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PL-11-216Inspection Number: INSP - 165244 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 O H �� Permit Number: PL -2 -11 -216 Scheduled Inspection Date: October 07, 2011 Inspector: Hernandez, Rafael Owner: HUTCHINSON, MARK Job Address: 1041 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: PROFESSIONAL PLUMBING CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060143720 Phone: (305)822 -8282 Building Department Comments RE- INSTALL PPLUMBING FIXTURES ADD POWDERBATH ,RELOCATION OF SOME FIXTURES 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 INSP- 155840. October 06, 2011 For Inspections please call: (305)762 -4949 Page 13 of 15 1 BUILDING PERMIT APPLICATION Miami Shores Village uilding Department 10050 N;ind- Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SPECTION'S PHONE NUMBER: (305)762.4949 Permit No Master Permit. No FBC 20 Permit Type: PLUMBIN OWNER: Name Address: gyp 4 City: 41 f .. Tenant/Lessee Name: Email: Pe iTi tlehal t JOB ADDRES: a: City: Miami Shores County: R9iami Dade Zip: Folio/Parceli# , , .......0 ., Is the Building H storical%y De ign�ated Yes NO l~laod 7mn r .., aN CTOR Company Name: , 6 r 4 Address: j City: State:tpt Qualifier Nanne: Phone# State Certif:eatkm or Registration : Certificate of Competency #: Contact Phone *: DESIGNER :'Architec n ineer: Value of Type of Description o or E it Address: 1_ . Phoni A ration � New Dernoli ; on' Submittals Fei Scanning Fee Notary $ Double Fee * * * * ** =Fees. * ** $ Permit Fee $ 3 5" --- $ Radon Fee $ I`iraining/Education F'ee $ Structural Review $ CCF $ iCO/C DIIPR $ Bond Technology TOTAL FEE NOW DU Bonding Company's Name (ii Bonding Company's Address City State Mortgage Lender's Name (ifappiicabJe) Mortgage Lender's Address City Application is hereby made to obtai commenced prior to ithe issuance of construction in this jurisdiction. 1 undersea 4V ELLS, POOLS, FURNACES, BOILERS OWNER'S AFFIDAVIT 1 cent applicable laws regulating conrttc Sta atit to do the work and installations as indi snit tend that all work will l peridrnted id that a separate permit mint be secured fon HEATERS, TANKS and AIR COND111ONER, ETC' on has. )atng GNS, -ith all that all the'faregaing information is accurate and that all worrk';wt11 to d on and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECO: COMMENCEMENT MAY RESULT IN YOUR PAY IMPROVEMENTS TO YOUR PROPERTY. IF YOU FINANCING, CONSULT WITH YOUR LENDER OR , AN RECORDING YOUR NOTICE OF COMMENCEMENT." CE OF FOR OBTAIN ORE Notice to Applicant As .a ctaraddtkort to the issuance of a building permit with an estimated value e3 promise' in good faith tlut a :copy of the notice of comnrent'eine ?rat and construction lien law br'ochun whose property is subject to attachment. Also, a certified copy of the recorded notice of eommettt eerie for the first inspection . which occurs seven (7J days after the buikling permit is issued. In tlte'ern inspection will not he app tedand a reinspection. fee will be charged use" p me person tt alte job site d:17olice, the Signature Agent The foregoing instrurneitt tnras acknowledged °befare me this , �1 The foregoing it4strumeia day of , 20 „ , by 14 / tics J day of, 0 , 20 who is personally known ,to me or who has produced '' ;A 1.0,..,,,,, who is personally known to me; As idenri cation and who did take an oath. as identiitc NOTARY PUBLIC:. NOT 'a,' P BLIC® Sign; Print: ion and tuiio slid take an oath. My Commission' Expires; APPROVED we vl ceci t Public • State of Florida mmission Expires Feb k, 2012 smmission # '00 754050 d Chrinttlh National No';3y Assn. My commission U.D5.'t +-. Z2Fa 30111 1 DRC Dgmsor J ,7 -/ Plans Exe+miner Structural Review gwgntin..i..r.nwanw Its ;41, it rRrrara ».oee1. .,ZOmOg Clerk 07/ 10/07 c tevisc i 4 &11 Ut2t }f iced 3/1 DATE(MMIDD/YYYY) 12/x8/2010 A. CERTIFICATE OF LIABILITY INSURANCE 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. PRODUCER (407)628 -3441 FAX (888)883 -8680 Lassiter -Ware Insurance Orange /Seminole, Inc. Box 940159 Maitland, FL 32794-0159 INSURED Professional Plumbing Corp. Roma Corp. 1755 West 39th PT Hialeah, FL 33012 INSURERS AFFORDING COVERAGE • INSURER k Amerisure Mutual Insurance Co. NAIC # 23396 INSURER B: Amerisure Insurance Company I9488. INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . INSR r' ADM. I` ; TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE - [ I:, ! 6 Ii i• PO CY EXPIRATION ! • • • LIMITS • _ ->, 09/04/2011 EACH OCCURRENCE $ 1,000,000 $ 300,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL20130350500 09/04/2010 DAMAGE TO RENTED PRFMIRF4 (EA nen irAnCA) X MED EXP (Any one person) 9 • 10,000 ICLAIMS MADE © OCCUR PERSONAL & ADV INJURY $ 1,000,000 $ 2,000, 000 X Contractual GENERAL AGGREGATE PRODUCTS - COMPIOP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY P-1( jE& In we n B ,) AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA20022790601 09/04/2010 09/04/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ X BODILY INJURY (Per person) BODILY INJURY (Per ac cident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ A EXCESS/UMBRELLA LIAt3IJTY OCCUR n CLAIMS MADE RETENTION $ 6 CU2064256 09/04/2010 09/04/2011 EACH OCCURRENCE $ 4,000, 000 $ 4,000,000 $ AGGREGATE T. $ $ TIDEDUCTIBLE C A WORKERS EMPLOYERS' '�ICRER/M If yes, SPECIAL COMPENSATION AND LIABILITY MBERPEXCLUDED? CUTIVE dearlbe under PROVISIONS below WC2025619 12/12/2010 12/12/2011 - x 1 Rv i n ITS I Kit EL. EACH ACCIDENT $ 500,00C $ 500,006 5.1.. OMEASE - EA EMPLOYEE E.1- DISEASE - POLICY LIMIT $ 500, 000 OTHER DESCRIPTION • OF OPERATIONS 1 LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS C• E . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAII.. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAILSUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2001/08) FAX: 305.756, 8972 AUTHORIZED REPRESENTATIVE /�j��� Christopher McClain /LORRIL L"�V' •^I ®AGGRO CORPORATION '1988 Miami Shores Village Building Department 050 N.E.2nd Avenue, Miami Shores, Florida' 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30$) 762.4949 BUILDING PE IT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Owner's Address � L�0i�II1�lI�j1 FEB 0 9 2011 �l Permit No. � 11-21 (10 Master Permit No.1 Phone # a 97/7 "' City ���� d t`/�dl $State Tenant/Lessee Name NA Email Zip Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # i 34047 of q -3' Is Building Ilistor Ball ' Designated YES Contractor's CompanyName pr •Pesci anat. f ivm R cd."hone ## City State t— Zip S3Q 1 Z 314m4 its 460 cam. County Miami -Dade zip I Contractors Address Flood Zone 305 8z z. 82.eg Qualifier Name i/{�i /2' A!' o rises State Certificate or Registration No. Contact Phone 5 0$7- 71 6- t et e °Alteration At t. a Fc ©Cpl Co Architect/Engineer's Phone # ;o5 '714- (a' . L e Certificate of Competency No. E-mail motiOY1s :a (p oa , mi rae ## V3-(/-3,0 °' 3300 Value of Work For this Permit $ 3c9 cO Type of Work: °Addition Describe Work: Re4-0C.A7to,v Square / Linear Footage Of Work: °A (New ❑ Repair/Replace 0 Demolition 446/4/ r feel di Shot rixr . ** **Fees********** * * * ** * ***** * ** Submittal Fee $ Permit Fee $ aZ�. CCF $ Notary $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Training/Education Fee $ COICC Technology Fee $ Bond $ Total Fee Now Due $ g\-71 See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Nance (if applicable) Mortgage Lender's Address City Zip A State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 understand that a separate pennit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.,... OWNER'S AFFIDAVIT: ;1 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 WITII YOUR LENDER OR AN ATTORNEY BEFORE RECOR ING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: ! As a condition to the issuance of 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 inspection will not be approved , nd a reinspection ee will be charged, Signature or Agent The foregoing instrument was acknowledged before me this 3 day of a afr? , 20 % by / 4ijG ArkolVasiRj who is personally known to me or who has produced ----- , As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Signa! Contractor The foregoing i strument was acknowledged before me this day of , 20// , by %! (el 4- Lon re. who is personally known to me or who has produced as identification and who did take an oath. Y PUBLIC: * * * * * * * * **** * ** *C * +. APPROVED BY 0,X,stY P00, =fl «�.t! Notary Public - State .1 My Commission Expires Commission # DD Bonded Through National of Florida Feb 4, 2012 754950 Notary Assn. Pia Examiner ** Engineer , 9-// iblo.distIZAU lerevisit (Revised 07110 /07XRevised 06Jt " ^" NOT Sign: Print: e44.•• . Eddy Jimenez My Commission Expir: es �,q po` Commission #DD641042 Expires: FEB. 15, 2011 Zoning Clerk checked