PL-12-1051Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174599 Permit Number: PL -6 -12 -1051
Scheduled Inspection Date: June 20, 2012
Inspector: Hernandez, Rafael
Owner: LIBONATTI, ALEXANDRA
Job Address: 10343 NE 6 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: JAVIER SPRINKLER SYSTEM
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number
Parcel Number 1122310120210
Phone: (786)218 -6468
Building Department Comments
SPRINKLER SYSTEM INSTALLATION
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 19, 2012
For Inspections please call: (305)762 -4949
Page 9 of 14
(A 1
BUIL ING
PERMIT APPLICATION
FBC 2010
Permit Types PLUMBING
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
MOZETZH
JU 8, 2012
BY: ............. _
Permit No. of 12 -) O
Master Permit No.
OWNER: Name (Fee Simple Titleholder): 1Cv� )O L 11'),01,-)
b
Address:
City: M t p ILt-k t cjyc-(� � � State: FM
Tenant/Less eeNe ame:
Email -411 `.1 :
) $3 NT i °fA,rtOJ CouL.
Phone# :i b 7_0 -171
Zip: -53
Phone #:
JOB ADDRESS: /0,3 43 o 9 e i' ( . r°lw
Miami Dade
City: Miami Shores County:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO
Zip:
Flood Zone:
CONTRACTOR : Coin p an y Nam,,e: si /4" ' 4, w �7r./
Phone #:
Address: ?I' Z,0 , c'..;;; odci "o
a r!t' lid.,
City: '444 ap State:
Qualifier Name: AP sy, s
7
i(6 21/g6
Zip: .3D% r�Z
Phone #: ) rep / $' 4d'
State Certification or Registration #: Certificate of Competency #:
•
Contact Phone #: ieb2 /$ 6 9' f Email Address: //As>.�.p,+l�j,/464p 0 �)iW® . &9
DESIGNER: Architect/Engineer: ••,�'� `'/ Phone #:
Value of Work for this Permit: $ /41,24a go Square/Linear Footage of Work:
Type of Work: ❑Address C1Alteration ' ' ''..
Description of Work: f'= ^' .A-4 r stle'
•°*^ /^ a �gvdw ,EN n iL fZ= 79a Nys. ✓da'G w 1 3.
j 2
t,�
eplace ODemolition
*********, x+ t, ***w*** * * *** **waw*** * **** ****F ******+ t<* ******** a= +x ***a=*+x+x+xxw ***x=** ***
Submittal Fee $ Permit Fee $ /eV
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ a
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.RCTRICAL 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 brochu r el red to the person
whose property is subject to attachment. Also a certified copy of the recorded notice of cormn sted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. posted notice, the
inspection will not ' /II s' ' • , _' reinspection jee Will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this -er The for oin� �in trument as ackn
day of 7 s , 20 4 4,, by s-nr, d \ 0 A+ , day of 11� , 2012, b
Q
who is personally known to me or who has produced V l.Jta,- ^� who 's personally known to me or who has produced
be,V & ...ac As identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLI : OTARY ' UBLIC:
Sign:
Print: \Viic■ L % ca
My Commission Expires:
,-.►� --
,, FRANCISCO JESUS PAGES
t Notary Public State of Ronda
IMy Comm. Expires Jun 29, 20
Cwnmission N EE 198327
Boned Through Naiional Notarp,AsM
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
t:
11' t 4
Commi
trs Notary 'u -
• ,, Comm. Expires Sep 23, 2015
='
V " Commission # EE 12;
�` ' Bonded Through National Notary Assn.
***********w******************************** ***** ** ********** *** ******** * **
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
JUN 082512
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Existing well +Electri
Pump existing
Timer + Rain
VI ON
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LIBONATTI RESIDENCE
10343 NE 6th AVENUE
MIAMI SHORES, FL
LAWN SPRINKLER IRRIGATION
3UNE 2012
Fax Server
EDT 6/8/2012 9:53:38 AM PAGE 2/002 Fax Server
cAlenra: 14413551
1. 1JAV Itbetl
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
6/08/2012
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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER BB&T- Oswald Trt Company
ppe and Com an
9200 S. Dadeland Blvd, Ste 314
Miami, FL 33156
305 670-0083
Allsa Josephs
PHONE
(NC No Ems: 305 670-0083 �a , Ne): 866 602 -6668
E-MAIL
ADDS
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Travelers Indemnity Company
25658
INSURE
Javiers Sprinklers Inc
Javier Aguayo
9120 Fouritalnbleu Blvd, Ste109
Miami, FL 33172
RnVCOArsc_ _.........._._ -__ ....- -- ■
INSURER B: Florida Citrus Business & Indus
WCSIF
INSURERG: AGCS Marine Insurance Company
22837
INSURER D, Sentinel Insurance Company, Ltd
11000
INSURER E
NO ce)
INSURER F :
•
THIS
INDICATED.
CERTIFICATE
NgERXCLUSIONS
rccITIORJ111 IY umoCK:
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
YAM
POLICY NUMBER
(MM D
(MP )
LIMITS
A
GENE
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
6604236N72A
04/ 07/2012
04/07/2013
EACH OCCURRENCE
$1,000,000
$1 00,000
NO ce)
CLAMS-MADE X OCCUR
MED EX, (Any one person)
$5,000
PERSONAL &ADV INJURY
$ 1,000,000
$2,000,000
$2,000,000
GENE2ALAGGREGATE
GENT AGGREGATE UMIT APPLIES PER:
—1 POUGY n nLOG
PRODUCTS- COMP/OP AGG
D
AUTOMOBILE
_
X
X
LIABE17Y
21 UECNX5946
03/25/2012
03/25/2013
COMBINED SINGLE UMIT
Ea aociderd)
$300,000
ANY AUTO
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
AUTOSWNFO
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(PeraccIdard)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION $
$
B
C
ANDE PLOYERENABILR
ANY AND EMPLOYERS' LUIBILRY
OFFICER/MEMBER EXCLUDED? EJ N I
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
10637069
04/01/2012
04/01/2013
I o8ATU-
IOOTH
EL EACH ACCIDENT
$100,000
$100,000
EL. DISEASE - EA EMR.OYEE
E.L DISEASE - POLICY UMIT
$500,000
Contractor Equip
MX193028508
06/24/2011
06/24/2012
$14,500
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space M rsqulrsd)
Insurer C - AGCS Marine Insurance Company - Contractor's Equipment coverage
Cause of Loss: All Risk; Valuation: Actual Cash Value; Coinsurance: 100%
All Other Peril Deductible: $1,000; Theft/Vandalism & Malicious Mischief: $2500; Wind/Hall Deductible: 5%
cERTIFIr vrp Firm nm a
Village of Miami Shores
10050 NE 2nd Ave.
Miami Shores, FL 33138
CELLATION
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
t..za. Par °vs-
01988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) 1, of 1 The ACORD name and logo are registered marks of ACORD