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PLC-11-607Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 158618 Permit Number: PLC -4 -11 -607 Scheduled Inspection Date: April 22, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 9537 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: KINGS PLUMBING SERVICE Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060133910 Building Department Comments INSTALLATION OF NEW 1" PVC WATER MAIN 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 - 15:•11. concealed work April 21, 2011 For Inspections please call: (305)762 -4949 41110 Page 8 of 8 141 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 APR 0 6 2011, k BY: BUILDING Permit No. Pc-c,( PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER: Name f(Fee Simple Titleholder): , ! S i LL� Phone #: 1 ° 1423 _ 1 Address: f y q`4 �r .. and 1 lam:_ City: `' { 1? Yi'l ie- State: Zip: 33 1 3S Tenant/Le ee Name: Phone#: Email: - e.S t. Q__. L Cz5 -4 JOB ADDRESS: 2, d t �► r-Ba) City: Miami Shores County: Miami Dade Zip: 1 316 . Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: g i oCi� S 1.u.mtc) (� Cue., Z 0 e- L. Phone#: Address: �J J City: AU®Q NI i'C&w►. State: FL Zip: 3 /y Qualifier Name: 36 r5 rp god r iSt 7 Phone#: 7 %'6-02S-1-9 ! 1 0 State Certification or Registration #: C F C 1 tY2 (0 7 9 S^ Certificate of Competency #: Contact Phone #: i V6 s25r ^f8f Email Address: (•_ DESIGNER: Architect/Engineer: Phone #: �n Value of Work for this Permit: $ G 2,7 e . Square/Linear Footage of Work: idp frm 90 Type of Work: Address DAlteration ❑New ❑Repair/Replace ❑Demolition Description of Work: I S h1 #4 /.ibx a tp Alf / / " R ii . G wee ev S°74 `.4-1 40 $/o r ., / rd ' * ********** ****** ********+ x*** a: ********* Fees****************** u: x: ***** *****+u*********x *** Submittal Fee $ Permit Fee $ /e5 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ O 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subjectt- attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inion which occurs seven (7) days after the building permit is issued.M the absence of such posted notice, the inspection rpot -j e approved and a reinspection fee will be charged. ° ► O Sig e, ._._ 0 e or Agent The fdregoingrinstrument was acknowledged before me this 3 )' day of It c k , 20 [ , by TA e esp (lap cu i s o , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: ?-- Print: yet ri My Commission Expires: NCr ,...,:=IRYPI7BLIC -STATE OF FLORIDA = Y v Offr APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this Yl day of Ne c el- , 20 M , by c;a1pC 1, , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: tit Sign: Print: , O\ . lc? ,�obet4,� o� My Commission Expiiis: a g d • s 0 e #DD 919634 ' Q pi�oRi2: '� ;Commission s�$ y�y��esIs�s�ssksh+ k* kakBasIaakak�kskakskakHeoF SkskaRaknk�knk�k � ? .6 skakHaxIsskska�a ED THU' Plans JNc. Examiner A ®'®l,f8lliea `l o�� Zoning (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review Clerk ACORIbr CERTIFICATE OF LIABILITY INSURANCE DATE (MIEDDIMY) 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 15 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 Limn of such endorsement(s). PRODUCER Temax Insurance, Inc 7990 SW 117 Ave # 113 Miami, FL 33183 Xamet Barreras PHONE Fax (AFC, No. Ent): (788)539-5989 I (AAC. No (305)366-1235 ADD : xaTTtet(�temaxlnsurance.COm PrtoaucER CUSTOMER ID 0: INSURER(S) AFFORDING COVERAGE NAIL @ INSURED um e tangs Plumbing Services, Inc 10450 NW 6 Ct Miami, FL 33168 INSURERA: Capadty Insurance Company UABAl7Y COMMERCIAL GENERAL LIABILITY INsu B: X c INSURER C : INSURER D MED EXP (Any one pin) INSURER E : 5.000 INSURER F : OVERAGES CERTIFICATE 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 LTR TYPE OF INSURANCE 1.1, INSR —WW1 WW) POUCY NUMBER CLM01001065A POUCY (MMMIIDDD/YY�YYI 02/12/2011 POU (MM/IDD �YYI 02/12(2012 LIMITS EACH OCCURRENCE $ $ 1.000,000 50,000 GENERAL UABAl7Y COMMERCIAL GENERAL LIABILITY ( OCCUR X DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS -MADE I X MED EXP (Any one pin) $ 5.000 PERSONAL & ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ $ $ 2,000,000 2,000,000 GEN'L AGGREGATE UNIT APPUES PER PRODUCTS - COMP/OP AGG X POUCY ■y ■ LOC AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS F 1 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Pet ecddent) 8 PROPERTY DAMAGE (Per accident)) $ $ $ UMBRELLA L IAO EXCESS LFAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ I AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION 0 AND EMPLOYERS' UAISUtY YIN ANY PROPRIETOR/PARTNEREXECUTIVE OFF10ER/MEMBER EXCLUDE)? ❑ [llandato y rn NH) u vrchiveew.w. N IA WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY OMIT $ F{� 1 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Aileen ACORD 101, Addllonai Remade Schedule, U more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Claudio B. Grande Building Official 10050 NE 2 Ave Miami Shores, FL 33138 305 - 795 -2207 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROMBIONa AUTHORIZED REPRESENTATIVE © 1988- 2 h ' ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD r ACORDTM CERTIFICATE OF LIABILITY INSURANCE PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()- F: (888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 INSURED KINGS PLUMBING SERVICES INC 1450 NW 6TH COURT ST MIAMI FL 33168 MAF UOBB DATE 05 -26 -2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Twin City Fire Ins Co INSURER B:. INSURER C: INSURER D: INSURER E: INSURANCE THE POLICIES OF LISTED CONTRACT E INSURED �D FOR PERIOD INDICATED. ING COVERAGES ANY REQUIREMENTTE M ORCONDIT O N OF ANY OR OTHER WTH 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. POLICY EFFECTNE LT rR TYPE OF INSURANCE POLICY NUMBER E i •D Y LTR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR GENT AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS POLICY EXPIRAA,IO1 NN LIMITS EACH OCCURRENCE FIRE DAMAGE (Any one tire) $ MED EXP (Any one person) PERSONAL & AOV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC AGG EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER EACH OCCURRENCE AGGREGATE 76 WEG ZV9784 05/09/10 DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 05/09/11 X WC STATU- TORY I LIMITS OTH- ER E.L. EACH ACCIDENT 000 E.L. DISEASE - EA EMPLOYEE $1 0 0 , 0 0 0 E.L. DISEASE - POLICY LIMIT $500 0 0 0 CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: Miami Shores Village 10050 NE 2 Ave Miami Shores, Fl 33138 CANCELLATION 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 (10 DAYS FOR NON - PAYMENT) 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. ACORD 25 -5 (7/97) AUTNORI EPRESENTATIVVE�j __ / ii-"'i\--''' ® ACORD CORPORATION 1988 MIAMI DADS COUN. TAX COLLECTOR 140 HIV FLAGLER S 1st FLOOR`U3'DDE,DI Tpu11 MIAMI, FL 33130 PUFiBU I Tt3.EOU DE CHAP 563783 -1 BUSINESS NAME / LOCATION KINGS PLUMBING' SERVICE INC 14050 NW 6 CT 33168 NORTH MIAMI THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 588089-4 STATE# CFC1426795 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 OWNER KINGS PLUMBING SERVICE INC Sec. Type of Business WORKERS THIS Is 6NCY-APL MBING CONTRACTOR ° 8 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE P R�IMITR FOR LICENSE KINGS PLUMBING SERVICE INC REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF LUIS BARIAS PRES T E'H.OLDER'S QUAUFICA- 14050 NW 6 CT NORTH MIAMI FL 33168 PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/20/2010 09010304001 000045.00 SEE OTHER SIDE ,. ► „82tt