PL-13-2322 � 4
J 'O
Inspection Worksheet
Miami Shores Village l
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795 4204 Fax: (305)756-8972
Inspection Number: INSP-201072 Permit Number: PL-10-13-2322
Scheduled Inspection Date: December 10,2013 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo Inspection Type: Final
Owner: RODIER,ALEXANDER&EMILIE Work Classification: Gas
Job Address:1009 NE 104 Street
Miami Shores,FL 33138-2655 Phone Number 305-756-6295
Project: <NONE> Parcel Number 1122320290140
Contractor: MP ASSOCIATES CONTRACTORS Phone: (305)599-9954
Building Department Comments
1 UNDERGROUND GAS TANK 500 GALLON 1 GAS tnfractio Passed Comments
STOVE 150.00013TU INSPECTOR COMMENTS False
Inspector Comments
Passed pw �
Failed trn �
Correction
Needed ❑
Ile-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid, t
December 09,2013 For Inspections please call: (305)762-4949
Page 7 of 32
Miami Shores Village
Building Department ocT �01�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BYE
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949°
FBC 20
BUILDING Permit No. — 222-
Z
PERMIT APPLICATION Master Permit No. I— S
Permit Type: PLUMBING
JOB ADDRESS:
City! Miami Shores County: Miami Dade Zip:
f Folio/ParceW.
Is the Building Historically Designated:Yes NO Flood Zone:
i ( VVNER:Name(Fee Simple Titleholder): �0 D g � ��C C3 S (� Phone4V- 02-•W2 fl
\A Address: ALeVA&ZA s�
City: _K•&tW, f'a o Stater Zip:
Tenant/Lessee Name: Phone#:
k Email: Z�
CONTRACTOR:Company Name:X4 H s-c x-,
Address•'7,5 9x- �� /7 ,r
City: State: I , Zip.33/S-7
Qualifier Name: /b dry .vim Phone#-
State Certification or Registration#: GFG O 4f LI//? Certificate of Competency#:
Contact Phone#:3 o S-• 6-J• ;a 9 3 S Email Address:&J?2 s_lr_,�,I�Aj P 49,0&m✓W. 416,7-
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 4.5-0a S e/Linear Footage of Work:
Type of Work: DAddress DAlteration ew URepair/Replace ODemolition
Description of Work: s/- 414--a d ft 6-00 CeA4,1 ?v
�eTraaattrdr,k*drirdrr *,rk�Y�rek�*,tWr,at�kaYtrTr,rnthtt�Trt�rF�ky#*,t�tr**,tiedrt^kdrtrokdFlriesk,t�Yeha�riet&,h,adear4,a,k9aYdrlrr�eatMr*
Submittal Fee Permit Fee$ Z. °�` CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Trandng(Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ > 4 . 01(11:;P
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 of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
w
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The fo oing instrument was acknowledged before me this
t
day of ,20_,by day of 0- 20 L3 by/ ° &,)/`) P)Azi "
who is personally known to me or who has produced who is personally known to me or who hal produced4!�Q
As identification and who did take an oath. 5 f l/3joas identification and yfN Nd take an oath.
NOTARY PUBLIC: `1
NOTARY PUBLIC: o Pr...n;s'''•,,
�. Exp
Sign: Sign. -� >6 =
Print: Print ':FF�ass;
Zo
My Commission Expires: My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06 110/2009)(Revised 3/15/09)
FROM : MP Associated Contractors FAX NO. : 3055993499 Oct. 11 2013 03:57PM P1
.4C0 l7�
�- CERTIFICATE OF LIABILITY INSURANCE DA�(MWbDAy»
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOFF HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BErwSEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IAIPORTANfi If t certifiaate holder is an ApDnmONAL INSURED,the policy(ies)must 4e entlor3pd, If SUBROGATION IS WAIVEQ,subject to
the i terms and corIn noes s the POlicy,certain policy may require an endorsement. A statement on this certificate does not confer rights to the
certYicate holder In Ileu of such elsdorsemont s,
PRODUCr:R
AccA UndeiwritErs,Inc. NANE- PABLO M GONDE
P ads 805-220.7447
8796 SW$St E � MO�;305-220821
Miami,FI 33174 4MRIME �._P�'e aunderwriters.corn
INSNiEW51 AFFOkD�l6 COYERgGE NAIC
nvsuRPV -- --•.. INSURER A:BU,SlNESS FIRTS INSURANCE GC} 012629
MP ASSOCIated Contractors,Inc. INSURER at
7525 SW 178th Torre INSUIx c c
tN.RURFR D• •. '. ..
! Miami
Fl 33157JRER s;
COVERAGES wstntr�tF. "
CERTIFICATE NUMBER; REVISION NUMBER;THIS IS To CERTIFY THAT THE POLI CIES OF INSURANOR 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 MiLY PERTAIN,THE IN4URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
1
EXCLUSIONS AND CONDITIONS OF SU.H POLICIES.LIMITS
T SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ALL THE TERMS,
1 L R TYPE OF INsuRANCE AO�L Sl7Bfi 0gp YYY �
COMMERCIAL GENERAL LIABILITY P NUMBER LIMITS
I CLAIMS-MADE OCCUR EACH OCCURRENCE $..
PREM
MFO.Q(P(Any one�rvany
„9ENLAGGREGATQLIMIT APPLIES PEEL -
PERSONAL&ADV IWURY $ "
# POLICY n L13f GEN—ALAGGREGATB S _
PRODUCTS-COMPIOPAGG $
OTHER: ,• „
AUTOMOBILE I-MILITY �
ANY AUTO (Es eac dartl SIMLA I,udli
AUTbs F� SCHEDUL D ROWLYRVJURY(P�pt+ron) S
ON-OWNED B<?DILYINdURY(PsaCdCHM) $
HIRED AUTOS NON-OWNED ROFERTY DAMAGE
S
UIVf9iiESJA LIAR OCCUR EACH OCCURRENCE
� ' CLAIMS-MADE $
DAIS
AGGREGATE
ETENTIUN
WORKERS COMPENSATION 521-00816 08-01-13 08-0i-14
A ANDEMPLOYMS'UABIUTY YIN X SRT TUTS TH- _
oFPi0SPjmmf:�FXC u��c CV NIA FLL EACH ACCW Nr. _ $ 11000,000
(M d In Wunder DISEASE-EA EM $ 1,000 000
tf yyam,o�aibe antler ,
DESCRPT ON OF OPERATIONS below E.L.DISEASE-POLICY L16mT S 1,000,000
DsSCRmrrOnt
OF
OPERATIONS I LO CAMONS I VEHICLM(ACORD 1 oI,ACtlwonal RanmitR sceern+Ie.r Ny W_n , Ir more"Rae 18 MWdeo
I Plumbing -Contractors
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village SHOULD ANY OF THE ABOVE DFSCRIB€D POIJCJEV BE CANCELLED SWORE
10050 NE 2nd Ave. n4i; EXPIRATION DAIS iFiE12EQi:, NOTICE WILL BE DELIVERED IN
Miami Shores, Fl. 33138 ACCORDANCE WITH THE POLICY PROVIS IONS.
AUTNORMD REPRIWENTATNE
0 1089-2013
ACORD 25(2013104) The ACORD name and logo are repisterod-arks o ACORD ACORD CORPORATION, All rights reserved.
PDF created with pdfFactory Inro trial version www-pdffactorv,com