PL-13-082407- 24 -'13 06 :41 FROM- T -605 P0010/'0013 F -759
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756.8972
Inspection Number: INSP- 195524 Permit Number: PL -4 -13 -524
Scheduled Inspection Date: July 23, 2013 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Owner: BROWN, DOROTHY
Job Address: 1560 NE 105 Street B -2
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122300530140
Contractor: DIAL PLUMBING CORP Phone: (305)221 -8569
buua
KITCHEN REMODEL
Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 189746. NO ONE HOME
7/17/13
PLEASE CALL 561- 504 -2259
!=ailed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee Is paid.
July 22, 2013 For Inspections please call: (305)762 -4949 page 20 of 34
Miami Shores Village
Building Department APR Ill"
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
FBC 2013
Permit No. PL 125
Master Permit No. . 1-3 " �
JOB ADDRESS: 1560 NE 105 ST °
City: Miami Shores County: Miami Dade gip; 33138
Folio/Parcel #: 11- 2230 - 053 -0140
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Joaquin Gomez Phone #: 561 -504 -2259
AAA— 1560 NE 105 ST
City: MIAMI SHORES
State: FL
Tenant/Lessee Name: Phone #:
Email:
33138
CONTRACTOR: Company Name: DIAL PLUMBING Phone #: 305 -554 -5711
Address: 9940 SW 22 ST
City:
MIAMI State: FL Zip: 33165
Qualifier Name: FRANCISCO FONTEBOA Phone #: 305 - 970 -7253
State Certification or Registration #: RF0042876 Certificate of Comnetencv #:
Contact Phone #: 305 - 970 -7253
Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $1000 Square/Linear Footage of Work: 112
Type of Work: ❑Address DAlteration UNew URepair/Replace ODemolition
Description of Work:
KITCHEN REMODEL
Submittal Fee $ Permit Fee $ �� CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ '
1
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 fee will be charged.
Si tore r , Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this.
day of fir , 20 L l , by ci u sue+ day of 0� , 20 �J, by a Few Se,
who is phonally known to me or who has produced who is personally known to me or who has produced
identification and who did take an oath.
Notary Public State of Florida
Marta Hernandez
My Commission EE 18$275
My Commission 1 M
APPROVED BY
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
My Commission Expires:
and who did take an oath.
Zoning
Clerk
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FROM (WED) APR 17 2013 11 ; 53 /ST. 11 ; 52 /No. 6830187095 P 2
ACC�1Rrr CERTIFICATE OF LIABILITY INSURANCE DATE;MM;D 1 _
I __ 04/17/13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS __
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. I _
IMPORTANT: If the certlNeate holder is an ADDITIONAL INSURED, the policy(Ws) must he endorsW. If SUBROQATION M WAIVED, vuppet t0
the terms and conditions of the policy, certain policies may require an endorse"rit. A statement on this certificate doea not confer eights to the
certificate holder In lieu of such endorsement(s).
PRODUCER _ CONTACT N ANGULOi
Pat Del Vecchio Insurance Agency ,IVo E:ip (305)246.9500 �, �I; (305)Z46.9502
263 N.C. 8th St. ADDRESS; paid V®dghreCChioins.cor11
Homestead, FL 33430 VkW]Lt S AFFORDING COVERAGE NAIC _
Phone (305)246.9500 Fax (305)246 -9502 _ INSURER a: ASCENDANT COMMERCIAL INS CO 110790
INWRED INSURER e I BUSINESS FIRST INS CO
• Dial Plumbing Corp INSUREa C: I
9940 SW 22 Street IN*3*URER D:
Miami, FL 33165 (305) 221.8569 �� E I -- - - - -
uowe!!. P _
COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: _
iTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 6E6N 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE A7GL-37813-1 POLICY EFF ' POLICY EXP — r-
_ IN POUCYNUMBER IMwDDrwv_q (MMiDD1YYYY1 , ,, LlMrrs
GPJ "AL LIABILITY
EACH ocCURRENCE _ s 1,000,000.00
L .i COMMERCIAL GENERAL LIABILITY SAGE TO RENTED S 100,000.00
I..J �I CLAIMS -MAOE 60J OCCUR F��S�� �I
A s 6,000.00
! I07i25no12 o7n5/z013
I : •,• , _ __ I PERSONAL a aDV INJURY $ 11000,000.00
GENERALAGOREGATE S 2,000,000.00
GEWL AGOREGATE LIMIT APPLIES PER: I PRODUCTS • COMP /OP ACG s 2,000,000.00
❑ Poppy L.I jER ❑ Lop
AU70MOM" LIABILITY I I — �Ee1� Sll NC,LE LIMIT s _
I I ANY AUTO i i BOIXLY INJURY (Per parson) S _
ALL OWNED n AUTOSULED -(!Y INJURY (Per ftddon l S
MIRED AUTOS — i ^I AUTOS
I (Pa acE_c1_doNN,Ab1AGE S
I UMBRELLA LIA9 .
Gr ❑ OCCUR I EACH OCCURRENCE $
I I EXOE9'S LIAR n CLAIMS_MADE I I AGGREGAYL S
nn ,
„ U OED__ L..I RETENTIONS 7
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WORKERS COMPENSATION �— I WC STATU- 0TH- -�
+ AND EMPLOYERS' UABILITY Y/ N TORY..LIMIIS n ER..
ANY PROPRIEwwPAR'rNtPJEXECUTNE I 1 521 -07379 I E.L. EACH ACCIDENT S 100,000.00
B OFFICERIN�ER EXCLUDED? ; NIA I 07129/2012.07/2912013 - --
h ddendbcN,mdor li i I E.L. DISEASE . EA EMPLOYEE S 100,000.00
DIE RIPTIONOF MRAT10�(Sbalow _ E.L. EASE POLICY S 500,000,00
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I� DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Anach ACORD 101. AWfic ul Remaltls Schedule, if Mda apses Is nyubml
PLIJM9ING CONTRACTOR I
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C_ ERTIFICATE HOLDER _ _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1
MIAMI SHORES VILLAGE THE EXPIRATION DATETHEREOF NOTICE WILL BE DELIVERED IN
10050 NE 2ND AVE ACCORDANCE WITH TM ROVISIONS.
MIAMI SHORES FL 33138 AUTHORED R ENT P;Fid
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0 1988,4010 ACORD CORPORATION. All rights reserved.
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