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PL-11-1757V Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 l �- La3u1 Inspection Number: INSP - 164821 Permit Number: PL -9 -11 -1757 Scheduled Inspection Date: February 24, 2012 Inspector: Hernandez, Rafael Owner: GOLDBERG, JONATHAN Job Address: 9901 NE 13 Avenue Miami Shores, FL Project <NONE> Contractor: LIVING WATER PLUMBING SERVICES CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050090480 Phone: (305)362 -2863 Building Department Comments PLUMBING WORK FOR BATHROOM AND KITCHEN REMODEL, AND LAUNDRY LINES Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 23, 2012 For Inspections please call: (305)762 -4949 Page 3 of 12 CFA 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 I I Permit No. Y yI Master Permit No. RC- t 1- 16314 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Feeg Simple Titleholder): Address: C.0 \ \) City: Q\A t c\1l9 State: Tenant/Lessee Name: Phone #: Zip: 33 3Sc Phone #: Email: JOB ADDRESS: 99(_)1 i ( City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 0 -52,65 —00c 0 t) Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: L \J \ A. U (a_f—. V \ i\A. �`M CI Phone #: 2- 7 % i:, Address: C 0 2 0 WiC il q 2 City: 1�t c_v\- c \\r\ State: L Zip: 3,30t 6 _ j Qualifier Name: O S \I \i\ < L Q �� Phone #: T b State Certification or Registration #: k F C t '2 1 t Certificate of Competency #: Contact Phone #:,, ,c (0 F, /2 6 3 Email Address: USv11\CMn ,c\INCtitr 1..6 N e--:`Z C---) YO, tZ Cr 0 i`t'1 DESIGNER: . Architect/Engineer: Phone #: Value of Work for this Permit: $ 6 00 - Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: `.j t a o 0 ******** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** Feed,************ * * * * * * * * * * * * * * *** ** * * * * * * * ** * ** Submittal Fee $ Permit Fee $ 3o /-"- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 not be app' ed and a reinspection fee will be charged. Signature er or Agent The fore oingyinstrument was acknowledged befo a me this day of t 't - who d9(/IW2 l� / , who personally known to me who has produced As id NOTAR PUBLIC: S Arfr 9 11)//QtY is /' /_,1/, J /' (407) 3^ I yr. •rri . ;, MY COMMISSION # EE032278 • EXPIRES October 05, 2014 FloriBat4ota gorvico.com My Commission Expires: /e) APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) Signature Co .. tractor The foregoing instrument was acknowledged before me this day of S' f ,k" , 20 i/ , by who is personally known to me or who has produced Plans Examiner Structural Review as ide NOTARY PUBL ' an • • iAt * , MY COMMISSION # EE032278 ' ♦�'>. EXPIRES October 05, 2014 ov � � � ��`, Floridatdota orvico.com (,071 °e: X153 S. P s't: /A Q My Commission Expires: Zoning Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EAC °IiNE A, PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FORA $30.00 E E PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. V COPY OF QUALIFIER'S STATE LIC CARD B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. 1/' COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. t;./ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION Qop BUSINESS NAME: V r \i . \\ 0■\--er l V ‘Nn r. n6\ -e 1r BUSINESS ADDRESS: -1-SCIQ (i) 12.0 C? -li'Z CITY STATE Q 1 ZIP CODE 3-0 110 BUSINESS PHONE: (f )3_\;i `L 252 .FAX NUMBER ) 3L 2- ZS &' CELL PHONE (3 25) qn -6�36 QUALIFIER'S NAME: L k C QUALIFIER'S LIC NUMBER: t �. f �J E -MAIL ADDRESS (IF APPLICABLE): IN-VA AV11Ckr -i `C�ktit Created on 3119109 BY MLDV 1 RV 3126109 MLDV ACORDTM CERTIFICATE OF LIABILITY INSURANCE MM/DD/YYYY) DATE (9/26/2011 PRODUCER MENDEZ INSURANCE & FINANCIAL SVC 508 E 49 ST HIALEAH FL 33013 305 769 4936 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED LIVING WATER PLUMBING SERV, CORP 7880 W 20 AVE,UNIT 42 HIALEAH, FL 33016 I INSURER k. GRANADA INSURANCE COMPANY A INSURER B: SOUTHERN INSURANCE COMPANY GENERAL INSURER C: 0185FL00014925 INSURER D: 08/02/12 INSURER E: $ 1,000,000 COVERAGES 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. LTR ILTR INSRD INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY ((MM/ /DD/YY)) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 0185FL00014925 08/02/11 08/02/12 EACH OCCURRENCE $ 1,000,000 X PREM (Ea RENTED $ 50,000 $ 1,000 $ 1,000,000 X CLAIMS MADE OCCUR MEDEXP(Anyoneperson) X 500 DED PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 —1 POLICY i PRO- JECT JECT AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS COMBINED SINGLE LIMIT (Ea accident) $ _ BODILY INJURY (Per person) _ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY- EAACCIDENT $ EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR jCLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ _ $ _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Oyes, describe under SPECIAL PROVISIONS below PWC001202 -11 09/23/11 09/23/12 TORY LIMITS X OER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 50 0 , 0 0 0 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PLUMBING COMPANY A IF CAT HOLD CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORE S , FL 33138 I SHOULD ANY OF THE ABOVE SCRIBED DATE THEREOF, THE ISSUIN INSURER NOTICE TO THE CERTIFIC TE HOLDER IMPOSE NO OBLIGATIO 0 IA3ILITY REPRESENTATIVES. POLICIES BE CANCELLED BEFORE THE EXPIRATION WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NAMED TO THE LEFT, BUT FAILURE DO SO SHALL OF ANY KIND UPON THE INSURE , ITS AGENTS OR AUTHORIZED REPRESENT T • I „kik,A.A.4."} ACORD 25 (2001/08) © ACORD CORPO'tATION 1988 637110-8 THIS is NOT A BILL - DO NOT PAY RENEWAL V VAIWINNBING SERVICE STATEIMEM7148 CORP 7SBO W 20 AVE 33016 HIALEAH OWNER WATER PL' INS SVC CORP n1PLi6 CONTACTOR Lff4E8 'J' FNE HOU 7�O '6tQ7' VIM ANY EASSIMAJNWORvio WM THE LICENSE LICESE . MISTS AMON OF P f= TAR 07/08/2011 60020000438 000045 00 SEE OTHER SIDE 42 DO NOT FORWARD •S LIVING WATER PLUMBING SERVICE CORP OSMANY MARTINEZ PRES 7880 W 20 AVE 842 HIALEAH FL 33016 It tI1l ,IIitr11tt111'I1IIttllt'I'lltr1 n3u'liA3I1eJf )411I1I FIRST4DLASS U.8FkOSTAtit FAO 11'597 -6 FL. .231 FSC Mixed Sources City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2011 -12 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION. INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MARTINEZ, OSMANY LIVING WATER PLUMBING SERVICE CORP 7880 WEST 20TH AVE STE 42 HIALEAH FL 33016-1848 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto wvvw.myflorktalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE .02 P.ittt. .4.4.