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PL-11-20221 1' Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170763 Permit Number: PL -11 -11 -2022 Scheduled Inspection Date: March 07, 2012 Inspector: Hernandez, Rafael Owner: DAVIES, JOHN Job Address: 1041 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: THE NEW MIAMI SHORES PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050120080 Phone: (305)751 -2446 Building Department Comments INTERIOR RENOVATION OF KITCHEN AND BATHROOM REPLACEMENT FLOORING CABINETS AND 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- 166106. no access 3:20 March 06, 2012 For Inspections please call: (305)762 -4949 Page 20 of 27 Miami Shores Village ID Buildin g Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 97° BUILDING PERMIT APPLICATION FBC 20 Permit No. ,(-�/ // -eV Master Permit No. CC -9 -11 -1738 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Miami Country Day School, Inc. Phone#: (305) 206 -1761 Address: 601 NE 107th Street City: Miami See: Florida zip: 33238 Tenant/Lessee Name: Miami Country Day School Head Master Residence Phone#: (305) 206 -1761 Email: cabanm @miamicountryday.org JOB ADDRESS: 1041 NE 94th Street City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: 11-3205-012-0080 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: The New Miami Shores Plumbing, Inc. Phone#: (305) 751 -2446 Address: 900 NW 144th Street City: North Miami State: Florida Zip: 33168 Qualifier Name: Dennis Michael McLaughin Phone#: (305) 751 -2446 State Certification or Registration #: CFC019205 Certificate of Competency #: Contact Phone#: (305) 751 -2446 Email Address: diana @miamishoresplumbing.com DESIGNER: Architect/Engineer: JDC Architect, Inc. Phone#: (305) 285 -4343 Value of Work for this Permit? ', Square/Linear Footage of Work: 500 SF Type of Work: ❑Address, * `:' 'ration ❑New ❑Repair/Replace ❑Demolition gs to reflect addition of ceiling light fixtures, additional receptacles, additional Description of Workevisionv, electrical circuits grid .voteralye box. Original drawings consisted of Interior renovation of kitchen & bathroom replacement flooring, cabinets arYd fxtties J Submittal Fee $ Permit Fee $ -7) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ _ .` Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Zip Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 FTP.CTRICAL 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 inspection will not be approved and a reinspection fee will be charged T. Owner or Agent The fore oing instrument was acknowledged before me 2/l The foregoing instrument was acknowledged before me , this +h day o Wde1 , 20 / by 6#;./7 day of D OiI Y, 20 \� , by c (U V II lI 1r). who is perso y nogg to me or who has produced As identification and who did take an oath. as identification and who did take an oath. Signature Dennis Michael McLaughin Contractor who is personally known to me or who has produced NOTARY PUBLIC: 4;4 .��a L. pa+i Sign: /� * �•'�? Sign: *- : EXPIRES 4 .v Print: t. . (c KENNE flitiKOTAL K My Commission Expires: September *• '•��: 4;c� My Commit ;pi - �iAY COMMISSION EE088935 ........ Sts ++ +` ':`?/'; ` EXPIRES May 02, 2015 ,,,nuuna+ (407) 398.0103 Flarwa lotmvse,vtce.00m NOTARY PUBLIC: APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 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 No. ITR-CwE„ NOV 01 2011 BY. Master Permit No. CC -9 -11 -1738 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Miami Country Day School, Inc. Phone #: (305) 206 -1761 Address: 601 NE 107th Street City: Miami State: Florida zip: 33238 Tenant/Lessee Name: Miami Country Day School Head Master Residence Phone#: (305) 206 -1761 Email: cabanm @miamicountryday.org JOB ADDRESS: 1041 NE 94th Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: 11- 3205 - 012 -0080 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: The New Miami Shores Plumbing, Inc. Phone#: (305) 751 -2446 Address: 900 NW 144th Street City: North Miami Qualifier Name: Dennis Michael McLaughin State: Florida Zip: 33168 Phone #: (305) 751 -2446 State Certification or Registration #: CFC019205 Certificate of Competency #: Contact Phone #: (305) 751 -2446 Email Address: diana @miamishoresplumbing.com DESIGNER: Architect/Engineer: JDC Architect, Inc. Phone#: (305) 285 -4343 Value of Work for this Permit: $ 5,200.00 Square/Linear Footage of Work: 500 SF Type of Work: DAddress ®Alteration ONew ORepair/Replace ODemolition Description of Work: Interior renovation of kitchen & bathroom replacement flooring, cabinets and fixtures. * * * * * * * * ** **** ***+ x*********+ x******** Fees********** * * * * **** * * **** ****** * * ** ******* *,x* bb Submittal Fee $ �' Permit Fee $ ' CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Scanning Fee $ Radon Fee $ TOTAL FEE NOW DUE $`-t' Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Zip Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 inspection will not be approved and a reinspection fee will be charged. Signature ary T. B Owner or Agent The foregoing instrument was acknowledged before me this 0/ day of lrih , 20 L/ , by Cfr $1741 whoi&przionally-linniyato me or who has produced As identification and who did take an oath. NOTARY PUBLI Sign: P • 7Posadas * : E UUaea E028 f 75f yy•oEDt,0v 3 , Z • ,: '9 N 0;44: My Commission Expires: September 22, 21ige,o ;`.:? ? o,� I,, /C,4Stai.,°00 Signature Dennis Michael McLaughin Contractor The foregoing instrument was acknowledged before me this c day of 0c'b , 201L., by 2 enn,S n iaw jp),• -i • who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: _ Print: Anne /6 My Commission Expir * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) KENNETH B KOTALIK oi MY COMMISSION # EE089935 EXPIRES May 02, 2015 346153 * * * * ** " ••• Zoning Clerk 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. x COPY OF QUALIFIER'S STATE LIC CARD B. x COPY OF LOCAL BUSINESS TAX RECEIPT C. x COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. x 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: € Aew Mkc rn\ Scores Plornbin,5, 1 nC - BUSINESS ADDRESS :CI 00 NW t44 5 T CITY M 1 CA n'1► STATE ZIP CODE n I C BUSINESS PHONE: (305 ) J I Z4.4 G FAX NUMBER (�05) 75 its .0 2 CELL PHONE (___) QUALIFIER'S NAME: Den )S < < vo iNt n QUALIFIER'S LIC NUMBER: CA' CO \A O5 E -MAIL ADDRESS (IF APPLICABLE): hrffp` urn biY13 @.c ©\ -c& rri Created on 3119109 BY MLDV 1 RV 3126109 MLDV ACO °® CERTIFICATE OF LIABILITY INSURANCE 8/23/20 ) 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 Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 CONTACT SllZle B PHONE FAX IA/C.No. Ext1:954- 724 -7000 _CNC,No):954 -724 -7024 ADORES S:suzieb@keyescoverage.com CUSTOMER ID O: 8658 INSURERS) AFFORDING COVERAGE NAIC IT INSURED New Miami Shores Plumbing, Inc. Miami Shores Plumbing 900 NW 144th Street Miami FL 33168 . INSURER A :Hanover Amer Ins Co Y mvomRB:Depositors Ins Co /Nationwide 42587 INSURER C : Hanover Insurance Company 22292 INSURER D : Bridge f ield Employers Ins Co $1,000,000 INSURER E : EM PR E TO RENTED ��MES ( Ea occturence) INSURER F : '.. ... . COVERAGES CERTIFICATE NUMBER: 619329152 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 TYPE OF INSURANCE AIXILP INSR )B R YYVD POLICY NUMBER POUCY EFF (MM IDD/YYYY) POUCY EXP (MM/DDIYYYY) LIMITS A GENERALUABIU1Y COMMERCIAL GENERAL U ABILITY OCCUR Y Y RZJ3841050 04 8/23/2011 8/23/2012 EACHICE $1,000,000 X EM PR E TO RENTED ��MES ( Ea occturence) $100,000 CLAIMS -MADE X MED EXP (Anyone person) $5, 000 X PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT 1 POLICY F JEGT APPLIES PER PRODUCTS - COMIP/OP AGG $2,000,000 — [ ILOC Ded: PD $2,000 B AUTOMOBILEUABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS Y - BAPC 5924082319 7/1/2011 7/1/2012 COMBINED SINGLE UMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY (Per accident) accident) $ X X $ $ C x UMBRELLA LAB EXCESS LIAR X OCCUR CLAIMS -MADE UHJ3841053 03 8/23/2011 8/23/2012 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DEDUCTIBLE RETENTION $0 Completed Ops $5,000,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS YIN N/A 83034950 8/23/2011 8/23/2012 X VJCSTAUMTU- RS IOTH- TORY ER EL. EACH ACCIDENT $100,000 EL. DISEASE - EA EMPLOYEE $100.000 below El. DISEASE - POLICY MIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additonal Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NW 2nd Ave 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. AUTHORIZED REPRESENTATIVE *1? ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 8001730 -1 BU MIAMI AS MAE RVUMBING 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY 900 NW 144 ST 33168 UNIN DADE COUNTY OWNER THE NEW MIA SHORES PLBG Sec. T oe of Business 1.96 - PLUMBING CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAURCA- WONS. PAYMENT RECEIVED W AMIA ADE COUNTY TAX COLLECTOR: 08/02/2011 60030000019 000075.00 SEE OTHER SIDE INC FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL 001730 -1 ST ATI=R� #CEIR0t.9205 WORKER /S 10. DO NOT FORWARD MIAMI SHORES PLUMBING THE NEW MIA SHORES PLBG INC 900 NW 144 ST MIAMI FL 33168 i „l1 it. 11,.E, II, 11 „1.,1, .,11,11.,E „i,1,11 di,,,ll„Tlahl Ac# 4993859 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L10063.400568 MAW ' 'BWMHNUMBER LICENSE NBR 06/14/2010 090482272 CFC019205 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2012 MCLAUGHLIN, DENNIS MICHAEL THE NEW MIAMI SHORES PLUMBING INC 900 NW 144TH STREET MIAMI FL 33168 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY LAW CHARLIE LIEN :INTERIM SECRETARY