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PL-10-495
Inspection Number: INSP - 138897 Permit Number: PL- 3- 10-495 Scheduled Inspection Date: April 07, 2010 Inspector: Bruhn, Norman Owner: PIPER, SHERYL & MARK Job Address: 1311 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: LASSETER PLUMBING CO INC Building Department Comments April 06, 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 Phone Number G►� Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1132050300110 Phone: 305 -893 -7180 RE -ROUTE 4" WASTE LINE ON WEST SIDE OF HOUSE TO NEW SEPTIC TANK AT SW CORNER OF HOUSE. RUN NEW WATER SERVICE & SLEEVE LINE. Passed /1/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 6 of 16 Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Contractor(s) Phone LASSETER PLUMBING CO INC 305 - 893 -7180 CeII Phone Type of Work: NEW WATER SERVICE 8 WASTE LINE Type of Piping: Additional Info: PLUMBING Bond Retum : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Aiterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.40 $150.00 $3.00 $50.00 ($50.00) $1.60 $156.20 Building Department Copy March 30, 2010 Address Parcel Number Authorized Signature: Owner / Applicant / Contractor / Agent Phone Pay Date Pay Type Invoice # PL -3-10 -37389 03/24/2010 Cash 03/30/2010 Check #: 2404 Amt Paid Amt Due $ 50.00 $ 106.20 $ 106.20 $ 0.00 March 30, 2010 Date Expiration: 09/25/2010 Applicant 1311 103 Street Miami Shores, FL 33138- 1132050300110 Block: Lot: SHERYL & MARK PIPER CeII 1311 103 Street MIAMI SHORES FL 33138 -2623 Valuation: Total Sq Feet: $ 1,200.00 0 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground 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. 1 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33 B8 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Titleholder) /-L,c P / PC/t Phone # 3V 961-6 6 7 Owner's Address /3 /1 / / & Ia 3 ST City »21// P?/ S /G &S State - Zip 33/3/ Tenant/Lessee Name Phone # E -MAIL: /.31/ �c(& : 11.03 :' City Miami Shores Village County Miami -Dade Job Address (where the work is being done) FOLIO / PARCEL # Is Building Historically Designated YES ' Value of Work For this Permit $ joZ4p Structural Review. $ NO Permit No. Master Permit No. State Certificate or Registration No. Cr--C- I/6 9 6 Certificate of Competency No. E -MAtL: Jf &7 ®ternC/!UG-o 4r Architect/Engineer's Name (if applicable) Phone # Zip .33/39 Contractor's Company Name L)SS&T- Pe-V/ G Phone # C -e (3 — Contractor's Address s461 N . 1 3 City /y. / J/ State • Zip 33/6 / Qualifier Name , 3 - 0/0 , LA f frEie Phone # Square / Linear Footage Of Work: 13CIERWIEtli IA MAR 2 ¢ 2010 BY: �l. I0 35.- ?J -g Type of Work: ❑Addition ['Alteration ['New 0' Repair /Replace [I Demolition Describe Work: Re t?c1Tg 4" WA-gra 1...ijliE�7e Al LOWS" $E BB 17e90.-7 ,i �J ep C. - i J k 147 C) W 7 �/2A) /2 c # / -/ i..ce .. ROA) /1/6a' pa4r R 4 4 s' (e a /e. La �E **** e***** aku ite4e4******** dcnY +Fo:****”*** **Fees***x drat ****uxx &eY*****************s4**** Submittal Fee $ D . Permit Fee $ C/ �� N CCF $ 9 Notary $ �° 'Training /Education Fee $ 0.40 Technology Fee $ Scanning 0 7 Radon $ DPBR $ Zoning $ COICC Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ ta See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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. l 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me thiso?-__t The foregoing instrument was acknowledged before me this' VX i P, by / Pob , day of 224 , 20 h9, by XIMJ day of who is As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: :,.I s• it1 k•1(:11 i1 RES. My Commission Expires: xxxxxxxww** e****�Y* * Ye�Y******** draY�Ydryt, Y, 4, ti ****xaYx * *xdrxx9e****xxx�Yx**** :****s *** APPLICATION APPROVED BY: (Revised 02/08/06) ersonally kno me or who has produced Zip State who i Signature Contractor me or who has produced as identification and who did take an oath. NOTARY PUBLIC: CHRISIINA S � D85847c, SO: a, ‘ EXPI May 30, 8013 Undaroa P r. nt: c T f r /A(' � F My Commission Plans Examiner Engineer Zoning MAR 2 4 2010 BY: ........... MESMIllome 1.) 77 17 177 M.ami Snores Village ZONI1 DEPT BLDG DEPT • BY A S t i1 ALr DR le uhl e NEtA) .. r/intw WAN £ t.D ortAEKS 3f DATE5Ele 14E SUBJECT CO COMPLIANCE WITH ALL FEDERAL STATE AND CII.UNN riULES AND REGULATIONS EX 4.t el SELveR • - r #J 3(4 s E)(5-r-;(41 ill+"cdoppee GOArreg Satzvica 0E1 r.) MM. 1:1 4 1* 1 rafrt R eel( ID— /Vito 1" -4- miglrE'R SOgviCE ;Al SWIM', 1 I k i 1 C-4 1 1" coep 4- Folz spri.Wetoz -I --a by &7-14ER. 1 4 , I in Aff..10 4" pk. ii ...ER. 1 e;$TZt.i5 TANK. NAT Ado Atommod by I14 R. e L • "kit* l• Cl II /xi' 4" er. ," E4' !eA -,1pR 4R■',v i`Yjie ITEM BATH TEO UNIT FEE ITEM SWITCH OUTLETS UNIT FEE I1EM SPACE HEATERS UNIT FEE DIDET LIGMT OUTLETS CEFTIRAL HEATING DISHWASHER RECEPTACLES A/C (WILD) DISPOSAL SERVICE TEhPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AhPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE 111AP APPLIANCE OUTLETS PROCESS MO PRESS PIP NG INTERCEPTOR RANGE TIP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TNIKS LAUNDRY TRAY WATER NEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 IP STEAM BOILERS SHOWER MOTORS OVER 1- 3 If NOT WATER BOILERS SINK, POT /3 COW. MOTORS OVER 3- 5 If 1ECHANICAL VE11TILATION j SINK, RESIDENCE MOTORS OVER 5- 8 IP TRANSPORTING ASSEM3LIES j SINK, SLOP MOTORS OVER 8- 10 IP ELEVATORS/ESCALATORS TE/PORARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 IP VIOLATION IMO I RECT WASTES A/C W I WOW RE INSPECT ION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER F IRE SPRINKLER GENERATORS TRANSFORMERS T HEATER -NEW IFIST. GENERATORS TRANSFORMERS HEAVER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SYIIMdING POOL SPECIAL PURPOSE OUTLETS COMAERCIAL , I WATER SERVICE / SIGN TIRES SEWER CONNECTIONS SIGN TRANSFORMERS , UTILITY -SEWER /' SIGN TIME CLOCK UTILITY -WATER F IXTU{ES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GIAINFIELD, 4" TILE/RES. VIOLATION FIJM' & ABANDON SEPTIC TANK RE IUSPECTTON SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL _ DOMESTIC WELL AREA. I DRAIN ROOF • INLET 0LAR WATER HEATER ' IRE STAMPIPE VOL PIPINIG - .AWN SPA I NXLER SYSTEM r • S I ;AS RANGE ETER SET (GAS) LAS PIP ING -- SI I ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEr OBTAINED, THE OWNER'S NOTARJ.ZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL u�- s t D CENSE`" B ' .- 07/02/2008 0..880,Q 0924 ,;_ CFC041496. ' - ;.,.;: AC# .. 3837048 The PLUMBING 'CONTRACTOR Named below IS CEl2TIFIE Under tie prpv .s on Expiration date: LASSETER_ JOHN MARK. LASSETER PLUMBING ,'C0 13925 NE 1ST P AVE MIAMI CHARLIE CRIS?, GOVERNOR STATE OF FLORIDA E?ARTMENT OF FBtrSTOS jAND ?ROEESSIOl'AL CONS"II�UCT 0�1T_ USTR - 3' IS I�G R DRAGO RT, BERET MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33120 2009 LOCAL BUSINESS TAX RECEI MIAMI-D • I7 , ® FLORI EXPIRES SEPT., 30 2010 MUST BE D PLA P CB OF BUSINES PURSUANT TO COUNTY CODE CHAPTER BA -ART. 092209 - THIS IS NOT A BILL DO NOT PAY R `ENE11l BU IN SS E / LOCATION _RECEIPT NO LASSET PLUMBING CO INC STATE# trco4169 865 NE 130 ST 33161 NORTH MIAMI OW LASSETER.PLUMBING CO INC Sec PLUMBING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CMES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/07/2009 60040000753 000045.00 SEE OTHER SIDE DO NOT FORWARD LASSETER PLUMBING CO INC 865 NE 130 ST N MIAMI FL 33161 1 „11„ „11,11,,,,, B i, i„l 1, 1,1„111 11, s,1,12n,i ST GLA :POSTALiE . I MIT ND 2 3 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 _ IL ADD'L ._ _. it _ e ,._.. : .c POLICY NUMBER POLICY EFFECTIVE , L+ ■ - P. AAA kJ POLICY EXPIRATION _ _ Lily... ! ∎AAA/ MOTS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 04GL000767389 9/1/2009 EACH OCCURRENCE $ 1,000,000 X 9/1/20 P SES (Ea occurrence) REM $ 100,000 $ EXCLUDED CLAIMS MADE X OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,000 $ 2, 000, 000 GENERAL AGGREGATE GEM_ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 2, 000, 000 POLICY PRO- JECT 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 UABIIJTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (MandatorylnNH) If yes, describe SPECIAL COMPENSATION UABILRY 83021471 5/25/2009 5/25/2010 WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 500, 000 EXCLUDED? E.LDISEASE - EAEMPLOYEE $ 500,000 under PROVISIONS below E.L DISEASE - POLICY LIMIT $ 500, 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 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 pp�� Greg Waltz /DIANA _ - _ ' es ACdRD 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 Mi 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 INSURER A: Mid- Continent Casualty INSURER B: Summit Consulting Company INSURER C: INSURER D: INSURER E: DATE (MM/DD/YYYY) 9/9/2009 NAIC # COVERAGES CERTIFICATE HOLDER ACORD 25 (2109/01) INS025 pow) ANCELLATION © 1988-2009 ACORD CORPORATION. All rights reserve& The ACORD name and logo are registered marks of ACORD