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PL-10-1039Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 145569 Permit Number: PL -6 -10 -1039 Scheduled Inspection Date: February 04, 2011 Inspector: Hernandez, Rafael Owner: LEARY, KIMBERLY Job Address: 72 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ISLAND PLUMBING CO Permit Type: Plumbing ,Residential C Inspection Type: Final Work Classification: Addition /Alteration Phone Number 305 - 759 -1808 Parcel Number 1121360130870 Phone: (305)361 -2929 Building Department Comments REPLACE KITCHEN SINK FOR KITCHEN REMODEL Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 04, 2011 For Inspections please call: (305)762 -4949 Page 1 of 8 Miami Shores Village Building Department 1005Q 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.V-� 1 10 — I 0739 Master Permit No. 5-/ d BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Ici? Owner's ddress 7 2 1 D4-741 cr 7 City L4 r MI 1 � 1 ` U State F1i JUNO82010 4 ...... 15.E 2S Phone # (i%'. g Tenant/Lessee Name Email zip 5 &1 -3? Phone # Job Address (where the work is being done) 7z, /J.& (eLi lee+ City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES Zip 36 NO Contractor's Company Name (, 4c6 CC . Contractor's Address 3 CU-1W) ,eke City 1,Agi State Qualifier Name '('S tsChr\ Flood Zone Phone # 1 _-tq z-G Zip 351"19 Phone # ( t -macog' State Certificate or Registration No.0 °C 9 4 Certificate of Competency No. Contact Phon) k—T--RZ-R E -mail 9(yfei Architect/Engineer's Name (if applicable) Value of Work For this Permit $ 91 Phone # Type of Work: ['Addition ['Alteration Describe Work: CL4 n Square / Linear Foots Of Work: ❑New "�j' Repair/Replace El Demolition * * * * * ** ** * *: * * * ** * * * ** * * * ** ** * * * ** * * *** Fees** * * **** * *** * * * * *, * * * * * ** * * ** * * * *** * ***** * ** Submittal Fee $ Permit Fee $ / C° CCF $ '0 CO /CC $ Notary $ Training/Education Fee $ 0 090 Technology Fee $ 0. gj Scanning $ b' Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 104'0 See Reverse side -+ 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 broch re will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of com ent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued 'I the bsence of such posted notice, the inspection will no be a' proved and a reinspection fee will be charged. la / i er or Agent The foregoing instrument was acknowledged before me this if tt day of \ 20 l C by e4-4.4-17- PPS. who is known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ° <_ My Commission Expires- - . CHARLENE D. SMEWE Commission DD 786599 Expires July 19, 2012 ontractor The foreg ing ins!. ment was acknowledged before me this &/17 day of , 20 i) , by (1)47.5 < %` 3 ;" ,.? , who is person lly known to me or who has produced as identification and who did take an oath. /f ' � APPROVED BY Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) NOTAR Sign( Pri . Qw et /0Ju UBLIC: My Commission Expir y ?� , COMMISSION DD976761 =3. � . QE`s EXPIRES: MAR. 30, 2014 ,��� +�.;;,?F��;;°.�� WA W.AAR0NN0TARY.com Zoning Clerk checked S4m 'Pave &ed!l Vow :tame 10050 NE 2nd Ave Miami Shores, Fl 3313 Phone 305 - 795 -2204; Fax 305 - 762 -5253 www.miamishoresvillage.com CONTRACTOR LICENSING/ REGISTRATION REQUIREMENTS FOR ALL CONTRACTORS TO REGISTER IN THE VILLAGE OF MIAMI SHORES THE FOLLOWING REQUIREMENTS ARE NEEDED: DADE COUNTY CONTRACTORS: A. Certificate of Competency B. Dade Municipal Occupancy C. Dade Occupational Occupancy D. State Registration E. Liability Insurance Certificate F. Workers Compensation Insurance or Exemption STATE CONTRACTORS: A. State License B. ,/ Occupational License C. Liability Insurance Certificate D. ✓ Workers Compensation Insurance or Exemption *** *******ALL INSURANCE CERTIFICATES MUST BE MADE OUT TO THE FOLLOWING**'********" Miami Shores Village 10050 NE 2 AVE Miami Shores, Fl 33138 ALL PERMIT APPLICATION REQUIRE THE QUALIFIERS NOTARIZED SIGNATURE ********,*+* ****A, *, kirk**k**** , *** , ,k * * *, , * ******** * *** * *** *,* , ** Business Name: .Ancr\ ?junyt Co_ Business Address: ¶i C cii $0c\ ( t c , rL i` C1 Business Telephone: ()- ?C zc, Fax Nu Qualifier Name: DO NOT FORWARD ISLAND PLUMBING COMPANY JUAN C REYES PRES PO BOX 490984 KEY BISCAYNE FL 33149 lll+ILAdnlldu ludAululAdim hatma SEE OTHER SIDE r, Q 305 - 381 -9188 HP LASERJET FAX r NUW!:3E R Oct 11 2010 1:49PM HP LASERJET FRX 305 - 361 -9189 '�` CERTIFICATE OF LIABILITY INSURANCE CE W. F Roemer Insurance Agency William F. Dowd P.O. Box 190669 Fort Lauderdale FL 33319 Phone: 954-731-5566 Fax: 954-731-9438 INSURED P. Island 0. Box 490984 ay Rey Biscayne IL 33149 COVERAGES p.1 OP ID DE DATE (haleuo!WYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO ! A 0 22 10 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 IINSLRE2 A: bird - Continent Casualty Co empeEFt B: Travelers INSURER C. tNBURER O: INSURER E: FCCI Insurance Company ANY RELOUIR SENT. TERM OR CONDITION OF ANHAVE ONTRACT OR OTHER DOCUMENT WITH RESPECT TTOO YMiICH THIS CERTIFF ICATE 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 Wass st.p01. POLICIES. AGGREGATE LIMITS SHOWA MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NERD A C TYPE OF INSURANCE GENERAL LIABILITY X COMvIERC IAL GENERAL LIABILITY CLAIMS MADE © OCCUR GEPL AGGREGATE LIMIT APPLIES PER n POLICY n JEC°' f in LOG AUTOMOBILE UABIUTY X ANY AUTO ALL OWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNED AUTOS GARAGE UABOJTy ANY AUTO POLICY NUMBER 04E11400778922 BA94881402410812, OATS DIWODr /Y YY) 01/10/10 01/08/10 DATE otUMDDDNYnYOY)) 01/10/11 01/08/11 LIMITS EACH OCCURRENCE PREMISES ( Qc'Cuurrence) MED Rice (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Es accident) BODILY INJURY (Per person) NAIC # 23418 25674 10178 $1,000,000 $100,000 SExcluded 61,000,000 82,000,000 $2,000,000 $500,000 $ EXCESS ! UMBRELLA LIABILITY OCCUR Lij CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS AN COMPENSATION ANY IETORIPARTbER CUTIME OFFICLRIMQNABER EXCLUDED/ (Mandatory Int WI it es. describe under SPECIAL FROVISIONS bsbn, OTHER BODILY INJURY (Per =Men) (Per PROPERTY GE s $ AIIro ONi.Y- EA ACCIDENT' AUTTO ONLY: EACH OCCURRENCE EA ACC AGO 6 $ i S AGGREGATE S $ S YIN WC1DA62179 07/23/10 07/23/11 DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES, EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVIBKINS CERTIFICATE HOLDER X IT R LIMITS I I ER El. EACH ACCIDENT E.L DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT 4 $1,000,000 $1,000,000 $1,000,000 Village of Miami shores 10050 RE 2 Ave. Miami Shores FL 33138 ACORD 25120G9!01) AIL4MIS2 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL IIINDEAVOR TO MAIL 2..0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TWINE LEFT, BUT FAILURE TO Do 80 SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTM ° REPRESENTATIVE_ 0 1988 -2009 ACQR D CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD