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PL-11-1790
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164948 Permit Number: PL -9 -11 -1790 Scheduled Inspection Date: August 06, 2012 Inspector: Hernandez, Rafael Owner: PENKWITT, PATRIK Job Address: 520 GRAND CONCOURSE Miami Shores, FL 33138- Project: <NONE> Contractor: DOUGLAS ORR PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060171430 Phone: 305/887 -1687 Building Department Comments INTERIOR WORK REMODEL 3 BATHROOMS Passed El- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 03, 2012 For Inspections please call: (305)762 -4949 Page 4 of 61 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 Permit No. PL -9-11 -1790 Master Permit No. RC11 -1500 OWNER: Name (Fee Simple Titleholder): Patrick Penkwitt Phone#: Address: 500 Grand Concourse City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email- JOB ADDRESS: 520 Grand Concourse City: Miami Shores Folio/Parcel#: 1132060171430 Is the Building }Historically Deslgnated: Yes CONTRACTOR: Company Name: Address: 301 Flagler Dr. County: Miami Dade Zip: NO X Flood Zone: Douglas Orr Plumbing, Inc Phone#: (305) 887 -1687 City: Miami Springs state; Florida Zip: 33166 Qualifier Name: Wayne Orr Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this 606 0°0 Type of Work: OAddress OAlteration Description of Work: Re -pipe hot and cold water Layout change in master bath $ Square/Linear Footage of Work: ONew ORepair/Replace from west side o oyse td ©Demolition ti + Submittal Fee $ Permit Fee $ 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 ZAP 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 approved and a re tion fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 AL by \r‘Q V k/uo- , who is � ' i y k i n n e or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signature ("'`° Contractor The foregoing instrument was acknowledged before me this ? . day of , 2011, by nally known to me s who has produced as identification and who did take an oath. NOTARY PUBLIC -STATE OF FLORIDA NOTARY PUBLIC: • " "' °., Kathryn Anne Blakeman Commission #DD933300 r ": rATOV. 30, 2013 My Commission Expires: t1 136 t 3 * * *** * * ** * * * * * * * * *** *** * * ** APPROVED BY ************************************************ *** * *** * * * * * * * * * * *** * ** *** * **** Plans Examiner Structural Review (Revised 07/10/07)(Revised O6/10/2009)(Revised 3115/09) Zoning Clerk 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 RECEIVED SEP 2 8 2011 BY:_ Permit No. ?LI 1— (1 6710 Master Permit No. �'- ° i1-- I �B OWNER: Name (Fee Simple Titleholder): - (/C4/ 1 / Phone #: Address: p C � Cc r City: /\1 (j , �1/1/] State: - Tenant/Lessee Name: Phone#: Email: _r -7 72I( Zip: 33 (.jr JOB ADDRESS: c—D-0 j Cc o0 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: (1 ® 310 6 x-0 11 " 14--24) Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ° 1.9 9191.1 OM ikmt� 1 . C.. Phone #:.� G s, S S 7- / 4, d' % Address: 3 0) F �: "c.c.. 2i( . City: /1, 0..ti , /'/t.ti 3 State: Qualifier Name: LL% y,J t (0/2A-- State Certification or Registration #: • ei0e. O Z 1 eir*2_ Certificate of Competency #: Zip: 331-b Phone #: Contact Phone #: DESIGNER: Architect/Engineer: Email Address: "" ain, S1� Phone#: y 5�2 2 — (0 y y (,a Value of Work for this Permit: $ �(i'b'� Square/Linear Footage of Work: Type of Work: UAddress ❑Alteration ❑New /ORepair/Replace Description of Work: t)1eidaN Wc. -- 14,1 6h / a `.�z+l b Rer 0 3 ❑Demolition ** ** x * * * * * *** * * * * ** ** **************Fees******************************************** Submittal Fee $ Permit Fee $ 2 2f Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ d`t'I ' i' 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) dates after the building permit is issued. In the absence of such posted notice, the inspection will not he approved and a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was acknowledged before me this Thiel day of cU► �--, 20 t7 , by 1" iel l� UV 111 who is personally known to me or who has produced 1 Signature 2r\ ..�-� Contractor The foregoing i trument was acknowledged before me this2-$ day of , 20 i , by 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: uniiu,,,,, Sign: SOI` >�,' Sign: • Print: :::ssi)ilorirel.....1: 6/1Print: F.: My Commission Expires: _ PUI =_ My Commis N: �C �'•. OD 7659D ,s • * * * * * *......x: * * * * * * * * * * * *. �x.�x...x�. s', ''':x�x x x�$ ` :x�xx� * * *�x:x *�x�x *�x * * *�x�x �,,, p F LO, ��,`�' APPROVED BY °-� `� Plans Examiner NOTARY PUBLIC: Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 11, BRITTANY r.' ABS a Notary Public - State at Florida My Comm. Exp', es May 8, 2015 ac Commisstat # EE 91397 * :x**** * * * * * * * *o * * * *** * ** Zoning Clerk 10/11/2011 14:51 3058880678 DOUGLAS ORR PLUMBING PAGE 01/04 DOUGLAS ORR PLUMBING, INC. 301 Hagler Drive . Miami Springs, FL 33166 phone (305) 887 -1687 FAX 005} 888-0678 Licensed & Insured CC 0012463 STATE: CFC 02 452 To: (/1- Vr'AIJ A b . 6. prr From: , 4 " Fax No: 30S-- i S‘ - $' '77 a. Date /0-n-// «4 .-) i w} c7 f - Re: , roxr-t q-, r`r` J .o d No# of Pages: Commenis: l' ° Ufrrb4, - r--�. urn L1 /� l C'„o .2b 10/11/2011 14:51 3058880678 DOUGLAS ORR PLUMBING PAGE 02/04 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER (305)822 -7800 FAX (305)55$-4294 Collinsworth, Alter, Fowler & French LLC 8000 Governors Square Blvd Suite 301 iami Lakes, FL 33016 T16$URED Doug as Orr P umbing, Inc. 301 Flagler Drive Miami, FL 33166 DATE(MMJDDIYYYY) 08/01/2011 HIS 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 POLIO ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A! Amerisure Insurance Co 19488 INSURER B; AeeriSUre Mutual ins Co 23396 INSURER 0: Crum & Forster INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ADOVE FOR TWE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REDUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE 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. I R ADU1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLIOY EXPIRATION LIMITS A GHNEFIAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPP2063609 $5,000. PD PR CLAIM DEDUCTIBLE APPLIES 08/02 2011 08/02/2012 EACH OCCURRENCE $ 1•0004000 DAMAGE TO RENTED RFRFMLCFR WI M1hh intnr,i) MED EXP (Any one per8on) $ 300,000 $ 10,00C X X CLAIMS MADE X OCCUR B kt Add"' Insd PERSONAL & ADV INJURY $ 1,000,00C Blanket Waiver GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000 $ 2,000,000 0£N'. AGGREGATE LIMIT APPLIES PER: POLICY X JECT . LOC B AUTOMOBILE X i X X LIABILITY ANY AUTO All OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA2063607 _ 08/02/2011 08/02/2012 COMBINED SINGLE LIMIT (Ea axltlaMI $ 1 000, 00C $ BODILY INJURY (Per pereon) BODILY INJURY (Per BccIdent) $ PROPERTY DAMAGE (Per golden!) AUTO ONLY LEA ACCIDENT $ $ GARAGE UA61L17Y ANY AUTO to OTHER THAN EA ACO- $ AUTO ONLY: A00 S C EXCESS/UMBRELLA LIABILITY -- OCCUR CLAIMS MADE X30171454 08/02/2011 08/02/2012 FJICH OCCURRENCE $ 5,000,000 AGGREGATE $ 5 000 000 — X DEDUCTIBLE RETENTION $ 0 $ A WoRNERS OOmPEN$AT10N AND EMPLOYERS' LIABILITY AFYIPROPR TOR ARTNEFV DE7 ECI TN$ If yysr„ d�crfbe »Iffier SPECIAL PROVISIONS below WC206360800 08/02/2011 08/02/2012 X 'rosy &A X 51 E.L. EACH ACCIDENT $ 1,000,000 $ l: 1 000 000 E.L. DISEASE , EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000, 00 Y A inand Marine CPP2063609 08/02/2011 08/02/2012 Rented or Leased Equipment $100,000. Per Item w/ a $2,500. Deductible. DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ElitiORSEmENF t SPECIAL PROVISIONS Except 10 days notice for Non - Payment of Premium RE: Plumbing Contractor No, CFCO21452 ,..01.01.11e10. AT,! U..., wi1=w Village of Miami Shores Building & Zoning 10050 N.E. 2nd Avenue Miami Shores, FL 33154 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TOO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OSLIGAT WN OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) AUTHORIZED REPHES NTAriyE Richard French/TERESA 0:0ACO14D CORPORATION 1988 PAGE 03/04 DOUGLAS ORR PLUMBING 3058880678 BATCH NUMBER 10/11/2011 14:51 3058880678 N IAM1%DAD! COUNTY. TAX i.ECTOI>l:' • 140R�LrER ST; 1ff* R','. MIAMIfL 33130• DOUGLAS ORR PLUMBING PAGE 04104 2011 LOCAL BUSINESS TAX RECEIPT* • . MIAMI•DADE COUNTY - STATE OF',$LORIDk• Mao SEFT: 3% 201'1c MWST BE DISPLAYED AT PLACE OF 9USJNLSS•: PURSUANT TO COUNTY COpb CHAPTLITBA.- .AFiTI.ff .. r r•.• .... • i •: o-: ••y ' f''`;i .. • .. •i1:;h1�••�.' 1.0.1.;:yr 411.'i;fll 445228-0 rl II,,i I.:, NOT A s•tII •...• X) NOT PAY RENEWAL BUSINESS NAME LOCATION RECEIPT NO. 464791 -4 ORR DOUGLAS PLUMBING INC STATE* CFC052664 301 FLAGLER DR 33166 MIAMI SPRINGS FIRST CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO, 731 OWNER ORR DOUGLAS PLUMBING INC Sec. Type of Business T109 is 12,6A LOCAL INC BUBINEBB TAX RECEIPT. IT OOEB NtT PERMIT TIE EMUS I�NG RECIULA V OR ZOPaNg LAW! OP TM COUNTY OR OMER. NOR DOER IT EXEMPT THE pH�OLLDDEER FROM ANY OTHER R@QUIRt�D 9Y I,AW TNO 8g$ NOT A O PICAT* N OP THE HOLDER'S COALIFIGA• TIONN. PAYMENT RECEIVED MIALD.OADE COUNTY TAX COLLECTOR: 07/13/2011 09010051001 000045.00 SEE OTHER SIDE CONTRACTOR WORKER /S 1 DO NOT FORWARD ORR UQUSLAS PLUMBING INC ORR WAYNE 301 FLAGLER DR MIAMI SPRINGS FL 33166 1, 111ll► fh 1► 1Ui. t!„/ Jiu ,pJIdII,IIII,li, 1i11 j