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.