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RC-11-1921Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 187395 Permit Number: RC -10 -11 -1921 Scheduled Inspection Date: March 19, 2013 Inspector: Bruhn, Norman Owner: OBERMEYER, JOSEPH & JULIE Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: JMR CONSTRUCTION CO INC. Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060171310 Phone: 305 - 672 -8055 Building Department Comments INSTALL NEW TILE ON FLOOR SHOWER WALLS. INSTALL NEW GLASS SHOWER ENCLOSURE INSTALL NEW VANITY AND TOILET. 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 CREATED AS REINSPECTION FOR INSP- 165609. CANCELLED BY LYLE ROBERTSON March 19, 2013 For Inspections please call: (305)762 -4949 Page 25 of 41 PERMIT # PC 11 -- 19 fa ' CONTRACTOR: -Ern t\ts-p 7 °i®N) SUBMITTAL DATE: tt )1 61 `' 0(1 ADDRESS: 0 69 NA- Li AVE- NAME: RESUBMITAL DATES: PROJECT TYPE: Z ING FIRE UCTURAL IMPACT . E S ELECTRICAL HRS/DE - M 0 PLUMBING PLU' NOC MECHANICA, BLDG 1 le NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST BISPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 111111111111111111111111111111111111111111111 TAX FOUO NO. 1/ 3 Z e P/7 /3/0 STATE OF FL I HEREBY CERP THE UNDERSIGNED hereby gives notice that improvements will be made to property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. N .201 1 R07' 4 (7.0;«Ma 17 IJR Bk 27830 F's 3723; (IA's) FE CORDED .11 /02/2011 10:53:32 HARVEY RUVIHr CLERK OF COURT MIAMI -DADE COUNTYr FLORIDA LAST PAGE 1. Legal description of property and street/address: SE n. HARVEY RUM 004TY OF DADE Y the/ fro la a, Mg' of ilhe dog al AA& A 2 // 1Jif1'MSett Cern Owls X90, y, Space above reserved for use of recording oil ma 2. Description of improvement: RE»or/477OA,, DC- C.444-4 yj, , f... 3. Owner(s) name and address: Tb.ioo/i ,06 -/i r ?% / 99"Li ' Li6' /Jjf #fi r fs Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address andphone number. f0 667. 77 5. Surety: (Payment bond required by owner from contractor, if Kny) Name, address and phone number: Amount of bond $ 6. Lender's name and address: G 3307 a 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. S. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner& oLQwner(s)' Authorized Officer/Director /Partner/Manage Prepared By 1--V Le 66)0ewrie *'1 Prepared By Print Name Print Name % • f ' ft ©d& e7 c Title/Office Title /Office c,4i —e).---- STATE OF FLORIDA COUNTY OF MIAMI -DADE day ��� e-"-- The foregoin instrument was acknowledged before me this ( da of By .S eioet- D!1 eM- ritcA7 -. n idually, or ❑ as : 7 4Y for ersonaliy known, or C7 produced the following type of identificat Signature of Notary Public: Print Name: (SEAL) R L .2 q l'hQ ttil , f, a_ • VERIFICATION PURSUANT TO SECTION 92.526. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signet 1 - =(s) of By er(s)'s Authorized Officer/Director/Partner/Manager who signed above: -rte By Miami Shores Village Building Department /0050 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 Typ ROOFING Permit No. ial"1X2011 Master Permit No. OWNER: Name (Fee Simple Titleholder): Os E'4I 060A-do ePhone#: 30r/ 7 %f'' (► /6 d Address: 1909 100- ,! aE Qr , City: 7/427/ ggileDA ? State: ' zip: 33/38 i Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 998 `� 9 //o6- Z.€2 City: Miami Shores County: Miami Dade Folio/Parcel #: l/— 3 2-0 4 - b/7- /3 /0 Is the Building Historically Designated: Yes NO X zip: 33/.9 Flood Zone: CONTRACTOR: Company Name: 1,7/L t„e74'J7A.&G77OV ay, ,''c Phone #: 3f/97�"W3 1 Address: 1/6 c d Ali.d /915'0' City: CO%RY■ S'/o'L e f .f State: Pt- Zip: 33c) 7/ Qualifier Name: — +' /pAJCy Z-4j .E /a, g "X..T.,roN Phone#: 3tV/9.7.4/ - 3fa State Certification or Registration #: e6d /2-r-24 2c1 Certificate of Competency #: Contact Phone #: /9?u —'feY, ef Email Address: a�!/Z CO S74XT/atr € 1494g/G1.co4" DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ,3 70 r Square/Linear Footage of Work: %b SP Type of Work: ❑Addition DAlteration UNew Repair/Replace DDemolition Description of Work: /04(.577,4,--. 'V ) 7/40 dew ; S7ibwts tAJ hZuJ; 2•0517r1.4... Wit✓ 6440 -lar . '#4 'c- teraircte*.ra •uc ; /444170t. 418-24) Mforl/ i *so ******* ************** ****+x +********** **Fees.p** x*****+ x+ x*******************+************* Submittal Fee $ Permit Fee $ ' I Q • 5° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l U . 9 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip U /jr Mortgage Lender's Name (if applicable) lUf 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 IlVIPROYEMENTS 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 comme I ment must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In y'' absence of such posted notice, the inspection will not be approved and a reinspection fee will be c d. Signature 1 Owner or nt The f. going instrument was acknowledged before me this % day of OC7bi, s .20 g , by %may DBitm. -.�, ay.,. who is personallWknown to me or who has produced As identification and who oath. NOTARY PUBLIC: tio°�® ° \1*. M* BA0C 4 �A' •D4MISSION••.4•'_ ■ �, 4 • A ,c114, p0 , •. y 09• • Print: 'JOiY1� (3,'6 C-°1 O S #EE050204 • ' . My Commission Expires:'��.o••. Fenrtr.•• o e° '.":9 -4t , S311 O�tom````` Sign: Signature Contractor The foregoing instrument was acknowledged before me day of x-20 %/ , by who is personally known to me or who has produced as identification and who did take au NOTARY PUBLIC: ��E••••••QC,r % • Fi7�'(/l: j s N • �l —fir 6rU l :oI IkEE 050204 ate • �: 'ii ilii ii � \���! Sign: Print: My Commission Expires: ***************** ** *: x*********** *** ********** * *** * * ****x *** * * * ******* ***** **** ***** **** * ** *** ** **x * ** *** **** APPROVED BY � i_ //, 0, Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ROBERTSON, SIDNEY LYLE JMR CONSTRUCTION CO INC 11690 NORTHWEST 19TH DRIVE CORAL SPRINGS FL 33077 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 www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's 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 BATCH NUMBER [ DAM tIODUDIYYTY) CERTIFICATE OF LIABILITY INSURANCE 10/1 7/11 THIS CERTIFICAIS IS ISSUED AS A OUITTER OF INFONNATIONOORX At10 OOSPERSI 5 RIGHTS UPON THE CENDFICATE MOLDER. THIS WITWICATE DOES Nor AFFRIRATnruLy oR riErIATIVEN AREM, MEND OR ALTER TIE COMACH AFFORDED EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSUME A CONTRACT SEMEN TEE MEM HARMER" AUTHORIZED REPRESENTATIVE OR PRODUCER ANDTHE CERTIFICATE DOWEL alproadltr: if the nertMente holder In an ADISTiCHAL MAMA th e pallasfinn) mud be ssearand. 8VEROC87104 WARM; aublut to en Winn and condns Or Uls policy, nodal piggies may MISR* lin endorsement. A statement an Ifen eareaanfe na1c0efer riShta to HI* cniaffinsaa Inkier b IIra Of sada andaraaniantla). PRODUCER Onions= Of MOMS Ins Sew Ine 184988 Dbde HINV8110 Wird, FL 33157 Phone (305)740.6478 JMR INSURED CarastrUenan co, brim P.O. Sox 770871 Coral Springs, FL 33017 common Fax (32§ 7Lel DES51 aga ANIMA IlwafrOAHNONMENIALKI (305)741)4478 1 E. Nat (305)7404951 , INIMERpli *Mosta= commit ERIC f wawa= COMmance Ibidasby en. INELOISR C: SOURER : _ESSEggg: EUREERR GeRTFICATE NUMB SEWS= PASSIMR: fits 13 TO CERTIFY THAT THE fOUDIES OF MBURANCE usito mow HAVE BERN [mum TO THE BBAMED NAASIDABOVE FOR TI-E POLIcY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRELENT. TERd OR CONDITION OF ANY CONIRAOT OR OTHER Documerr WM4 MP= TO WHICH TM ok-prrinererE MAY BE ISSUED OR IdAY PEITTAIN, THE INSURANC:E womb BY THE Patna; DEMABBED NUM M BUM= YO ALL THE TENS. EXCWSIONS Aan CONDMCNB CF OUCH POUCIBI. LISTS SHOWN MAY HAVE BEEN REDUCED EM MOGAN& . TYPN OF DIEURANCE ADM/AM IMSR WED POLICY MI= OMMIAIIVYX, POW,' OFF =Xi EN ORNIOIALLSOULETY o ccavERen GENERAL minim • 0 otANAs-MAD E occuR 0 0 V OEM negaRDIATB LSAT /WPM* PER DD pouch, 20c-T Loc AUTONONLE LIMILITY ▪ SWAM° U UTINW • HIRED AMIN O 0 AuToacHtsULDD NUN-WNED o UNEDUILLA LIRE n Occuk O EXCESS MS Ej OLAIIAD-EADE ▪ DED RODAYM$ SIOIOUERD cosIPENSATION AND ogWY EINV Maur/ V ANY PROPRIETOR/PARIWIERIERECUIWE OFFICERJUMBER EXCLUDED? aktimatont at NH) IURRENten"EntlEs normared RED ERPSA two Inman PERSONAL d ADV MAW GENERAL aDOREGATE PRODUCTS- CCIIIPIOP ADZ $ 17-1 ffrailiPTKIN5"11. OF OPERAUDNS below DRECRIFOON OP OPERATIC= -oloanFicicrE HOLDER MIA pRe$ED$$SDICILE LRET $ BODILY INJURY MR pawn) $ nedaLV DLIURY (Poe aaardena PAP=IrillAriE UAW COORNENCE AGOREDATE =Mt ORM5/2012 fia UM% Th- EL MOD ACCIDENT $ 1000E0.00 E. noratan -EA ialPLOYE s 100,000.00 EL. DISERSE- POUCY UNIT $ =mons tvulcupsoll AMMO 181, Addllamel Ramis seasses, Noni map niquard) The VIVI Of liAami Shores 10050 NE 2nd AVM MIERD MOMS, FL 33138 SOORD CO CROWNS) CV LOO/LOOtI CANCEJLATION 500.000.00 SCUD IRCV CIF AMR ABOVE OBBCROBB) FOLMAR& CANCELLED UFOS! T)E10IP13AJ1C$I OPow TIERE3F, Nonce MIL IEE DISIVERID W lecuottbANIZISIIII THE POLICY PROVISIONS nunanum nyvadellhAINE _ . D VISS-2010 MORD OORPORA DO& AS WWI wilorcul. Tice ACOND cows and logo we registered molls ACORD 3o8nos 3N0 1.9690172.908 131 8Z:80 LlniLL/01. 1011712011 09:28 9546308114 PREMIER PROTECTION PAGE 01101 JMRCO -1 OP ID: CM ''dam RI CERTIFICATE OF LIABILITY INSURANCE .(MEDDANYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the palicy{ies) must be endorsed. If SUBROGATION LS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of SuCh endorsement(s). PRGDUSEIr 9I467 -8738 Premier Protoctlon insurance 95444 •101 409 SE 7th St Fort Lauderdale, FL 33341 Dougla6 A.Levy ' r PION$ rte: Fax '" -- I IA/a, Igo): ADDRESS: INSURENIS) AFFORDING COVERAGE NAIC a INSURER A : Accident Ins. Co. UARIUTY COMMERCIAL GENERAL LwBiLRY INSURED JMR Construction Co. 11690 NW 19th Drive Coral Springs, FL 33071 imam B: AGL9005195 INSURER G: 45115!12 INSURER!, : $ 1,000,000 INSURER a : $ 700,000 INSURER F : $ 5,000 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED {NAMED ABOVE FOR THE POUCY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL�RED IN ACCORDANCE WITH THE POLICY PROVISIONS. TYPE OF WSURANRE ' ADDrijOint DAR �D POLICY NUMBER POLICY EFP (NIDDDIYYYY} POLICY IMP (MMIDDFYYYY) UMITS A caNERAI. X UARIUTY COMMERCIAL GENERAL LwBiLRY AGL9005195 05/15/19 45115!12 EACH OCCURRENCE $ 1,000,000 P S QED,, 1 $ 700,000 NIED Fes+ (Any one parson) $ 5,000 CtA1ME -MADE X OCCUR PERSONAL $ ADV -INJURY $ 1,000,000 • GENERAL AGGREGATE $ 2,000,000 PRODUCTS •COMP /OP AGO $ 2,000,000 Ti EN'L AGGREGATE pLIMIT APPL,IES PER A POLICY n EyY r LOCI $ AUTOMOBILE — r.- LIABILITY ANY AUTO ALL OWNED NED HIRED AUTOS — _ WED ULED Amos ( rSINGLE LGVIIT 3 BODILY INJURY (Per wean) 3 BODILY INJURY (Per accident) ) $ (Per ridant) 3 — UMBRELLA IJAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE . $ $ DEB 1 RETENTION $ WORKERS COMPENBAT1ON AND EMPLOYERS' UA CITY Y / N ANY PROPRIETCR/PARTNEWEXECUTIVE ORRCERIMEMBER EXCLUDED? in (mammary in NH) If yea, ribn wider DESCRIPTION OF OPERATIONS below J A d}[C STATU- I TORY I NITS CM 1. ER E.L EACH ACCIDENT $ LL DISEASE -EA EMPLOYEE $ E.L DISEASE - POLICY UMrr - $ DESCRIPTION Op OPERATIONS !LOCATIONS !VEHICLES (Attach ACORD 101, Ad3NIonal Reams Soule, IN more apace is rsqulre4) General Contractor DER CANCELLATION MIAMISH Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 3313$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL�RED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE "a444411.1:41 ACORD 25 (2010105) ill 1908 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: J M R CONSTUCTION CO INC Owner Name: Business Location: Business Phone: Rooms Tax Amount 27.00 SIDNEY L ROBERTSON 11690 NW 19 DR CORAL SPRINGS 305 - 672 -8055 Seats Employees 10 Receipt 8 0 - 64 79 Business Type: RALCONTRACTOR Business Opened:03/28/1991 State /County /Ce rt/Reg : CB C 12 5 2 6 3 0 Exemption Code:NONEXEMPT Machines Professionals Number of Machines: For Vending Business Only Transfer Fee NSF Fee Penalty Vending Type: Prior Years (GENERA Collection Cost 0.00 0.00 0.00 0.00 0.00 Total Paid 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. WHEN VALIDATED Mailing Address: SIDNEY L ROBERTSON P 0 BOX 770871 CORAL SPRINGS, FL 33077 2011 - 2012 Receipt #03A -10- 00013653 Paid 09/30/2011 27.00 JMR CONSTRUCTION, CO., INC. CBC #1252630 305/970 -4434 JOB ADDRESS: 9909 NE 4th Ave Rd, Village of Miami Shores, FL 33138 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. BATHROOM RECEPTACLE ON 20 AMP CKT AND G.FI PROTECTED oi/ 41144 11-#41 Scope of Work: Install new floor and wall tile over 5/8" durarock wall board Install a new glass shower door Install a new vanity with new sink basins and faucets; new mirror Install a new toilet Install new shower valve and new shower pan Install new trench drain Repair drywall and paint 1 C112'1 Miami Shoes @4iilage OCT- 1 8 2011 aspROVED ' 7 NIVNG DEPT SUR FCT TO COMPLIANCE WITH ALL FEDERAL S? ATE AND COUNTY RULES AND REGULATIONS JMR CONSTRUCTION, CO., INC. CBC #1252630 305/970 -4434 JOB ADDRESS: 9909 NE 4th Ave Rd, Village of Miami Shores, FL 33138 FIRST FLOOR PLAN Scale 3/16" =1' -0" Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 -^6L\ Inspection Number: INSP- 165939 Permit Number: EL -10 -11 -1994 Scheduled Inspection Date: April 18, 2012 Inspector: Devaney, Michael Owner: OBERMEYER, JOSEPH & JULIE Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: MV ELECTRICAL SERVICES Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060171310 Phone: (305)216 -0677 Building Department Comments REPLACE GFI SWITCHES /OUTLETS IN BATH Passed Failed Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. /9,AP/7,63,/2,_ April 18, 2012 For Inspections please call: (305)762 -4949 Page 3 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 FBC 20 IYT 2 21,1 Permit No t 11 ) 994— Master Permit No. A € - / D ° / / - / 9 ?/ Permit Type: Electrical C OWNER: Name (Fee Simple Title_holderr)):: JD S P Obers't e qev Phone#: 0/7 q�" - / 0 Address: ,, /� l / 0 1 p4) 97 , o e RD / p City: A-f' / G3 �% •xi 0 /-PS State: r L Zip: e� / c 8 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 9 0 / /06-- A u e l( P City: Miami Shores County: Folio/Parcel #: // — D (p -017 ° J, / D Miami Dade Zip: - /0 8 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: A • v E/ e e 7'(C ce-/ 60 /of Q °7//kPhone #: 0/"' - 0677 Address: /931f /0 a) 92 q' City: ' J State: Qualifier Name: $410 f / b V ct (Je5 State Certification or Registration #: Contact Phone#: l - 0 ( 7 7 Email Address: L Zip: 3 3 D /7 Phone#:.3,% •=2/ tP - 0 0 77 Certificate of Competency #: E 00 0 gas Ira /7 0 nu ePe r(e tz% DESIGNER: Architect/Engineer: Phone #: epo Value of Work for this Permit: $ R7 J Square/Linear Footage of Work: U10 S F Type of Work: DAddress OAlteration New ❑Repair/Replace Description of Work: e- a e e & Fr .5 ou l i e / 0 o7/ e rs / 4 ODemolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** gees * * * * * * * * * * * * * * * * * * ***+six** * * **************** Submittal Fee $ Permit Fee $ / eD@ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 crpy of the recorded notice of •mmencement must be posted at the job site for the first inspection which occurs seven (7) da r the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspec fee will be charged. Signature AGA Owner or _ent The fore;.' g instrument was acknowledged before me this day of L 20 , by t - / e 9 s i D e t e ' a d ® L' ; who is pe onal{s ly known to a or who has produced As identification and who did take an oath. NOTARY : LIC: Sign: Print: QG n tQ My Commission Expires: tNe, S etiiiiitZ hik ldj S� Yvl Dr'UE i �► : 4 ' tN ••• N01SSIT, Signature Contractor The foregoing instru ent was acknowledged before me this 2D day of Oclb h Pk- , 20 % , by o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: * *** ** **+x*********** ** * **+x******* ** **** ** *** ** x: x***+ x******* ****** ******* ********************* *+ *** f'12- g /��4-7 Plans Examiner Zoning APPROVED BY Structural Review Clerk (Revised 07 /10/07)(Revised 06 /10i2009)(Revised 3/15/09) 9/2011 13:12 3058600907 MUTUALINTEREST PAGE 01/01 ACORD ,M CERTIFICATE OF LIABILITY INSURANCE M DATE ` (8/201/1 J 10JM/DD 1 PRODUCER Serial # 100164 MUTUAL INTEREST ASSURANCE,INC. ELIZABETH VERDURA 12815 CORAL WAY MIAMI FL 33145 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 NAIL# INSURED M.V.ELECTRICAL SERVICES, INC 18311 NW 82ND CT MIAMI, FL 33015 I INSURER A: ASCENDANT UNDERWRITERS, LLC INSURER B: ASCENDANT UNDERWRITERS ,LLC INSURER C: INSURER D: . INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURSD 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE, LIMITS SHOWN MAY HAVE 138EN REDUCED BY PAID CLAIMS. , PPM LTg D, TYPE OP INSURANCE POLICY NUMBER LIMY MIIDDOG$N P X AO LIMITS A GENERAL © �� LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR GL/50105 -1 9/23/2011 9/23/2012 EACH OCCURRENCE $ 1,000,000 $ 100 000 liR MIa S rlEa rencel MED EXP (Anyone person) S 5,000 PERSONAL & AM INJURY S 1,000,000 GENERAL AGGREGATE $ 1,000,000 $ 1 L000.000 PRODUCTS • COMP /OP AEG GEN'L AGGREGATE LIMIT APPLIES PF.R: POLICY iThe LOC AUTOMOBILE IIII LIABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNFJJ) AUTOS COMBINED SINGLE LIMIT (Fe occident) S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY AMAGF, pet decicient) $ GARAGE LIABILITY IIII ANY AUTO ■ AUTO ONLY • EA ACCIDENT $ OTHER THAN EA ACC 5 AUTO ONLY: AGG 5 EXCESS III • /UM@RELLA LIABILITY OCCUR EJ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ 5 5 B WORICA%COMPENSATION AND EMPLOYS,R,• LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMSCR EXCLUDED? s yyes, deraf under SPECIAL. PR VISIONS boI w WC-504845 7}{ ITwo RY uM�S l Pk EL EACH ACCIDENT 5 100,000 S 500,000 EL DISEASE • EA EMPLOYEE EL DISEASE • POLICY LIMIT 3 100 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG. DEPARTMENT 1 0050 NE 2ND AVE MIAMI SHORES, FL. 33138 SHOULD ANY OF 11•IE 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 NY It 0 UPON THE INSURER, RS AGENTS OR REPRESENTATIVES. 1 AUTHORIZED REPRESENTATIVE OF IND DL-NT INSURANCE AGENCY ACORD 25 (2001/08) C :IPMPROICERTPROS.FP5 tD ACORD CORPORATION 1988 Construction TQQBifying Board BUSINESS CERTIFICATE OF COMPETENCY 06E000405 MV ELECTRICAL SERVICES INC D.B.A.: VALDE ' MARIO Is certified under the provisions of Chapter 10 of Miami -Dade County QUALIFYING TRADE(S) 0001 ELECTRICAL MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 MUNICIPAL CONTRACTOR'S 2012 FIRST -CLASS TAX RECEIPT U.S. POSTAGE MIAMI -DADE COUNTY - STATE OF FLORIDA PAID PURSUANT TO COUNTY CODE SEC. 10 -24 MIAMI, FL EXPIRES SEPT. 30, 2012 PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY RECEIPT NO. 30- 6019046 CC NO: 06E000405 BUSINESS NAME / LOCATION MV ELECTRICAL SERVICES INC 18311 NW 82 CT OWNER :MV ELECTRICAL SERVICES INC SEE BACK OF RECEIPT FOR A LIST OF NON- PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COL9Y472172011 02240017001 000200.00 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD MV ELECTRICAL SERVICES INC MARIO A VALDES PRES 18311 NW 82 CT MIAMI FL 33015 111111111111,111111 III I111111111111hilillii111 11111111hI�1 *01P4MtPcIPT MM 2 ATE tip f LORIDA X012. ,USINfiSS BA - ART. 9 & `10 THIS IS NOT A BILL 577238-0 BUSINESS NAME / LOCATION MV ELECTRICAL SERVICES INC 18311 NW 82 CT 33015 UNIN DADE COUNTY OWNER MV ELECTRICAL SERVICES INC Sec. Type of Business THIS IS 6P,LY6A4ACTRICAL CONTRACTOR DOES ENOTP ER�PTHE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 08/15/2011 60000000239 000075.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 - DO NOT PAY RENEWAL RECEIPT NO. 601904 -6 CC 1 06E000405 WORKER /S 1 DO NOT FORWARD MV ELECTRICAL SERVICES INC MARIO A VALDES PRES 18311 NW 82 CT MIAMI FL 33015 1.11.11.il.filly ill ,ililfh,Ilhil,hil,>,iin,ii boll Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I� -I X7,1 Inspection Number: INSP- 165931 Permit Number: PL -10 -11 -1993 Scheduled Inspection Date: September 28, 2012 Permit Type: Plumbing - Residential Inspection Type: Final Owner: OBERMEYER, JOSEPH & JULIE Work Classification: Addition /Alteration Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Inspector: Hernandez, Rafael Project: <NONE> Contractor: SOUTHWEST PLUMBING SERVICES INC Phone Number Parcel Number 1132060171310 Phone: (305)232 -6203 Building Department Comments INSTALL NEW SHOWER PAN & DRAIN, REMOVE AND RESET TOILET, AND VANITY BASIS, NEW SHOWER VALVE AND SHOWER HEAD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 28, 2012 For Inspections please call: (305)762 -4949 Page 3 of 18 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) 762.424949 BUILDING PERMIT APPLICATION FBC 20 Permit No. OCT 2 7 201 Master Permit No. l2.0 --10 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder):...ri ; oee h, ©8ol-in Phone#: 24 J' /`7%�� /ed Address: [ 09 U A P- eRe City: v k,V052 S an, \ State: TA Z'ip:, T9. Tenant/lessee Name: Phone#: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: -t JeS r'S;)1t)( ►r2.9 Phone # :3D a3a-(cQD3 Address: P-A C4- City: i '1`► rirro% State: li—i Zip: 33 2 Qualifier Name TThr r' Qs \! a cow Phone #: SOS" .. -(0 3 State Certification or Registration #:c "FC Q 7Q(71Q Certificate of Competency #: Contact Phone#: 3CS-- - Email Address tnp®5L)01/4) P' CIS. (ILA DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2, Sb G d'' Square/Linear Footage of Work: Coo SF Type of Work: °Address °Alteration ONew °Rep:dr/Replace ODemolition D e s c r i p t i o n o f Work: - Z ^ ' f r7Pa4.- A/ E ) S#fa w g")-- opt A. ,( 0'.c stea.J ) eF mvei A1y13 "QE sei m, e er f if O da9N t77 R Asi.t • illar, 1,42..0 Sat a■- Ali OE 01- Sft.ew — ern . OOOOOO tO 0000******************000N *OO *F *0* *000000 ** * *0 *000 *000 *000000000000000 #0000 Submittal Fee $ Permit Fee $ f CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ L9 c-- Bonding Company's Name (W 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: 1 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 10 Applicant: As a condition to the issuance cyf 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 auacltment. Also, a cert(Jied ropy of the recorded notice of co ncement Hurst be posted at the j>>! site for the first inspection which occurs seven (7) days after the building permit is isc - ' In he absence of such pos, !d tl/ ce. the inspection will no be approved and a reinspertion fee will be charged Signature The f day o oI` Owner or Age nt .! ,,,wl 4ei .6. oy. <et. is�� tru r Fits .10 11 oispe naily k NOTAR Y I ► Ir wn PUBLIC: Contractor The foregoing instrument was acknowledged before me this Z I day of , L1_, by y k:i I to me or w ■ has produced ho is personally known to me or who has produced li2entification and who did take an oath. as identification and who did take an oath. BLIC: Sign: /f.'.. Print: My Commission Ex s************** * *9 * * ** * * ********0a*****e **** ** * *** ** *********** * * *s*o ********* APPROVED BY fD mil/ Plans Examiner Structural Review (Revised 07/10/07 )(Revised 06/10t21109)Revised 3115/09) Zoning Clerk w.` D d E LICENSE CLA S E T AS MICHAEL WATSON 1I T GOOF ALL CT ST N. FL 333 2833 02-27-1959 . M -1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 WATSON, THOMAS M SOUTHWEST. PLUMBING SERVICES INC 12925 SW 134 COURT MIAMI FL 33186 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 www.myfloridahcense.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 Department's 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 tor doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 :31rAT OFF mA ACP ,41966 e0" DEPARTMENT OF BUSINESS AND PROFESSIONAL-.REGULATION • .Pf z. a . '�l, M. c9'CO37090 .. 06/161,1;0 09.0487431 CERTIFIED..PLT.Th ING !CONTRATTQR WATSON, THOM L9 M: - -`.. • SOUTHWEST -,p%U INC SERVICES .INC • 15• CERTIFIED under the pruvi,aiana vE Cb.489 vii *004enton ague: •$`t1Ci 31, 2012 L10061600813 c ., -., : t` `- T ATEOF FLORIDA .. �_ DEPARTXENT TBI IN ON NSRCToN INDUSTRY LI sISG BOARD 5 4 SEQ#rto06160..0813 DATE 33ATCH NUM ER 06 16 2010 09648743.1 'Wile • The PLUMBING CONTRACTOR Named below XS TIFIEO Under the provisions of Cha Expiration dater AUG 31, 20 "r ra': WATSON, THOMAS M SOUTHWEST PLUMBING SERVICES X ic,71 „;, ,0r 12925 'SW 134TH COURT NN) wP 11". MIAMI " . , . a FL. 33186 CHARLIE GRIST GOVERNOR • DISPLAY AS REQUIRED ay LAW CWARLIIi LIEN ' °" INTERIM: 'SECRETARY 'RAY 2011 LOCAL BUSINESS TAX RECEIPT 201E O a MIAMI -DADE COUNTY - STATE OF FLORIDA FIRST -CLASS ' •� U.S. POSTAGE EXPIRES SEPT. 30, 2012 99130. MOST BE DISPLAYED AT PLACE OF BUSINESS PM1, PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 0 & 10 PERMIT iN0 231 THIS IS NOT A BILL — DO NOT PAY RENEWAL SOUTHWEST PLUMBING SERVICES INC STATE* RECEIPT NO. 628202-4 12925 SW 134 CT 33186 UNIN DADE COUNTY OWNER SOUTHWEST PLUMBING SERVICES INC Sea. Type of Buelneee 602136 -4 BUSINESS NAME! LOCATION 196 PLUMBING CONTRACTOR WORKER /S TT#S I6 Y A LA AL 5 0 GOP. i8 TAY PERMIT R HOLDER TO VIOLATE ANY REiULATORY OR ZONING LAWS OP THE COUNTY DO 8 O EXEMPT EM THE HOLDER FROM ANY OTHER PERMT OR LICENSE REQUIRED SY LAW. THIS 1S NOT A CERTIFICATION CF THE HOLDER'S OUALNRCA• THINS. PAYMENT memo MIAMPORDE COL I:EDUNryTAX 07/21/2011 60020000363 000275.00' SEE OTHER SIDE DO NOT FORWARD SOUTHWEST PLUMBING SERVICES INC THOMAS WATSON PRES 12925 SW 134 CT MIAMI FL 33186 I1/ 1II$1 111 p1 11J111L11p1 Rf11111IhH1aIfd1111l11111114411 CERTIFICATE OF LIABILITY INSURANCE OP ID Vii. DATE {MM /Dp/YYYY) 10/20/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on title certificate dots not confer rights to the certificate holder in lieu of such endoraement(a). PRODUCER Kahn- Carlin & Company, Inc. 3350 S. Dixie Highway Miami FL 33133 -9984 Phone:305 -446 -2271 Fax:305-448 -3127 INSURED Southwest Plumbing Services, Inc. 1;925 SW 134th Court Miami FL 33186 -5869 L.UX NE:6 1 PHONE ' FAX , 1 No. WI .M A. ADDRESs, 'PRODUCER CUSTOMER ID SOLITE -9 INSURER(S) AFFORDING COVERAGE (ANC. No): INSURERA: Indian Harbor Insurance Co INSURER B: Tsavelers ir♦daumiiy Cc. a¢y INSURER C: North River Insurance Co. NANC 0 36940 25658 INSURER D: aridgetield EFpioyera tee Ca INSURER E: INSURERS : 10701 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS INDICATED. CERTIFICATE EXCLUSIONS TO CERTIFY THAT THE POLICIES OP INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS. CLAIMS POLICYEFF i - P-0JCYECP— (MM/DD(YYYY) (MMIDDIYYYY) LIMITS TYPE OP INSURANCE INSR JWM Yr11D POLICY NUMBER WVD I A GENERALUABIUTY X ~ GEM COMMERCIAL GENERAL UABILITY 1 CLALMS.MADE . $1 OCCUR j ESG0033178 to /olno f ill /ID /11 EACHOCCURRENCE ! s 1,000,000 000,000 000 I $ 5 , 0 0 0 — - PRE ) _15100, MED EXP (MY tale person) PERSONALSADVINJURY I $ 1, 000, 000 GENERAL AGGREGATE 5 2,00 0 , 000 AGGREGATE UMr APPLIES PER POLICY X ! EC O LOC 1 PRODUCTS • COMP/OP AGO 82,000,000 2, i � Ben. 51,000,000 B AUTOMOBILELIAB1UrYT - - X i ANYAUTO ALL OWNED Atrros scuarea.ao AUTOS HIRED AUTOS NON-OWNED AUTOS f BA0069T262 ;iorolni i to /airs COMBINED SINGLEUAAIT (Ea wade l) - -- BODILY IwURY (Per mum) - - _ - BODILY IN IURY(Per =emu ' PROPERTY DAMAGE , (Per acoidenu - t 1000000 - S S • $ 5 1 C $ UMBRE"11A8 8 1 OCCUR EXCESS UAB 7 CLAIMS-MADE 5530937139 lo/02/so la /ie/li EACH OCCURRENCE 54,000,000 AGGREGATE 54,000,000 DEDUCTIBLE 1 RETENTION 5 0 S S D WORKERS COMPENSATION I AND EMPLOYERS* LABILITY Y /N OA O� ART ec.rn � L.lA (ManditoryInNH) U F� If yes. dascnbe under DESCRIPTION OF OPERATIONS IX /Law 083035571 01/11 01 /OS /11 �TOC Y SAMTU I Oy- E.L EACH ACCIDENT $1000000 E.L DISEASE - EAEMPLOYEE 5 1000000 EL DISEASE • POLICY LIMIT 5 10 00000 DESCRIPTION OF OPERATIONS l LOCATIONS 1 VEHICLES (Attach ACDRD 101, Addlpanal Remarks Schedule, 5 more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores FL 33138 ACORD 25 (2009109) MTAM -04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAID«ELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE OELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 20 /CC BATIaA All rights reserved. The ACORD name and logo are registered ma of ACORD