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PL-13-2489lei Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 202410 Permit Number: PL -11 -13 -2489 Scheduled Inspection Date: November 14, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: EACH, STEVEN Work Classification: Solar Job Address: 9304 NE 5 Avenue Miami Shores, FL Phone Number (305)754 -2705 Parcel Number 1132060140420 Project: <NONE> Contractor: THE NEW MIAMI SHORES PLUMBING Phone: (305)751 -2446 Isui comments REMOVE SOLAR PANEL LOCATED IN FLAT ROOF AND ' --- REINSTALL BACK ON ONCE ROOF HAD BEEN INSPECTOR COMMENTS False RENOVATED Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 13, 2013 For Inspections please call: (305)762 -4949 Page 21 of 31 Miami Shores Village Building Department 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. PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: q 3 ® 4 AVE A �ve, City: Folio/Parcel#: 1/- 3 7-p (,' > ®/ q - h the Building Historically Designated: Yes Master Permit Nof d 13 County: Miami Dade Zip: 3 00 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): C=D N `�� If Phone #. Address: q 3 o q /U 5-A 4 ye City: A4 9A d,i es State: FL Zip: 3 3/ 3 0 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 0�7Q �1/QW 1%( l ��¢J A'ftAMt Phone #: XF- �Q-) Yqq Address: go 0 luw l yq g g4wt City: L-�c �,�.�i. ..State: FL- Zip; 3-3 / U 5 A Qualifier Name: /JI nA t .t �1 0_L � / t v9 Phone #: State Certification or Registration #: OF e /01 i 2-0 5- Certificate of Competency #: Contact Phone #: Email Address: ryl s � / V pn 6 n 9 ao DESIGNER: Architect/Engineer: Phone #: P� 4 Valve of Work for this Permit: $ :' W —Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration UNew ODemolition Description of Work: �Repair/Rcplace Submittal Fee $ -Permit Fee $�'/ 60 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) _ Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 th . e of commencement and construction lien law brochure will be delivered to the person whose property is subject to It ent. A o, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi oc rs en (7) days after the b ing permit is issued. In the absence of such posted notice, the inspection will not be app ved a reinspection fee w c carged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknow edged before me this day of 20 �, by %even �;w day of AhD §mQ . 20 /3� by 1Q,lniJ el 41i i who is personally known to me or who has 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. NOT Y P NOTARY , Sign: Sign: Print: Print My Commission Expires: My Commis NATHALIE ANNE FERNANDEZ ;* *: Commission # FF 42370 August 04, 2017 APPROVED BY / O s 9-0 7 Plans Ekimin__er Structural Review (RMsed3 /12/2012XRevised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) KENNETH 8 KOTAUK MY COMMISSION 0 EE069935 EXPIRES May 02,20i 5 Zoning Clerk Nov 04 13 07:32a MSP 3056887382 P.3 l 1 '% " C RTIFICATE OF LIABILITY INSURANCE DAT> (0.SMJIIDlYYYY) 8/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFF RMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODU ER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pclicy(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 endorsements). PRODUCER Keyes Coverage Insurance PHON Snzie B. PHaNE 5900 Hiatus Road AIC No,Ezt): 954- 794 -7000 I (A/c No)•9.54- 724 =20.24 Tamarac :L 33321��. INSURED - - - - - - -- - ENSURERA:HanOyer Amer Ins Co 2927 New Miami Shores Plumoir. , Inc. [The] — •- Miami Shores Plumbing INSURER 8: Hanover Insurance Con an 22292 9CC0 NW 144th Strect tNSURERe:Assoc_ated Irdustr es .Ins. Co._ 23140 Miam- =L 33168 _•.____ — COVERAGES I ccoTlclrArr wn1KMnc__, . - THIS IS TO CERTIFY THAT THE POLIS r%=VF0IVnl munRIiCK: IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED PERIOD INDICATED. NOTWITHSTAN NAMED ABOVE FOR THE POLICY ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER WHICH THIS CERTIFICATE MAY BE It DOCUMENT WITH RESPECT TO SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN TO ALL THE TERMS, EXCLUSIONS At IS SUBJECT ID CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DL S POLICY NUMBER MP1001/LOICY EFF MPI/�/OCY EXP LtMfr9 INSR LTR TYPE OF INSURANCE A GENERALUAt31UTY Y RZJ384 105006 ife/23/2013 2/23/22014 1EACH :'00C,000 X 'COMMERCIAL GENERAL LIASIL �Y OCCURRENCE .$ ;- ' DAMAGE O R1 ' � i i PREMISES (E,p pgQ aencet $100, 0C C CLAIM$•MAOE t "' J OCCU MED EXP (Any aae person) $5,000 i i PERSONAL &ADVINJURY $1,000,00. -- GENERAL AGGREGATE $2,C00,000 GEN'L AGGREGATE LIMIT APPLIES PE X PRO n I I PRODUCTS- COMPIOPAGO S2,000,0_00 POLICY I I LOG Ded: PD S2, OCC R AUTOM061LE LIABILITY A042149J0 7/_/2013 :7 /1 /2C:S COMBINED SINGLE LIMIT X ANY AUTO 1AVJ • Ea accident $1100C1000 ( ) ED AUTOS BODILY INJURY (Per persnn) $ LED AUTOS BODILY INJURY (Par accident) $ UTOS PROPERTY DAMAGE $ (Per accident) NED AUTOS I 6RETENTION I S S LALWB X OCCU IU:iJ3c4105305 8/23/2013 12/23/2014 EACH OCCURRENCE $5,000,C00 LIAB ,CLAIM ADE i (AGGREGATE $5,000,000 BLE ON SO C WORKERS COMPENSATIO N AND EMPLOYERS• LIABILMY Y A7iC1024829 $/23!2013 HJ23/2C 14 X I WC STATU- OTH- ANY PROPRIETDRIPARTNER /EXECUTIVE YIN Ofi°ICERIMEMBER EXCLUDED? N )A EL_EACH ACCIDENT 5. 00,000 (Mandatory In NH) s 100, 000 If yos, describe under E.L DISEASE - EAEMPLOYE DESCRIPTION OF OPERATIONS below , E.L.OISEASE _POLICY UA71T 1 $500, Dec I I DESCRIPTION OF OPERATIONS / LOCATIONS J VEHICLES (Attach ACORD 101, AddI Tonal Remarks Schedule, it more space Is required) C9Zi7T3FIeTATC LInI non w ' 700YYun - %L'urcLJ t.;uKeuKA110N. AN rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD V/111 VI.:LLNIIVnI Miami Shores Vil 1005C NW 2nd Ave age SHOULD ANY OFTME ABOVE DESCRIBED PLICIES BE CANCELLE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Miami Shores FL 3138 AUTHORI7E0 REPRESENTATIVE w ' 700YYun - %L'urcLJ t.;uKeuKA110N. AN rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Nov 04 13 07:32a MSP 3056887382 to.4 htti 1M- 3 " 2014 d I tails -Business TaxAccount MIAMI SHORES PLUMBING - Ta4W - Miami -Dade CountyTax Collector Account details „Account history .. ......... _._._..... _.. ....... 2 ---- - - - .....:: 14 2_013 2012 2011 2010 ._.__....Paid _ . _-.. Paid Paid_._,_.�__ I?aid id Account number: 17301 Ow ner(s): THE NEW MIA SHORES PLBG INC Business start date: 08/24/1988 900 NW 144 ST Business address: MIAMI SHORES PLUMBING MIAMI, FL 33168 900 NW 144 ST Mailing address: THE NEW MIA SHORES PLBG INC MIAMI, FL 33168 900 NW 144 ST Physical business location: UNIN DADE COUNTY MIAMI, FL 33168 ®; Print account application (PCF) Paid 2013 -08-08 $75.00 Contracting 10/011 _ 013 — NAICS code: 23822 Receipt MHS1 - 13-044553 Print this bill PLUMBING 09/30/2014 Units: 10 `- CONTRACTOR Additional documentation required CF0019205 State /County License or Certificate is:// vww vmiarrmidade,countyLtwaes.00,T biic/business weaccounts/17301 1/1 Nov 04 13 07:32a MSP 305GB87382 P.5 , t AC #:61.5.416.3.... STATE OF FLORIDA. D.PARTMENT.OF'•BUSINLSS AND PROFESSIONAL REGULATION CO17474. F!TXON IND 31CRY LICENSINq..:. BOARD SEQ#L12060601065 II k ' t •06 06 201.2 77• CFC0192.05." - --Z The:: PirUMB;INP,CTOR' 7Z.SC ' ' "-•:' ; °x`:;71 I Named belbw TTFiED F Und ®r the P na cif ChaptExpiration ae: UG 31, 2014 ...XCLAUGHLIN, 11 • THE NEW MIAM IS- MldkAEL • SHORES PLUMBING 900 NW..144TH- STREET'= . ,.'.:; rTNCr'r MIAMZ FL 33266 RICK SCOTt.. I .: GOVERNOR KEN LAWSON ? •- SECRETARY DISPLAY AS REQUIRED BY Nov 04 13 07:31a MSP 3056887382 P.2 -9 Fotm Request for Taxpayer Give rorrin to the Noverber2C:13) Identification Number and Certification requester. On not 06ne Geaarfine�:t al t^.,r 7ra Fury i:.ta =rw rt � sw, — send to the IRS. cy rn Name (as shown on Y01 The New Miami Sh r rrico•ite tax Mum) res Plumbing nest name. if cif! nt :rcm above �Bus dt ba: €Uiiatril Shores Plumbing e Ctsc:k appropriate box: ^- !ncividuaU Carperatlon Aarinersh P ❑ other ► � Excrospt from backup = Soia propnetar .................. ' 0 wthholdng C & Is, adoress (number, stred. ao NW 144th St and apt. or suiN no.) Requuster'a narrw and acdreas (opuona9 i Gty, state, and 21P coc F1.33168 jkMiarrtl t account rumber(s) a toptionalj ` Tax aysr ! ntification Number Enter your TiN in the appro backup withhoiding. For indi ate box. The TIN provided must match the name given on Line 1 to avoid Social security number iduals. this is your social security number (SSN). However, for alien, sole proprietor, or disregarded your employer identification r a resident entity, see the Part I instructions on page 3. For other entities, it is umber (EIN). If you do not have a number, see Now to get a 7fh' on S. or Note, If the acccunt is in moi number to enter. page a than one name, see the chart on page C for guidelines on whose Certificatio Under penalties of perjury, t certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup Revenue Service (IRS) that withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal I am subject to backup withhold€rig as a result of a failure to notified me that I am no It report all interest or dividends, or (c) the IRS has inger subject to backup withholding, and 3. 1 am a U.S. person (InCIU ing a U.S. resident alien). Certlfication instructions. Yc withholding because you have u must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup tailed to report all interest and dividends on your tax return. For real For mortgage interest paid, acquisition arrangement (IRA), and goner estate transactions, item 2 does not apply, or abandonment of secured property, cancellation of debt, contributions to an individual retirement Ily, payments other thas interesl provide your correct TIN. {S and dividends, you are not required to sign the Certification, but you must the in cIlona on p9ge 4.) Sign Here $ ignawreat us.,erson bete .. Purpose or Form A person who is required t file an info ation return with the IRS, must obtain your correct taxpayer Identification number (TIN) to report, for example. income pai)i to you, real estate transactions, mortgage Interest you pal(i, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to n IRA- U.S. person. Use Form W 9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN yoi are giving is correct (or you are waiting for a number to be Issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. In 3 above, if applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S, trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives u a form other than Form W -9 to request your TIN, you must use tide requester's form if it is substantially similar to this I orm W -9, For federal tax purposes, you are considered a person if you are: • An individual who is a citizen or resident of the united States, 0 A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or • Any estate (other than a foreign estate) or trust. See Regulations sections 301.7701 -6(a) and 7(a) for additional information. Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign= partners' share of income from such business. Further, in certain cases where a Form W -9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business In the United States, provide Form W -9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. The person who gives Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases. • The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form w -9 (Rev. 11 -20-5)