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PL-12-61Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 168751 Permit Number: PL- 1 -12 -61 Scheduled Inspection Date: January 25, 2012 Inspector: Hernandez, Rafael Owner: PINEIRO, ROBERTO Job Address: 9400 N BAYSHORE Drive Miami Shores, FL 33138- Project: <NONE> Contractor: RAPID ROOTER INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050100110 Phone: (954)943 -9100 Building Department Comments REPLACE APPROX 10 FT OF EXISTING DRAIN LINE Passed [K1 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comme is rt January 24, 2012 For Inspections please call: (305)762 -4949 Page 18 of 30 Miami Shores Village Building Department 050 N.E.2nd Avenue, Miami Shores, Florida 33 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 l aft BUILDING Permit No. PERMIT APPLICATION FBC 20 Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): 13M2134104 eP ►14120 Phone#: Address: WO OAy3itooRt Z . City: in iArrli u`' HOi1t.3 State: fL Zip: 33/38 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: Q1/40 011415HoR1 V. City: Miami Shores County: Miami Dade Zip: 3313 $ Folio/Parcel #: /1- 3245,5 - (NO - 6110 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: r1?f19 I f) iloo ?812 Phone #: 95`/- 911' - 47/0a Address: 2 S" Are S .7. City: V607PAAJo 731'*W State: / L Zip: 3304 a Qualifier Name: 1:)Arui .t 'iZice, Phone#: State Certification or Registration #: [►F'G GS66 $4// Certificate of Competency #: Contact Phone#: Email Address: /,gyres c€ i2AP, pereac, 'i2. Coen DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ �/ 2S-0 Square/Linear Footage of Work: Type of Work: UAddress DAlteration New G�Repair/Replace UDemolition Description of Work: (Re" lace &Irene JO -% c rt eAash s eke A / %!e. ********* *** **** ****** * * ** * * *** ** *** * * *F ******** ******* *+ x******************* **** Submittal Fee $ Permit Fee $ /�.a . CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Technology Fee $ 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, 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." Owner or Agent The foregoing instrument was acknowledged before me this a— day ofJR/AM-1 ( , 20 I' , by O,411'BA104 i2/1.4. G , who is personally known to me or who has produced D/L As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: *********0********* **** APPROVED BY eV Plitt Notary Pubic State of Florida 4 Dorothy L Barnes c My t;ontraission EE123973 �a op‘' Expires 08/22/2015 Contractor The foregoing instrument was acknowledged before me this 1 Z day of J}AM'492 Y , 20 12 , by Dcw' i v r. (Rice_ who me or who has produced as identification and who did take an oath. NOTARY PUBLIC: r' /z/ Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15109) Sign: Print: 'mooRov y L FARAits My Commission Expire Zoning Clerk 1A0 vk 1 RAPIDROOTER. CFC058684 PLUMBING, SEWER AND DRAIN SERVICE, INC. MAIN OFFICE 25 Northeast 5th Street 0 Pompano Beach, FL 33060 0 (954) 943 -9100 c Fax (954) 943-0022 MIAMI (305) 899 -8100 January 10, 2012 HOLLYWOOD FT. LAUDERDALE BOCA RATON WEST PALM BEACH (954) 920 -9111 (954) 583 -4555 (561) 394 -8700 (561) 832 -4444 Sleuth Plumbing Technologies Pinerio Residence 9400 N Bayshore Dr Miami Shores, FL 33138 RE: Tunnel Rapid Rooter Plumbing Sewer and Drain Service, Inc. appreciates the opportunity to provide you with our quality services, as per your request here is the proposal for the work to be done at the above mentioned property. 1 -SCOPE OF WORK ➢ Excavate a starter hole outside of the building by the kitchen for access. ➢ Use the Vac -con industrial truck loader to dig tunnel approximately 15 -20 feet total under the building to expose the existing drain line. ➢ Cut and remove the existing pipe and fittings for the drain line approximately 10 feet. ➢ Install new sections of PVC pipe and fittings for the laundry drain line approximately 10 feet. ➢ Install new pipe hangers every 3 feet as needed underneath the building for pipe support. ➢ We will use a pressurized sand gun to backfill tunnel to required compaction requirements as per engineer. ➢ Backfill the starter hole outside of the building using the previously removed soil. Total Cost of the Job $5,250.00 Initial ➢ There will be an additional charge to secure the required permit and inspections and engineer reports (if necessary), due to permit/engineering fees vary from different municipalities. Initial: COST This proposal will only be valid for 30 days after the date it was issued The cost for this service will be $5,250.00. A deposit of fifty percent (50 %) is due upon acceptance of the signed proposal and remaining balance plus permit costs and any additional charges are due upon completion. The total cost does not include any additional work possibly required after re- inspection. Any unforeseen problems delaying the timely completion of the job will be an additional charge. All work will be done in accordance with State and local Plumbing Codes the total cost does not include any additional work possibly required after re- inspection `"0tl S) Initia NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOUO NO.IJ Z&S GIO- 0110 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: STATE OF FL I HEREBY CER THE UNDERSIGNED hereby gives notice that improvements will be made to, property, and in accordance with Chapter 713, Florida Statutes, the followin is provided in this Notice of Commencement. 1 111111 11111 11111 11111 11111 11111 11111 1111 1111 CFN 2012R0029928 DR Bk 27962 Ps 0501; (1ps ) RECORDED 01/13/2012 15 =38 =16 HARVEY RUV'INr CLERK OF COURT MIAMI -DAC'E C0UNT't y FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: 01 4011 gHo'Rt.) WPf V PEW 'Pa No -1 G L4 T / 3 (911 66 5/415No2tt fit. 117;14111; 31- 16141", GL 3313g 2. Description of improvement l�-.epla cc. cep 0,4 /d err- G,4eseh rfia,%. /,, . 3. Owner(s) name and address: *B1 'BMW 1441 R 0 90* 30eSHoRt PR. 01p»1 . tR+TZ>rJ f 3313g Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number: IOW Waar92 "'SW- 9V3— T100 Z - atJe S 5-r Veer/P, .'0 $a01.eN. /GL 33cia0 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of er(s or ner(s)' Authorized Officer/Director /Partner /Manager Prepared By / Prepared By Print Name • n 0 Print Name Title/Office � 1'\ o r^ P O LA.J Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this 12- day of By ?A12130PRA- P/N$1 R 0 .individually, or U as for U Personally known, or Erproduced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFIC TION PURSUANT TO SECTION 82525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signatur ,�f Owner( By 129.01 -82 PAGES 3/10 PNotary Public State of Florida Dorothy L Barnes I My Coraon EE123873 'S R Expires 08/22/2015 wner(s)'s Authorized Officer /Director /Partner /Manager who signed above: By Vine-VC) cQ7. 94c0 Scf3ko'Q. Dr, , Snares, �- �, 33(38 v5 2csic6 Ai ia-kotai ee/acc " ;9. ipccibues 1' Arc, cdoero- 5er& C� pee; ' Ro0* 1 . vd 668ZZ6L1'96 4oe1 sulgwnld 141nelS it d99:E0 36 60 uer 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) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR 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 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 1� I`j} `Rc o r 21Z BUSINESS ADDRESS: ZS Air 6- 37 CITY Pom� .va i ict'-1 STATE — ZIP CODE 3362 o BUSINESS PHONE: ( 931 ) qea- 9/00 FAX NUMBER ( 9 ) 9 00 z z CELL PHONE ( ) QUALIFIER'S NAME: 'uAt.D '• 'R t QUALIFIER'S LIC NUMBER: CI-6- 65 -6 6 g E -MAIL ADDRESS (IF APPLICABLE): bumf ce !2i 7>,12()o 77 %2• Cci Created on 3119109 BY MLDV 1 RV 3118109 MLDV BRO NARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt #:182-939 Business Name :RID ROOTER SEWER & DRAIN SERVICE Business Type :PLUMBING /LWN SPRNKL, /CO INC (PLUMBING CONTRACTOR) Owner Name: DONALD E RICE /QUAY Business Location: 25 NE 5 ST POMPANO BEACH Business Phone: 954- 943 -9100 Rooms Seats Employees 10 Business Opened:o3 /01 /2001 StatelCountyiCerNReg:CFC 056684 Exemption Code:NONExEmPT Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee - Penalty Prior Years Collection Cost Totaf Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: DONALD E RICE /QUAL 25 NE 5 ST POMPANO BEACH, FL 33060 2011 - 2012 Receipt #04A -10- 00012709 Paid 09/20/2011 27.00 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301- 1895 954 -831 -4000 VALID OCTOBER 1,2011 THROUGH SEPTEMBER 30, 2012 DBA: Business None: RAPID ROOTER INC Owner Name: RAPID ROOTER INC Business Location: 1551 NW 27 AVE POMPANO BEACH Business Phone: 954- 943 -9100 Rooms Seats Employees 1 Receipt #:329-232203 Business Type:ALL OTHERS (PARKING LOT) Business Opened:03 /31/2010 State/County/Cleft/Reg: Exemption Code:NONEXEMPT Machines Professionals 1 Number of Machines: For Vending Business Only Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 33.00 0.00 0.00 0.00 0.00 t 0.00 33.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non- regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: RAPID ROOTER INC 25 NE 5TH ST POMPANO BEACH, FL 33060 2011 - 2012 Receipt #034 -10- 00003755 Paid 09/20/2011 33.00 13A fCH Ni)MiyER The PL` IZ G CONTRACTOR lamed ki0.0W IS CERTIFIED `� U d$r t6_0,40MOmisioris of Chaptt`rr gird - 331, 2012 fret Orr,. A Rif CERTIFICATE OF LIABILITY INSURANCE 1/12/2012 DATE D/YYY1/) 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 Bateman Gordon and Sands 3050 North Federal Hwy Lighthouse Point FL 33064 CONTACT NAME: aco.NN . Erd):954-941 -0900 I FAX . No):954 -941 -2006 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A :Amerisure Insurance Co. 19488 INSURED Rapid Rooter Sewer & Drain Svcs. Inc. 25 NE 5 Street Pompano Beach FL 33060 INSURER B : INSURER C: INSURER D GL2008589080011 INSURER E : 3/1/2012 INSURER F : $1,000,000 COVERAGES CERTIFICATE NUMBER: 1 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 LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL2008589080011 3/1/2011 3/1/2012 EACH OCCURRENCE $1,000,000 X PRMMGE TO RENTED PREMISES (Ea occurrence) $50,000 CLAIMS-MADE X MED EXP (My one person) $5,000 X XCU /Contractual PERSONAL & ADV INJURY $1,000,000 X Broad Form PD GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY n PRO- n LOC PRODUCTS - COMP/OP AGG $2,000,000 7 PD Deductible `COMBINED 01,000 A AUTOMOBILE LIABILITY ANY AUTO AAtLL OS OWNED HIRED AUTOS -OWNED CA13298221101 3/1/2011 3/1/2012 SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ SCHEDULED BODILY INJURY (Per accident) $ X — X NON PROPERTY DAMAGE (Per accident) $ _AUTOS $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS Y / N N/A WC133001910 3/1/2011 3/1/2012 X WC STATU- 1OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 below E.L. DISEASE - POLICY LIMIT 01,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. 10050NE2Ave Miami Shores 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. . ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD