PL-11-1812Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 165068
Scheduled Inspection Date: October 17, 2011
Inspector: Hernandez, Rafael
Owner: OSTERGAARD, OLE
Job Address: 307 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: THE NEW MIAMI SHORES PLUMBING
Permit Number: PL -10 -11 -1812
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1132060136000
Phone: (305)751 -2446
Building Department Comments
Remove and cap refrigerator and sink lines
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 14, 2011
For Inspections please call: (305)762 -4949
Page 22 of 31
Oct 11 11 07:23a MSP 3056887382 p.3
AC•RD®
CERTIFICATE OF LIABILITY INSURANCE
DATE (M .14201 TY)
8/23/2011
THIS CERTIFICATE 15 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 tho certificate holder is an ADDITIONAL INSURED, tho policy(les) must bo endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on thls certificate does not confer rights to the
cartificato holdor In Ilou of such endorsement(s).
PRODUCER
Keyes Covorago Insurance
00 Hiatus Road
Tamarac FL 33321
IN3uMeD
New Miami Shores Plumbing, Inc.
Miami Shores Plumbing
90D NW 149th Street
Miami FL 33168
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INSURER B :�0.1;10EitOrE Ins Co/Na tiorlwide
INSURFRCtHanover Insurance ComOaiw
INSURER D : Drj dgef i eid Employers Ins Co
INSURER E :
INSURER F t
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42587
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COVERAGES
CERTIFICATE NUMBER:61932915
REVISION NU
THIS
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IS
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INDICATED. NOTWITHSTANDING ANY
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INSURANCE
REOUIRIMENT,
OR MAY
AIDE
iNSR
PERTAIN,
OF
SUBIT
intro
LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
TERM OR CONDITION OF ANY CONTRACT
THE INSURANCE AFFORDED BY THE POLICIES
SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN
NAMED
OR OTHER
DESCRIBED
REDUCED
Pui7i•V'E*P"
tMM5) YYl
ABOVE FOR THE POLICY
DOCUMENT WITH RESPECT TO
HEREIN 15 SUBJECT
BY PAID CLAIMS,
TYPE OF INSURANCE
_
POLICY NUMBER
POLICY EFF
IMMIDD/YYYY1
UM175
R
GENERALUABILI'IY
X
COMMCRgAL GENERAL
LIARILITY
U OCCUR
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Y
R7J3E41050 04
8/23/2011
8/23/2012
FACHOCCURRENCE
31,000,00Q
IRaneSdS 1du ccuru
PRENISLS IC:r xLVrturcv)
5 100, 000
.I CL54MS ,4APF.
,
MFDFXP(Any nnerprmtun)
55.000
PERSONAL 6 ACV INJURY
$1,000,000
GENERAL ACCRFC,ATF
$2.000, 0UU
GENI. AGGREGATE LIMIT
APPLIES PER
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PRODUCTS • COMP•O AGG
52.000, 000
32 , 000
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i POLICY .IFCOT�
Deg: PD
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AUTOMOBILEUABILITY
X
I ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
t-0Hh:D AUTOS
NON -OWNED AUTOS
Y
11APC 3929002319
7/1/2011
7/1/2012
COMBINED SINGLE UMIT
(E3 3eei4 u)
51. coo ,ouo
BODILY INJURY (Ply poson)
$
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0/23/2012
0/23/2012
CACHOCCURRENCE
$s,000,000
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$,000,000
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RETENTION 30
Cumple Lel1 Op.
55, 000, 000
X ...TM $' Ilk
$
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WOHKCHSCOMPENSATION
AND OMPLQYERS• LIABILITY
ANY PROPRIETORPARTNEIWNEEXECUTIVE
(mummy In WMEMHt)I:xCL000D7
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Urns, describe der
DESCRIPTION under
RIPTION OF OPERATI• 5
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8/23/2011
_CL_EACH ACCIDENT
E.L. DISEASE • CA ,_$100,000
holOw
El. DISCAOC • POLICY LIMIT
5500.000
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VENICLCS (Attach ACORD 101, AddINonal Ramirka Scti dula, If more apSCrr M tlpulroa)
CERTIFICATE HOLDER
CANCELLATION
Mi,.`lrni Shores Villago
10050 NW 2nd Ave
Miami Shores FL 3313R
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED
BEFORE THE EXPIRATION GATE THEREOF. NOTICE WILL eta DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORi2ED REPRESENTATIVE
ACORD 25 (2009/09)
®1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Oct 11 11 07:22a
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FL.AGLER ST.
1s1 FLOOR
MIAMI, FL 33130
MSP
3056887382
2011 I
MIAMI -DADE COUNTY SS TAX ATE OF FLORIDA
2012
FLORIDA
. EXPIRES SEPT. 30, 2012
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10
THIS IS NOT A BILL - DO NOT PAY RENEWAL
001730 -1
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO 231
001730 -1
au IAI aSRTIL STAY# c I C 9205 MM HOESPUMBING
900 NW 144 ST
33168 UNIN DADE COUNTY
OWNER
THE NEW MIA SHORES PLBG INC
Soe T4 go of err loess
Tut IS ONLY A LOCAL
SUE NESS TAX RteeIPT. {T
DOES NOT PPNMST 'MS
HOLDER TO Y1Q1.ATE A,IY
EXIST{NC ,tEGULATORY OR
ZONING LAIRS OP THE
CogNYY OR DOLS ry EX 7 P1 N E
HOLDEN FRO,• ANY OTHER
PERMIT OR LWO
REQUIRED DY LAW. THIS ra OF
MOT A THE HOLDER'. OUAALLINFIC'
•LOWS.
I PL MBiNG CONTRACTOR
vwYMENT AECEWI:D
I Li W •QAOE GDUNTY TtA
ooLLZCToA.
08/02/2011
60030000019
000075.00
SEE OTHER SLOE
WORKER /S
10
DO NOT FORWARD
MIAMI SHORES PLUMBING
THE NEW MIA SHORES PLBG INC
900 NW 144 ST
MIAMI FL 33168
iLI lilt ,illl „li,il,li „lt {tillJJlll,l lllllllll] {,Ills „1�b1
p.1
3056887382
1P.cit 4993859
STATE OF FLORIDA
DEPARTMENT BUSINESS ANDRYRLICENSINGLBOARULATION
SEQ# 1,10061400568
YICENSE NBR
06/14/2010 090982272 ICFC019205
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 989 FS.
Expiration date: AUG 31, 2012
MCLAUGHLIN DENNIS MICHAEL
THE NEW MIAMI SHORES PLUMBING INC
900 NW 149TH STREET
MIAMI FL 33168
CHARLIE CRIST = CHARLIE LIEM
INTERIM SECRETARY
GOVERNOR
DISPLAY AS REQUIRED BY LAW
J
'fibI �e�lI- kticv-1
BUILDING
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 APPLICATION
FBC 20
Permit Type: PLUMBING
O3/ � / � �,h � Phone #:3 � / //L % v,
Address //>> E /��` �7 —r-
Permit No. ^ /7-7P4.2
Master Permit No.
City:
State:
Zip: 03 /mac
Tenant/Lessee Name: Phone #:
Email:
>[ JOB ADDRESS: (O�J
/\ City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
County:
Miami Dade
Zip:
,\ O mpany Name : f Y4
re s• 1 I(I ./
hone#•, 3 %� <? (j g4
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 2"E D Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration
Descri ' ' n of Work:
❑New ❑Repair/Replace
h (p C )6.J7 1aisr
❑Demolition
x*****u:********* * * *** ** ******** ***** ** *Fees*+x*** ** * * *** * *** * * *** x** * * * *** * * ** x** ** *****
Submittal Fee $ S� Permit Fee $ / CCF $
CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ _ Structural Review $
TOTAL FEE NOW DUE $ 5 v ( 0
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.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of °�i , 20 ( ,,.X
, by _ CkS A
who is personally known to me or who has produced I9
As identification and wh\ortAiiditakfwpoath.
$.�;