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PL-10-1988Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 153198 Permit Number: PL -11 -10 -1988 Scheduled Inspection Date: November 19, 2010 Permit Type: Plumbing - Residential Inspection Type: Final Owner: MARTINEZ, MAURICIO Work Classification: Sprinkler System Job Address: 189 NW 105 Street Inspector: Hernandez, Rafael Project: <NONE> Miami Shores, FL 33150- Contractor: AFFORDABLE IRRIGATION, INC Building Department Comments REPALCE EXISTING LAWN SPRINKLER SYSTEM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 18, 2010 For Inspections please call: (305)762 -4949 Phone Number (305)710 -1732 Parcel Number 1121360080090 Phone: 305 - 681 -6322 Page 5 of 7 BUILDING PERMIT APPLICATION FBC 20 Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder), ll�j'C�O 141ZTyj e Z Phone # (c3 0.17) 7G0 /73 2 Owner's Address / >9 ,4/. 4/ /0,r S�tiee-7. 4 e FOLIO / PARCEL .# Contractor's Company Name Contractor's Address rclietect /Et gi ;'lee° s Name ei :Appli : lhte0. • Value of Work k'ori- this Permit $ Miami Shore i k„ , a„ _ . 11.00 1 i` E2nCi A 6-tue, Miami Short',;, F ioricia 33138 ' ei, (305) 79:5.2204 Fux' (305) 756,8972 City /11"mss State PC- Zip 3 3 /e'' T enant/L,essee Name Phone # Email Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES City #?'7 • State Qualifier Name A/04/ /1-00 _ IP.S.A -..P State Certificate or Registration No. Contact Phone 0 County Miami -Dade Zip 3 3 1 (f ` NO Flood Zone Type of Work. LIAM ition m PP �y lte9`at!(?n tl�TTe`;AI lllese obi` O ° Is. L slCC i / d J'�t Permit No, Master Permit No. Zip 33 6f Phone # C. 051 3 to -- i•!ii / Z Certificate of Competency No. / �D D O a.1 9 3 2-2-- . E -mail c Y ''a e- 4 if )L G Ph Square LirrReair Fool-Re 1l £'Work, Phone #(3 0116 IV- 6 3-0 Z Repai_1RPpla,ce: [ 1 Demolition :•k **** ** ** * ** ***** *:g k*.k * *** * *** ******** F **** * * * * * * * *** *** **** * * **** k****** ** * ** Submittal Fee $. , Permit Fee $ /527 Notary $ Training/Education Fee $ Technology Fee $ Scanning $ . Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side CCF $ CO /CC 1.3 O sill Riess rirt rtt a€ e L ( ,s Na. ir(` iii ol_ipll(: -atl Mortr-arie Lender 's Address City State Zip Application i, 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 ELECTRICAI, 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 W The foregoing instrument was acknowledged before me this day of /Y77 ,20 /n by who is personally known to me or who has produced As NOTARY PU (Revised 07/10/07) Contractor 71- The foregoing instrument was acknowledged before me this 2 7' �j icf r e.:( 0 l r "/L day of 2C7 , 2010, by /7j 42-e-0 ,24,./' i•:A % MY COMMISSION 0 ©0 706232 EXPIRa August 19, 2011 eonded?hru Notary Public Underwriters APPLICATION APPROVED BY , e / Examiner Engineer who is pew halt know t , rn or who has produced h. as identification and who did take an oath. Ri T A �° }T I J ' �L CC ]46TARY PUBLIC-STATE OF FLORIDA Commission #1)1)815435 '`••., ,,,,•,, Expires: AUG. 22, 2012 j 1 : ' / : r . P ' r THRII ATLANTIC BONDING CO., INC. / ' ,. srf 6 xp ..... * * * *** * *** *** *** ** * * * ** * * * ********************** *************************** * ** ** **** * *** * ** * ** *** *** ** *=k* Zoning Clerk checked 7 i n \ 7q e r -- 1 __ 4 Ett ,/4- i fla"fr 4 Y i , A e $ 4 4 _id 112 Di 11 12 e 0 :2411 1..8j 4LQ1 VI .4: CC# 96P000219 Affordable Irrigation, Inc. 198 NW 139 Street Miami, FL 33168 Tel: (305) 681-6322 itt 3 / 1 r, DEPT OF:PI • i; 0 00MPLIANCE WITH ALL FEDERAL NITY RULES i\ND REGULATIONS A iam Shores itta e EY DATE A) I( I IZ, L e Z d r 7 --- • R ° i ft. if _ 264e _Ock e s 0 5435 2012 0,121e, II j • IRIS I5 1U etKIII Y IHAI IHt HOLICIES 01 INSUKANCt LIS1EU BELOVV HAVE B tEN ISSUED 1U IHt INSUKtL) NAMtL) AI3UVt 1 IHt POLICY HLK IUD 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS INSURER(S) AFFORDING COVERAGE GENERAL LIABILITY INSURED Affordable Irrigation, Inc. P.O. Box 601743 Miami Beach FL 3316 0 -174 3 INSURER A :FCCI Commercial Ins Co 33472 INSURER B : EACH OCCURRENCE $ 1,000,000 INSURER D: X COMMERCIAL GENERAL LIABILITY INSURER F: DAMAGE TO RENT— PREMISES (Ea occurrence) $ lOQ, OOO A CLAIMS -MADE X OCCUR 'L0006847 3 3/2/2010 3/2/2011 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , 000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY PRO- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300,000 (Ea accident) X ANY AUTO BODILY INJURY (Per per son) $ A ALL OVVNED AUTOS CA0010999 3 6/11/2010 6/11/2011 BODILY INJURY (Per accident) $ - SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accdent) NON- OVNVEDAUTOS Undennsured motorist $ Included Uninsured motorist combined $ 300,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY Y I N E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below Y L D I S E A S E P O U C Y L I M I T $ DESCRIPTION OF OPERATIONS f LOCATIONS ( VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Village of Miami Shores 10050 N.E. 2 Ave Miami Shores, FL 33138 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 Laurie Lane /ML • '. /Y w. /,A+-�_ , ACORN® CERTIFICATE OF LIABILITY INSURANCE Y) 7/14/2010 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER T.R. Jones & Company 1780 N Krome Avenue Homestead FL 33030 CONTACT Melody Lower NAME: y y (A/C, Ext): (305) 247 FAX No): (305) 248 -8543 E -MAIL ADDRESS: � Y mlower @tr ones .com PRODUCER 00034562 CUSTOMER ID R: INSURER(S) AFFORDING COVERAGE NAIC# INSURED Affordable Irrigation, Inc. P.O. Box 601743 Miami Beach FL 3316 0 -174 3 INSURER A :FCCI Commercial Ins Co 33472 INSURER B : INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES ACORD 25 (2009109) INS025 (200909) RECEIVED 11/09/2010 11:20 3054610121 Date: 11/9/2010 Time: 11:29 AM To: 3056816321 Page: 1 CERTIFICATE NUMBER:2010 GL BA Rev 1 9 -2010 TIO The ACORD name and logo are registered marks of ACORD REVISION NUMBER: © 1988 -2009 ACORD CORPORATION. All rights reserved. Village of Miami Shores Bldg & Zoning Dept 10050 NE 2nd Ave Miami Shores, FL 33138 1 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 REPRESENTA �ZL 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. ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM PRODUCER Affiliated Agency Ops 16 South River Street Wilkes- Barre, PA 18702 Tel: (800) 673 -2465 Fax: (570) 820 -7968 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 Employee Leasing Solutions, Inc. Phone: (941) 746 -6567 1401 Manatee Ave W. Suite 600 Bradenton, FL 34205 INSURER A' FastGUARn Insurance Cnmoany 14702 INSURER 8: INSURER C: 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YY) POLICY EXPIRATION DATE (MM /DD/YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Fa occurer el $ CLAIMS MADE 1 J OCCUR MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER' _ PRO - POLICY JECT LOC PRODUCTS - COMPIOP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY' AGG $ EXCESS /UMBRELLA LIABILITY OCCUR 1 1 CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED If yes describe under SPECIAL PROVISIONS below EM WC 109947 01/01/2010 01/01/2011 y WC STATU- OTH- /� TORY LIMITS ER E L EACH ACCIDENT $ 1,000,000 E L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER Client ID: #4042131 • DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS EastGUARD Insurance Company COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF: Affordable Irrigation Inc carries an A.M. Best Qualifiers Name: Marco and Milcian Rosas Rating of A- (Excellent) Financial Strength Aprox active employee count: 13 and a financial sip Category of VIII A- Exctlent CERTIFICATE HOLDER ACORD 25 (2001/08) CANCELLATION © ACORD CORPORATION 1988