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PL-11-1741Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ■ Inspection Number: INSP - 164756 Permit Number: PL -9 -11 -1741 Scheduled Inspection Date: November 07, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 10070 N MIAMI Avenue Miami Shores, FL Project: <NONE> Contractor: ALLURE PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)220 -6990 Parcel Number 1131010210100 Building Department Comments REMOVE AND SET KTICHEN SINK, LAV, TOILET & BATHTUBS FOR NEW TILE. Passed EiJ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 04, 2011 For Inspections please call: (305)762 -4949 Page 17 of 42 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 RECEIVED SEP 2 2 2011 BY �..� �►. BUILDING Permit No. 12U —11 PERMIT APPLICATION FBC 20 Master Permit No 12 C .11 --Irl l-to Permit Type: PLUMBING a / /t OWNER: Name (Fee Simple Titleholder): E l01 7(TT f r' en) ✓f Phone #(30 l ad-G-6 % 9 f2 Address: t 1- C Q. nfltAirtett 1N City: "RA 1 1 ��-� k/n✓o� State: Zip: 3 31L Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: /00 70 1 /7' r e -pie 7 42" City: Miami Shores County: Miami Dade Folio/Parcel #: 11,3/ 0/ 0.21 W. -1W/ i CD Is the Building Historically Designated: Yes NO L. Flood Zone: Zip: 35 / S e, CONTRACTOR: Company Name: / 11 017.E ?W m j3 h % • amt Phone #(7 3 % _ / j -SZo Address: ` , / 3 6 . City: O me57379A state: Zip: ?O33 Qualifier Name: & $ fr2 #/7 The-vie.--e0 o Phone #: (4J 379 State Certification or Registration #: 0 fd_ I KZ- 6Z (97 Certificate of Competency #: Contact Phone #: Email Address: �C%�Wite /%4/i24.,>1 ' & *V . n -% DESIGNER: Architect/Engineer: / `'Phone #: Value of Work for this Permit: $ /# OW 9 Square/Linear Fop tage of Work: / Type of Work: OAddress UAlteration ONew n Repair/Replace UDemolition Description of Work: izemei/k Mieci 74Z!. * * ** * * * * * *** * *** *** * * * * * * * ** ** ** * * ** Fees************* * * * ** * * ** * * * **** ** * * * * * *** * ** ** i Submittal Fee $ ) ( to ' Permit Fee $ / / C° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 `I • �® 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 th % >,:- ence of such posted notice, the inspection will not be approved and a reinspectio�, ill be charged. Signatur er or Ag The foregoing instrument was acknowledged before me this, day of 20 /1, by v'r � (tee- who is personally known to me or who Ms produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Y-'`' 7 My Commission Expires: APPROVED BY The foregoing day of ctor trument as acknowledged before me this 2-5 , 20 E , by f rn� ! LD who is personally known to me or who has prlidw> 4A ,j, C'1.O as identification ank, �`v "�; &�� � 03106/2012 NOTARY PUBLIC: Sign: riot: NOTARY 1 RIIC /i /,,FOFF1.%),%%`S 1EAdNErrE TEY DIEZ �yI Commission Expires: MY COMMISSION # DD 914519 y p EXPIRES: August 16, 2013 Bonded Thru Notary Public Underwriters & **k *uhst*** kiz4e*** k**** 3c> iraY& 3r3e**3e* *3e4e4rde*4e***4c4c4r**3e3e9r3e3 ***k*da*********ik3e3z*** * ** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09) BATCH NUMBER MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 493609 -3 BUSINESS NAME / LOCATION ALLURE PLUMBING CORP 23701 SW 133 AVE 33032 UNIN DADE COUNTY 2011 MIAMI-DADE COUNTY 2012 NTY STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 TI-US iS NOT A BILL — DO NOT PAY RENEWAL OWNER ALLURE PLUMBING CORP Sec. Type of Business 196 PLUMBING THIS IS LY A LOCAL DOES SNOT TAX PER T THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER REQUIRED BY LAW. THIISSSIS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/05/2011 09010845001 000075.00 SEE OTHER SIDE CONTRACTOR FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 2311 RECEIPT NO. 515365-5 STATE# CFC1426297 WORKER /S 1 DO NOT FORWARD ALLURE PLUMBING CORP GEOSMANY PACHECO PRES PO BOX 925077 PRINCETON FL 33092 }711kk1it 1111111 1 F9 F1FS}eS kil}k}j } }}�h n I1 }f,ih uIJ11F&1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF TRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: COMPLETE CONTRACTOR'S INFORMATION Mait,C Wayngh,lo tot" BUSINESS ADDRESS: 2.5 70/ 4&) /3 4/6 CITY ,4 jii i 9D STATE FC� ZIP CODE 33 03' BUSINESS PHONE: (73' (D) 37 9 / SZ% FAX NUMBER (5 ) z - 9( CELL PHONE ( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: e /54,0 6 Z-7 E -MAIL ADDRESS (IF APPLICABLE): iteo, 17i9‘, �L'Pi',S9ri • n0-, Created on 3119109 BY MLDV 1 RV 3126109 MLDV 6 cas-n-1 lip Pelc Policy Number: Date Entered: AW °® CERTIFICATE OF LIABILITY INSURANCE 1 DAT/E pal /2D/MN) 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(les) 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 lleu of such endorsement(s). PRODUCER MULTIPLE INSURANCE COVERAGES, INC. 8772 S.W. 8TH STREET (CENTRAL COURTYARD) MIAMI, FL. 33174 CONTACT (Arc. No. (305)559 -5453 I rtig. NM: (305)559 -5021 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: TECHNOLOGY INSURANCE COMPANY LIABILITY COMMERCIAL GENERAL LIABILITY INSURED ALLURE PLUMBING CORP. (W / C) P.O. BOX 925077 PRINCETON, FL 33092 -5077 INSURERB: INSURER C : INSURERD: $ INSURERE: $ INSURER F: $ 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL ,: SUBR .i. POUCY NUMBER POLICY EFF ::M/DDUII) POLICY EXP .1 ,D LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ GE ES (Ea occurrence) PRREM $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ GEN'L AGGREGATE UMIT APPLIES PER: 7 POLICY n jERCT 7 LOC $ AUTOMOBILE _ _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per RO�d DAMAGE $ $ UMBRELLA UAB EXCESSLJAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 1 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE Y / N OFFICER/MEMBEREXCWDED7 (Mandatory in NH) if DESCRIPTION describe under DESCRIPTION OF OPERATIONS below N/A TWC3272992 04/14/2011 04/14/2012 1 WRY L MATS I 1 ER E.L EACH ACCIDENT $ 100,000.00 E.L DISEASE - EA EMPLOYEE $ 500,000.00 E.L DISEASE - POLICY UMIT $ 100,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space 18 required) PLUMBING CONTRACTOR CITY OF MIAMI SHORES 10050 NE 2ND AVE. MIAMI SHORES, FL. 33138 P#(305)795 -2204 / F8( 305 )756 -8972 I 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 LAURINDO R. PARDO O ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Producedusing Forms Boss Plus software. www. FomisBoss .comlmpressivePublishing 800 -208 -1977 9,R CERTIFICATE OF LIABILITY INSURANCE ATE (MM/DD/YYYY) D09/23/2011 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(les) must be endorsed. If SUBROGATION 15 WANED, 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 ABTA Underwriters, Inc. 8796 SW 8 St Miami, Fl 33174 NC°NTACT Pablo M Conde PaONo. Eld►: 305 - 220 -7447 1 Fa. No): 305-2204821 ADDRESS: pmc @aaunderwriters.com INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: Scottsdale Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Allure Plumbing Corp. PO BOX 925077 Pricenton FL 33092 INSURER B : CPS1358920 INSURERC: 04/14/2012 INSURER D : $ 1,000,000 INSURER E : $ 50,000 INsURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP (MM/DD)YYYYI LIMITS GENERAL XX LIABILITY COMMERCIAL GENERAL LIABILITY CPS1358920 04/14/2011 04/14/2012 EACH OCCURRENCE $ 1,000,000 PRISES (Ea occurrence) $ 50,000 MED EXP (My one person) $ 5,000 CLAIMS -MADE XX OCCUR PERSONAL & ADV INJURY $ 1,000,0000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 1,000,0000 GENII AGGREGATE UMIT APPUES PER: XIC POUCY 1 AT I jFr°T [1 LOC $ AUTOMOBILE — _ LIABILITY ANY AUTO AAUUTOOWNED HIRED AUTOS ALL UTOSULED NON -OWNED AUTOS COMBINED BId SINGLE LIMIT (Ea $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 1 RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yea, describe under DESCRIPTION OF OPERATIONS below N / A I WCY LIMBS 1 I ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ • DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Addltional Remarks Schedule, If more space N required) I Miami Short Village 10050 NE 2da Avenue Miami Short, 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PDF created with pdfFactory Pro trial version www.pdffactory.com