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PL-10-1695BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Owner's Address (o 3 . 7 NE City M tG - bl 1 Sll(ovr-S State Tenant/Lessee Name Email Is Building Historically Designated YES Contact Phone E -mail 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 Master Permit No. Ca ro 1r1GISao Phone# 305'7574 (0 8 IOc Zip 3313R Phone # Job Address (where the work is being done) (13 Yr NE. . . `J - 1 9C. - City Miami Shores Vill'aee County Miami -Dade FOLIO / PARCEL # 5206 - bq 3-0 0 Co 0 NO Flood Zone Contractor's Company Name 2. (� WJ M (CtVYt 1 S LO MS 910 M Phon # 3(9.5-7s 1244 G Contractor's Address • 0 0Q N W 144 54 City M rn l State P Zip 3 31( 2 ' Qualifier Name -e f P t S' G l u 1.4,1 n Phone # State Certificate or Registration No. C E C 0 k920 s Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # pozawnt SEP232010 gil Permit N V I (.0 Zip Value of Work For this Permit $ 1, (D K Square / Linear Footage Of Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair/Replace Describe Work: 12.0 U�L W ❑ Demolition ********* * * * ** * * * ****** * *** * * * * * * * * **** F *** * * * * * * * * * * * * * *** * * * * * * * ** *** Submittal Fee $ Permit Fee $ ice/ CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ t(00.10 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. The fore day of who is personally known to me or who has produced who is personally known to me or who has produced P . L . As identifica ' • + who did take an oath. as identification and who did take an oath. NOT ' Y PUBLIC: Si /...S ignature y�$ignature ' Signature Owner or Agent rr�� trument was acknowledged before me this C95 The fore oing • strument was acknowledged before me this a3 20 ID, by QCWDI 5/ S C a day of , 20 / 0, by ahnf S Print: My Commis APPROVED BY ARMEN A. P.IVERA 1J1Y COMPJMISgIO v 753565 q;Po EXPIRES P ° i 0, 2012 (407)398 -0153 FloddallotaroS©rvico.com (Revised 07 /10 /07)(Revised 06/10/2009) 1417/0 Plans Examiner Engineer JV RA 5 3565 401'6' EXPIRI, f'crc:, ,,, 2012 (407) 396 - 0153 FloddallotEncli -.•-, com T Print: My Co Y PUBLIC: Contractor F*****9ea' * * 3 r 3 e 9 e** 9 e ** *** *9r** k*ir* * 4e3aick9c k9e4:* *9eie**9ekia3: 9cBcie* dedr3c** **Frk*9e3c* ********** **** a **4e* * Zoning Clerk checked Inspection Number: INSP - 151592 Scheduled Inspection Date: September 29, 2010 Inspector: Hernandez, Rafael Owner: BRUNT, NORMAN Job Address: 637 NE 92 Street 10 -C Project: <NONE> September 28, 2010 Miami Shores, FL Contractor: THE NEW MIAMI SHORES PLUMBING Building Department Comments 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 -9 -10 -1695 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060430060 Phone: (305)751 -2446 ROUGH & SET FOR NEW WASHING MACHINE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 9 of 17 ACQ6N4L CERTIFICATE OF LIABILITY INSURANCE 18 /23/20 0 PRODUCER (954)724 -7000 FAX: (954)724 -7024 Reyes Coverage, Inc. 5900 Hiatus Road Tamarac _ FL 33321 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. THIS CEHTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC tF IN$IJRED The New Miami Shores Plumbing, Inc. dba /Miami Shores plumbing 900 NW 144th Street Miami FL 33168 INsu ER k Hanover American Ins Co 36064 INsuRERaNationwide Depositors Zns 42587 INSURERC. Insurance Company 22292 701 01 IN$uMFH0.Bridgefield E z pLoyers Ins INSURERS COVERAGES ` THE POLICIES OF INSURANCE LISTED BELOW REQUIRCMCNT, TCRM OR CONDITION OF ANY THE INSURANCE AFFORDED BY THE POLICIES ACTRFAATF I IMITS SHOWN MAY MAVtrtE HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, DESCRIBED HEREIN 15 SUBJCCT TO AU. THE TERMS, EXCLUSIONS ANO CONDITIONS OP SUCH POIJCIES. FDI Irpo BY PAID CI AIMR NBR I TR ADD'L WRRD TYPE OP LNSURANGB POUCY NUMBER FOUOY F.FFRCpTNE DATE (MM O ETCPIRATIQN P DATE IJCY (MMIDDIYYt UNITE GEENERAL LZJ3541050 - 02 C52503 er project a t? ? !t9 xnc Ludo GL 8 readferm EON OngoiAg Colep1*toe ODA es requir.d by written eerier eat 8/23/2010 8/231201.1 AACHCtGGVHHh 1,000,000 X X X COMMERCIAL GENERALLMBNTY i g [ OAMMGTORCNTCD PRF I TOR P lral s 1.00,000 I woks MADE X OCCUR mF0 PEP {Amt one Ir.mnt1 $ 5 , 000 Prim L Non- Contrib - PERSONALSAOVINJURY S 1,000,000 siaak•t AY CG2037- etfNrR I AR(;RrfATC $ 2,000,000 Owl_ -J AGGRCGATCLoWT APPLIES PER POLICY ill !it jLOC PRODUCTS - P/OPADO $ 2,000,000 AUTOMOBILE X _ X R UABIUIY ANY AUTO ALL OWN 0AUTOS SCHEDULED AUTOS HIRED AUTOS NONdYrNEO AUTO ACP59040$2319 1 142587i 7/1/2010 7/1/2011 COMBINED SINGLE LEANT (E7 BCddenl) $ 1,000,000 8001LYIWURY (' P '') $ BODILY DUURY (Le 80 5 PROPERTY DAMAGE (For a¢MmI) $ GARAGE LIABILITY MICLe Y1Y.g1 OI, OlJ3841053 02 0/23/2010 8/23/2011 AUTO ONLY - EA ACCIDENT 5 — ANY AUTO OTHER THAN EA ACQ 5 AUTO ONLY. Apo Cacti frCURRPNCE _ E $ 5,000,000 C E% CESSIUMBRELLAUADMITY T OGGUR CLAIM MADE AOC,RFRIATE $ 5,000 000 COMPLETED OPERATIONS S 5,000,000 x DEDUCTIBLE RETENTION _$ 0 $ $ D WOIAueRS COMPENSATION AHD EMPLOYERS' UARIUTY ANY PROPRIETORlPARYNERIEXECUTNE OFFICER/MEMBEREXCLUDED7 If was, doaoibo Wdor SPFCIAL PSOVISIONS Wow 83034950 8/23/2010 8/23/2011 X I T7 I C.L. EACH ACCIDENT $ 100,000 el. DISEASE-EA EMPI OZP 5 100,000 ELOIS$AS$ - POI ICY I IMIT 5 500,000 OTHER DEBCRIPIION OF opeNATIGNsuwcAnoNervouCwartr.CLuMONS ADDED BY EN0QR3EmEN BPECW. PROYI+5IONS Sep 28 10 0S:4Sa MSP CERTIFICATE HOLDER Miami Shores Village 10050 NW 2nd Ave Miami shores, FL 33138 ACOKO 20 (2001/08) MMgell,4 m,w, ww CANCELLATION 3056887382 p. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR THE EXPIRATION DATE THEREOF, TH8 ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL, IMPOSE NO OBUGATION OR LABIUTY OF ANY KIND UPON THE INSURER, EIS AOENTS OR REPRESENTATNES. AUDI W IUD RFPRE5ENYATI V8 Carey NoyeO /SEE I m ACORD CORPORATION 190E Pen* 1 M 7