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PL-15-2566 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245371 Permit Number: PL-10-15-2566 Scheduled Inspection Date: December 27, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: MARIANA JULIA LIVORE, FABIANO Work Classification: Addition/Alteration CII \/CICA AfN 111 AD Job Address:9935 NE 13 Avenue Miami Shores, FL 33138-2634 Phone Number Parcel Number 1132050090470 Project: <NONE> Contractor: DEL RIO&SON PLUMBING CORP Phone: (786)295-0098 Building Department Comments NEW BATHROOM, NEW KITCHEN AND CONNECTION Infractio Passed Comments TO SEPTIC TANK. INSPECTOR COMMENTS False ------------------ Inspec r Comments Passed UtC Failed G� o Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 27, 2016 For Inspections please call: (305)762-4949 Page 1 of 28 Permit NO. PL-10-15-2556 `5oa hs h Miami Shores Village Permit Type: Plumbing-Residential X- 10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Pen- Permit Status:APPROVED f � Phone: (305)795-2204 CORiDp` Issue Date: 1011512015 Expiration: 04/1212016 Project Address Parcel Number Applicant 9935 NE 13 Avenue 1132050090470 Miami Shores, FL 33138-2634 Block: Lot: FABIANO SILVEIRA AGUILAR M Owner Information Address Phone Cell FABIANO SILVEIRA AGUILAR MARIANA 9935 NE 13 Avenue --- MIAMI SHORES FL 33138-2634 9935 NE 13 Avenue MIAMI SHORES FL 33138-2634 Contractor(s) Phone Cell Phone Valuation: $ 17,400.00 M&C CONTRACTORS (305)763-8166 _......,_„_� _......... _ Total Sq Feet: 0 Type of Work:NEW BATHROOM,NEW KITCHEN AND CONNE Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return: Top OutFinal Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.80 DBPR Fee Invoice# PL-10.15-57372 $9.14 10/15/2015 Credit Card $609.08 $50.00 DCA Fee $9.14 Education Surcharge $3.60 10/09/2015 Credit Card $50.00 $0.00 Permit Fee $609.00 Scanning Fee $3.00 Technology Fee $14.40 Total: $659.08 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 inform ti n i ae#o d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- a e othe work stated. October 15, 2015 Authorized Signature:Owner / Applicant / o tract / Agent Date Building Department Copy October 15,2015 1 Miami Shores Village Building Department OCT 0 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ) BUILDING Master Permit No. IAC " (�-_ PERMIT APPLICATION Sub Permit No. F(_r " ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL "PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP q 2 CONTRACTOR DRAWINGS Q J JOB ADDRESS: 1 I S V;5 City: Miami Shores County: Miami Dade Zip: 33 3 Folio/Parcel#: �) 3 zo S Oo 9_ 0L/ --nIs the Building Historically Designated:Yes NO k Occupancy Type: Load: 1,,Construction Type: Flood Zone: BFE: 1 [FFEE: �y OWNER: Name(Fee Simple Titleholder)): /Able-r^ja S �-U�7.1 ' Phone#: `s T( a�" yo de� Address: 0 7 01nn0,n� 8"Tm f, 1 ? City: &�A'q ' State: Zip: Tenant/Lessee Name: n ^/� Phone#: Email: FA0ligA J5/LVe tAA�#��00 � (:AC MA 4,COPA CONTRACTOR:Company /N� � l=•ame:--" 9 C COh tyozio SPhorn'e#:�s-• �3 . �� Address: 960 /- kur c .l.i em / surf-r, :WT City: ulQ m1 '� State: e l0 r id a Zip: 14-0 Qualifier Name:GPr iY can �cP�_)%�fWy-% r-, Phone#:305. 463 N C>G State Certification or Registration#: CT-C_ 14 Z(o UO9 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$_J2 .qU3f Ar�ri Square/Linear Footage of Work: Type of Work: U Addition Q Alteration u New ❑ Repair/Replace ❑JDemolition Description of Work: /vela *4tW"o,­� ry�y 'f�H r.� _ CoN �1a� ']�b S vTi e_ 7i*j Specify color of color thru tile:' Submittal Fee$ r 0� Permit Fee$ yak �`-y CCF$ "CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ ('� TOTAL FEE NOW DUE$ 60 9• Qy (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 sjv'" l / Signature ' OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I day of Y 20 �� by �- day off'��� Q 1� 20 5 by �(}�h1G1/��5, Ih�r,w ersonally known t (rer an Prey1 S om,W•is personally known to me or who has produced 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: Sign: Sign: Print: Print: /nLfid/ ` ' MY COMMISSION t FF 912061 Seal: �`' a4°• CARMEN ESTHER JUSINO Seal: '_: '..o; MY COMMISSION#FF046931 A EXPIRES:August 2,2019 r J��or nd• Tlw Budget Notary Sentra 9 v: `••,'eoF�.oP� EXPIRES August 19,2017 (407)398-0153 F121daNqtgri APPROVED BY �-f�/S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 003303 i B_ :Local Bushless Tax Receipt Miami-Dade County, State of Florida THIS '19 NOT A BILL - DO NOT PAY 566'9941 L T, ' SUSWES&NAMEJLACATION RECEIPT NO. ` S E�r�PtRES M&c coNTRAcroks RENEWAL SEPTEMBER 36, 261.6 960 41 ST#304 5914008 MuM be dispisyed at place of business MIAMI BEACH FL 33140 Pursuant10 County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS [ 196 PLLiNigINCiCON1RACi�I� PAYMENT1tECEIVED MANAGEMENT&CONSULTING INC r BY TAX C&LECTOR Worker(s) 1, CFC1426809 $45.00 08/25/2015 CHECK21-15-117.106 This'Local'Business tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, peinuk or a.certification of the holders guilificatioas,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and r0quireme its which apply to the business; The RECEIPT NO.above,must be displayed on all commercial vehicles-Miami-Dade dodo See la-276. For rt ore intonmation,visit wwwmiamidede,nAydaxculleM . RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE.OF FLORIDA { DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �,• CONSTRUCTIORINDUSTRY LICENSING BOARD dFC14126909, The PLUMBING CONTRACTOR Named-betow IS CERTIFIED • �R�t�`" i Underthe provisions-of Chapter 489 FS. r , '` -4. , Expiration date: AUGi31, 2016 is " A,- p ' PR�VISbQMINI;GERMAN ` M.8r'C CONTRACTORS.%+02_'.':. 4d -960`ARTHUR-G0a,ERIEX1R , b .ITE'3 n✓" MIAMF8EA'd' ,; a13"146"el (t '` '" -rr ." fin.Y^" s I. E, w `Mr J� ti ° ,�_ x '� • a v4 '` ISSUED: 09/03/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1509030000675 DATE(MM/DD/YY) CERTIFICATE OF LIABILITY INSURANCE 10/08/15 .i 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 BYTHE.POLICIES BELOW...-..-,... Phone (305)266-6493 Fax 305 262-0679 (__ ) ( .. INSURERS AFFORDING COVERAGE NAIC# INSURED MANAGEMENT&CONSULTING INC INSURE - ESSEX INSURANCE COMPANY INSURER B-_. _......_............. -- - D/BIA M&C CONTRACTORS INSURER C: f .. 960 ARTHUR DFREY RD. STE. 304 ;INSURER D:_-. 4...... . .... ............................ _. MIAMI BEACH, FL. 33140 'INSURER E: ?.._...._. _ ...... ..._. _ ......__. ... ................................ .... COVERAGESj INSURER F: -- _ .. .._.._.. . __ _.. ...._....... ....... - .. ---------- -- -- ................._. 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. - --- ------ — - - ----- -- - ----. _....... ..........._........ . ......__... -.. jINSR ADD'L TYPE OF INSURANCE POLICY NUMBER ::POLICY EFFECTIVE POLICY EXPIRATION; LIMITS i.LTR._INSRD_ ---..__..__-_ _._.... ........ _._-----.-- DATEfMMIDD_I_YY) DATE(_MM/DDIYY�-------..._...._.------- GENERAL LIABILITY EACH OCCURRENCE 1000,000.00; ©COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED - -J 3 DY5751 04/19/15 04/19l16 PREMISES(Ca occurence) 100,000.001 ❑❑ CLAIMS MADE Q OCCUR MED EXP(Any one person) 5,000.00! ❑ Q PERSONAL&AOV INJURY 1 1000,000.00i _ — _ i ❑ GENERAL AGGREGATE — 2000 000.001 PRODUCTS-COMPIOP AGG 1000.000.00'; GENT AGGREGATE LIMIT APPLIES PERI _.. _._ I W POLICY El PROJECT -E] LOC (... .... _ ........-------------� _.. --- I- --------- I ----I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I ❑ ANY AUTO (Ea accident) _.....__...__._. ❑ ALL OWNED AUTOS ' BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per ❑ HIRED AUTOS i BODILY INJURY j ❑ NON OWNED AUTOS (Per accident) ❑ ------------ PROPERTYDAMAGE (Per accident GARAGE LIABILITY AUTO ONLY EA ACCIDENT ❑ ❑ ANY AUTO i OTHER THAN EA ACC 1 ❑ i ___...._._..—;AUTO ONLY: AGG — -- ---- — _ __ — EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE I I ❑ OCCUR ❑ CLAIMS MADE prrR£I.CATE __.__ _ ❑ DEDUCTIBLE ❑ RETENTION $ - ._._v---- -- - --- - - .. _..._..._.. ...._.. ------------------ ...... - WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH EMPLOYERS'LIABILITY _TORY LIMITS _-_ER. _ ,.__.. ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? _.. -------._......_.._._....-_........-.__...._._.....----.---..._..__.._.. If yes,describe under E.L.DISEASE-EA EMPLOYEE SPECIAL PROVISIONS below 'E.L.DISEASE-POLICY LIMIT -.E ....-- _. ___.- .._..__. .._._..- .... OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CFC1426809 I --...._ ------------.. _.... ..................... ........... CERTIFICATE HOLDER CANCELLATION ... _ . ...,.—. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BLDG DEPT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL 33135 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. -- - - --------- - - - --- - -- AUTHORIZED REPRESENTATIVE _ ACORD 25(2001!08)QF ©ACORD CORPORATION 1988 Date CERTIFICATE OF LIABILITY INSURANCE 6/26/2015 Producer: Plymouth Insurance Agency This Certificate Is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of insurance Policy Number Date Date (MM/DDIYY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises(EA Claims Made 0 Occur occurrence) $ Med Exp Personal Adv Injury General aggregate limit applies per: General Aggregate Policy ❑Project ❑ LOC Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) Any Auto Bodily Injury All Owned Autos (Per Person) Scheduled Autos Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X WC Statu- OTH- Employers'Liability I tory Limits ER Any pmpdetorlpartnerlexecutive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocationsNehicies/Exclusions added by Endorsement/Special Provisions: Client ID: 92-68-800 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Management&Consulting,Inc dba M&C Contractors Coverage only applies to injuries incurred by South East Personnel Leasing,Inc&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 06-26-15(TLD) Begin Date 9/2212014 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to BUILDING DEPARTMENT do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2 AVE MIAMI SHORES, FL 33138 ,