Loading...
PL-07-694f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -45486 Permit Number: PL -4 -07 -694 Scheduled Inspection Date: March 28, 2012 Inspector: Hernandez, Rafael Owner: MOORE, DANIEL Job Address: 130 NW 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FERNANDO ALICOT INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number ()_ Parcel Number 1131010160020 Phone: (305)773 -6611 Building Department Comments replace galvanized lines under house Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 27, 2012 For Inspections please call: (305)762 -4949 Page 21 of 21 Miami Shores Village Building Department 10050 N.E2nd 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 No31- 4 0/ Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): IflAve. Abort. Phone#: AO- INes — 51 Address: 2J )0 E 2,7 `�-- City: IJP� &lc. State: 0 Zip: koo l34, Tenant/Lessee Name: Phone#: Email: 31400n 1?s @ yklAcn.cAm JOB ADDRESS: l30 N W 412 St City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: t1310O0 L1p0b2Z0 / Is the Building Historically Designated: Yes NO ✓ Flood Zone: A CONTRACTOR: C o m p a n y N a m e : c e i' Q O NI t cst S,A (.... Phone#: 305 - 77 3 46' Address: City: C,.8 r, (ikt jl c 5 State: P L. Zip: 33 l Qualifier Name: Phone#: State Certification o r R e g i s t r a t i o n #: yy • l l 0 7 0 Z.-- Certificate of Competency #:0000 /1 B O ? Contact Phone(2tX) 1 (; (o k 1 Email Address: At_ ( C.,-9 IT lc Q 6.1— S OkIns. . ;-) C DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: l'etMte... 11Z- 4,4 (Al LOA NI agt Qlee% (aer (A0 . 0 ew i M ea _t rtt P1 tef. * ***** * * * *** x **** *** * * ****** * * *** ****** Fees * * ** **** **** ** *** * * **** ,** **** ** * *** * * * ***** Submittal Fee $ Permit Fee $ jC%� 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 FT FCTRICAL 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 • ' ction which +" curs seven (7)- days after the building permit is issued In the absence of such posted notice, the inspection w pr<, ed ' a reinspection fee will be charged Owner or gent before me this R-1 forego' i � g ins nt w acknowledged bef. y 200 by U'; '' Contractor The foregoing instrument was acknowledged who is personally known to me or who has produced i l/S who is onga� ntification and who did take an oath. OTARY PUBLIC: SHEILA MANN! NOTARY PUBLIC: No. 01 MA6057838 Notary Public, State of New York Qualified in Queens County My Commission Expires April 23. My Commission Expires: !/1/7/ • Sign: Print: My Co I/ * ,, ,sir tiPµY 1g . Notary Public - Sta e 23. 015 �5:.� � • s Sep 2 c r Commission # EE 12 Assn. '••;F,v;,;; 0"s Bonded TbrOU ' National Noiary *w* *** * * * ** **** **** **+e** *e** • . * ***** ** * * ** ***** * **e, ** aye= * *** * *** x************** ** * * * * ** ** *********** * ****** APPROVED BY ','jl-' Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) A b CERTIFICATE OF LIABILITY INSURANCE 3/27/ o°1' z") 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(les) 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 Ileu of such endorsement(s). PRODUCER Gil, Garden, Avetrani Insurance Group 10689 N. Kendall Drive Suite 208 Miami FL 33176 CONTACT Marta Barrionuevo NAME: laC No Fxrl. (305) 630 -4777 I ac No): (305)279 -3022 E-MAIL ADDRESS: martab@ggaig.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Mid-Continent Casualty Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Fernando Alicot, Inc. 1138 Milan Avenue Coral Gables FL 33134 INSURERB:COarimerCe & Industry Ins. Co. 0401.000839879 INSURERC:National Union Fire Ins. Co. 1/15/2013 INSURERD: $ 1,000,000 INSURER E : $ 100, 000 INSURERF: I CLAIMS -MADE B OCCUR COVERAGES CERTIFICATE NUMBER:CL1211302388 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 TR TYPE OF INSURANCE ADDL i, , SUBR ,i a POLICY NUMBER POLICY EFF lu u 1.1 POLICY EXP I. L D►,1>►l1 LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 0401.000839879 1/15/2012 1/15/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100, 000 I CLAIMS -MADE B OCCUR MED EXP (Any one person) $ Excluded PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREG POLICY I ATE LIMIT APPLIES PER: ^ I .Pi F T [1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE — — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE MC084146475 1/15/2012 1/15/2013 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED 1 B 1 RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC003603404 8/12/2011 8/12/2012 1 WC STATU- I I T FR E.L. EACH ACCIDENT $ 500, 000 E.LDISEASE - EAEMPLOYEE $ 500,000 E.L DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Miami Shores Village Building Department 10050 NE 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 S Rodriguez/MMB ACORD 25 (2010/05) INS025 (20100541 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village 04-liccf),-c. Building Department `' 4 10050 N.E.2r4d Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. 14R4 PERMIT APPLICATIO Master Permit No. 2004 APR 9 2007 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) _ 6 1L 0 Owner's Address ! 0 Al Z S r Phone # City l y( State Zip 33/ 3 9 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) j 3f /-" 9 Zs T City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO l Contractor's Company Name A/ °047 4 1./ W f' h%'CPhone # Contractor's ' 's Address /13 G. ( L✓ c, City i 1( ( State d {°7, Qualifier Name r7L 0L44 .4 f r- Zip Phone # 520,0 723 P 4 ' State Certificate or Registration No. 'Y�G'o // Certificate of Competency No. 000 a / / 8 E -MAIL: Architect/Engineer's Name (if applicable) Phone # cAJZ Value of Work For this Permit $v0 Square / Linear Footage Of Work: Type of Work: DAddition ., ❑Alteration ❑New Repair/Replace D Demolition Describe Work: "rte - 6/3 t/® // 7- 'e.10 LC'/v C-° C/ A e2 CceC 4 1 re. ************* xxxxx********** * x: rxxxxxxx aFFees****** *****.xxxx *aYicaY xotaY*************xxxx$x*** 0-C. nn,,nn Submittal Fee $ Permit Fee $ / 70 CCF $ 7.20 CO /CC Notary $ 6.(30 Training /Education Fee $ a -40 Technology Fee $ 4' 6.(30 Scanning $ 3• C Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ I • See Reverse side —> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip or a e Lend Nanie ' applicable) M-t &rd's Add City State Zip Application is hereby made to obtain a permit to do the work a d4rris Moons as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all '- wcik "vi[I" 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: [ 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 ins # - Lion which curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection w not be ' pp roves i nd a reinspection fee will be charged. Signature O r o • gent The foregoing instrument was acknowledged before me this I day of , 1L , 20 0, by -Dretitet 414K tkAri, who is personally known to me or who has produced R 5O As identification and who did take an NOTARY PUBLIC: Sign: Print: ei Contractor The foregoing instrument was acknowledged before me this Cr day of l , 20 R, by &;#41 146 1444"11 I�L'tI, 11800 is personally known to me or who has produced '77yrrt„ �3 Z/G pOO as identification and who did take an oath NOTARY PUBLIC: My Commission Expires: x xxxxxxxxxXXx%xxxxxxxxxxxxxxxxxx APPLICATION APPROVED BY (Revised 02/08/06) xxx *Xx %X xx % % %XxXXxXxxxx Sign: Print: My Commission Expires: xxxxxxxxxxxxxxxxxxxxxxx`�,• "x ** xxxxxxxxxxxx Plans Examiner Engineer Zoning