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PL-11-818Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165270 Permit Number: PL -5 -11 -818 Inspection Date: October 07, 2011 Inspector: Hernandez, Rafael Owner: CARROLL, BARBARA Job Address: 1461 NE 103 Street Miami Shores, FL Project: <NONE> Contractor: MG PLUMBING & SPRINKLER SERVICE Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Sprinkler System Phone Number Parcel Number 1132050310190 Phone: (305)525 -9236 Building Department Comments NEW SPRINKLERS SYSTEMS IN ENTIRE YARD Inspector Comments CREATED AS REINSPECTION FOR INSP- 159468. MISSING VACUUM BRAKER RH 1/5/11 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 October 07, 2011 Page 1 of 1 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 BUILDING Permit No. 1 L 1- 3-1 6- PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): /la rk and &VLY- C rrol Phone#: 30 g - 7 s q o 6S Address: /4 44 NP.: 1o3 S City: l ;aryl ; Sin oyes //�� Staate: -FL Zip: 33i3e-ab ,2S Tenant/Lessee Name: "' /V®f 4,p it(Ca b lam. Phone #: Email: J3 (, r r 11 cLo 1 , C-0 m JOB ADDRESS: / 4.41 AJE /03 r°L ST City: Miami Shores County: Miami Dade Zip: 33i 38'.-a %a5" Folio/Parcel #: /1-- 32 0 s- 0 3 j— 01 ? O Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: M G Pitt wi b i tut 1- Sr n kWY &yrd ice l Phone #: 3 0 fop Address: 1 R (o S N VJ 03 t sr City: M 1 G Zip: '33 I%? Cit i Cull 1 ��' � V', 1,,�11, � r State: � �.. Qualifier Name: 3—a wi es 1M• N y e L( frv' Phone#: State Certification or Registration #: C Fe 05621.20 Certificate of Competency #: Contact Phone #: 30. -- ..5-a S - 9a-34, Email Address: P kuwt bi ✓iQ b y wi3 • y et i1 oo 4, Cevvi °� �e DESIGNER: Architect/Engineer: Phone #: --roi- Value of Work for this Permit: $ ® Sq e/Linear Footage of Work: Type of Work: OAddress OAlteration . ew ORepair/Replace ODemolition Description of Work: ' IV 9A11-3 Sep Ai 14,41,....._ 5J 'T-g I 0 1 tc- 1 , -it-0 **** ** * ****+ x+ x+ x****** ***************** Fees *** *+x**+x***** **** : ** ******* * **************** Submittal Fee ', �a Permit Fee $ /5 CCF $ CO /CC $ f4- - Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 OE 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 properly 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 a. Signature (/3 • (-7( y ' Owner or Agent Contractor The foregoing inks ment was asil7owled ed before me. 's I j The fore 'ng instrument was acknowledged before me thil-gfr , 20 11 , by ' � 1 1 / 1i , ' day of , 20/4 , by <.Ia�ier «%1. is ' rsonally known to me or who has produced - I�fL r who is personally known to me or who has produced S° 11 V 2 identification and who did take an oath. as identification and who did take an oath. day of NOT Y PUBLIC: Sign: Print: My Commission Expires: NARY J' 'i LIC: RSA i/ �0� Vcr . ti Print: y iX�t 1C391611°9411c°11°711114c.12 My Commi�;.h '1res: APPROVED BY S (47— (./ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) A� CERTIFICATE OF LIABILITY INSURANCE OP ID: GC I tam pusozurrrn 04126111 71185 CEFICTIRCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERCTIHCATE HOLD THIS CERTIFICATE DOES NOT AFFI! ATIN13.Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUt2Es THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED ITEPRESENTATME OR AND THE CERTIFICATE HOLDER. IMPORTANT: If the certilicate halder is an ADDITIONAL INSURED, the plioy(es) most be endorsed. If SUBROGATION IS WANED, subject to the terms and coadflions of the policy, Pertain parades des may require an endaraement. A statement an this ceslificabo does not Caller rights to the corlificate balder in lieu of such endarsament(s).. PRODUCER Workers 41© Baca Ratan, FL 33429-0410 Werfars Cempensatfan Gump 561 -392 951-361-1132 NAM Greg Yartoon Lam, X561-1 - 1A Brok 561-361-1132 PRODUCHe CUSICIDER IRREis PLl! -1 INSUDERVOAFFCOURNIGOINIMAGE REC$ M Pfranbiltg & Sprinkler Sere 1265 NW 2T rd St taunt, FL 33169 A: Ffl:rida fin Co INSURER B: INSURER C: INSURER 1:1: INSURER E: INSURER F: CCNERAGES CBITIFICATE NUMBEIt REVISION NUS THIS IS TO COMFY 11-PAT THE POLICIES OF INSURANCE LISTED BELOW HAVE ':? ISSUED TO THE MIRED NAMED ABOVE FOR THE POLICY INDICATED_ NOTWITHSTANDING ANY REGUMEMENT. TERM bit CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO INISCH THIS GERITURCATE MAY ISSUED OR MY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN IS SURIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. WITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HER L1R UPEOF MISURASEE GEIERIAL UAZILnY COMMERMAIL GENERAL M EILEN OCCUR GEAR_ A TE LmSQAPPLIES PER POUCY n flLoc ORR *OD MOM MOWER POLICY EFF PAVvvvnIBIP MRS EACH OCCURRENCE TO Ream 1M sone ) PE TAL&AU1VNARY GENERAL A TE 1 PRODUCTS - &COMPAUG $ $ $ $ AliOCUIGERE LIABIUA ALL OWNED AUTOS SCHEUELED Al1IKIS HIRED AUTOS AUDIOS COMBINED UMW (Ea au:HEM =OW =LOW (Per ) SCUILY RAW (Par accEefea$ DAMAGE IDABROULA Leas EMCEES LIAR cuaterweE A UEDUCTIBLE REPEZNITION $ ISCHRERSCCISIPERSAYMNI AND ELWL0Y LfABIUrY Y7R ANY PROPPIETCRIPARIMEREESSUMAE El RSA (Mandalay fa NH) rirsounescrilunder CIF OPERATIONS EACH OCCURDIENI:E AGGRESATE 10112110 10/12111 Sr16TU- EL EACH ACCIDENIT ;ER $ IEL SE -EA 0109LOYEE, $ 100,509 imam EL DISEASE- PCLICif WT $ 5130,080 DESCROPRON OFOPERAUCIes/LOCA1 ® (Attach WORD t0l,amaiffonaI !Wanks Schedule, if marespace rSEequi CERTIFICATE HOLDER CANCELLATION Wage of Men' Shores 10050 NE 2nd Ave. Miami Shares, FL 33138 SHOULD ANY OF THE AIDE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TIME THEREOF. MICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY ACORD 25 (2009109) 01909 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks Rf ACORD 1 s ,: Ack ?;r `;511,51,11'3!. KEY KNEMLEIOGE Irk CA-24703 4 9/21/2007 CERTIFICATE OF LIABILITY INSURANCE raimuswrim 45r2�,%�33 T TE I$ [ISSUED A0 A MA:136 ONLY Ate NO IWtw THE LATE MSS OELCVL '� D1� NOT ITIV®.Y CR [ A1WftY CA *L1 THE THE mews THIS TE OF NOT A Tl6E REWMPITAIIVE OR AND T E TE ems. HWORTANT: OS If Is as , th i s If T 19 W AIUEIi�, to t and Otto � an A an t� daas rust o to ontHaNN ttnt 11otd� In � aft giuraisentmft maws , tee. 9101 -0 S. W. 3 s. > FL. 33324 �i. G. & SVCS. , .Y INDRDon 1235 NW 20 BOINN2, NA 33149 1934)-3,2-5259 Mit (954) 362-00 Asolso lraYkranntisoganal .ams IngouteassWITEROMOsgssass irasumA,AlmovXdirgit Cozaurallsa, Easzerammi, wimata:Asaciadarit dal inincrance. Sic. 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NZA103,, 5 7 010 Ate CORMAAITON. All gigots miervgd. ACOSUD 2 5 MUM n o MORD inanza g r a d logo am ragistared marks ACOND