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PL-12-174Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 c Inspection Number: INSP - 180779 Permit Number: PL -2 -12 -174 Scheduled Inspection Date: December 17, 2012 Inspector: Hernandez, Rafael Owner: GALARNEAU, LISE Job Address: 1070 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: RELIABLE SPRINKLERS, INC. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Sprinkler System Phone Number Parcel Number 1132050010350 Phone: 305/866 -9625 Building Department Comments LAWN SPRINKLERS FRONT YARD ONLY. PERMIT RENEWED ON 10/24/12 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 INS'- 169492. missing vacumm breaker December 14, 2012 For Inspections please call: (305)762 -4949 Page 18 of 41 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 No. 14 )2r- Or PERMIT APPLICATION FBC 20 Permit Type: PLUMBING % OWNER: Name (Fee Simple Titleholder): (-` I-S� Address: /l1 767 Master Permit No. hhone #: City: / 1 »I #t i ,$� 5 State: Zip: 33/3i Tenant/Lessee Name: Phone #: j D 7 �V K6 Email: c.he-i5 0 4-0c. ci- JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: l 9 i�C// City: `%1/ */.1)//eic 2 ide- State: ,1 Phone #: Zip: 35/)C/' Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: OAddress UAlteration Description of Work: Xke., , Square/Linear Footage of Work: ONew ORepair/Replace ODemolition **+r+x**********, ****+ x***** ***** ********* Fees******* **** ****+ x**** ***w*+x**** *****+x******** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 (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 FT .FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOl.FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv and a reinspection fee will be charged. Signature The f day o who is 0 ,ns• gag 1 e sonall f d, ' P it i Signature Owner or Agent ent was a knowledg - • r of • e me this 24 The for •1 A 20 by known to me or who has produced itification and who did take an oath. UBLIC: NOTAR Sign: Print: My 1An Ex C� Pubttc state • 23, 201 t� so z •`ay Co' mis xon # EE 1 oBay Rssn. j"4.5 . .5 Comm h fat onat N dSbtnu9 O , ,s • •-• ***44 ,ti° +x+x�x�xa,e,+r x,+a,x,x oin day of Ir •� onally Contractor me ,� 1was ackno 1- . ged b for 20�, by own to me •r who has produced 1 N VARY .j LIC: ion and who did take an oath. Sign: Print: My Commission •:,j -4N, i Pu• s Notary 23 2015 Ex ires5ep ry ; Commission # EE e National Notary Assn. •,,; ;,;; °` Banded Through *** ** ********, a**********************+ se ua,*, a,*** ********* ********s**,a****** ** APPRO BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk 91 (19\ ar- rtof-d\ril BUILDING PPLICATION 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 Permit Type: PLUMBING RECEIVED FEB 0 1 2012 Permit No. P\--(2---‘1A Master Permit No. OWNER: Name (Fee Simple i i Titleholldder): L /�e G�• /`til ��t Address: 7® N ! / ye. t ` € City: /1 /'471/ State: et. c136.5.1-96S--2.33(, Phone #: /6C-7C-1— L(6 (A0 Zip: 3313 & Tenant/Lessee Name: Phone #: Email: L t- i£,P'N °� att. t.7 Yid eeQ., A11401; . e4e.4_ JOB ADDRESS: 1670 0 et)j% City: Miami Shores County: Miami Dade Zip: ) 313 g Folio/Parcel #: Is the Building Historically Designated: Yes NO ✓ Flood Zone: / CONTRACTOR: Company Name: r56/44 - 5,40/J-U zJ Address: /99 29 WE Phone #: City: l/j/I //tfaf State: // Qualifier Name: /'39 State Certification or Registration #: /' Contact Phone #: 30S Y (9,,s Email Address: DESIGNER: Architect/Engineer: Zip: 3 3/ re) Phone Ili C- / /t 2S Certificate of Competency #: Qp© ©P9,,? q S 7-- Phone #: Value of Work for this Permit: $ / 5790 Type of Work: ❑Address ❑Alteration /,a)/J Description of Work: Square/Linear Footage of Work: XRepair/Replace ❑Demolition f ?c,J /'® 5,140 (AU ❑New **+ x+ x*************** ** **** * * ** x********* Fees• x*x: *+ x**** **a:******** *+ x**** ***+x ******+x*+x***** Submittal Fee $6 Permit Fee $ Po < CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l� Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o such posted notice, the inspection will not be approved nd a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The fore oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this / day of , 20 Q, by L g It + " /3 day of f , 20 (v?, by r44--r i3 44--r ! pt/,51( /t ,1j , who is personally known to me or who has produced T —4 who is personally known to me or who has produced 1 I� As identification and who did take an oath. as identification and who did take an oath. `1111111111/1/11/1, NOTARY PUBLIC: NOTARY PUBLIC: s. ,, ,, \,.. : \\\�NII I u t Hi 14-11/, 1i1i P�1en� ,, �Q ® .."7.-'''''-'- . Sign: �° �'�: = Sign: �� i, ' ° . co„ Print: _ �'_ J .. `; = Print: — ` - - %�1 `'' .. ,��a'��° My Commission Expires: .• pd� isf ' '''�� /1/1ItI111U1a�`\ '�-.:, ••• ...... • ` \:� %� FL OR \�P\\`` * ******* *** ****** ************ �n* �r° x�:**** x��x�xu��x**** �x= k* �x�:x�+xx�>H�:�x *�x�x�:+x�x *�x� **** �x�x�x�x*> is�xx��x> H�x�x=k�x�x=k******* ****/4Worh� oU y ` ,` I , fz._ Plans Examiner Zoning My Commission Expires: APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 1"01 ,tu BY: - _ (- V, IJj BY: .... M Shores Village APPROVED ZONING DEFT GLDG DEPT SUBJECT 10 C(,IPI ,IANCE ALL FEDERAL '1TE ANU CLUN 1 Y RULES AND REGULATIONS 10-70 )ci6 / 7413• .E 3,4 e").11& 9 6/1 • 4) ci AdE 0/4m t fr7/4 3 67c) -30 -5- 1 MIAMI -DADE COUNTY 2011 MUNICIPAL CONTRACTOR'S 2012 FIRST -CLASS TAX COLLECTOR TAX RECEIPT U.S. POSTAGE 140 W. FLAGLER ST. MIAMI -DADE COUNTY - STATE OF FLORIDA PAID 1st FLOOR PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI, FL 33130 EXPIRES SEPT. 30, 2012 PERMIT . 231 RECEIPT NO. BUSINESS NAME / LOCATION RELIABLE SPRINKLER SYSTEM 19741 NE 24 AVE OWNER :H R RELIABLE SPRINKLERS INC 30- 0263053 TE IibOT A BILb- 016/MitY stt HACK OF IttU iri FOK A LIST OF NON - PARTICIPATING MUNICIPALITIES Receipt holder must register In the city where work Is to be done. PAYMENT t".ro us°07.1 02210008001 000175.00 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. SPECIALTY PLUMBING CONTRACTOR DO NOT FORWARD RELIABLE SPRINKLER SYSTEM ROBERT L PUSHKIN 19741 NE 24 AVE MIAMI FL 33180 1 6 11n 11{ talT h ull4 I { 1t j n all 026305 -3 BUSINESS NAME/ LOCATION RELIABLE SPRINKLER SYSTEM 19741 NE 24 AVE 33180 UNIN DADE COUNTY THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 026305 -3 CC# 000002707 xm FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 OWNER H R RELIABLE SPRINKLERS INC Sec. of Business ].9b ORE.YA SPECIALTY PLUMBING CONTRACTOR RACTOR YORK1100fS THEi�LOCAL RUSINESS DOER 1IOTT PF FIE 110W151 TO VIOLATE ANY EicMER§ REGIRATORT OR ZONING LA05 OF THE 001RTTY OR 5fl15L 555 DOW TT EiT THE HOWER FROM ARV OTHER PERMIT OR LICENSE MIMEO RV TAW.115518 ROT OERMRCATION IRE ROWER'S 0IIMERCP, PAYMENT RECM/E0 amammt T " 12/14/2011 02210008002 000090.00 SEE OTHER SIDE DO NOT FORWARD RELIABLE SPRINKLER SYSTEM ROBERT L PUSHKIN 19741 NE 24 AVE MIAMI FL 33180 111111111111111111111111111111111111111111111111111 1 111 II% Ag2812 CERTIFICATE OF LIABILITY INSURANCE DATE 1128/2012 PRDnuceR Phone - 964 683 -5444 Fax - 954- 683 -2820 Pelican Insurance Agency 6950 Cypress Rd Ste 208/7 Plantation, Fl 33317 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 POUCIES BELOW INSURERS AFFORDING COVERAGE NAIC A Ascendant Insurance Th' I romn Reliable Sprinkler's Inc. 19741 NE 24th Avenue Miami, FL 33180 INSURER IN Progressive American Insurance INSURER D: SBA Insurance INSURER I3: INSURER E: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI THSTANDU4G ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE 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 A GENEBRAI. LIABILITY X COMMERCIAL GENERAL LIAe0.ITY CLAIMS MADE OCCUR TYPE OF INSURANCE POLICY NUMEER POLEY EFFECTIVE RATE (MUtDOIYY) POLICY EXPIFULTION DATE (MA!DDITY) MTh 12/23/2011 COWL AGGREGATE LEM APPLIES PER: POLICY IX I JJEECTT t { LTC 12/23/2012 EACH OCCURENCE DAMAGE TO RENTED MEO EXP (Any tarepereon) PERSONAL & AflV KEAY $ GENERAL AGGREGATE PRODUCTS - COMPIOP AGO 300,000.00 50,060.00 $5,OO;i 300,000.00 300 &00.00 $300,006 AUTOMOTIVE LIABILITY ANY AUTO AU. OWNED AUTOS X SCFEDULEDAuTOS HIRED AUTOS NflN•AWIMFOAIITt1R 05847427 6/26/2011 6/26/2012 COMEINED SINGLE LIMIT (Ea acdeienl) BOOLY PI JURY (Per Peron} BODILY INJURY (Per accident) PROPERTY DAMAGE (Per maidens lGE IITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO EXCESS LIABILITY OCCUR I -"CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURENCE $ AGGREGATE $ c WORKER'S COMPENSATION AND EMPLOYERS' UABIUTY AANY ROPRIETOR A� SPECiALOVI OWNS bakes 8UA424422785 2113/2011 2/13/2012 pJI I 1 El EL EACH ACCIDENT EL DISEASE - EA EMPLOYEE 100,000.00 100,000.00 EL DISEASE - POLICY LIMIT $ 500,000.00 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESSEXCLUSIO ADDED BY ENIXWISERIENMPECIAL PROVISIONS CERTIFICATE HOLDER ADIST1ONAl.INSURED; INSURER LETTER: A CANCELLATION (See Below) - Village of Miami Shores Attn: Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY Of THE ABOVE DESGRINED POLICIES CANCEL= BEFORE THE EXPIRATION DAT THEFEOF THE ISSUING COANY KILL MIDE.AVOR TO MAIL 30 tacmCE Tante CERTIRCATE MPHOLDER NAMED To THE LEFT —IRIT TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR merlin, OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORMD REPRESENTATIVE Samuel Jacks ACORD 25 (2001/08) 1 of 2 c ACORD CORPORATION 1988. Miami -Dade County - Building and neighborhood Compliance Office Page 1 of 1 Home' Product Control 'Contractors Building Officials 1 Contact us Contractor License Information 000002707 RELIABLE SPRINKLER SYSTEMS 19741 NE 24 AVE MIAMI (305) 866 -9625 Contractor Number: Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D /B /A: Contractor Status: (305) 932 -6333 ACTIVE FL 33180 Class Category Category Description Expiration Date PLUM 3 LAWN SPRINKLER 09/30/2013 CONTRACTOR INQUIRY COMPLETE Contractor Inauiry and Complaint Search 1 Home Paae I State License Search Menu* ome 1 Usina Our Site I About I Phone Directory 1 Privacy 1 Disclaimer E -mail your comments or questions to sWGDept@miamidade.aov © 2001 Miami -Dade County. All rights reserved. http: / /egvsys. metro- dade.com: 1608 / WWWSERV /ggvt/BNZAW941.DIA ?CNTR= 000002707 2/9/2012