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PL-11-1548I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176522 Permit Number: PL -8 -11 -1548 Scheduled Inspection Date: August 03, 2012 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael I Owner: FORBES, JOHN Job Address: 304 NE 99 Street Miami Shores, FL Project: <NONE> nspection Type. Final Work Classification: Addition /Alteration Phone Number (305)757 -7750 Parcel Number 1132060135600 Contractor: WILCONS PLUMBING SERVICE INC Phone: (305)219 -8987 uepartment comments DRAIN, WATER SYSTEM AND FIXTURE INSTALLATION FOR NEW ADDITION Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 176359. CREATED AS El" 1 REINSPECTION FOR INSP- 163636. 625/2012 - cancelled by john forbes Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. August 02, 2012 For Inspections please call: (305)762 -4949 Page 15 of 18 Miami Shores Village Building Department AUG 2 2 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 aa BUILDING Permit No. . tl PERMIT APPLICATION Master Permit No. 11 —5 FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): J y Vj n Phone#: Address: 30!4 N E 9S S*- City: M t Ap%-- e $ State: r-e_ Zip: Tenant/Lessee Name: Phone#:_ Email: JOB ADDRESS: 3o q NE 9 o, s+ City: Nfiami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO ✓ Flood Zone: CONTRACTOR: Company Name: W 0 1 Cyrts f 10 evi-b e rv- wdice 5 T e- Phone#. E s 2-15 —F c),' % Address: Li 3 5 1 MO 7 City: ktocmt State:. Zip: 331 lo L Qualifier Name: T e s %js Phone#: -3 0 S " State Certification or Registration #: )e F o G 37 5 Pe Certificate of Competency #: 0000 1 �'V cr s Contact Phone#: W t t� Ali n®� Email Address: ✓� ®� � 1 o nel DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 7 to S-0 - SquardLinear Footage of Work: Type of Work: DAddress iteration ONew ORepair/Replace ODemolition Description of Work: Wake- Sys A '�- Submittal Fee $ ea`�%P— Permit Fee $ 2 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Trainin Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 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 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 avproved and a reinspection fee will be charged Signature V Owner or Agent The foregoing instrument was acknowledged before me this day of `Xt� .201-1. b (A to r'04Y_'� , who i Hall known o has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY a1?° 9 Signature Contractor a� The foregoing instrument was acknowledged fore me this —1 2 day of AY�V S -� , 20 L! , by Te & J s I 'Fe ✓tea 7 who is personally known to me or who has produced ✓ identification and who did take an oath. NOTARY PUBLIC: Sign: Print: J Q rs0 N '• Comm 6194 My Commission 0'r FI (�R�'0, (Revised 07 /10 /07)(Revised 06/ion w)(Revised 3/15/09) //Plans Examiner Structural Review F.LV RA MUNOZ MY COMMISSION # OD7502715 EXPIRES March 02, 2012 Zoning Clerk A� °� CERTIFICATE OF LIABILITY INSURANCE 8/15/2011 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. IMPORTANT: If 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 endorsement(s). PRODUCER Eastern Insurance Group, Inc. 9570 SW 107 Avenue Spite 104 Miami FL 33176 CNAOMT David M. Lopez PHONE (305)595 -3323 FAQ 0.(305)595 -7135 E'er .CSR @easterninsurance.net INSURERS) AFFORDING COVERAGE NAIC @ INSURER A Mid-Continent CasualtV Company INSURED Wilcons Plumbing Services Inc 4357 NW 72nd Ave Miami FL 33166 INSURERS CastlePoint Florida Insurance 0/22/2010 INSURERC: EACH OCCURRENCE INSURERD: DAMAGE TO ffE-WM PREMISES Ea occurrence) INSURER E : IVIED EXP (Any one person) INSURER F: PERSONAL BADVINJURY COVERAGES CERTIFICATE NUMBER:Master 11 -12 REVISION NUMBER- 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 LTR I TYPE OF INSURANCE POLICY NUMBER POLICY EFF D POLICY EXP LIMITS A GENERAL LIABILITY X COM MERCIAL GENERAL LIABILITY CLAIMS -MADE ril OCCUR 4 -GL- 000805498 0/22/2010 0/22/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO ffE-WM PREMISES Ea occurrence) $ 50,000 IVIED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N L AGGREGATE LIMIT APPLIES PER: X I POLICY PRO- LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED NON -OWNED HIRED SAUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ (PeOPERT ntDAMA E r _804e) $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOPJPARTNERIEXECUTIVE YIN OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA P760854100 /13/2011 /13/2012 X RS TATU- OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, V more space Is required) Plumbing Contractor TICS Contracting Corp 16649 NE 19 Avenue North Miami Beach, FL 33162 I1VVF%L# AU Ica lwva/ IN9028 rgninnal m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lopez /AMANDA U 7958 -2010 AGORD CORPORATION. All rights reserved. Tha Arnian nama and Innn are ranlataraA marka of ArnRrt MIAMI -DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE 11805 SW 26TH ST. SUITE 207 MIAMI FL, 33175 (786) 315 -2880 CONTRACTOR'S BUSINESS CERTIFICATE OF COMPETENCY ISSUED THIS IS TO CERTIFY THAT WILCONS PLUMBING SERVICES INC CONTRACTOR CERTIFICATE NO.: 000018898 TRADE: PLUMBING CERTIFICATE EXPIRATION DATE: 09/30/2013 HAVING MET THE CODE REQUIREMENTS OF MIAMI -DADE COUNTY, AS AMENDED, IS CERTIFIED AS A CONTRACTOR IN THE FOLLOWING CATEGORY(S): 0001 PLUMBING WITH ALL WORK TO BE DONE UNDER THE SUPERVISION, DIRECTION AND CONTROL OF QUALIFYING AGENT FERNANDEZ JESUS S.S.N. - -3818 ALTERATION, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE IS PROHIBITED. CHARLES DANGER, P.E. SECRETARY, CONSTRUCTION TRADES QUALIFYING BOARD WILCONS PLUMBING SERVICES INC 4357 NW 72 AVE MIAMI FL 33166 WILCONS PLUMBING CORP JESUS FERNANDEZ 4357 NW 72 AVE MIAMI FL 33166 19t461f9S�1411191e 11 III t 1113 1111 1111 4 1111111 11 11 1111 *11 a I .SEE OTHER SIDE DBPR - FERNANDEZ, JESUS; Doing Business As: WILCONS PLUMBING SERVICE... Page 1 of 1 3:52:51 PM 812212011 Licensee Details Licensee Information Name: FERNANDEZ, JESUS (Primary Name) WILCONS PLUMBING SERVICES INC (DBA Name) Main Address: 4357 NW 72ND AVE MIAMI Florida 33166 -5601 County: DADE License Mailing: LicenseLocation: County: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: 4357 NW 72ND AVE MIAMI FL 33166 -5601 DADE Registered Plumbing Contractor Reg Plumbing RF0037588 Current,Active 11/05/1980 08/31/2011 Special Qualifications Qualification Effective Construction Business 02/20/2004 View Related License Information View License Complaint Contact Us :: 1.940 North Monroe Street, Tallahassee FL 32399 :: Call.centeradbor.stateAus :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mall to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterOdbpnstate.fl.us. https:// www. myfloridalicense .comlLicenseDetail. asp ?SID= &id= 99E99B5301A132849AD... 8/22/2011