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PL-12-774Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shoress..FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172982 Permit Number: PL -5 -12 -774 Scheduled Inspection Date: May 16, 2012 Inspector: Hernandez, Rafael Owner: RHODES, LISA Job Address: 1341 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: BEST OF BROWARD SPRINKLERS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050300140 Phone: 954- 961 -9732 Building Department Comments INSTALL PUB BACKFLOW FOR EXSITNG IRRIGATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 0k/ May 15, 2012 For Inspections please call: (305)762 -4949 Page 12 of 22 Brothers Backflow Specialists Inc 6800 Bird Road, #439 Miami, Florida 33155 Telephone: 954 - 382 -2099 CFC1426564 BACKFLOW PREVENTION ASSEMBLY FIELD TEST REPORT DATE OF TEST: b)/6117- NAME OF PREMISE: CONTACT: STREET ADDRESS: 1 1 \F (C)T SA TEL: CITY, STATE, ZIP: ((1 rr I S k 3r ) r c FAX: ( LOCATION OF ASSEMBLY: 5 . TYPE OF DEVICE: RP 0 D.C. 0 PVB AVB 0 OTHER: MANUFACTURER: (At )C 1 I'`-" MODEL: 7z,029 SERIAL NO.: METER NO.: INVOICE NO. 7y ?s9 SIZE: 1 ,+ LINE PRESSURE psi: NOTE: ALL REPAIRS/REPLACEMENTS SHALL BE COMPLETED WITHIN (10) DAYS. REMARKS: EXISTING DEVICE [ ] NEW INSTALLATION I HEREBY CERTIFY THAT THIS DATA IS ACCURATE AND REFLECTS THE PROPER OPERATION AN TEST GAUGE USED MIDWEST 845 CERTIFIED TESTING COMPANY PASSED 18T [X] 0 2ND FAILED - REPAIR NEEDED INITIAL TEST BY: Pedro Santana CERTIFIED TESTER NO. REPAIRED BY: DATE REPAIRED FINAL TEST BY: CERTIFIED TESTER N CERTIFIED TESTER SIGNATURE p,...7'__d, c MAINTENANCE OF THE ASSEMBLY Brothers Backflow Specialists 6/ R1290 EXP. DATE: MO. 11 DAY 30 YR 13 CHECK VALVE #1 RELIEF VALVE CHECK VALVE #2 PRES VACUUM BREAKEit T E S T 0 Leaked 0 Closed ght Gauge Press a across Check Valve psi Opened at psi 0 Leaked 0 Closed ht Gauge Press re Across Check Valve psi Air inlet opened at f , psi [Did Not o rren \ 0 Did Not Open Check Valve: ['Leaked Held at L psi R E P A 1 R S 0 Cleaned Only r\ REPLACED: 4 0 Rubber Kit 0 CV Assembly or 0 Disc 0 0-Ring 0 Seat 0 Spring 0 Stem/Guide 0 Retainer 0 Lock Nuts 0 Other [ Cleaned Only REPLACED: 0 Rubber Kit 0 RV Assembly or [Disc 0 Diaphragm(s) 0 Seat 0 Spring 0 Guide 0 0-Ring 0 Other 0 Cleaned Only REPLACED: 0 Rubber Kit 0 CV Assembly �• Or [Disc 0 0-Ring 0 Seat 0 Spring 0 Stem/Guide 0 Retainer 0 Lock Nuts 0 Other 0 Cleaned Only REPLACED: 0 Rubber Kit 0 CV Assembly or [Disc, CV [ Spring, Air 0 Spring, Air 0 Spring, CV 0 Retainer [ 0-Ring F 1 N A L Gauge Pressure Across Check Valve psi Relief Valve Opened At psi Gauge Pressure Across Check Valve psi Air Inlet psi Check Valve psi NOTE: ALL REPAIRS/REPLACEMENTS SHALL BE COMPLETED WITHIN (10) DAYS. REMARKS: EXISTING DEVICE [ ] NEW INSTALLATION I HEREBY CERTIFY THAT THIS DATA IS ACCURATE AND REFLECTS THE PROPER OPERATION AN TEST GAUGE USED MIDWEST 845 CERTIFIED TESTING COMPANY PASSED 18T [X] 0 2ND FAILED - REPAIR NEEDED INITIAL TEST BY: Pedro Santana CERTIFIED TESTER NO. REPAIRED BY: DATE REPAIRED FINAL TEST BY: CERTIFIED TESTER N CERTIFIED TESTER SIGNATURE p,...7'__d, c MAINTENANCE OF THE ASSEMBLY Brothers Backflow Specialists 6/ R1290 EXP. DATE: MO. 11 DAY 30 YR 13 1 S 2,I,, _j��si BUII,DirYG 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 RECEIVE: MAY 012012 °-:ter. Permit No. 9u LICATION Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Lisa/ (� '' II CC ► ! ® J Phone #: l 1 (4- 33R- 763 Address: 1 3 T � 1v E 103 rc City: M 1 q ill I CS hp r. S State: F 1. Zip: 53 i 32 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: / 34 1 WE . rci City: Miami Shores County: Miami Dade Zip: 331 3 8 Folio/Parcel #: /1 ,apilOS00/y® LOT 5 L6 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 13 e5-1— O F biro Ward $p bi phone #: `4 4 -C1 .0 t ' —{ l 3. Address: f d 1 1 QTi' ( 4- . ' 1 Ca City: 1[I c - State: E Qualifier Name: ±Ub�'F C .11 Fore State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: Email Address: Zip: 33 lOOu2.'L °� Phone#: 9 514 - -q / 5 Certificate of Competency #: 6 °PC:100 6roc� 5pri in 10 a bet sou -14 o n e,+ Phone#: Value of Work for this Permit: $ �� Square/Linear Footage of Work: Type of Work: ❑Address ❑Alters 'on ��Mew ❑Repair/Replace ❑Demolition Description of Work: �+U.5i L � /e-�—Lpi /C11- ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees******+ x*+ x***** ******* ***+x******************* Submittal Fee $ O. opor Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5 CCF $ CO /CC $ DBPR $ Bond $ 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 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 The forego day of who is perso Wov Owner or Agent instrument was acknowledged before me this ,20 /Z;by known to me or who has produced r� � 3� 0 -51 '1.0.-10:1-0 As identification and who did take an oath. NOTARY P. LIC: Sign: Print: �ifitf i• L . My Commission Exp i es: APPROVED BY 5 1. Plans Examiner Contractor j The foregoing instrument was acknowledged before me this , day of , 20,E y who is personally known to me or who has produced as identification and who did take an oath. NOT Y UBLIC: else ®� seems I YNP7 L1�fCliA°I °..e ° -,p Sig' Print: `�olum ' °j Comm My COIllIIllSSlOt x °eeeeaaeoeae ®'- !eeeava •oases,aleooee ®vx �= Expires 511912013 ; y p1I31STY LYNN DUGUAY ' i . __ �� "y`P' Comm# DD0879074 = �, x Notary peen.. Inc �• ®G° � Florida 1 ;= Expires 5119/2013 eeeeeeeeeeeueeeeeeceeeeeeeeoeeueeud .._..... �� ***44M**************************************** �k Th�k*** ... .even =enaxmaeaeuoeseeseeoeeea9 (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Structural Review Clerk ACORD CERTIFICATE OF LIABILITY INSURANCE DA. TE (MD- MMMDDIYYYY) 05/01/12 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 ADDr17ONAL INSURED, the policy(ies) must be endorsed If SU8�2OCATION 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 J A J Insurance Associates 7037 -B Taft St Hollywood, FL 33024 Phone (954) 893 -5558 INSURED BEST OF BROWARD SPRINKLERS 7081 TAFT STREET HOLLYWOOD,FL % ACT BRAD BRAOCIO LA No. F4 (954) 893-5558 i (AfC. Nok Vass: Uns7Gbcllsoukh.net INSURER(S) AFFORDING OOVERAGE MACS FaX (954) 893.1174 < INSURER A : LLOYDS OF LONDON (954) 893.1174 J 33024 4 IP SURER B: ' INSURER C: INBURERD: INSURER E : ijj$URER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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, EXCLUS IONS AND CONDI11ONS OF SUCH POUCIES. L HITS SHOWN MAY HAVE BEEN REDUCED BY PM) CLAIMS. ENSR LTR A POLICY OF INSURANCE S I p pUCY NUMBER (1MMOMYiMMID1fY UMW GENERAL UARILITY I ® COMMERCIAL GENERAL Lamm, ❑ ❑ CLAIMSMADE OCCUR GENT. AGGREGATE UMR APPLIES PER: ❑ POLICY ❑ PRA ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑AU. SCHEDULED AUTOS I ❑ HIRER AUTOS ❑ UTo "'"� ❑ ❑ UMBRELLA LIAR ❑ OCCUR LAB ❑ C LAIMS-MADE Excess ❑ DED ❑ RETENTION $ 1 TCNR0190058 08/25x~2011 08125/2012 EACH OCCURRENce s 500.000_00_ PR S (6a accwaree) $ 100.000.00 IVIED EXP (Any ono parson $ 5,000,00 PERSONAL & ADV INJURY $ 500,000.00 GENERAL AGGREGATE S 500,000.00 PRODUCTS. COMPIOP AGG $ 500,000.00 5 DAMAGE TO RENTED WORKERS COMPENSATION AND EMPLOYERS LIABnrIY YIN ANY PROPRETORtPARTNER i(ECUTIVE OFFICERIMEMBER EXCLUDED? E I (Mandatory in Nth Kyes dee�be under DESCRtP110N OF OPERATIONS below N1A I P $ORIPTION OF OPERATIONS !LOCATIONS I VCIhcLE$ (ASIacb ACORD 101, Addllionat Remarks S:hedut , If more space is required) SPRINKLER REPAIR AND OR INSTALLATION CERTIFICATE HOLDER COMBIIN,Liam* EDD SINGLE II BODILY INJURY (Per person) s BODILY INJURY (Peracaidensi 5 P CeDAMAGE $ EACH OCCURRENCE 5 AGGREGATE 5 q�U q7� $ ❑ TWQRY LIMITS ❑ ER E.L. EACH ACCIDENT S EL DISEASE - GA EMPLOYE $ EL DISEASE - POUCY LIMIT S CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT. 10050 NE 2ND AVE MIAMI,FL 33138 ACORD 25 (2010105) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W ACCORDANOE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE BRAD BRACCIO CORPORATION. All rights reserved. and logo are registered [narks of ACORD L00 /L00'd C989# 1'LLL668V96 9I :ZZ ZLOZ /0C /1x0 * 5/1/2012 09:'00 Lion Insurance LION INSURANCE COMPANY-Best of Broward Sprinklers,Inc 1/1 CERTIFICATE OF LIABILITY INSURANCE 1 5/1/2012 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate is issued as a matter of Information only and confers no rights upon the Certificate Bolder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 InstuerA. Lion Insurance Company 11075 Insurer B: insurer C: Insurer 0: Insurer E: Coverages The policies of insurance bated below have been Issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contract cr 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 at the terms, exclusions, and conditions of such policies. Aggregate Omits shown may have been reduced by paid claims. NSR LTR ADDL INSRD Type of insurance Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Claims Made ❑ Occur , Each Occurrence 3 Damage to rented premises (EA occurrence) 3 Med Exp 3 Personal Adv Injury 3 — General aggregate limit applies per. General Aggregate 3 3 Poky ❑ Project LOC Products - ConplOp Agg 3 AUTOMOBILE LIABILITY Arry Auto All Owned Autos Scheduled Autos hfired Autos Non-Owned Autos Combined SindeUmit (EA Accident) 3 w= ... Bodily Injury (Per Person) $ Bodily buy (Per Accident) 3 Property Damage (Per Accident) 3 EXCESS /UMBRELLA LIABILITY Each Occurrence Aggregate Occur Claims Made Deductible A Workers Compensation and Employers' Liability Any proprtetorlpartnerlexecutive officerhnember excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2012 01/01/2013 X I WC Limits ' ' ER E.L. Each Accident 81,000.000 E.L. Disease - Ea Employee 81,000,000 E.L. Disease - Policy Lints 31,000,000 outer Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 11 -19 -155 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Best of Broward Sprinklers,Inc Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX 954 - 584-7980 & 305 - 756 -8972 / ISSUE 05 -01 -12 (SD) Be nin Date:_7 /20/2000 CECERTIFICA1E HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Should any of the above described potties be canceled before the expiration date thereof, the Issutng insurer will endeavor to marl 30 days written notice to he certificate holder named to he teat, but failure to do so shat impose no obligation or Oabirtyof any kind upon he insurer, its agents or representatives. ,� fta.y. r MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 MUNICIPAL CONTRACTOR'S 2012 FII, , SS TAX RECEIPT U.5 tE MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10-24 r: EXPIRES SEPT. 30, 2012 PER: '3 RECEIPT NO. 30- 3850360 BUSINESS NAME / LOCATION BEST OF BROWARD SPRINKLERS INC DOING BUS IN DADE CO OWNER :BEST OF BROWARD SPRINKLERS INC THIS IS NOT A BILL — DO NOT PAY CC NO: 96P000385 SEE BACK OF RECEIPT FOR A LIST OF NON- PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED =6;401Al2 02250012002 000175.00 I._ RECEIPT HOLDER MAY 1,, BUSINESS AS A CONTRA. AS SPECIFIED HEREON. SPECIALTY PLUMBING'CONTRACTOR DO NOT FORWARD BEST OF BROWARD SPRINKLERS INC ROBERT SANFORD PRES 7081 TAFT ST #165 HOLLYWOOD FL 33024 ►„ti -11114 t- 1111 -1111) 1ilrl,l,iiI,+- II1I111111- -11-IL MIAMIDADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. •1St FLOOR MIAMI FL 33130 368581 -6 2011 LOCAL BUSINESS TAX RECEIPT ..+ MIAMI4DADE • COUNTY- STATE .OF FLORIE EXPIRES. SEPT. 30, 2012 MUST BE DISPLAYED AT ACE OF :BU PL SJNEr PURSUANT. TO _COUNTY_ CODE CHAPTER 8A `A`- THIS IS NOT A BILL — DO NOT PAY RENEWAL Bu$lN s NSMELIno�AARD SPRINKLERS INC B DOING WABUS IN DADE CO OWNER BEST OF BROWARD SPRINKLERS INC FIN U.S GE PER' CCEC96 385036 -0 000385 Se9P � Ms LTY PLUMBING CONTRACTOR WORKE1 /S 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 CRIES. 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. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 01/05/2012 02250012001 000093.75 SFF ATHFR SIr1F DO NOT FORWARD BEST OF BROWARD SPRINKLERS INC ROBERT SANFORD PRES 7081 TAFT ST 8165 HOLLYWOOD FL 33024 w11a11tI--ILht- iltllil -.'-11- . IImani/P/IB1'Lt1 ��A10TICE 2011 -12 AOCAL 1/5/ Last Loca MIAM: LOCAI 140 1 Mien TEMP( 2011 - Local State Issue 3EST Type 3PECI PHIS F 'AVMED )R PEF 'OUR C .0 YOU 'ALIDA 'aymen liami ACCOUNT NUMBER 368581 -6 December 31, 2C US1NESS TAX SEE REVERSE SIDE FOR MORE INFORMATION TOTAL NO. OF RECEIPTS STATE/CC# 0000358 RECEIPT NUMBER '"? EXEMPTION 385036 -0 1 OF 1 96P000385 PIM BEST OF BROWARD SPRINKLERS INC Owner/ on BEST OF BROWARD SPRINKLERS INC Phone (954)961 -9732 Business Locailon; DOING BUS IN DADE CO Mi Tiros Address, 7081 TAFT ST #165 HOLLYWOOD FL 33024 PAMMININIV Business Type 196 SPECIALTY PLUMBING CONTRACTOR Unite 1 WORKER/S NAILS Carle 238220 DESCRIPTION OF TAXES You can pay this tax online. www.miamidade.gov/taxcollector Current Year County Wide Tax Beacon Council - Economic Dev Unincorporated Area Tax 25% Penalty 2012 TAXES LEVIED 30.00 15.00 30.00 18.75 Amount Due b Janua 31, 2012 $93.75 delinquent penity` FEBRUARY 25% + $100 193.75 T RETAIN FOR YOUR RECORDS T IF REQUESTING CHANGES, COMPLETE AND RETURN THIS PORTION WITH YOUR PAYMENT dr ggccat Number• 385036 -0 e. uire documentation for re uested change * Business Name Business Address Mailing Address * C/O (President) Phone Number Employees /Units * Owner Name * Employer Identification Number or Social Security Number Your receipt is on hold. To receive your receipt, you must submit copies of the following documents. - 1. Miami- Dade Co. Cert. Of Competency. The Municipal Tax Receipt is an addl S175.00 + $25 per addl category. + RETAIN FOR YOUR RECORDS T