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PL-14-1636 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228469 Permit Number: PL-7-14-1636 Scheduled Inspection Date: February 24, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: MIAMI PROPERTY SOLUTIONS LLC, Work Classification: Repair 11111ARAI 00n0C0TV Qf%I 1ITIf%kIQ 1 1 r Job Address:38 NW 108 Street Miami Shores, FL 33168- Phone Number (305)807-4045 Parcel Number 1121360110120 Project: <NONE> Contractor: PSG PLUMBING SERVICES, INC Phone: (305)796-7304 Building Department Comments PLUMBING WORK WILL BE REMOVE. NEW TITAN Infractio Passed Comments WATER HEATER. REPLACE FIXTURES AND LAUNDRY. INSPECTOR COMMENTS False NEW PIPES FOR MASTER BATH. PER PLANS REPLACE FIXTURE IN EXISTING BATHROOM. Inspector Comments Passed CREAT/ED AS REINSPECTION FOR INSP-228385. not ready Failed Correction Y Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 23,2015 For Inspections please call: (305)762-4949 Page 37 of 51 Miami Shores Village RECEIVED Building Department JUL 2014 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 2 L(n) BUILDING Master Permit No--, - 1 (4_ 42-5 PERMIT APPLICATION Sub Permit N07L ,q_ ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL (PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ,..11 CONTRACTOR DRAWINGS JOB ADDRESS: S W !O bT City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: '21 36-0(( -0( `LO Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �i OWNER: Name(Fee Simple Titleholder): M 1M M?—V 6DW-DONS Phone#: 3097 60-7,404 Address: n) iJ F- I( 1 -��T City: MA N M1 'VW1r4-=6 State: L Zip: 331 61 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: _ �=S ��U w,410 Phone#: 7e6 -315 Address: .3% I q. /V "-D 1 SS / 1 City: C7.0 ✓ I<& State: i=10'm 7-d A Zip: 3A ► S� Qualifier Name: Leri g->D > to c!>-Z'Wt ✓t'r`D Phone#: State Certification or Registration#: 1 6 7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �� Square/LinearFoot a of Work: Type of Work: 1:1 Addition F-1Alteration El New Repair/Replace ❑ Demolition Description of Work: e414 ih A fi C.()` I` � b c Q,c --V o U n� 0-74 t ac e �c�v !-�cY 2 y `., . Pee Specify color of color'thru'tile: 'x-f�,e Submittal Fee$ -' ' `' Pe"rmit Fee$ - Z.5-xy CCF$ _.,.__�. _':..•.CO/CG$-•-- --- Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ r- TOTAL FEE NOW DUE$ �V (Revised02/24/2014) r 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 po ted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the Absence of suc posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONT CTOR The foregoing instrument was acknowledged before /mce�this The foregoing Vstrument wags acknowledged before me this ��/��day of J`� p 20 / / by --� day of J U ` �/ 120 by f�iYG�Q-,e �'�( who is personally known to ,vo„YIL� &1'P-?A?&1'P-?A?/4W who 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 PU IC: NOTARY PUBLIC: Sign: GA'/� r�Ate' Sign: y� Print: 1 run Print: \CITYY1-A� Seal "AK'•- RICARDOIRIARTE Seal: -'�`'� RICARDOIRIARTE MY COMMISSION#FF088736 MY COMMISSION#FF088736 FOFa aEXPIRES February 2,2018 EXPIRES February 2,2018 (407)398-0153 FloddallotaryService.com (407)398-0153 Florldallota Service.com ********** ******************** ************** APPROVED BYZS��Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 010321 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 5352612 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES PSG PLUMBING SERVICES INC RENEWAL SEPTEMBER 30, 2015 3892 NW 125 ST C 5590170 OPA LOCKA FL 33054 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PSG PLUMBING SERVICES INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED Worker(s) 1 CFC1426257 BY TAX COLLECTOR $45.00 07/17/2014 CHECK21-14-023276 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's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to.the business. The RECEIPT N0.above must be displayed on all commercial vehia:4-Miami-Dade Code Sec 8a-276. For more information,visit www.mtnm{Wpae nnvlc ^;motor STATE OF FLORIDA DEPARTMENT OF 3."= PROFESSIONAL REGUILATION NESS AND CFC 1426257 ISSUED: 05/29/2014 CERTIFIED PLUMBING CONTRACTOR GUZMAN, PEDRO S PSG PLUMBING SERVICE INC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date:AUG 31.2016 L1405290001749 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD V The PLUMBING CONTRACTOR Named below IS CERTIFIED °}r __�y Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GUZMAN, PEDRO S D PSG PLUMBING SERVICE INC 343 NW 96 ST MIAMI FL 33150-1939 ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SECT# L1405290001749 0812812014 15:08 TA)() P.0011001 CERTIFICATE OF LIABILITY INSURANCE °AB128 is PRODUCER Excellence Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3801 SW 10T Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33165 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)226-3900 Fax (305)226-3997 INSURERS AFFORDING COVERAGE NAIC# INSURED PSG Plumbing Service, Inc. INSURERA: Scottsdale Insurance Company 41297 3892 NW 125 Street INSURER B: Infinity Auto Insurance Company 11738 Opalocka,FL 33054 INSURER C: Guarantee Insurance Company 11398 INSURER D: •.. INSURER E: COVERAGES 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. I1M INIRD N8R ADD•L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMOP _-_DATE(MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE _3,000,000 Q COMMERCIAL GENERAL LIABILITY DAMAGE TO RERMD CPS1854001 08/22/14 08/22/15 PREMISES Ea occurence 300,000 A ❑❑ CLAIMS MADE ® OCCUR MED EXP(Anyone person) 51000 ❑ PERSONAL&ADV INJURY 11000,000 ❑ _ GENERAL AGGREGATE 3,000,000 GEML AGGREGATE LIMIT APPLIES PERPRODUCTS-COMP/OP AGO 3,000,000 ❑ POLICY ®PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AU509-55946-6827-001 07/09/14 07/09/15 Ea accident) 1,000,000 ® ALL OWNED AUTOS B ® ❑ SCHEDULEDAUTOS BODILY INJURY © HIRED AUTOS Per person) Q NON OWNED AUTOS BODILY INJURY © Comp$500.00 Ded (Per accident) Coll $500.00 Dad PROPERTY DAMAGE (Per accident) GARAGE LIABILITY 0 AN1'AUTO AUTO ONLY-EA ACCIDENT ❑ ❑ OTHER THAN EA ACC AUTO ONLY: AGG EXCESS1 © OCC $/22 IUMBRELLA LIABILITY CPS1854001 08/22/.14 . 0 /15• EACH OCCURRENCE 2,000,000.00 A ❑ OCCUR ❑ CLAIMS MADE AGGREGATE 2,000,000,00 ❑ DEDUCTIBLE .—._. ElRE M01ON S WORKERS COMPENSATION AND _..... EMPLOYERS'UABILTTY WCP100209103GIC 11/18/13 11/18/14 © WC SLA�u- ❑ OE TRH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT 1,000,000 If yes,describe under N E.L.DISEASE-EA EMPLOYEE_ 1,00_0,000 SPECIAL PROVISIONS below _EL.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Plumbing Contractor-CG2033 Blanket Additional Insured- Included/CG2404 Waiver of Subrogation-Blanket coverage Included per written agreement; GLS-295s Primary and Noncontributory Wording—Included as applicable to CG 20 33; CG2503 Designated Construction Project(s)General Aggregate Limit—Included 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 Building Dep 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2 Ave THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Miami Shore,FI 33138 OF ANY KIND UPON THE URER,ITS AGENTS OR REPRESENTATIVES, Fax 305-756-8972 AUD ET7TIVE ACORD 25(2001/08)QF ®ACORD CORPORATION 1988