PLC-13-927 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 O 3 — 9�S
Inspection Number: INSP-190497 Permit Number: PLC-5-13-927
Scheduled Inspection Date: August 14,2013 Permit Type: Plumbing - Commercial
Inspector: Diaz,Osvaldo Inspection Type: Final
Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration
Job Address:11300 NE 2 Avenue Health&Sports
Miami Shores, FL 33138-0000
Phone Number �
Parcel Number 1121360010160-23
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC Phone: 305-652-6108
Building Department Comments
RUN APPROX 200 OF NEW WATER LINE TO PORTABLE Infractio Passed Comments
UNITS INSPECTOR COMMENTS False
i
Inspector Comments
Passed
' �►�ra �`c1i't�r� �u �x� s i�� �� }�
Failed
0
Correction , ly� 175
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 13,2013 For Inspections please call: (305)762-4949 Page 4 of 36
08/07/2013 15:57 3056523135 MARLIN PLUMBING PAGE 01/01
r 7 DATE(M
ACG7R/3 CERTIFICATE OF LIABILITY INSURANCE
5/fi/2013 M/DDIYYYY)
AND D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
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 pollay(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).
Er
t PRODUCER Sandra jonAa
y atusr Coverage PH
O E
5900 Hiatus P
E-MAIL No
Tamarac FL 33321 A v RIP
1NSU ING a NAIL#
1N$URM A
INSURED 55937 INSURER B
Martin Plumbing of Miami, Inc. rNSURERC:
20145 N.E.16th Place INSURER O:
Miami FL 33179
INBUR E:
INSURER F
COVERAGES CERTIFICATE NUMBER:1206120063 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.
TAR TYPE OK INSURANCE tN 1NVD POUCYNUMBER I I1rIlEfO E F �I LIMITS
GEVFRALLiAMU Y Y Y 2559410 518=13 918=14 EAC4OCCURRENCE $1,000,000
X COMMERCIAL GENERAL UARIUTY PRGMISES(go 0=rranw) 5100 000
CLAIMS-MADE Q OCCUR MED EXP(Any one $6,000
PERSONAL&ADVINJURY $1000,000
GENERA RATE 52.000.000
GEITL AGGREGATE UMITAPPLIBSPER: PRODUCTS-COMPIOPAGG $1,000,000
POLICY X PRO. L,OC $
AUTaMO81LE LI461LfTY Ea serve
ANY AUTO BODILY INJURY(Per poison) $
ALL OWNED SCHEDULED BODILY INJURY(PeraoWern) 8
AT A
HIRBDAUT05 MRT-WNED PLOP RTY g
$
UMBRELLA LIAR OCCUR EACH OCOURRENCS S
EXCF=UAB CIA1615 MADE AGGREQATE $
DED I I RETENTION $
B WORKERS COMPENSATION Y 0.25781 211/?Al2 21112013 X 8TA U- 0 -
AND EMPLOYER$LIABILITY
ANY PROPRIVORIPARTNEWE)=UTLVE E.L,NA014 ACCIDENT 81,00 0m
OFFIC9R tMMSER EXCLUDED? N NIA
(MOndaBOry h1 NH) F.L.DISEASE-EA OMPLOYEE 31,000,000
It yes,describe under
DESCRIPTION OF OPERATIONS belaw E.L,DISEASE•POLICY LIMIT $1,000,000
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIQLE8(AtIsch ACM Tai,AdManal Remarks SchedWe,if more space 15 reuWred)
1 CERTIFICATE HOLDS CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EMRATION DATE THEREOF, NOTICE WILL GE DELIVERED IN
Village of Miami Shores ACCORDANCE WITH-ME POLICY PROVISIONS.
10000 NE 2nd Avenue
Miami Shores FL 33138 AUVRORIZED REPRESENTATIVE
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Miami Shores Village
Building Department
90050 N.E.2nd Avenue,Miami Shores,Florida 33138 �L'
Tel: (305)795.2204 Fax:(305)756.8972 ^
INSPECTION'S PHONE NUMBER:(3057 762.4949 `+ •
�Y�®P•�a®Opp
FBC 20 F,'�m
BUILDING
Permit No.ja —012:�
PERMIT APPLICATION Master Permit No.)r) �5
Permit Type: PLUMBING
JOB ADDRESS: I V3 IJ E 2 kVe- b\C a I-1 S C
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 213 00e) n n Sd
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER:Name(Fee Simple Titleholder): ESawf 6)1 14eaP Phone#:305- 3-/zzo
Address: 113D[> OJ E Z AYe -
City: M i 0.rte.► -S`W reS State: r Zip: 331/d/
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: /l U M i vag D T AA;&rK► Tne Phone#:305-6 52-3031
Address: a a!YS N E 16
City: 004h A;C"M., idea c.h State: FL 17-17
Qualifier Name: FjWa4rC1 S *10-1ke-^r Phone#: -IoS-roSZ-303e
State Certification or Registration#: C FC O 4 B 531 Certificate of Competency#:
Contact Phone#: 305-fo52- 30 31 Email Address: fa' O-66 T 10 m I i T L. ay 1- Coln
DESIGNER:Architect/Engineer: Phone#:
•t; - S uare/Linear Footage of Work: I
Value of Work for thus Permit:
Type of Work: OAddress ❑Alteration l<ew ORepair/Replace ODemoh 'on
Description of Work: R u n A D92`0 k Zb 0 0� Ale-0 Wct.4� /i I12- 4p "66 uol d-c
x�xxxxx��x�:xx��•xxx•xx�xxx�x�:xxxx:xxxxxxx�Feesx�x�x��xx�xxx�xx����x��xx�x��x:��x���m�����n�
Submittal Fee$ Permit Fee$ f`�� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
a
LIAb
a
I
Bonding Company's Name(if applicable)
Bonding Company's Address
City State zip
li
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 a reinspection fee will be charged. ?4W
Signature
Z Signature-r�-
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 3J�'- The foregoing instrument was acknowledged before me this 22.
day of r ,2013,by Frl.� Ariga cg4
day of >20 ,by 1n�
.who is personally known to me or who has produced who is personal!y 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:
Sig Sign:
Print
Print: e°✓f
My Commission Expires:L l• l 9A
AMY J.YAO :_ M ':ZA4pAISSiON1#DD94
MY COMMISSION M BE36829 ER..,' .S:December 6,2013
Bander :ru N Pub9c U
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t diCY my PL NamyDh*%W AU=C&
APPROVED BY ? 7 6 ` Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15109)