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RC-10-1409Scheduled Inspection Date: December 10, 2010 Inspector: Hernandez, Rafael Owner: HUNTER, MARK Job Address: 1245 NE 93 Street Project: <NONE> Miami Shores, FL Contractor: HABER & SONS PLUMBING INC Building Department Comments December 09, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 - o 1 Inspection Number: INSP - 153896 Permit Number: PL -8 -10 -1411 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (917)604 -8328 Parcel Number 1132050270070 Phone: (305)461 -8653 GENERAL REPAIR OF TOILET LAVATROY AND SINK Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments RE- INSPECTION PAID toy Page 9 of 13 I. iNiRi TYF! OR saau*auel OIARRA1.LIAINUTY j COAQNBNCIA OM R% LIABILITY I POLtOY ..... ► 1 • LIM BAt 5 ,r1 1 V ACA I CH PRE MX4Any ee eueAne� 1 B 1 CLAMS MAD( OOQus MQDlXP {Ngrawprgq FEMORAL a ADYBVJURY B GENERAL AGOVNITi 5 MLACGAa POLECY I I PICT n LOC --1 PRODYOT6- CDMP(OrA00 5 AYT*M0E:LE LMOLLITf /MAUI* ALL ONVNED*mg BC *ULED ALMON NIRED'AUTGS NNFOVNNEDAUTCN I. $IAN NA LMR B — ilLOWNI4JURY I _ IP•►� • l GARAGE MOLT • ANY mini , ONTO ONLY - CA ACCIBNT • p� IAA= • AUTO ON AGO • BROEBBAlMeNC LAMIIjTY cu110) lACN08t:URRpliCl 5 DEDUCTIBLE RETENTION • AOG*GATE • • • t► WORKERS , @A�iION AND ► P r outles �8te �A� billow TMC3247354 08/22/10 09/22/11 ,1elrwlr� X ITI Rn UM S1 1 1 LI..sACsACCIOeNT a 100000 ELeteCA•E • eA ER1M OYEt: • 100000 EL w8EAoo . POUCY um • 500000 Aug 26 2010 10:OOHM Haber !26 Sons Plumbing 305- 587 -9976 page 2 08/28/2010 WED 10159 FAX 3054463051 Insuraoss nitric/tars Q003/001 aG. CERTIFICATE OF LIABILITY INSURANCE PRODUCER Insurance Marketers, Inc, 2600 Douglas Road Suite 712 Coral Gables S'L 33134 phone: 306- 442 -0507 Fax t 305 -447 -9527 INSIMIED COVERAGES CERTIFICATE HOLDER' ACORO 26 {2001109) p ami - i 4 v r"o• Meal Shores Village H►aile8iaq Department 10000 TIE 2nd Avenue Mali Shores FL 33139 oars IIRINCO wq ?AMU" oe /22110 THIS CEkTTFICATE 13 ISSUED AS A MATTER OF INFORMATION HOLDER. T CONFERS H Cpi E2TTF (CATS 033 UPON AMEND, UZTEND OR ALTER THE COVERAGE AFFORDED aY THE POUCIES DELOW. INSURERS AFFORDING COVERAGE &9URE1 A TeObnology =rurance Co &BURSA & Fauna C: FOURS 0: NBUaeR & INC KAN: MW ncluRANCf LnTeo mew ways sear 5$uE TD TNl Immo twaD Aims FOR ne mum Pan INOICAMI. BROWTTOOTMEDBO ANY R Oura&CNT, TM OR CONDITION OR ANY CONrucroA OTHER comma VYITM ti3PECT mew THIS CENIIRICATE MAY ai L99UBD OR MAY PERTAVI, nee 119Uw i E AFFORDED NYTMB POLICIES D DEO NMA61N t8 9U•JECT TO ALL THCURN, ENCLYBION8 ARO CONOITIONR OF SUM MAIM AGGRIIGATLLIMIT• RH0WNNIAY NAVE Mau RIMED ByPAtDWan P1u+obi.ng TPeae i n rivire.COv.rage are sUlb3aat to the terms, conditions, deductible and exclusions above in the policy. .10 Days notice of cancellation for non payment of prem•uia. CANCELLATION 9NO414,0 ANV OF The ADM D 6 1 C M N 0 MORI UCARGILL= Room ma CRIRRI :aN Me TNE#EOP, THE n1 UIN3Hctinum smosounrro t•Al- *30 DArselirrlN NOTION TOINIE CEATIPIOATE NOLOMR Woo TOTMClIFT, /YT PALYRE TO MOO WALL WPM NO aauSATIONORWARLITYOP ANY IOW UPON TNII Munk MIAORNT$OR RvlelIGNr TWINE A00W CORPORATION lilt NAIL s 42376 Rug 26 2010 10:00AM Haber °1.26 Sons Plumbing 305- 567 -9976 page 3 Aug.25. 2010 2:51PM No.0988 P 1/1 PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 phone (305)266 -6493 INSURED Haber & Son Plumbing Inc. 4108 NW 37 Ave Miami, FL 33142- (305) 481 -8853 COVERAGES AUTOMOBILE UABIUTy ❑ ANYAVTO ❑ AU. OWNED AUTOS El SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OINNEO 0 n GARAGE LIABILITY ❑ 0 ANYAUTD ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YANI ANYPROPRIETORJ PARTNER / EXECUTIVE OFFICER /MEMBER EXCLUDED7 a as under SPECIAL PRQ/ISIONS Seim OTHER CERTIFICATE HOLOER ACORD 25 (2009/01) CIF EXCESS /UMBRELLA LIABILITY ❑ OCCUR ❑ CLAWS MADE MIAMI SHORES VILLAGE BUILDING DEPARTMNT E 10050 NE 2ND AVE MIAMI SHORES, FL. 33138 CERTIFICATE OF LIABILITY INSURANCE 1 Fax (305)282-0879 THIS CERTIFICATE IS ISSUED AS A MATTER OP 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: MAX SPECIALTY INSURANCE CO. INSURER E: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREOUIREMENT, TERN OR COWDrrI01N OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BYTNE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUBJONSAND CONDITIONS OF SUCH POLICIEB.AGGREGATE UMITS SHOWN MAYHAVE BEEN REDUCED BY PAI D CLAIMS. INBR Awn ICY EFFECTIVE p� E►��pp TYPE OF IN CUIIANCE POLICY NUMBER DAZE POL trawrD>vYYrtn , DA72 ICY 110N (RJrAIDpiTrni I.MTi OENERALIIABIUTY EACH OCCURRENCE 1,000.000.00 p COMMERCIAL GENERAL LIABILITY MAX011601001102 -1 08/20/2010 08/20/2011 DANIAGE T O R . N ) A ❑❑ CLAIMS MADE ® OCCUR NED EXP (Any one ps r) ❑ ❑ PERSONAL 8 ADV INJURY 0 GENT-AGGREGATE LIMIT APP LIES PER: POLICY ❑ PROJECT ❑ LOC CANCELLATION GENERAL AGGREGATE PRODUCTS - COMP/OP AGO COMBINED SINGLE LIMIT (Ea sccldant) BODILYINJURY (Per pomp) BODILYINJURY (Psrac eidant) PROPERTYOAMAGE (PK.etider0 AUTO ONLY- EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO EACH OCCURRENCE AGGREGATE ❑, mIds ❑€H E.L. EACH ACCIDENT E.L. DISEASE • EA EMPLOYEE El. DISEASE - POLICYLIMIT B VACANT LAND /GENERAL LIABILITY OU5009008499 -01 08/20/2010 08/20/2011 GENERAL AGGREGAT DESCRIPTION OF OPERATIONS (LOOATIDNB I VENCLE8 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS NAIC O AUTHORS:ED REPRESENTATIVE ��ii,�• cis: 100,000.00 5,000.00 1,000,000.00 2,000,000.00 1.000,000.00 2,000,000.00 61400.0 ANY OP THE ABOVE DESCRIBED POLIO BE CANCELLED BEFORE TIE EXPIRATION DATE THEREOF, THE MERINO INSURER WILL ENDEAVOR TO MAN. 30 DAYS wRn - rBN NorICB TO ma CERTIFICATE BOLDER NAMED TO TR9I8I'T, BUT FAILURE E TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, REAGENTS OR REPRESENTATIVES. • 01918 -2009 ACORD CORPORATION. Ail rights raservad. The ACORO name and tam aro registered marks of ACORD BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 124 5 N . e. • QzEP SIVA A,G f50, V D Miami Shores Village Building Department M EC�L�II�9 AUG t 5 20 N Ni 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 No.. 10 I Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): ?Z afiomft a 1 -Ls'`( —g3 s Address: IstA 5 *WE. E . "RSV- City: l�' (%i & \ S AOS?. Es state: r- Zip: '3 3 ► 3$ Tenant/Lessee Name: Phone#: Email: City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11- 3905- O 1 - 00 O Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: C o m p a n y N a m e : > - I A tS f . & - £ 5t3g S 1 0M P J 1 ‘6 Phone#: ( ) yU ► -8663 Address: L\b11 itt3 Sill Proe ` cit N‘i % AM'1 State: * Zip: 1 631 t4 C1 Qualifier Name: ,.1CSE 1A6RM Phone#: (3 ( 44 1.. $19.5 3 State Certification or Registration #: F' adf 1I l.Q 5 Certificate of Competency #: Contact Phone4)D5) - 1 q ID - Q 3 217 Email Address: u4kleg Nta PI WM E 5Ot)174. NET' U ; DESIGNER: Architect/Engineer: SF AX ,. S1 ov .1e1F.�Q... Phone#: Value of Work for this Permit: $ a 5bb — Square/Linear Footage of Work: Type of Work: ' DAddress ; DAlteration °New THItepair/Replace °Demolition 6 Description of Work: CIZARk. 'k fie„ O - TON 1 CA- , t- MTDQ.4 ANb SI N 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 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 ci 'ncement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature r gent The fo going instrument was acknowledged before me this S The foregoing instrument as ackno • `edged be ore me this .a. day of .�...�� 20 a, by 1T"tr k, 44 Wm'CV , day of /lures , 20 EA., by s e .476e who is 4 , +nally known to me or who has produced who i personally know to me or who has produced _ dentification and who did take an oath. as identification and who did take an oath. T ARY PUBLIC: Sign: Print My Commission pires: 1.8004-NOTARY * * * * *.****R ***,*** *** **** ** * ** *** *** ******************S s* ** *************s ******** * **** ** *fait * **** * ** * * *** APPROV b BY (Revised 07 /10/07XRevised 06/10/2009)(Revised 3/15/09) State MY COMMISSION # DD854159 EXPIRES: January 25, 2013 zPz` R. Notary Discount Assoc. Co. RA Plans Examiner Zip Sign: Print: l_G.a.e/ ,Q d We 2 My Commission Expires: ///09A-- Zoning Structural Review Clerk Inspection Number: INSP - 152445 Permit Number: EL -8 -10 -1410 Scheduled Inspection Date: October 20, 2010 Inspector: Devaney, Michael Owner: HUNTER, MARK Job Address: 1245 NE 93 Street Project <NONE> Contractor: DJ ELECTRICAL SERVICES OF S FLORIDA Building Department Comments NEW KITCHEN CAB, UPDATE ELECTRICAL IN KITCHEN AND DEN. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 19, 2010 Miami Shores, FL 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 Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (917)604 -8328 Parcel Number 1132050270070 Page 19 of 24 BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 12-45 N. E • q3 al' City: Miami Shores County: Folio/Parcel #: 11 -32.. 05 - 02.1 •- 0010 Type of Work: DAddress *Alteration Description of Work: N 111-l and den. 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 ❑New Miami Dade Value of Work for this Permit: $ 2..18k45 . 00 Square/Linear Footage of Work: gaalErM3 AUG 652010 Ett •■%0000 Permit No ELI 0 1 t 0 Master Permit No. Permit Type: Electrical t ' ' Q OWNER: Name (Fee Simple Titleholder): M>=1'r' R.. b. +-lun "eX Phone #:cirl -0 4. - 83 Z8 Address: 12_45 M. • ctg 2 City: M L pem 1 S+IOrC S . State: FL zip:3313 8 Tenant/Lessee Name: Phone#: Email: zip:33136 Is the Building Historically Designated: Yes NO X Flood Zone: -• CONTRACTOR: Company Name: 1:),) r � IeCill Ca I ,vLCeS 0 3. Phone#:.`Y 5 -210 Address: 8Z.kt05 S 1/%3 11 Q ORepair/Replace Zip: F 15 5 Cit p1 L pt-r..4 L State: 7 �. Qualifier Name: MPtrNi L P OF Phone#: State Certification or Registration #: C C. 000 21O, Certificate of Competency #: I 1 Contact Phone#:78to -35.5 �1t.081 Email Address: d� i d djeLe(i 1 CSP.rsif CPS .COQ DESIGNER: Architect/Engineer: set F des 19ned ' ()win e Y' Phone#: ❑Demolition .-n 1 *.a *.x *qua.*****+r ******** *** Aux *** F **a•:r**** * * ** * * ** rwa.a.** ****era. *** ****:x*** Submittal Fee $ 9. k.0 Permit Fee $ Z' e ` "0/ $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Ill • 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 approved a a reinspection fee will be charged Sign: Print: 0 1/4 , Inil l*AMm i alb.. \ . Owner or Agent The foregoing instrument was acknowledged before me this 3 / " �'�`i day of r �'\ , 20 0 , by RINOrCIP who is y known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: My Commission ' pires: * * *s@*+k****sk* APPROVED BY • (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) MY COMMISSION # DD854159 EXPIRES: January 25, 2013 1.800.3.NoTARy Fl. Notary Discount Assoc. Co. Dn.". ^. "VArenasre WW- Signature The foregoing day of who is person Sign: Contractor strument was acknowledged before me this , 20 /U, by J a,„;1 ar, A 7 known to me or who has produced D L as identification and who did take an oath. NOTARY PUBLIC: j / Print: /- / P My Commission Expires: r a alav b�, PLESHETTE P My OO MMiSS�pN # 00920459 eG� 7 i ,, EXPIRES: August 27, 2013 , 2-/3 ,> SetiCeS 9TFOF �p ***** ******H�+kNa hH� sp�F+spskasHasNNsH+dsdo �k �k ejssk d�q+H��kHs+kN��HH�Hsoffoff �k hd��k�k+ H4es kikdsN�N�sk�hsHHa+ kH�** H�4sHsNtsl +HsslsHtHs�s�h Ns 4-4 Plans Examiner Zoning Structural Review Clerk Lion Insurance Company 2739 U.S, Highway 19 N. Holiday, FL 34691 titre 71949 This Certificate is issued as a matter of infonnat3ow only and WAITS no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. South East Personnel Leasing, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 Tray bces rky[ be below sledtodmirr usdnameaet nathrespeutt3s dhtlusc 6Ti =re y be *sued umeipeaan,toi u ce t! [rats sh [ to > reduced by pad dams TOMOBILE LIABILITY nut AfledAutas ScheduileiPan Wed Aral Policy Effective Date (MMIDDNYI i tragamtsP 7iLt6?mSr onettio) O2 comma [' $10arnegt r . 1 uscv4: EMI CeratOM Such GO:lsa.Agg AllgeOle In surer A Insurer 8: Insurer C: insurer t?' PropeNDernage Per Accidef '._ E.L. Each Accident E.L. Disease - Eat _! E.. Disease • Policy tire s #28/2OW 11075 Descdptlons of OparatlanslLocatlo (uslares added by Endorsementr'Sp.claI PTovls[ons. Meath 253 Coverage only applies to active employee(s) of South East Personnel leasing, Inc. that are teased to the following "Client Company": D3 Elecoilcal Services of South Florida, tire. Co verage + applies to Injuries Incurred by South East Personnel Leasing, Inc. active employees} , while working in Florida. gage [eat apply to statutory employee(s) or lr pendent contractors) of the Client Company -are qty other entity. A I1st of the active employee(s) teased to the Client CorMailY + be obtained by faxing a request to (727) 937 or by oiling (727) 938-5E62. Project Name: FAX: 305-397-2571 ! ISSUE 07 -28-10 (TD) CERTIFICATEHOLDER CrAtiCIEUATIon t M* LmFlflRES VILCAt3E BUILDING DEPARTM Sho,darr,f re descant! p esbe coxenee bst %rneevairaflon dale Owed, Ina tssod rruerrr "ra endea+ error; 130deyswr[lten[acetot?* zee, cats !tokle, romedtbthe tadtigure o - -- dosoa +mpne nhucoustien orCabt4fi ( of any kind u r iOleiftWer ;7TU ageraofra.rfeentat". 10850 NE MD AVENUE MIAMI SHORE, FL 33138 CERTIFICATE OF uABturt 1 w Izratio I�arlce .::THIS CERTIFICATE ISSUMIASA ISSUED MATTER .OF INFORMATION ONLY AND coven NO ROOS UPON THE OATS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTIMCOVERAGE AFFORDEDOV THE POLICIES BE O* FSx ( )279 9705 NAIC 8. PRODUCER Gil & mss 9787 SW. 72nd St, Mien*, FL 331 Phone (305)279-7885 URED DJ Electrical Services of South Florida INC 12251 SW 50th Place Cooper City. FL. 3333U- 1 (786) 355 -7687 INSURERS AFFORDING COVERAGE IIaSI A: Max Spetatly IDSUFEI I INSURER S: INSURER C ER O: E. COVERAGES THE POUCIES OF INSURANCE US rttl HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM #1R OONO TIOtN Of ANY CONTRACTOR OTHER :f UMENT W1 h RESPECT TO WHICH THIS CERTIFICATE MAY SE 1S$ ED OF MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND c0NDrRONS OF SUCH POLICIES.: AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCEDBY'woo CLAIMS: INSR 0 0 n ATE ACORD 26 � ) OF TyPe OF INSURANCE GO MMERCIALGENERAI. UABIU1Y 00 CLAIMS MADE Q OCCUR 0 GEM. AGGREGATE LIMIT APPLIES PER: 0- POLICY 0 PROJECT 0 LOC AUMMOEFILE LiAB fiY O ANY AUTO O ALL OWNED AUTOS • SCHEDULED AUTOS O HIRED AUTOS O NON OWNED AUTOS GARAGE.LTY 0 E l ANY AUTO 0 ExCESs/UMBRWA LIABILITY El OCCUR D CLAIMS MADE • DEDUCTIBLE O RETENTION S WORKERS COWENSATION AND SRS' UABIUTY ANY PROPRIETOR .f PARTNER I EXECU7i OFFICER! MEMBER EXCLUDED? (Mandatary In NH) S PROVISIONS trelcw OTHER POLICY ER PDUCY EFFECTWE DATE 111.0 MAX024905000141 03/27/2010 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES BY ' !SPECIAL PROVISION$ DA CANCELLATION MIRA EACH OCCURRENCE 3/27f20i 1 DAMAGE S (Ea ) EX arm T PERSONAL # ADV INJURY • GENERAL AGGREGATE PRODUCTS - COMPRIPAGG COMBINED SINGLE LIMIT (Ea acci BODILY INJURY (Per BODILY INJURY (Per accident) PROPERTY DAMAGE (Per AUTO ONLY - EAACCI OTHER THAN EA ACC AUTO ONLY AGO EACH OCCU AGGREGATE Tfltt UlwflS . E,L: EACH EL. DISEASE - EA EMPLOYEE EL DISEASE POLICY LIMB 1,000,000 50 ,000 1,000,000 2,000,000 1,000,000 Miami Shores %nage Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY QP THE ABOVE DESCRIBED IBS BE CANcELLED.BEFORETHE EXPIRATION DATERIEREO, THEISSUING IN$ ER W LE DEAVOR.TOMAIL 30 6)0%m tt9OTiCE TO THE CEit1IFlcATE HOLDER •Wiesto'iO • Tits to aU'f FAWN TO DO SO SHALT IAAPOSENQ 0130000#01t LIALiILITY of ANY idtai UPON THE INSURER.ITS AGENTS t l fotpAgtE4yOnv0.4 AUTHORIZED REPRESENTATIVE 01988 -20 ACORD CORPORATION; All rights reserve& The ACORD name and logo ale registered masks 01 ACORD Inspection Number: INSP - 154074 Scheduled Inspection Date: December 10, 2010 Inspector: Hernandez, Rafael Owner: HUNTER, MARK Job Address: 1245 NE 93 Street Miami Shores, FL Project: <NONE> Contractor: HABER & SONS PLUMBING INC Building Department Comments GAS LINE FOR KITCHEN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 09, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments CREATED AS REINSPECTION FOR INSP- 151068. not ready For Inspections please call: (305)762 -4949 Permit Number: PL -9 -10 -1614 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (917)604 -8328 Parcel Number 1132050270070 \ 0 _AV Phone: (305)461 -8653 Page 12 of 13 SIZE EQUIPMENT DATA CODE DESCRIPTION OF WORK DONE , 23 qn3 IBS LP 100 W A R 28 #1 #3 DOT # ASME GWC DOT # ASME GWC DOT # ❑ ASME GWC ,r' ,; - / . ` _� G I" S, +. ,• n'_.f f.: _ . .r; .r<.C:•r s ..f ..A..: ,. '! ' .J'. 4 , ,,.r. t �� .; F.. . i "r:' t itT . ° , , i° 357 150 42 ❑ 476 200 57 714 300 85 ❑ ❑ ❑ a >r J -. i ,� A ` � A' y p ' r ' . .`a(/�r' 1000 420 120 ❑ ❑ - 200V 57V ❑ CI CODE DESCRIPTION +' AMOUNT - 420V 120V ❑ ❑ ❑ / , ,-i r .. �+ ( (:V i .' . °S '4 125 ❑ ❑ ❑ ❑ 250 ❑ ❑ 325 ❑ ❑ ❑ 500 ❑ ❑ ❑ 1000 ❑ ❑ ❑ OTHER VESSEL TYPE ❑ C Q T ❑ C ❑ T ❑ C ❑ T MFG DATE MO/YR YR MO/YR / YR MO/YR / YR /( p RECERT DATE MO/YR MO/YR MO/YR Al ❑ 1 °No Mark° ❑ 2 'S° ❑ 3 °E° ❑ 1 °No Mark° ❑ 2 'S° ❑ 3 °E° ❑ 1 'No Mark ❑ 2 °S° ❑ 3 °E° RECERT TYPE SCHEDULE SERVICE OR El ■ • T ime y 1 1 lime - "'Hrs Total Material TANK/CYLINDER INSTALLED DATE Total Labor MFG. SERIAL NO. % FULL t d ' _, l T/C # 1 Serial No. Material /Labor Tax T/C # 2 Serial No. Gals. Propane @ $ TANK/CYLINDER RK/IOVED SATE TIC # 3 Serial No. Sales/Local/Muni Tax MFG. SERIAL NO. % FULL `� PLEASE PAY THIS AMOUNT CHECK HERE IF ADDITIONAL SHEETS • PAYMENT TYPE CASH 0 CHECK 0 VISA 0 M/C 0 DISC AMEX 0 CC Authorization # FURNACE BOILER SPACE HEATER WATER HEATER RANGE CLOTHES DRYER FIREPLACE LOGS OTHER MAKE / MFR MODEL NO SERIAL NO SYSTEM TESTS SINGLE STAGE INTEGRAL it TWO STAGE THREE STAGE 1 Regulator Data LEAK TEST (3 Min.) PRESSURE TEST (10 Min.) OPERATION TEST Sing/Int/1stStage 2nd Stage 3rd Stage Mfg. START FINISH START FINISH EQUIP. USED I`MAPGAUGE /OTHER Model EQUIP. USED HP GAUGE Ur�WC FLOW ((. SINGLE/_ INTEGRAL 1 STSTAFE EQUIP. USED MAN %TB / OTHER TIME c 7 f .° ' : -""'�- TIME i %, ®PSI LOCKUP � f • C-, Date /Code rd • WC • ,`�°? - ` L The undersigned: Knows how to turn off the propane gas supply valve in case of emergency. Has smelled propane and can detect its odor. Understands the service that has been performed. Has read and understands the above statements and the safety information on the back of this form. PSI -t PPS! EQUIP USED HP GAUGE EQUIP. USED MAN / HP GAUGE / OTHER 2ND STAGE EQUIP. USED MAN / TB / OTHER • WC FLOW TIME TIME • PSI LOCKUP • • • WC PSI PSI EQUIP. USED HP GAUGE EQUIP. USED MAN / HP GAUGE / OTHER EQUIP. USED MAN / TB / OTHER • WC FLOW FJ '° Customer Signature Date 3RD STAGE TIME TIME • PSI LOCKUP ■ ❑ WC PSI • PSI DISCLAIMER: The scope of Suburban's work is set forth above. It does not 1) include an inspection of equipment, piping, the Internal workings of sealed equipment and /or structural components for latent, manufacturing or other defects; 2) cover items not visible and accessible to the service technician; 3) attempt to determine if any item is subject to :. a recall. Customer further acknowledges that Suburban's work cannot be construed to detect or prevent future defects or happenings arising from aging, use, casualty or otherwise. "- ce Signatur Date PROF; -INE P BOX 129 ANFORD 32008 305-891-8392 E e'_1f 0I` r TURN QF1= -SYST fM P' I. OPEN NEW. MOPN ING ZZMEE.7444614 OLDRE 100 GLS ..CALL FIRST AT 305- 318 -6853 * , 04 25E1A , L1o1Ii5/1 , tf1.3 13 :t3 (ScHED> 0/15/1Q i3:29 Tech: 03 CCTit: 1 1:3E:3` 5#:1 D I'V :1 TYP:1 ONE:33138 14:54 14-Oct-10 . HEFA CON'NNOR TEL: (3051318-6853 C- NE 93 ST '1 SHORE. 2313 5C,(: 90 L TX PT: ; .,A'1EF, -- CONNOR 1245 PIE 93 ST . MIAMI SHORE 3313E BY: PLEASE SEE REVERSE SIDE FOR IMPORTANT SAFETY INFORMATION. Think You! MTEWZ DEC 1 3 2010 Q 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 No. ROO 11(9 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): MFTr ).. T.). AI fifer Gr Address: 12 N. e q g� Cit 1ul 1A- M Si-16 r ES State: FL. Tenant/LesseeName: l`�.� A Email: JOB ADDRESS: 1245 N • e • 93 City: Miami Shores County: Miami Dade Folio/Parcel #: 11-32_05 -021-0010 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: P1Q n 4r-1- . 1w5 QC 1 Q' f ' S • In ( Phone #: 954-5 La ca -,g100 Address: 3 331 is . L • 32. V Si- • p 2 City: - Pi'. �.•-a1.1 G e rCtQ I e State: Fl.- Zip: 3 3 3 0 5 Qualifier Name: 5 Cott LaS K`J Phone#: State Certification or Registration #: C, el C. O to 00 IS Certificate of Competency #: N ) A- Contact Phone#: - l.Q 1Z - ZO 1 1 Email Address: DESIGNER: Architect/Engineer: SE- 1 F Des 1 C1 i\1 D owner lei c Value of Work for this Permit: $. Square/Linear Footage of Work: Type of Work: DAddress Description of Work: et ec -rICQ 1 11 a n-r Miami Shores Village Building Department 'Alteration ONew ❑Repair/Replace COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: SY9l> i******** dt4i*** *x9Y@tStSY*****n'tiCiY** *** * es % % %xfYiF******** 6]4$iN**** % % % %]Y4C4t %4t% YoY *f *** Submittal Fee $ )L 3 Permit Fee $ a Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Phone #:911 ` ki0L1- -8328 Phone #: Rsamnwiln dUG 0 520 a Zip: 33 is Zip: 33138 Phone #: ODemolition CCF $ CO /CC $ DBPR $ Bond $ 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 Al''l+ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature APPROVED BY Sign: Print: My Commission xpires: Owner or Agent The foregoing instrument was acknowledged before me this 3_ day of 20 f v by Mk flutik Iv who is pers� own to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: MY COMMISSION # DD854159 EXPIRES: January 25, 2013 1-SOb3.NOTARY Fl. Notary Dieaoum ASSOC Co. ' I '. a, (Revised /1W3 e se 4(i & /2009XRevised 3/15/09Xrev6/4/10) Signature Co ctor The foregg ng instrument was acknowledged before me this day of (,T 20L0_, by c( / a S y who is pers ly known to me or who has produced Y - ' 6 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: aety S keloNia F4A+to9 E 10? isnonicsaion a 2 a)-0 3 6st4kti ^:: ' NOISSINN00AN iL'**** 9YlY9YIk*9Y9Y9YaY %9Y9Y*iY9YtYiYR4CikiY*** x ekfYati9e4t iY1Y86TYiYaY$ tYlYl kaFtlCfYd6*9RD@ 9YaFaY3r**** 8C*4[ ikiJPtYaYi' 9t9YnY fYfYeYft9Y{tcYcY$a4dtiY9Y9 *** CC1 89Yikik964 god Autio fV `' / () Plans Examiner - Zoning Structural Review Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE .10B SITE AT TIME OF FIRST I1 PECTION PERMIT NO, RC- ? - (0 - IL-109 TAX FOLIO NO.11- 3205-027 -0070 STATE OF FLORIDA: 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 following information is provided in this Notice of Commencement 1. Legal description of property and street/address: BAY LURE PB 44 -63 LOT 6 LESS WLY25FT BLK 1 &W25FT OF LOT 7 LOT SIZE 75.000 X 151 OR 18792-1099 09 1999 1 COC 21751 -3431 09 2003 4 1245 NE 93rd ST 2. Description of improvement INTERIOR RENOVATION 3. Owner(s) name and address: MARK D HUNTER 1245 NE 93 ST MIAMI SHORES FL 33138- Interest in property: Name and address of fee simple titleholder. • 4. Contractor's name and address: Antonio Deli ' lo BNB, INC President PO Box 267896 Ft Lauderdale, FL 33326 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the follow' in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice - Commencement: (the expiration date is 1 year from the date of recording uni diffe t date is specified nature of Owner Print Owner's NarneMBEEMBESSER Swam to and subscribed before me this documents may be sery 1 Print Fora 11111 1 1111 C FH 2010Rn54 -618!5 OR Ek 27385 Ps 4243; Ups) ) RECORDED 08/12f2010 13:17:05 HARVEY RUVINp CLERK OF COURT MIAl1I -CDADE COUI4TYr FLORIDA LAST F'AGE rson(s) to receive a copy of the Lienor's Notice as S hart - Qck Con no v Prepared by Your Permit Solution, Inc . 5 day of AUG , 20 10. 414=,'S FRED ROY s * MYCOMMIS,SION 4 D0 68893 Notary Public EXPIRES:June 2014 Print Notary's Name Fred Roy My commission expires: 12301 -52 PAGE 4 13/02 p, ate` BondedThm ,i.F.v ae*es Address: 9035 NW 13th Ter. #23 Doral, FL 33172 -ACO CERTIFICATE OF LlABtLtT`Y INSURANCE .— , 1 07/23/2010 PRODUCER Gulfstream insurance Agency, Inc- 5833 Johnson street Hollywood FL 33021 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE INSURED Plan Art Associates Inc and Simon Architectural p _A. 3331 N.E. 32nd St. Ft Lauderdale FL 33308- A Un9.ted Specialty ins. CO. INSURER & INSURER C. iNSURER0: sVSSRERE: 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 WrnI RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. OCCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OFILSURANOE POLCYNUMBER MMENDDITY) DATE(LIWIIDIY U UIB GENERAL LIABILITY Corm1ERCIAL GENERAL UABILUY 0401,20090424 _ 1 / 04/24/201004/24/2011 / / / / / 1 EACH OCCURRENCE $ 1,000,000 S FIRE DAMAGE (Arty DasEre) S 100,000 I CLAIMS MADE X OccuR mEntaa $ 5,000 / / / PERSONAL &ADVmum: s 1,000,000 'lemma_ $ 2, 000, 000 GENtAGGREGA'rEUMWAPPUE9PM XI POJcYn J El Loo PRODIJCTu- COMPIOPAGG $ 2,000.000 AUTOMOBILE UABILI Y ANY AUTO ALL SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS • / / / / / / / / / / / / / / / / COMBINED SINGLE LIMIT pa d) $ — BODILY INJURY (Perpereen) s — — 800ILY INJURY (Perms) $ _ _ PROPERTY DAMAGE (I'&acciaen0 $ GARAGE MINIM ANY AUTO / / 1 / AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC $ R AUTO ONLY: AGO $ EXCESS LWBRnr / / / / ' / / 1 / EACH OCCURRENCE $ OCCUR NI CLAIMS MADE AGGREGATE S $ $ R INAUCTIBLE RETENTION $ $ / / / / / / / / 1 o+YI 1 EL EACH =Dm S E.L. DISEASE- EA MIPLOYEE $ EL DISEASE- POLICY LIMIT $ OYHER / 1 / / DESCRIPRON OP OPERATIONEILOcATIONGNEKICLESIEXCLUSIONS ADDED BY RREORSIMENREPECIAL PROVISIONS Fax0954- 566 -3286 COVERAGES ACOF I CATEHOLDER Miami Shore Village Building Department 10050 NE 2 Ave Miami Shores, FI. 33313 mONAL D15YWED- INSURER LErTEit LASER FORKS. UV(.. -Mora CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIss BH CANCELLED BEFORE THE EXP81AT10N DATE THEiEOF, THE ISSUING INSURER WILL ENIESWOR TO am. 10 DAYS WIOTIEN NOTICE TO THE OERTIloATH MOLDER NAMED TO THE LET, BUT FAILURE TO 00 SO SHALL IMPOSE 00 OBLIGATION OR LIABSITY OP ANY KIND UPON THE mum, ea RD CORPORATION 198E 1 Page 1 c : !Simon Architectural Group; are'ilezit re • cmg n er ng • Mt.:whin u1911a emelt To whom it may concern, AUG 1 3 2010 3331 N.E. 32nd Street Ft. Lauderdale Florida 33308 P:954.566.7298 F:954366.3286 This letter is to inform you of the scope of work at location 1245 N.W. 93 Street Miami Shores. The work being preformed is demo and removal of 2 interior non bearing walls located in the kitchen area. All cabinets are to be removed and replaced with new cabinets. No drywall on the exterior walls is to be removed. No moving of plumbing just reinstalling of existing plumbing and new appliances. The work to be performed is sanding, patching, priming, painting, and installing new hard wood floors and framing and building of new partition wall for kitchen breakfast nook. Framing and building of new non bearing interior wall for new office. We understand that we must obtain inspection of framing and electric inspection prior to drywall installation.