PLC-13-2600V_
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 r r �
Inspection Number: INSP- 199794 Permit Number: PLC -2 -13 -260
Scheduled Inspection Date: October 03, 2013 Permit Type: Plumbing - Commercial
Inspector: Diaz, Osvaldo
. Inspection Type: Final
Owner: INC, PUBLIX SUPERMARKETS,
Job Address: 9050 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project: <NONE>
Contractor: PINNACLE PLUMBING INC
comments
ALL PLUMBING WORK AS PER PLANS
Work Classification: Addition /Alteration
Phone Number (863)688 -747_
Parcel Number 1132060100010
INSPECTOR COMMENTS False
Phone: (954 )426 -5555
Inspector Comments
Passed El CREATED AS REINSPECTION FOR INSP- 198256. CREATED AS
REINSPECTION FOR INSP- 185559. BILL 954- 818 -3448
1. PLUMBING WORK OK NEED TO PROVIDE GAS PERMIT FOR GAS
WORK PRIOR TO GETING PLUMBING FINAL AND ALL AS EQUIP. SHALL
Failed ❑ BE CONNECTED
Correction
Needed
Re- Inspection
Fee
6 �(
No Additional Inspections can be scheduled until
re- inspection fee is paid.
October 02, 2013 For Inspections please call: (305)762 -4949 Page 15 of 27
MAR -5 -2013 16:19 FROM:PINNACLE PLUMBING 9544265490 TO:30575GO972 P.1/1
PINNA -1 OP ID: HC
CERTIFICATE OF LIABILITY INSURANCE °A'X`E
02/OSM3
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOIAER. THIS
CERTIFICATE DOW NOT APARMATIVELY OR NEGATIVEI.Y 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 MOLDER,
IMPORTANT: n s Cent he to holler loan ADDITIONAL INSURP.D. the pollcy(las) must be endorsed. f SUBRU= -ION IS WAIVED, subject to
the toMwand ,condltlars of the policy, certain policies may require an andorsoment. A stet ®mant on this eartHioste does not confab rlplifs to the
ceetificata hdlder In lieu of such ondorasma s
PrAMMR Phone: 561803.8383 SIATON INSURANCE E Heldl McGuire
,- ..,_...,.._...._,_.... __..._.
P.O. BOX 220537' Fax: 561.884.6995 v we 561 -TZ1 -1305 Na 661.684.5895
West Palm Beach, FL 33422 ,L - -• — - -- — -
RlChard Neymany. Jr. noDRC hmcguiraLslatonMBicsenriOea.COm
�. _.!.N! ..M•gaRF NO OOVERAGE NAM A
INSUMMA :Into on National Ineuralnc6 Co. 28742
Pinnacle Mgmt Group. Inc. wsuReR a -First tYll�ra;u Insurance Co. - • ._
1058 aw. "
Dwrfleld
COVERAGES
NY II
t, FL 33441
CRRT1Wr±ATW W1IM0e0.
mrth River In&UraPgq Co. _
Idgefield Employers Ins.Co.
TNIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED OELOW HAVE BEEN ISSUED TO THE INBURM NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMITHSTANDiNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT %MTN RESPECT TO ViMiCH THIS
CERTIFICATE MAY 39 -ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,
FJ(OLUSIONS AND CON0ITION5 OF SUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCISD •DY PAID CLAIMS.
rim o0 neumNre NUMBER
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MICG1LO00a0;3q"o1
02101M3
02101114
EACHOCCURRENCE
5 1,000,00
-
y' 300.00
NIED EW Lft am pew,
PERSONAL A ADY INJURY
s Oulu"
E - 1,000,0 -
_ 21000,00
GENLRAL Al3QR8 TS
GEN'L AGORRGATE LIMrT APPLIES P&k:
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MIASHOR
MIS'ml' Shores Village
10050 NI=. 2nd Ave
Miami Shares, FL 33138
A J%Jft w.. ,..
814OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXP1RA11ON DATE THLRLOF, NOTICE WILL BE DELIVERED IN
ACCORVANOC VVITN YH4 POLICY PROVISQNS.
AUWWR= RZPMMTATN9 -
®1088.2010 AC:ORD CORPORATION. All rigtde reserved.
-• -- -- -- •r.r.., I rneAwKu name and i0go are registered marM of ACORD
.a
Miami Shores Village
Building Department FEB ® 8 2 13
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20 to
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. (71C_1 1 a — 1
Permit Type: PLUMBING
JOB ADDRESS: 7Q�D /�fL'AG//✓� ;�!Y
City: Miami Shores County: Miami Dade Zip: 15313dp
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): N bl ix 54per AL r I 5 � -ne, Phone#: y y/' � u � a 1 /f �
Address: PC' Boo =k i/0' 7
City: L u k e %yi d State: % L Zip: 3 3 0112
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: ' /NAyra �e, J"L nK i V Z Phone#: 7.7 046
Address: IaS( .'.5'
Qualifier Name:
State Certification or Registration #: 666&V 2Z'�/-Jf Certificate of Competency #:
Zip: ".I, fk /l
Contact Phone#: �2w dal '�.�`�S! Email Address: u MC416 6,4t Ae.&
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ l / 14a Square/Linear Footage of Work:
Type of Work: ❑Address ,!'Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: AK lumbs%2C welrk e.S per x/477
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 40 %w
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
•
Signature
caner or Agent
The foregoing instrument was acknowledged before me this
day o nonallykno 1, by � -`-6,
who i to me or who has produced C
As identification and who did take an oath.
NOTARY PUBLIC:
Si
Print:
My Commission Expires: JODI L SLOA(d
* MY COMMISSION I EE 058818
r EXPIRES: February 5, 2015
Signature Zffffl,4ed2f�
Contractor
The foregoing instrument was acknowledged before me this / %
day of 1-1,01140 ,20/4 , by &&&L4 W_ /I Wd /,re,
who is pe , nal y knnwn to me or who has produced '
APPROVED BY K �� 2 — I37 { 3 Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: xtrUav pr>nt rC-S'PM OFD
s % "° L. Vonder Strasse
My Commission Expir CCommission # EE042567
o,.,,,,,,,'' Expires: NOV 16, 2014
B0'D$D TSRC ATT A1TiC B0'1DWr. CO., INC.
Zoning
Clerk
:.. ' MA,CH. FL. .33441
i
T
OR
SEA 7'
DISPLAY AS REQUIRED BY LAW
CITY ODE.D
TAX RECUT :.
tisH
•r BUSINESS TAX RECEIPT
13 $
w. ,x
2012-2013
NEW RENEWAL '�
k
PINNACLE PLUDMING INC
no. 149942 0
DATE ISSUED /
's i ne -P.]. ACLE PLXMING INC
BUSINESS TAX 58'.80
E
SW 1 WAY
DELINQUENT CHG. �(
IV PIING CONTRACTOR
TRANSFER FEE ..�
TOTAL AMOUNT PAID
RECEIPT ISSUED FOR THE PERIOD
- OCTOBER 1 2 012 sEPTU46kR 36
;L - PLUMBING INC
. 5 TAX 1 SAY �C.;EWT IV.W- T BE
- .$IELD BEACH FL. 33.4-41 D10 PLA
: TO Pil:
BLESS LOC#
. at :boecomes NULL and V(W ' .owne TRANSFER FEE '
tf ►sk+P, busuress :name, or address is "changed B>siness m-er must apply to Business
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013
DBA: PINNACLE PLUMBING INC Recelpt # :182 - 929
Business Name: PINN PLUMBING /LWN SPRNKL/
Business Type:(MASTER PLUMBER)
Owner Name: MICHAEL E NECAISE Business Opened:lo /12/1990
Business Location: 1056 SW 1 WAY State /County/Cert/Reg :CFC057845
DEERFIELD BEACH Exemption Code:
Business Phone: 305-849-6306
Rooms seats Employees Machines Professionals
1
i
i
Number of Machines:
Tax Amount Transfer Fee NSf Fee
27.00 0.00 0.00
Penalty Prior Years Collection Cost Total Paid
0.00 0.00 0.00 27.00
E
PINNA -1 OP ID: HG
'4` °.-RO CERTIFICATE OF LIABILITY INSURANCE
F DA 01M8( /ID13 1
THIS CERTIFICATE 18 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: H the certificate holder is an ADDITIONAL INSURED, the policy(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 certificate does not confer rights to the
certificate holder in lieu of such endorseme S ).
PRICER Phone: 661 - 683 -8383
SLATON INSURANCE
P.O. Box 220537 Fax: 661- 684-5996
West Palm Beach, FL 33422
Richard Neyman, Jr.
cowAcT Heidi McGuire
PHONE .561- 721 -1305 A No • 561 - 684-5996
ADDRESS: hmcguim@slatonriskservices.com
Miami Shores, FL 33138
1
21 UUNTS4534
NO SUBCONTR EXCLUSION
INSU S AFFORDING COVERAGE
NAIL 0
INSURER A: Hartford Casualty Company
29424
DMAGE TO RENT PREMISES Me ocrxiurenW
INSURED Pinnacle Plumbing, Inc. &
Pinnacle Mgmt Group, Inc.
1066 SW 1st Way
INsuRERa:Brid efield Employers Ins.Co.
10701
INSURER c: Federal Insurance Company
20281
X
XCU &Contr Liab
Deerfield Beach, FL 33441
INSURER D
GEML AGGREGATE LIMIT APPLIES PER:
ri POLICY X PRO- LOC
INSURER E
$ 2,000,0
INSURER F :
A
AUTOMOBILE
COVERAGES CERTIFICATE NUMBER_ IRFVIClMd NI IMRCD•
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
L
SUBR
POLICY NUMBER
P
eXP
LIMITS
A
GENERAL LIABILM
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE FK OCCUR
X Broad Form PD
Miami Shores, FL 33138
1
21 UUNTS4534
NO SUBCONTR EXCLUSION
02/01/12
02/01/13
EACH OCCURRENCE
$ 1,000,00
DMAGE TO RENT PREMISES Me ocrxiurenW
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
X
XCU &Contr Liab
GENERAL AGGREGATE
$ 2,000,00
GEML AGGREGATE LIMIT APPLIES PER:
ri POLICY X PRO- LOC
PRODUCTS - COMPIOP AGG
$ 2,000,0
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOS AUTOS U�D
HIRED AUTOS X AUTOS�ED
21UUNTS4534
02101M2
02101 /13
,OMBI ED SINGLE LIMIT
$ 1,000'00
X
BODILY INJURY (Per Person)
$
X
BODILY INJURY (Per sodded)
$
X
POPE ddera) AGE
$
A
X
UMBRELLA LIAR
LIAe
X
OCCUR
O(AIMSMgpE
21XHUAG0i82
02/01/12
02/01M3
EACH OCCURRENCE
$ 5,000,00
HE,x,71
AGGREGATE
$ 5,000,00
X RE TENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERJEXECUTIVE
OFRCER✓Ar WBER EXCLUDED? F
(Mandatory in NH)
,Ibe under
DSC N OF OPERATIONS below
N NIA
0830 -25168
07/01/12
07/01113
X WC STATU OTH-
T I R
$ 1,000,0
E.L. EACH ACCIDENT
EL DISEASE - EA EMPLOYEE
$ 1,000,0
I EL DISEASE - POLICY LIMIT
$ 1,000,00
A
C
Crime
Equipment Floater
21UUNTS4534
46465630
02/01/12
02101112
02/01/13
02/01/13
Fidelity 50,00
Leased 100,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (Atmeh ACORD 101. Addillonal Remarks Schedule, If more epee is required)
CERTIFICATE HOLDER CANCFI I ATInlu
MIASHOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village
ACCORDANCE WITH THE POLICY PROVISIONS.
10060 NE 2nd Ave
AUTHORIZED REPRESENTATIVE
*40-2 --
Miami Shores, FL 33138
1
V 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD