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RC-10-1864 (2)
Inspection Number: INSP- 152521 Scheduled Inspection Date: March 02, 2011 Inspector: Bruhn, Norman Owner: LAGOMASINO, JUAN Job Address: 1021 NE 93 Street Miami Shores, FL Project: <NONE> Contractor: FAB INTERIOR & EXTERIOR INC. Building Department Comments REMOVE AND REPLACE KITCHEN CABINETS, FRAM CEILING TO ADD HIGH HATS LIGHTS AND FIXTURES Passed / y Failed Correction Needed Re- Inspection Fee March 01, 2011 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments CC_ For Inspections please call: (305)762 -4949 Permit Number: RC -10 -10 -1864 Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132050150070 Phone: (305)751 -4447 Page 12 of 44 BUILDING P RMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING • M Owner's Name (Fee Simple Titleholder) Owner's Address City Miami Shores Village Building Department 1 0030 N.E,2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756 S972 INSPECTION'S PHONE NUMBER: (305) 762.4949 St Tennant/Lessee Name Email Job Address (where the work is being done) 024 - ° N E.. VS-1- City Miami Shores Village County Miami -Dade FOLIO / PARCEL # l l - : 7 72.•05 - 015 - l rL 10 Is Building historically Designated YES NO L a o Re stration No. - 4** t N t l - State tN 0 • or 10C Zip Phone # ficate o Co ' pete c. No. Flood Zone el r ` • ' uW\ Cont•actor's Cony Name Contr ct is Address • City `t. t it I II I M Qualifier Name . .4,4 • 0 State Certificate I Contact Phone Architect/Engineer's Name (if applicable) ork: :place . . 0 Demolition Value of Work For this Permit $ , J i WV `" Type of'Woric + °Addition DAiteration ]New III Repo t Describe Wor w. ,Apt ' ( i &, . o P f 1 ll Eh • 0. .. tkraw, .1.vammistimasemmatarala. : Y : E& 74 k*ot******* sir***** *ic3cicknkeFrt:klriFl*F *** kit* d:9;*!r***k:F**cR ** *➢k** :4:kot3tikpF3k ***** * ** Submittal Fee $ Permit Fee $ ) 0 CCF $ CO /CC $ Notary $ Scanning $ . Radon $ Double Fee '$ Violation date: Training/Education Fee $ E -mail DPBR $ -- 1�i Permit No, i f, /1 Master Permit No, Phone 30 'ATI -19 q{ zip_ S Square / Linear Footage Of IgaMITVIn RY: ....��_ Phone# Phone # Structural Revlevv. $ Total Fee New Due $ 5 •3 Technology Fee $ Bond See Reverse side --* 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 inspection will not be appro : d and a reinspection fee will be charged. 2 The `r day o ho has produced who i AlFi Notary Public State of Florida Desiree Ramos My Commission DD877402 OF OP Expires 04/05/2013 Contractor - lot , g ins ment was acknowled d bef e e t r e sonally kno .1. �C��tr s r€�'�`arnos My Commission D0877402 Expires 04/05/2013 Signatur Owner or Agent The fpreginglinstrument was acknowle day of 1 . 0k4-; 20 0, by who is personally known to-Me or, As ident. NOTARY P 1.,IC: Print: D r(Pe My Commission Expires: 0 `t APPROVED BY (Revised 07 /10107)(Revised 06/10/2009) 00,2 Plans Examiner Engineer Signature. <' / Sign: P e or who has produced as identific • tion and who did take an oath. 13 Zoning Clerk checked NOTICE OF COMMENCEMENT A RECORORO COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. . STATE OF FLOilIDA: COUNTY OF hilAMI-DADE: 11-IE UNDERSINED hereby gives notice that improvements will be made to certain real property, and 14 accordSnce with Chapter 713, Florida Statutes, the following Information is provided in this Notice of Commencement. al desctibtioi 2. DesciiptiOn of improvenient: _ ferAOAA 3. Owner (s) iarne and address: _ _9 Signature of Interest in pro'perty: 0 W Name and address of fee simple titleholder: _... I 4. Cont actor' !name an4addrcss: _ Print Owner's Name Sworn to and b.pbscri _Notary Publi Print Notary's Name My commissicin expires:________ TAX FOLIO NO. \ 132,05 7 M..100_40 of property and street/address: 0 '2- \ 1\le, ( A3 S __C) • day of CANN HAR B • 111111111111111111111111111111111111111111111 5. Surety: (Pa iirtent bond required by owner from contractor, if any . Name and address: ..._ ____ Amount of boi $ 6. Lender's naMe and address:__ _ i :• . 7. Persons wiii)in the state of Florida designated by Owner upon whom notices or other documents may be served as provided by SpCtion 713.13(1)(a)7., Forida Statutes, Name and address:._______ . . .. __ ' _i_,. • B. In addition te himself, Owners esignates the following person(s) to receive a copy of the Uenor's N9tice as provided in Section 71 1.13(1)(b), Hod a Statutes. Name and adess:._ , cl 9 . Expiration' ate of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date s sp 4- Addre Nrag DADE I HEFiEBY CERTIFY that this Is e CFN 2010R0689643 OR Bk 27450 Fs 36881 (1p9 ) RECORDED 10/12/2010 12:12:51 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY7 FLORIDA LAST PAGE A.D. 20 WITNESS aw hand and Official Seal. - 1111 111. dai V °V of Prepared b 0 33\3 • MAT! I MEL TEC Wmie kv Weiir Q eks . t '� � F k2S e Cec`tI vsiN t F u` Uti`e1 �y vv`mk 1s nsat e,u;_t - 1 OW( Ulf .0 LOH O 0 ° KITCHEN I 13 / LAUNDRY .�u 0 r H OCT ZOERVIE Q z U LIVING ROOM I L FAMILY ROOM WOODEN DECK WE -V-6 a/r EXISTING FLOOR PLAN BLDG DEPT vc1D-- APPROVED ZONING Din Miami Shores Village OM WM rote BY DATE sue.ECT10 STATE MD COUNWalling APO RFGIA Al 0 z In E _, c•.) w ceD a Q F Q d T/ za0 z ' cT) • • • • • •••• • • • • •• �( R pp @ e : tl�' : z wi ,;°;mss a 1/8 ROO, 1144 c ��r ! '3- (,11 - 34 1/4 -1. 4 1 1/2 1/8 1/8 179 1l4 Roam 1 - Wall 2 -t - 18 1/8 94 1/2 0 000 • • • 00 000 00 000 00 00 • 00 00 O 0 000 • • • O 0 4100 O ▪ 0 000 91 1 19 1/2 1/2 34 112 1 <- ---21 1/2 24 34 ?4 12 1/2 Pc 1 peier oegc a/�/ ' � A - 1 29 Room 1 - Wall 1 94 112 • • • • • • •• • •••• • • • •••• • • • • •••• •• • • • • • • • • •••• • •• • • • • •• •• • • • • • • • • • • • •• • • • • •••• • • •••• • • • • • #1 129 #3 92 #2 179 1/4 Pnnrn 1 • • • • • .. • • ••• • • • •••• • • • • • • • • • • .. • . .. • . • • .... • • • • • • • • • • • • • .. • •••• • • • • Inspection Number: INSP - 154739 Scheduled Inspection Date: January 27, 2011 Inspector: Perez, JanPierre Owner: LAGOMASINO, JUAN Job Address: 1021 NE 93 Street Project: <NONE> January 26, 2011 Miami Shores, FL Contractor: RAMA AIR CONDITIONING INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \ KITCHEN HOOD RECONNECTION t 17- 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 - 154682. CANCELED BY DESIREE For Inspections please call: (305)762 -4949 Permit Number: MC-1 0-10-1874 Permit Type: Mechanical - Residential Inspection Type: Rough Work Classification: A/C Replacement Phone Number rt,n&A Parcel Number 1132050150070 Page 12 of 29 Email: 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Tenant/Lessee Name: Phone#: JOB ADDRESS: 102.1 1 e C ''Y ck City: Miami Shores Co . Folio/Parcel #: 1 dL© — M - 1. 31- v CONTRACTOR: Company Name: ,/VIM /9% Phon Miami Shores Village Address:, 1`‘"(. 5 7 c 7 City: /110/774.1/ State: / C. Miami Dade Permit NoWC1 I l JI 4 Master Permit No. i 10 1 UVO4- OWNER: Name (Fee Simple Titleholder): 1 f (- 1 1.�„�,� acre Phone#: t1 q — ► ` q Address \ 9_\ t 93 1 Cit V&A S 0 Ire 5 State: Zip: 3 51 3 Zip: ? J Is the Building Historically Designated: Yes NO Flood Zone: f ))262 //4" zip: . 7 -Z�a Qualifier Name: c ll 6702 l G 7//9P /3 Phone(I6117 State Certification or Registration #:'9 o /f/72. Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ `C 0 Square/Linear Foo of Work Type of Work: ClAddress OAlteration ONew C1R air/Rep ce ODemolition Description of Work: e Lor\rec c5\- tc.bet\I f aO ************************************** F s******************************************** e Submittal Fee $ Permit Fee $ 3 ) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 FI .RCTRICAL 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 apr - - 'd and a reinspection fee will be charged. . 44,00 ., Signature The forg day o who is ,personally known to Notary Public State of Florida Desiree Ramos My Commission DD877402 Expires 04/05/2013 Sign: Print My Commission * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * ** APPROVED BY Agent Owner or Z1. I .owledg before me this 2L U ` a e , instrument was ac As iden o5 100 Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) who has produ Signature Print: 01 /6-14eet... ) Contractor The foregoing instrument was acknowledged before me this /3 day of 4 , 20 ZO , by gi2a2 C` i — fjee fg //5/ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: I Q L t c \oe A \ COL My Co mmission ►►, Lisble taco ;¢ o COMMISSION # 00883642 � EXPIRES:JUNE 15, 2013 avismagampiL fkret.too Zoning Clerk 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L • . • i. , . _ . POLICY NUMBER POLICY EFFECTIVE • . • , .. 121 111•• POLICY EXPIRATION ,, ,, .• ■■• LIMITS B 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. GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 02L0001489 0329/2010 03/29/2011 EACH OCCURRENCE $ 500,000 X DAMAGE TO RENTED PRFMISFS (FA nccurencA) $ 100,000 INSURER C CLAIMS MADE X OCCUR MED EXP (Any one person) $ EXCLUDED INSURER E: PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 500,000 G AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 500,000 I POLICY P1 F iTr 9r i I LOC AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ A WORKERS EMPLOYERS' ANY O CPROPRIETOR/PARTNER/EXECUTIVE ERB It yes, describe SPECIAL PROVISIONS COMPENSATION AND LIABILITY 520361080000 08/16/2010 08/162011 1 TORY T ATU- 1 1 Ew E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (c UD under below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS ! VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS NC CONTRACTOR LICENSE #CACO43192 ACORD CERTIFICATE OF LIABILITY INSURANCE DAM 2°0 PRODUCER ALL CITY INSURANCE INC- ACI 7200 CORPORATE CENTER DR SUITE 316 MIAMI (305) 463-9431 FL 33126 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 # INSURED RAMAAIR CONDITIONING, INC 310 NW 57TH CT MIAMI I FL 33126- INSURER A FLORIDA RETAIL FEDERATION INSURER a NATIONAL GROUP INSURANCE INSURER C INSURER o INSURER E: COVERAGES CERTIFICATE HOLDER ACORD 25 (2001/08) SilentFax Oct 13, 10 VILLAGE OF MIAMI SHORES BUILDING, PLANNING, & ZONING DEPARTMENT 1841 GALLEON STREET NORTH BAY VILLAGE 09151 From Monica Palenzuela To 3057541851 FL 33138- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE 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. AUTHORIZED REPRESENTATIVE ; ``i • . rf Page 1 Al 000131 O ACORD CORPORATION 1988 Inspection Number: INSP- 152549 Permit Number: EL -10 -10 -1872 Scheduled Inspection Date: January 26, 2011 Inspector: Devaney, Michael Owner: LAGOMASINO, JUAN Job Address: 1021 NE 93 Street Miami Shores, FL Project <NONE> Contractor: CARLY ELECTRICAL SERVICE Building Department Comments January 25, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Phone Number c6(.0'A Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1132050150070 Phone: 305 - 970 -6345 KITCHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 9 Page 7 of 18 2C /D /0 le BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fait (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 , Submittal Fee $ (5O OO"" _ Permit Fee $ 6 Scanning Fee $ Radon Fee $ Notary $ - Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE wznyzn OCT 252010 AY Permit Type: Electrical —�• / 1 OWNER: Name (Fee Simple Titleholder): �J O A 'J �i OO M A s / 60 0 Piioae�# 3 0 S' / Q ! ' 5 4 (. Address: / 0 2- / O 13 zf 5/ City: 0/444; J it-L.S. State: • Zip: 3 3 / 3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: / / - ..3 Z f, 5- ®/ - 0 ®9-0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: e4.4/ / C/ G 'fie si 8-2, Phone#: Address: 6 4 d felQ - 6 A i3`J • . City: a�'4 i State: M M . Zip:. 3 / V cif Qualifier Name: € S 4 Phone#: State Certification or Registration #: 9 0 0 0 3/ 0 ° Certificate of Competency # Contact Phone#: 3 0 5 3 t/4- S 5 Email Address: DESIGNER: Architect/Engineer: Phone#: 30S 241 eo'} Value of Work for this Permit: $ A 7 - el ° Square/Linear Foore of Work: Type of Work: °Address alteration ONew epair/Replace °Demolition Description of Work: — 1i"6 # 4a C ( .) - 4cc £ C1 L. 6, At e J '.., 6. /e.4 5..4) • ***************************************F **** * ******** ****** *vee*+ *********** *****ens CCF $ CO /CC $ DBPR $ Bond $ Technology. Fee $ -- Bonding Company's Name (if applicable) Bonding Company's Address City 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 certi fy 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 WORD, 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 The fo eg day o who g instrument was a 9. 1 ! -•� by , personally kno Owner or Agent n owl - i ged before me this Van 11) 0116'0 M oduced 49 4 01 N , Notary Public State of Flonda Desi Ramos rC .. < My Commission DD877402 p pires04 /05/2013 As identification and who did take an oath. .NOTARY ' r' LIC Sign: Print: My Commission Expires: 4144************ APPROVED B State Zip who has p six*.a,x************ * *****a ** ** * ****** (Revised 07 /10/07)(Revised 06 /10/2009)(Reviscd 3/15/09) Plans Examiner Structural Review Signature Contractor The foregoing • strument was cknowl before me s ® Z day of I- 20 0 , by who i ersonally known me or who has produced as identification and who did take an oath. NOTARY PUB; , C: t : L t � L. S4 0 My Commis AWAREZ Ci011r1r 000017084 Etokei 11/20/2010 Zoning Clerk Inspection Number: INSP - 152550 Scheduled Inspection Date: January 07, 2011 Inspector: Hernandez, Rafael Owner: LAGOMASINO, JUAN Job Address: 1021 NE 93 Street Project: <NONE> Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Miami Shores, FL Contractor: EXCEL PLUMBING Building Department Comments RE SET ALL PLUMBING FOR KITCHEN AND WATE WATER January 06, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: PL -10 -10 -1873 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050150070 Phone: (305)273 -1138 Page 2of5 Address: City: Lnu BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: \O2 \ f . C V.? - ) City: ®U State: l� Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: )< Ce Qualifier Name: State Certification r Re istration #: L ' 5 ( 5 Contact Phone #: ? e(1. 'e Email Address: e DESIGNER: Architect/Engineer: Value of Work for this Permit: $ \ � Square/Linear Foo Type of Work: OAddre Description of Work: 113 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 State: L teratio j( r\CANJ Submittal Fee $ Permit Fee $ / 5� Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Miami Dade ONew epair, \IV av■ 303E 3 OCT 2 5 2010 $Y: o...,.,< .............0. Permit No. � \ V _ I c 3 Master Permit N 10 — 1 c(04 Phone4? L c‘ -c `( Zip: 37.› 1 " R Zip: JI (31 Phone#: VS -213 ° W3g 1' Phone#: Y - Lk,2 qty 5 Certificate of Competency #: Phone #: ge of Work: place I ODemolition CtSY\SL ** * * **** * * ***** ****x *******+x*** **+x***** F ees * *** x********** **+x+x************way**** ******* CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ I (.0 (0 10 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. the absence of such posted notice, the inspection will not be a ved and a reinspection fee will be charged. /Iii /is The fo • day of Y � • who is p rsonally known me who has prociced NOTY PIBL Sign: Print: caner or Agent (�7r - o n; instrument was ac owledged before me this The fore ►t, by Ali) rst ; A ,. eta ° et Notary Public State of Florida Desiree Ramos o Q My Commission DD877402 0, 0 , Expires 04/05/2013 APPROVED BY As ide My Commission Expires: 0 05 oszcc * ***+ x******e**********+ + x************ ******** *****mm*mm* ***+ x* x**m ****** ***** ***** ************ ****** **+x**x+= *** Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ( / 0) Plans Examiner day of who is rsonally kno Aft '1' a e V ° 4. Notary Public State of Florida 144 l Desiree Ramos ' � t I ires 04/05/2013 DD877402 p �rGa rl 0 Signature NOTARY P Sign: Print: Contractor ng ins i ent was ackno illeed d befo th 0 ,, b QV �®S 1!X � , o me or who has produced as identifi LI My Commission Expires: p Lk n5 take an oath. Zoning Clerk PRODUCER Work Comp Associates, Inc. P.O. Box 33297 Palm Beath Gardens, FL 33420 -3297 USA INSURED Excel Plumbing Services, Inc. 9261 S.W. 85th Street Miami, FL 33173-4526 CO LTR TYPE OF INSURANCE 1 POLICY NUMBER GENERAL UABIIJTY COAWIERCIAL GENERAL LIABILITY I CLAIMS MADE [] OCCUR OWNERS & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS GARAGE UABILLTY ANY AUTO EXCESS LLABIUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PA E T PARTNERS/ EXE EXEC INCL PA RNERS/ CUTIVE OFFICERS ARE: X)( EX OTHER DESCRIPTION OP OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER Miami Shores Village Building Dept 10050 N E 2nd Avenue Miami Shores Village, FL 33138 -2382 w TIFICATE INSU 0521024100000 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 POLICES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A BusinessFirst Insurance Company COMPANY B COMPANY C COMPANY POUCY EFFECTIVE POLICY EXPIRATION DATE (MM IDDIYY) DATE (MDMIDDJYY) 41!2010 1 411!2311 CANOE AGGREGATE WC STATU- TORY I IMTTS THIS IS TO CERTIFY THAT THE POLCES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERK INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CNNDITION OF ANY CONTRACT OR OTHER DOCIAIENT 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. GENERAL AGGREGATE EACH OCCURRENCE EACH ACCIDENT EL DISEASE POUCY LIMIT EL DISEASE -EA EMPLOYEE AUTHORIZED REPRESENTATIVE AC' a '' LIMITS PRODUCTS - COMP/OP AGE PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Any one person) COMBINED SINGLE LIMIT BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT $ $ $ $ $ $ $ $ $ $ AGGREGATE $ $ $ $ MMIDDrYY) 112010 $ 100 000 $ 500,000 $ 100,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UABWTY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. (BAP) m THE ANY MAY POUCIES. ,e,- LTR POUCIES REQUIREMENT, PERTAIN, ,n.). INSRC OF INSURANCE USTED BELOW HAVE TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY THE AGGREGATE LIMITS SHOWN MAY HAVE TYPE OP INSURANCE BEEN ISSUED TO THE INSURED NAMED CONTRACTOR OTHER DOCUMENT WITH POLICIES DESCRIBED HEREIN IS SUBJECT BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER ABOVE FOR THE POUCY RESPECT TO WHICH TO ALL THE TERMS, -'• a r ' �-_- - DATE (M MIIPIYYYY) PERIOD INDICATED. THIS CERTIFICATE MAY EXCLUSIONS AND CONDITIONS ., a , =r. is ■ DATE (MIMIDDIYYYY) NOTWITHSTANDING BE ISSUED OR OF SUCH LIMITS A GENERAL UABIUTY COMMERCIAL GENERALLLABIUTY 7CG14076 01/08/10 01/08/11 EACH OCCURRENCE $ 1,000,000 X PREM ISES(F-a o cure ) $100,000 CLAIMS MADE IX I OCCUR MED EXP (Any are Perwn) $ 5,000 PERSONAL &ADVINJURY $ 1, 000,000 GENERAL AGGREGATE $ 1,000,000 GEM-AGGREGATE LIMIT APPUES PER: POLICY n JE n LOC PRODUCTS - COMP/OP AGO $ 1,000,000 — 1 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE OMIT ax�e $ BODILY INJURY (Per ) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY AGO $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 7 OCCUR 1 1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYED UABIUTY Y / N ANY CER/MEETDRIPARMBER EXCLUDED? UDED? OFFI CXITIV� r CERIMEUDED? u (Mandatory In NH) If yea, describe under SPECIAL PROVISIONS below IT WC ST LQdHTS I I ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY LIMIT $ A OTHER DESCRIPTION OF OPERATIONS !LOCATIONS / VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ® CERTIFICATE OF LIABILITY INSURANCE PRODUCER Combined Underwriters of Miami 8240 N.W. 52 Terr, Suite 408 Miami FL 33166 Phone :305 -477 -0444 Fax:305- 599 -2343 INSURED EXCEL PLUMBING SERVICES, INC 9261 SW 85 ST MIAMI FL 33173 DATE (MMIDD/YYYY) OP ID 10/11/10 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: SCOTTSDALE INSURANCE CO . INSURER B: INSURER C: INSURER D: INSURER E: NAIL # CO F"4 CERTIFICATE HOLDER CANC€6IATION MIAMI SHORES BUILDING DEPARTMENT 10050 Northeast 2nd Avenue MIAMI SHORES FL 33138 MSHORES MOULD ANY OF THE ABOVE DESCRIBED POUCIES 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 FALURE TO DO SO SHALL IMPOSE NO OBUGATKIN OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2009101) The ACORD name and logo are registered marks of ACORD AUTHORIZED REPRESENTA ® 1988 -2009 ACORD CORPORATION. fights reserved.