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PLC-12-204Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 169662 Permit Number: PLC -2 -12 -204 Scheduled Inspection Date: March 19, 2012 Inspector: Hernandez, Rafael Owner: SKLAR, ARI & OSCAR Job Address: 9400 NE 2 Avenue 9400 Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: MOODY PLUMBING INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)326 -2747 Parcel Number 1132060132780 -00 Phone: (954)972 -1079 Building Department Comments PLUMBING WORK FOR TENANT IMPROVEMENT. NEW SPRINT RETAIL STORE Passed 1:K1 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 16, 2012 For Inspections please call: (305)762 -4949 Page 10 of 19 1 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING p OWNER: Name (Fee Simple Titleholder): M $ v C (,..(.(° Phone#:' s� `Z �'S 5.)$? D' Address: a`'� l b L. 6 c - 1... i> 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. City: Li _ O c State: 2L.. Tenant/Lessee Name: sP e) NI 1 Phone#: 1 l0 1 Email: Zip: 330a 3 JOB ADDRESS: 9400 NE 2 AVENUE, SUITE 11 & 12 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: MOODY PLUMBING, INC Phone #:954972 -1079 Address: 4100 NW 120 AVENUE City: CORAL SPRINGS State: FL zip: 33065 Qualifier Name: RONALD MOODY Phone #: 9547534541 State Certification or Registration #: CFC057434 Certificate of Competency #: Contact Phone #: 954-972 -1079 Email Address: JAMIE ©MOODYPLUMBING.COM DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2,372.00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: REPLACE 2 LAV & 2 W/C AND ROUGH IN DRINKING FOUNTAIN ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** � Submittal Fee $ Permit Fee $ 56 r / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ ! DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ 12 ' 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 issued. In the absence of such posted notice, the inspection will no pprd and a reinspection fee will be charged. Signature ee,A° The fore oiin�g�iinstrument was ac day of = �'�'■" , 20/Z- , by who is personall Signature Contractor yc( ged before methis 3 / The foregoing instrument was acknowledged before me this 9 (900,1 ark; day of JANUARY , 2012 , byRONALD MOODY known to or who has produced As identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission ii NOTARY PURUC :_ STATE OF FLORIDA .- 44" ' ,, Comm# EE1181I57 ****:PRI : n1 ** ************** * **** ***** ***x * ** ************** * * * ******* *** *** * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: C�y� midutaa Print: JAMIE MUSCAT My Commission Expires: Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 01/09!2012 10:41 9543409540 A EY INNOVATIVE I NS1.3tANCE PAGE 81101 OP !U: TG CERTIFICATE OF LIABILITY. INSURANCE DATE IMAND YYt 01109!12 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)r AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the mettle ate holder Is an ADDITIONAL INSURED, the poliey(les) Rust be endorsed. If SUBROGATION IS WAIVED, subject to the tarns end eendkitlens of the policy, certain policies may require an endorsement. A statement on tens eertlFlcide does eat caller eights t0 the oei9Rcate holder In lieu of such end° s PRODUCER INNOVATIVE INSURANCE CONSULTANTS INC. 9461 UNIVERSI 5103 CORAL SPRINGS FL 3333d&7 BARRY s. GOLDSTEIN INBOARD MOODY PLUMBING, INC. 018)A MOODY PLUMBING & IRRIGATION 4100 NW 1?.BTH AVENUE CORAL. SPRINGS, Fl 33065 854-340.9551 9544409456 CRAG CERTIFICATE NIANIBER: mom * J APf ROfNeCOYENAsa INSuREAA:MID CONTINENT CASUALTY CO. imams :NATIONAL TRUST INSURANCE CO INSURHRC COMMERCE & INDUSTRY 1 CHARM , . ER O J FCCI COMMERCIAL INSURANCE CO. INSURER 0 t waRetto 23418 20141 19410 33472 THIS INDICATED. CERTIFICATE ©LC.LU9IONS IS TO CERTIFY THAT NOTWITIISTANDSZ atief BE 18SUED AND CONDITIONS TYPE OF USURANCE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REOUIREMENNNT. TERM OR CONDrnON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WN1CH ?1413 OR AIRY PERTAIN, THE INSURANCE AFFORDED BY NE POLICIES DESCRIBED HERSiN IS SUBJECT TO ALL THE TERMS, OF SUCH POLICIES. UMIT9 SHOWN MAY HAVE HEWN REDUCED BY PAID CLAIMS. • Li , 7.:11,1-L wl ,r.. Lr- �PI+,iili UM A COMRIALUAthUIV X X CO RCIAL 0ENERA�LIMELITY � � �xj IR BWtT ADDI.It118D BLKTWAIVER tt4•Gt-080827840 08118/11 0811011 Z EMIOCCURReaeE _ arru aS L. tee 3ENIP a+ePena t a 1,000.0,,,: e 100 , w w: 3 >� � PERSONAL s ADP WOW a 1,000,00 t X GENERA,. AGGREGATE a '2,000,': + AWL AGOR6GATE OAT APPLIES PEA mix f L i it, IT100 PRODUCT9- COMP/OP ADD S 000,+ s L1 AYTOMONLE X X X L1ABWtY ANY AUTO ALL OWNS* Auras SCHEDULED AUTOS MIREDAUT09 NONowns AUTQS CA0018947 f OVUM 01010/12 COrieuess SINGLE LOOT N"°` s 1,Q00,0 :+ 98DILY INRJRY NPR PPM) e BODILY INJURY IPA/ wars) s PROPERTY OAE 3 a • II C x UMBRELLA Los MESE MAD X occult DIAIMSVADE M857087067 00110/11 08110112 ow QCGeJI itiNCE a 1,00,0 0 re _ a 1,00, , , , D WORKERS CONPENSATION AND 6RIPLOYERS'UABJITr ANY PROPRIETQwoARTn esECUTNE Y!N OFFiceRiatEt ER DT p C {� .� - r CAM r:c��°� .• R!A 46742 08010111 08/10112 x '; .�� * EL. EACH ACCIDENT 1.000 L° t ICE D • pA EMPLOYEE E 1, ELL DISEASE •OOLKGY 3 trim + . OSsemPTIDN OF OP renore i LOCATIONS J YILIACLE9 (ADAM ;CORD let AdaJerml EM MA SOW" It mom spew Is leNulnAlk 5. 753.11972 • • • CERTIFIEATE HOLDER CANCLI_L AT1ON MIAMI4 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVENUE WWI SHORES, FL. 33132 SHOULD ANY OF The ABOVE 0830RIBEDPOUGIES BE CANCELLED BEFORE MS EXPIRATION DATE THEREOF. NOTICE WILL se DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORIEND AIDINESENTATIVE ACORD 20 4200949) �. 011988 -2009 ACORD CCUIPORAT ION. All rights reserved. The ACORD name and loge are registered narks of ACORD The PLUMBING CONS I4NR Named below Ts mama= of Chapter 489 FS. Under the provisions Expiration date: AUG 31, 2012 MOODY, RONALD W MOODY PLUMBING INC 7379 NW 22 PLACE MARGATE CHARLIE CRIST GOVERNOR FL 33063 DISPLAY AS REQUIRED BY LAW CHARLIE LIEN SECRETARY LOCAL BUSINESS TAX RECEIPT City of Coral Springs au= tetorrlattea, Tax 89555531n• e8t 8azapleiRRoad 2.012 Coral Springs. 77,.. 33065 -3800 Miens (954)344 - 5958/(954)344 -5963 Lassa mistaesa Tau ?Cr. MOODY PLUMS /Ea IMC 4100 MN 120 AVE CORAL EPRXRGS 71. 33065 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave.. Rm. A- 100. Ft. Lauderdale. FL 33301-1895 - 954-831-4000 VAUD OCTOBER 1, 2011 THROUGH SEPTEMBER 30.2012 BteNemxNOODY PLIR03IN0 INC Receipt%#: � 1PLDMHINa cosrtRi Amo "t'ttPaid 'e 9/16111. 0 Empires off= 12'09/30/12 ;9%20 /%t'_ Owner Nemet RONALD ei MOODY Business LO0etl00:4100 NW 120 AVE CORAL sPRIHCs Business, phoebe: 954 - 972 -1079 • Rooms Tai AMMO. 27.00 Sams Rees 1 182 -1292 Bueirte86 .PIW4SIRO /LVN SPRRRL/ R • Business Oponed :04/04/ 1983 Stetei•County/CertlRee:CPCO ST4 3 4 Exemption C0de:NO PT car YaniCa Only Number or etsctanes: Irma: Fee NSF Fee Panetta Pttw Y@are 0.00 0.00 0.00 • Machines P VO11 n0 Tom 0.00 Cose oncost 0.00 Tctsinno 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS 7NIS BECOMES A TAE RECEIPT INNEN VALIDATED Malting Address: MOODY PLUMBING INC 4100 NN 120 AVE CORAL SPRING$, PL 33060 TMs bane is levied fCr the pmrdege Ol dobg businea8 wiINa Ss�tl COunh ehd B net ns9u1et019 if naOiae. You must mess 80 County ewer MiaitoTpn0ty p w# n9 and wining rei entents. This 'Business Tex Recelpt OROt be tediseined when Me business Is solo. �ness name has or you have Awed the Ovalness location. This =six does hat indr0ale that Ore business is legal orBrM it a in 0am921010s 0111 State or local laws and regulations. Raoeipt *138 -10- 00007101 Paid 08/06 /a011 27.00 2011 •- 2012 _ •