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PL-11-2190Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167043 Permit Number: PL -11 -11 -2190 Scheduled Inspection Date: December 16, 2011 Inspector: Hernandez, Rafael Owner: ORTIZ, LAURA & JAVIER Job Address: 474 NE 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: AFFORDABLE IRRIGATION, INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Sprinkler System Phone Number Parcel Number 1132060140440 Phone: 305 - 681 -6322 Building Department Comments INSTALL LAWN SPRINKLERS AND WELL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 15, 2011 For Inspections please call: (305)762 -4949 Page 10 of 16 BI IT. ING PERMIT APPLICATION Miami Shores Village Building Department 10050 II.E.2nd Avenue, Miami Shores, Florida 33 138 Tel: (305) 795.220? Fi,ax: (305) 756.8972 Permit No. I ,� Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Nov 2 3 2611 S,g !/i e/2- d/l 7' Owner's Address .� 7 City A) Z / /3 /yt i State / C Phone # 76 [O - 3J'o - 3,mod/ zip 33/38— 2 730 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) ' 7 f/ .//. E s--- 57.ece 7• City. Miami Shores Village / County Miami -Dade Zip 3 3/ 3!'' 2 73 ' Z ( FOLIO / PARCEL # 1/ 3 D 0/ •O 5-- Is Building Historically Designated YES ' NO Flood Zone Contractor's Company Name __A DC 11a% 6.c . ./t i >c4 %aa Phone #� 3. rJ b d / '" e 3 2 Z L YF w l.3 s s7�cc 2 Contractor's Address City ,/%1 i AZ I?? e` State Qualifier Name 4-e-0 Or ,%rtf State Certificate or Registration No. Contact Phone (3 O T) 310 y0 / Pc' zip 3 31 (/ Phone # C•� S7 d J'/' 6 3 2- 2 Certificate of Competency No. f' `6/1 ©O 002 / 9 E -mail a,/?2 C/JI G 3er /S0 /e 7 rl e Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 27 7t9O Square / Linear Footage Of Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair./Replace ❑ Demolition Describe Work: . .f� e ra i 4e/it/ �'%J/LFtJ / a-dt" Submittal Fee $ Permit Fee $ / 7 �. CCF $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ c� 2 �•-- Structural Review. $ Total Fee Now Due $ 1 i 1. 3 ( 7 CO /CC See Reverse side --* Bonding Co.mpany'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 qnd a reinspection fee will be charged. Signature (C' Owner or Agent The foregoing instrument was acknowledged before me this / 7' The foregoing instrument was acknowledged before me this day of ,r/a (% , 20 LE, by TA (.1 eA. ©A 7; 2_ day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: .0 169 Print: A' .qtiG' f,l-f My Commission Expires: .....•Y .. MARCO ROSAS •; 1.,14 :4 MY COMMISSION # EE 115873 EXPIRES: August 19, 2015 t9,R. r Bonded Thru Not y Public underwriters ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY (Revised 07/10/07) NOTARY PUBLIC: Sign: Print: J r e T p My tltrmmission Expires: NOTARY FEIBLIC -STATE OP FLORIDA Jorge Toledo .***************************** * * * * * * * * * ****** **** *******�* * ** dt k * * * * * ** U Plans Examiner Zoning Engineer Clerk checked d MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST.. 1st FLOOR MIAMI, FL 33130 2011 LOCAL BUSINESS TAX .RECEIPT:;'-: ;2 MIAMI -DADE COUNTY - STATE OF Ft. )RIDA EXPIRES SEPT. 30, 2012•'•' MUST BE DISPLAYED AT PLACE OF BUSINE PURSUANT TO COUNTY CODE .CHAPTER THIS IS NOT A BILL — DO NOT PAY RECEIPT NO. 377988 -2 CC # 96P000219 RENEWAL FIRST -CLASS U.S. POSTAGE ; PAID • MIAMI, FL PERMIT NO. 231 361770-2 BUSINESS NAME/LOCATION AFFORDABLE IRRIGATION INC 198 NW 139 ST 33168 UNIN DADE COUNTY OWNER AFFORDABLE IRRIGATION INC Sec. Type of Business 196 SPECIALTY PLUMBING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY CMES. NOR DOES IT OR EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BYLAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 08/29/2011 02210018001 000075.00 SEE OTHER SIDE MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 RECEIPT NO. WORKER /S 8 DO NOT FORWARD AFFORDABLE IRRIGATION INC MARCO ROSAS PRES P 0 BOX 601743 NO MIAMI BEACH FL 33160 lililllYllStll }I I��IF��ii kkil ll1T 11 )ilfl]111�1 i�12�i l�Fi��41 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10-24 EXPIRES SEPT. 30, 2012 THIS IS NOT A BILL — DO NOT PAY 30- 3779882 CC NO: 96P000219 BUSINESS NAME / LOCATION AFFORDABLE IRRIGATION INC 198 NW 139 ST OWNER :AFFORDABLE IRRIGATION INC SEE BACK OF RECEIPT FOR A LIST OF NON - PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX LOLL 0729 /2011 02210018002 000175.00 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. SPECIALTY PLUMBING CONTRACTOR DO NOT FORWARD AFFORDABLE IRRIGATION INC MARCO ROSAS PRES P 0 BOX 601743 NO MIAMI BEACH FL 33160 1111111£1!t£f£1tl1l£1113iflk£ 11111)1£ %1511£i1f£1£IFIII133111 ACO ��' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 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 . Jett to PRODUCER Mark van Wert c/o Willis of Florida, Inc. 3000 Bayport Drive; Suite 300 Tampa, FL 33607 INSURED Employee Leasing Solutions, Inc. Alt. Emp: Affordable Irrigation Inc 1401 Manatee Avenue West Suite 600 Bradenton, FL 34205 -6708 COVERAGES NAME: I PHONE (A/C. No. � FAX E -MAIL A/C PRODUCER INSURE • 5) AFFORDING COVERAGE INSURER A : American Zurich Insurance Compan INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: 10FL079807968 NAIL 0 40142 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED ANY REQUIREMENT, TERM OR CONDITION BEEN ISSUED CONTRACT INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAY INDICATED. NOTWI ISTED BELOW HAVE PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS R • • L POLICY EFF POLICY EXP REVISION NUMBER: INS LTR TYPE OF INSURANCE GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR U GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ' PRO- LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB EXCESS UAB DEDUCTIBLE RETENTION $ OCCUR CLAIMS -MADE WORKERS COMPENSATION AND EMPLOYERS LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE IY / NI OFFICER/MEMBER EXCLUDED? U (Mandatory In NH) If I DESCRIPTION OF OPERATIONS below N/A POUCY NUMBER WC 90- 00- 818 -00 Location Coverage Period: MM/•D MM/D 12/31/2010 12/31/2010 12/31/2011 12/31/2011 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addhionai Remarks Schedule, if more space is required) Coverage is provided for Affordable Irrigation Inc only those employees g leased to but not 198 NW 139th St subcontractors of: Miami, FL 33168 CERTIFICATE HOLDER LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OPAGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE $ X I TORY LIMITS I IOER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Client#: 000725 $ $ 1,000,000 $ 1,000,000 1,000,000 Village of Miami Shores Bldg & Zoning Dept 10050 NE 2nd Ave Miami Shores, FL 33138 CANCELLATION 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 �G JA /l ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC�„°,-R°I CERTIFICATE OF LIABILITY INSURANCE 6�;� o�NYYY) 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 Brown & Brown of Florida , Inc . dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 CONTACT Michelle Wilson NAME: raft Extl (305)247 -5121 JCC.No) :(305)248 -8543 ADDRREss :mwilson @trjones.com PRODUCER 00014336 cusTOMER ID g, INSURER(S) AFFORDING COVERAGE INSURERA:FCCI Commercial Ins Co NAIC # 33472 INSURED Affordable Irrigation, Inc. P.O. Box 601743 No Miami Beach FL 33160 -1743 INSURER B : LIABILITY OCCUR INSURER C INSURERD: 3/2/2011 INSURER E : EACH OCCURRENCE INSURERF: DAMAGE TO RENTED PREMISES (Ea occurrence) COVERAGES CERTIFICATE NUMBER:2011 GL, BA THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 ADDL INSR SUBR WVD POLICY NUMBER POUCY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A - GENERAL X LUU3tlJTY COMMERCIAL GENERAL X LIABILITY OCCUR GL0006847 4 3/2/2011 3/2/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 I CLAIMS -MADE MED EXP (Any one person) $ 5,000 GEN'L X PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JET LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0010999 3 6/11/2011 6/11/2012 COMBINED SINGLE LIMIT (Ea accident) $ 300, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Underinsured motorist $ Uninsured motorist combined $ UMBRELLA UAB EXCESS LUAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ below E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY OMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space Is required) CERTIFICATE HOLDER Village of Miami Shores 10050 N.E. 2 Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLIQIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE Laurie Lane /CRECIO `� i!16;1 dG�..L ACORD 25 (2009/09) INS025 (200909) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A (l e. f 9C- S 7 Ce' / Sfrf/,vgteZ iCGenD b., - 7.i r70 5,,r 4, /444. h -6) C€ ,Z ' iv . j° &o 2® AZ Addl. 2 e (/ii /l/G (3 20 3070' o) w N CC# 96P000219 Affordable Irrigation, Inc. 198 NW 139 Street Miami, FL 33168 Tel: (305) 681 -6322 NOTARY PUBLIC -STATE OF FLORIDA Jorge Toledo 1 Commission #DD815435 Expires: A 2, 2012 Tau :O ' %' G CQ, INC.