The URL can be used to link to this page

PL-10-1272BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING ■ Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # � a ;x13 '-' O Q ' O L/® 0 Is Building Historically Designated YES NO t/ Contractor's Company Name 4 A- SSE pc,014�J Contractor's Address C) t 5 /t/6-", /36 s/ City /1/ /47 / State / Contact Phone , go s 4 93 7 /Yo Architect/Engineer's Name (if applicable) Describe Work: Notary $ S op Scanning $ , c)U Double Fee $ Radon $ 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 8'9 NC /b1 County Miami -Dade Training/Education Fee $ V .70 Violation date: DPBR $ Permit No. FL-1 10 - 1211- Master Permit No. ) S5 " 10 / —i Sr3 Owner's Name (Fee Simple Titleholder) k7 ci (# l ekij, t e /k r Phone # 905" - 75- $' -4/I 7 Owner's Address cm IV / 01 14 J t 'City M £ State f "- Tenant/Lessee Name /v/4 Email 6rat,3 g e7sn'YL Zip 3 3 /6/ Phone # Phone # t o _ 2019 Zip 18 /4/ /k/° 3S -'77t6 Flood Zone ,a Zip 3316/ Qualifier Name �® /0 Ai- L c 6 7 5 Phone # 3Qs f9 7/X State Certificate or Registration No. C / C 1 Y/ 69 Certificate of Competency No. _ E -mail Lp,ssEr-ERPOT 4/' c (P/5 Phone # ( /fit " Value of Work For this Permit $ /C7 O, Square / Linear Foota e Of Work: fee e Type of Work: ElAddition ❑Alteration Ac6 ro A sr F • Ltd ,O r S c4 cA Ar S t-b 1='�? E Et T_G plti# ['New Repair/Replace : ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * ** ******** * * * * * *** * * ** ***** * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ire 6 CCF $ .�Q CO /CC $ Structural Review. $ Total Fee Now Due $ ❑ Demolition Technology Fee $ , Zr° Bond $ (eo See Reverse side -* 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 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 /� gn �1 "c-• rJIJ tip 4/ et:4.0y0 Signature ,, %yL Owner or Agent r Contractor i The foregoing instrument was acknowledged before me this l� _ The foregoing instrument was acknowledged before me this / day of l , 20 [Q, by ?11-T121 CIA" &51 day of / sona , 20 / ®, by � H7 149--Sit , who is personally known to me or who has produced ' 1 0 who is � y kno o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) / Plans Examiner Engineer NOTARY PUBLIC: oil Iiiii Sign: 8 Print: = . ` � �r? ` Q ��% ': �' �p` , \ \% . My Commission Expire sr <C %3 �QQ ® Q ��\ c # \t,t)V1o� 0 ��6 • • * * * * * * * * * * * * * * ** * * * * * *_ * ** • mot . *j `***** * * * * * * * * * ** * * * * * * * * * ** * * * * * * *** E o,.• Sign: Print: as identification and who did take an oath. d iA:47 - 64-4;ar.)AA C i -iet STAB P6 iS My Commission Expires: Clerk checked REPLACE WASTE ARM FOR KS DRAIN. HOOK UP NEW FD AND DISHWASHER, AND REF ICE MAKER Passed Inspector Comments CREATED AS REINSPECTION FOR INSP - 148392. cancelled Bishop over the insp. line 9/7/10 P-E ' 7 'S DU LEI RD12 by Patricia 'ci f Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until I nspection Number: INSP- 150894 Permit Number: PL -7 -10 -1272 I Inspection Date: September 08, 2010 Inspector: Hernandez, Rafael Owner: BISHOP, PATRICIA Job Address: 89 NE 107 Street Project <NONE> Contractor: September 08, 2010 Miami Shores, FL Building Department Comments 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 Phone Number rAoS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1121360070400 Page 1 of 1 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MISR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE I ■ P ,,• • ••' POLICY EXPIRATION , ,, ui. DIYYYYI LIMIT'S A GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY 0401.000777251 9/1/2009 9/1/2010 EACH OCCURRENCE $ 1, 000 , 000 X AGE TO RENTED P EMISES Ea occurrence $ 100 000 CLAIMS MADE X OCCUR D EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY JECTT LOC 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 LIABIUTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS AND EMPLOYERS'LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, describe SPECIAL COMPENSATION Y/ N 83021471 WC STATU- OTH- TORY LIMITS ER 5/25/2010 5/25/2011 E.L EACH ACCIDENT $ 500,000 EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 500,000 In NH) under PROVISIONS below E.L DISEASE - POLICY UMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS (305) 756 -8972 City of Miami Shores Village Attn: Eiviva 10050 NE 2 Ave Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 Greg Waltz /JEANET ACG U CERTIFICATE OF LIABILITY INSURANCE PRODUCER Mack, Mack & Waltz Insurance Group 490 Sawgrass Corporate Parkway Suite 120 Sunrise FL 33325 INSURED Lasseter Plumbing Company, Inc 865 N.e. 130 Street North Miami FL 33161 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 INSURERA:Mid Continent Casualty INSURER B: Bridgefield Employers Ins. INSURER C: INSURER D: INSURER E: DATE (MM/DDIYYYY) 5/18/2010 NAIC # 10701 COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/01) INS028 (200901) CANCELLATION ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD