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PL-10-1714Inspection Number: INSP- 151713 Permit Number: PL -9 -10 -1714 Scheduled Inspection Date: October 18, 2010 Inspector: Hernandez, Rafael Owner: UCHIDA, KYOKO Job Address: 1700 NE 105 Street 406 Project: <NONE> Contractor: Miami Shores, FL Building Department Comments October 15, 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: Repair Phone Number Parcel Number 1122300500630 NEW TANKLESS WATER HEATER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 7 of 14 BUILDING PERMIT APPLICATION FBC 20 DESIGNER: Architect/Engineer: 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 Permit Type: PLUMBING , !!,^, p� OWNER: Name (Fee Simple Titleholder): K yoko VII / e& Phone #: 2�_ c Ig 747 Address: /700 A4 E, /O.S i/i Sfreet it 4496 City: Plain i Shores State: R0 h (/Gx Zip: 33 Tenant/Lessee Name: Phone #: _ Email: `'I I {9t 1 o- & /1 arma1 / 4 Co'" JOB ADDRESS: /'700 Y. 0.57/7 S»AP. f #( 6 Permit No. Master Permit No. City: Miami Shores County: Miami Dade Zip: Wag" Folio/Parcel #: 1/ — 2,2300 ,O0 630 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Ad e aJig2 el: ®J Phone #: T?' / r re Address: !�.-9 S 0. q rt.. "� City: a- - e / State: ,( Zip: 3S t °9S Qualifier Name: Th' 7 4 `'`/ ' rts' mono: / 0 State Certification or Registration #: C/ C B44 3 Certificate of Competency #: e P C Contact Phone#: �/ � Email Address: ®'"€1A -- Phone #: d " Value of Work for this Permit: $ C-3 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration / ❑New ❑Repair/Replace ❑Demolition Description of Work: /4.1 Meet 7R•t - <� ********** * * * * * * * * * * * * * * * * * * * * * * * F ** **** **** * ** * * *** ** Submittal Fee $ Permit Fee $ /.(s/O e 3 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 1 TOTAL FEE NOW DUE $ 1 5 i. 10 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 Rt.F.CTRICAL 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 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 Owner or Agent The foregoing instrument was acknowledged before me this 7 74 1 day of - ,20 %L),by i<y,o teo , who is personally known to me or who has produced 40fr °tiat`.e /A , ^�_. •ems As identification and who did take an oath. NOTARY PUBLIC: FRANK ELIAS Print ( tin 0. omm ss on My Commission Expire .` �° ,cl; ,;;°4` Bonded Through National Notary Assn. APPROVED BY (Revised 07 /1Oro7)(Revised 06/l0/2009XRevised 3/15/09) Si Signature Contractor The foregoing instrument was acknowledged before me this day of 10 4/47 -- , 20,x, by /4 41 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: • FRANK ELIAS ride My Commission Expires Apr 28, 2012 .,�,� `m„0. omm ss on 220 ifs; AV Bonded Through National Notary Assn. Print My Commission **spa saw. ***** *Res** * **+ asa ******wa * * ** **** ******* a *****e.a * * ** Plans Examiner Zoning Structural Review Clerk -dRIf, (CERTIFICATE OF LIABILITY INSURANCE L "IIG11. no Y) PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 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 ALL JER CONSTRUCTION CORP. 12294 SW 29 TERR MIAMI, FL. 33175 1(786)348 -9180 INSURER A: AMERICAN VEHICLE INSURANCE CO J INSURER B: INSURER C: 1 INSURER D: 1 INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONE ITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR INSRD NSRD TYPE OF INSURANCE POLICY NUMBER DATE (EM�pIY�Y) POLICY y) N LIMITS A ❑ GENERAL LIABILITY k COMMERCIAL GENERAL LIABILITY GL- 0504003267 -00 10/30/09 10/30/10 EACH OCCURRENCE 1,000,000.00 , DAMAGE TO PREMISES (Ea occ 100,000.00 I lin CLAIMS MADE D OCCUR MED EXP (Any one person) 5,000.00 r PERSONAL & ADV INJUF Y 1,000,000.00 L] GENERAL AGGREGATE )00,000.00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COA 000,000.001 , 0 POLICY 1 PROJECT • LOC AUTOMOBILE LIABILITY l7 ANY AUTO L] ALL OWNED AUTOS ❑ SCHEDULED AUTOS COMBINED SINGLE LIMI I' (Ea accident) r - BODI LYINJURY (Per person) • HIRED AUTOS • NON OWNED AUTOS BODILYINJURY (Per accident) ❑ PROPERTY DAMAGE (Per accident) 1-1 GARAGE LIABILITY • ANY AUTO 1 AUTO ONLY - EA ACC ID =NT OTHER THAN EA ACC AUTO ONLY: At XG a EXCESSIUMBRELLA LIABILITY Ei OCCUR 1 CLAIMS MADE [7 DEDUCTIBLE • RETENTION $ EACH OCCURRENCE AGGREGATE ■ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below II WC STATU- • OTH- TORY LIMITS ER E.L. EACH ACCIDENT --1 E.L. DISEASE - EA EMPL OYEE E.L. DISEASE - POLICY( I MIT OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS �, 111111 4. CERTIFICATE HOLDER ACORD 25 (2001/08) QF MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2nd AVE MIAMI SHORES, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 © ACORD CORPORATION 1988