PL-11-499Inspection Number: INSP - 157437 Permit Number: PL- 3- 11-499
Scheduled Inspection Date: April 13, 2011
Inspector: Hernandez, Rafael
Owner: MCGILL, ANDREA
Job Address: 715 NE 92 Street
Project: <NONE>
Miami Shores, FL
Contractor: MARS CONTRACTORS INC
Building Department Comments
April 12, 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 Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060141570
Phone: (305)278 -2122
REPAIR WATER PIPE
Passed
)4-,
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 13 of 21
BUILDING
PERMIT APPLICATION
FBC 20
Address: - 71 1j `E. c=1
Cit IA co-J.4.1-g/ 1 State:
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
JOB ADDRESS: `7[S c 12-
Tenant/Lessee Name:
Email: L � .
Phone#:
;G g 1
LIAR 2 2 2011
Permit No�J )) - 4 99
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): 22
L- Phone #: ' 159. 337
Zip: 3
City: Miami Shores County: Miami Dade Zip: ` 1
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: M 0 Z C.04-6 l iNk— Phone #: 30 5 -
Address: ( 3 3 50 i,,,J ( 1 5 ' L/ t 1 103
City: - di F .) 1 State: ( Zip: S5 l'
LA Qualifier Name: ` A vS , I �y g f S' 1 l_ Phone #:
State Certification or Registration #: C--k- 0 661 4,C) Certificate of Competency #:
Contact Phone #: Email Address: P'" 1P> M A 11.5 <0"4 i t.q�. tlL)
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $
ep or= ° �� Square/Linear Footage of Work:
Type of Work: Address DAlteration ❑New C epair/Replace Demolition
Description of Work: t P t (iL— (p-> i F • p , I.,J -1--t,
(c.. t'I
Q\w'
********+ r��x ��x* a��x�x* �x**** �n***** �x�x�x*** F �nx:**** x�**** x��r*+ x�x�x ** ***** *�:�:�x+x�x�xa��n�x****� * **
Submittal Fee $� `9 Permit Fee $
470 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 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 prop <. is subject to attachment. i,o, a certified copy of the recorded notice of commencement must be posted at the job site
for the spection whic .•cc rs s (7) days after the building permit is issued. j.4z the absence of such posted notice, the
inspecti l 4irot be appr, ir pection fee will be charged.
/ � ' /
Signat �� / / Signature V
Owner . Agent Contractor
trument was acknowl- I ged before thi 401 i The f, + �e;r ing ins . ment was ackno
20 , by - 6u l dB , 2011 , b
fir
known to me or who has produced � /� a sonally known to me or who has produced
The fore
day o
who is person
NOTARY P
Sign:
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
day o'
ho is
TA ' PUBLIC:
ntification and who did take an oath.
4 ,..„ . 0 . �� °� a,, ' ) �y.
��y. �° My Commission Expires: s.
,
* * * * * * * * * * * * * * * * * * * * * * * ** ** * ** * * *4 *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
0 -3///
Structural Review
N
Sign:
Print:
cation and who did take an oath.
Plans Examiner Zoning
Clerk
THIS IS TO CERTIFY TNATTHE POLICIES OP 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 DESOR BED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. uMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
TR
TYPE OF INSURANQE •
,
POLICY NUMM I%
( C MM D DD YYYY}
p
(MM D DD/YYYY)
LIMITS
A
GENERAL
X
IdAHILrrY
GOMMEROIAI. GENERAL LIAgII„
ITY
OOCUR
CCP620653
09/23/2010
09/23/2011
EACH OCCURRENCE
31,000,000
DAMAGE TO HENTED
PREMISES (Ea nonce)
$100,000
1 OL AIM S- MADE
X
MED EXP (Any one peron)
s5,000
X
BUPD Ded:2
• PER SONAL
&ADVINJURY
91,000,000
s2,000,000
GENERAL
AGGREGATE
EEN
n J r Loo
PRODUCTS-
COMP/OPAGG
52,000,000
� POUDY
5
C
AUT OMOBILE
LIABILITY
ANYAUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
ED AUTOS
NON-OWNEDAUTOS
047279030
06/01/2010
06/01/2011
COMBINED SINGLE LIMIT
(Es =Went)
1.000,000
—
BODILY INJURY (Per person)
5
X
BODILY INJURY (Per accident)
9
X
PROPERTY DAMAGE
(Per =Mena
5
X
$
9
B
_
�-
tlmeREULAUAa
EXCESS LIAR
oocu
CIAIMS•MACE
0E026045275
09/23/2010
09/23/2011
EACH OCCURRENCE
54,000,000
s250 000
AGGREGATE
DEDUCTiBLB
RETEN11ON 5
5
5
WORIa RS COMPENSATI 7N
AND EMPLOYERS' LIABILITY
ANY PROPRIETOMPAATNER/EXECUT
OFFICER/MEMBER EXCLUDED?
(Manda�tory yiin��NnN�)
OESC 'P'fON OF OPERATIONS
Y/ N
WA
WO STATU•
TRAY I IMrrA I 1
EL EACH ACCIDENT
S
below
EL DISEASE - EA EMPLOYEE
S
EL DISEASE - POUCY LIMIT
3
DESCRIPTION OR OPERATIONS/ LOCATIONS /VEHICLES (A1taeh ACORD 101, Additional Remarks Sc1 edule, It more space Is required)
Mar. 22. 2011 10:02AM MARS CONTRACTORS INC
Client;f: 1452157
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDM/YY)
3/17/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer lights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
BB &T Oswald Trappe & Co Miami
9200 S. Dadeland Blvd, Ste 314
Miami, FL 33156
305 670-0083
INSURED
MARS Contractors Inc
Brenda HIII- Riggins
13350 SW 131 St, #103
Miami. FL 33186
NAME:
Josephs
PHONE 305 670-0083
(NC. Na. E xt):
Amass, a @bbandtcom
NM: 305-670-0086
PRODUCER
CUSTOMER ID #:
INSURER AF FORDI NG CO VERAGE
INSURER A: Scottsdale Insurance Company
INSURER 5: Commerce & Industry Insurance C
INSURER C: Progressive Casualty Insurance
INSURER D :
INSURER E :
INSURER F
NAIC •
41297
19410
24260
COVERAGES
CERTIFICATE HOLDER
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
CERTIFICATE NUMBER=
CANCELLATION
No. 5090 P.
134MARSCON
REVISION NUMBER:
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
670444:14- ?or lora*.
01988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S6519648/M5635323
ALJO