PL-10-1306Contact Phone
Notary $
Scanning $
Double Fee $
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
BUILDING Permit No. /Z
PERMIT APPLICATION Master Permit No.
FBC20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) ( /�.. ' ' 4.j4 ✓C 6.u,, L..._ Phone #
Owner's Address (�
City (t J - 4 or State --i Zip ,3 .313 c
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES / 4dsflh)f% NO
ed
Contractor's Company Name / / / �� 4/) . Phone #
Contractor's Address / •/ X / 4j sr
f
City /Cs i State r e— Zip ,3 U l U
Qualifier Name /l %& C a4cei/ Phone #
State Certificate or Registration No.; ePe /1 Certificate of Competency No.
Architect/Engineer's Name (if applicable)
a
Value of Work For this Permit $ ? b� , ° Square / Linear Footage Of Work:
Type of Work: ❑Addition ['Alteration ❑New ❑ Repair/Replace
❑Demolition
Describe Work: A d.. b G.t� r
Training/Education Fee $
Radon $
E -mail
Phone #
?(4 2)3 31
Flood Zone
(or) Pte- 2724
g
* * * * * * * *** * * * * * * ** * * * * *** * * * * * * * * * * *** F ees * * * * * * * * * * * * * * * ** ** * * * * ** * * * * * * * * *r * * * * * * **
Submittal Fee $ Permit Fee $ / « CCF $ CO /CC $
DPBR $
Technology Fee $
Bond $
Violation date: I �� ' �
Structural Review. $ Total Fee Now Due $
See Reverse side -+
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Bonding Company's Name (if applicable)
Bonding Company'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 isesubject 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 ' reinspection fee will be charged.
3( Signature
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 7'
day of J ty , 2010 , by J'e(1 iM ifr C4 l4 t'k , day of , 20 , by
who is personally known to me or who has produced F> ®L who is p rsonally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY UB
tint:
My Commissio Expires:
* * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Owner or Agent
(Revised 07 /10 /07)(Revised 06/10/2009)
o tol v
4y
MARY A. R088INS
.1 i rida
• My Comm. Expires Mar 25, 2014
• Commission • DD 972518
Beaded Throsph National Notary Assn.
Signature
tractor
Sign:
My Commission Print: i AtS / �o✓� I H S FEF11 24q�
. e uR� ` 1 SS1041 Q 83
61:::01° /1 COMO 201
, �p 1Et ES: Nov emb e c7,
8ondedlhNBud9et14005 ce
e
*******;*************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
/P Plans Examiner Zoning
Engineer Clerk checked
Inspection Number: INSP- 148742 Permit Number: PL -7 -10 -1306
Scheduled Inspection Date: September 20, 2010
Inspector: Hernandez, Rafael
Owner: CANNATA, SEBASTIAN
Job Address: 622 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LONGA CONSTRUCTION INC
Building Department Comments
RENOVATE INTERIOR POOL HOUSE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 17, 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 Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
-13,6
Parcel Number 1132060171830
Phone: (954)254 -0491
Page 6 of 26
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 AU. THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN '
LTR
TYPE OF INSURANCE
L
INSR
JUNK
WVD
POLICY NUMBER
POUCAFF
(MM1DD/YYY /YYYY)
POLICY EXP
(MM/DD/YYYY)
UMITS
A
GENERAL
UABILITY
COMMERCIAL GENERAL
X
LIABILITY
OCCUR
CPS1150320
03/31/10
03/31/11
EACH OCCURRENCE
$ 1,000,000
X
PREM ISES (Ea occ
$ 50,000
CLAIMS -MADE
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY n jE Q n LOC
PRODUCTS - COMP/OP AGG
$ 1,000,000
7
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE UMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLALIAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVC
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N / A
830 -23430
05/07/10
05/07/11
X WCSTATU- OTH-
TORY LIMITS ER
E.L EACH ACCIDENT
$ 100,000
(
E.L DISEASE - EA EMPLOYEE
$ 100,000
below
E.L DISEASE - POLICY LIMIT
$ 500 , OW
0
DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
PLUMING RESIDENTIAL & COMMERCIAL
i
RO CERTIFICATE OF LIABILITY INSURANCE OP ID MA
DATE (MM/DDIYYYY)
07/01/10
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 thls certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
iSure Insurance Brokers
2700 SW 137 AVE
Miami FL 33175
Phone:305- 223 -2533 Fax:305-220-0765
INSURED
M e tro p4 o l an Plumbing, Inc.
120 Hialeah FL 33010
L.UN IA(.I
NAME:
PHONE
A/C, No, Est):
E-MAIL
ADDRESS:
FAX
(A/C, No):
PRODUCER
CUSTOMER ID #: ME - 1
INSURERS) AFFORDING COVERAGE
INSURER Scottsdale Ins.
INSURER B: Bridgefield Casualty Ins. Co.
INSURER C :
INSURER D :
INSURER E :
INSURER F :
NAIC #
41297
10335
COVERAGES
CERTIFICATE HOLDER
CERTIFICATE NUMBER:
CANCELLATION
REVISION NUMBER:
Miami Shores Village
Fax: 305 - 756 -8972
10050 NE 2 Ave.
Miami Shores FL 33138
VILLAMS
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
ACORD 25 (2009/09)
/' 009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD