PL-14-480Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 208826 Permit Number: PL- 3- 14-480
Scheduled Inspection Date: March 19, 2014
Inspector: Diaz, Osvaldo
Owner: RINCON, NINFA
Job Address: 38 NE 109 Street
Miami Shores, FL 33161 -7040
Project. <NONE>
Contractor: DOUGLAS ORR PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360110370
Phone: 3051887 -1687
Budding uspartment comments
INSPECT AND PUT GAS FLUE VENT UP TO CODE. infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed F
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 18, 2014 For Inspections please call: (305)762 -4949 Page 30 of 51
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
i
�L
FBC 20 LD
Permit No. �--'L— I LA P°- 4 S®
Master Permit No. ) y
JOB ADDRESS:tC N f D
City: ____._. Miami Stores Count : Miami Dade
Folio/Parcel* '1'.13 U) 0 11 - 0
Is the Building Historically Designated: Yes NO V Flood Zone:
OWNER: Name (Fee Simple Titleholder): Phone#:
City:
Tena
Emai
State:L Zip:�A�
CONTRACTOR: Company,Name ,� ! �� ` �� ` ��� P'— F) Lill WI L 16 Phone#:
Address:,- 'XI
City: State: ice,
Qualifier Name: £ I J Phon
i
State Certification or Regi l ^on #: s - .� iii ) �' Certificate of ompetency i
Contact Phone# -, Email Address: [66 1, �ij'OKW
DESIGNER: Architect/Engineer. Phon
i
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: t]Address
DAlter a O New O RepairlReC ace on
Description of Work: (01 A _ D AM � e p ri �
CIDemolition
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * *** * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ - Q CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ Lin-
M
Bonding Company's Name (if applicable) _0, 10
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) n
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
P 1
Signature Signaturev"
Owner or Agent _ // Conrracr��
The forego' g instrument was acknowledged before me this
day of �, 20 L_t_, by_ 1611449 Z/A16W ,
who is personally known to me or who has produced t "l
f C4-,AB As identification and who did take an oath.
NOTARY
The foregoi4/ilnstrument was acknowled d before me this
day 0 k�,.by who i or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign v Sig . t V�
Print: Print: WA �NJQ"IVARF7
M COmini55i0nEX Tres: oAW"p9e Notary Public State of Florida ^t Commission #FF70091
My p = �` Aida A Sanchez My Commissi e"g
A.�r My Commission Expires
�+� My Commission ";'er..��o�� OCtOb @t 22, 2016
'�ornoe• Expires 06 /21/2014
APPROVED BY z --/-/Plans Examiner Zoning
Structural Review
(Revised3 /12/2012)(Reviwd 07 /10107)(Revised 06/10/2009)(Revised 3 /15T)
Clerk
03112/2014 11:32 3058880678 DOUGLAS ORR PLUMBING PAGE 02/03
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Local Business Tax Receipt
Miami -Dade County, State of Florida
-7"18 IS NC':A BILL - Do NOT Pay
44522
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ORR DOUGLAS KUMOM INC
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301 RAGLER DIR RENEWAL
4 7914
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MIAMI SSPRINGS FL 33166
Must bs sty of buslfmn
Pursuant to County Cody
CtnaptW eA , Art. 9 & 10
GVVNM s6G TvM OP sfdamnes
ORR DC WUM PLUMBING INC 196 PU M ING CONTRACTOR PAS RVftW :o
Wa*er(5) y CFC052SU MY TAX aeUOTOM
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03/12/2014 11:32 3058880678 DOUGLAS ORR PLUMBING PAGE 01/03
UUUGOKR -92 551MEUN
CERTIFICATE OF LIABILITY INSURANCE 1 DAM $/212013 /2013 '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
:ERTIFICATE DOE $ 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
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IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) Must be endorsed. If SUBROGATION IS WAIVED, subject to
the larms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
PRODUCER
Collinsworth, Alter, Fowler & French. LLC
8000 GovemOt9 Square Blvd
Suite 301
Miami Lakes, FL 33018
I,N9URED
Douglas Orr Plumbing, Inc.
301 Flagler Drive
Miami Springs, FL 33168
822-7800
382-2443
INSURetta,Amerisure Mutual In CO 23396
INS„RERa:Amerisure Insurance Co 19488
iNsuRER S, FIMt M arcurY Ins. Compen 10657
L;LIVCKANIi N fLPRTIFf@ATE U1116mcn. ISMA0If1u u""Emn.
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THc 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 SEEN REDUCED BY
PAID CLAIMS.
LTR TYPE OF 1N8URANCE MMAM POLICY NUMB�it LIC7 EFP
LIMIT$
GENERAL LIABILITY
PACM OCCURRENCE
9 11000.00
A X1 wmmeROtAL GENERAL uA8IUTy X X 06207835702 8/212013
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DESCRIPTION OF 0MATIONO I LOGA110a l V6HI M (AURnh ACORD 7111. AMelwt Remarks Schedule. N morespum E fewh"
"Except 10 days for Non"IrIont of Prom(um.
*Except 10 days natlee for Non- Paymont of Premium RE: Plumbing Contractor No- CFCM452
Village of M(ami Shores Building & Zoning
10050 NAL 2nd Avenue
Miami Shores, FL 33154
ACORD 25 (2010105)
SHOULD ANY OF THE ABOVE DESCRIOMED POLICIES 91q CAN** -LED BEFORE
THE EXPIRATION DAT£ THEREOF. NOTICE WILL 6E DELIVERED IN
ACCOROANCE {AIiTH THE POLICY PROVISIONS.
AUTM018M REPRESENTATIVE
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The ACORD name and logo are registered marks of ACORD
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