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PL-11-2311Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 l L-29eo Inspection Number: INSP- 172914 Permit Number: PL -12 -11 -2311 Scheduled Inspection Date: May 02, 2012 Inspector: Hernandez, Rafael Owner: , DUSA ACQUISITION LLC Job Address: 455 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PALMETTO PLUMBING CO OF HIALEAH INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)496 -7442 Parcel Number 1132060140140 Building Department Comments KITCHEN AND BATHROOM REMODEL Passed L�J 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- 167809. May 01, 2012 For Inspections please call: (305)762 -4949 Page 22 of 25 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 0 Permit No. 1' I k 2t1 Master Permit No..l I u ^ 2� Permit Type: PLUMBING © OWNER: Name (Fee Simple Titleholder) ,4' /i X77/ Phone #:3653 ' 77t 40-a Address: 4.76 &T , /3 7.. ' /c'-4 / City: f% /a State: a- Zip: 3r5/k.3 Tenant/Lessee Name: - - Phone #: a `19 L '" WIZ kmspell& O'citiVI., /. rA fue- Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3S / �P Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: PII McAc5 itu Nth L Phone #: S &t 1- 3S'1 Address: p910 Ss. w ?A Sr City: (f ( .kL FA-* State: `�L-- Zip: 3 3c) Qualifier Name: F!3 ( j �L,d.,���, C &2 t. AJ Phone #: State Certification or Registration #: C= f t°. '7'1 ifttif %' Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration UNew ❑Repair/Replace ❑Demolition Description of Work: * ** * * * * * ** * * ** * * ** * * ** n****+x**x:**** ** Fees **** **** ***** **** * * ** *+x+x************a ***arm* Submittal Fee $ Permit Fee $ S. — CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ j� n TOTAL FEE NOW DUE $ 1 (- 6 L-' '14 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 issu In the absence of such posted notice, the inspection wt t be approved and a reinspecttiion fee will be charged. 4 Ak7u Signatu?? €e Owner or Agent The forgoing instrument was acknowledge)d bef a me pis day of�9aci� , 20 A, by r e. i1 . )C Ib 1( who is personally known to me or who has produced Signature Contractor et) The foregoing instrument was acknowledged before me this 3 , day of Um'f , 20 12, by Et,J# J who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOT ' Y PUBLIC: My Commission Expires: 04.1•I.'et, JOSEPH R. COLLETT! * MY COMMISSION #DD988187 EXPIRES: September 4, 2014 qrs -o°. Bonded Thru Budget Notary Services **** * * * * * * * * * * * * * * *** ******`>kF e **** * * ******* *********** :**** ***************** **** ** ***** *************** *e:*** Sign: Print: }� v i,t- TM, S `aY P�,4 Miguel Peuate My Commission Expires>�a?l`;• eV.iGOMMisSioN #DD878093 EXPIRF:.S; APR. 08, 2013 ®•'•j . :�' wwW.AARONNoTARY.com APPROVED BY 2 Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk Ha,.vnu VCI'i 1 IrIL,M 1 C Ur LIMDILI 1 Y IIVzUI imPlum 1 11/22/2011 ADM PRODUCER (305)822 -7800 FAX (305) 558 -4294 Collinsworth, Al ter, Fowler & French LLC 8000 Governors Square Blvd Suite 301 Miami Lakes , FL 33016 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 Palmetto Plumbing Company of Hialeah 2655 W 78th St. Hialeah, FL 33016 INSURER A: Hartford Casualty INSURERS: FCCI Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURER C: 11/25/2011 INSURER D: EACHOCCURRENCE INSURER E: X 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 1: ADM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 1 IuI,,L.A ■d POLICY EXPIRATION ._y Jul,b• 1 LIMITS .1. A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 21UUN)B4045 END'T HGO 01 -0605 11/25/2011 11/25/2012 EACHOCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PRFMI.SFS (Fa ncxhiranca) $ 300,000 1 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 X Blanket ADD'L Insd PERSONAL & ADV INJURY $ 1,000,000 X Blanket WOS GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: POLICY n 2,-- n . PRODUCTS - COMP /OP AGG $ 2,000,000 —I A AUTOMOBILE LIABIIJTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS $ 500 comp/coll ded 21UUNJB4045 11/25/2011 11/25/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ X Blanket Waiver GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ —I OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 001WC11A66671 05/01/2011 05/01/2012 X I TORY LIMITS I IOER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS V....1......1.■..V4v4.. Miami Shores Village, City of 10050 NE 2nd Avenue Miami Shores, FL 33138 v.-a .,� - -. ...�.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , Richard French /GLADYS ACORD 25 (2001/08) © ACORD CORPORATION 1988 eBPU6A PRINTED WITH ENVIRONMENTALLY FRIENDLY GREEN INKS FSC Mixed Sources ma�aga.�aomma Can am xscocccnn mossfscsag City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2011 -12 062233 -3 BUSINESS NAME / LOCATION PALMETTO PLUMBING INC 2655 W 78 ST 33016 HIALEAH OWNER PALMETTO PLUMBING CO Sec. Type of Business 196 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 Cn7ES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. LOCAL BUSINESS ,TAX REC'EIP'T "' '66, DAD.E COUNTY STATE OF FLORIDA .EXPIRES'SEPT 30, 012 s DUST DE DISPLAYED AT "PL/1GE OF BUSINES, JANT TO COUNTYr? CObE CHAPTER $i1 AR C THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 062233 -3 CO OF HIALEAH STATE* CFC1426276 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 OF HIA INC PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 08/16/2011 09010072001 000045.00 SEE OTHER SIDE WORKER /S 10 DO NOT FORWARD PALMETTO PLUMBING CO OF HIALEAH INC GENE OBRIEN PRES 2655 W 78 ST HIALEAH FL 33016 it tlltttliiIlttaratlirlltr trft {1trl1,3rlltlirt,3,3l,1rft�8t t� Miami Shores Village 7v 7 Building Department DEC I .. 2111 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 E, INSPECTION'S PHONE NUMBER: (305) 762.4949 n II Permit No. Master Permit No1Z-C- 22C-)° BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING 4(7?t' )�/�/ OWNER: Name (Fee Simple Titleholder): ZY)&1 1g /7 /) Phone #: 32 `7(74 41/2/°Z Address: � /9J /32 City: /11/4,77 State: Zip: 3.31 €3 Tenant/Lesee Name: / Email: /Yjsf°/�('t.i..0i9 6V / • coral._ JOB ADDRESS: 1/55 Nt / i" City: Miami Shores Folio/Parcel #: 1/— 320 Is the Building Histori Phone #: Coun, Mia ` Dade CONTRACTOR: Compan Address: City: c36 A) s/ deli* 1 Zip: 331 Flood Zone: Phone #: 2 q (-1z1`T z Zip: 333/2-- Qualifier Name: Phone #: 306- (7/9 74/1/z. State Certification or Contact Phone #: c DESIGNER: Architect/Engineer: or- / --7 /q? 210 Certificate of Competency #: Email Address: seella 6:3,74..., c„)„,, a'G2rC'cS Phone #: ,707 Value of Work for this Permit: $ �1 , Square/Linear Footage of Work: Type of Work: ❑Address CIA. iteration ❑New �Repair/Replace Wt—,Z707 J ❑Demolit one Description of Work: Z G 42 7 CiL s -- //''/ OVAI i zO- __AV 7/ re/77 * *** r**** *************x:**** **** * *** **** Fees *** * **** x*: a*************** ***** * **** **** ** ** Submittal Fee $ Permit Fee $ 2.2 57 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 perrliit 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 willobe 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 asence of such posted notice, the inspection will .1. e approved and a reinspection fee will be charged. • l 11c 77, , Signature l/ ! • . " A: Signature ,e�;e�16 f// Owner or Agent f Contractor The foregoing instrument was acknowledged before me this / V The foregoing instrument was acknowledged before me this jci day of 200_, by I], Sap /19 , day of 4/, ,, "r 20 , by a. ', �� a �� , ■ who is personally known to me or who has produced who is personally ko me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio JACQUELYN S. R08LEDp MY COMMISSION d EE �JI�{ EXPIRES: February 16, 2015 2015 Bonded Thru Nary Public Undei wit NOTARY PUBLIC: Sign: Print: My Commissio 4 *nkN kds**ds**+ k*nk***Nsd :Nsd:sk**sk*d++k**** Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) AacAs ._.,., MYCOMMISSION ROBS EXPIRES: Feb #EEQ3$515 i Undsj�e0 to k Sk*e nYfliE'S Clerk