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PL-13-2465or I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 202251 Scheduled Inspection Date: February 05, 2014 Inspector: Diaz, Osvaldo Owner: PENDLETON, CAMILA & RYAN Job Address: 166 NE 93 Street Project: Contractor: Miami Shores, FL 33138- <NONE> TH BUILDING GROUP LLC tiui wing uepanment comments REMOVE AND REPLACE KITCHEN SINK Permit Number: PL -10 -13 -2465 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments Passed Ea, � Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1132060133090 Phone: (866)599 -4530 February 04, 2014 For Inspections please call: (305)7624949 Page 11 of 47 Miami Shores Village Building Department 10050 NY-2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 sUMDING PERMIT APPLICATION Permit Tnx: PLUMBING OCT 31 2013 FzC Permit No.ro 13- Master Permit No JOB ADDRESS: 166 NE 93rd Street City: Miami Shores County: Miami Dade Zip: 331 �' a Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Ryan Pendleton phonet 305-- Address; 166 NE 93rd Street City: Miami Shores State. FL Z TT i 3,S Tenant/Lessee Name. 0 L,'' Al e Email: - -- 9t' P6 h t 0 CONTRACTOR: Company Name: TH Building Group, LLC phone; 866 -599 -4530 Address: 877 SW Roberts Ave City; Fort White State. FL ;p; 32038 Qualifier Name. Scott Thomason phone 386- 315 -0527 State Certification or Registration #: CFC1427522 Certificate of Competency #: Contact Phone#: Email DESIGNER ArchitwdEu&ecr. Value of Work for this Permit: $ 400.00 Type of Work: OAddress i7Atteration Description of Work: Remove and replace kitchen sink :Ert ,6P !N ~.g111 ONew i7Demolition caes eseee�see�F�eesxsseeeee�sse� as�ee�� Submittal Fee $ • U Permit Fee CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Trainiag/Edncation Fee $ DBPR $ Bond $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $­j (e�• J 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 roust 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 Signature AwseF WK4 esE 4°+ i ro cTa C- The foregoing instrument was acknowledged before me this 2� day of ( )Ch '.fit, 20 L5, by ftrYlllXSdy'1 , who is personally known to As i4 NOTARY PUBLIC: Sign: Print: d *"a low FO _t - S!b of Frr--- a �1�17 My Commission Expires: Peb IT' 201-7 Signatum- The foregoing instrument was acknowledged before me this , 1 day of CY(n , 20 -13 by y tl/ PE�U 9 lik 7#,, who is personally known to me or who has produced APPROVED BY is -V-/2 Plans Examiner Structural Review (Revised3 /1=012XRevised 07 /10/07)(Revised 06110/ M)(Revised 3115/09) identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 016 My Commission Expires: cp '; 041#1 • 9 `' ssi0# P :P Zoning Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: TH Building Group, LLC BUSINESS ADDRESS: 877 SW Roberts Ave CITY Fort White STATE FL ZIP CODE 32038 BUSINESS PHONE: 8( 66 .) 599 -4530 FAX NUMBER (—_) CELL PHONE 3( 86 ) 315 -0587 QUALIFIER'S NAME: Scott Thomason QUALIFIER'S LIC NUMBER: CFC1427522 E -MAIL ADDRESS OF APPLICABLE): shomason@thbuildinggroup.com Create! on V19109 BY M LOV 1 RV 326109 MLDV THBUI -1 01P 10* LR T A+ICC3RL71'® ,. CERTIFICATE OF LIABILITY INSURANCE DATE tmlloomYY1 10/21/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER11FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR,PRIDDUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the pollcypes) 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). PRODUCER Doff Schackowlnsurance Agency 5200 - B Neokerry Road Gainesville FL 32607 John Darr Iv CONTACT NAME: PROM Na E uai� ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC A INSURERA : FUBA 10050 NE 2nd Ave ENSURED TH Building Group, LLC 877 SW Roberts Avenue Fort White, FL 3203$ INSLIRERB: wsuRERc EACH OCCURRENCE INSURER D : PREMISES (Ea occunence INSURER E : BRED EXP (Any one person) INSURER F : PERSONAL &ADVINJURY rntrCaah_CS t 1:12M .9f_ATF NIIMRFR- REVISION NUMBER: THIS 1S 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 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 ROM POLICY NUMBER MID ACCORDANCE WrFH THE POLICY PROVISIONS. LILM GENERAL LIABILITY COMME9RCIALGENEIMLLIABILITY CLAIMS -MADE F-1 OCCUR 10050 NE 2nd Ave Miami Shores, FL 33138 John Darr IV EACH OCCURRENCE $ PREMISES (Ea occunence $ BRED EXP (Any one person) $ PERSONAL &ADVINJURY $ - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALLOSWNED SCHEDULED NON-OWNED HIRED AUTOS AUTOS � BI E5 S GL MT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ iA (PPEORPACCICDE5PI OE $ 8 UMBRELLALUU3 EXCESS UAB CLANS-MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED I I RETENTION $ $ A WORMS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRiETORIPARTNERO(ECUMVEV� OFFICERIMEM�t EXCLUDED? LJ (Mlandatm in NH) )fyess, desa4be under DESCRIPTION OF OPERATIONS below NIA 10653235 10/0212013 10102=14 X WR - H- I EL EACH ACCIDENT $ 100,000 EL DISEASE -EA EMPLOYEE $ 100,wo EL DISEASE - POLICY LIMIT $r DESCRIPTION OFOPERA7NON8I LOCATNONSI VEHICLES (Attach ACORD 107, AdAffem T Remarks Sche&de, It space Is rsquh A CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FHE EXPIRATION DATE 1HEREOP, NO-nCE WILL BE DELIVERED IN Miami Shores Village Building ACCORDANCE WrFH THE POLICY PROVISIONS. Dept. auTFIORIZEDREmeENTATIVE 10050 NE 2nd Ave Miami Shores, FL 33138 John Darr IV X71888 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE THM C RMCATE IS LSSUED AS A MATTER OF ROMMATION ONLY AND COPOUN NO RIGHTS UPON THE CERTWMATE HOLDER. THiS CERTiFICATE DOES NOT AFFLRMATMELY OR NEGATIVELY AMENDI EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELAW TIC CERT FICATE OF OMURANCE SNOT CONS71TUM A CONTRACT BETWEEN THE SIB ATEOR ANDTHE TE . i 1 Iv >.- ! � : %i •:i ! H�;:.' ei_ - i •3' 1 !' _. f31: : i.' :.•i 1 l• -r-r 1'fy- • ;�". t. f #:`s: f^ d `�•? -:I ♦:., .aaa :..`:::: 3.,�a. f _� !'2.^e► :7E ';'.• *.e f,,- i. ,. ,•._ t .:.i -y f:E - f: r,• 4E _; •. ,.aEep r,c , - ��. -•+ i � '. •�- vrr - -day yes r xs`� f }- • i'. a f w I;� - -:�. .` y :.n is 4r.. - `s^ �- >:3 'aa s ° °' € -:c s,- ;dips t i •'• .ems s� 7. •:°71,x- -r a --.aP ti - • I �': r.. 3� • ^s: •. !I Y +s � ;al.':f, b f, .: ,� w • .i v[" i.� i ,•'.. E'.�� "41: �•i�E .!I ■ e'�Si:...t-... :ti f♦ :s•i'�`iR' r:a +a' M , � f...' «.:• • �. il.l I,I:b i -1 .•�. 2ti. - '1 1 -1:A i.1 11:1 I:Y i 1.1 11.1 1�1_I lE 1"7- e.. •7 ] -:: ia.. ..- :. • :E: v1�. '• '• - z :_IiM�!�■! �:.diE■ . ids r• .aaFi:a�r 'L1 "Y 9'CI Y'e . f.� .�- i., . • itt'� (•,, � a r. @ +' i'.•_jl. i`... 1. ..Y .re e - li/ Hal @.@ ice` ii ! -• ( • f: "�' ' • E ' ���� •t_....t.:'!' Y:. .a'.°' 'k: :.: R oi" *. '. .: ': ti+. ]: - Ya•�:Ye A..9:::2. t ....�.a:. t�,tY.; .4 x...o-tre::, •: .... ., r. E ITiil4@fai SHORES 1 lU-4M BUILDING OEPARThffAT IMONE2NDAVE MIAMI SHORES. FL'=38 wigrt • . 20fi -14 COLUMBIA COUNTY BUSINESS TAX RECEIPT RONNIE BRANNON, TAX COLLECTOR AECEV. NUMBER: RECEIPT EXPIRES 09/3012014 7003500 ;,MAO INES i ROOMS SEATS EMPLOYEES 2 BUSINESS TYPE: 000105 SUPPLEMENTAL PLUMBER CONTRACTOR X RE"AL 18.00 TH PLUMBING CONTRACTOR NEW RECEIPT:. SCbTTTHSON 8T7 S w RaE3ERTS AVE _ TRANSFER FT WHITE, Ft. 32038 PENALLY 1.80 TOTAL 19.80 LOCATION $77 S1IV ROBER7 S AVE ADDfiESS. FT WHITE, FL 32038 ,x SIGI±i Aide EtTUR11�1+Fftif PAYMIt 01JQ13901811D 0001NID11180 19WEAa"%TWnaaurAnoN{�}aECamr iB+aao�£�� eumN�sseM wtoss�areo a�aanam s rnueiuro conxeat 0000000000001.882 1001 8 2M44 . COLUMBIA COUNTY BUSINESS TAX RECEIPT RONNIE BRANNON, TAX COLLECTOR REOEIPT NUMBER: RECEIPT` EXPIRES 09/3012014 7003$60 MACHINES ROOMS SEATS EMPLOYEES 2 BUSINESS TYPE: 000105 SUPPLEMENTAL PLUMBER CONTRACTOR X RENEWAL 18.00 _ .. , ,..,.....,„ ...,, ...., .... 1311 IMRN11% MKITRAPT41R PLEASE SIGN BOTH RECEIPT (ABOVE) AND RETURN WITH PAYMENT TO THE TAX COLLECTOR'S OFFICE FOR VALIDATION. YOUR ORIGINAL RECEIPT WILL BE RETURNED TO YOU. THIS RECEIPT IS FURNISHED PURSUANT TO CHAPTER 205 LAWS OF FLORIDA AND COLUMBIA COUNTY ORDINANCE 87 -12, AS AMENDED THIS BUSINESS TAX RECEIPT DOES NOT CONFIRM THAT REGULATORY OR ZONING REQUIREMENTS HAVE BEEN MET, IT IS THE OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE. The law requires this receipt to be displayed conspicuously at the place of business in such a manner that it can be open to the view of the public and subject to inspection by all duly authorized officers of the County. Upon failure to do so, the receiptholder shall be subject to the payment of another full business tax for the some business, profession, or occupation. Pursuant to state law, all receipts shall expire on September 30th of the succeeding year. Those receipts renewed beginning October 1st shall be delinquent and subject to a delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter until paid; provided that the total delinquency penalty shall not exceed 25% of the business tax receipt for the delinquent establishment. This receipt Is a business tax only. It does not permit the receiptholder to violate any existing regulatory or zoning laws of the state, county, or cities, nor does it exempt the receiptholder from any other license or permits that may be required by law. Business Taxes are subject to change according to law. PLEASE MAKE CHECKS PAYABLE AND RETURN TO: RONNIE BRANNON, TAX COLLECTOR, 135 NE HERNANDO AVE. SUITE 125, LAKE CITY FLORIDA 320554006 OR CALL (386)758 -1077 THIS DOCUMENT HAs A coLORED BACKGROUND MICROPRINTING -'LINErvIARK-" PATENTED PAPER x >. S 7. i D$I?AR ' O 5 ES 1 AND 14010 �IONAL REGULATION 1 tiSTRY LI M1B TNt3 OAW L7.2083002035 so Al IS SZVQ�- i1x C-lw- B lIR bMtTV Nyl tTtider rerav3as o Chap. L { .. .� - �TL'i/�M�QA'7� � . SiY4'i�E- i- `� ^�'.. l •��"i'�`�i!�i�%� E y tt.��' -P^a, "` \y y \ W � N I YCM '_`- LAW ©N.:.' .:i I AW THIS DOCUMENT HAs A coLORED BACKGROUND MICROPRINTING -'LINErvIARK-" PATENTED PAPER x >. S 7. i D$I?AR ' O 5 ES 1 AND 14010 �IONAL REGULATION 1 tiSTRY LI M1B TNt3 OAW L7.2083002035 so Al IS SZVQ�- i1x C-lw- B lIR bMtTV Nyl tTtider rerav3as o Chap. L { .. .� - �TL'i/�M�QA'7� � . SiY4'i�E- i- `� ^�'.. l •��"i'�`�i!�i�%� E y tt.��' -P^a, "`