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PL-12-2996 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 175107 Scheduled Inspection Date: September 28, 2012 Inspector: Hernandez, Rafael Owner: FORBES, JOHN Job Address: 304 NE 99 Street Miami Shores, FL 33138 -2437 Project: <NONE> Contractor: WILCONS PLUMBING SERVICE INC lsuuamg uepanment comments INSTALLATION OF GAS LINES FOR FUTURE GENERATOR AND SERVE THE HOUSE el Permit Number: PL -2 -12 -299 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)757 -7750 Parcel Number 1132060135600 Phone: (305)219 -8987 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP - 170219. cancelled by john forbes Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 28, 2012 For Inspections please call: (305)762 -4949 Page 5 of 18 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 PE A- PPLICATION FBC t . Permit Type: PLUMBING OWNER: N��tne ¢ee Simple Titleholder): -- - cal:• g ':2 AL-12 Permit No. I Master Permit Nt r V v;' - City: —L= �' �—j_ i4 I k 44 � �a � rt s State: � L �p Tenant/L.essee Name: Phone#: Email: JOB ADDRESS: S t. City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes NO V Flood Zone: C CONTRACTOR: Company Name: t 1. L b PL-0 N� ��, �_ ),� -"V � Phone#: 3t?S . -Lj j ,7 q 9-�' Address: City: A I Ala ► _State: F�i_•. Zip: Qualifier Name: 253 f . - iyit, A e2 Phone#: State Certification or Registration #: 7, ft 00 '3 " 5 S of Competency #: Contact Phone#: >0 fit` -Dkl �5 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Footage of Work: 15L Type of Work: LIAddress OAlteradon UlNew ORepair/Replace []Demolition Description of Work: Submittal Fee Scanning Fee $ Permit Fee $� CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 he 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 ralue exceeding $2500, the applicant must promise in good .faith that a copy of the notice of commencement and construction lien laver 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 isst d. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be clanged. A' / Signature Signatur Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this day of �'r , 20 f� by l-i.(V day of Oeeeal1Y. 20 �, by �e5- uS Te1tna��r who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: d�I n " A,60— �2 0 Sign: Sign: i `` i Print: - ��' Print: t!t My Commission Expires: _ �M >t, ` �'�� My Commission My Cp�ppAISSIOIV # DD750276 EXPIRES March 02, 2012 a Ptor NofaDaarvfce.00m W; 11111111110", APPROVED BY �� —Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06/10/2009 N Revised 3115109 ) is 44g 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 AC #58 6 M .: p STATE OF FLORIDA_ . :iiEPAR STRUCTTONN INDUSTRYRLICEENSING REGULATION SE09 LlllllSO1854 RITIRPS tit CENS R 1088 IRF0037508. w NTRACTOR, REGISTERED t sioas of Chagte FS JLUG 31, 2013 T NEST ALL L,OCA RO (M QTQE? �."Ci 'RACT n9us , 3 �7$Z NG 3ERVICLu Ili �a D AVE.:. FL 31166-54-01') yza a;` RT BR ARYN DISPLAY AS REQUIRED BA" AMOK CERTIFICATE Of LIABILITY INSURANCE 10/29 /' ' 011 TNW CERTIFICATE NS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFLVMATNELY OR NEGATIVELY ANEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REDRESENTATNE OR PRODUCER. AND THE CERTIFICATE HOLIER IMFORTANT: B the eev-- holder 6 an ADDI L OUNn D, the pofiWies) swat bs endorsed. It SUBROQATION M WANED, subject to the terms avid condMas of the P000Y. oarleto poUdes any requlrs an andomen sul. A stdo ne1d on thb cevlEoate does not coder rV to 110 the oerdfhrats Imldar In Dew W ouch erdovemne e ppODUOUR East*= inouzzmas Gam, 1". 9570 SW 107 Avenna suite- 104 Via" 8L 33176 0,WMTDavid M. roper (305) 895 -3323 Pax wos)as--nm easte>miasoranae.sat I AFFORDS a l"s IwSURERA did-0ontinent Clsaval AVn10R¢EDRNTAlIVB TRilcons Plumbing Bervicas Zoe 4357 NMT 72nd Ave B°L 333,66 nuaurM84Mstle8oint 8lorida Insurance GENERAL UA81Id7Y S COMIMCIAL GMEPI& UAHLITY C.A.. A4DE ® OCCUR n801MR C: 4-OL- 0000941732 0/22/20u INSUMFI C EACH CCCURMCE $ 1,000,00 THIS IS TO CERTIFY THAT THE POUCtES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED AWNED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANONG ANY REOUIREIE3T, TERRA OR CONDITION OF ANY CONTRACT CAN OTHER DOCUMENT WTH RESPECT TO YS11CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSLERANE AFFORDED BY THE POUCIES DESCRIBED HEIEtN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIM ITS SHOVA MAY HAVE BEEN REDUCED BY PAID CLNN6. SHOULD ANY OF THE ABOVEDNSCRBED POLICIES BE CANCELLED BEFORE TYP80Pa14WtA11C@ THE EWMATION DATE THEREOF. NOTICE WILL BE DELIVERED N NAM 6MUR FOLCYNUNM B;1=d =g Depart merest 10080 = 2 Avenue AVn10R¢EDRNTAlIVB LAOIS A GENERAL UA81Id7Y S COMIMCIAL GMEPI& UAHLITY C.A.. A4DE ® OCCUR David raper /AM3N MA 4-OL- 0000941732 0/22/20u 0/22/2012 EACH CCCURMCE $ 1,000,00 s 10010001 MW FJP M s E=on PERSONA. 4 ADV INJURY 4 1,000,00( GENERAl. AGGREGATE s 2,000,00( c na0¢IR£SIATELU/OTA- LIESPER; $ POLiCY IDi'i PROD=S- COW)OPA00 $ 2,000,00 s auroNDiSIP UA9am ANY AUTO aOwa9) SCRODUM wR0 ®SOaJTO& AAUrtlOA�R�09'"" ®9 e=v IKMIRY (Pa PM" s B=Y inWRY (Pe axrtm) s s s 10111IRRUA UAB 9ffiESSUA9 OCCUR Qt1U118•UWE EACHOOGUpREICE 3 AGGREGATE s B AIiDB1FL0Y8R8 UARILM AnY p1AR1@TORAARTIIRNE� OFFICE MMEN E:(Ci1DEDT pgo0a20ry In wo g NIA 80993100 /13/2011 /13/2012 8 TMEAT&I IN- EI. EACH ACavB:Nr s 100,00 EL .O> -EA EAIPLOYES $ 100,000 ELOMEM- POLICY UWT $ 500 000 OESCRIPWN OPERA TDNSILOCATIMISI V81B0.f8 (AtYehAOD]m191. A6dM nWRand*SmemM.nmoisspmtemquM) Plumbing Contractor rAuOZ3, An W ACORD 25 (2010A6) W'JU D-ZU -119 AgNKU WKr'VKA 1 MAN. Ail flgFIW 19seraa0. SHOULD ANY OF THE ABOVEDNSCRBED POLICIES BE CANCELLED BEFORE THE EWMATION DATE THEREOF. NOTICE WILL BE DELIVERED N Miami shares village ACCORDANCE WITH THE POLICY PTOMMOUL B;1=d =g Depart merest 10080 = 2 Avenue AVn10R¢EDRNTAlIVB Miami Shares, NFL 33138 David raper /AM3N MA ACORD 25 (2010A6) W'JU D-ZU -119 AgNKU WKr'VKA 1 MAN. Ail flgFIW 19seraa0.