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PL-11-1561Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 163712 Permit Number: PL -8 -11 -1561 Scheduled Inspection Date: January 11, 2012 Inspector: Hernandez, Rafael Owner: CHARLES, R GREGORY Job Address: 790 NE 91 Street 8 Miami Shores, FL Project: <NONE> Contractor: MIAMI PLUMBING & SOLAR HEATING Permit Type: Plumbing - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1132060390080 Phone: (305)835 -8008 Building Department Comments KITCHEN SINK Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 1441,„/L January 10, 2012 For Inspections please call: (305)762 -4949 Page 8 of 37 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 APPLICATION FBC 20 RECEIVED AUG 242011 BY: Permit No. 13L 1 1 - 1 S( Master Permit No. C 1 1 I LA (0 6) Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Ok`i DL PIA c i1 PISS Phone #: Address: / �� E r ri City: 01 ! A rfl State: zip:.3 a l .,3 g" Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 7 �a Of . 4/ L </ City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade zip: 1 ,3q1 CONTRACTOR: Company Name: Address: City: Qualifier Name: State: frfa e istra ion #: `� 5q, c NO Flood Zone: Phone #: ?�5 X51 --d ,,F zip: 3 3/! 2 State Certification or R g ertificate of Competency #: Contact Phone# ? i 5YJ /%%/ Email Address: DESIGNER: Architect/Engineer: Phone#: % ®'CS Value of Work for this Permit: $ 6 9 7 Square/Linear Footage of Work: Certificate of Work: Address OAltera 'on ONew /F'tv' ' S,'4 /X Description of Work: /Replace ODemolition Submittal Fee $ I Permit Fee $ /.‘' a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ U (oQ 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 the absence of such posted notice, the inspectio -'t •t be approved and a re'- v. ' . • ee will be charged. Signature Signature Owner or Agent Contr. tor The for e _oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 20 11 b 1�I `_ 2 11 > y day of 0 \ by VA , day of who is personally known to me or who has produced CLA D 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: NOTARY PUBLIC;u Sign: - g - Sign: �� ® c® • Print: : r„ : °,�3 .-' e : _ Print: _ �, ° e, y cn = -� �, -Q My Commission Expires: o 1,3,,, .5, .. ��°' � °" Y P '7;-. .° . '4a My Co Cor s c x s° c.: ' ° °. -- ei . : -P..... ' = Yom' •: �� °- ''ice -s Oz. '....... $,"''' ii �'• � ° 7 s ** * **** * ** * * **c*** ****** ** �xu�4 ►Ilq `: ��******** �x�x* �a�x: n�x�xa�* �+ �x�x+x****�x�x:xx� ***911`i * * * ** > * * * * *x�x�****** **�xx�a: *�x�xa� APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk AGGRO; CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/07/2011 PRODUCER McTaggart Insurance Agency, Inc 9900 Stirling Road Cooper City, FL 30024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Miami Plumbing &Solar Heating 2170 NW 95th Street Miami, FI. 33147 INSURER A: National INSURER B: INSURER C: INSURER 0: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW ANY REQUIREMENT, TERM OR CONDITION PERTAIN, THE INSURANCE AFFORDED BY POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED OF ANY CONTRACT OR OTHER DOCUMENT THE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID CLAIMS. - POLICY NUMBER NAMED ABOVE WITH RESPECT IS SUBJECT TO ALL pp�� '�y DATE MM/DD/YY)E FOR THE POLICY TO WHICH THIS THE TERMS, EXCLUSIONS POLICY (MN U TI N L PERIOD INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH LIMITS IN INSTIL) TYPE OF INSURANCE � A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE V OCCUR 02L 0001500 -01 05/07/11 05/07/12 EACH OCCURRENCE $ 100,000 DAMAGE TO RENTED PREMISES (Ea occurence) $ 50,000 MED EXP (My one person) $ 5,000 PERSONAL & ADV INJURY $ 100,000 GENERAL AGGREGATE $ 100,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n PROJECT n LOC PRODUCTS - COMP /OP AGG $ 100,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS (Ea accident) nINGLE LIMIT $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE "(Per accident) $ GARAGE LIABILITY ANY AUTO 7 AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA U ABILITY OCCUR CLAIMS MADE DEDUCTIBLE 7 RETENTION $ EACH OCCURRENCE $ AGGREGATE • $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N describe under SPECIAL PROVISIONS below WC STATU- O I H- 7 TORY LIMITS n ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERA IWNS / LOCATIONS / VEHICLES / EXCLUSIONS ADDID PROVISIONS CANCELLATION City of Miami Shores 10050 NE 2ND Ave. Miami Shores, FI. 33138 I ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE SENTATIVE AA- ,f;e:)17 © ACORD CORPORATION 1988 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08/05/2011 EXPIRATION DATE: 08/04/2013 PERSON: GEORGE KITZMILLER FEIN: 352219643 BUSINESS NAME AND ADDRESS: MIAMI PLUMBING & SOLAR HEATING INC 2170 N W 95TH ST MIAMI, FL 33147 SCOPE OF BUSINESS OR TRADE: 1- SOLAR ENERGY SERVICE 2- PLUMBING IMPORTANT 0 Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be Fi exempt.. apply only within the scope of the business or trade listed on Ethe notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609