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PL-13-2645-inspection Worksheet Miami Shores Village 10060 N.E. 2n.d Avenue Milaini Shores, FL Phone,. (306)796-2204 Fax: (306)766-*8972 Inspection Number: IN-SP-20381-9 Permit Number: PL ,4 1-13­2646 Scheduled Inspection Date: December 03, 2013 . Permit Type,., 'PlOmbing - Residential Inspector: Diazi Osvaldo Owner: SLAYS AMY Job Address: 9326 NE 6 AVenue Mlang Shores, FL Project: <NONE> IhOoctloh Type: Final Phone Number Parcel Number 11132060140980. Contractor: ROTO- ROOTER SERVICES COMPANY Phone: (790 . )444-1080 INSTALL 235 FT OF 314" PVC PIPE AROUND THE HOUSE TO INSTALL 10 HOSE BIBBS December 02,20113 For Inspections ple4se q..alI:,(305)7.424W. Page 27 of 40 �iih22'i3 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING FBC 20 ID NOV, g 1 2013 Permit No. Master Permit No T U 3-; O 4 S JOB ADDRESS: 9 *3 a 5 4E 5 Pt' 9e- City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11 -3- 0 0_® e j 07S-0 Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder): F16 lA y e I 1--Le- Phone #: City: %�� ,-,�j �f"�'°j State: Tenant/Lessee Name: Email: 3,1_5I.9F- CONTRACTOR: Company Name: I Rar-4&r Phone #: Address: 0 City: - AR&PO -1 State: ; 6144 zip: 3 i ( f17 f- Qualifier Name: Phone#: /� �' �7 J � State Certification or Registration #: 0: rk Certificate of Competency #: 1 Contact Phone #: � 't6C-f X 4 1 9 Email Address: 1 k0412 • /�/��18 � r %.�L6 •��i r DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ,.�7 ®0 ° ®® Square/Linear Footage of Work: Z 35, F4- Type of Work: DAddress DAlteration ONew ORepair/Replace ODemolition Description of Work: JA q Submittal Fee $ ' Permit Fee $ 0� a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ vJ�'� 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection eel be ch ed. ev,d i n - - A ignature gent -� Contractor The foregoing instrument was acknowledged before rue this The foregoing instrument was acknowledged before me this day of , 20 ZO f 1 by 1-4,(\ "e(\6eZV- , who is personally known to me or who has produce t44 S who is personally known to me or.who has produced Q,C®'je— As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: ° Print: My Commission APPROVED BY - P++�4• Notary StWe of RoAda Manly pez v My Commmaion EED17604 OF fWo� Expire$ 10/26/2014 i 9 ° L,{ 11, Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3 /15/09) NOTARY Sign: Print: My Notary PUbli& §l &t6 Of PIC`10- Ma*# Lftez + c MyC&WIt sionEED17504 ?� @x its 10/261201 Zoning Clerk AC�4 0-1A. I CERTIFICATE OF LIABILITY INSURANCE °� 03fMM13 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. N the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A staterrsrrt on this certified does not confer rights to the cerlificate holder In Hou of such endorsement(s). PRODUCER MARSH USA INC 525 VINE STREET, SUITE 1600 NONE PHONE FAX No nd CINCINNATI, OH 45202 Attn: nnBti cerlrequest@mnh.o'NII IN AFFORDING COVERAGE NAIC# INSURER A; Old Repubfc Insurdnce Co 24147 40D40-RRSC -GAUW -13-14 OW44 INSURED 44 - ROTO -ROOTER SERVICES COMPANY 04SURER B : NIA N/A $ Zwo.000 1550 NORTHWEST 79TH AVENUE rNSURI32 c : $ 6,006.000 INSURER D: PRODUCTS -COMPIOPAGG MIAMI, FL 33126 INSURER E $ A INSURER F: COVERAGES CERTIFICATE NUMBER: CLE-003526DBO -25 REVISION NUMBER.1 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 TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUBR POLICY NUMBER MMQDf YY N DIP UNITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR John F. Schultz MWZY60132 04/012013 041012014 EACH OCCURRENCE $ Z0001060 MAGE TO RENTED REM ES o $ 751,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ Zwo.000 GENERAL AGGREGATE $ 6,006.000 GENL AGGREGATE LIMIT APPLIES PER. X POLICE PRO LOC PRODUCTS -COMPIOPAGG $ 6.OWODO $ A AUTOMOBILE LIABILITY �� ED SOS D Ix AMY AUTO NON-OWNED D HIRED AUTOS X MWTM957 04/012013 041012D14 LI IT 5,000,0 BODILY INJURY (Per person) $ BODILY INJURY (Per mdde� $ PROPERTY DAMAGE $ UMBRELLA LIAR EIMESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WOI*U tS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICEMMEMBER EXCLUDED? ❑N (Mm�uktory in NN) DESCRIPTION OPERATIONS N I A MWC111M01 101013 1012014 X STATl6 OTH EL EACH ACCIDENT $ 1,000,lXtt1 EL DISEASE - EA EMPLOYEE $ 1'�'� EL DISEASE - POLICY LIMIT $ 1,0w,000 DESCRIPTION OF OPERATIONS I LOCAT=s / VEHICLES (Attach ACORD 101, Addi ww Remarks Schedule, B more spew is required) CFRTIFICATF "0 nFR CANlCFLLATIQN MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1005D N.E. SECOND AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE Of Marsh USA Mc. John F. Schultz (0 188&2010 ACOKE) GURPOKATWN. All rlgntS rOSO VOU. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD R ROOTER. PLUMBING s BRAIN, SERVIGE PROPOSAL Ticket No.T Proposal Submitted To QQ.mmerelal Work To Be Performed At Name r _ ❑ 30 Days Street Street A p 24 Hours City ` :. City t- ° ❑ 90 Days - . .. State State `" A r~' ❑ 90 Days Telephone Number Telephone Number ❑ 1 Year We hereby propose to furnish all the materials and perform all the labor necessary for the completion of w , i b Roto - Rooter will perform the work described above and supply all required materials for the sum of $ •'customer will make payment as follows: Option A (complete if applicable): Option B (check if applicable): % of the cost ($ )i upon execution of this proposal ❑ The total sum will be billed upon completion of the work and is % of the cost ($) upon the start of work. payable within 30 days (commercial accounts with approved credit only). Balance of the cost upon completion of the job. 2. The approximate starting date is t ; _ , and the approximate completion date is Neither date is guaranteed. Unexpe ed conditions or problems could cause delays. 3. If a box is checked below, Roto- Rooter is providing a service guarantee on the terms described on the reverse side of this proposal. 4. THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PROPOSAL WILL BE BINDING ON THE PARTIES. 5. This proposal may be withdrawn by Roto - Rooter if not accepted within _ days. This proposal constitutes the entire agreement between the parties, and no modifications will be valid unless in writing and signed by both parties. 6. Other Respectfully submitted: ; Technician Signature Printed N Printed Number Dates ACCEPTANCE OF PROPOSAL Customer authorizes the work-and accepts the above terms (including the terms and conditions on the reverse side). Accepted: - °r Customer Signature Printed Name Date PF -031 (Rev. 9108) QQ.mmerelal Resideplial Main /Branch Lines ❑ 30 Days ❑ 6 Months Toilet Auger p 24 Hours ❑ 7 Days Plumbing Repair ❑ 90 Days Months Plumbing Replacement ❑ 90 Days ❑ 1 Year Extended Guarantee ❑ 1 Year 4. THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PROPOSAL WILL BE BINDING ON THE PARTIES. 5. This proposal may be withdrawn by Roto - Rooter if not accepted within _ days. This proposal constitutes the entire agreement between the parties, and no modifications will be valid unless in writing and signed by both parties. 6. Other Respectfully submitted: ; Technician Signature Printed N Printed Number Dates ACCEPTANCE OF PROPOSAL Customer authorizes the work-and accepts the above terms (including the terms and conditions on the reverse side). Accepted: - °r Customer Signature Printed Name Date PF -031 (Rev. 9108) 1 111 11 11111 111111111111111 IN 1 1 NOTICE OF COMMENCEMENT OR Bk 28922 P9 10488 (Ipg) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 11/211X113 12'.3640 HARVEY IiiJVINY CLERK OF COURT MIAMI —DADS' COUNTYs FLORIDA PERMIT NO. TAX FOLIO NO. 11- 3(6b -6jq- Y'0 LAST PAGE STATE OF FLORIDA: COUNTY OF MIAMI -DADE: q r J#' e-LO IUA, LouN I r ur UAUE PNO Cover FaY i ERTIFY that this is a true copy of the me CIM THE UNDERSIGNED hereby gives notice that improvements witf1b6 't 1c ina" ----_- day °f U property, and in accordance with Chapter 713, Florida Statutes, the f A o 20 _ is provided in this Notice of Commencement. _ . •rye mV hand tat Seat. INQWWSMIN 1. Legal description of property and street .AID .. _ —, I _ _ _. .W ._ _ — D.C. 2. Description of improvement: j L'4ze411 ;1 3 3. 4. 5. 6. Name and address of fee simple titleholder: Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is speeiiied)- 7 Print Owner's Name" Sworn to and subscribed before me this Notary Public: Print Notary's Namd _ My commission expires: (,e It i, /AAi Prepared by day of V , 20. Marilys Lopez y C' nay Commission EE017504 111%0 � Exrires 10 /26/2014 Address: \ | | w/3 � \ ` < < ' \ \ � � / \ / / y / / \\l `�] | \ � ---- ------' -~~ / � } / ' \ _ fv , .'