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PL-13-2704Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 203852 Permit Number: PL -12 -13 -2704 Scheduled Inspection Date: January 22, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: ANGOSTINI, ANA & WAYNE Work Classification: Addition /Alteration Job Address: 9800 N MIAMI Avenue Miami Shores, FL 33150- Project: <NONE> Phone Number Parcel Number 1131010330030 Contractor: LASSETER PLUMBING CO INC Phone: (305)525 -5075 EXISTING FLUE PIPE ON HOT WATER HEATER INSPECTOR COMMENTS False Inspector Comments Passed Failed �� ,� 1 J��J c Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 21, 2014 For Inspections please call: (305)762 -4949 Page 14 of 39 - Miami Shores Village Building Department �� "�` �.;�� jib 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ED- 0 2013 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (3057 762.4949 FBC 20 bO BUILDING Permit No. P L4 ® 2`2 b`t PERMIT APPLICATION Master Permit No. a-1 3 ? Li 2Z Permit Type: PLUMBING JOB ADDRESS: 9BOD M, M I e" I avl?" City: Miami Shores County: Miami Dade Zip: 331b Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): f OI�L%t � ( 1 l 1'>I Phone #: Uo.2 1G . J71 Address: 9 90D •• - Y-n I#q ,, clue- ,,VA city: r� M I D -yn _shorn n State: 9L, Zip: 33j3 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: L g xs t-rt .�2 ))z_ t 1) ` 13 /1d Address: 'Aar IV_L _ l 3d Phone #: 36j ft3. S 1 SO City: A/- In Cit P/ State: �L Zip: Qualifier Name: Phone #: 30-47 3 -71 State Certification or Registration #: Cil ° Co 16 f& Certificate of Competency #: Contact Phone #: 30 5_49- 710 Email Address: Z /d - ISL`Z&W l -tVA & t *rr /1le7_ DESIGNER: Architect/Engineer. Phone #: Value `of Work for thus Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address QAlteration ONew ORepair/Replace Descri tion of Work: / \ r 1 ODemolition Submittal Fee $ Permit Fee $ AL11 • i CCF Scanning Fee $ Notary Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond Technology Fee $ t 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 zip ' 1 R State 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. i /) Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of , 20 � , by AN& (& &WL- f t ^t who is orally kna a or who has produced As identification and who did take an oath. The foregoing instrument was acknowledged before me this day of =,2- S— OL160 , 20 �� by 6 I f /0 who is onally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ��XM %,�� NOTARY PUBLIC: .API$' Sign: _ —e • Sign: POF1 N Print: Print: ( 30, 2017 My Commission Expires: Q � My Commission E \\\\\\\. �mrrnn►►�� APPROVED BY Plans Examiner Structural Review (Revised3 /12/2012XRevised 07/10/07 )(Revised 06 /10/2009 )(Revised 3/15/09) zoning Clerk ,;- 2�-1 G--f A Cr CERTIFICATE OF LIABILITY INSURANCE M.M(M o13m THIS CERTIFICATE 13 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 CER71FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifleate holdw Is an ADDITIONAL INSURED, the policyges) must be endorsed. It SUBROGATION IS WAIVED, subject to the ferry and conditions of the policy, certain pollcies nmy require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in Neu of such endorsements . PRODUCER Mack, Mack & Waltz Insurmn.ce Group, Inc. 1211 S Ktlitary Trail Suite 100 Deerfield Beach FL 33442 ACT MOILSSa Ri.hm 4954) 640-6225 PAX Issel r►ao -s22s etti}rm @maakiasurinace. con INSURER AFFORMSCOVERAGE NAM IV INSuwRAMi.d- Continent Casual Coal INSURED Lasseter Plumbing Company, Inc 865 M.N. 130 Street North Miami FL 33161 INSURmeAs&ur8nce Company of America 19305 INsDRERc ri eheld FmplSXe=s Ins. Co. 0701 wsuRaln MEDEXP one lm" WBUIIERE PERSONAL & ADV INJURY INSURER P. COVERAGES CERTIFICATE t+ LIMBERI=382128848 REVUM014 N11MFIF0- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE 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. am LTR TYPE OF INSURANCE NUMMR /1/2013 ? 11/2014 tin= GENERALLIABILITY X COMMERCO"ENERAL LIABILITY CLAWSAWIE 'LA I OCCUR GL000884232 EACIiOCL11RRENCE $ 1,,000,000 DAMAGE F01MMI-ba Iccurnmal S 100,000 MEDEXP one lm" $ EXCIMED PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEWL ACiOREGATE LIW APPLIES PER: X PoUCr PRO. LOC PRODUCTS . COMPIOP AGO S 2,000,000 S 13 AvrolxomLEUA ®Lrrr X ANY AUTO Ate D SCHEDULED CNON -OWNED HIRED AUTOS 005321056 11/2013 11/2016 a ' L INI 1,000,000 BOIDILY INJURY (Parpenw) E BODILY FNJURY(Pmaadwt) $ R s Ih t-'-- rw la S UMBRELLA LWB EXCESS UAR OCCUR CWNAS -MADE EACH OCCURRENCE S AGGREGATE $ N$ $ C WORIMR,S COWENSAT10N ANDEOIPLOYOWLIA81LnY YIN ANY PROPRIETORIPARTNERIEX ECU TNE❑ OFFICEWMEWER EXCLUOB:D9 I{M7�a edaMry In N DESGiRlPTION OF OPERATIONS belflw NIA 3021471 /26/2023 /25/2014 X ATU- OTH- ER 500,000 EL EACH ACCIDENT E.L DISEASE - EA EMPLOYEE S 00 000 E.L. DISEASE- POLICY LIMIT S S001000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEM CI.IS {AUGM ACORD 111. Admanal Remarks ScImIale, N mare spaco le mquftd) Plumbing contractor work (305)756 -8972 Miami Shores village City Hail, Bldg Dept 10050 NE 2nd Avenue Miami Shores, FL 33138 (201 INWI25 i"rm%n1 Z•d SHOULD ANY OF THE ABOVE DESCRIBED POLMES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROMSIONS. AUTHORIZED REPRESENTATIVE waltz /LAVRM Thra Ar.rwn nwna and lewm era ranlwMrnri raarke of Ar`Jwn All rights reserved. 88Z:80 £ L 6 6 Oe0 fl I% '`1ieO CERTIFICATE OF LIABILITY INSURANCE DATE(N6stDD►YYYYI 6/21/2013 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 BEIWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder to an ADDITIONAL INSURED, the pollcy(les) 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 certiflcals does not confer rights to the certificate holder in Ilea of such endomemen a . PRMUCER Mack, Macs & Waltz Insurance Group, Inc. 1211 S Military Trail suite 100 Deerfield Beach FL 33442 1 CT 14.139881 Riiam PHONE (954) 640 -6225 I MI.Nal: (954) 6" -6226 E' .mr3.hm$mackinsnranaei.com INSURIERM AFFORDING COVERAGE NA�Ip INSURERA- Lid - Continent Cavialty Company Greg Waltz /LAURSN MIRED Lasseter Plumbing Company, Inc 665 H.E. 130 Stmt North x ami FL 33161 INSURER a Assurance Company of America 19305 I RERcEri field Employers Ins. Co. 10701 INSURER D: TO A4 � p i _arson) 1NSURFR E: S ZYMUDED 1 INSURER ; S 1,000,000 COVERAGES CERTIFICATE NU11ISER:CL1382128848 REVISION NuIIliBER_- THIS 15 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 PERTAIK 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. SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE TYPE OF INSURANCE THE EXPIRATION DATE THEREOF. NOTICE WILL 86 DELIVERED IN Mi8m3. Shores Village ACCORDANCE YaiTH THE POLICY PROVISIONS. LILY E F E7tP LIMITS A GENERAL LIABILITY X COMMERCWLGEi�ERALL1ASILITY OCCUR Greg Waltz /LAURSN OOO8421 /1/2013 /i /2DI4 EACH0 CCx1RRENCE S 14000,000 TO A4 � p i _arson) S 100,000 S ZYMUDED PERSONAL & AM IWURY S 1,000,000 GENERALAGGREGATE S 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: X POUOY PRO LOC PRODUCTS - COMPIOP AGG S 2,000,000 $ $ AUTOMOBILE LIABILITY X ANY AUTO ALLLID D SCHEDULE" HIRED AUTOS AU -OVONED 05321056 /1/2013 /1/2014 a uNrr 11000,000 BODILY INJURY (Per w Pi S ODDLY INJURY (Per ecdderdl & P GE Lftle:§ta uetl mwst S S UMBRELLA LIAR EXCESS LIAR CLAM-MADE EACH OCCURRENCE S HOCCUR AGGREGATE S DED LJ METE NTIONS S C WORKERS COMPENSATION AND E IMPLOYER9'UAINIMY ANY PROPME?TORMARTNERMXECUTIVE OFFICERAWEMBER EXCLUDED? Q [MandaUnyInN}0 it yes, dasabe under DESCRIPTION OF OPERATIONS W.. A MIA 3021471 /25/2013 /25/2014 xi VVC STATU- OTH. EL EACH ACCIDENT 3 5001000 E?.LDiSEASE - EA EMPLOYEE S 50D,000 E.L DISEASE -POLICY LIMIT 8 500 DD DESCPJMCN OF OPERATIONS t LOCATIONS 1 VE NCLM (Atlxrh ACORD IK AddNional Re n ics Schedule. If mare spacs Is teWtadl Plumbing eonteaetor work v2mnATr uem n=o r-AIMCFt I ATInIM ( 305) 756 -8972 SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL 86 DELIVERED IN Mi8m3. Shores Village ACCORDANCE YaiTH THE POLICY PROVISIONS. C:Lty Hall, Bldg Dept 10050 NB 2nd Avenue AUTHORIZED REPRESENTATM Miami Shares, FL 33138 Greg Waltz /LAURSN ACORD 26 (21110/05) ® 7985 -ZO70 ACORO CORPORATION. Ali rights reserved. IN8025nnir ni Tho ArnPn nowm and Innn cry► raniatorod n+orbe nt OfVWn s,d 8woL t, L so ular ,. .AC #6252366 S wow .00a 1 Business -'ax Becei t � State of F�on N19ami Dade NOT r NOTPAY jHIS IS NOT A HILL. - � EXPIRES //�� 92%037 RL,CgR.TtuO. 3,Os ZV�4 suomms �r��aaol aN SZW97 =- SEP'i'ENLBER ace of bus,nem at �$ETER pLU�ABING GO It 4C g p97 Must be diaper Pwsuant�CouAM & 10 865 NEE 130 ST Chapter Nom MIAMI Fl. 33161 PAY Tfmcewap see- - fype OF OUSTAOSS gy TAX COL A 196 PLUMBING CONTRACTOR $,45,00 07103%2013 Ip�SS un pJ.UMBINGCo INC CFC041696 ¢ppulo -- 13--0 91 Wodcs<(S) aecaiptisa�a nceasa. at the Laeei snsias�Tax. "rie I vaitL aaY �,�„eatal or IbIBLooelBus'orj ��po � s�� 4o6usi hb*si Y perrolt era i N ws aml ragnira g ' icb apptY staff -Dade Coda Sec @a-Z16 aoa9 he Ospieved aU ea rl vretiioles- 7><sAECEiPTNO.ah � yolorr"sttat Wit •'_da c Rea�anlJ� STATE OF FLORIDA. ae /:off /202,: 110415323.:::' CFCD41696 Z•d SEf#L3.2080- KEN TIAWSON SECRETARY ees:m t L so uer