PLC-11-731Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
A-65'
Inspection Number: INSP- 158782 Permit Number: PLC -4 -11 -731
Scheduled Inspection Date: October 28, 2011
Inspector: Hernandez, Rafael
Owner: SCHOOL INC, MIAMI COUNTRY DAY
Job Address: 107 ST AND 6 AVE STREET
IIIADDA\/CAACILIT MwwwF
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: LANDSCAPING ASSOCIATES INC
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number (305)759 -2843
Parcel NUMIN9OVEMENT PROJECT
Phone: (305)258 -6310
Building Department Comments
IRRIGATION SYSTEM
Passed
Failed
(
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 27, 2011
For Inspections please call: (305)762 -4949
Page 2 of 9
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
Permit No. l ( -'1 c4 I
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
at APR 2 6 2011
B Y: - --
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): litt(a.•t ( OU,. r y Vo. y ccitrol Phone#:
Address: (90 ( 0 ) 54—
City: 11A-Z0-4A---;1- l State: rC Zip: 3i
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 A}'lP'IDAVIT: 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/ "': ?")
OOlwner or Agent
The forgoing instrument was acknowledged before me this
day of 'III , 20 P { , by Dr U C7ri D Ct e .s ,
who is person ly knn n to me or who has produced
As identification and who did take an oath.
NOTAR ' UBLIC:
Sign:
Print: �1 1 ck cU t. \I a
My Commission Ex
***********m** **
APPROVED BY
Signature
ontractor
The fore oing instrument was acknowled ed before me this
day of _ i ,20 I �,by aCO %.®oC &v
wn to me oftivl_tita pr duced C
as identification and who did take an oath.
NOTA ; PUBLIC:
who is person
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign: /�� (� `'
Print: I ., ! 1 to l; v Q
My Conunission Exi
LILIANA CUEVAS
Notary Public - State at Florida
og Commission # OD 881908
* `f` My Comm. E Tres Apr�1S
40 —J
Zoning
Clerk
04/27/2011 09:23 FAX
pcis
0001/004
001 /004
Miami Shores Viliag.7.
Building : Depar ment. ,
10050 N.E.2nd Avenue r „ ;:
Miami Shores, Florida 33135,..5c.:
Tel: (305) 795.2204` •
•
CONTRACTORS' REGISTRATION FORD Fax: (305) 756.8972
• ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT 18
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. :5
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE UC CARD
: B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAgI SHORE§ vp..LpE BL,DG.DEPTI •
D. COPY OF WORKERS COMPENSATION (EITHER c RTIFICATE OR EXCEMPTIONI.
17 CONTRACTOR HAS A MIAMI DADE COUNTY9ERTIFICATE OF COMPETENCY:
``
A. = COPY OF CERTIFICE OF COMPETENCY OF QUALI ER
B. V” COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. V COPY OF LIABILITY INSURACE (cERRTIFICCTE HOL4 R MAST BE MIAMI SHORESYILLAG.E BLDG DEPT]
D. V COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTIOM •
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW_:
VMIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
•
.i
BUSINESS NAME:
_FOMPLETE CONTRACTQR'S INFORMATION
BUSINESS ADDRESS: a (oczx I III.. CITY t"f'1 n C.e:.lzaf,
STATE 14-- ZIP CODE 330
BUSINESS PHONE: (3S) as-f. (03/0 FAX NUMBER ( ) 19
CELL PHONE ( ,) QUALIFIER'S NAME :CP,.O'k
QUALIFIER'S LIC NUMBER:
E -MAIL ADDRESS OF APPIJCABLE):
Created on 3H 9l99 8Y MLDV / RV 9128A09 MLDV
ate.
04/27/2011 09:24 FAX
Z003/004
0
LANDSCAPING ASSOCIATES INC
PEDRO ROBAU PRES
26002 SW 107 AVE
PRINCETON FL 33032
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04/27/2011 09:24 FAX
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CERTIFICATE OF 'ABILITY INSURANCE
Utz Conlil tl3t Insurance Agency
Douglas Rd., Suits 0401
FL 33145
Phot 45-6$50 F
X1027
C.E.RTIFICATE IS ISSUED AS A &wits QF INFQRMAT1t7N1
ONLY AND CONIC NO RIGHTS UPON[ T CERTIFICATE
HO CERTIRGA" GOES NO AMEND. EKTENL OR
IURERS AFi RDi[�O C 1AC E
INSURED LANDSCAPING ASSOCIATES, INC.
26002 SW 107th Ave.
F'clnceton, FL 33032-
St dale Ins. Go,
a 5 11 Sdate Inderrirtrty Co.
North River ins. Co.
PHIS
THE POLJCIES AF INSURANCE .ISTED NAVE BEEN ISSUED TOO THE NSuRED NAMED ABOVE FGRTHE POUCYPERIOD INDICATED. ND1WRIhSTANDINC
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OCOUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR
MAY PERTAIN. 711E WSURANCEA r1 RDEA HY THE POUr,IES DESCRIBED H REIN IS SUBJECT TO ALL THE "T M% E?iCUJ$IONS AND CONDmONB OF sUcH
ICiEB: AGG TE L1MT S SI# riN MAY HAVE BEEN REDUCED SY PAID CIAIMS,
CF 893447
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1 000 000
MIAMI SHORES VILLAGE BLDG. DEPT.
0050 NE 2ND AVE
JAMI.SHORES FL 33138
FINE
EIONRATION OAh THEN OF, ! 3Sttii +l0 VG,
030 DAYS SMITTEN TON TE HO
,_ RUT FAILURE TO 00 00 SHAIL iNFOSE NO a
OF ANY MO UPON THE ITO AUNTS OR
RES
NO
LANDSCAPING ASSOCIATES
['PEDRO. ROBAU PRES
26002 SW 107 AVE
PRINCETON FL 33032
M lami Shores
Building Department
10050 N.E2nd Avenuit
Miami Shores, Florida 33138:,
Tel: (305) 7952204
Fax: (305) 766.8972 7
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
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE JCERTIFICATE HOLDER TO SE MIAMI SHORES VILLAGE BLDG 92
D. COPY OF WORKERS COMPENSATION {EITHER CERTIFICATE OR EXCEMP110N1
IF GONT CTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMP ENCY
COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT
C. COPY OF um-Lire INSURACE ICERTIFICATE HOLD g MIST B. NIIAMI SHQRESVIL GE 3EPT
COPY OF WORKER COMP INSURANCE fEITHER CERTIFICATE OR EXEMPTION)
votirt INStiRANCEtOMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
/MIAMI SHORES VILLAGE SLOG DEPT
_-_:-.,-----
10450 RE 2No AVE:
MIAMI SHORES, FL =SO
cO)APLETE CONTRA CTORIINFORIYIATION
■
BUSINESS s s scQ
BUSINESS ADDRESS: atect- „."3 Itn Akt.- CITY
STATE Pt-- ZIP CODE 53°
BUSINESS PHONE: ( BCC) aCf. (T i0 FAX NUMBER (
CELL PHONE 'Tito -0 413 QUALIFIER'S NAME:(P.e4
QUALIFIERS LIC NUMBER: a e_4 000o 99
E-MAIL ADDRESS (IF APPLICABLE):
Created an 31181011 BY teILDV I RV 1121109 MAY
04/27/2011 09:25 FAX
U4/A0/4V11 A4 :90 t'ss 400 440 DJ.Z
WN'1'1N14N'TAL INS AGENCY
CERTIFICATE OF LIABI
PROM / R. CDntinettmlInsurat=Agency
41071 Douglas Rd., Sidle #401
Mlami, FL 83145
Phone (308)44$4$60
Fax (385)445.5122
INsURND LANDSCAPING ASSOCIATES. INC.
26002 SW 107th Ave.
Princetpn, FL 33032-
OONPRSUJI S INsuR
INSURER Pu.
THE POLICIES OF INEURANCE UATEO HAVE BEEN LOWED TO THE INSURED NAMEDABOVE'EORTF(E POUOYPERIOD INDICATED., NOTaMOH3 JW1Nd
ANY REGUIREMEN T,' FE RMORCONDMONOF ANY CONTRACTOR OTHER DOC (TMNRESPECTTOWH101411IS•O 1C1 EIMAY$E69s :OR''
MAY PERTAN: THE INSURANCE AITORDEDBY THE POLICIES DE $0RII HEREIN ISSUBJECTTOALLMETS°.Rty1 ;EXCLUSION$ANDCORP#I S0F.I9UC14
POLICIES. AGGREGATE LOVE GROWN NIAY WIVE BEEN REDO - • BY PAID CLAN&
eon Atm s •
POLICY NUMBER Alm R POW? 0 7lom
LITY INSURANCE j °�'�°` '
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THIS •CERTIFICATE IS ISSUED AB A GAITER OF INPORMAU0PI
ONLY AND COWERS NO, RIGHTS UM* THE CERTIFICATE : . .
H� OpR TIC CSRflPICAls DOES NOI/ENDaZoitIiDdR n� Sao*
MUMPS AFFORDING COVERAGE • : NAILS
memo Stintif4ele .Itfs. Cu.
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INSUAEot Ek SCatr iale.Indemnity Co.
INSURER c: North River Ins. co :
Agunkteld Ertiployers In3ura •�
t" Dim . TYPE OF I S TRANCE
LIABILnY
DoILINENDIAL GENERAL UABIUTY
q a0 cLAaelsmADE ®0OcuR
❑ ❑
❑
GEId.AOGREOATE WIT PER
® POLICY ❑ PROJECT 0 LOC
AUTOMOBILE LIABILITY
❑ ANYAJTO
n ALLOWNEDAUTOS
❑ ® scHSOuLEDAUros
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RI NON OWNEDAW
D
GARAGE IJABILflY
❑ 0 ANY AUTO
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EX RQ1A LIAISLITY
❑ ® OCCUR ❑ CLABIAS MADE
❑ DEDUCTIBLE
❑ !aETENTIoN II
WORKERS @AP ' umo COMPENSATION AND
ANY PROPRIBTOR /PARTNER EXECUTNE
OFFICER /I EMBER EXCLUDE
ByO. duct* wider
SPE UAL PROVISIONS belay
OTtIER
CP81289347
11/23/10
11/23/11
EACH CCc
PE
MED @XP Nal+a IaI2
PERSONAL WJURY
GENERAL AGGREGATE
PRODUCTS _ COMP/OP AGO
• 1,000 000
.• 60,000
::.6,000
•' .1:000.000
2,000„000
1.;00;000
CA10048391
41/2$/'10
11/23/11
COMBINED BiNGLE LIMrr. •
JEa a
BODILY INJURY
(Poraemon)
.1,000.000
BWILY NAM
(Vereoddall)
553 - 092875
083014734
PROPERi'1'DAMAGE •
jPeaeoaTdetiC. '
AUTO ONLY •BAAOCIDEQ1 ..
11/23/10
04/01/11
1123/11
04/01/12
OTHER THAN . EAAOC
AUTO ONLY; •
EACH OCCURRENCE
AGGREGATE
• 2,000,000
4 000 ,000
oTronlik D
E.L. EACH ACCIDENT
E.L. DISEASE • EA EMPLOYEE
E.L. DISEASE - POLICY LO
DEsCRIPTIONOF OPERATIONS / LOCA rIoNS / VEHICLES / EXCLUSIONS ADDED BY ENDORSMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
. 1.000.000
1,000,000
11000.000.
cANCELIATION
MIAMI SHORES VILLAGE BLDG. DEPT.
10050 NE 2ND AVE
MIAMI SHORES, PL 33138
cTh
- ..bRri 28 (Oo 64'4
21F
SHOULD my OF TIC ABOVEi DESCRIBED PamC16B IBS W 4N ELL D : • -
EXPIRATION DAIS THEREOF, TM ISSUING DUNA= WsN. tWDli11
030 DAYS WOMEN NOTICE TO THE ciNtlIPIOA.E! HO • •-1 zi.
Ti:Mi PT, BUTPAILURE 7000 So EMU. IMPO B MDOW •
a; 0'
OP ANY MD UPON THE itatneR. ITS AGEnTrati ` -
AUTHORS= REPRESENTATIVE