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PLC-10-630Inspection Number: INSP- 140631 Scheduled Inspection Date: April 30, 2010 Inspector: Hernandez, Rafael Owner: HINTERKOPF, ERNEST Job Address: 1550 NE 103 Street Project: <NONE> Contractor: ACER PLUMBING INC Building Department Comments April 29, 2010 Miami Shores, FL 33138- 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 Permit Number: PLC -4 -10 -630 Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1132050310110 Phone: 305 - 935 -4103 REPLACE 1 1/2 PVC WATER SERVICE LINE WITH BLASS VALVE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 9 of 14 Project Address Owner Information Contractor(s) ACER PLUMBING INC Phone 305 - 935 -4103 Cell Phone Type of Work: PLUMBING Type of Piping: Additional Info: Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations 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 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 21, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Address Parcel Number Phone Pay Date Pay Type Invoice # PLC -4-10 -37586 04/14/2010 Credit Card 04/21/2010 Credit Card Amt Paid Amt Due $ 50.00 $ 106.20 $ 106.20 $ 0.00 April 21, 2010 Date Expiration: 10 /18/2010 Applicant CeII Available inspections: 1550 NE 103 Street Miami Shores, FL 33138- 1132050310110 Block: Lot: ERNEST HINTERKOPF ERNEST HINTERKOPF eWMMIUMMW 1550 NE 103 ST MIAMI SHORES FL 33138 -2628 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 20 Permit Type: PLUMBING Miami Shores Village �M C��IIMi� � APR 1 3 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel (305) 795.2204 Fax: (305) 756.8972 INSPE4TIOrfS PHONE NUMBER: (305) 762.4949 Permit No. Plc, 10 5_0 Master Permit No. Building Department Owner's Name (Fee Simple Titleholder) LR 1 S# o ZE.S 1.1c, Phone # So S - 441 -C 000 Owner's Address 2 C o 0 3 . U(1 ^ j I h cA 'Rod Cit c rd r!-e State F LA Zip 3 3 13 3 Tenant/Lessee Name PIA- Phone # Email Job Address (where the work is being done) ( ) k (, 3 54 City Miami Shores Village County Miami -Dade Zip 3 3 \ 3 11- 3 our() � h FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name iPkir Contractor's Address City '� �! Sate �� Zip 2) Qualifier Name , Phone # State Certificate or Registration No. C By Flood Zone y °c5 i fl C Phone # ,W 2 S G,Z Certificate of Competency No. Contact Phone 93 ■•• ' E -mail Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ['Addition Describe Work: 'Pe ,p\ . ` 1 t2cto - Square / Linear Footage Of Work: ❑Alteration ENew R Repair/Replace c \,),) -g-- Phone # ********* * * * * * * * * * * * * * * * * * ** * * * **; * * ** ** F * * * * * * ** ** * * * * ** * * * * * * * ** * * * * ** Submittal Fee $ Permit Feel$ / Notary $ Training/Fducatibn Fee $ 0 40 Scanning $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 OC . �� J Violation date: CCF $1 -d.O CO /CC $ Technology Fee $ 1 Bond $ See Reverse side -* U ❑ Demolition fit �� 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. SignatureT.j��, Owner or Agent The foregoing instrument was acknowledged before me this 1 - The for day of 1 ( , 20 10 , by oOQ,T� LeC- t n) day of who is,ersonally known to me or who has produced l w o is As identification and who did take an oath. ( I NOT ;i' Y PUBLIC: . 1 4 M L COCCHIARELLA . • "c MY COMMISSION # DD88�16 Ar EXPIRES March 10, 2013 (407) 398.0153 Florwallotary8ervbe.com Sign: n Print: ' AA ,A� v! L-' CV U- 6+1 My Commission Expires: 31,0 Za13 APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) 0 1 � la Plans Examiner Engineer oine ' nstrument was ackno , 240, by ersonally kno to me or who has produced OTARY PUBLIC: Sign: Print: Contractor dged b fore •i e this IS , ,v , O I cation and who did take an oath. ' A 4 � r ) 1 ' 1 AG My Commission ExpgefcSa= 4f Zoning Clerk checked PRODUCER Presidential Insurance Services, LLC 7500 SW 57th Ave `Slauth Miami, FI.33143, INSURED Acer Plumbing 1851 NE 208 Tarr Miami 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 CONDrON 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 I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLJCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCER BY PAID CLAIMS. ;Asa ADD'L LYR NERD. TYPE OF INSURANCE A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 1 CLAIMS MADE El OCCUR GEN'L AGGREGATE LIMIT APPLIES PER; TO POLICY f EC IJLOC AIJrQrIOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED ALrTOS HIRED AUTOS NON -OWNED AUTOS GARAGE UABILTrY 7 ANY AUTO DEDUCTIBLE EXCESS / UMBRELLA UIBILITY OCCUR I CLAIMS MADE RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABIIJrY Y / N ANY PROPRIETOR/PARTNER/EXECUMIVE.l l OFFICERIMEMBER EXCLUDED? (Mandatory in NIT) if Yes, dmcnbe under SPECIAL PROVISIONS below OTHER CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL. 33138 ACORD 26 (2009101) CERTIFICATE OF LIABILITY INSURANCE FL POLICY (IUNBBR IJDuErEFFEcnvE I TF D/ t FCAIR -1 305- 668 -0881 33179 INSURER A INSURER B& INSURER C INSURER D: INSURER E: 2/9/2010 DESCRIPTION OF DPERATION$ LOCATIONSI vo4tCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIALPROV ISIONS The ACORD name and logo are mists 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE Lloyd's of London CANCE POLIO EXPIRATION Lpuvss EACH OCCURRENCE $ 1,000,000 `DO R ENTED „ o PREMISES acLVnBnLNI 0 50,000 MED EX? (MY ono Pelson) S 5,000 2/92011 mensorm & ADV INJURY s 1,000,000 GENERAL AGGREGATE $ 2,000,000 TION AUTHORIZED :3:I ESE d marks of ACORD PRODUCTS - COMP /OP AGG COMBINED SINGLE LMrr (Es am :Mom) BODILY INJURY BODILY INJURY (Par ocrldant) PROPERTY DAMAGE (Pet accident) AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ AUTO ONLY; A00 $ EACH OCCURRENCE $ $ AGGREGATE TQ S ER E.L EACH ACCIDENT $ EL DISEASE- EA EMPLOYEE, $ E.L DISEASE - POLICY. LIMIT S DATE (MMIDDIYYYY) 4/15/2090 $ 1,000.000 $ NAIC # MOULD ANYOFTHEABOVEDIT IBED POUCIE $ EECANCELLED BEFQRETHE ertPIRATION DATE THEREOF, THE *SOUIIIG INSURER WILL ENDEAVOR TO MIW. 10 DAYS WRITTER NONCE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIA OP ANY RINO UPON THE INSURER, KB AGENTS OR REPRESENTA 2009. &TRD CORPORATION. All rights reserved.