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RC-13-481Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 194559 Permit Number: RC- 3- 13-481 Scheduled Inspection Date: July 02, 2013 Permit Type: Residential Construction Inspection Type: Final Building Owner: OBERMEYER, JOSEPH & JULIE Work Classification: Alteration Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Inspector: Bruhn, Norman Project: <NONE> Contractor: JMR CONSTRUCTION CO INC. Phone Number Parcel Number 1132060171310 Phone: 305 -672 -8055 Building Department Comments SECOND FLOOR BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passe i2 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 02, 2013 For Inspections please call: (305)762 -4949 Page 23 of 23 PERMIT # CONTRACTOR: CJ`�Yf CO . SUBMITTAL DATE: 14 1 II 'I , ADDRESS: 9ATI 1/■1 14 V ed - NAME: I RESUBMITAL DATES: Al 1 PROJECT TYPE: 1.� �I� ;LL LA iii FIRE ZONING STRUCTURAL IMPACT FEES 4-11441d-91 /2 k t /Hi ELECTRICAL 4PtY HRS/DERM Ok tel 31,3 13 PLUMBING NOC MECHANICAL BLDG °` \is: 15Bi�JII,DING 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 r--, y ._ m: yes FBCi3 � Permit No. 2C� / ) PERMIT APPLICATION Master Permit No. Permit Type: BUILDING - ROOFING 9 JOB ADDRESS: a/ t2 9 V E ' �i A v.._ `Cot City: Miami Shores County: Miami Dade Zip: 3 3 / 3 S FoliolParcel #: // ° 3 2-0 /7 —/S./O Is the Building Historically Designated: Yes NO x Flood Zone: OWNER: Name (Fee Simple Titlehol der O Monet 3 Y/7 j. {/4e) Address: 9 o g nrie. City: State: Zip: 3-3 /3 S Tenant/Lessee Name: Phone#: 30 r/7 r t // Email: ,7-i? 460-42e) 'Yl 67- CONTRACTOR: Company Name: J 'C !z s hone #: . oj74,4) Address: 1 to P G 4,„) iq ! j l City: l %tf,✓ v.,, State: �Z Zip: C5 7/ Qualifier Name: 6'e N L . Rd ✓ .1..-Y' .ce:, Phone#: OJ7'9 cti3 5` State Certification or Registration #: - l�� Certificate of Competency #: Contact Phone#: d 0 - '/' 39 Email Address: j- a- 6W S7/2-Oe-7/ey-/ 6 4/� > '� . DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ a•® aCY, 0 Square/Linear Footage of Work: 6,0 S� Type of Work: OAddition `alteration ONew ORepair/Replace ODemolition Description of Work: l J 514U /1 Jaw.) -1-/e-e° i friuir // i_e r ` $41 -4) ��r ice 414'4 ° /` P cle- 006 4 , Color thru tile: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** { ******************************************** Submittal Fee $ Permit Fee $ r''' do CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 2U • 1 - 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 FLF,CTRICAL 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 co ement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. Ind/ absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature :..,.-- .,.... Owner or Agent The for going instrument was acknowledged before me this The fore day of t 20 fl, by �t 7I1r 04074020. e-r— - , day o who is personally known to me or who has produced or who has prod • ced NOTARY ' UBLIC: �lttiti t .�'t�.Oa��! � _'�7 Notary Public - ate of onsa My Comm. Expires Sea 23, 2015 Commission # EE 128810 Bonded Through National Notary Assn.. ation and who did take an oath. *** * * * ********+x****: raw***** *******> p+ *nr*x :**+r*******a+*** ************ ***** *********** ** **+x********rx***** ******** APPROVED BY i24-� Plans Examiner Zoning Structural Review Clerk (Revised 3 /12I2012)(Revised 07 /10 /07(Revised 06/10/2009XRevised 3/15109) NOTICE of COMMENCEMENT Return to (self addressed stamped envelope enclosed) This Manumit Prepared by Lyle Robertson Property Appraisers Parcel IdentMcaton Number 11-3206-017-1310 WAGE ABOVE THIS LINE FOR PROCESSION:DATA 111111111111111111111111111111111111111111111 CFN 2013R02100B3 OR Bk 28536 Ps 4282; (1Ps) RECORDED 03/19/2013 10:27:38 HARVEY RUVIH, CLERK OF COURT MANI-DADE COUNTY, FLORIDA LAST PAGE SPACE MOVE THIS LINE FOR RECORDING DATA NOTICE of COMMENCEMENT State of Florida County of Miami Dade The undersigned hereby gives notice that fmprovementsw�l be made to certain real property, and in accordance with section 713.13 of the Florida Statutes, the following information is provkled la this NOTICE of COMMENCEMENT. Legal description of property: Miami Shores Sec 4 PB-15 Lots 17 & 18 Eilk 98 Street address of property: 9909 NE 4th Ave Road Description ot improvements: Remodel Bahroom Joseph Obermeyer 9909 NE 4th Ave Road Fee Property Owner Name: Properly Owner Address: Owner's interest in property: Fee Simple Title Holder Name: Title Holder Address: Contractor Name: Contractor Wang Address: Surety Name: Surety Mailing Address: Lender Name: Lender Mailing Address: Person within the State of Florida designated by Owner Upon which notice provided by Section 713.13(1)(a)7., Florida Statutes. MINE Name Serve Owner Address Serve Address in addition to himself, the Owner designates the following person to a copy of the Moor's Notice in Section 713.13(110), Florida Statutes. Name Address Expiration date of this Notice of Commencement This Notice of Commencement expires in one year. JMR Construction Co., Inc. PO Box 770871, Coral Springs, FL 22077 None Amt of Bond $ None None s S" SCO Aainr'" '11#'114",^4,1r RINK —4' 41.2umanaenswfaigr ,Jo‘gril 013o-irte‘ge"--- 1 have relied upon the following identification of the Affiant Joseph Obermeyer Pruned Notary signerure BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL ,33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: J M R CONSTUCTION CO INC Receipt #:G80E>47 CONTRACTOR (GENERA/ Business Type:CONTR) Owner Name: SIDNEY L ROBERTSON Business Opened:03 /28/1991 Business Location: 11690 NW 19 DR State /County /Cert/Reg:CBC1252630 CORAL SPRINGS Exemption Code: Business Phone: 305 -672 -8055 Rooms Seats Employees Machines Professionals 10 Tax Amount 27.00 Number of Machines: Vending Type: For Vending Business Only Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 0.00 0.00 0.00 0.00 0.00 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 WHEN VALIDATED 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. Mailing Address: SIDNEY L ROBERTSON P 0 BOX 770871 CORAL SPRINGS, FL 33077 2012 - 2013 Receipt #03A -11- 00006629 Paid 09/05/2012 27.00 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 leam 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 STATE OF FLORIDA AC# E 2 4 7 4 7 5 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CBC1252630 08/04/12 128028752 CERTIFIED BUILDING, CONTRACTOR ROBERTSON, SIDNEY LYLE MIR CONSTRUCTION CO INC IS CERTIFIED under the provisions a ch.489 Fa expiration date: AUG 31, 2014 L12080400456 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK" `PATENTED PAPER AC #6247479 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L12080400456 DATE BATCH NUMBER LICENSE NBR 08/04/2012 128028752 CBC1252630 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 ROBERTSON, SIDNEY LYLE JMR CONSTRUCTION CO INC 11690 NORTHWEST 19TH DRIVE CORAL SPRINGS FL 33077 RICK SCOTT GOVERNOR KEN LAWSON SECRETARY JMRCO -1 OP ID: CM ACOREY k„.....---- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/06/2013 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 policy(les) 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 certificate holder in lieu of such endorsement(s). PRODUCER Phone: 954 - 467 -8738 Premier Protection Insurance 409 SE 7th St Fax: 954 -944 -1881 Fort Lauderdale, FL 33301 Douglas A. Levy CONTACT PHON AICO.Ni o. Ext): FAX , No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA :Accident Ins. Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED JMR Construction Co. 11690 NW 19th Drive Coral Springs, FL 33071 INSURER B : 1677731 INSURER c 05/15/2013 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IANSR SWVD POLICY NUMBER (MMIDDD/YYYY) IMM/UDDD/YY 1 umrrs A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 1677731 05115/2012 05/15/2013 EACH OCCURRENCE $ 1,000,000 PREMISDAMAGE TO RENTED ES (Ea occrsrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES FIT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED tSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y IN N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) General Contractor CERTIFICATE HOLDER MIAMISH Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 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 .44401#11 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ASR °� CERTIFICATE OF LIABILITY INSURANCE D TE(MM/2013 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 policy(ies) 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 certificate holder in lieu of such endorsement(s). PRODUCER Onesource Of Florida Insurance Services Inc. 18495 South Dixie Highway, #110 Miami, FL , 33157 CONTACT NAME: PHONE o. ): 305- 740 -6949 aC. No): 305 - 740 -6951 AnnRless: onesourcewcins @gmail.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Castlepoint Florida Insurance Co. LIABILITY COMMERCIAL GENERAL UABIUTY INSURED JMR Construction Co, Inc. P.O. Box 770871 Coral Springs FL 33077 INSURER B : INSURER C : INSURER D : $ INSURER E : $ INSURER F : CLAIMS -MADE COVERAGES 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 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POUCY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ PR S (RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY UMIT APPUESPER: JECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) DESCRIPTION OF OPERATIONS below Y/ N N / A WCP761174100 09/05/2012 09/05/2013 X I CRY I I T- OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN 10 NE 2nd Avenue ACCORDANCE WITH THE POUCY PROVISIONS. Miami Shores, Fl 33138 AUTHORIZED REPRESENTATIVE I ©19 ACORD 25 (2010/050 05) The ACORD name and logo are registered marks 88 - of ACORD 2010 ACORD CORPORATION. All rights reserved. JMR CONSTRUCTION, CO., INC. CBC #1252630 305/970 -4434 JOB ADDRESS: 9909 NE 4th Ave Rd, Village of Miami Shores, FL.33138' bAIHR)OM RECEPTACLE Ulu zu AMP CKT AND 6.F I PROTECTED SECOND FLOOR BATH SfOPE OF WORK: 1. Install new floor and,wall tile over durarock cement board; 2. Remove and replaceexisting toilet, vanity and shower fixtures, including a new shower pan; 3. Install new mirror and glass shower enclosure; and, 4. Install new GFI outlet, 4 recessed lights and switch. C) 5 co LANCE WITH ALL FEDERAL 31 GUI ATIONS ezi J 1 PROVED BLDG DEPT N! 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. SECOND FLOOR PLAN. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 194467 Permit Number: PL- 3- 13-482 Scheduled Inspection Date: July 01, 2013 Inspector: Hernandez, Rafael Owner: OBERMEYER, JOSEPH & JULIE Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: SOUTHWEST PLUMBING SERVICES INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060171310 Phone: (305)232 -6203 Building Department Comments PLUMBING WORK FOR SECOND FLOOR BATHROOM REMODEL Infractlo 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- 187166. June 28, 2013 For Inspections please call: (305)762 -4949 Page 29 of 32 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 Permit Type: PLUMBING JOB ADDRESS: gQo9 rtve_.., 20 57S BY: ®_____________ ____ __ FBC 20 0l ) Permit No. Master Permit No. 3- 4g1 City: Miami Shores County: Folio/Parcel #: //J -3 2 06 r2/ 7— /3/1/2 Is the Building Historically Designated: Yes NO OWNER: Name (Fee Simple Titleholder): Address: 9q ®1 "for -6 44 4-2--w. /2--3 City: m State: 71_, Miami Dade Zip: -33/le Flood Zone: g �JL 17 i'16 %i- Phone#: 3o ;c. /L6 Zip: 3 /3rr' Tenant/Lessee Name: Phone#: L7,r/ 7q 4/C e Email: 8 /1 4,1 CONTRACTOR: Company Name: Address: 1 O- City: LI ' t State: Ft, Zip: 53) LS l0 f .�i Qualifier Name: a9 Phone#()) J State Certification or Registration #: . Certificate of Competency #: Contact Phone#: y` Email Address: Te OtA3P10131 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ .2y6 Square/Linear Footage of Work: Type of Work: DAddress >Alteration ONew DRepairlReplace DDemolition Description of Work: P 4) S 1u S t, P4 aL) j ZALI kid e.- / Y...71 46' tA-)C, 6-4V, ***************************************F ****************** * *** * * ****** *********** * ** Submittal Fee $ Permit Fee $ r0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ w 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 FI.RCTRICAL 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 iss ja f the absence of such poste d i tice, the inspection will not be approved and a reinspection fee will be charged. Owner or Ag The for instrument was acknowledged before me this day of ) ,200, by '06 -int,e who is personall known o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp. : WMm frgdres N o v M . 281 Contractor The foregoing instrument was acknowledged before me this day of IMCI C 1 ,201 , by who is personall known tojne_or who has produced as identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission • onY ?v: N. - Public State of Florida Lourdes Tatiana Calvi • • c` My Commission D0889865 oa lop° Expires 05/14/2013 ********************** *i ************** *sk***ih****Kask: la**#s R*****+ k*sB*+ R***** ***** ****+H****aN **** **:k**de** APPROVED BY _ . % ;'l 3 Plans Examiner Structural Review (Revised3 /12/2012XRevised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk SOUTH -9 OP ID: EC AWR CERTIFICATE OF LIABILITY INSURANCE DATE(MYY) 12/226/12 6/12 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 policy(ies) 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 certificate holder in lieu of such endorsement(s). PRODUCER 305 -446 -2271 Kahn - Carlin & Company, Inc. 3350 S. Dixie Highway 305 -448 -3127 Miami, FL 33133 -9984 Diane Mack -Berk CONTACT ac°. No. Ext): FAX No): E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Security National Insurance Co 33120 INSURED Southwest Plumbing Svcs, Inc. Tom Watson 12925 SW 134th Court Miami, FL 33186 -5869 INSURER B : Travelers Indemnity Company 25658 INSURER c : North River Insurance Co. 21105 INSURER D : Brldgefield Employers Ins Co 10701 INSURER E : $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EX? (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY SES110358500 11/10/12 11/10/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea e) occurrenc $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X PERSONAL & ADV INJURY $ 1,000,000 PER PROJ AGGREGAT GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JECT PER LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUTOS BA0069T262 11/10/12 11/10/13 C0 BI deD SINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per acEciid DAMAGE $ $ C X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 5821009659 11/26/12 11/10/13 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENT ON $ 0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y IN N / A 083035571 01/01/13 01/01/14 X TWTATIUS OTR - EL EACH ACCIDENT $ 1,000,000 El. DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POUCY UMIT $ 1,000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION MIAM -04 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ' (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 WATSON, THOMAS M SOUTHWEST PLUMBING SERVICES INC 12925 SW 134 CT 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 bette 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 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 for doing business In Florida, and congratulations on your new license! .AP# ON.t.i#R DETACH HERE STATE OF fLORIpt AC# 6 it .5 5a 3.6 '..inEARTONTOF.EVSIOSS.Akp,. PROFESSIONAL REGULATION tiCO3.7690 06/07/12 110418111 r. cBgTOXED PLUMBING CONTRACTOR VATBOL., TIMMS 'M SOUTHWEST PLUMB;NO SERVICES imc .CERTIF IED ufldr,th iTpvii0.cli* 61 sh.489 FS ion date *119 (3.4: ;.:,204.:4 0.24syss874 THIS ,IDOCUMENT.HAI3 AICOLORED "BACKGROUND • MICROPRINTING • LINEMARK"',PATENTED:RA'PER ' STATE OF FLORIP4; NT, .0 -13 SZNEE1SiAND PROFES I VAL TILATION 9110. PO ;ION., IMISTRY LICE 0 IsMI BO. SEQ# L12060700874 06/01/2012 340418717 pc,03700' porn-RA.0MR Named below IS cititTZFIED ' tinder ' the provisions of Chapter 489 F. Expiration date: AUG 31, 2014 WATSON„ SOUTHWErNo SERVICES INC 12925 SW 134m cotiret, MIAMI FL 33186 . • RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY • FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 602136 -4 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 628202-4 SOUTHWEST PLUMBING SERVICES INC STATE* CFC037090 12925 SW 134 CT 33186 UNIN DADE COUNTY OWNER s 196 SOUTHWEST PLUMBING SERVICES INC OU r J IG CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER SOUTHWEST PLUMBING SERVICES INC Y REQUIRED B LAW Th LICENSE THOMAS WATSON PRES e OD�A-T HOLDER'S GUAUPICA- 12925 SW 134 CT WONS MIAMI FL 33186 WORKER /S 50 DO NOT FORWARD PAYMENT RECEIVED COUNN TAX 07/25/2012 60040000501 000275.00 SEE OTHER SIDE i 111111 I1lliII1+ulll1IH IIl1 ilI17IIIIl,IIIIIIIIIII1I ?1160t i1I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 qv( Inspection Number: INSP - 187174 Permit Number: EL- 3- 13-483 Scheduled Inspection Date: June 27, 2013 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 ELECTRICAL WORK FOR SECOND FLOOR BATHROOM REMODEL 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 June 27, 2013 For Inspections please call: (305)762 -4949 Page 4 of 32 4 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 'BLJiLDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 9101 Ab" Ada, B FBC 20 Permit No. t ..t Z 4&3 Master Permit No. JC/ 1 1 City: Miami Shores County: Miami Dade Zip: 3 3/ 3t Folio/Parcel #: // ® 7-e g - 0/ 7' /.5j Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): V T S 04 im - Phone#: 7/7qa- - (./"Z27 Address: 4 q 6- 16-11 d City: Xti4- State: Tenant/Lessee Name: Zip: 3/3P Phone#: Email: 1i' .' e G 73e2-4---,./44-... CONTRACTOR: Company Name: //I if It 56x.oe , -'tone#: Address: / ff1 City: (4 State: 3 r/..z. /6 —6 6. -`7 Zip: 3,01 t Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: at 6" O0t _/ �y 5 Contact Phone#: 3t21 - 04, 7 7 Email Address: DESIGNER: Architect/Engineer: Phone#: IA Value of Work for this Permit: $ / °v Square/Linear Footage of Work: Type of Work: °Address °Alteration UNew epair/Replace °Demolition Description of Work: ' . .0 �)e /_ ,t', ✓ : :, ' C _c,r- 146 e , _s �f�) A �) L/ & tom' S' iv c 7-C-H . ********** * * * * * * * * ** * * ******* **********F ********* ******** * * * * * * *a:*:x******** * * * * ***** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ s 4 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 FT.F.CTRICAL 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 c mmencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued \ n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agen The foregoing instrument was acknowledged before me this r The foregoing instrument was acknowledged before me this S day of ; ; ,i _ 1 20 ��, by ‘1°19.0 C7e- , day of rnarol--) , 20 3by who is nally known to or who has produced who is personally known to me or who has produced F As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Contractor NOTARY PUBLIC: APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Accomr, CERTIFICATE OF LIABILITY INSURANCE 03/06/2013 THIS 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 IS WAIVED, subject to the terms and conditions of the pallet', certain Policies may require an endorsement. A statomont on this certificate does not confer rightt to the certificate holder in lieu of such endorsemont(s). PRODUCER MUTUAL INTEREST ASSURANCE 1295 CORAL WAY SUITE 3 MIAMI, FL 33145 INSURED. M.V. ELECTRICAL SERVICES, INC 18311 NW 82ND COURT MIAMI, FL 33015 T ESTHER VIDAL o"E .305.880 -2003 LA= MI,XTUALAS@AOLCOM WSUREI F1:ORDINtaCOVERAGE INSURER A: ASCENDANT UNDERWRITERS INauRSa a: ASCENDANT UNDERWRITERS INSURER C • INSURER 0: INSURER E COVERAGES CERTIFICATE NUMBER: SURER Tra. ypr, 305- 860 -0907 NAIL a REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED S'ELOW 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 SY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERM$, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE S VIND POLICY NUMBER (gip EFF CY EXP arYYYYi IMMIDONfYYY) GENERAL LIAILIYY GL/33643 -3 09/2312012 A X COMMERCIAL GENERAt. LIABILITY CLAWIS -MADE d OCCUR GEM- AGGREGATE LIMIT APPUE$ PER; 1PRT POLICY LOC AUTONOBILEUANIUTV ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBP,HU A UA EXCESS LIAR SCHEDULED AIMS WNED B MD 1 RETENT ON $ OCCUR CIMMS -MADE MIORIERS COMPENSATION AND EMPLOYERS'LAMIUYY ANY PROPRIET°klFA.qR�TTNryERIEXECUTNE OFFICER1MEMSEREXCWQED? (mandatorym NH) you, y F OESCR ! TION O DPESATIONS below LIMITS 09/23/2013 EACH OCCURRENCE $ 1 000 000 PREMISES tea accurowth $ 100,000 MED EXP (Any ane Person) s 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 1,000,000 PRODUCTS - COMP/OP AGG . 1,000,000 S (Ea etcIth i) _ BODILY INJURY (Per per -.-en) 5 SODILY INJURY (Per a e dun» (ReO P Onr�itGt ereidentl s $ EACH OCCURRENCE AGGREGATE NIA WC- 63529-1 10/11/2012 10/11/2013 5 3 TORY LIIMITS I 1 °ER EL. EACH ACCIDENT $ 100,000 EL, DISEASE - EA EMPLOYEE $ 500,000 E.4. DISEASE - POLICY OMIT $ 100.000 osseRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES WWI ACORD 101, Addltlaml marks Sohedulo, If mars space Is mcodeato ELECTRICAL WORK CERTIFICA HOLDER CAN ELUTION MIAMI SHORES VILLAGE BUILDING DPET 10050 NE 2ND AVE MIAMI SHORES, FL. 33138 188/513 -0793 SHOULD ANY OF THE ABOVE DESCRIBED POUCIFS BE CANCELLED BEFORE THE EXPIRATIQN DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHO REPRESENTATIVE ACORD 25120101051 t0�t0 3E d ID 18882010 ACORD CORPORATION. All rights reserve. The ACORD narne and Iona are reaistered marks of ACORD 1s3a3.LNz1Ianinw L96909090E 6E :6t Et06 /L0 /E0 QUALIFYING TRADES) 0001 ELECTRICAL FIV ELECTRICAL SERVICES INC @MARIO A VALDES PRES 1811 NW 82 CT MIAMI FL 33015