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PL-18-1026 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-301965 Permit Number: PL-4-18-1026 Scheduled Inspection Date:April 26,2018 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection type: Final Owner: LITZENBERG,MARC AND ANNE Work Classification: Sprinkler System Job Address:1420 NE 103 Street Miami Shores,FL Phone Number Parcel Number 1132050310030 r Project: <NONE> Contractor: ACME SPRINKLERS OF BROWARD INC Phone: (954)232-6863 Building Department Comments 6 ZONE PVC PIPE,70 MIST HEADS,TIMER, RAIN Infractio Passedcomments SENSOR AND 1 PVB BACKFLOW. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re-inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 25,2018 For Inspections please call: (305)762-4949 Page 19 of 34 i Permit NO. PL-4-18-1©26 st'O1R us Miami Shores Village Permit Type:Plumbing-Residential 10050 N.E.2nd Avenue NE trlill� WorkCtassfarcation:Sprinkler System " Miami Shores,FL 33138-0000 Pennit`Status:APPROVED yam,` Phone: (305)795-2204 F�ORtDp' Issue nate:4/231,2018 Expiration: 10/20/2018 Project Address Parcel Number Applicant 1420 NE 103 Street 1132050310030 MARC AND ANNE LITZENBERG Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MARC AND ANNE LITZENBERG 1420 NE 103 Street MIAMI SHORES FL 33138- 1420 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,800.00 ACME SPRINKLERS OF BROWARD Ih (954)232-6863 (954)604-2818 _._.,.._., , ... ..... _.__... Total Sq Feet: 0 Type of Work:6 ZONE PVC PIPE,70 MIST HEADS,TIM Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Underground Sprinkler Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee InVOICe# PL-4-18-67210 $2.25 DCA Fee $2.00 04/18/2018 Credit Card $50.00 $ 119.65 Education Surcharge $0.80 04/23/2018 Credit Card $ 119.65 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $169.65 1 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 information is accurate and that all work will be done in compliance with all applicable laws regulating construction an Futh authorize the above-named contractor to do the work stated. April 23, 2018 Author¢e -Signature: / Applicant / Contractor / Agent Date Building Department Copy April 23, 2018 1 ' Miami Shores Villag a ��� Building Department O La 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 • INSPECTION LINE PHONE NUMBER:(30S)762-4949 Gj FBC 20�� BUILDING Master Permit No. / PERMIT APPLICATION Sub Permit No.�l .Ltd — 4 BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL r ' [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS J JOB ADDRESS: /l� lO NF- City: Miami Shores County: Miami Dade Zip: ':3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: r OWNER: Name(Fee Simple Tiitleholder):�kIAIF— L/j2jE2j&5iLP r-.- Phone#: 7Z Address: City: Ml�f V�/ `�HnOEE C State: F F Tenant/Lessee Name: Phone#: i Email: f _ a b 1 �, 4bb- _-3CONTRACTOR:Company Name: one#C6_: � Address: � I1 City:rf��d' CA41--u .State:d rUL Zip: OualifierName:, klo ep-1 "Nf(a Phone#:�S (,e(DQq6,7�CJ State Certification or Registration#: Certificate of Competency#: 15Q 1.7p.�C.1!?0 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/linear'Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -70— Nisi rleaAi 1) r O(' IV PV 0) WC6&J' Specify color of color thru tile: Submittal Fee$ w Permit Fee$ �, � CCF$ CO/CC$ ' a� Scanning Fee$ Radon Fee$ 00 DBPR$ v) Notary$ Technology Fee$ Training/Ec!ucation Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ • (27 S F (Revised02/24/2014) r Bonding Company's Name(if applicable) Bonding Company's Address i City State Zip Mortgage Lender's Name(if applicable) t 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." C 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 low 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 t for the first inspection which occur ven (7) days after the building permit is issued. In the absence of such posted notice, the t inspection will not be approved and r 'nspection fee will be charged. Sig to Signatur OWNER or AGENT CONTRACTOR The foregoing instrume t was acknowledged before me this The foregoing instrument was acknowledged before me this y f!` `( /� day of ,�J�'l 1 ,20 � � ,by � day of -�l_�1� � ,20��by C ix U poh(3�r ,fwho (iiss personally known tto �(°vyo LQl� kwho is personally known to me or who has produced cit`' v` vii > _�( �h aS me or who has produced as identification and who did ak an ooafh. 5 ( 0 identification and who did take an oath. NOTARY!PUBLIC: NOTARY PUBLIC: TSI Z � � v I •'Sign:15 Sign: Print: - - Print: ko z •'� #R1-5 cri k o .++"rP''•• Matilde Jeroma Rios -,, / vin �10.1K1t g..�e�, �i99L ahlstScae •Q��� Seal: x° nSCOMKIISS!ON#FF131916 A O '''� 911 C STA1E1�`���\'�\ of o.,`� EXPin e ND DnTHRU'2018 /lllllll i,,,%% 1st FLORIDA NOTARY,LLC ***s******s*s**********s************G******s****s**s*********ss*******s**ssss***ssss*ss**s*s*ssss*****s*ssss* APPROVED BY y rO Plans Examiner Zoning f I Structural Review Clerk + (Revised02/24/2014) , f tet►,SNOR�s G,! eggs Jnuol" Miami shores Village All � * Building Department ORiDp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 f CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IFCONT TOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER i COPY OF LOCAL BUSINESS TAX RECEIPT _ f C C. OPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. /CO Y OF LIABILITY INSURACE* E. /COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. ................. ......... ................................. No IN ■......................■ ' BUSINESS NAME: BUSINESS ADDRESS:awo sw U•1 —CITY 0� STATE Z `TJ U BUSINESS PHONE: QM'alaab(eJ FAX NUMBER( ) CELL PHONE! C�4 / )(018 QUALIFIER'S NAME: 1�1koyna LWq QUALIFIER'S LIC NUMBER:k'; 01, : alk -- '::'w ,�* �' iiia f� •, � b2 „• � :� .. 1;o c= ������rl���11 fll(��of�I�II _ Ili IM�IIII I I VIII it ." con r, a OWN atipk3 y; ,I s. 0 � , RT EIWI I11, I , I �E USN 5. �� h� \ WWI" gL` OF 4•� sR'j E 4 P� E vriiE: d Miami-Dade County - Building and neighborhood Compliance Office Page 1 of 1 F Home Product Control Contractors Building Officials Contact us Contractor License Information Contractor Number: 15P000080 Contractor name: ACME SPRINKLERS OF BROWARD INC Address: 9220 SW 54 PLACE City,St,Zip: COOPER CITY FL 33328 Phone: (954)604-2818 Other Phone: Fax: Email: ACMESPRINKLERS@GMAIL.COM D/B/A: Contractor Status: ACTIVE Class Category Category Description Expiration Date PLUM 3 LAWN SPRINKLER 09/30/2019 CONTRACTOR INQUIRY COMPLETE BCCO Contractor Inquiry and Complaint Search l BCCO Home Page l State License Search Menu G Home l About I Phone Directory l Privacy l Disclaimer N>_, 4 ®2001 Miami-Dade County.All rights reserved. t t R I t i r 1 i r l http://egvsys.miamidade.gov:1608/WWWSERV/ggvt/BNZAW941.DIA?CNTR=15P000080 4/10/2018 i r Local=Busi nest Tax Receipt, Miami., Dade' Counfy,:SfaW6f.'F1orida," ' t` THIS'IS NOT A BILL-,DO'NOT PAY `- n•. w , e rt 7195905 _ a BUSINESSNAM'_E/LOCATION'S RECEIPT.NO EX;P.IRES_ ACME'SPRINKL'ERS,OF'r RENE­41-11WAL •SEPTEMBER.^30,2018, BROWARD INC, r 747815.5 `; s Must be displayed at place o71 f business DOING BUSINESS'IN;DADE _ Pursuant to County Code, r COUNTY Chapter 8A •Art^sa'.10 OWNER SEC.TYPE OF BUSINESS pAYM ENT'RECEIVED ACME SPRINKLERS OF BROWARD 196 $FECIALTY PLUMBING: ; BY TAX COLLECTOR- INC CONTRACTOR f.r./O Mir.HAFI°.1 1 FYVA PRFC 75.00 08/07/2017 Worker(S) 1 15P000080•, 0202-17-004835 This Local Business Tax fbcsipt orgy con"rens payment d the Looe(Business Tax.Rhe Rwei pt is nota license, penrit,or a cer "cation d the holder's qual i"cations,to do business.Holder mist corroy with any`govemnwtal. orrvgovernrnahtal reguiatory.lowsarxl �ert>�whichapplytothe business qP EV - .. The REM 0.above r'r►.ist be displayed on oil co mwdal veNcles,+Miami-Dade Code 8a-276 MifAM� For more inWrration`visit www mam dada g&wxcallector , - i , t _ Muni_d_pal__Contractor's Tax_f_bcei pt_ MC Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY CC NO: 15P000080 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES ACME SPPoNKB;SOFBROwARDINC SEP "EMBER 30, 2018 DOING BUSINESS INDADECOUNTY 7531994 Pursuant to County Code I Sec 10-24 OWNER TYPE OF BUSINESS pAYM ENT RECEIVED ACME SPRINIQHZSOFBROWARD INC SPECIALTY PLUMBING CONTRACTOR BY TAX COLLECTOR G O MICHAEL J LEYVA PIES 175.00 04/18/2018 0237-18-004284 This receipt is not val id in the following Municipalities:Aventura,Doral,Hal eah,Key Biscayne, Miami Gardens,Miami Lakes,Palmetto Bay,Pnecrest,Sunny Isles Beach,Town of Cutler Bay. M®ME For more information,visit www.nianidade.goy/taxcollector r ' I i l 1 I l r ACORDrM CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YY) 04/09/18 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY RED LION INS GROUP AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS 3401 N FEDERAL HWY CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE BOCA RATON, FL 33431 AFFORDED BY THE POLICIES BELOW. Phone: (561)338-4854 Fax: (561)338-4852 INSURERS AFFORDING COVERAGE # 1 INSURED INSURERA: Lloyd's of London (AIIN: AA1122000) ACME SPRINKLERS OF BROWARD INC. INSURER B: 9220 SW 54 PL INSURER C: COOPER CITY, FL 33328 INSURER D: Phone: (954) 604-2818 INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR-THE POLICY PERIOD INDICATED.NOTHWITHSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MM/DD/YY) GENERAL LIABILITY EACH OCCURANCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE 0 OCCUR MED EXP(Any one person), $ 5,000 A CIBFL0002413 12/29/2017 12/29/2018 PERSONAL AND ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PROJECTn LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURANCE $ OCCUR ❑CLAIMS MADE AGGREGATE E $ DEDUCTIBLE RETENTION WORKERS COMPENSATION AND WC STATUTORY EMPLOYERS LIABILITY LIMITS n OTHER E.L.EACH ACCIDENT 5 E.L.DISEASE-EA EMPLOYEE is E.L.DISEASE-POLICY LIMIT Is OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS IRRIGATION SYSTEM INSTALLATION : Lawn irrigation work; CERTIFICATE HOLDER I JADBITIONAL INSURED:INSURED LETTER: I ICANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. Miami Shores Village Bldg Dept AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores, FL 33138 Faxed to: ACCORD 26-S(7/97) ACORD CORPORATION 1988 I 1 , f. h ' IN, �J' � 94' 0000 0000.. e Z • • /rte Q � � • • � .,�a.:. i AL 3i� . 31yr 2 T�Me r Q`Gt /t $8450/` 0\� l{ h 10, �lenoio( l'' vat yes �u17Vfj Real grass growing in etw en oomerete 36y _ AM7 31t7 f 31yt 31y° l;ne t•r pi-ip GA 3l4' WATERMETER31 31 ' _1,, ' • i C;pm Scale: 51 to, ,s' 20' '1 Real grass growing in between comcrete ' S46 z pY,I ����s . .. .s 6fpM