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PL-10-1579Inspection Number: INSP - 152286 Permit Number: PL -9 -10 -1579 Scheduled Inspection Date: October 15, 2010 Inspector: Hernandez, Rafael Owner: BRAUER, JASON & CHERI Job Address: 878 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: L&J CONSTRUCTION LLC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 INSTALL NEW ELECTRIC WATER HEATER.SUPPLY WASTELINE , HOT AND COLD WATER LINES FOR WASHER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 14, 2010 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060050320 Phone: (786)255 -1980 Page 5 of 6 THE POLICIES OF INSURANCE LISTED BELOW HAVE EEt ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH MAY P32TAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. DNS PERIOD INDICATED. THIS CERTIFICATE MAYBE EXCLUSIONS AND � T(8 DATE IMMID�DVYYYI')� NOTWITHSTANDING SUED OR CONDITIONS OF SUCH LTR AUL yy SINSR[I TYPE OF INSURANCE POLICY NUMBE R DATE (MWDD/YYYY) UITITB A GRJERALLEABRITY COMMERCIA - GENERAL uAeury 04GL000800556 09/05/10 09/05/11 EACH OCCURRENCE $1,000,000 X P I ES( o t " (rte ocns) $ 100, 000 CLAIMS MADE I X OCCUR MED EXP (Anyone person) $ EXCLUDED PERSONAL &ADV INJURY $1, 000, 000 GENERAL AGGREGATE $ 2,000,000 $2,000,000 GEL AGGREGATE UM APPLES PER: POLICY f JE n LOC PRODUCTS - CCVPR)PAGG A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 04GL000800556 09/05/10 09/05/11 C O M B I N E D SINGLE LIMIT (Ea accident) $ rfl 000 BODILY INJURY (Pee person) X BODILyINJURY (Per accident) X PROPERTY IPA $ GARAGE UM/MTV ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ECCESS / UMBRELLA e UABILXY EACH OCCURRENCE 5 I OCCUR I I CLAIMS MADE AGGREGATE $ DEDUCTS RETENTION $ $ $ $ WORKERSCOWENSAMON ATM EMPLOYERS' ANY PROPREETDRlPARTNE OFFICER/MEMBER (Mandatary Data de act5►e SI�ECIAL PROVISNCQ UABILITY Y / N 1 W b1,4 1 u. 1 IOC R/EXECUTI R EXCLUDED? E.L EACH ACC/DENT $ In NW und er bai oa E.L DISEASE - EA ELIPLO $ EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS! LOCATIONS VEHICLES / EXCLUSIONS ADDE O BY E aDO SEMENT ( SPECIAL PROVISIONS Sep 10 10 11:56a l CERTIFICATE OF LIABILITY INSURANCE zao i PRODUCER W.F Roemer Insurance Agency William F. Dowd P.O. Box 190669 Fort Lauderdale FL 33319 Phone:954-731 -5566 Fax:954- 731 -8438 INSURERS AFFORDING COVERAGE INSURED COVERAGES CERTIFICATE HOLDER ACORD 25 (2009101) L & J Construction LLC 16351 SW Street 33033 Village of Miami Shores 10050 NE 2 Ave. Miami Shores FL 33138 MIAMCS2 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. INSURER& Mid- Continent Casualty Co INSURER B: INSURER C: INSURER D: INSURER E: CANCELLATION p.1 DATE (MINIOWYYYY) 09/02/10 NAIC # 23418 SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEE IRATION DATE THEREOF, THE ISSUWG @LSURER HELL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NOOBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORT ED REPRESENTATIVE e ©1988 -2009 AGORD CORPORATION. AB rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOUO NO. 1 -"3QD( f 00S STATE OF FLORIDA: ©32 COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the followir Tr ; • �_ ®P 7A, h COUNTY OF DADE I he this is t copy is provided in this Notice of Commencement. In al fwd In , , rte• 445 G ear -7, ,. ` • i clel 'y 2. Description of improvement: i i Y1 f jsdizs 3.Owner(s) name and address: �– Interest in property: Name and address of fee simple titleholder: 4. Contractor's name, address and phone num By VERIFICATIO Under pen that the fa Signatu • �N WITNESS my HARVEY RU VIh1, 1. Legal description of property and street/address: � i 41 I , dividually, or ❑ as for ersonally known, or ❑ produced the following type of i•; ioation • Signature of Notary Pu Print N (SEAL) ANT TO SECTION 92.525. FLORIDA STATUTES ury, I declare that I have read the foregoing and it are true, to the best of my knowledge and belief. er(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: 1111111 Hill 11111 111111111111111 1111111111111 CF P4 2010R0 07708 DR Bk 27413 Ps 2528; (19s) RECORDED OW08 /20110 12:29 :13 HARVEY RUVINp CLERK OF COURT MIAMI -DADE COUWTYa FLORIDA LAST PAGE Spa above reserved for use of recording office .t! QMi Shot Welk )1 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER .PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YO • PERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE .BEFORE THE FIRST INSPECTION. OU 1 : D TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTOFINEY BEFORE COMMENCING WORK ReApvre- by Prepared Prepared By IN Ca ' 0 ii_.': Af Print Name .11IM Print Name wit Ariterimatsr40111' Title/Office Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foreg ,i min �� m nt was acknowledged before me this -4'7 day of 14)'/ .abt V nRIDA NpTARYTC>, —' C? Fe dge • • n010908 BY BUILDING PERMIT APPLICATION FBC 20 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 Permit Type: PLUMBING n OWNER: Name (Fee Simple Titleholder): ` h :t f-yriqd Phone#: Address: 1 13 G1 - k,rr04.1."--• City: MI client b o State: Zip:3611 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 41i p . q 1 44J'rCuL... City: Miami Shores County: Miami Dade Folio/Parcel#: "" 3 2 0 °' DO 5- Is the Building Historically Designated: Yes CONTRACTOR: Company Name: L t C /V Jl r v Phone#(1 %)a 56• I ql 0 Address ____ilp S 2 2 5 , , City: 4 4 Ontk_. S"fe CUL State: - Zip: 3' p 33 Qualifier Name: 1 —�,� L 3 Cr✓1Q1r1(�..t Z. Phon `� y)) Z56 1 0 i () State Certification or Registration #: CFC- i Li 2.77 Certificate of Competency #: Contact Phone# 7)36)222- t 4 2, Email Address: DESIGNER: Arc itect/Engineer: IV 1 & Phone#: Value of Work for this Permit: $ i 4 0 0 • 0 O Square/Linear Footage of Work: Type of Work: DAddress DAlteration +O n pNtWLS , epair/Replace ODemolition Description of Work: 1 n S+ t _ t ToggacED SEP (l ;? 2610 pennitN0 Master Permit No. TOTAL FEE NOW DUE $ Zip: 20 • NO Flood Zone: Submittal Fee $ Permit Fee $ /5-6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Name (if applicable) nding Company's Address 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 FT.ECTRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occ . seven (7) days after the building permit is issued the absence of such posted notice, the inspection will not be apprr reinspection ee . '- harged. Owner or Agent The fo =oing instrument was acknowledged before me this 10 day of , 20 Lb, by who is personally known to me or who has produced As identificat*cy4 NOTARY PUBLIC: Al ► «D Sign: Print: My Commission Expires: APPROVED BY State Zip l"'"%, Ali Hodge Commission #DD908592 Expires: JULY 19, 2013 �pN1j�D TgRU ATLAICT IC BONDING CO., MC. (Revised 07 /10/07)(R.evised 06 /10/2009)(Revised 3/15/09) G/ Plans Examiner Structural Review Contractor The foregoing instrument was acknowledged before me this .10 day of , 20,0 0, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print))i, My Commission Expires: NOTARY PUBLIC -STATE O£ ELOBTDA �$ , ' All Hodge Cernrlssion #11)908592 JVL?19,2013 * * * * **+s+x*r *** spa *** **** ****** sae+ ******** ***********+ x************* x ****s**+xa** *s<*** ****** ****** Zoning Clerk