The URL can be used to link to this page

PL-10-14919r171 I �o Miami Shores Village paMWZD Building Department AuG 1 8 solo BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING City: Folio/Parcel #: Is the Building Historically Designated: Yes 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 OWNER: Name (Fee Simple TitlehoIder): �� A - ' Address: F 2- el 616* City: M I P lc 1111 SO C)?-I State: FL Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: `2-e 6 el 6 t 14- 5 Miami Shores County: Miami Dade c1 -3 NO CONTRACTOR: Company Name: 1°T 1TJ ® (NI RVrn Address: L IZ, S • 1 �� ' jav d� City: tALLNI 0 State: WL- Qualifier Name: ��0 S o 1 tPiCA4 State Certification or Registration #!: N 2.5 7 5'1 Certificate of Competency #: Contact P h o n e # : 1 �� '' J 1 4 Email Address: ° 1 " t ' 1 r o e 1411 OI'■i' .0 01 DESIGNER: Architect/Engineer: Phone#: I Value of Work for this Permit: $ l 72 ? 6411 Square/Linear Footage of Work: Type of Work: DAddres " ` DAlteration Description of Work: - 1 -1»+T LL IN3=' UL L DNew BY: Permit Noq 10 1 1 Master Permit No. Phone#: J ®� 4 Flood Zone: Zip: -3 176 Zip: 3g 13 Qi Phone#: CTS`i q2' 3 1 q zip: 3 3 z Phone#: 1-1z q • 7 q5- epair/Replace DDemolition MIN Lass Wv ea fL Submittal Fee $ W ,li , Permit Fee $ /0 — CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ '01.% -J 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 AIF'1DAVIT: 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 wi . be delivered to the p on nce ust e post ' at site the whose property is subject to attachment. Also, a certified copy of the recorded notice o for the first inspection which occurs seven (7) days after the building permit is • inspection will not be approved and a reinspection fee will be charged Sign: Print: My Commission APPROVED BY The foregoing instrument was acknowledged before me this 19 day of AUCouSi , 20 b0, by HIA 3G44iPPS who is personally known to me or who has produced 0, L. As identification and who did take an oath. NOTAR Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) The foregoin • 1 trument was acknowledged before me this day of 4'(, r , 20 AL, by ,vt44.T,'J 8e.6FSitiA , who i personall kno , me or who has produced did take an oath. '� Plans Examiner Zoning Clerk • 4 Inspection Number: I NSP- 152448 Scheduled Inspection Date: October 20, 2010 Inspector: Hernandez, Rafael Owner: COFIELD, SANDRA Job Address: 1286 NE 96 Street Project: <NONE> Miami Shores, FL Contractor: EH WHITSON PLUMBING Building Department Comments October 19, 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 -8 -10 -1491 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas el ommie Phone Number Parcel Number 1132060143890 Phone: 954- 929 -3599 INSTALL NATURAL GAS LINE, TANKLESS WATER HEATER AND GAS PIPING TO DRYER AND FUTURE GENERTOR ON SEPERATE PERMIT. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 22 of 24 PERMIT # DROP TEST crsTomER t AI)DRESSJ k4je11 4<-- _5 ?) rd_z_ PUONl T5 0 - - 1 )rop Test By :_ 1 7 116_ YesA No Indies of Water (.'olut1111 Minutes DAM ID ,q --/0 \VIII UN( )\ 191;11i1N(.', 4 11101 mull, 1191 iii : o i41).1) (154 -929-3599 PLEASE INQUIRE ABOUT OUR AIR CONDITIONING' & ELECTRICAL SE.RVICES MIME 0541 929.35t)9 F-Mslit Address: iiiroltheltwhitson.com \ tgq) 071.5050 Wel? Site: ‘cww.elmintson com Scheduled Inspection Date: October 27, 2010 Inspector: Hernandez, Rafael Owner: COFIELD, SANDRA Job Address: 1286 NE 96 Street Project: <NONE> Contractor: EH WHITSON PLUMBING 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- 152585 Permit Number: PL -8 -10 -1491 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132060143890 Phone: 954- 929 -3599 INSTALL NATURAL GAS LINE, TANKLESS WATER HEATER AND GAS PIPING TO DRYER AND FUTURE GENERTOR ON SEPERATE PERMIT. 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- 152448. need access For Inspections please call: (305)762 -4949 Page 9 of 10 Customer Palm: Addreg: City, Statr, De5c1 Grcr ~AAP p e& SS ' #DD842986 • 1 Ts 04,201 tt ‘co 14300-3-NOTARY = oc.0 o. 421 "::.;otith 21 r1 Ave.i•Rie HO I ywcxyl, CFC 1 d 257f. Surve Sheets / Plans e F _5/ Pho 4 : 4.-----.--------------.. ..--, . All Wori< I:n Comply With NI,P.R. ( tirir :ll : 8 .,,,: :- 0 "C /. • ‘ 'i' 1115191. 91*77 Estimairi lop (1.: WA seg ,,— y/ 4V' 6 -777 4 :•_- 47 ,t, PP A OVF.D DLIDG DEPT SUBJECT 1-0 CC,MPLiANCji- ■,^VIE (=.0 FF_DE7--,L --^ i '' :- lop r yu i /e ST ! ATE A f'-D Uc., -.' l -_,-, I :' • • • • • • • •• • ••• • /Iff •• a . FUTU2-,C-11'- ..:d!It004"*: 7/#1,0 •.Aeff, Pipinu J) 7:000 /.6 5,414// 4y •• • f llu AUG 9.2010 i! BY: ..m ----------- • • 1, 4 41014t AVIi• • • to .„( 41 00 0 • r—C 1 `127 8/ N q DD842986 .mr her 04, 201 I. Nozer, r, cOUat Assoe. Co. Piping ISO PPS E.H. Whitson Plumbing 421 South 21st Avenue Hollywood, FL 33020 CFC1425789 Survey Sheets / Plans Customer Name: � f er Address: / 2 F64 ,d7L City, State, Zip: �`•� ,- . - Phone #: All Work to Comply With N.F.P.A. Code #: � Estimated Job Cost: P071._:7. Description of Work: ,6p b*/2 ,, 10 Z • • •• • • • • ••• • • • • • • ••• • • •• • • • • • •• • • • • • • • • • • ••.• • • • • • • • • • • • • • • • •• • • •••• • • • • •••• 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 MA PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PO LICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR - INSRC TYPE OF INSURANCE POLICY NUMBER •P@LYCY' CTIVE • DATE)MM/Di)7YYYY) POLICY•EXPIRATION• DATE ONSUDDIYYYY) LIMES • A B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY MPG95316 FMGA001502 03/07/2010 05/30/2010 05/30/2010 03/07/2011 EACH OCCURRENCE $1,000,000 s500.000 X DAMAGE TO ENT PREMISES (Ea R CLAIMS MADE X OCCUR axurre nce) MED EXP (Any one person) $See Below X BI/PD Ded:5,000 PERSONAL & ADV INJURY $1 ,000,000 $2,000,000 $2000000 GENERAL AGGREGATE GEM_ — I AGGREGATE LIMIT APPLIES PER: POLICY n J P CO n LOC PRODUCTS - COMP/OP AGG , , E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PHPK539652 03/07/2010 03/07/2011 COMBINED SINGLE LIMIT (Ea accident) $ X BODILY INJURY (Per person) $ — X BODILY INJURY (Per accident) . $ X PROPERTY DAMAGE (Per =Went) $ GARAGE UABILITY ANY AUTO . . AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ �� AUTO ONLY: AGG $ C EXCESS / UMBRELLA LIABILITY OCCUR [] CLAIMS MADE DEDUCTIBLE RETENTION $ 10,000 OK06803638 03/07/2010 03/07/2011 10/12/2010 EACH OCCURRENCE $1,000,000 $1,000,000 $ AGGREGATE $ X 1 TRI IM i II 1 R $ D WORKERS COMPENSATION AND EMPLOYERS'LIABILRY ANY CCPERERROffPMMRIIEETBOR /PARTNER/EXECUTIVE FICER 1 N EXCLUDED? 2 If Pr SPECPEC IAL AL PROVISIONS below WCV002778402 10/12/2009 E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 $500,000 E.L. DISEASE - POLICY UMIT OTHER Property Windstorm Emp1 Practices LHP6716510 Various EK13015919 03/07/2010 Various _ 03/07/2010 03/07/2011 Various 03/07/2011 See Below See Below See Below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Location - 423 S. 21st Avenue, Hollywood, FL 33020 General Liability Coverages: Carrier - Old Dominion Insurance w d- De"scrip1bn } • COVERAGES CERTIFICATE HOLDER City of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Client#: 33931 EHWHI ACORD. CERTIFICATE OF LIABILITY INSURANCE PROI UCER Advanced Insurance U/W -3250 N. 29th Avenue Hollywood, FL 33020 954 416 -9712 INSURED E.H. Whitson Plumbing Al & John Enterprises, Inc. dba 4233 4 21-stAvenue Hollywood, FL 33020 DATE (MMIDD/YYYY) 9/21 /10LCA 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 AL TII€CI Z B I — `YLTI - BaD V). INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Dominion Insurance Co. 40231 INSURER e: First Mercury Insurance Co. 10657 INSURER C: St. Paul Fire & Marine 24767 INSURER D: Wire Tn tifeila �GolnpaRj/ T6332 INSURER E: Philadelphia Insurance Companie 18058 CANCELLATION AUTHORIZED REPRESENTATIVE 10 Days for Non - Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL nn 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. ACORD 25 (2009/01) 1 of 3 #S676586/M643205 ei, e 1988 -2009 ACoRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LCA r 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. I NSR LTR A B ADD 'L 1 NSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/OD/YYYY) POLICY EXPIRATION DATE(MMIDDIYYYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY MPG95316 FMGA001502 03/07/2010 05/30/2010 05/30 /2010 03/07/2011 EACH OCCURRENCE $1,000,000 X P RE EM M I S F S TO RENTED (Ea occurrence) $500,000 18058 I CLAIMS MADE X OCCUR MED EXP (Any one person) sSee Below X BI /PD Ded :5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JEC n LOC PRODUCTS - COMP/OP AGG 82,000,000 7 E AUTOMOBILE LIABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PHPK539652 03/07/2010 03/07/2011 COMBINED SINGLE LIMIT (Ea accident) $1 ,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO ® AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/ UMBRELLA LIABIUTY OK06803638 03/07/2010 03/07/2011 EACH OCCURRENCE $1 ,000,000 OCCUR CLAIMS MADE AGGREGATE $1,000,000 DEDUCTIBLE RETENTION $ 10,000 $ $ $ D WORKERS EMPL OYERS' ANY PROPRIETOR/PARTNEWEXECUTIVE OFFL 1 andatory Ii yes describe SPECI COMPENSATION AND LIABIUTY EXCLUDED? N ^ N 11 83031592 03/05/2010 03/05/2011 X ORV LIMr I 1° R E.L. EACH ACCIDENT $500,000 $500,000 E.L. DISEASE - EA EMPLOYEE under PROVISIONS below E.L DISEASE - POLICY LIMIT $500,000 OTHER Property Windstorm Empi Practices LHP6716510 Various Binder 489190 03/07/2010 Various 03/07/2010 03/07/2011 Various 03/07/2011 See Below See Below See Below DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Air Conditioning Location - 423 S. 21st Avenue, Hollywood, FL 33020 (See Attached Descriptions) ACORD CERTIFICATE OF LIABILITY INSURANCE DA 0 PRODUGE R Advanced Insurance UMW 3250 N. 29th Avenue Hollywood, FL 33020 954 416 -9712 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 E.H. Whitson Air Conditioning JSL of Hollywood, Inc. dba eta/ • 423 S. 21st Avenue Hollywood, FL 33020 INSURER A: Old Dominion Insurance Co. 40231 INSURER B: First Mercury Insurance Co. 10657 INSURER C: St, Paul Fire & Marine 24767 INSURER D: Bridgefield Employers Ins. Co. 10701 INSURER E: Philadelphia Insurance Companie 18058 Client#: 33931 COVERAGES CERTIFICATE HOLDER City of Miami Shores Attn: Margarita 10050 N.E. 2nd Avenue Miami Shores, FL 33138 CANCELLATION 10 Days for Non - Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n 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 ® 1988 -2009 C D CORPORATION. All rights reserved. ACORD 25 (2009/01) 1 of 3 #S642829/M642614 AZT The ACORD name and logo are registered marks of ACORD