C'`q- State Certification or Registration #: Certificate of Competency" . ' a "9- C (OOO) 7" Contact Phone #: 216,• 3 ® ( 2' 0 ZEmail Address: E 'e,) Z. Ai 4 4) I/ ALI T,M 4 % I- i (dam /t-1 DESIGNER: Architect /Engineer: Phone#: Zip: 8 rVlahlppf Work fot this Permit: $ / �• Square/Linear Footage of Work: E Type of Work. OAddiess Alteration New ORepair/Replace� ®��J�C..olition Descripti nt'f� `W rk• /� Ai 0 3 / /1J /� — /1q v ► of � e e< „1-01/44-7-1e-- Submittal Fee irk Permit Fee $ 2-Z CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 4:23 t • -Ili" Bonding Company's Name (if applicable) Bonding Company's Andress 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 certif►ed copy of the recorded notice of commencement must be posted of 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. • Signatur e Owner or Agent The for '. in;; instrument was ackn v ed ed be re me this I � da y of ` , 20 12byq...._A w is rsonally_ Ot; own to me or who has producedl l l 1 As identification and who did take an oath. N'TAR LIC: Sign: Print: My Commission Expires: APPROVED BY 4 l ' OS P,--r; Notary Public - State of Florida ,01 • _ My Comm. 1. s. '! :o Commission # EE 128810 ,,,, ,`,,, Bonded Through National Notary Assn. Signature -�i Contractor The foregoing instrument was acknowledged before me this Ly day of oky , 20 2., by .A' e- a t Ag.e � id who is personally known to me or who has produces) F L Is L C- ii- n- 470.5'i -6 aas identification and who did take an oath. NOTARY PUBLIC: rtuee *my Publb r: Amide Sign: gornmwal Eqgyes it Print: '■ tt-Qk 1—t©Q't-.a mitt.. r. My Commission Expires: 1 k Ct -ZS Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) BU ESSNAME / LOCATION THIS IS NOT A BILL — DO NOT PAY mcmpTUNEWAL 522894 -5 CC * 03P000074 R & I PLUMBING SERVICES CORP 7898 NW 174 TERR 33015 UNIN DADE COUNTY OWNER R 8 I�ampING SERVICES CORP souLTIme TH13 LS JNZWA R 9BING CONTRACTOR BUSINESS TAX RECEWC R 1 DOES NOT PERMIT THE HOLDER TO VIOLATE ANY -MISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR ORES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED SY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 10/06/2011 02240013001 000082.50 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD R 8 I PLUMBING SERVICES CORP RENE GUZMAN PRES 7898 NW 174 TERR MIAMI LAKES FL 33015 IItI' frl��l' lrftr l3�l1�!! rlt��l M�!!ttlllilllit!!Ittl!!tdo%,� MIAMI -DADS COUNTY 2011 MUNICIPAL CONTRACTOR'S 2012 TAX COLLECTOR TAX RECEIPT 140 W. FLAGLER ST. MIAMI -DADE COUNTY - STATE OF FLORIDA 1st FLOOR PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI' FL 33130 EXPIRES SEPT. 30,2012 THIS IS NOT A BILL — DO NOT PAY RECEIPT NO. 30- 5228945 CC NO: 03P000074 BUSINESS NAME / LOCATION R & I PLUMBING SERVICES CORP 7898 NW 174 TERR OWNER :R & I PLUMBING SERVICES CORP SEE BACK OF RECEIPT FOR A LIST OF NON— PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI -DADS COUNTY TAX c ��06/2011 02240013002• 000200.00 11 FIRST -CLASS U.S. POSTAGE PAID MIAPM„ FL PERMNO.231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. PLUMBING CONTRACTOR DO NOT FORWARD R & I PLUMBING SERVICES CORP RENE GUZMAN PRES 7898 NW 174 TERR MIAMI LAKES FL 33015 hill frill► lrfttttihhirrtjirtllrrrt !lijlttlh :ie,Ass, 03 -28 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT PROM 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: PERSON: FEIN: 03/28/2011 EXPIRATION DATE: 03/27/2013 GUZMAN RENE 611433275 BUSINESS NAME AND ADDRESS: R & I PLUMBING SERVICE CORP 7898 NW 174TH TERRACE HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED PLUMBING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05114), 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 benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election 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 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt 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 department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/28/2011 PERSON: RENE GUZMAN FEIN 611433275 BUSINESS NAME AND ADDRESS: R & I PLUMBING SERVICE CORP 7898 NW 174TH TERRACE HIALEAH. FL 33015 EXPIRATION DATE: 03/27/2013 SCOPE OF BUSINESS OR TRADE 1- REGISTERED PLUMBING CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L wider this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on Ethe notice of election to be exempt. E Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt and certificates of election to be exempt 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 department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? 1850) 413 -1609 CUT .HERE * Carry bottom portion on the job, keep upper . portion for your records. IWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISF1 01 -11 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 03P000074 R & I PLUMBING SERVICE CORP. D.B.A.: GI ZMAN RENE Is certified under the provisions o er 10 of Miami -Dade Co THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK " PATENTED PAPER �C# _ :0 8 6. DEPAR STATE OF FLORIDA O BUSINESS AND PROFESSIONAL REGULATION CO NST U ..TrION.'.1NDi75TRY LICENSING BOARD SEQ#L11092301293 LICENSE NBR 09/23/2011. J.17013315.; , R2'0067119 The. PLUMBING CONTRACTOR, Named below .HAS REGISTERED Under the provisions of Chapte Expiration date: AUG 31, 2013 (INDIVIDUAL MUST MEET' ALL LOCA REQUIREMENTS PRIOR TO .CONTRACT1 GUZMAN, RENE INDIVIDUAL` 7898 NW. 174TH TERR MIAMI LAKES FL 33015 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BYLAW KEN LAWSON SECRETARY