PL-11-1896t
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165490 Permit Number: PL -10 -11 -1896
Scheduled Inspection Date: November 16, 2011
Inspector: Hernandez, Rafael
Owner: HYNES, ANTHONY
Job Address: 302 NE 100 Street
Miami Shores, FL
Project <NONE>
Contractor: PSG PLUMBING SERVICES, INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060135470
Phone: (305)796 -7304
Building Department Comments
REMODELING BATHROOM
Passed
i
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 15, 2011
For Inspections please call: (305)762 -4949
Page 16 of 43
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 1 ]
BUILDING Permit No. ` l —
PERMIT APPLICATION Master Permit No. c /O / /—az
FBC 20 t
Permit Type: B R _
OWNER: Name (Fee Simple Titleholder): Ptefre i/f2- Phone #:
Address: ‘7767R /h //
City: d26!®rm iTepierY, State: .A.?..'
( I Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: ...?OO /696-= /8 "
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: PS6 ?1&4a.,Vc E7 c 7 ' c Phone #:
Address: a ¥9a ,A JW / 2,r S -r
City: 0 d — Loc '"'c- 3 goS ` .
ty: � state: � zip:
Qualifier Name: P 0 4i) c c, Z A-to Phone #: 65 7F4 - 73) ('
State Certification or Registration #: 21-e /c/2‘2,5--2 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ / / ®6 •lad Square/Linear Footage of Work:
Type of Work: ❑Addition
Description of Work:
11)Ie A
, C_.v,
//. 4
❑Alteration ❑New
44,0 o 6L iQ fh 4-t-H a ®aµ
uQ -4-u 65 •
epair/Replace ❑Demolition
Submittal Fee $ CO Rio Permit Fee $ /571 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ " t b� t
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, BOII.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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap roved and a reinspection fee will be charged.
Signature
Owner or Agent II
The foregoing instrument was ackn /owledged before me this t4
day of 1 , 20 l L , by ►v11`Y1 li%L(,' s1 �� 3 Z ,
who is personally known to me or who has produced 6"'t l
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * *** * * * * * **
APPROVED BY g
\ \\ , t111 u ! 111 /i, ////i
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706
The foregoing instrument was acknowledged before me this 1`,"
day of f7cf Cpr , 20/ / , by c rn'cc) S 24-4 ,0'J
who is personally known to me or who has produced )�
as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
1�
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789013 • '�
IIDD . —
St 42
419/01/c, sine
Zoning
Clerk
TNO.a
535261 -2
BUS SS NAME /LOCATION
P56 P UMBING SERVICES INC
3892 NW 125 ST
33054 OPA LOCKA
OWNER
PSG P12:2:4P12:2:410 SERVICES INC
sec R ofi WORKER /S,
196 P UMSING CONTRACTOR 1
I dILY
VAX E A R
MOT PEEWIT , .
TO VIOLATE
Ol OS
LAWS OF I WW
��O'.�OR
ITFROMMArY Ot16i..
on LICENSE
YL*W
itwenCEITInAu T'° OF
RENEWAL
WAMWTNIM 559017 -0
STATE$ CFC1426257
SEE OTHER SIDE
DO NOT FORWARD
PSG PLUMBING SERVICES INC
PEDRO S GUZMAN PRES
3892 NW 125 ST C
OPA LOCKA FL 33054
1..11..1ll.il....l.l.11t.1.1.. AJ..l..i.l.l bh...1A1 ..1
—
ALCCAVZOZPe DATE (AIMIDWYY) 1
CERTIFICATE OF LIABILITY INS1JRANCE 05/02/11
PRODUCER Excellence Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3801 SW 107 Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone (305)226-3900 Fax (305)226-3997
Miami, FL 33165
INSURED PSG Plumbing Service, Inc.
3892 NW 125 Street
Opalocka, FL 33054-
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: NATIONAL GROUP INSURANCE COM
INSURER a: Progressive
INSURER c: Technology Insurance Company
INSURER D:
INSURER E
COVERAGES INSURER F:
THE POLICIES OF INSURANCE LISTED 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Bien ADM POLICY TivE POUCY EXPIRATION
LTR TYPE OF INSURANCE POUCY NUMBER DATE (MWDBIYY) DATE (rANIAIDNY) LBWS
A r]
B
GENERAL. LIABILITY
17 COMMERCIAL GENERAL LIABILITY 01L0003705
OD CLAIMS MADE OCCUR
0
GEN't. AGGREGATE LIMIT APPLIES PER:
g POLICY fl PROJECT 0 LOC
AUTOMOBILE LIABIUTY
• ANY AUTO
ALL OWNED /arms
O SCHEDULED AUTOS
El HIRED AUTOS
• NON OWNED AUTOS
WA Comp $500.00 Ded
Coll $ 500.00 Ded
GARAGE LIABILITY
D ; 0 ANY AUTO
06288837-3
EACH OCCURRENCE 1,000,000
DAMAGE TO RENTED
04/30/11 04/30/12 ; PREMISES (Ea occurence) 100,000
1 MED EXP (Any one person) 5,000,
PERSONAL & ADV INJURY 1,000 000
,___H
GENERAL AGGREGATE 1,000,000 :
02/18/11
EXCESS/UMBRELLA UABIUTY
O OCCUR 0 CLAMS MADE
O DEDUCTIBLE
O RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS LIAEMITY
C ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER /MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
11 OTHER
TWC3254681
02/18/12
PRODUCTS - COMP/OP AGG 1,000,000
COMBINF_D SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per acddent)
PROPERTY DAMAGE
(Per accident)
10,000.00
20,000.00
10,000.00
AUTO ONLY- EA AC.CIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
AGGREGATE
11/18/10 11/18/11 WI WC STATU- OTH-
TORY WATS_ ER
EL EACH ACCIDENT 100,000
EL DISEASE- EA EMPLOYEE 100,000
EL DISEASE - POLICY LIMIT 500,000
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Plumbing Contractor
CERTIFICATE HOLDER
ACORD 25(2001/08) OF
Miami Shores Village
Building Department
10050 NE 2 Avenue
Miami Shores FL 33138
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO 00 80 SHALL IMPOSE NO OBLIGATION OR UABIUTY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ACORD CORPORATION 1988