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PL-11-1763Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 170113 Permit Number: PL -9 -11 -1763 Scheduled Inspection Date: February 22, 2012 Inspector: Hernandez, Rafael Owner: INC, NICAMERICAN Job Address: 1360 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DIMITRI CONSTRUCTION SERVICES Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050300070 Phone: (305)345 -1199 Building Department Comments PLUMBING WORK FOR INTERIOR REMODEL Passed C�] 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- 164838. pending gas February 21, 2012 For Inspections please call: (305)762 -4949 Page 29 of 52 10/11/2011 07:33 9547558925 HARVEY PAGE 01/01 ACORPTM CERTIFICATE OF LIABILITY INSURANCE PRODUCER HARVEY FIRESTEIN PO BOX 9168 DATE (MMIDOIYYYY) 10/11/2011 CORAL SPRINGS, FL 33075 INSURED DIMITRI CONSTRUCTION SERVICES INC 6065 NW 167TH STREET SUITE B -11 )MIAMI, FL 33015 COVERAGES 954-755-1480 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 # INSURER A: CENTURY SURETY CO INSURERS: INSURER C: INSURER 0: INSURER E: I nt ruLIL:lt . I„,I- INDUKANf,:k LISTED BELOW ANY REQUIREMENT, TERM OR CONDITION MAY PERTAIN, THE INSURANCE AFFORDED POLICIES_ AGGREGATE LIMITS SHbWN MAY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH HAVE BEEN REDUCED BY PAID CLAIMS. I L ER _ _ _ A D D GENERAL X PEQ ,t�iANDE POLICY NUMBER 1 roL{CY EFFEG jp/E .L pATE(MAa)Dp1YY1 08/18/11 PpLICY E9(t IRAUQN DATE(MM/DDrvY) 08/18/12 LIMITS EACH OCCURRENCE $ 1,000,000 uABIUTY COMMERCIAL GENERAL UABILITY CCP718271 PREMISESjEaoccurcnccl $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ EXCLUDED PERSONAL L,ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2 000 000 GE''N�'L AGGREGATE LIMIT APPLIES PER; PRODUCTS -COMP/OP ACIO $ 1,000,000 —X1 t'OLICY . (JEC ! l Loc AUTOMOBILE LIABILhT ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 5 BODILY INJURY (Pet Se/ean) S BODILY INJURY (Pa accident) $ PROPERTY DAMAGE (Par Wzad nt) $ GARAGE LIABILrry ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC 1 S AUTO ONLY: AGG $ EXOESSWUM®RELLA uABIRITY EACH OCCURRENCE S OCCUR Li CLAIMS MADE DEDUCTIBLE RETENTION 3 AGGREGATE S S 5 $ WOR4(ERS COMPPAISATION AND EMPLOYER*. LIAEIUTY ANY PROPRIETOR/PARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? yes, under SPECIAL PROVISIONS below I ST411% IOER E.L. EACH ACCIDENT $ E.L, DJSEA$E - EA EMPLOYEE $ E.L. DISEASE - POUOY LIMIT 5 °Tim DESCRIPTION OP OPERATIONS/ LOCATIONS r VEHICLE$, I rXCLUSIDNa ADDED I:Y ®NDOHSEMENT rr SPECIAL PROVISION$ CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 26 (2001 /081 6HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAnCIN DATE THEREOF. THE ISMUINQ INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 5O SHALL IMPOSE NO RBLIDATION OR LIABILITY OP ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESEN L 9, AUTOO @ ACORD CORPORATION 1988 f y 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 Permit Typ • PLUMBING OWNER: Name (Fee Simple Titleholder): JJ!alj/9 /[4,J lM Address: • i i • 0 City: Permit N. PI 11 DZ Master Permit No. A 11 - 1589 Phone#: /44 AI State: Zip: 3359/ Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: j 3 6 0 N 6 /0 3 s1. City: Miami Shores County: Miami Dade Zip: 3 3 1 38 Folio/Parcel #: 11 7j Z O 5 d 3(9.0 7 0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: b vet i rR r 6Nsr & vtT7 O' Sways ce Phone #: 13 o$) 3 95- 11 9 g Address: 6065 X1/017 / 6 1 Si . $- // City: 1`1 • A9rt State: F t o It i p q Zip: 3 3 0 /5 Qualifier Name: / c A R D o b, Mora, Phone #: (0 %) 3 YS - I 1 9 9 State Certification or Registration #: C F I Y 2.7881 Certificate of Competency #: Email Address: fA Contact I hone #: - .701/ Phone #: / !7/ op 3410 Value of Work for this Permit: $ ' %' it �': }, Square/Linear Footage of Work: Type of Work: ❑Address Itineration y UNew ORepair/Replace / UDemolition Description of Work: Zl -,/ _LD ! w G ► 4 8I 1,39a/ * * * *** 0000* * * * ** ** * * ** * * * ** * ** * * * * * *Fee5 ** :�x * * * *:x�x * * *�x * * * *�n * * *u * * * *** * ****** : * * *** Submittal Fee $ Permit Fee $ ‘‘F: 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 'es'timated vatue 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 wilt (tot be aamved and a reinspection fee will be charged. Signature The fo day of who • -tom• pers NO ,, Ogee or Agent nstrument as ackno �` ed • e► before ' is / 0 20 b�,J�1t .10 1i_klJ il nall kno n to me or who has produced Ir_ R P BLIC: identification and w o did take an oath. Signature ": .S• Contractor • The foregoing. instrument was acknowledged before me this J S Jay 54-0; , 20 // by i1 ► c w aso D ► ii . riti who islarsonally known to moor who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY + S ' , \ le °23. 015 l''4 %,,,, 140tat l '0.0x9%(ss EE .aN sol \7 p$0 Pc - � Z . g`�gps o e4IW'''' Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: Print: My Commission Expires: PABLO NAY Pubnc' state of ARUS Conunissionf +F 2oi Zoning Clerk 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 Permit Type: PLUMBING OWNER: Name (Fee Simple Title i older): Address: ( 13(4-) City Tenant/Lessee Name: Email: Phone 45 ` OUP? Zip: D State: Phone #: JOB ADDRESS: City: Miami Shores 1 c�� �, 103�51" County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 11.1 + T tZ 1 C Al rl7AVC 71 Oa SE7 l c S Phone #:(0 5) S Y5 --// 9 Address: . 6 0 6S N' W /6 7 51 -1/ City: 1/*7 -1 t State: /— C... Zip: 3 3 0 /3 Qualifier Name: g. 1 c-*n- o D i ice% , Tom, State Certification or Registration #: CGG 1 5 0 V 0 % 4 Certificate of Competency #: Contact Phone#: Email Address: Phone #: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: ❑Address ❑Alteration Description of Work: Squ ❑Ne Footage of Work: .[epair/Replace ❑Demolitidn f; WPM, W V , — — r,i o& ►S 4 RAW- *, x�x�x****, x**** �x�x�x*, x+ x **** * *** ** * **�x******Fees,x **** •,x�x+a *x��xx��x***** ,a�,x *+a+��x�x** *** *** ******* Submittal Fee $ Permit Fee $ < CCF $ CO /CC $ Scanning Fee $ Radon Fee $ ` DBPR $ Bond $ Technology Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l �'19 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 CONDmONERS, 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 inspection will not be appro d and a reinspection fee will be charged. Owner or Agent The fore trumen trumen was ackno,,.. ged befor � e�this3`A The foregoing instrument was acknowle ed befor me is day of k I , 201L , byQ 'f • # f/ 11444 day of ' 1 20 l l, by 1 i CP-( •4{• who s personally known to me or who has produced ho is personally kno me or w o has produced b(L„ identification and who did take an oath. 3 1 - as cation and who did take an oath. Signature Contractor NO Sign: Print: My Commission Exp ssion Expires: * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)