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PL-15-620 (2)Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 2ci Y- 223 Inspection Number: INSP-269321 Permit Number: PL -3-15-620 Scheduled Inspection Date: October 20, 2016 Inspector: Hernandez, Rafael Owner KERMANI, AMIR Job Address: 1680 NE 104 Street. Miami Shores, FL Project: <NONE> Contractor: PSG PLUMBING SERVICES, INC Permit Type: Plumbing - Resi¢eptial Inspection Type: Work Classification: Addition/Alteration Phone Number (305)965-0170 Parcel Number 1122320320440 Phone: (305)796-7304 Building Department Comments PLUMBING REPLACING Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-269024. CREATED AS REINSPECTION FOR I-249528. LESS ROMAN TUB no access 1pm Dec 151510:57a p.1 ---. -O® — DATE (MM/DD/YY) 12/14/15 CERTIFICATE OF LIABILITY INSURANCE ___ 7 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I PRODUCER Excellence Insurance Agency 3801 SW 107 Avenue Miami, FL 33165 Phone (305)226-3900 INSURED PSG Plumbing Service, Inc. 3892 NW 125 Street L Opalocka, FL 33054 r ALTER THECOVERAGE.AFFORDED_BY THEPOLICIES BELOW_ Fax (305)226-3997 --- INSURERS AFFORDING COVERAGE 1 NAIC_# INSURER A: Scottsdale Insurance Company 41297__ _ ` I ENSURER B: Infinity Auto Insurance Company — - 11738 _ INSURER C_ Ascendant Commercial Insurance Co. 11398 - - ____ INSURER E_ COVERAGES - INSURER F: THE POLICIES OF INSURANCE USTED 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 P_O UCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNsrADD' L.1- Lrg'il.I.gRD: TYPE OF INSURANCE PO !POLICY EFFECTIVE pOL1CYEXPIRA710N1 — DATE HMO) DATE�MIM/DD1YY) LIMITS A!G�7 B LILY NUMBER T GENERAL LIABILITY -4— ! COMMERCIAL GENERAL LIABILITY j CPS2294310 08/22/15 rJ L.; CLAIMS MADE OCCUR CI _ Li GEN'L AGGREGATE UMIT APPLIES PER Cl POLICY PROJECT L1 LOC AUTOMOBILE LIABILITY L] ANY AUTO , iv ALL OWNED AUTOS it SCHEDULED AUTOS HIRED AUTOS r j NON OWNED AUTOS [� Comp $500.00 Ded ;;j1 $500.00 Ded GARAGE LU161LITYEl El El ANY AUTO EXCESS/UMBRELLA LIABILITY R( OCCUR L; CLAIMS MADE A 6I , j] RETENTION S WORKERS COMPENSATION AND ' --'---- - — •- EMPLOYERS' LIABILITY I WC -66349-1 �I 11/18/15 C ANY PROPRIETOR / PARTNERI EXECUTIVE OF=ICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below [TJ DEDUCTIBLE 509-55946-6827-001 1 07/09/15 EBU 012060234 08/22/15 OTHER • DESCRIPTION OF OPERATION-B-71— VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS .I..__—._ 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 • Desigrated Construction Project(s) General Aggregate Limit—Included CERTIFICATE HOLDER 08/22/16 07/09/16 --•- 08/22/16 . EACH OCCURRENCE DAMAGE 70 RENTED '— PREMISES (Ea accedence I 1j MED EXP (Any one person) PERSONAL& ADV INJURY GENERALAGGREGATE —4 PRODUCTS - COMP/OP AGG L COMBINED SINGLE LIMIT (Ea accident) _-- — - ! BODILY INJURY Per _ person).----.__ BODILY INJURY ( I — , (Per accident) PROPERTY DAMAGE (Per acddent) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC 3700b7ci00.00 f 300,000.001 5,000.00J 1,900,919.9_9_1 3,000,000.00' 3,000,00.00 1,000,000.001 • ! ._ AUTO ONLY: — AGG EACH OCCURRENCE 2,000,000.00' AGGREGATE ____.— 2,000,000.00, 11/18/16 ;wc rnrl� i orH-+ -- _I E.L EACH ACCIDENT _ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE 1,000 000 00 E - E.L. DISEASPOLICY LIMIT 1 ,000,000.00. -- 1 Miami Shores Village Building Dep 10050 NE 2 Ave Miami Shore, FI 33138 Fax 305-756-8972 ACORD 25 (2001/08) QF CAN CELLATION T 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -- ©ACORD CORPORATION 1988 -j Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -3-15-620 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 3/25/2015 Expiration: 09/21/2015 Parcel Number Applicant 1680 NE 104 Street Miami Shores, FL 1122320320440 Block: Lot: AMIR KERMANI Owner Information Address Phone AMIR KERMANI 3180 S OCEAN DRIVE HALLANDALE BEACH FL 33009- (305)965-0170 Contractor(s) PSG PLUMBING SERVICES, INC Phone (305)796-7304 CeII Phone CeII vswntxtTS:"--1 Valuation: Total Sq Feet: $ 6,800.00 00 Type of Work: Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $4.20 $3.38 $3.38 $1.40 $225.00 $9.00 $5.60 $251.96 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3-15-54868 03/20/2015 Credit Card $ 50.00 $ 201.96 03/25/2015 Check #: 1262 $ 201.96 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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,/ ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zuermore, I authorize the above-named contractor to do the work stated. )Aifthorized Signature: OvJlve` / Applicant / Contractor / Agent Building Department Copy March 25, 2015 Date March 25, 2015 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 R.ECETv1 D1 MAR 2 0 2015 BY: FBC 20/ 0 BUILDING Master Permit No. PC /1/ ",R )3 ( - PERMIT APPLICATION Sub Permit NoPL. 49-e) BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / ' 0 ,%I/-- / o ( /s City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNE� me (Fee Simple Titleholder): Phone#: Address: 16' 80 /At A9 City: i/•-•.---t-r ..‹./ .State:(;;;" ,--Zip:__ Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: s 6. f 6u/4 %k96 5 (J G Phone#: Address: 5)- KJ W / 2- cr S T City: V p D L6 Ce -Co State: Zip: 33 C.Y"`f Qualifier Name: 10011.0 S 6 i..e? dti Phone#: 30S- 7 54- 730y SvateGertificatio'RegistTationr#:- (FL I10ba Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 4- g4247 i2z Square/Linear Footage of Work: Type of Work: ❑ Addition n Alteration ❑ New Repair/Replace n Demolition / Description of Work: L�ul.� ,-7 Sit)fi l3'e 4, Specify c !rof_4poltruie:`, f Submittal Fe t`rYit kt"Yi rly .^ M ; ^t1 r "/"i"PePMfie$'' 225 • -P14---- CCF 14«- _ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ O_o t _ c 6 (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 o curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr.(a : a reinspection fee will be charged. Signature OWNER or AGENT Signature The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this kCP day of M2..CAA. , 20 k 5 , by / day of i/ , 20 «Cby ---,, \C.em.s,at& t , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Pri S *************** APPROVED BY (Revised02/24/2014) 1 "r‘• a.: +: MY COMMISSION x EE 171828 I EXPIRES: May 7, 2018 Atr a Bonded Tin Notary Public llndane;M t�Cos.44. �m or who has who as identification and who did take an oath. NOTARY PUBLIC: who is personally known to Sign: Print: Seal: 5 "23 -rS Plans Examiner Aee- YESERIA RUIZ -11 Notary Public - State of Florida "' : • e Bonded My Comm. Thr Expires Jul 1, 2018 Commission N FF 138319 ouph National Notary Assn, *********** Zoning Structural Review Clerk