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PL-13-1591f N Inspection Worksheet Miami Shores Village 10060 N.E. 2nd Avenue Miami Shores, FL Phone: (306)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 204046 Permit Number: PL -7 -13 -1591 Scheduled Inspection Date: December 10, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type.°---' - ��x Owner. THERMITUS, GRACw Work Classification: Addition /Alteration Job Address: 225 NW 91 Street Miami Shores, FL 33150- Project: <NONE> Tjg-�k Phone Number Parcel Number 1131010331350 Contractor: BROWN PLUMBING LLC Phone: (305)764 -1731 Department Comments PLUMBINGL WORK FOR KITCHEN REMODEL 1mract1O Passed Comments INSPECTOR COMMENTS False December 09, 2013 For Inspections please call. (305)762 -4949 Page 24 of 32 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 09, 2013 For Inspections please call. (305)762 -4949 Page 24 of 32 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, BUILDING PERMIT APPLICATION Permit Type: PLUMBING JUL L 6 201 3 �F'Y. aoa------ oovooaoo FBC 20 �I I Permit No. 3 " �� I Master Permit No.ff jj JOB ADDRESS: a7� jj Uj C�� 5, °1" City. Miami Shores County: Miami Dade Zip: Folio/Parcel#• Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleeholder): � Phone#: S- Uf) A —?b C t Address:) S; A) W Ck k S- jj a City: rn � Ct m State: Tenant/Lessee I I Phone#:_ 2 S ? C State Certification or Registration #: C& % Certificate of Competency #: Contact Phone#: Address: DESIGNER: Architect /Engineer:" Phone #: Value of Work for this Permit: $ �.�^ 1 Square/Linear Footage of Work: Type of Work: [Address ` ` $l teration [New W[Repair/Replace Descrintion of Wnrk! r [Demolition Submittal Fee $ Permit Fee $f CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ DBPR $ Bond $ _ Technology Fee $ Double Fee $ Structural Review $ ` TOTAL FEE NOW DUE $ °r 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. i l 10100 � Owner or Agent Signature Contractor The foregoing instrument was ackno ged before me this 0/� The foregoing instrument was acknowledged before me this day of �� , 201 , by ld� �/edt dY .day of u �yknovw 20 / by A�� who is personally known to me or who has produced who is p n to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PlVBI ICf _ % / NO Sign: . Sig, Print . �N 23, 2pr s grin p My Commission ® ®® �!_ #DD953828`�� *` MY - ararWW��xa��r�a��aua� ,�aP,x,��ra��r,xv�rt�,x APPROVED BY _ / / 3 , Plans Examiner Structural Review (ReAsed3 /1=012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) o %, #DD953828.s:• STATE Zoning Clerk I I MIAMI -DADS COUNTY 2012 LOCAL- BU."ESS TAX RECEIPT 2013 FIRST -CLASS TAX COLLECTOR MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE 140 W. FLAGLER ST. EXPIRES SEPT. 30.2013 PAID 1st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL MIAMI, FL 33130 PURSUANT TO COUNTY CODE CHAPTER SA - ART. 9 a 10 PERMIT NO. 231 639987 -7 THIS IS NOT A BILL - DO NOT PAY RENEWAL ®ullF�WA�►��I._QCA_6NLLC STATE# CIPC1427691666744 -4 19101 NW 37 CT 33055 MIAMI GARDENS OWNER BROWN PLUMBING LLC S @I PLU u+IBI&G CONTRACTOR WORKE1 /S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. R ODES NOT PERMIT THE HOLDER TO VIOLATE ANY E 15TtNG REGULATORY OR ZONING LA.9 OF THE DO NOT FORWARD COUNTY OR CRIES. NOR GOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. TIBS IS BROWN PLUMBING LLC NOT A GUNT'S QU ION A- ROBERT BROWN MGR pWg, HOLDER'S OUALUTCA� 19102 NW 37 T PAYMENT RECEMM MIAMI GARDENS FL 33055 99AM -PAUS COUNTY TAX COLLECTOR: 10/12/2012 000049150 0001 in li Llellt �lun�tlu �e �tnll��rlul�a l�ri lra liarurl ��ul SEE OTHER SIDE THIS DOCUMENT HAS A COLORED BACKGROUND- MICROPRINTING • LINEMAPK PATENTED RAPER e - W . 8 - " • er t AM SEWLi2ogion5is KEN lawsoU owrso"Rov &-0/10.1213.2627S639, CK1427691 BLMBWG CMTRACTOR i, , belaw IS CB IFIED W the psoviaion4 of :Ma tee,'rA$ o. t-I Lratlon date AVG 21. 2014,, iraltl: } a 5 'N r, e �y L . v 3 3�, 4 BM�,p A LLC BLt3 191101 mmm FL 33055 SCOTT DISPLAY AS. REQUIRED BY LAW KEN lawsoU owrso"Rov R j fI 1 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL tWRUiCHS DIM610111 OF tlp MEW COMPENSATION CONSIT1111WIC1N 1111IM STRr cERTIF1CATe of ELECTION ro Be eXEmPT FRom FLoRiOA WORKERS' CONIPUMTION LAW ,` n EFFECTIVE. 08/01/2012 EXPIRATION DATE: 06/01/2014 PERSON- ROBERT BROWN FEIN: 2611141118115 GIUSMSS NAh4E AND ADDRESS: RROWN PLUkOna LLC IMPORTANT Pursuant to Chapter 440.0504!, F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election `- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.051121, F.S., Certificates of election to be H exempt~. apply only within the scope of the business of trade listed on R Me notice of election to be exempt. E Pursuant to Chapter 440.05(131. F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation ,10LVW000. CL 33027 certficate, the person, maned on notice or certificate no anger the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this I• CERTaa:O PLUfdant0 CCtRTauTOR I section. QUESTIONS? 1850) 413 -1809 CUT HERE * Carry bottom portion on the Job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISEO 01-11 AC ®RD. CERTIFICATE OF LIABILITY INSURANCE DAM"IDDAM T8!13/13 PRODUCER QUANTUM INSURANCE GROUP 12399 -1 PEMBROKE ROAD PEMBROKE PINES, FL 33025 PH- 954885 -8000 FX 954885 -8097 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED BROWN PLUMBING LLC 19101 NW 37TH CT. OPA LOACKA, FL. 33055 INsuRERA- SCOTTSDALE INSURANCE COMPANY INSURER 8- INSURER C- INSURER 0- INSURER E- CAVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER 'pAT E' POLICY EXPIRATION DATEBANDWYn GENERAL LIABILITY CIAedAERCtAL GENERAL LIABILffY CLABAS MADE [ OCCUR 0187000249401 12/19/2012 12/19)2013 RACH OCCURRENCE $ I,000,000 FIRE DAMAGE (Am ww &e) s 50,000 MED EXP Y" one Person) $ 1,000 PERSONAL AADV INJURY $ 1,000,400 GENERAL AGGREGATE 32,000,000 GEML AGGREGATE LIMIT APPLIES PEIt PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS; NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY ffi BODILY INJURY (ParaeddenQ $ PROPERTY DAMAGE (Per ecddentj $ GARAGELUUBRM ANY AUTO AUTO ONLY- EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGO $ $ EXCESS LIABILITY OCCUR u CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ ffi ffi S WORKERS COMPENSATION AND EMPLOYERS' LIABILRY i 1 L EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLO!LFA $ EL DISEASE - POLICY LUT 1 $ OTHER DESCRIPTION OF OPERATIONS (LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS PLUMBING CERTIFICATE HOLDER jXjADomoNALtmsuRmiNsupmtLETrER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED Pou ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. TAU ISSUING ENSURER ENDEAVOR TO NUUL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMIAM SHORES VILLAGE BUILDING DEPARTMENT IMPOSE NO OBLIGATION OR LIABILITY ANY MNO UPON THE INSURER ITS AGENTS OR NE 2ND AVE R SHORES, FL 33138 REPRESENTATIVES, AUTHORIZED REPRESENTATNE ACORD