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PT-09-2077 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP-131823 Permit Number: PT -12 -09 -2077 Scheduled Inspection Date: March 16, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: HAMILTON, KATHRYN Work Classification: New Job Address: 117 NW 101 Street Miami Shores, FL 33150- Phone Number Parcel Number 113101022015 Project: <NONE> Contractor: KINGS PLUMBING SERVICE Building Department Comments PAINT EXTERIOR OF HOUSE AND ROOF TILE SAME EXISTING COLOR Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 15, 2010 For Inspections please call: (305)7624949 Page 8 of 23 -' Miami Shores Village f � 10050 N.E. 2nd Avenue m Miami Shores, FL 33138-0000 r Phone: (305)795 -2204 Expiration: 06 /19/201 Project Addre Parcel Number Applicant 117 101 Street 1131010220150 MICHAEL SOSTRE Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell 6, MICHAEL SOSTRE 117 101 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 KINGS PLUMBING SERVICE Total Sq Feet: 0 Type of Work: Exterior For Inspections please call: Color: (305)762 -4949 Additional Info: Available Inspections: Classification: Residential Inspection Type: Color: _Approved Code Comments: Final Color: _Approved_ Color: _Denied Fees Due j An Invoice # Total Amt Paid Amt Due CCF PT -12 -09 -36675 $ 61.60 $ 61.60 Education Surcharge $ �•�� Permit Fee Scanning Fee Technology Fee Total: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 23, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy December 23, 2009 1 Miami Shores village \, Building Department 1 0050 N.L;?nd Avenue. Miami Shores. f lorida 33138 Tel: (305) '79`;.2204 Fax: (305) 756.8972 BUILDING Permit No. _� —C PERMIT APPLICATION Master Permit No. FBC� �. • Permit Type: PAINT PERMIT p Owner's Name (Fee Simple Titleholder) K f'hryo f -}ct vr1 t j I QY I Phone # ,305 3 r7 j 3t7 S Owner's Address 1 SE L AVM Gc l t 9D 1 City {`1 i C1..Y l State FL Zip 3313' Tenant /Lessee Name _ ' Phone # E-MAIL: 1 J th 1'y Job Address (where the worlds being, done) N w 101 Sr City _ _ Miami Shores Village County Miami -Dade Zip _ FOLIO / PARCEL # I I - 34 C) (� D CqL a DISO Is Building Historically Designated YES NO Contractor's Company Name _ h rnbi 5t:(_UI Phone # 2�0S cj25' S� Conti Address I `ID 5 o N v 6 City____ Nowt NII ( State T_L Zip ?3 (67 Qualifier Name _Tbgsje_ P-DI)e44 o . Phone # Mn State Certificate or Registration No. Certificate of Competency No. OWNER BUILDER: Value of Work For this Permit $ Type of Work: ❑ Addition / F1 Alteration / ❑New / ❑ Repair /Replace Describe Work: PayRr �1� - t og— Ur Ij y ��1� � LE C J Y I 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 ora permit and that all work will he per armed to meet the standards orall laws regula(ingconslnrction in this jurisdiction. I understand that a separate permit must he seemed liw EI.EiC "rRIC.'AI WORK: PIA)MBING. SIGNS, WEL.IS, POOLS. FURNACES, BOILI:iRS. H ATERS, TANKS.and AIR CONDITIONERS, ETC...... "WARNING TO ONVNER: YOUR FAILURE TO RECORD A NO "rICE OF COMMENCEMENT MAY RESULT` IN YOUR PAYING TWICE. FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND - 1'0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORk RECORDING YOUR NOTTCIE OF COMMENCEMENT." Notice to. Ipplicant: .Is it condition to the issuance ofo building permit with an estimated value exceeding 52500. the applicant tnust promise in goodfailh that a cops of the notice of commencement and construction lien lair brochure: will be delivered to the person whose property is subject to atlachtnent. Also. a certilied copy cf the recorded notice of conrmencenu:nt must be ported at the job site fir the, first inspection which occurs seven (7) days after the building permit is issued ht the absence of such pasted notice. the inspection will not her approved and a reinspection fee will be charged �: ��: xxx} �� :��•:x�x��xx��xx��x�� *x�x * ** F �**** �: �* ��:* �>< , x� *�� *�� + �� *�� ** Permit Feel CCF s 0- (Do Technology Fee: Training /Education Fee $ (� - �—� Notary $ Code Enforcement $ Double Fee $ Zoning $ Total Fee Now Due s (A •�� See Reverse side a PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be painted Directions: Please circle corresponding number to appropriate c:oloT samnle_ Walls l ; 4 C L� l ��T - name and Fascia: I C N 2 - ! ) j 4 Drip Cap /Drip L;dge: 1 2 3 4 Soffit 2 3 4 Roof: 2 3 4 Flower Bins: 1 3 4 n coastal fog Shutters: 1 3 4 IA 3 Awnings: 1 2 3 4 Chimney: 1 2 3 4 €R Doors and DOOI Janis I 2 � 4 � ;h Garage Doors: 1 3 4 E i s Railin<�s: I 3 4 r Fences: I 3 4 �,! I;' f 7; All bricl: (simulated or regular` I 2 3 4 ' i' , i ¢ aar Stucco Banding: l 2 3 4 Any other Stucco Features: I 2 3 4 4 Accessory Buildings Other: 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. Si nat Si nature 4� L g cane)'r Agen1 CJdthi, or The Foregoing instrument was acknowledged before me this The foregoing instrument was acknowledfore me Yp day of 0,( V 20 O . by ka'�nrv�v� icy Mt�� day of YQ k 1s . 20 Vii%. by \ )Q %L who is personally known to me or wiio has pttiduced e e who is crsona I known to me or who has produced 1 C v— As identification and ` t � Aifi an oath. as identification and who did take a� 1S BA /a `eo ��liA 'tF!}�j� ®41 ��.....: NOTA Y I 1[iLIC: \er �,V \SgAIf,Q�, � NOTAR UBLIC: o MtSSIO,•• °• ® i ��` ••QpAS °'•. � ; �4 oiler 4, Sign: _s ;'LO aara ,Eto•. Sign: o` �'S Print: L Vos � jat.a� °� °� u ' • .�= Print: �V� �aC.tA� °'® *s - - - - -- ®.® %o.A'• 919634 My Commission E3Npires: yo'� #DD 919634 ; oX My Commission Expires: 9�L oQaa s 99`?�,dedt� �• :�pe'� ' � i sii Gel/ •.....• �F `��,�`w STOR �t+t•� � �r�• x��, x• ��* xxx�, ��*, r, ��*** �* t * * * * * *�� *�x�� * ��t''�� ,t.�,: �Itliltt�"� ��r�tllJif14143114d� _ APPLICATION APPROVI31) BY: ,6 /f7� I�`�/ Plans Examiner Preservation Board Code E:nl'orcement (Revised 04/24/0 DATE (MMIDDIYYI^() �® CERTIFICATE OF LIABILITY INSURANCE OP KIN ID GS RC -1 02/1 THIS CERTIFICATE IS ISSUED AS PRODUCER A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Advanced Insurance & Financial HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1645 North Hiatus Rd #14 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pembroke Pines FL 33026 NAIC# Phone:954- 436 -4027 Fax:954- 436 -4029 INSURERS AFFORDING COVERAGE INSURED INSURER A. Atiantic Casualty Insurance Co INSURER B: King's Plumbing Services, , Ia INSURER C: North Ni ho amiFL331 INSURER D: 69 INSURER E: COVERAGES 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. FA NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE M EACH OCCURRENCE D LIMITS $ 1000000 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY L 17 4 0 0 0 010 0 2/ 12 / 0 9 0 2/12/10 PREMISES Ea occurence $ 50000 CLAIMS MADE OCCUR MED EXP (Any one person) $5000 PERSONAL & ADV INJURY $1000000 GENERAL AGGREGATE $ 2 0 0 0 0 0 0 PRODUCTS - COMP/OP AGG $ 2000000 GERL AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC AUTOMOBILE LIABILITY EIUR LIMIT $ ANY AUTO ALL OWN ED AUTOS $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Paracddent) NON -OWNED AUTOS PROPERTY DAMAGE -- er a en AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS I UMBRELLA LIABILITY OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVFM OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS See Notes CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Miami Shores Village NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Claudio H. Grande IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Building Official REPRESENTATIVES. 10050 NE 2nd Avenue I pUTH R REPRESENTAT Miami Shores FL 33138 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(M9VUDD/YY) 12/26/08 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Providence Property & Casualty CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT P.O. BOX 2009 Frisco, TX 75034 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Insured INSURER A: Providence Property and Casualty I 28711 02HR, LLC UC/F INSURER B: King's Plumbing Services, Inc 2031 NW 53rd St INSURER C: Ft Lauderdale, FL 33309 INSURER D: INSURER E: COVERAGES 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 DESCRIBEDHEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. POLICY ADD'L EFFELTIVE DATE POLICY EXPIRATION NSR LTR msRD TYPE OF INSURANCE POLICY NUMBER M DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ CLAIMS MADE = OCCUR MED EXP (Any one pew) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEJ'L AGGREGATE LIMIT APPLIES PER: PRODUCTS — COMP/OPAGG $ PRO POUCY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Perm) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Pereccldent) $ PROPERTY DAMAGE $ (Per acciden GARAGE LIABILITY AUTO ONLY— EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X WC WATU- OTH- EMPLOYERS LIABILITY TORY LIMITS R ANY PROPRIETER/PARTNER/FJCEC UTIVE EL EACH ACCIDENT $ 1,000,000 A OFFICE IMEMBER EXCLUDED? Ifyes, describe under NO WC0100390 -109 1/01/09 1/01110 E.L. DISEASE —EA EMPLOYEE $ 1,000,000 SPECIAL PROVISIONS below E.L. DISEASE — POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Workers' compensation coverage Is provided by contract to all employees of 02HR, LLC assigned to King's Plumbing Services, Inc. Coverage does not apply to any employees not approved and assigned by 02HR, LLC to King's Plumbing Services, Inc effective 01/01/2009 CERTIFICATE HOLDER FIADDITIONAL INSURED: INSURER L ETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Village of Miami Shores MAIL X 30 DAYS WRITTEN NOTICE TO TH ISSUING CERTIFICATE HOLDER NAMED 10050 NE 2 Ave TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Miami Shores Fl 33138 LIABILITYOF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE .c# 3884739 `F't; ®F FLORIDA DEPARTEN� f)"A �ROFE'SSIONAL REGULAT _ C OTSa'R�T b7;t]9� R LICENSING BOARD :y.r C *Tf3�._ SEQ_#�LO- �;o�sLro:s� 07/ /W J O x$ . 8 Utele` E rzon date:: -AUG 31z—` xP at �t = 6 Ear RODRZfUE� b3tO�GE� -' -_ NORTH MlAmi: `, �t * s. '{.a* .� °� �t`� rG1r`e _ q- � }w`gl`��u �`�y�n(r�4`i,�fe«`+•. P �.1�{.+ � w ,a 4 �A r sai s�f t��;r t 4r` F as ` C 1 A T - EaS TnT D +,+ SECRE'�ARY t� al ' r r fLORIDA DE ARTX 0 7 P OEESSIONAL REGULATION S 0� I}�R3_ LICENSING BOARD g�Q# L08073014 y kkp, iration date AUG , f _ +py RR t 7 RE)DR UE UORG I1VCs ` a SLUA�H 1'4 0 5 - rrr� 6T�� f L "Va�s C - K �.AtiGO � `AtTER�' SECRETARY a MIAMI -DADE COUNTY 2009 ,, dk $i>!IL EG Q 2bt0 FlFIS '�Q B'.'. TAX COLLECTOR I<III�AaAt` T�l�ai 60 ply §Ri@4 140 W. FLAGLER ST i r `h` +k S�F ' bI a LAID MIAMI, O O 33130 ` 8 1511 � � r MIAMI, pL PURSUIyWiT t,` 11�I{flf'CGa E �f � y 9 $f fib PER IT. NO 231; THIS IS NOT A BILL — DO NOT PAY 563783 -1 RENEWAL 1 ss N ei c oN pct Q" 5880$9 -4 su �ClNGS Pf 6 hT113G : SERVICE INC STATER; c '$2 67"'95 14050 NW 6 CT 33168 NORTH MIAMI OWNER KINGS PLUMBING 'SERVI'CE INC' s 9 PLI� TI CONTRACTOR ` WORKIi= /S HIS IS ONLY A LOCAL IUSINESS TAX RECEIPT. R CES NOT PERMIT THE [OLDER TO VIOLATE -ANY owG LAWS O F R THE DO NOT FORWARD OUNTY OR CITIES. NOR tOES IT EXEMPT THE (OLDER FROM ANY OTHER 'ERMIT OR LICENSE IEQUIRED BY LAW. THIS IS KINGS PLUMBING SERVICE INC HE HOLDER'S C ERTIFICA TI ON LUIS BARIAS FIRES IONS' 14050 NW 6 CT 1AYMENTRECEIVED NORTH MIAMI FL 33168 HAMI -DADE COUNTY TAX :OLLECTOR: 09/24/2009 60030000483 �e.Wik4SeQP i s I ttl4ttfl�fttf�ltllffl,lltltttfl �r��lJ�dl�tll�rd {o HHrfflfe+at�r {tf�ttdt ttl� SEE OTHER SIDE MIAMI-DADE COUNTY 2ffOS t,11SiN�S IPX 2Q1Q FIRST CLASS.; TAX COLLECTOR @NIAI$Il' U S POST 'aEr, 140 W. FLAGLER ST I(pIRES SPT$3B,'1Q11� Pkl[J 1 st FLOOR MU$T'BE DISp1:AiYI =Q ATLCE O BSIt�SS MIAMI, FL MIAMI, FL 33130 pURSCJANT �b t f Gt1NT1( CODE LHI� 8I� ATto S,, &,t0' PERMIT IV0.2Si THIS IS NOT A BILL _ DO NOT PAY 616783 -7 RtkWAL su KINGS PLUMBING_ SERVICE. TNC STATES CCGC1514442�43�07 4 14050 NW 6 CT 33168 NORTH MIAMI OWNER KINGS PLUMBING SERVICE I-NC. WORKER'/S ' 19 y rdef u ig AL BUILDING CONTRACTOR I HIS IS ONLY A LOCAL - - ;USINESS TAX RECEIPT. IT OFS NOT PERMIT THE (OLDER TO VIOLATE ANY - X ISTING LAS OF THE THE DO NOT FORWARD OUNTY OR CITIES. NOR OES IT EXEMPT THE !OLDER FROM ANY OTHER ERMIT OR LICENSE •EGUIRED SY LAW. THIS IS KINGS PLUMBING SERVICE INC IOT A CERTIFICATION OF HE HOLDER QUALIFICA- LUIS BARIAS FIRES I 14050 NW 6 CT AYMENT RECEIVED NORTH MIAMI FL 33168 IIAA"ADE COUNTY TAX OLLECTOR: 09/24 /2009 60.030000484 lltl�litiltftf�If ,fitftitll , �d7 1ld1dtdt tl0fdl d�ddtdtlldd�ttd�l!lttldtlr� SEE OTHER SIDE