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PL-14-215a A Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (306)795 -2204 Fax: (306)766 -8972 Inspection Number: INSP- 206657 Permit Number: PL -2 -14 -215 Scheduled Inspection Date: February 13, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: MARY ELLEN BENTON, DOUGLAS Work Classification: Addition/Alteration QADKICC Job Address: 10108 NE 1 Avenue Miami Shores, FL Project <NONE> Phone Number Parcel Number 1132060131660 Contractor: BOB'S PLUMBING CO INC Phone: 305 -229 -9932 comments REPLACE SECTION OF SANITARY DRAIN LINE UNDER 'nrraau° rassea toomments HOUSE AND SEWER OUTSIDE INSPECTOR COMMENTS False -inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 13, 2014 For Inspections please call: (306)762 -4949 Page 15 of 26 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 1 BUILDING PERMIT APPLICATION Permit Type: PLUMBING C - V FD BC 20 Permit No. Master Permit No. pL.1 4 9k F JOB ADDRESS: i 9 ( (D ls� 4-1 E-1Y u C City: Miami Shores County: Miami Dade Zip: 2, a t 3 C6 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 4 P'a, S Phone #:'30-S7' 'Ix-- �S 2 Address: I Q ( cc? �� AIA J� City: M c ,kN t State: f—L Zip: Tenant/Lessee Name: Phone#: Email: Address: Company Nam:n7 ��nL 0SS --1 City: °" l Qualifier Name: JS State: Zip: 3 3 I to S 5t o Phone#• 3O -T' 22-' -101 32 State Certification or Registration #C C 0 S S 4-?- 2— Certificate of Competency #: Contact Phone#: (e �° Z ' Email Address: �WA+ 13 Cg C-°J°'( DESIGNER: Architect/Engineer: Phonek Value of Work for this Permit: Square/Linear F�oo/tage of Work: ( 50 Type of Work: ❑Address ❑Alteration ❑New epair/Replace ❑Demolition Description of Work: —?, - S9— ' °mot C %-f —iSf. -� -Sgzcg�- Qkg7-So4 r:,- Submittal Fee $ Permit Fee $ A 1-5c), ® CCF Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ` �C) kj 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 A 19 Signature �5 Owner or Agent r7C� The fore oing instrument was acknowledged before me this 6 1 day o Ua/ , 20 ! 1-., by DI) ( 410 g0fl? -OS w s personally known to me or who has produced S" 2 l73 .l�5 !a� -b As identification and who did take an oath. NOTARY PUBLIC: Sign: y COmmi 'o fire%Wry Public State of Florida • Joanna M Fenc lano ' My COmmiaeion FF 082753 Expires 01/14/2018 Contractor The foregbingin aw*as acknowledged before me this day of Z +k , 2011, by -YO�l 11 C 6( o!5sf'r who is 04Ealli known me or who has produced as identification and who did take an oath. APPROVED BY I ° / "/ Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: `s,%y 1, F vin Print: Cf- f M2 My Commission Exp EXPIRES: NOV. 25, 2015 www,MxNNOTARYcom Zoning Clerk THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPM14TING LIMEMARK" PA'TtN'rCO PAPER, 6226:168 OF FLORIDA: cons Q C r i � 07 2.5 2012 128017263 CFC055672 = - mn.,, sr_nultarwr/3. NPi1 rt+D��TAA - - -- SCOTT SECRETARY TT LAWSON RICK S CK COT DISPLAY AS REQUIRED BY LAW OVVF460 SEC. VTPE OPMMNESO BARSPLOMBING CO INC 196 PC IURTMilifINTrtAM BOBSPLU -01 SSIMEON CERTIFICATE OF LIABILITY INSURANCE D 11122/20 11/22/2013 3 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 Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT NAME: PHONE SOS) 822 -7800 FAX Noll: (305 362 -2443 e E ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: Houston Casualty Company X INSURED BOWS Plumbing Co., Inc. 4055 SW 89th Ave. Miami, FL 33165 INsuRER 13: National Trust Insurance Co 20141 INSURER C:FCCI Insurance Company 10178 INSURER D: PREMISES Me ow 00I INSURER E: MED EXP (Any one person) INSURER F: PERSONAL & ADV INJURY COVERAGES CFRTIFICATF NIIMRFR! 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 CONTRACTOR 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY POLICY EXP STS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X X TEN13306 11128/2013 11128/2014 EACH OCCURRENCE $ 1,000,0 PREMISES Me ow 00I $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000.00 GENERAL AGGREGATE $ 2,000,00 GEWL AGGREGATE LIMIT APPLIES PER: POLICY X PRO LO, PRODUCTS - COMP /OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X H RED AUTOS X NON-OWNED AUTOS X X CA0022736 11/28/2013 11/28/2014 COMBINED SINGLE LIMIT Ea a.garft 500,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accderd $ UMBRELLA LUAS EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N OFFICER/MEMBEREXCLUDED9 F—] (Mandatory In NH) If yyes describe under DESCRIPTION OF OPERATIONS below NIA 001 WC13AS071 9/1/2013 9/1/2014 X WC STATT OTH- EIR E.L. EACH ACCIDENT $ 500.00 E.L. DISEASE - EA EMPLOYEE $ 500.00 E.L. DISEASE - POLICY LIMIT $ 500100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Ir more apace Is required) Master Permit #RC 10-259 Plumbing Contractor *10 Day cancellation for nonpayment of premium d%=0riCI1%ATI= unl n=17 1%ANCPI I ATIntU ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village 10050 NE 2nd Avenue THE E CE WLL BE DELIVERED IN ACCORDANCE WTH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD mt �IOZ 0 8A �golV9 ��C(Wvl s v� -t�� 1 s . v i AytoZ Sys sy � - ©•� � drr2 � VlHlg C74> v I h dr-174- a14djlb +;w.xad -7pvVT v►t,-09 +moo 100 p va-'�P5 wo. 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