The URL can be used to link to this page

PL-12-15931 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 177749 Permit Number: PL -8 -12 -1593 Scheduled Inspection Date: October 22, 2012 Inspector: Hernandez, Rafael Owner: HYNES, KIMBERLY Job Address: 302 NE 100 Street Miami Shores, FL Project <NONE> Contractor: PSG PLUMBING SERVICES, INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060135470 Phone: (305)796 -7304 Building Department Comments REPLACE BATHROOM FIXTURES (EXISTING TUB TO REMAIN) Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 19, 2012 For Inspections please call: (305)762 -4949 Page 22 of 45 Miami Shores Village Building Department 90050 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 FBCZO1a -�� Permit No. I 1 M Master Permit No. �J ��►'! 2— Permit Type: PLUMBING j JOB ADDRESS: 3© lO �� A7057 . City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Nulte (Fee Simple T T/itleholder): �1' 4 ✓%''y i''%7°r®� Phone #: Address: 42 , f�� /Do el 7 r City: ir�°z -/ 't�� State: % Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: f C PLAA, jl.t f b 1/ 6 C t) G Phone #: 3 a S'`7l 6° 730V Address: 'Baia ti.D (L g--- S' City: Q 196. ti 4-0 CI State: pi' Zip: 3305E Qualifier Name: e' 2 W S ��C (.Q t, '.-.' Phone#: (�) State Certification or Registration #: Fe, fLj 2 6 2 E 7 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ (CO r - Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: ❑Alteration ll rr ❑New epair/Replace ❑Demolition * * * * * * * * * ** * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ nv i-62° 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 conunenced 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, BO!! FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFH)AVIT: 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 e approved and a reinspection fee will be charged. Signature ent The foregoing instrument was acknowledged before me this day of da. , 20 IL.by w NOTARY PURL Sign: Print: My Commi Signature ctor The foregoing instrument was acknowledged before me this VI— day of ► ') , 20 tL, by A. , e or who has produced who is or who has produced cation and who did take an oath. As identification and who did take an oath. ARMCO PALENZUELA MY COMMISSION SEEi94194 EXPIRES May 04 +3015 * * * * * * ** *11.11 wsy Sign: Print: My Co APPROVED BY cfri2 -- Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 08/2412012 14:43 f'AX} CERTIFICATE OF LIABILITY INSURANCE PRODUCER Excellence Insurance Agency 3801 SW 107 Avenue Miami, FL 33185 Phone (305)226 -3900 INSURED PSG Plumbing Service, Inc. 3892 NW 125 Street Opalocke, FL 33054- Fax (305)226 -3997 P.001/001 DATE (MMIDDmr) _ _ 1 08/24/12 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 POLIC ES (5/LOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: Granada Insurance Company INSURER B: Progressive Insurance Company INSURER C: Guarantee Insurance Company INSURER D: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDmQN 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 I8 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDrnON8 OF SUCH POLICIES. AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTSSR Lem TYPE OF INSURANCE PouCY NUMBER ~PDL.CY EFFECTIvE POLICY EXPIRATION DATE (tdM1r wY y) DATE (MM(DD(YY) GENERAL LIABIUTY COMMERCIAL GENERAL LO,Istu1Y 0185FL00031657 -0 11/18/11 INSURER E; INSURER F: c ❑❑ CLAIMS MADE ® OCCUR ❑ GEN'L AGGREGATE LIMIT APPLIES PER I POUCY ❑ PROJECT ❑ LOc AUTOMOBILE UABILIiY ❑ ANY AUTO ❑ ALL OWNED AUTOS ® SCHEDULED AUTOS ❑ HIRED AuTOs Cl NON OWNED AUTOS • Comp $500.00 Ded Coll $ 500.00 Ded GARAGE LIABILITY ❑ ANY AUTO 0 06288837 -3 EXCESS /UMBRELLA LIABILITY O OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION S WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below OTHER 02/18/12 11/18/12 EACH OCCURRENCE 1,000,000 PREMISES (Ea ocouLenre) 100,000 MED EXP (My one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG 5,000 1,000,000 1,000,000 1,000,000 02/18/13 COMBINED SINGLE LIMIT (Ea accident) PROPERTY DAMAGE Per accident AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: EACH OCCURRENCE AGGREGATE 10,000.00 20,000.00 10,000,00 WC325785 11/18/11 11/18/12 TQRY LIM ❑ ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE • POLICY LIMIT 100,000 100,000 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS General Contractor. CERTIFICATE HOLDER Miami Shores Village Building Dep 10050 NE 2 Ave Miami Shore, Fl 33138 ACORD 25 (2001/08) OF CANCELLATION 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 TO. THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED :i SENTATIVE COR ' CORPORATION 1988