PL-10-19of
Scheduled Inspection Date: July 30, 2010
Inspector: Hernandez, Rafael
Owner: POZNER, MARCIA
Job Address: 9013 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: MITO PLUMBING CORP
Building Department Comments
July 29, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 132672 Permit Number: PL- 1 -10 -19
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060460070
Phone: (786)553 -5003
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 1 of 11
BUILDING
PERMIT APPLICATION
FBC 20 Mite:4 Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)
Owner's Address 3 y 1 Q h' '-
City n [ Maw.' 'State )(qS Zip
Tenant/Lessee Name / \ J A
Email T T)( & Q GL../ avr L,
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contact Phone
Architect/Engineer's Name (if applicable)
Submittal Fee $
Notary $
Scanning $ 3' •
Double Fee $
Miami Shores Village trgrNTE779
Building Department MAR 2 5 NO ji
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
/Ncti A
.1111a111109111/ ,
c?) I3 NE
County Miami -Dade
Permit Fee $
NO
Master Permit No.
CCF $
Permit N. FL-1 b
Contractor's Company Name M l0 /Y V 19 IM L Phone #
Zip
Phone #
Phone #
a
BIB:
Phone # itg
Zip 3r
Flood Zone
& - 3S3 3
33DJS
Contractor's Address .) cir )- _ S
City
Qualifier Name /d ,,Q S /72-°°
State Certificate or Registration No. ficate f : :_ . etenc No.
g
Cc am° --;� )--1 7-� �' ��
-7710 3 J 603 E -mail l / h i { 6 / 613 / �:JC11
V .
Value of Work For this Permit $ �(5® Square / Linear Footage Of Work:
Type of Work: EAddition ['Alteration ❑New Repair/Replace ❑ Demolition
Describe Work:
417.41U , (M'` (lox �p- .,
******** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * ** * **
Technology Fee $
Training/Education Fee $ 040
Radon $ J 4(10 DPBR $ 04QO
Violation date: �
Structural Review. $ Total Fee Now Due $ r0
See Reverse side -
CO /CC $
Bond $
9
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 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
inspecti will not be approved and a reinspection fee will be charged.
Signatu
Sign:
Print:
Owner or Agent
The foregoing instrument was acknowledged before me this Z2, The foreg g instrument was ackno . edged before me
1
day of ft%) k , 20 i0 , by Pia '(T1, ..„ vi day of , 20 ID, by \i
who is personally knows to me or who has produced Teems who is p- rsonally known to me or who has produce
ac; vet L :cease As identification and who did take an oath.
NOTARY PUBLIC:
r
s i t
1 1
1 S O�o vl� ,s
BERNARD JOSEPH SPADONI, III
STS►
Notary Public
* * ** *.
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
Plans Examiner
Engineer
and who did take an oath.
4, ev •'Gtie>
'4" 4"-.° S 5c9
4
*********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
TARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Clerk checked
A
GENERAL LUMP/ITT
® CCIMMERClAL GENERAL LIABILITY
GL- 00000002067-00 1 07/23/09
1
I
i 07/23410
a
EACH OtxI +ICE 2,000,0001
' PREMISES (Ea txzl:urerms 100,000
❑ • CLANS MADE ® OCCUR
MED EXP (Any one Peen) 5,000
in
❑
PERSONAL A ADV INJURY 1,000,000
GENERAL AGGREGATE 2.000,000
GEML AGGREGATE L114fIT APPLIES
0 POLICY .❑ PROJECT 0 LOC
PRODUCTS - COMP/OP AGG 2,000,000
O_
AUTOMOBILE UABIUTY
COMBINED SINGLE LIMIT
(Ea accident)
! I
• ANY AUTO
• ALL OWNED AUTOS.
(Per BODILY INJURY
Pennon)
0 SCHEDULED E ALrcOS
0
❑ NON oWNE AUTOS
C
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
❑
GARAGE UABILITY
AUTO ONLY -EA ACCIDENT
•
• ANIYAUr0
OTHER THAN EA ACC
•
AUTO ONLY AGG
❑
i
WORKERS
EXCESSIUMBREU.A L.IABIUTY
❑ OCCUR • MAIMS MADE
•
I
EACH OCCURRENCE
AGGREGATE
CI DEDUCTIBLE
❑ RETENR0N $
COMPENSATION
j
/M -
EMPLOYERS' LIABILITY
ANY PROPRIETOR/ PARTNER! EXECUTIVE
OFFICER / MEMBER EXCLUDED?
If yes, describe under
SPECIAL PRA below
I
❑ TORY S ■ Eft
EL EACH ACCIDENT
E L DISEASE - EA EMPLOYEE
EL DISEASE - POLICY LIMIT
OTHER
t
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER Equilnstsance, LLC - -
6638 Main Street
Miami Lakes, FL 33014
Phone (305)557 -5578
INSURED Milo Plumbing Corp
7879 NW 173 St
Hiealeah, FL 33015-
COVERAGES
Fax (305)557-5197
DATE (IHMIDDNY)
07/24/09
:.� 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 NAIC 8
INSURER A: American Vehicle
INSURER B:
INSURER C:.
INSURER D:
• INSURER E
i INSURER F:
THE POLICES OF NSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.. NOTWITFLS1ANDING
ANY REQUIREMENT, TERM OR CONDrBON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED DREW IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONINFIONS OF SUCH
POUCIES. AGGREGATE UM1TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
i t sa 1 ADDI I TYPE OF INSURANCE &POLICY EFFECTIVE I POLICY EXPIRATION:
I.TR 1 WORD POLICY N UMBER DATE f> flfy n DATE l rvvt LIMITS
SPECAAI. PROVISIONS
ACORD 25 (MIMS) QF
Miami Shores ButkLng Department
10050 ne 2 nd Avenue
Miami Shores , Florida 33135
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE TO THE «y - 1: CATS HOLDER NAMED TO
T IFE TT, OUT FAILURE TO DO SO SHALL. I' - y NO OBLIGATION OR LWBILI7Y
OF ANY KIND UPON THEW 1�i�r r - .' REPRESENTATIVES.
ACORD CORPORATION 1988