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PL-11-983Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160368 Scheduled Inspection Date: June 10, 2011 Inspector: Hernandez, Rafael Owner: PACE, BRUCE Permit Number: PL -5 -11 -983 Job Address: 69 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: BOB'S PLUMBING CO INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060131150 Phone: 305 - 229 -9932 Building Department Comments REPIPE WATER SYSTEM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 09, 2011 For Inspections please call: (305)762 -4949 Page 9of12 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: City: ems � E yip 3 1 2011 fi BY: Master Permit No. L y Phone#: e' 1 3- -79 a ,i %s State: Zin: -3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: r Qc Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: e( j` P,_1 �b t hC C� Address: a 5 � 9 A,Je d'1 U�- City: tr t A /x"11 Qualifier Name: (;ilh e (O55 ' State Certification or Registration #: C C055 (09-`, Contact Phone # - /2 9 ° �iq 3 Z Email Address: State: Phone #c.O » 2 ' q 9 ��.. Zip: 33 I (0 s Phone #L y1 lO 't- zz } _ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone #: of Work for this Permit: $ 4,1 o QC) Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ❑New 121(epair/Replace ODemolition Description of Work: f -y� - **** *** *********** ********************* Fees**** ***** ********** ***** ********* ** ********* Submittal Fee $ Permit Fee $ / 5-0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 65 -q° r�� Wk 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 AMk'IDAVIT: 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 ap ed and a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was ac owledged before me this ( The foregoin day of 0 1 ,20 It ,by L1 Chl.1h cbd( who is personally known to me or who has produced vet Lk ceh As identification and who did take an oath. NOTARY PUBLIC: Signature Sign: Print: tie -tom L Carmen Lugo My Commission Expires?�r. ...COMMISSION 0D722503 Gil ,,,: ;4l /mac ,���• • 0�� EXPIRES; NOV. 25, 2011 9 ���hinto° WWW.AARONNOTARxcom ° ° °i; OFG��O`` yyy,/yy. 9NNOTARY.COrt1 *************:*************************************************** ***** *********** *** * * *�x+t'<�k` **** * * * *�x�x�x�x*** *** r p APPROVED BY .. ' C ` f'-1/ Plans Examiner Zoning Structural Review Clerk day of who Contractor ins u ent was acknowledged before me this 161 , 2011 , by r) E. t) t75s-o— , me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: 4\u_s Print: Ca use h Luq 0 My Commission Expires: �.�`�1 Y'P„° Carmen Lugo _R.• ,.,' c :COMMISSION #DD722503 3� • -'-�= EXPIRES: NOV. 25, 2011 (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) OP ID: NM '`,� °� CERTIFICATE OF LIABILITY INSURANCE DATE(M20 /1YYY1f) 04/20/11 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 poilcy(ies) must be endorsed. If SUBROGATION 15 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 305 455 -7250 Global Risk LLC❑❑ 5959 Blue Lagoon Dr Suite 101 ❑ ❑ 305-455 -7251 Miami, FL 33426 ❑❑ Gayle Bainbridge COONMEACT (ajccNNo. �); FAX , No): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: BOBSP -1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Bob's Plumbing Co., Inc.❑❑ 4055 SW 89 Avenue❑❑ Miami, FL 33165 INSURER A: Gemini Insurance Company OCCUR INSURER B : Mapfre Insurance Company of FL INSURER C : Technology Insurance Company 11/28/10 INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGES (RENTED PREMISES (Ea occurrence) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE IA SR WVD POLICY NUMBER (MMMIUDDY/YYYY) (MMIDDIYYYYY) OMITS A GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY OCCUR VIGP012768 11/28/10 11/28/11 EACH OCCURRENCE $ 1,000,000 X DAMAGES (RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 PR LOC X POLICY $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 4150110004169 02/28/11 02/28/12 COMBINED SINGLE LIMIT (Ea acddent) $ BODILY INJURY (Per person) $ 100,000 BODILY INJURY (Per accident) $ 300,000 X PROPERTY (Per accident) $ 50,000 X X $ $ UMBRELLA LJAB EXCESS LJAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' UA BIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y/ N N/A TWC3250764 09/01/10 09/01/11 r (TORY LIMITS i IOER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION QF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Plumbing- ommercial/Residential E 0 0 0 CERTIFICATE HOLDER CANCELLATION Miami Shores Village❑❑ 10050 NE 2 Avenue❑ ❑ Miami Shores, FL 33138 I 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 1 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD