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PLC-11-1505Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 (Acal Inspection Number: INSP- 163412 Permit Number: PLC -8 -11 -1505 Scheduled Inspection Date: September 28, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 9501 NE 2 Avenue Miami Shores, FL 33138- Project: BENNETT BUILDING Contractor: PALMETTO PLUMBING CO OF HIALEAH INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)756 -3711 Parcel Number 1132060133920 Building Department Comments DEMO & CAP OF EXISITNG PLUMBING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments fi September 27, 2011 For Inspections please call: (305)762 -4949 Page 13 of 26 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 Permit Type: PLUMBING OWNER: Name (Fee Sim 1e Titleholder): Address: (14-0) r City: Ht l kei?.ec) State: LC Permit No 1 ") S S Master Permit No. lImO I I — Cis Phone #:3& 742___ r Zip: 3313$ Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 9 &i' 964 A G 21')A/6 City: L Shores // County: Miami Dade Zip: 33'j 3 O Folio/Parcel #: L 32O Ip -o 1 3- 3/1)(:)___ Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Alier a 0 IAh9A/!i1'�' Phone #: 305 F2 / 3s if' 1 Address: 2S u .7 7 S' `J City: kI c ©l a ,"? State: R. Zip: .370 o f, Qualifier Name: Ed to kRel ® bPt1 em Phone #: ^s OS 22 i 35 (PI State Certification or Registration #: C' .1C.. 0 9 4/1 g q Certificate of Competency #: Contact Phone #: 1(95 '195-300) Email Address: 94/MAf 044/ 6 &tJ #St j% .Alt DESIGNER' ngineer: IM (JAW Pq (c I". Phone #: Value of Work for this Permit: $ a` . oo Square/Linear Footage of Work: Type of Work: UAddress Description of Work: D-e•„n® f tip cif ,:tcit Lai tr- DAlteration UNew DRepair/Replace ❑Demolition * * * * * * * * * * ** * *********** *****+x**w***Fees*********+ * * * * ********** ***** ** *******w***** Submittal Fee $ Scanning Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 Permit Fee $ /'4 f CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Technology Fee $ 1 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 s ' - ct to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first insp ven (7) days after the building permit is iss he absence o such posted notice, the inspection will ection fee will be charged. The fo egoing ins day Alt-T d ,0 10 , by'7 j ei<e - acre .,4 44 , day of y , 20 IL, by ui4.121 NM , o is personally known to me r who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Signature wner or Agent Contractor nt was acknowledged before me this / L'�" The foregoing instrument was acknowledged before me this Sign: Print: -- a ky i V ® 7iz- h`OT4RY PUBLIC -STATE OF FLORIDA .a�"Oj1v, Miguel Penate My Commission xpires: ,.��.,, i'aniv Offir My Commission Expires: ;'o�Y P6eG,; m = Commission #DD795680 ?; u. „„.. M15SI0N #DD878093 ,,,, - �' -": °� EXPIRES: APR. 06, 2013 ° >.,,�,��,,0 Expires: AUG. 22, 2012 ' %;;;� ➢�; °, ` %M%W.I AA NNOTARY.com * * ** a�,x * *w a. * *.s+w * ** .� * *.x�.::,., , •� !:..;:.r err it�S� S>:�xa��xx * ** * ***** *** * *** * *** ******x�*%4, xx�* *acv **-A ***NN *ex•x�x� ** / APPROVED BY ' 1 Sign: Print: / I' 'it.te 1,3s' Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ACOR • CERTIFICATE OF LIABILITY INSURANCE 05/03/2011 TYPE OF INSURANCE PRODUCER (305)822 -7800 FAX (305) 558 -4294 Coll insworth, Al ter, Fowler & French LLC 8000 Governors Square Blvd q Suite 301 Miami Lakes, FL 33016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Palmetto P1 umbi ng Company of Hi al eah 2655 W 78th St. Hialeah, FL 33016 INSURER A: Hartford Casual ty GENERAL INSURER B: Sentinel Insurance Co Ltd 21UUN]B4045 END' T HGO 01 0605 INSURERC: FCCI Insurance Company 11/25/2011 INSURER D: $ 1,000,000 INSURER E: DAMAGE TO RENTED PREMISES (Fa nrruranra) 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 LTR ADD'L INSRu TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YY1 POLICY EXPIRATION DATE (MM /DD/YY1 LIMITS A GENERAL UABILITY COMMERCIAL GENERAL LIABILITY 21UUN]B4045 END' T HGO 01 0605 11/25/2010 11/25/2011 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Fa nrruranra) $ 300 000 ICLAIMS MADE X OCCUR MED EXP (My one person) $ 10,000 X B1 kt Addl Insd PERSONAL & ADV INJURY $ 1 , 000,000 X Bl kt Waiver GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n T n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 7 B AUTOMOBILE LUIBIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS $500 comp /colt ded 21UUNJB4045 11/25/2010 11/25/2011 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 B1 kt waiver GARAGE UABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ 1 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 1135633 05/01/2011 05/01/2012 X TORY LI TU- 1 I ER 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 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Mi ami Shores Village, City of 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 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 LUU3ILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Richard French /GLADYS ACORD 25 (2001/08) © ACORD CORPORATION 1988 FSC Mixed Sources Prodnaproaptsamagetknougad forostseadotbacaftelledsolaces Cast 4o.SCHMIX27Z5 onsIS crowd City of Hialeah • Business Tax-Receipt Mayor Julio Robaina 2010-11 062233 -3 BUSINESS NAME / LOCATION PALMETTO PLUMBING CO OF HIALEAH INC 2655 W 78 ST 33016 HIALEAH OWNER PALMETTO PLUMBING CO OF HIA INC Sec. Type of Business WORKER /S This Is loN ?Y6A tile BING CONTRACTOR 10 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. 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. OCAL°BUSINESS TAXFIECEII MI, DADS COUNTY`x STATE OF 1RES SEPT 30,;20 UST BE,DISPL.AYED;ATuPI AC RSUANT O COUNT ,CODE CF APT THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 062233-3 STATEI CFC1426276 FIRST -CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/19/2010 09010140001 000045.00 SEE OTHER SIDE DO NOT FORWARD PALMETTO PLUMBING CO OF HIALEAH INC GENE OBRIEN PRES 2655 W 78 ST HIALEAH FL 33016 111F111171131II111Ii IdIt11FI1 1 111111111111 11ItljI811i111