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PL-10-127 r NO ow ma y ' � � " Miami Shores Village 3.�y PO c 10050 N.E. 2nd Avenue ' R Miami Shores, FL 33138 -0000 a tlt fitu AP�t Phone: (305)795 -2204 xcoftts ��i �A E xpiration: 0110'U Project Addre Parcel Number Applicant 9127 1 Avenue � _.. 1131010160100 CHARLES HUMPHRIES Miami Shores, FL Block: Lot: Owne Information Address Phone Cell CHARLES HUMPHRIES � 9127 NW 1 AVE MIAMI SHORES FL 33150 -2248 Contractor(s) Phone Cell Phone LValuation: $ 1,000.00 LASSETER PLUMBING CO INC 305 - 893 -7180 Sq Feet: p Type of Work: PLUMBING For Inspections please call: Type of Piping: GAS HEATER (305)762 -4949 Additional Info: Available Inspections: Bond Return : Inspection Type: Classification: Residential Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 PL -1 -10 -36906 $ 104.60 $ 104.60 $ 0.00 Education Surcharge $0.20 Permit Fee - Additions /Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $104.60 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 and zoning. Futhermore, I authorize the above -named contractor to do the work stated. February 02, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Co pra February 02, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No.1" PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleh6lld�er) tf G�-� !T (� iel� Phone # Owner's Address X� 7 l City State Zip 3313P Tenant/Lessee Name — Phone # E- MAIL: Job Address (where the work is being done) ] City Miami Shores Village - County Miami -Dade Zip 33/3' FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name L ) _Jf4T�2 )OZ-UW19 6 Phone # 3 ) ' P3 f 1 Pa Contractor's Address _ ��.� City �.l�/I?� State Zip 33� � Qualifier Name �1VlTl� �,i�� Phone # State Certificate or Re istrati n No. �r- �i V/6 X1 4 Certificate of Competency No. E -MAIL: s L yi �3 /iU �1T A) T Architect /Engineer's Name (if applicable) r '_ Phone # d� Value of Work For this Permit $ 306 Square / Linear Footage Of Work: Type of Work: ddition E Alteration rlNew [) Repair/Replace ❑Demolition Describe Work: ` Submittal Fee $ Permit Fee $ /06 jW1 h - lie— - CCF $ 0 •� � CO /CC Notary $ Training /Education Fee $ Technology Fee $: , Scanning $ Q Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ //��UU Structural Review. $ Total Fee Now Due $ 1V —` • �U See Reverse side Bonding Company's Name (if applicable) 13944ding CC 4Y 3any's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage tknder''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. l understand that separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 ! _ Signature g ture r� Owner or Agent �,.,/ Contractor The foregoing instrument was acknowledged before me this �/ v(r The foregoing instrument was acknowledged before me this day o 20 )U by day of , 20 1 by �.17Jt/0 /h LAC =T C' who lly kn to me or who has produced who is e nally now me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC f c Sign: Sign: 9/�smC 6" Print: Print: My Commission Expires: My Commission E CHli11NAPdHHAS No 79 ht!! CdMla IKON # DD 5 8ondo ift %wo pwa 0 t Banded thru Notary APPLICATION APPROVED BY: Gj !®' Plans Examiner Engineer Zoning (Revised 02/08/06) ADDENDUM TO BUILDING PERMIT APPLICATION (All APPLICATION FOR BUILDIF1 PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMTT HAS BEF OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUASEQUrKHT APPLICATIONS,) PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM LfNIT FEE BATII TLO SWITCH OUTLETS SPACE HEATERS BI LI GIG OUTLETS CENTRAL II EATItV, _ 0 1911ASIIER R ECEPTACLES A/C (WIN)) DI SERVICE TEhf'ORARY A/C (CENTRAL) r DR INKING FOU NTAIN SERVICE SIZ IN APS DUC WORK j FLOOR D(IAIN _S ERVICE REPA IRAIETER GIWIGE REFRIGERATION GREASE TRAP APPL INICE OUTLETS _PR OCESS AIIU PRESS PIPING j INTER CEPTOR RAT�GE UP Um ERGROU10 TANKS LAVATORY _ OVEN _A BOVE GRO UIIO TANKS LAU tURY TRA WATER HEATER U.F. PRESSURE VESSELS CLO THES WASi1ER MOTORS a- 1 IP _STEAM BOILERS SHOWER _h 1JTORS OVER 1- 3 1p HOT WATER BOILERS SI NK, POT /3 M. P. hIOT ORS OVER 3-- 5 If h ED IAN I CAL VENTILATIO � i SINK, RESIDENCE MOTORS OVER 5-- 8 IP TRANSPORTING ASSER3L IES _ I SItIK, SLOP hUJORS OVER 8- 10 If ELEVATU TEWORARY WATER CLOSET KNORS OVER la- 25 IP FIRE SPRINKL S YSTE MS j UR INAL ht)TORS OVER 25 -100 [P COOLIN TOWERS WATE CLOSET h1J1ORS OVER 100 IP VIOLATION INDIRECT WASTES A/C WItaw REINSPECTION WATER SU PPLY T0: AIR CUO I T I OILERS A/C UNIT STRIP FIEATER FIRE SPRINKLER GENERATORS TRANSFORME HEAT NEW INST. GEN ERATORS TRANS FORMERS HE ALER - REPLACE GE NERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIh NING POOL OUTLETS COh1MERCIAL — - WATER SERV ICE SIGN TIJBES - -" SEWER CONNECTIONS SIGN TRANSFORMERS U TILITY -SEW SIGN TIME CLOCK UTILITY -WATER F I X R�IES - SEPT IC TAI)( ANTCNNA REL TELEVISION OUTLETS -^ - DR 4" TILE/RES. VIOLATION ' FU &ABANDON SEPTIC TAt)( R E I NSPECT ION s SUA'(AGE PIT CU. FT. _ CATCIi BASIN DISUNG WELL _.. IAJMEST IC _WELL — AREA. ORA — 1t I _.,. ROOF INLET SOLA WATE IiEATER _I FIRE S TNtd]P IPE POOL PIPING LAWN SPRINKLER SYSTEM --- I 3AS RAi1GE E , ETER SET (GAS) _ J AS PIPING ' II%. R CERTIFICATE OF LIABILITY INSURANCE 9/9 2 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mack, Mack & Waltz Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 490 Saw rasa Corporate Parkway HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g rp y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 120 Su nrise FL 33325 INSURERS A FFORDING COVER NAIC # INSURED IN Ca sualty Lasseter Plumbing Company, Inc INSURER_B: S C onsulting C ompany 865 N.e. 130 Street IN SURER C: I NSURER D: North Miami FL 33161 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 POLI AG GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LTIR .. TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE _ $ 1 U00 000 DMAGE ODD X_ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100 A 1 CLAIMS MADE [x] OCCUR 04GL000767389 9/1/2009 9/1/2010 M EXP (Any one per son) $ EXCLUDED PER SONAL & ADV INJ URY $ 1 000,000 GENERAL AGGREGATE $ 2 G_ENI AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000, X _ POLICY PRO- LOC _ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS 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 / UMBRELLA LIABILITY EACH OCCURR $ OCCUR L1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION WC STATU- H- AND EMPLOYERS' LIABILITY Y / N TOY IMIT OT ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 83021471 5/25/2009 5/25/2020 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (305)756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Miami Shores Village DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Attn : Elviva NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 10050 NE 2 Ave Miami, FL 33138 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Greg Waltz /DIANA ACORD 25 (2009101) ©1988.2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD - STATEw OF FLORIDA DEPARTMENT OF BUSINESS D PROFESSIONAL REGULATION CQNSTRU�'�IO 7 I1�1DL TR I<�CENSTN� BOARD a $EQ# L08A7Q,2009 ...,. LICENSi �TBR u a 07/02/2008 088000924 CFG041596 v F: The PLUMBING CQNTRACTOR Named IS tERTIFIEI3 Under the prov,js.�ons of -Chapter 4 - Expiration date': AUG 3'1, 2.010 LASSETER J M � OHN A ' �� LASSETER PLUMBING GQMPANXE� 139 2 5 NE 1ST AvE �� , � :. �� US, - _ MIAMI CHARLIE C�RI - ' CHU CK DRAGO � GO ERN - �� ..i INTERIM SECRETARY A V A RfUiREp �Y LAU1i P ... . ....... . .. . ........ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)796-2204 Fax: (305)756-8972 Inspection Number: INSPA 34287 Permit Number: PL-1-10-127 Scheduled Inspection Date: February 03, 2010 Permit Type: Plumbing - Residential Inspector. Hernandez, Rafael Inspection Type: Final Owner: HUMPHRIES, CHARLES Work Classification: Addition/Alteration Job Address: 9127 NW I Avenue Miami Shores, FL Phone Number Parcel Number 1131010160100 Project: <NONE> Contractor: LASSETER PLUMBING CO INC Phone: 305-893-7180 Building Department Comments REPLACE GAS HEATER FLUE PIPE Inspector Comments Passed 7 Failed Correction Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 02, 2010 For Inspections please call: (305)762-4949 Page 14 of 22 STO/COO Z SHOIAUHS TIBIA NVOS VJX(I 092L 989 008 T XVA 05 60 OTOZ/90/ZO