PL-11-2034Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 166176 Permit Number: PL -11 -11 -2034
Scheduled Inspection Date: November 09, 2011
Inspector: Hernandez, Rafael
Owner: COLLINS, BARBARA
Job Address: 9100 NW 1 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BREIER & SONS PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010160060
Phone: (786)525 -7547
Building Department Comments
REPLACE STOLEN COPPER LINES UNDER HOUSE.
REPLACE WITH CPVC
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 08, 2011
For Inspections please call: (305)762 -4949
Page 19 of 32
—
B I DIN
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
NO 0.1 2011
BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 I l
Permit No. i 41 -()(Z
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): 1 (�air( S • h�t 4�n teict j
Address: q100 N
city: korr i Shore.)
one#:
State: 1 Zip: 33 )30
Tenant/Lessee Name: Phone#:
Email: -i °''D04 *OO
«yr .
JOB ADDRESS: q I k1.e0 O Ate.
City: Miami Shores County:
Folio/Parcel #: I " 3 ) O I - ®1 (0 - 0000
Miami Dade Zip: 33150
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: freer SOn5 IG`Ifl9 ilic, Phone #: —7( ?)(D-5-5- 154
Address: tl3CI d
City: t\ O1-V tI 2 flI f aril State: PI Zip: 33/ iOdk
Qualifier Name: RAVI 01 1.51fe,1 �)f Phone#: c 3 ` 53 5 - .34 '
State Certification or Registration #: C Fa 135 a Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
4,0
Valve of Work for this Permit: $ 12® 0
Type of Work: ❑Address
Description of Work: taf
UAlteration
Square/Linear Footage of Work:
RRepair/Replace
New
❑Demolition
I1o'.)
***************************************F ***F **+ r********** ******************** * *** * * ** **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
/06 CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1 CYr U `50
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.
r
Signature t (/ 4 ! -._„(�
Owner or Agent
The foregoing �i_nsstruu instrument was acknowledged before me this A Ile
day of 4V�w , 20 11, by � ' S A Ul L eA- �►�],�
who is personally known to me or who has produced ?1,... WAS
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
O
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
a
�+ ; Joanna Moreno
N s My Commission DD900933
40 foir Expires 06/21 /2013
Signature
Contractor
The foregoing instrument wasiacknowledged before me thi
day of l " \ie-C1494(20 IL, by (i 't re?-(r
who is tersonally u wi to me or who has produced
as identification and who did take an
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: /0 — 8° (4"
w, x ****a: ****+x** ** * *******,x: +x+s+ **** * **** **,z,x********** :,x*****e**** ****+x**********
if z-- (/
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
BREIER, DAVID HARRY
BREIER & SONS PLUMBING INC
17201 NE 11TH AVE
NORTH MIAMI BEACH FL 33162
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you bette
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn more about the
Departments initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license
DETACH HERE
IS CERTIFIED under the provisions of Ch.489 Fs
sz3xatiOfl =nat®c AUG 31-.: '2012 M10061100623 .
-
LI00 0069
DATE BATCH NUtBEF2
06/11/2010 098174778 CFC
The PLUMBING CONTRACTOR
Name below ISRTIFI`
tinder the provisions of ' C.
Expiration date: AUG 31,
BREIER, DAVID BAR'.R3
BREIER & SONS ; PLU1►I
17201 NE 11TH AVE -
NORTH MIAMI. BEACH
162
, - _ ----- --,
MIAllf-13ADE COUNTY 2011 LOCAL. SUSItiESS TAX RECS1PT - 2-0:1 ' F1RST-CLASS
TAX OLLECTOFt - - tarAyai-ziAzi-E actrTiTy - OF FLORIDA U.S; CS GC
' TON.iFLAGLER ST EXPIRES azp.T. SG, 2an PAID_
ist FI4U°R ' ties-r SE O;SPLAYEC AT PLAC OF BUSINESS - _ i MIAMI, 1..
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604951-4 " RENEWAL
THIS IS -,•-v-r L -RI, — -6` ',,: - .., --;:,,,,,,,
Buillereitagiii%itiPLIJIMBI146 INC STAT tizarg2 2-7
17201 NE 11 AVE 7352
33162 Ufilig DADE COUNTY
°BREIER & SONS pLUngING INC
s°11vgefl,tillieftle CONTRACTOR 1
tiORNER/S
TIES IS ONLY A LOCAL
BUSINESS TO RECEIPT. rr
IROSTEM necturrenY on
EOMNO LAWS OF THE
NOES a exzwiPr THE
COUNTY OR CITIES. nun DO NOT FORWARD
noimett ERONI ANY OTHER
PRM' OR LICENSE
ouns) errur. THIS IS
NOT A CERTIRCATION OE
THE nowErrs anAtnicA-
rants.
RAYZENT REcisivED
NImmoActe coutrrr TA!(
couxer0a:
00/19/2011
09010024001
000075.00
SEE OTHER SIDE
BREIER & SONS PLUMBING INC
DAVID BREIER PRES
17201 NE 11 AVE
MIAMI FL 33162
WhAmiliihn4,1,1hhihmAhhhil.""Wil
Ph-
AeORET CERTIFICATE OF LIABILITY INSURANCE
kom-- -�
DATE(MM/DDIYYYY) .
09/12/11
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 POUCIES
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 pollcy(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
M S Services Of South Florida
3651 NW 50th Street
Miami, FL 33142
Phone (786)514 -4782 Fax (305)403 -5611
CONTACT
NAME:
/ucD No Ezt): (786)514 -4782 FAX
. NQI: (305)403 -5611
AD cgs. sholominsurance@gmail.com
INSURER(S) AFFORDING COVERAGE
NAIC 0
INSURER A: GRANADA INSURANCE COMPANY
INSURED
Breier & Sais Plumbing, Inc
17201 NE 11 Ave
Miami, FL 33162-
INSURER B :
04/19@011
INSURER C :
EACH OCCURRENCE
INSURER D :
J COMMERCIAL GENERAL LIABILITY
• • CLAIMS -MADE .n OCCUR
INSURER E :
$ 100,000.00
INSURER F :
$ 5,000.00
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED 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
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
IMM/DDIYYYY)
POLICY EXP
IMMIDDIYYYYI
LIMITS
A
GENERAL LIABILITY
0185FLOt1025777-0
04/19@011
04/19/2012
EACH OCCURRENCE
$ 500,000.00
J COMMERCIAL GENERAL LIABILITY
• • CLAIMS -MADE .n OCCUR
DAMAGE TO RENTED
PREMI SES (Ea occurrence)
$ 100,000.00
MED EXP (Any one person
$ 5,000.00
PERSONAL & ADV INJURY
$ 500,000.00
•
GENERAL AGGREGATE
$ 500,000.00
GENII AGGREGATE LIMIT APPUES PER
• POLICY • JECT • LOC
PRODUCTS - COMP /OP AGG
$ 500,000.00
$
AUTOMOBILE LIABILITY
❑ ANY AUTO
• AAA NED ❑ SCHEDULED
AUT
GOMBIdED SINGLE UMIT
(Ea
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per acddent)
$
❑ HIRED AUTOS A W"ED
■ •
PRrOPY riAGE
$
$
UMBRELLA LIAR an OCCUR
• EXCESS LIAR • CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
❑ DED • RETENTION $
$
WORD COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N 1 A
II TWCRY ATU- ITS = ER
E.L EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
E.L DISEASE - EA EMPLOYE
$
If desaibe under
DESCRIPTION OF OPERATIONS glow
EL DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
i
City Of Fat Lauderdale
Building Department
700 NW 19th Avenue
Fort Lauderdale, FL 33311-
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
Sholom Weinfeld
ACORD 25 (2010 /05) QF
@ 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
ADDITIONAL INTEREST SCHEDULE
DATE (MMIDD/YYYY)
09/12/11
AGENCY
M S Services Of South Florida
CARRIER
Granada Insurance Company
NAIC CODE
POLICY NUMBER
0185FL00025777 -0
EFFECTIVE DATE
04/19/11
NAMED INSURED(S)
Breier & Sons Plumbing, Inc
ADDITIONAL INTEREST (Not all fields apply to all scenarios - provide only the necessary data)
INTEREST
ADDMONAL INSUREI LOSS PAYEE
❑
BREACH OF
❑ WARRANTY ❑ MORTGAGEE
❑ CO -OWNER ❑ OWNER
EMPLOYEE ❑ AS LESSOR ❑REGISTRANT
❑ oLEASEBACK ❑ TRUSTEE
❑ LIENHOLDER
v Certificate Holder
NAME AND ADDRESS RANK: EVIDENCE: V CERTIFICATE • POLICY ❑ SEND BILL
INTEREST IN ITEM NUMBER
Star Creek Apartment
NE 191 Street
Miami FL 33179-
LOCATION:
BUILDING:
VEHICLE
BOAT:
AIRPORT:
AIRPORT:
AIRCRAFT:
CUSS:
ITEM:
REM DESCRIPTION
REFERENCE 1 LOAN #:
INTEREST END DATE:
LIEN AMOUNT:
PHONE (A/C, No, Ext):
FAX (A/C, No):
REASON FOR INTEREST:
E-MAIL ADDRESS:
INTEREST
ADDMONAL INSURED ❑ LOSS PAYEE
❑
BREACH of
❑ WARRANTY ❑ MORTGAGEE
❑ CO-OWNER ❑ OWNER
EMPLOYEE ❑ REGISTRANT
LEASEBACK ❑
❑ OWNER
❑ LIENHOLDER
V Certificate Holder
NAME AND ADDRESS RANK: EVIDENCE: V CERTIFICATE • POLICY ❑ SEND BILL
INTEREST IN REM NUMBER
City of Fort Lauderdale
700 NW 19th Avenue
Fort Lauderdale FL 33311-
LOCATION:
BUILDING:
VEHICLE:
BOAT:
AIRPORT:
AIRCRAFT:
CLASS:
REM:
ITEM DESCRIPTION
REFERENCE / LOAN #:
INTEREST END DATE:
LIEN AMOUNT:
PHONE (AIC, No Ext):
FAX (A/C, No):
REASON FOR INTEREST:
E-MAIL ADDRESS:
INTEREST
ADDITIONAL ❑ LOSS PAYEE
❑ INSURED
❑ %AR neOF .
CO -OWNER II OWNER
NAME AND ADDRESS RANK: EVIDENCE: ❑ CERTIFICATE ❑ POLICY ❑ SEND BILL
INTEREST IN REM NUMBER
City of Margate Building Department
901 NW 66 Avenue
Margate FL 33063-
LOCATION:
BUILDING:
VEHICLE:
BOAT:
AIRPORT:
AIRCRAFT:
AS LESSOR REGISTRANT
■ LEASEBACK • TRUSTEE
• LIENHOLDER
n Certificate Holder
CLASS:
REM:
ITEM DESCRIPTION
REFERENCE / LOAN #:
INTEREST END DATE:
LIEN AMOUNT:
PHONE (A/C, No, Ext):
FAX (A/C, No):
REASON FOR INTEREST:
E-MAIL ADDRESS:
INTEREST
• raDMONAL ❑ LOSS PAYEE
BREACx of
• WARRANTY ii MORTGAGEE
• CO-OWNER ill OWNER
EMPLOYEE • REGISTRANT
AS LESSOR K . TRUSTEE
• UENHOLDER
NAME AND ADDRESS RANK: EVIDENCE: • CERTIFICATE ❑ POLICY • SEND BILK INTEREST IN REM NUMBER
Miami Shores Village Building Department
119050 NE 2nd Avenue
Miami Shores FL 33138-
LOCATION:
BUILDING:
VEHICLE:
BOAT:
AIRPORT:
AIRCRAFT:
ITEM
ITEM:
DESCRIPTION
REFERENCE / LOAN #:
INTEREST END DATE:
V Certificate Holder
LIEN AMOUNT:
PHONE (AIC, No, Oct):
FAX (AIC, No):
REASON FOR INTEREST:
E-MAIL ADDRESS:
INTEREST
1. ADDMOt4AL • INSURED ❑ LOSS PAYE?
BR
W EACH OF r F ❑ MORTGAGEE
• CO -OWNER • OWNER
• A�.SPLESSOR REGISTRANT
■ LL CK ■ .RUSE
OWNER
II LINHOLDER
0 Certificate Holder
NAME AND ADDRESS RANK: EVIDENCE: ❑ CERTIFICATE • POLICY ❑ SEND BILL
INTEREST IN ITEM NUMBER
City of Miami Building Department
444 SW 2nd Avenue, 4th Floor
Miami FL 33130-
LOCATION:
BUILDING:
VEHICLE:
BOAT:
AIRPORT:
AIRCRAFT:
CITEM
LASS:
REM:
REM DESCRIPTION
REFERENCE 1 LOAN #:
INTEREST END DATE
LIEN AMOUNT:
PHONE (A/C, No, Ext):
FAX (A/C, No):
REASON FOR INTEREST:
E-MAIL ADDRESS:
BDPSEl561)311: OI5*1RG
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U f IBDPSEIobn f lboelrphplbsf !sf hjt If sfeln bsl t 1paBDPSE
02 -25 -2011
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE:
PERSON:
FEIN:
04/28/2011 EXPIRATION DATE 04/27/2013
BREIER DAVID H
200862456
BUSINESS NAME AND ADDRESS:
BREIER & SONS PLUMBING INC
17201 NE 11TH AVE
NORTH MIAMI BEACH FL 33162
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED PLUMBING CONTRACTOR 2- PLUMBING
IMPORTANT: Pursuant to Chapter 440 . 0304), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, al any time after the filing of the notice or the issuance of the certificate, the person named on the notice 01
certificate ao longer meets the requirements of this sectiea for issuance of a certificate. The department shall revoke o certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
QUESTIONS? {850) 413 -1609
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 04/28/2011 EXPIRATION DATE: 04/27/2013
PERSON: DAVID H BREYER
FEIN: 200882450
BUSINESS NAME AND ADDRESS:
BREIER & SONS PLUMBING INC
17201 NE 11TH AVE
NORTH MIAMI BEACH. FL 33162
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING CONTRACTOR 2- PLUMBING
IMPORTANT
Pursuant to Chapter 440.05 {14), ES., an officer of a corporation who
O elects exemption from this chapter by filing a certificate of election
1 under this section may not recover benefits or compensation under this
D chapter.
H Pursuant to Chapter 440.051121, F.S., Certificates of election to be
exempt apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt
E Pursuant to Chapter 440.05{13) F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named an the certificate to meet the requirements of this
section.
QUESTIONS? {850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11