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PL-12-2081
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 181113 Permit Number: PL -11 -12 -2081 Scheduled Inspection Date: December 26, 2012 Inspector: Hernandez, Rafael Owner: RODRIGUEZ, JOHN Job Address: 29 NW 107 Street Miami Shores, FL 33168- Project <NONE> Contractor: PLUMBING BY SALOMON Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)776 -0889 Parcel Number 1121360070460 Phone: 305 - 935 -9214 Building Department Comments GAS FOR STOVE AND WATER HEATER AND DRYER Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 21, 2012 For Inspections please call: (305)762 -4949 Page 4 of 17 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 }13C 20 \-° -----7---------„,cE,,,,,,-, NOV 0 2 2012 IL) _I Permit No. Pt-- 12-7- .7123-1 Master Permit No. FeinliTType: PLUIVLB G OWNER: Name (Fee Simple Titleholder): C5Z t E)) Phone#: Address: City : State. k Tenant/Lessee Name: 16. t_t Phonet Email: JOB ADDRESS: City: Miami Shores Folio/Parcel#: Is the B County: HisteriCallY DeSignited: Yes NO Miami Dade Zip: . . bme CONTRACTOR: Company Name: (Rs." (9-6 16;U s h --&) Phone#: Address: 1/0 6,c, AO 9,1 City: VJ o State: --Zip: /1-7 Qualifier Name: 1 - C a 04.6.) (....A>c)gr Phone#: czo%s state certificatiork;iittigisfration* 443445-6 ceriifiate4doniiiieiicy* Contact Phone#: 717C 3in41 eq Email Address: (R.A.ixuad.-8 by sc,..6,-,06.) koo co DESIGNER :' Architect/Engineer: )46/4 Phone#: Plboo:Zone: . -3(-1T4V1 Value of Work for this Permit: $ /4.00 4''-13- Square/Linear Footage of Work: Type of Work: OAddress ti;diteration ONew ORepair/Replace Descripdon of Work: 14.3 ST0 l --ti IPSAMIT. ;010.kvi 3 'env tr,D9 Floth.wi, ilio,,,,tal '',4414,4 ******************* Submittal Fee $5...) ---cE3-- P ermit Fee $ /Fe. ---- CCF $ CO/CC $ M7r Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ODemolition TOTAL FEE NOW DUE $ 10 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable)i ,q Mortgage Lender's Address �dy/ 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 :r 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 nunencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue . In the abse • e, the inspection will not be approved and a reinspection fee will be charged. A1• • L*?i 4_ - -- Owner or Agent Contractor The foregoing instrument was acknowledged before me this Ce The foregoing instrument was acknowledged before me this day of 10 , 20 L by 44.64) -g/ 6a em--, day of Iv U V , 20).1„, bye •Lel ° -1 P4(..11 i, ) <ho is personally known to for who has produced who is personally known to me or who has produced : FL/ ,---- .. As identification and who did take an oath. as identification and who did take an oath. NOTARY PUB Sign: Print: NOTARY PUBLIC:_ My Cois on pines: * * * * * * * * * * * * * * * * * * * * ** Notary Palk - State of Reties My Comm. Eames May 4, 2016 Conti 0 EE 188421 Bonded Ito* Ndilry Aeon. Sign: 62 Print .011 HIM/ Ili My Commission Ex ...°• v�/ DAD Y P ri +****************** * * * * * * * * * * * ** * * * * * * * * * * * * * * * * ** APPROVED BY l� / %I' i /.. i� Plans Examiner Zoning Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk AR tam CERTIFICATE OF LIABILITY INSURANCE DATE -07 -2011 THIS CERTIFSCATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIRCATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADD)TIONALINSURED, the policy' ) must be endorsed. If SUBROGATION'S WAIVED, subject to the terns and conditions of the policy. certain policies may requlre an endorsement. A statementon this certificate does not confer rights to the certificate holder in lieu of such endorsement's). PRODUCER NORTHEAST AGENCIES INC /PHS 210204 P• (866)467 -8730 F• (800)308 -5459 301 WOODS PARK DRIVE CLINTON NY 13323 CONTACT l�°Ert) (866) 467 -8730 FaAx c .nm) (800) 308-5459 ' �o ER CUSTOMER ID :P: INSURERIS) AFFORDING COVERAGE NAIC 9 INSURED SALOMON PALACIOS D /B /A PLUMBING BY SALOMON 1060 NE 212TH TER MIAMI FL 33179 INSURER A: Twin City Fire Ins Co INSURER B INSURER C : EACH OCCURRENCE INSURER °: INSURER E : S INSURER F : 1 CLAIMS -MADE I 1 OCCUR COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTSRB TYPE OF INSURANCE INSR WYD POLICY NUMBER IIMAIDD/YYYYI ( RVW 1 URNS A'Z_. GENERAL L,tAMLP1Y COMMERCIAL GENERAL UABILITY EACH OCCURRENCE 9 DAMAGE i ttoc oera I ED PREMISES (Ea Mrerxe) S 1 CLAIMS -MADE I 1 OCCUR MED EXP (Any one oersted PERSONAL & ADV INJURY 9 1 GENERAL AGGREGATE _ 9 GEN'L AGGREGATE OMIT APPLIES PER: POLICY } I I T I I LOC PRODUCTS - COMP/OP AGG 9 9 AUTOMOBBE useartY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED HIRED AUTOS NON -OWNED AUTOS COMMNED SINGLE LIMIT (Ea accident) 9 — T- BODILY INJURY (Per person) 9 BODILY INJURY (Per accident) 8 PROPERTY DAMAGE (Per accident) $ 9 $ I `` lA IJAB 1 i OCCUR EXCESS LAB 1 I CLAIMS -MADE EACH OCCURRENCE 9 AGGREGATE $ DEDUCTIBLE RETENTION 9 g 9 A WORBERS AND EMPLOYERS' COMPENSATION Y! N ANY PROPWETORMARTNER/EXECUTI j O CER/MEM EXCLUDED? If es. rin PI � DESCRIPTION OF OPERATIONS below a/A 01 WEC LT5452 11/25/2011 11/25 /2012 X l T LIMITS) m ER E.L. EACH ACCIDENT 9 10 0 , 0 0 0 E.L. DISEASE - EA EMPLOYEE' s 100, 000 El. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / !.CATIONS i V&ICLES (Attach ACORD 101. Additional Remarks Schedule, if Mare VOW to required) Those usual to the Insured's Operations. ACORD 25 (20091091 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Miami Shore Village DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 10050 N.B. 2nd Ave. AMC AWE ` Miami Shores, FL 33138 A'Z_. ^--�' ACORD 25 (20091091 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS oocUMI=ty r HA A'COLOI .t „U f3ACKG 1OU�1fl MiC{;png1NTING • LINFMM K” PIATCriTrn P/1PCH , „ AC #6402302 STATE OF FLORIDA DEPARTM S RUCTI IND YRLIGENiIN ARELAT O SEQ# 142092501963 DATE PATCH NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provision of Chapptex 489;;FE Expiration date: AUG 31, 2014. , z PALACIOS, SALOMON . PLUMBING BY SALOMON 1060 N E 212 TERRACE NORTH MIAMI BEACH FL 33179 RICK.SCOTT: GOVERNOR DISPLAY AS REQUIRED BY LAW SEC ECREN TARY �.-� dcy r "l.°) / X E X X X X X X X X X X X X X X X X X MIAMI -OADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami. Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 10/10/2012 1300/226/001TRAM 0003 -0001 Last Seq. #:0001 WI LBT #:00 231513 -3 Local Business Tax $82.50 CA $100.00 CHAS $17.50 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagier St. - 1st Floor Miami. Florida 33130 TEMPORARY RECEIPT 2012-2013 LOCAL BUSINESS TAX Local Business Tax#:00231513 -3 State/CC#:CFC048483 Issued to: PLUMBING BY SALOMON Type of Business: PLUMBING CONTRACTOR THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector G°z Vitt CMCP a oz.r. ..11■612110Emigerci...^ 1-13L5 metet ".•••,L,,C112r ACaR°r CERTIFICATE OF LIABILITY INSURANCE DATE IM D11'YYY) 10/11/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TNE.CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the cndlftcate holder Is an ADDITIONAL INSURED, the pollcy(los) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certficate holder In lieu of such endorsamant(s). PRODUCER MA CUERVO INSURANCE GROUP, INC. 15927 BISCAYNE BOULEVARD N. MIAMI BEACH FL 33160 INSURED nnME: AhyX2a Rivera E.6: PHDIde 305-956-9992 N ADDRESS: SS, ahyl¢argihotrnail.corrl Ne} 305 -956 -9727 INSURERS) AFFORDING COVERAGE Plumbing by Salomon 1060 Ne212Terr Miami, Fl 33179 COVERAGES INSURER A : Granada Insurance Company INSURER 5: NAIL e INSURER 0 : INSURER D : INSURER E INSURV,R F: • - -- - -- ...... MtV1SION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS ILTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTfMTHSTANDING ANY REQUIREMENT, TERM OR CONDR'ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. O TYPE OF INSURANCE ADUL NV/ SOUR yNVD POLICY NUMBER POLICY EPP I1 POLICY EXP IINMlDDJYYYY) L mIT5 A S)ENEhpI, LIABILITY COMMERCIAL GENERAL LIABILITY 0185F1.00038918 • _j'MWDDIYYY 09/05/2012 09/05/2013 EACHO^(,,CURRENCE S 1,000.000 A PREMISES Ma oecurtpncol $ 1 �.� _ 2 CLAIMS -MADE n OCCUR MED EXP (Any oria parson) $ 5000 PERSONAL6.ADVINJURY $ 1,000.000 GENERAL AGGREGATE S 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: Al Poucv n n Loc PRODUCTS = COM /OP AGG $ 0 $ A(JTOM064EIJAEdL(7Y — _ . (EaMBIeN31NGLELIMIT >B ANY AUTO ALL OWNED AUTO$ HIRED AUTOS ' _, SCHEWLED AUTOS AUTOS SODltY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) S UMBRELLA LIAR EXCESS LIAR _ OCCUR CLAIMS -MADE EAO-I OCCURRENCE S AGGREGATE $ $ DED 1 I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LLABO.ITY ANY PROPRIETORIPARTNGR/D(ECU11VE Y! N OFFICER/MEMBER EXCLUDED? © (Mandatory M NH) Hyee, deaeltbe under DESCRIPTION OF OPERA11ON$ tam N /A _ – T y17t $rArtj tjYH- 1 TO LIMITS ER E.L. SACHACCI05NV $ E.L. DISEASE - EA EMPLOYEE $.L. DISEASE- POLICY I,IMrr $ • DESCRIPTION OP OP!RATtONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remark* Sc•dade If more *we IA wgUlrad) wrw.r..11..■ a T1.. .... mks=so, CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2ND AVE MIAMI SHORES,FL33138 305 - 756 - 8972 -FX ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 'd 0170 01 .O 1988 -2010 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD 1060:k /l06 'U 'Po