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PL-13-1038 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-191318 Permit Number: PL-5-13-1038 Scheduled Inspection Date: November 13, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: SLAY,AMY Work Classification: Sprinkler System Job Address:9325 NE 5 Avenue Miami Shores, FL Phone Number Parcel Number 1132060140980 Project: <NONE> Contractor: DESMAR PLUMBING INC Phone: (305)594-4930 Building Department Comments SPRINKLER SYSTEM INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed , Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 12,2013 For Inspections please call: (305)762-4949 Page 5 of 38 E� ACDRD.. CERTIFICATE OF LIABILITY INSURANCE 01/0 ANDD013 01/03/2013 PRODUCER (305) 270-1424 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pan Am Assurance en Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9100 Sunset Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami. FL 33173-3433 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:NORTH POINTE CASUALTY INS DESMAR PC, INC. INSURER B:BUSINESS FIRST INS CO 6405 NW 36 Street INSURER C: Suite #123 INSURER D: MIAMI FL 33166— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATE(MFMIDDDr PDATE(MMMIDI D nON LIMITS LTR INSRD A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEoN ence $ 100,000 CLAIMS MADE ❑X OCCUR 3094120082 01/07/2013 01/07/2014 MEDEXP one n $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY MT AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY $ NON-OWNED,AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSfUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ yy TT TTHH $ B WORKERS COMPENSATION AND 52103296 08/16/2012 08/16/2013 TORYLIMRS X OER- EMPLOYERS'LIABILITY j ANY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBEREXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERA'nONS ILOCATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (305) 756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Miami. Shores Village FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Building Department INSURER ITS AGENTS OR REPRESENTATIVES. 10050 N.E. 2 Ave. AUTHORIZED REPRESENTATIVE Miami Shores FL 33138- ACORD 25(2001108) ©ACORD CORPORATION 1988 VWT�;-INS025(oto8).05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 Miami Shores Village CIE-A 2013 Buildin De p artment r-my 4 �s 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. 0 PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: ' . °).) 1 City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): �� '�s 1'9 r' Phone#: Address: City: Stater Tenant/Lessee Name: Phone#: 9 Email: C° ,L C, (�' CONTRACTOR:Company Name: De iAA A-j i�C > of Ua C• Phone#:,�' 14 l�e �► 1 Address: fk(W 26 s4 501 je L � City: d- State: L. Zip: (� Qualifier Name: ca q y (D 0 r- A,LA e-- Phone#: 2¢.S �3 5� e3 S®�� State Certification or Registration#: C 1-C, F U 2Yj��2- Certificate of Competency#: Contact Phone#: 1®S e�C. -6 Email Address: 5-0 10 A?,1)C . C 0 DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit: $ 0i Square/Linear Foot �� age of work: Type of Work: ❑Address ❑Alteration ❑New ®epair /Replace ❑Demolition Description of Work: FI79 LCI a- i C i f s 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$ , ° Bonding Com'Vainy's Name(if applicable) a l9�A q� . ang,Compi y'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. Signature .:` ..���. Signature d - �'Y Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 a,by- /i?� 0 r a-1 i'1 day of � ,20 I 1,by y2�✓�� � � , who is perso lly known to me or who Ls produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 959= Print: kkf T. LEE Print: eAffc)s My Commission ExpireWl%.'!Pq MARY T.LEE My Commission Expires:* * MY COMMISSION#DD 886327 a°`,•=�:;8�% ROOM 0.OSIALLOS I EXPIRES:September 3,2013 * * MY COMMLSSIOiI# D 045 B=W Thru BWO Nfty Swyfm 1 EXPIRES:Jny14,2013 APPROVED BY G Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) A `D & CERTIFICATE OF LIABILITY INSURANCE 05 0/2"0" PRODUCER (305) 270-1424 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pan Am Assurance Agency, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 cY. Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9100 Sunset Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami FL 33173-3433 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A NORTH POINTE CASUALTY INS DESMAR PC, INC. INSURER B:BUSINESS FIRST INS CO 6405 NW 36 Street INSURER C: Suite #124 INSURER D: MIAMI FL 33166- INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATEYMFMIFDDmE POLICY(MMM/DO-Y) LIMITS LTR INSRD A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TO RENTED $ 100,000 CLAIMS MADE FXJ OCCUR 3094120082 01/07/2013 01/07/2014 MED EXP one son $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 X POLICY JET LOC / / / / AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS / / / f BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / f / / BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION y� g TU $ B WORKERS COMPENSATION AND 52103296 08/16/2012 08/16/2013 TORYLAMITS X OETRi- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ „ 500,000 OFFICER/MEMBEREXCLUDED? f f / f E.L.DISEASE-EAEMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (305) 795-2204 (305) 756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Miami. Shores Village FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 10050 NE 2 Avenue INSURER.ITS AGENTS ORREPRESENTATIVES AUTHORIZED REPRESENTATIVE Miami Shores FL 33138- �F ACORD 26(2001108) ®ACORD CORPORATION 1988 *T, INS026(0108).05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 FIRST4XASS U.S.POSTAGE PAID MIAMI,FL PERM NO.231 THIS IS NOT A BIH DO NOT PAY RENEWAL 607648-3 BUSINESS NAME I LOCATION RECEPT NO. 633876-8 DES14AR PC INC STATE# CFC1427442 7933 NW 64 ST 33166 UNIN DADE COUNTY OMER DESMAR PC INC See.;r of Business WORKER/S 1 PLUMBING CONTRACTOR 2 THIS IS ONLY A LOCAL BUS04M TAX RECEPt.IT DOES Mar PERW THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT E)(EMPT THE HOLDER MOM MY OTHER DESMAR PC INC PERM OR LICENSE REQUIRED BY LAW.THIS IS MARIA L CEBALLOS PRES NOT A CERTWICATION OF THE HOLDOM OUAMCA- 231 NW 63 AVE MIAMI FL 33126 PAYMENT RECEIVED WAWDADECOUNTYTAX COLLECTOR:* 09/11/2012 09010247001 111111 Is Illj Ifh III Isis 11flillollrill IM 1 11M 000075.00 SEE OTHER SIDE 'r SAS 0 ACt 2- bR"; YJS3:=S- 4r FC142144Z A #12 L THIS DOCUMENT HAS A COLORED BACKGROUND MICROPRINTING LINEMARKTI PATENTED PAPER STATE, DF FLOR,I W., 2 0 13.85 W ULATT "qm b!al "k-k ii"1116 PidF"bi ON SEQ#L12071300819 loX AT.. 2`01 * 1*2800-t4 I 42 7,i ONT**­' T, li Pt IN&b RAd Fl -lb Cklift = l2ap r ratign -date: AUG- 1., 20-1411, IM F,- OA-F iNGEt DESMAR�--,pc 6405. 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