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PL-11-1418
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 162885 Scheduled Inspection Date: August 24, 2011 Inspector: Hernandez, Rafael Owner: LEWIS, MUSLIMA Job Address: 9343 NE 9 Place Miami Shores, FL Project: <NONE> Contractor: EH WHITSON PLUMBING Permit Number: PL -8 -11 -1418 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050070110 Phone: 954- 929 -3599 Building Department Comments RUN NEW GAS LINE FROM METER TO THE HOUSE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 23, 2011 For Inspections please call: (305)762 -4949 Page 12 of 23 1 t DROP TEST ct :sToMER. A Dm i i•SS_ ?3C/3 jjfTfrf:. _in S'-x-e,ics- Pi 1()r'1 1 II. \\ III I '-NON P31 .11\;:i.. 1,1 ,,4,11; 114.01 1 ; t lit;i) ();1_9:19_1CQL1 /lop 1 cst St' 2 _ cid Yes No clf I PLEASE INQUIRF. ABOUT OUR AIR CONDITIONINK; & ELECTRICAL SERVICES • _ • _ ■■• •-- ■•-- • --_, • - .:')c4 Ci.`1,„15,01 I: -N Atiiircts rt•t:,•11Nt hiNon eon \ Vt,t,...1, silt- IA ‘`. Chlt1111COn ct,t111 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 Permit NO.0 )41? BUILDING PERMIT APPLICATION FBC 20 AUG 0 2011 PJJ BY: ..e ...............aseso Master Permit No. Permit Type: PLUMBING OWNER: Name ((FL e Simple Ttleholder): M' Ma e PhoneT$b 3e 4230 Address: ,N � / a tJ City: II 1 .ii /' :C State: Zip: 31. Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: `� /V - / P/c ?( City: Miami Shores County: Miami Dade Zip:.9. Folio/Parcel #: 1 1 °' 3205- bO7 -CI 1 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 4-1 Wh fr5L)J1 Phone# q2 { 3 q Address: City: Qualifier Name: State: ±0 Zip:3 ��) Phone #: q State Certification egistration #: L4 2S7 Certifi . to of Contact Phone #: or r "� Email Address: {%_ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2-300)1 00 Square/Linear Footage of Work: Type of Work: °Address ❑Alteration /.14-ew °Repair/Replace °Demolition Description of Work: &ALAI ******** * * * * * * * * * * * * * *** *** *** ****** *** Fees************* * **** ******* *** ** * *********** ** Submittal Fee $ Permit Fee $ (S / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 11)*: 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, BOTT.RRS, 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 i ; st promise in good faith that a copy of the notice of commencement and construction lien law brochure l be deliver ' to the rson whose property is subject to attachment. Also, a certified copy of the recorded notice o v ° nence for the first inspection which occurs seven (7) days after the building permit is • ued. 1 th�.sen of s //7 poji % not the inspection will not be approved and a reins ection fee will be charged. Owner or Agent / on ctor The foregoing instrument was acknowledged before me this 1 The foreg g instrument was acknowledged before me this day off 4 , 20 I , by day of Ii / , 20 C )by who is personal y known to me or who has produced L- who ersonall kno � to me or who has produced as identification and who did take an oath. NOTAR - PUBLIC: As identification and who did take an oath. My Commission Exp * * * * * * * * * * * * * * ** APPROVED BY Sign: Print: My Co *********************** *******+x** **** ** ************* ** **** ** * *+x****+x+x** **** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06110/2009)(Revised 3/15/09) '4 °-�� CERTIFICATE OF LIABILITY INSURANCE _A 8/4/201 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 policy(ies) must be endorsed. If SUBROGATION IS 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 Keyes Coverage, Inc. 5900 Hiatus Road Tamarac FL 33321 TACT Deanna Elias Eat): (954) 724 -7000 i .No4 (954)724 -7024 ADDRESS: PRODUCER 00012193 CUSTOMER ID #:' INSURERS) AFFORDING COVERAGE NAIC # INSURED E.H. Whitson Plumbing Al & John Enterprises, Inc. dba 423 S. 21st Avenue Hollywood FL 33020 INSURERA:Allied Property & Casualty Ins 42579 INSuRERBNationwide Ins Co of America 25453 INsuRERcNationwide Mutual Ins Co. 23787 INsuRERDBridgefield Casualty Ins Co 10701 INSURER E PRM TO RENTED PREMISES (Ea occurrence) INSURER F COVERAGES CERTIFICATE NUMBER :11 -12 EH Whitson Plumbin 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. IN SR TYPE OF INSURANCE ADD INSR yip POUCY NUMBER (MM ID Y (MMMIDCO YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR ACPOLP05904902956 3/7/2011 3/7/2012 EACH OCCURRENCE $ 1,000,000 X PRM TO RENTED PREMISES (Ea occurrence) $ 100 r 000 CLAIMS -MADE X MED EXP (Any one person) $ 0 X Blk Waiver Subrogation PERSONAL & ADV INJURY $ 1,000 ,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X JEC LOC $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Comp $50 / Coll $1,000 BCPCPP &5904902956 3/7/2011 3/7/2012 COMBINED SINGLE UMIT (Ea accident) $ 1,000,000 X �DILYINJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ C X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 5113709974 3/7/2011 3/7/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ X $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER OFFl a ER EXCLUDED? (Mandatory tory In In NH) If yyes describe under DESCRIPTION OF OPERATIONS Y / N N! A 196 -26105 4/12/2011 4/12/2012 Y WC STAMITS TU I OTHER - TORY LI E.L. EACH ACCIDENT $ 500,000 $ 500,000 CU7IVE E.L. DISEASE - EA EMPLOYEE below E.L. DISEASE - POUCY UMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) CERTIFICATE HOLDER Miami Shores Village building Department 10050 N.E. 2nd Avenue Miami, FL 33138 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 Carey Keyes/DE '"�"ar'.'if""+0' ACORD 25 (2009/09) INS025 (200909) ©1888 -2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E.H. Whitson Plumbing 421 South 21st Avenue Hollywood, FL 33020 CFC1425789 Survey Sheets / Plans /7J5 /&,"/„.6 ?‘.8 „P .0°19e ie. J,0007/ I r/7•' aJ /1.0,4".6 Customer Name: Address: City, State, Zip: Phone #: All Work to Comply With N.E.P.A. Code #: /`' � ('2 :/7- -W � D Estimated Job Cost: Z 34 • Description of Work: ikvles.S G/fr 11 a93 polet/-erg--1 agera-- Piping ISO Lit 421_ (.:;01.111) 71 s..1. Hollyvvm-y1, I Cr( -1,12.57P,f Survey Sheets Plans or-A:0mm Nome.: Address: Stotp, Phgne it: All V\Ifirl< 1-) (Torn pi ( )(-le ,47/Afre, 44 E. EFAimt0 Jo, 1.1)e'3tzi-ipt-iori nf \Not k Astfi';',#1 --cAe Mrn 114 '..ePfc' Po,74,401 • ROSSI # DD 930571 ;z4t4iPtz.S: October 5, 2013 rat, Natal Pubic Wanders G�'If,/ ogit ,7;_2, 20. 7-Aorrne, ae,x'er. 4140Z---