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Pl-13-1605 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-195430 Permit Number: PL-7-13-1605 Scheduled Inspection Date:August 15,2013 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: MOFFETT, ROBIN Work Classification: Addition/Alteration Job Address:230 NE 101 Street Miami Shores, FL 33138-2423 Phone Number Parcel Number 1132060134640 Project: <NONE> Contractor: WESTLAND PLUMBING CORP Phone: (305)863-6223 Building Department Comments HOT AND COLD WATER LINES REPLACE AND NEW Infractlo Passed Comments WATER SERVICE LINE FROM METER TO THE HOUSE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 14,2013 For Inspections please call: (305)762-4949 Page 16 of 46 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 '! INSPECMON'S PHONE NUMBER:(30.+ 762.4949 FBC 2010 BUILDING ' W7sVI Permit No PERMIT APPLICATION . JUL 18 20 r Permit No. Permit Type:PLUMBING BY.'___ ®®® JOB ADDRESS: 230 NE 101 Street City: - Miami Shores County: Miami Dade 71P; 33138 Folio/Parcel#.. 11-3206-013-4640 Is the Building Historically Designated:Yes NO X Flood Zone: No OWNER:Name(Fee Simple Titleholder):Manuel Lamazares phone#;305-401-3012 Ate;230 NE 101 Street city; Miami Shores State: F1 Tenant/Lessee Name: Phone#: Email: miamazares@me.com CONTRACTOR:Company Nam: 3 -L.2 Phone* Address: ` 5=1 City: a e-� CAM State:_ � r L 0,ems Zip: C) t y Qualifier Nam: C hM !r_z' W (70 t V fl�. Phone#: State Certification or Registration#: ,-Q'2 p i 61 Certificate of Competency#: Contact Phone#: `79(-,) a&4- 9 Email Address DESIGNER:Architect/Engineer Phone#: Value of Work for this Permit:$ Squareahtear Footage of Work: Type of Work: OAddress UAlteration UNew #RepairMeplace ODemolition Description of Work: 14,n I, 1_ —n 5 +s+o� �e� e�swe�eF�ems��n� ��seeeea e Submittal Fee$ Permit Fee$� Z 5 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Tr'alning/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ r , s ` -qWunding Company's Name(if applicable) Bonding Company's Address City State zip Mortgage Lender's Name(if applicable) WeIIS FargON.A. Mortgage Lender's Address 1616 W 17 Street, Floor 1 city Tempe State Az zip 852816217 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 CONEVIENCEMENT 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 CONIMENCENIENT:' 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 S' S' Owner or Agent T7forme oin g instrument was acknowledged before me this The fo -me instrument v actin ed day of 20 t . f � �- 20 y AS-by &6.11�1 I&MAZA eg day o ,by who is personally kno to o is pe tome or who has prbeucai / •d JOE ROSS ".j 1 MAM"tification 6+ o ' 181' 4Itor;;a t; and NOTARY P LIC• k f °°- My Comm.Expires Mar 1,�Of 4 `i� - e LA O A�' ate of Florida 9i' 4 cc NOT ., 'c 2015 Gommiss!on#DD 9 1578 , °;�;�_, N ar P ; e 3, Bonded Through N tiaoal Not!,,; y = C i t N ary Assn. Si Sign: My Commission Expires: _qf4 lM11yWCommission Expires: �e��e��e� � ��a+��e, a� �� e��e�em��es�e�a ��a��ee�ee•.a� � � �� e�eeaa�s� APPROVED BY I y -/ 3 Plans Examiner Zoning Structural Review Clerk (Ravi /l 212012)(Revised 07/101M)(Revised 06/10/2(WXRevised 3/15109) F P.Yp k N,Yary PubIOC SEW:,of Fli�ij3 [{ 2i)+4 ;, M Miami shores Village Building Department Rte 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. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION,(EITHER CERTIFICATE OR EXCEMPTION) 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 (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) 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: 5 BUSINESS ADDRESS: U-1 51V � CITY i�LOA V°1 STATE A16 t°L u->c%- ZIP CODE BUSINESS PHONE: ( ) FAX NUMBER( ) CELL PHONE ( ?fifes) Za t ! QUALIFIER'S NAME: A®CI QUALIFIER'S LIC NUMBER: C- F- C 0,3 ? ! / 0 EMAIL ADDRESS IF APPLICABLE): Created on 3119109 BY MWV 1 RV 3126109 MLDV I RV 6127111 AS ILL WESTPLU-01 DGOLDEN e CERTIFICATE OF LIABILITY INSURANCE 51132013rn 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 pollcy(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 CONTACT NAME: RSI Insurance Brokers of Florida,LLC -FL Lic#1-061315 EH •�ggg)830-4396 N,;(800)505-7306 3111 N.University Drive,Suite 402 Coral Springs,FL 33065 ADDPM: INSURERS)AFFORDING COVERAGE NAIC S INSURER A:Mt-Vernon Ins.Co. 26522 INSURED INSURER B: Westland Plumbing Corp INSURER C: 101 W 24 Street INSURER D: Hialeah,FL 33010 INSURERS: INSURER F: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE POLICY t FF POLICY EXP LIMITS POLICY NUMBER MMID MMID GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CL2571980C 5/9/2013 5/912014 PREMISES =,,=) $ 300,000 CLAIMS-MADE I—XI OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN%AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBBIINEDSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED AUTOS SCHEDULED BODILY INJURY(Per sodderd) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS ERACCIDENT) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E-1 NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ If yes, escribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remaft Schedule,B more space M required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami,FL 33338 AUTHOR2ZD REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE 701/08/2013 m 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 ALTERTHE COVERAGE AFFORDED BYTHE 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)musf be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 NAME: Risk Transfer Programs,LLC PHONE 888.481-9363 219 East Livingston Street NO. Orlando,FL 32801 EMAIL ADDRESS: INSU S AFFORDING COVERAGE NAIL 0 INSURER A:CastlePolnt National insurance Company 40134 INSURED INSURER B:Tower Insurance Company of New York 44300 Engage PEO Labor Contractor for leased workers to:Westland Plumbing Corp#131011 3001 Executive Drive INSURER C: Suite 340 St.Petersburg,FL 33762 INSURER D; INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:WES-1061 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 ADOL SUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER WDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DCOMMERCIAL GENERAL LIABILITY PREMISES Es oawrm;V $ CLAIMS•MADE �OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN L AGGREGATE LIMB APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per eculdent) $ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per eod ent UMBRELLALWB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WSLTHPEOW35303 1213112012 12/31/2013 X MWO�ATU- FTH B AND EMPLOYERS'LIABILITY YIN SLTHPE00041402 ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Coverage is extended to the leased employees of altemate employer in all states except in monopolistic states(ND,OH,WA,WY): Westland Plumbing Corp#131011 (Effective 12127/12) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZED REPRESENTATIVE 10050 NE 2 Ave Miami,FL 33338 Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DSPARTMM aF BUSINESS AND ,PROPHS8I0NAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) X8'-7-11'95 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-.0783 COBOS, CARLOS M WESTLAND PLMSING CORP 10 1 WEST 24TH STREET IiIALM FL 33010 s A oi� l dras►A Ae# &IN'190C Cc rahrlaticursl With this license you become one.of the nearly one million bSPAR QF' $Q�I I S. Fiotf ans�censed by the 1 +partrraant of Business and tonal Regulation. PROFESAI IL?l Our profsiQnats and bnesses range from architects to yacht brokers,from boxers tc#barbeque restaurants,and they keep Florida's economy strong. .< `6rco37il0 . , 2.9049289 Every day we work to Improve the way we do business in order to serve you'befter For information about our services;please tog onto www.�rtdalicense.dotn. �#�01 F� There you catr end more Information about our di�tisiorrs t �e re guietions that t;O ... .5 impact you,subscribe to department newsletters and learn more abut the 1p STL Department's Initiatives. Our mission at the Departmwt Is:License Efficiently,Regulate Fairly.We constantly strive to same You better so that you can serve your customers. $'CMTIFXZD-und4W-A;h0, � rs1�., s8a Thank you for doing business in Florida,and congratulations on your new license! "s�DSr.�sem aae*.s:�t 311 .•'�lA�'� �+I�88��3.9� DETACH HERE kC 2 9 190.9 STATE OF FLORIDA _ DEART8ISTRt1DE78TRYL I $ ' . : _ . . ".. ,..,,. ... � SEA MM2=345 08 2i. 2012, 112804'0.2-' 2, 1,28 X49.2 .l PC2273,1. The PLV"ING C ONTR C1"OR. Named be '0W IS C =V1:� "under the ptovjG.J6 Le of Chart: EViratwion date: AUG 31, 201 4�y r, 95 COBOS,i CARLOS WEST 81M CO 101, T STREET' , m k ►EAgI FL. 01.0. , ,a,v RIZEN LKIWSM ECRETARY► DISPLAY AS REQUIRED BY LAIN Fes. � 4rM s Tax e oar Ws Hernandez s +e ��1 y� r''�" _ _ �,4„+ �, k ��, '� i� r^u � -3��`Y �'it,�� 'L.a~;:# "��!�, a u •aE�I�s � .- s, n s 1: nrs eE 6 I �� "jt� dia "f'��-'��7 '� � �rt€� y tr•.:� _ 's�`G�,+r �Fak � '"c.�^�� '�g"�` #�u"s� :,.0 �rh��n .;� ... � *i},'_ 'rte-f„�.'+�;'riu"r ar r NPR ASU-00, dr z 1SQr253- EWAL BUSMM r ,r4 R IS62S: k WESTLAND PLUMOIN6 CORP STATE# CFC037110 1.01 H 24- ST 3301:0 HIALEM owtm WESTLAND T"'Of N PLUM ONO SIB CORP ORKE IS 19 A 1NG CONTRACTOR 10 j oof� OOWTfWMAM ear u,�. is a F WESTLAND PLUM INB CM 101 W 24 T L33QYQ PAYYYIENT i'�i � �jn�ft(�(Y`TNf +t 000045• IAf!l//D��i�iNUt97: �11tf 90 t#!i.#tdMlei 4l FFD�ll tiff lfl Difil SEE O"#fM r