PL-13-1623 08-23-'13 06:14 FROM- T-684 P0001I0003 F-933
:r
A-
Inspection Worksheet
Miami Shores Village
10060 N.E. 2nd Avenue Miami Shores,FL
Phone: (306)79"-2204 Fax. (305)766-8972
Inspection Number: INSP-1 95521 Permit Number: PL-7-13-1623
Inspection Date: August 22,2013 Permit Type: Plumbing-Residential
Inspector: Diaz,Osvaldo inspection Type: Final
Owner: HOWARD,JAMES Work Classification: Addition/Alteration
Job Address:1421 NE 101 Street
Miami Shores, FL Phone Number
Project: <NONE> Parcel Number 1132050240290
Contractor: LASSETER PLUMBING CO INC Phone:(305)526-6076
Building Department Comments
install vent pipe for water heater Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 14 Pee"
Failed
Correction
Needed
Ro-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspaction fee is paid.
For Inspections please call., (305)762-4949
August 22,2013 Page of 1
I
Miami Shores Village -
Building Department JUL 19 2013
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 C)
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.VL— 13° (t---7ZS
Permit Type: PLUMBING
JOB ADDRESS: A-)/ ) -E m d oy f I -
City: Miami Shores County: Miami Dade Zip: o
Folio/Parcel#:
Is the Building Historically Designated:Yes NO 4 41 1 d Zone:
OWNER:Name(Fee Simple Titleholder): p/Tf �`�'�-� � Phone#: N d `®17`�
Address: `F'� �� /0® 47-`
City: Sf l Sfi0 k&'s State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:, �� �.� �tl Phone#: °��` �93_® �
Address: �'- 3(2
City: l Stater Zip: 33)
Qualifier Name: . Phone#:,_tkJ
State Certification or Registration#: C FC 61 We Certificate of Competency#:
Contact Phone#: 3 C__S?-3- Email Address: w, A777 Ze�
DESIGNER:Architect/Engineer one#:
Value of Work for this Permit:$ .5 46 li Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New Qkeepair/Replace ❑Demolition
Description of Work: .
Submittal Fee$ ermit Fee$
do CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ '�
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 afier 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 4! -,-7. Signature Qi
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of . 20 by `J ►�'S F �7 ^r day of 20 1'4 by �#A) M J
who is Cersondy kno to me or who has produced who is onall i�ec�n 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:
r
Sign: U44 Sign:
Print: !�, MT V Print: Amewj-
My Commission Expires: ( -MAC My Commission Expires:
S:MaY 207 PORN
@�(P1F1 p Und fi Q#EE871216
"'sdtnN 4a�Y,x4eaYxY�Y�Y3nY3e3nY�Y39nY�Y�Y�Y�Y3e3eaYiktr�rarsF�YFrFrik d _ Y ISSI r11M7
'.,���;. g�dedShruNot�y
APPROVED BY 9' Plans Examiner zoning
Structural Review Clerk
(Revised3/12/2012XRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
A�° CERTIFICATE OF LIABILITY INSURANCE e TEIMMIoi�")
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THOS
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: U the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. N SUBROGATION IS WAIVED,subject to
the term and conditions of the policy,certain policies may rewire an endorsement. A statement on this certificate does not confer rights to the
certificate holder In Ileu of such endorse s.
PRODUCER A Melissa Ribm
Mack, Mack & Waltz Insurance Group, Inc. PHONE EO.. (954)640-6225 .(954)"O-6226
1211 S Military Trail .mribmgmack3asuranae.cam
Suite 100 MEMAFFORDINGCOVERAGE NAIC e
Deerfield Beach FL 33442 INSURERAMid-Continent Causualty Covomy 3418
INSURED ENSUREIRs)Bridgefield Rmployers Ins. Co. 0701
Lasseter Plumbing Compa y, Inc INsuRERcyAssurance Co. of America 19305
865 N.B. 130 Stmt RERD:
INSURER 6:
North Miami FL 33161 I F:
COVERAGES CERTIFICATE NUMBEILC1=2S2026807 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.
in TYPE OF INSURANCE pp LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMEROAL GENERAL LIABILITY $ 100,000
A I CLAIMS-MADE ®OCCUR D40L000830044 /1/2012 /1/2013 MED EXP one $ ENC==
PERSONAL&ADV INJURY 8; 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000
X POLICY PRO LAC $
g AUTOMOBILE LIA RJTY BA9485MIGA 0/1/2011 9/1/2013 NGLF LIMIT 110 0 000
X ANY AUTO BODILY INJURY(Per pa=) t
ALL OS ED AUTOS SCHEDULED BODILY INJURY(Per actldent) $
HIRED AUTOS AUTOS $
$
UMBRELLA LW! BUR EACH OCCURRENCE S
EXCESS LIAR HCLAIMSAIAOE AGGREGATE $
DED I I RETENTION 8 F $
B WORKERS COMPENSATION X MSTATU-
AND EMPLOYERS'LIABILITY YIN *I�Iv
ANY PROPRIETORIP,ARTNERIE)MCUTiVE E.L EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? 0 NIA 3021471 /as/2019 /2S/a014
( rY In NRI E.L.DISEASE-EA EMPLOYEE $ 500,000
M
ea uraw DESCRIPTION OF OPERATIONS below E DISEASE-POLICY LIMIT S 500 000
DESCRIPTION OF OPERATIONS LOCATIONS I VENItU ES(Attach ACORD 101.Additional Rem SdwduI%B more specs Is requhad)
Plumbing contractor work
CERMCATE HOLDER CANCELLATION
(305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Miami Shores Village ACCORDANCE WfTH THE POLICY PROVISIONS.
Attn: Eiviva
10050 NS 2 Ave AUTHORIM REPRESENTATM
Miami, FL 33138
Greg Waltz/1ILISS
ACORD 25(20IN ®1988-2010 ACORD CORPORATION. All rights reserved.
ItM25 rmimw m The Arrmn ream am bran am.anieta.mt nwrlm of Arxhan
9< < S xA'TE QF FLtD
�
:61,
.0 { 1 X104 X323. ._
Tie:P / I:Nt# :0133AL"' R Ye
N�36$d bra�E3� �a�'i C�fiII��LD �.%N'
r the pr ovielosl� o Cpp ��pirattQa date: AUGI ,31/ 2014
i `a�S
ilS05 R
1342 'a; ✓r�.�fi�lY(.Iw��-c�,� ,t��•w __
1ST, AVE
Fl 3:3161 �-
4
k.
DISPLAY AS REQUIRED BY LAW
MIL)AW
PEFUW KM 231
3`rl � F!.
THIS IS NOT A BILL—DO NOT PAY
13UM ILOCATION NEWAL 092209-7
LASSETER PLUMBING CO INC STATE* CFC041696
865 NE 130 ST
33161 NORTH MIAMI
OWNER
� SSsF ER PLUMBING CO INC
WORKER/S
B M6A W MBING CONTRACTOR 7
ammm UX Bar.fr
es star Powl "m
UNM To VMATB Mff
Sun Fmm"Tm Cm
OM LAWS OF TX@ DO MOT FORWARD
UK" OR anal. rm
UM FR=MW UDM
reef cm
XMW BY LAW
I LASSETER PLUMBING CO INC
865 NE 130 ST
N MIAMI FL 33161
u ACIM lYT71X
60000000111 11 1111 111 11 ill 11 11 1
000045`.00 1„ll}�, }��� ��u� it �����: �E rf ��� ' '
SEE OTH01 SIDE i
i