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PL-10-1852Miami Shores Village BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: (06 City: ON(NINA 14r Tenant/Lessee Name: Phone#: Email. CONTRACTOR: Company Name: 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 x(0 Permit No. 1' OCT 2, � ?010 1 3""731 )ftI Master Permit N P'1 *1 a L, J OB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: . Is the Building Historically Designated: Yes NO Flood Zone: 4 0 a c _ S r a Phone#:_ 6s / l G Address: VO t, Cat City: State: 1 Zip: Qualifier Name: G, A4-2. 1 C Phone#: State Certification or Registration #: Cr)CO Certificate of Competency #: Contact Phone#:.05 -C fe/ Q94z2_a__Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1 �� Square/Linear Footage of Work: Type of Work: ❑Ad ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: XW`' 1 1 \ \�QQ *+x****** *** *** ****•••••••••• •••••••••••p ••••••••• ray * **•• •••••a+••••••••* ***** Submittal Fee $ Permit Fee $ ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 9 e D • 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. 1 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: 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature C. Owner or Agent The foregoing instrument was acknowledged before me this The fore •: oin; ' � el - t was ackn edged be day of _CLLT___2a_ 20 by day of I.. di 20 [ 0, by who is personally known to me or who has produced NOTARY PUBLIC: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Structural Review N T _ PUBLIC: Sign: Print: My Commission Expir@$ij3`•Y k Gary W. Robulock � 2 :COMMISSION # DD729280 9 �'' .p EXPIRES: OCT. 25, 2011 ,' ''';�n n` WWW.AARONNOTARXeom ***************** *****+ bdo*********# iAd+ ***eB9i* rN **A+9nk*****A+*********** ** * *** *****b****** Sign: Print: My Co ssion Expires: ntific ation and who did take an oath. Zoning Clerk Inspection Number: INSP - 152483 Scheduled Inspection Date: October 25, 2010 Inspector: Hernandez, Rafael Owner: LENZ, JOSE Job Address: 965 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: BIONIC PLUMBING CORP. Building Department Comments October 22, 2010 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 -1852 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration N onneumum aione Number Parcel Number 1132060060040 Phone: 305 -498 -9100 REPLACEMENT OF EXISTING FLUE PIPE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments r 'j( Page 18 of 26 4 Scheduled Inspection Date: October 27, 2010 Inspector: Hernandez, Rafael Owner: LENZ, JOSE Job Address: 965 NE 92 Street Project: <NONE> Contractor: BIONIC PLUMBING CORP. Building Department Comments October 27, 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 Inspection Number: INSP- 152591 Permit Number: PL -10 -10 -1852 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060060040 Phone: 305 -498 -9100 REPLACEMENT OF EXISTING FLUE PIPE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 10 of 10 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �ygEE I LTR TYPE OF INSURANCE DO 8 y D POLICY RIMER IA M(ODIWYY) (MYIODIYYYI(b LIMITS A GENERAL UABILITY WB ® COMMERCIAL GENERAL LaITY ■ CE CLAIMS-MADE ® OCCUR • $500 9211...000305694-1 07/29/2010 07/29/2011 EACH OCCURRENCE $ 1000000.00 PREMISES ) $ 1000000.00 MED EXP (My one mason) $ 5000 PERSONAL & MY INJURY $ 1000000.00 ❑ GENERAL AGGREGATE $ 2000000.00 GEN'L AGGREGATE LIMIT APPLIES PER: • POLICY ❑ JECT • LOC PRODUCTS - COMP/OP AGO $ 1000000.00 $ AUTOMOBILE LUABIUTY COMBINED SINGLE UNIT (Ea eoodent) $ • il ANY AUTO BODILY INJURY (Per penton) $ NI ALL OWNED AUTOS BODILY INJURY (Pereodderll; 5 • SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ • BRED AUTOS • NON -OWNED AUTOS $ 8 IN ■ LWABREI.LA LIAR ❑ occur ❑ 'OWESN UAB • CLAIMS.MADE EACH OCCURRENCE $ AGGREGATE S In DEDUCTIBLE IN RETENTioN $ S 3 WORKERS COMPENSATION qqA�N D EMPLOYERS' LII JTY Y l N OFFiCEA/GIEM6EREXCLI}DE9 CU71VEl N /A t g � -t ' 1 TORY T I I- 1 FR E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (bylleeenaad ly 1i r DESdRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION GENERAL OP OPERATIONS I LOCATIONS !VEHICLES LIABILITY COMMERCIAL (Attach ACORD 101, Additional Remark Schedule, If more space Is required) / RESIDENTIAL PLUMBING - MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES , FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B - CAN • _ . BEFORE THE EXPIRATION DATE THEREOF, NOTICE , . BE - • IN ACCORDANCE WITH THE POLICY PRO r - = LT AUTHORIZED REPRESENTATIVE i Oct 22 2010 8:38AM HP LASERJET FAX 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(les) 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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER Fed USA 01554 9808 S. Dixie Hwy. Miami, FL 33156 Phone (305)870 -1422 Fax (305)870 -0013 INSURED Bionic Plumbing 8011 SW 99 Ct MIAMI, FL 33173- (305)412 -3744 CERTIFICATE OF LIABILITY INSURANCE atarT PH Ng o. Me E ADD I f LNak PRODUCER CUSTOMER El H: INSURER(S} AFFORDING COVERAGE INSURER A; SEMINOLE CASUALTY INSURANCE INSURER B : INSURER C : INSURER D INSURER E INSURER P: DATE (MWDDIYYYY) 10/22/10 NAIL COVERAGES CERTIFICATE HOLDER CERTIFICATE NUMBER: ACORD 25 (2 9109) QF / r CANCELLATION ® 1988 -2009 The ACORD REVISION NUMBER; • .,• I : • p.1 TION: All rights reserved. go are registered marks of ACORD