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PL-14-180Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)766-8972 Inspection Number: INSP- 208586 Permit Number. PL -1 -14 -180 Inspection Date: March 11, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner JACOBSON, LAUTARO Work Classification: Repair Job Address: 815 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132060050240 Project: <NONE> Contractor. SOUTH BEACH PLUMBING CONTRACTOR INC Phone: (786)337 -1582 REAPIR REPLACE PIPING IN HOUSE Infractlo Passed Comments INSPECTOR COMMENTS False Passed Ef Inspector Comments (� Failed E]— Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 March 17, 2014 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 f INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: �� /C) C / ( 7-&'A FBC 20 Permit No. JAN 3 0 2014 Master Permit No. 2 I 1 y, ^ 10 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: //--32 °06 " 04IS- 0 2!S,10 Is the Building Historically Designated: Yes NO Y Flood Zone: OWNER: Name (Fee Simple Titleholder)./ NUT-,q /o C) %/aCO 656, ti Phone #: Address: RZE IV E '/ 7—"22 City: 67!12 ES State: Z/ -zip: _-4-3/341Z Tenant/Lessee Name: A.) �/4 Phone #: 3D.5 4/7 9- Yz O,� Email: ©, /& a . CONTRACTOR: Company Name: �.YJ�(i I� N V"GLl�.�7��3r t-19h ��%f�!'c Phone# - '47/53 Address: , 57V?O S4,() % City: _ 4Z46y ^- State: Qualifier Name: �e," A5 4n7a !�;.//a Phone #SOS a 1P/00 . State Certification or Registration #: G FG.- /`t/Z 4F* (% Certificate of Competency #: Contact Phone #.7,& :3Z '71 S'-e Z' Email Address: as C- ib%%/%1 !/9 AOXfAf1- C~'7. DESIGNER: Architect/Engineer: Pho a #: ®Q.�� Value of Work for this Permit: $ Square/Linear Foota f Work: Type of Work: ❑Address ❑Alteration ❑New ep ' /Replace ❑Demolition Description of Work: / /9-01 O `a r lc <i x, r�r�rti> �rivr�e�xa��raxrxFeeS�r >ti�e�r�er Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ No Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ 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 zip City 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 seve 7) days after the building permit is issued. In the abs nce of such posted notice, the inspection will not be approved and e' s ction fee will be charged. Signature Signature s Owner or Agent ./ ontractor The foregoing ms ent was acknowledged before me this 2z The foregoing instrument acknowledged before me this day of 20 1 , by A O day of , 20 , by `� � m b� � who is onally known to me -avKo has produced who is perso y own to me or ho has produced As identification and who did take an oath. 1 entification and who did take an oath. NOTARY PUBLIC: Sign: / Print: My Commission Expires: APPROVED BY MY COMMISSION #EB1aM EXPIRP . Jx=y 19.2.416 Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: Q__ SA (cf GQ ✓� l�� My Commission Expires: CLAWIA sALCARgiAGRA MY Comm. mpir" pup cfa, & Commission * 00 826103 gorded Through Nelonal NoMy Assn. I Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: BUSINESS ADDRESS:�r3D .S� Trz CITY �r��i STATE / ZIP CODE 33/-5 e/ BUSINESS PHONE: t,7?& /00f/ FAX NUMBER �) CELL PHONE () a�7 �✓`��� QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: ��� /� R6 6'�7 Created on 3119109 BY MLDV 1 RV 3126109 MLDV 1 RV 6127111 AS SOUTH BEACH PLtrMBING CONTRACTOR INC 2300 SW 70TH xl:Am 'FL 33144 I To: south beBoh plumbing Peg- 3 of 5 2014- 0'I -27 17:06:x4 (OMT) 13059667841 Prom: YANELIS Martinez To: mouth k e -h plumbing Page 6 of S 2014-01 -27 17:14:23 (G3MT) 13069567941 Prom: YANELIS Martinez ACC DAaE tlae�DaYYVt �,�, . CERTIFICATE OF LIABILITY INSURANCE D1Pt3114 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAVION ONLY AND CONFERS NO RIGHTS UPON THE CERTIR E HOLDER. THOS. CERTIFICATE DOES NOT'AFFIRNHATNELY On NEGATIVELY AMEND, ExTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF•INSURANCE DOES NOT- C0NSTITUTE A CONTRACT BETWEEN THE.ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE. OR PRODUCER, AND THE CERTIFICATE HOU ER. IDAPORTANT: the certifocat9 holder Ilan . INSU ER the piol"Ies) must be endorsed. if 4LIB ROGATION IS. , VED, WA*Wt to the terms end canditlons of the policy, cWUIn PQIICWS may Iraghire an SMOMement. Aslsientent on aft cerdflsefe does -not:confer d>hts to the' totklffcate holder In Bee of such Oulowantent(s). PROFUtR YANELIS i QARi FNiEZ Uniwistet Insurance- Little Hwam P" 88) 953••5338 (786 63-7MS 2810 NW 7•st yrnarit ul�> tit&IrttwrartCe.( Ye Mlarrti, FL 33128 INt:URE MASI- PltOrt9 "953.5338 Fah( 9&% -7029 I M A : GRANADA @+ISi1tRANtCE CO RMREO I IEJSFNESS FIRST iN%tRAr.�cE CO SOUTH BEACH PLUMBING CONTRACTOR INC • 11OURERG: 5728 SW 3RD STREET MAM, FL 33144. (788) 337 -152 INSURER t: DE PTM OF OPC-RATIONS F LOCA'nONS I VEACi S {Reach ACOIffi hat, i Sdksdule.'8P epees is raquHetlt Miami Sharv&Vilfta BukIM9 Deparltwt 10050 NE 2 Ave. Miartd Shore's, FWda 33138 AC03ttrl 2S (2010M) OF SHOULDANY'OF THE ABOVE DESCRIBED POL1C10 BE CANCEI I BEFORE TM EXPIRATION DATE THE MF. NOTICE WILL BE DELIVERED IN ACCORDMCE WITH THE POLICY PROVISIONS, RD CMP40PATIOR All rights reserved. The ACORD name and We wu registaa W nuft of ACORD nisu�ta r= COVERAGES CERTIFICAtTE NUMBEk HiIMSION NUMBER:' THIS IS TO CERTIFY THAT THS PouOtEs OF INSURANCE iiSTEi3 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED WVE FOR THE - KUCY•PERIQD INDrATED. NOTWITHSTANDING ANY REQUJIiEM[ENi'T; TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OJ R MAY PERTAIN, THE INSURANCE AFFORDSD. BY THE POuctES DESCRIBED HEREIN is EUBJF.CT ToAI.L THE TERms, EXCLUSIONS ARID 0014 01ONS OF'SUCH POLICIES. LIMrrS SHOWN MAY HAVE BEEN R�fCEO BY PAID CLAMS. I tt PE4Pi1�uAANCE tNi$R itAlGt ...,...._ CY utarts A ceRAa LlaeatTY GOt1IMERS.tALGt3NE1tALttA6®RY ❑� ❑ GL rs -nAaa� ®orcwt ❑ GEWLAGGREaATE LWTAPPM PM. ® POLICY ❑ t ❑ Loa. OISSFLOD032818 01109V2014 01/09!201 5 RRENCE r! 1, ,oaD.DD I�ISES1EaoccuO MEDeXP m,e s !IW,00D.00 a 5,000.00 PERSONAL &ADV INJURY N 1,000,000.00 OEM—StALA GATE s 2,000,000.10 PR00U=- CcMpj0PA06 B 2,000,000.00 >Q Alt' ON09E,L tJAWd1Y ❑ ANYAUTO ❑ AAil@VED ❑ SC dE)lED ❑ HMAUl•08 ❑ RtfT( CEO Ott BODILYR&IURY(P&fpen -wM) $ SQDL*1NJURY(Petacd(I�tt S• R t $ ® UMBREIIA WAD ❑ OCCUR EXG>l3 we. 0 CtAWS.44ADE 0 EACH OCCURRENCE- �6 AGGREGATE DEO B WOFUCERS t:0&IPtr7J$A°DON AND EAPL0YM' I„ tAplt,` Y / M ANYPROPRE`MRiPARTNEIVEXECUTIVE ( In NM1 r~xCLUDEOa �sba' N � RAats w r A ._ 052137737 08131f2013 08V311P2014 AT U El 22" E'.LEACHAC PENT_ S E.L.D1SEASE -EA Et LDYB I 1.00b.000.00 E.L.O- �o`.ecY__cr ffi 1,�0,01p0:00 DE PTM OF OPC-RATIONS F LOCA'nONS I VEACi S {Reach ACOIffi hat, i Sdksdule.'8P epees is raquHetlt Miami Sharv&Vilfta BukIM9 Deparltwt 10050 NE 2 Ave. Miartd Shore's, FWda 33138 AC03ttrl 2S (2010M) OF SHOULDANY'OF THE ABOVE DESCRIBED POL1C10 BE CANCEI I BEFORE TM EXPIRATION DATE THE MF. NOTICE WILL BE DELIVERED IN ACCORDMCE WITH THE POLICY PROVISIONS, RD CMP40PATIOR All rights reserved. The ACORD name and We wu registaa W nuft of ACORD