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PL-16-350 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 TJ P P lb — 3 '1 q Inspection Number: INSP-264682 Permit Number: PL-2-16-350 Scheduled Inspection Date: August 11, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: LAWRENCE, GILDA GREENE Work Classification: Pool - Private Job Address: 10675 NE 11 Avenue Miami Shores, FL 33138-2120 Phone Number Parcel Number 1122320280300 Project: <NONE> Contractor: APA PLUMBING CORP Phone: (305)992-4614 Building Department Comments POOL PIPING TO POOL AND SPA. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-252454. missing lid for collector 1Z tank Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 10,2016 For Inspections please call: (305)762-4949 Page 18 of 23 Permit NO. PL-2-16-350 �s�`Oes hi Miami Shores Village ® Permit Type:Plumbing-Residential y� 10050 N.E.2nd Avenue NE Work Classification:Pool-Private Miami Shores, FL 33138-0000 rvrlmlllitPermit Status:APPROVED Phone: (305)795-2204 toniv� Issue Date: 3/29/2016 Expiration: 09/25/2016 Project Address Parcel Number Applicant 10675 NE 11 Avenue 1122320280300 .�...�..___..__._.��...�.�.�__.�. ...�.�..__....� Miami :ikores, FL 33138-212033138-212020 Block: Lot: GILDA GREENE LAWKENCE Owne::r:c..nation Address Phone cell [GIL"A GREENE LAWRENCE 10675 NE 11 Avenue MIAMI SHORES FL 33161-2120 Contractor(g) Phone Cell Phone AP4 Pt UMRINC CORP (305)992 4614 Valuation: $ 1,600.00 Total Sq Peet' --- — ---- ¥. Type -kAtorK 700L PIPING TO POOL AND SPA. _ v y --� Available Inspections: Type of Piping: In "hype: Add lits ,1 +; Main Drain Bond Return. Final - CIaSSifinatinn Residential SCai1111r1U. f (Rough Review Plumbiny Vftl if[Vl&IVN..7:/MT.1t.QAN IVAN 7l.�i/IOE�/iEf1f�1 Feer, Due Amount Pair DaN: i:ay Type rmt Paid wmt Flue CCF' $1.20 Invoice# PL-=-16-5171;920 DBPR -ite $3.38 DCA Fee $3.38 03/29/2016 Credit Car' $ 187.96 $50.00 Educ,•jtior S1roh2rg3 $7.40 1 02/08/201;' Check#: 1010 $50.00 $0.00 Permit F7- $225.00 scarF-'e $3.00 Technology Fee $1.60 Total.. $237.96 In CC,­-+^­f;^^�^Q +tiA +o m- �t th ^?rrr + I agre^ ��� ,i^ ^+ h-rend-r rr, r^mc' ance with all ordirances and regulations pertairimg tmereto and in strict contormlty with the plans,drawings, statement.3 or specifications submitted to the prof er authorities of Miami Shores Village. In accep'ir;g '%^s permit I assume responsibility fur all t ork done by either myseh, my agent, --e vants, o.- Empl;,yes I understand that separate permits are requirrxi for ELECTRICAL, PLUMBING,MECHANICA ,WINDOWS,DOCRS ROOFING and SWIMMING POOL woi c. OWNE=RS AFFIDAVIT: I certify that i0l the foregoinc informat!on is accurate and that all work will be done in com,-liance with all applicable laws regulating construction and zoning. Futhermor authorize the r bove-named contractor to do the wore:stated. Mar :h 29, 2016 A.i.t'r;orized Signat `Owner / Appiica it / Contractor / A len' ll" — - ---------- - -- ----- Midlili a11U1 CJ viiidge I Building Department FEB os 2316 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 = INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20(`1 BUILDING Master Permit N.S. FF -3,-f PERMIT APPLICATION Sub Permit Nolu 3 5-0 [-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACT�O+R� DRAWINGS JOB ADDRESS:__&gk 76 AJ.G /� ,�s/�• �G�/r)/, �f'LFl.� City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: e�1a1 OWNER:Name(Fee Simple Titleholder): Address: AQ 7_S /V, // /�- P1 City: 4 ,DU4yl ��(/l�r State: :_ Zip: / Tenant/Lessee Name: Phone#: Email: �n 1 CONTRACTOR:Company Name: , l ate"' u Wei 'a �h r� Phone#: 3 °� Address: / 0 S w q-G 'ru�- City: Pq Awn, State: �4 Zip: Qualifier Name: 6 11 CA CA 924�'*,. Phone#: State Certification or Registration#: C' f YA 1> 9 3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Nalue3fWor�his Perm$ A 411�00• Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration [9 ew ❑ Repair/Replace ❑ Demolition Description of Work:. Specify color of�llcolor �thru tile: Submittal Fee$ �V ``� Permit Fee$ ,5- CCF$ 20 CO/CC$ Scanning Fee$ -Q Radon Fee$ 3 DcB�PR$ `l, Notary$� Technology Fee$ d Training/Education Fee$ `1 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE S 9� - 9 G 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. Signature2� 41r IC...I'r.�A,-4 e t��- n Signature ° OWNER or AGENT CO CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �Z day of / 7 20 15 ',by /day of / 20 /5 • ,by 6- �fPP..�'l who is personally known to ` N - /- ,who is personally known to me or who has produced ?`.� /t-/��n� 'as me or who has produced G1 dGr5 kle- l CP as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: AMAR ID Print: Print: Itte y ComExpi►ea Nov 30,ALL 16Notary Public-State torid,Seal: Seal: ° My Comm.Ex irea Nov 30,2016 Commission#E EE 851056 dr`O'� Commiasiori#r EE 851056 APPROVED BY Plans Examiner Zoning Structural Review Clerk 001682 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 6281687 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES 70 s SW 46 ST CORP RENEWAL SEPTEMBER 30, 2016 6547369 Must be displayed at place of business MIAMI R 33155 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS A P A PLUMBING CORP 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC1427783 By TAX COLLECTOR Worker(s) 1 $75.00 09/14/2015 A CREDITCARD-15-045815 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,ora certification of the holder'syualffications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws end requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-278. For more information,visit www miamidade aov/taxcollector ®© DATE f60YYY)CERTIFICATE.OF LIABILITY INSURANCE 1m2016 THI$ 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 114SURANCE 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 ADDIT)ONAL INSURED,the policy(iss)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 SUNZ Insurance Solutions, LLC. 1D: (Ally) NAME CT Melissa Ash C/O Ally HR, Inc. PHONE FAx PJ:9016 Philips Highwa AIC.N 904-739-2722 I ,Uc N : 904 262 2760 Jacksonville, FL 3226 ADDRESS: mash,@matrixonesource.com INSURER(S)AFFORDING COVERAGE MAIC INSURER A: SUNZ Insurance Company I 34762 INSURED Ally HR, Inc. - INSURER a. AS en Re-London-Best Rating"A" { 9016 Philips Hwy INSURER C: Catlin Syndicate-Uo ds-Best Ratin "A" Jacksonville FL 32256 INSURER D: Brit Syndicate-Lloyds-Best Ratin "A" f INSURERS: I INSURER F: { COVERAGES CERTIFICATE NUMBER: 28042689 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 POLlI,CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ IlNSR i TYPE OF INSURANCE INS I WVD 1 POLICY NUMBER SUOR POLICY MI IDDIYYYY MMIVDCD�P LIMITS ( l COMMERCIAL GENERAL LIABILITY ! I�'—i I � ` , EACH OCCURRENCE j S I I CLAIMS-MADE 17 OCCUR I ( { P MIS Ea ocaurencel is MED EXP(Any one pemon) Ls PERSONAL 8 ADV INJURY IS GEN'L AGGREGATE urd)T APPLIES PER: j GENERAL AGGREGATE I S I 1 POLICY I 1 PRO- 1 11 PRO- JECT LOC 1 PRODUCTS-COMPIOPAGG I S ! __I OTHER: AU70rd08ll E LIABILITY 1 I I I 1 I COMBINED SINGLE LIMIT (S 1 � Ea acdtlentl ! I ANY AUTO ( ABODILY INJURY(Per person) Is (� LL OWNED (�SCHEDULED I I j t_J AUTOS �i t)AUTOS ! {BODILY tRJURY(Per acdaml)1 S HIRED AUTOS NON-OWNED AUTOS j 1 PROPERTY DAMAGE is I II I < i 1 { 1 , IS UMBRELLA LLAB 1 ' I 1 i ' I OCCUR I i (EACH OCCURRENCE I I I I I 1 I {I S EXCESS LIA6 1 {CLAIMS(+FADE I 1 i I AGGREGATE {S I DED I I RETENTIONS l 1 1 A l WORKERS COMPENSATION I ' IWCPEODD00323 02 1/112016 1/1/2017 PER 0TH- I S )AND ROPRIFTORIPA TNERI I j WCPE00000323 01 1111/2015 1/1/2016 I -/I�ATUTE I ER I IPh'YpRO?RI.,OR1?ARTNcRIEXECUTiVP YIN ` I OF:ICERAAEMBER EXCLUDED? I N l A i E.L.EACH ACCIDENT I S 1,DDD,DDD ((Mandatory in NH) ! I l { I E.L DISEASE-FA EMPLOYEE S 1,000,000 I D-SORPTION OF OPERATIONS belmv !{ I f B 'Workers CompeI C.LDISEEASE-POLICYLIder I S 1,000,000 nsation i C { 1 This is for informational purposes O (Excess Coverage ` , and nothing shall create any right 1 ( under such reinsurance. ) i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD tOt,Additional Remarks Schedule,maybe attached if more space Is required) Coverage provided for all leased employees but not subcontractors of A.P A.PLUMBING CORPORATION Effective date:3/10/2015 CERTIFICATE HOLDER CANCELLATION 9109 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax: 305 796 8922 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NW 2 AVE MIAMI SHORES FL 33138 AUTHORIZEDREPRESENTATNE � u ' Glen J Distefano A ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 2505266: 1 Mstez Certificate 1 Candice'fcno ei1 1 1/7,12016 11:.3:33 >.. (raT) 1 'rage a .,_ -