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PL-13-2725 M _1� _3 Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-203961 Permit Number: PL-12-13-2725 Scheduled Inspection Date: December 10,2013 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: Work Classification: Sprinkler System Job Address:163 NW 101 Street Miami Shores, FL 33150- Phone Number Project <NONE> Parcel Number 1131010230150 Contractor: ALLPHASE CONTRACTING INC Phone: (954)5484548 Building Department Comments REPAIR 6"OF 1"SPRINKLER PIPE NEXT TO DRIVEWAY Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed /n ,�� -- ) Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 09,2013 For Inspections please call: (305)762-4949 Page 23 of 32 l Miami Shores Village LBY: EI� Building Department 1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No& Permit Type: PLUMBING JOB ADDRESS: / 65 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): .-e • Caw Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C0 a��,4g-�A)4 / Phone#:��1� ' TX Address: �v-2- City: ( State Zip: < < Qualifier Name: Phone#: State Certification or Registration#: f`0_G-P k'g-7 Certificate of Competency#: Contact Phone#: ST• s`��'�s`�� Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ !�J® Square/Linear Footage of Work: 1 �VG Pt Type of Work: ❑Addresss ❑A�llteration P�New�/ Wepair/Replac�e OD em/Vol�iti on' r Description of Work- 1jV er #O/Pa- 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'S Bonding Company's Name(if applicable) Bonding Company's Address City State zip t8, 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 of such posted notice, the inspection will not be approved and a reins ection fee will be charged. Signaturd Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day o ,20 t�,by l ' °tip 'I�iB a�, day of le ,20( ,by 6S N A- day is ovally known to or who has produced who is personally known to me or who has produced As identification and who did take an oath. t I �- t '�S-identification and who did take an oath. NOTARY PUB C: NOTARY PUBLIC: Sign: Sign: Print: i Print: a i►� e. My Commission Expires: �?� Y P``�+-= Notary Public-State of Florida My Commis ' pir � _• •€My Comm.Expires Nov 15,2015 * * COkSA�SSfONpFF Commission#EE 146500 , �° B No Y�Selvteae Bond Through Natfanal t+�ry Assn• ��at�� APPROVED BY /?- /3 Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Boom Miami shores Y Building Department lR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. L) COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME:_RLLP+4 -C7 a ( A)e, , A.)e" BUSINESS ADDRESS: �� 'c 5 s-ef 3cg-CITY Q(4 L s STATE fFl= ZIP CODE L I BUSINESS PHONE: (� ,)-5W, 5 FAX NUMBER( ) -� W CELL PHONE (_Y 9 $ QUALIFIER'S NAME: Ry�,q-s L R C QUALIFIER'S LIC NUMBER: Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDNYYY) `,. 12103/2013 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 CONTACT Sarah Dixon NAME: CASUAL INSURANCE GROUP acNN : 561 429 3181 No, 561-537-7007 224 DATURA STREET SUITE 500 E-MAJL ADDRESS: sarah@casualinsurance.com INSURE R($)AFFORDING COVERAGE NAIC# WEST PALM BEACH FL 33401 INSURERA: Atlantic Casualty INSURED INSURERS: All Phase Contracting Inc. INSURER C: 770 NW 17th Ct. INSURER D: INSURER E: Pompano Beach FL 33060 INSURERF: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SR WVD POLICY NUMBER MMIDD M/DO LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 COMMERCIAL GENERAL LIABILITY PREMISES Es occurrence $ 50,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 5,000 A L216001560 03/19/2013 03/19/2014 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 500,000 GEHL AGGREGATE UMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 500,000 POLICY F PRO-CT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ AAL OWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Par acddent $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'=11LITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is mclutred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 2 Ave Miami Shh Miami ores FL 33138 ACORD 25(2010105) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 115 S. Andrews Ave.,Rm.A-1 00, Ft. Lauderdale, FL 33301-1895--954-831AOOO VALID OCTOBER 1,.2013 THROUGH SEPTEMBER 3Q,20-1 Reeipt#:PLa cW/zit sau / Ime: +Li?kiASE CONTRACTING -INC ype:{pIIPKv t ?AtfiRACTt3R} Business Name: Busi T owner Name.BERNARD a.ACx Business Clpnt:11l0e/205 Business Location:3143 NAT 3'9 ST S telC UntylGe :CFC 1426557 FT LAUDERDALE Exemption Code: Business Phone: i ROOM s Y r 41 ,h i, vewwo ausio only NumbW Of itfac4* Tax Artl4unt Transfer Fee td3f Fee PrWr Ybars CWWJon Cost Toth Paid 27.00 0.0� � ...., f 4 0100 27.04 t 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 wilt Broward. Cournfy and is non-regulatory In nature.You must meet';all.County and/pr Municipality planning. WHEN VA UOATED and zoning requirements.This Business Tax:Receipt must be Itanobtred when the business is sold, business name has changed or you have moved this � business ion.This receipt does not indicate.thaI the business is legal or that it is in compliance with State or local laws and regulations. Malting Addrwm: BERNARD LACY Recei. 401C-712-00014530 3143 Nod 39 ST Paid 09/26/2013 2740 PORT LAUDERDALE, FL 33309 �I i 2013 12!3/13 DBPR-LACY,BERNARD;Doing Business As:ALLPHASE CONTRACTING INC,Certified Plumbing Contractor 4:27:50 PM 92/3/2093 Licensee it Licensee Information Name: LACY, BERNARD(Primary Name) ALLPHASE CONTRACTING INC (DBA Name) Main Address: 2840 SOMERSET DR APT 305 LAUDERDALE LAKES Florida 33311 County: BROWARD License Mailing: LicenseLocation: License Information License Type: Certified Plumbing Contractor Rank: Cert Plumbing License Number: CFC1426857 Status: Current,Active Licensure Date: 10/28/2005 Expires: 08/31/2014 Special Qualifications Qualification Effective Construction Business 10/28/2005 View Related License Information View License Co faint 1940 North Monroe Street,Thiiahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer.Copyright 2007-2010 State of Florida.Prtvagi Statement Under Florida law,email addresses are public records.If you do not want your email address released in response to a public-records request,do not send electronic mail to this entity,Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.*Pursuant to Section 455.275(1),Florida Statutes, effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may be used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.Please see our Chapter 455 page to determine if you are affected by this change. https:/A mm.nryHaridalicense.comUcenseDetail.asp?SID=8jd=C2E9D473DB8F25D729B17E30480596FD 1/1 vbe �YY d C r r { `Report Viewer Page 1 of 1 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE ------------------------------------------------------------r - - - Ila ditYAW-- STATE OF FLORMA Pu auantto Chepte1440. 74)P 8.,an ofdom o!a ooryomHen DEPARTMENT OF FINANCIAL SERVICES �ermreemfrom°tmdot �rbr re aemu0eceor DMSION OF WORKERS'COMPENSATION F CONSTRUCTION INDUSTRY EXEMPTION Pbe u eaxeemtptt0..Cghpapp1y m ondryQ w.oanmt2�. .aseo..�caoltmtheoeusaanteeelascmeatmtdo a ; L rotted on the na6ce of etediait to N exempt. i capnwwtaCWVXCT a TOMUXUAFTFRWKO M p was caAaRa6ATtrot LAW Pondem to Chapt0r aa0.06(1a.F S..Mofto olahlCOon to be exempt end eerotkams al ete�n m be exempt ahea be 09MOT"DAM or"13 exwnateox CAM WIMMa s ea revocanand at am/mro aae7 me oftAe rmace .H a.aaueaa�ewnoea�alram.nwpe>son�msfth Aa POMN: LACY ROUVAD :E noaoe or aertdkam no lmlper ma�Dre reewmmenm ottlds sadden far Issuance of a tempests.The dew"n:snap revoke i Fflpt: 061703188 iR a certabete at time faf fepum of thepenwn named an are tenpmate m m a a requtremenm ottn�esecom. BUSINESS NAME AND ADDRESS: E i ALLPHASE CONTRACTING INC MNW»cT # POMPANO BEACH FL 35080 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL PLUMBING NOC AND ROOFING-ALL KINDS CONTRACTOR DRIVERS AND DRIVER L-------------------------------------------------------------------------------------------------------------------------- OFSF2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07.92 OUESTIONSr(QW)413-lWe https://apps8.fldfs.corn/crreportviewer/reportV iewer.aspx?data=kdvpginc9D7Q3gH6TER6e... 6/7!2413