PL-11-965Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 166173 Permit Number: PL -5 -11 -965
Scheduled Inspection Date: November 02, 2011
Inspector: Hernandez, Rafael
Owner: RABALAIS, JEFFREY
Job Address: 726 NE 92 Street 12 -L
Miami Shores, FL
Project: <NONE>
Contractor: DEL MAR PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (954)261 -9513
Parcel Number 1132060440500
Phone: (305)271 -2800
Building Department Comments
REPLACEMENT OF EXISTING KITCHEN SINK
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR IN P- 160285. no one home
PLEASE CALL HOME OWNER 954. - '•1.9513
November 01, 2011
For Inspections please call: (305)762 -4949
Page 19 of 21
:t'JN -09 -2011 i HU 11:40 AM
CAX No. 3C52481030
r. 002
--. K_-' LtlITIFICATE OF LIABILITY INSURANCE
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PRODUCER DISUISTICe Marketing MaiVlork
SOT At. Kroane Avenue
Homestead= FL 33030
Phone (305)24&5000 Fax (305)248 -1000
Tits CIQinFICATE IS ISSUED M A MATTEL OF INFORMAUON
ONLY AND CONFERS NO NIGHTS UPON THE CERTIFICATE
' HOLDER. THUS CERTIFICATE DOES HOTAMEND, E
ALTER IHE GCMgatiflE AFFORDED BY Tli Q tC
1ENO OR
ag ,PW.
NAIS 0
INSURERS AFFORDING COVERAGE
1NSuRED Del Mar Plumbing, Inc
9013S V 133$T#A
Istlepolnt
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1HSUlt 6 CeAscendant
dam rartce Co.
Miami, FL 33178
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INSURER D:
INSURER e
COVERAGES
DSURER F:
THE POLJOR:S OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSUFasD NAMED ABovv FoR THE POLICY PERIOD WIRCATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CR OTHER co CUME+tT YAM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOO ALL THETF.AM$. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE UM 'S SHOWN MAY HAVE BEEN REDUCED HY PAID CLAIMS.
WM
AOa 1.
TYPE OF INSURANCE
POLICY NUMBER
PDUCY EFFECTIVE
DARE ;
04114111
FOLIEY MINIM ON
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01/14112
LIMITS
A
DERMAL LIABILITY
0 CI�IMMERC1AL GENERAL L1AaxrrY
00 MAWS MOE (.i+ OCCUR
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Cpl= 37081-0
EACH OCCURREI�ICE
1,000,000
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50.000
5,000
PERSONAL a AW INJURtr
1,000,000
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1.000,000
GENT. AGGREGATE LIMITAPPUES PER:
❑ POLJ-Y ❑ PROJECT 0 LoC
PRODUCTS - L`OMPIOP AGG
1.000,000
❑
AUTOMOBILE LIABILITY
❑ ANYAUT0
❑ ALL OWNED AUTOS
❑ SOEDULED AUTOS
■ HIRED AUTOS
❑ NON QWNED AUTOS
COE68 SFNc I H IJMEr
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800LYfN:iURY
{Per perms)
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AUTOOILY- EAACCE NT
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EXCESS/UMBRELLA LIABILITY
❑ OCCUR ❑ CLAIMS MADE
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❑ RETENTION a .
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MIAJ I -DADE COUNTY
TAX COLLECTOR
140 W.
1st FLOORGLBR S7:
M1AN11, FL 33130
598016 -5
BUSINESS NAME / LOCATION
DEL MAR PLUMBING INC
• 9013 SW 138 ST
33176 UNIN DADE COUNTY.
2010 LOCAL BUSS TAX RECEIPT 2011
MAIM—DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 30, 2011
MUST BE DISPLAYED AT PLACE OF BUSINESS:
PURSUANT TO COUNTY CODE CHAPTER 8A - AF(. 9 & 10 . '.
THIS IS NOT A BILL — DO NOT PAY
OWNER
DEL MAR PLUMBING. INC
Sec. Type of Business
sus is 12Y6A P UlMBING CONTRACTOR
a SeE.&3 TAX !. IT
DOES NOT PERMIT THE
HOLDER 10 VIOLATE ANY
EXISTING REGULATORY OR
ZORIHG LAWS OP THE
COUNTY OR CITIES. NOR
QOES IT BUMPY TEE
NOLOER FROSI ANY OTHER
PCRWr OR LICENSE
REQUIRED EN LAW. THIS IS
NOT A CERTIFICATION OP DEL MAR PLUMBING INC
WE R RODEOS O ICA- GERMAN E ROLDAN PRESIDENT
MON
9013 SW 138 ST*A
MIAMI FL 33176
DUPLICATE
RECEIPT NO. 623874-5
STATE* CFC1427248
A
FEIST- CLASS
U.S. POSTAGE
PAID
"MAIM, FL
PERMOT N0.231
WORKER /S
1
DO NOT FORWARD
PAYNENTRECBTED
NOTADADE COtnfTiT TAX
COLLECTOR
g•d
07/21/2010
60000000177
000000.00
SEE OTHER SIDE
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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. F-I( ^ `%
PERMIT APPLICATION
FBC 20
Master Permit No. 1 Q —Cf5D
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): � 2 ( l S
Phone #: '9,5; 3 s a... ZZ S8
Address: , I ZAP lJ e g Z i z- L
city: M 1 !W1 \ S vite state: PL zip: -12 /
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 Z ic qz CJI ° 4 I Z
City: Miami Shores County: Miami Dade Zip: 7) 31 'J 3
Folio/Parcel #: 1 / 2 o ( ' _ 004- ®Sd 0
Is the Building Historically Designated: Yes NO iG Flood Zone: Ai
CONTRACTOR: Company Name: � et Aft
Address: 9-0/3 Ste✓ /3 0 S t o4
Phone #:
3.c 2'i (Z,9&L
City: ; 1 z ® ®t u ` State: /C (e Zip: 3 3 / 4 6
Qualifier Name: ( 0, 4 ' Q ° 1.2- /4 Jr +-e--- Phone #: T b ( ?_71 C/26
State Certification or Registration #: (.`VC NZ 72- V Certificate of Competency #:
Contact Phone #: Email Address: 7 '-f -v, " 2 0 t1,-^- • ).. (r G A as S a,.it, _ '.-'
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ it) 0 d 00 Square/Linear Footage of Work:
Type of Work: Address ❑Alteration ❑New Repair/Replace ODemolition
Description of Work: PI.iN,) M.1ai"t' Chi= .--.1.1s 1-I iU i U U Sin) / -
********** * * * * * * * * * * * * * * * * * ******* *** ** Fees**** x:m ****** ****m**************x:*a *** * **+ ***
Submittal Fee $ 60 Permit Fee $ /da `O CCF $ CO /CC $
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 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 sub'ect to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspe t ' which occurs seven. (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will ot.. approved and a ' nspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this "5
day of ■ 42 , 20 � , by
who is person i ly known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: .,./t u.
Print: NOTARY PL'BLIGSTATEOFFLOR1D
Myrna.
My Commission Expires:
Commission #913303
a1
IBM giUteletettreg
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 2d , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PLTBLIC•STATE OF FLORIDA
"°,,.,, Myrna Martinez
My Commission Expo,,, ai0 �,D91a630�
A0NDB8 MS at etttin �y Illy,
*** ************* * ************ **+ p= k***jk*** ****sis ******* *jh******N ****= kjk********* aksksk***si: *** ****************sk***
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk