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PL-16-674 Inspection Worksheet Miami Shores Village (�(v� 10050 N.E.2nd Avenue Miami Shores,FIL �p -19a Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264714 Permit Number: PL-3-16-674 Scheduled Inspection Date: October 25,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: MUSAFFI,NICOLE&JEFFREY Work Classification: Addition/Alteration Job Address: 1178 NE 99 Street Miami Shores, FL 33138- Phone Number (561)414-9398 Parcel Number 1132050180120 Project <NONE> Contractor: AMERICAN DRAIN CLEANERS& PLUMBING INC Phone: (786)290-3530 Building Department Comments REPLACE PLUMBING FIXTURE AND RELOCATING tnfractio Passed Comments PLUMBING IN MASTER BATH ALSO REPLACE KITCHEN INSPECTOR COMMENTS False SINK, ICE MAKER AND DISHWASHER. Inspector Comments Passed Failed Correction D Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid Permit NO. PL- -16-674 `SNOB;s y� Miami Shores Village at Permit Type:Plumbing-Residential ji►10050 N.E.2nd Avenue NE ON I 'n Work Classification:Addition/Alteration ' Miami Shores,FL 33138-0000 f Phone: (305)795-2204 Permit status:APPROVED N— �ORtDp' Issue Date: 3118/2016 FixP iration: 09/14/2016 Project Address Parcel Number Applicant 1178 NE 99 Street 1132050180120 Miami Shores, FL 33138- Block: Lot: NICOLE&JEFFREY MUSAFFI Owner Information Address Phone Cell NICOLE&JEFFREY MUSAFFI 1178 NE 99 Street (561)414-9398 (954)993-5151 MIAMI SHORES FL 33138- 1178 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 7,500.00 AMERICAN DRAIN CLEANERS&PLUI (786)290-3530 .__..._.._w_ _._.............. __.._. _A.. Total Sq Feet: 0 Type of Work:REPLACE PLUMBING FIXTURE AND RELOCA 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 $4.80 DBPR Fee Invoice# PL-3-16-59015 $3.38 03/18/2016 Credit Card $202.56 $50.00 DCA Fee $3.38 Education Surcharge $1.60 03/15/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $6.40 Total: $252.56 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. OWNEW AFFIDAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru *noni hermore,I authorize the above-named contractor to do the work stated. March 18, 2016 A Sig t Owner / Applicant / Contractor / Agent ate BuildDepartment Copy March 18,2016 1 • Miami Shores VillagecEI TED Building Department M R Al2�016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 :74 FBC 2011-4� BUILDING Master Permit No.-F_C(.(�; – 1 6 PERMIT APPLICATION Sub Permit No.y'x ((s- (off ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [911-66MBING ❑ MECHANICAL DPUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP rr CONTRACTOR DRAWINGS JOB ADDRESS: 11 p� C / City: Miami Shores p� /� County: Miami Dade Zip: Folio/Parcel#: I-3ya6 — V 10 � V 1*. Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: CAdd NER-Nm(Fee Simple Titleholder): t-('- r V re'I U`^ 4 I '� r' Phone#: { ( (4 939P ress:: tr79vwl� �f�-a � State: r - Zip: 3 3 ao Tenant/Lessee/�Name: -/ Phone#: Email: le �` r-e- • Mu m��• FpJ[ �!✓e CONTRACTOR:Company Name: MIZritC'A-1 Ara in 0 �•��SW91 Phone#: Address �� 6 0 s f City: ,OeA � State:k- ' Zip: EJ Qualifier Name: �l S Phone#: k� v)f� \J✓3� State Certification or Registration#: j Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ N w ❑ Repair/Replace ❑ Demolition Description of Wor • �C-e- ��J r�°C `-� 2- 2--Cof. N l l� mak/ I0414L jW ox w� Specify color of color thru tile: Submittal Fee$Vy -0Z) 1-4.Permit Fee$ 3�— CCF$ ,] CO/CC$ Scanning Fee$ Radon Fee$ �" U DBPR$3' SU Notary$. C6 Technology Fee$ lD Training/Education Fee$ �G Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 'E3(o (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 aff 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatures ' OWNER or AGENT ✓ CONT I tACTOR The foregoi instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of I�/ IF� ,20 ,by (4�4 day of f� oty CA ,20l by `'SaK? « f Q r s personally known to �o3alt- (;04-,A,i,.. Z. who is personally known to me or who has produced T(— UWDaT— me or who has produced D4 Y.521-72-c>(,Z 13 0 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si n: ✓TZ�'� Sign:];N411 f� (�-�1 g Print:�5:,-S1 rAy4- Print: `mss N e X LENER CASTRO Seal: W eW Pia, Notary PPublie Matto at kiHfldg eal =°�'r \� MY COMMISSION#FF093479 Sindia Alvar@k EXPIRES:FEB 17,2018 My cammi�5itih Fp 1§066 an+ Bonded through 1st State Insurance of a Ezgtb�t(iYt1315't$ __. ************************ **************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ' 4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1428514 ISSUED: 07/31/2014 CERTIFIED PLUMBING CONTRACTOR YANES. ROBERTO AMERICAN DRAIN CLEANERS&PLUMBING IS CERTIFIED under the provisions of Ch.489 FS. Exporation date AUG 31,2016 L1407310001780 42108 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 6925326 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES AMERICAN DRAIN CLEANERS&PLUMBING INC RENEWAL SEPTEMBER 30, 2016 2630 W 60 ST 7201122 Must be displayed at place of business HIALEAH FL 33016 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS AMERICAN DRAIN 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CLEAN IJ BY TAX COLLECTORMBING CFC1428514 $45.00 09/13/2015 Worker(s) 2 CREDITCARD—i 5-045727 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a 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 he displayed on all commercial vehicles—Miami—Dade Code See Ba-276. For more information,visit www.miamidade.00vkaxcollector Act CERTIFICATE OF LIABILITY INSURANCE °A>rE`MM'°"Y'"Y, 03/14/2016 THIS 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 INSURANCE 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 ADDITIONAL INSURED,the policy(les)must be endorsed. H 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 endorsements. PRODUCER NAME: JUAN TUNON ROYAL CARIBBEAN INSURANCE AGENCY II PHONE305-642-4541 _ A/C Noc305 642-10_8_7 1772 WEST FLAGLER STREETo MESS:JTUNONROYALII@GMAIL.COM MIAMI,FL 33135 INSURER(S)AFFORDING COVERAGE MAC I INSURERA:USLI INSURANCE CO. INSURED AMERICAN DRAIN CLEANERS AND PLUMBING, INC. INSURER a:ASSOCIATED INDUSTRIES INSURANCE CO. 2630 W 60 ST INSURERC: �. HIALEAH,FL 33016 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ILN" TYPE OF INSURANCE POLICY NUMBER EFF Y EXP LIMITS A X COMMERCIAL OENERALLIABILrrY CLI731311 12/07/201512/07/2016 EACH OCCURRENCE $ 1.0w.wo DAMAGE 75 CLAIMS-MADE Q OCCUR RENTED r $ 100,000 MED EXP[Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE $ 2,000,000 X POLICY❑JEC Loc PRODUCTS-COMPIOP AGG $ 2_000,000 OTHER: S AUTOMOBILE LIABILITYaCOMBI NEtint $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ HIRED AUTOS ANON -OWNED PROPERTYOAMAGE UMORELLALIAS OCCUR EACHOCCU_RRENCE q EXCESSUAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AWC1031702 3/21/2015 21/2016 1 STATUTE I I ER AND EMPLOYERS'LIABILI T -- ANYPROPRIETORIPARITNER!EXECUTIVE YIN MIA E.L.EACH ACCIDENT $ _ 1,000,000 OFFICERAMEMSEREXCLUDED? ❑Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1 000 000 It res,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000 000 DESCRIPTION OF OPERATIONS d LOCATIONS d VEHICLES(ACORD 101,Additional Rernarks Schedule,slay be attached it more space is required) PLUMBING CONTRACTOR EXCLUDED FROM COVERAGE ON WORKS COMPENSATION(ROBERTO YANES-OFFICER) STATE OF FLORIDA CERTIFIED PLUMBING CONTRACTOR CFC1428514 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE T OF, NOTICE WILL BE DELIVERED IN PROVISIONS. BUILDING DEPARTMENT A OR Nc Ic 10050 N.E.2ND AVENUE RIZE�RMiESENTA MIAMI SHORES,FLORIDA 33138 i 8• D CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and loco are realstered marks Of CORD ACORZ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 04/12/2016 THIS 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 INSURANCE 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 ADDITIONAL INSURED, the policy(les)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 endorsements . PRODUCER CONTA NAME: JUAN TUNON ROYAL CARIBBEAN INSURANCE AGENCY II PHOfAIC.NENo. .305-642-4541 we No):305-642-1087 1772 WEST FLAGLER STREET Aooale $:JTUNONROYALII@GMAIL.COM MIAMI, FL 33135 INSURER(S)AFFORDING COVERAGE NAIC Ir INSURER A:USLI INSURANCE CO. INSURED AMERICAN DRAIN CLEANERS AND PLUMBING, INC. INSURER B:ASSOCIATED INDUSTRIES INSURANCE CO. 2630 W 60 ST INSURER C: HIALEAH, FL 33016 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL UB POLICY EFF POLICY EXP LTq -WM POLICYNUMBER MM/ D/Y YY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CL 1731311 12/07/201512/07/2016 EACH OCCURRENCE S 1,000000 CLAIM$•MADEDAMAGE TO RE FX OCCUR PRE MI E Ea NT rDn $ 100,000 MED EXP(Any oneperson) $ 5,00_0 PERSONAL 6 ADV INJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000000 X POLICY E]jR F LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED AUTOS AUTOS BODILY tNJURV(Par accident) S PROPERTY DAMAGE NON-OWNED $ Per accident HIRED AUTOS AUTOS $ UMBRELLALIAS OCCUR EACHOCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AWC1031702 03/21/2016 03/21/2017 SPE TATUTE ER" AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICEMMEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) PLUMBING CONTRACTOR EXCLUDED FROM COVERAGE ON WORKS COMPENSATION ( ROBERTO YANES -OFFICER) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGETHE��X�IRATION DAT THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT '"ACORDAN E WITH THIE P LICY PROVISIONS. 10050 N.E.2ND AVENUE ^HGRIZE EPRESrA MIAMI SHORES, FLORIDA 33138 J98$_-"f4 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and loco are reeistered marks of ACORD