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PL-13-2766a76 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210962 Permit Number: PL -12 -13 -2766 Scheduled Inspection Date: April 17, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: WALKER, MARK & PATRICIA Work Classification: Addition /Alteration Job Address: 237 NE 100 Street Miami Shores, FL 33138 -2418 Project: <NONE> Contractor: LUIS QUALITY PLUMBING tsunamg oeparltment comments KITCHEN REMODEL REPLACE SINK AND FIXTURES Refrigerator ICE SUPPLY Phone Number Parcel Number 1132060134670 INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP - 204265. Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 16, 2014 For Inspections please call: (305)762 -4949 Phone: 305 -553 -7155 Page 29 of 30 1 I � J 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: (3057 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING DEC 1­4 2013 FBC 20 Permit No. P C 1 c2) °'d"7 66 Master Permit No.o? 763 JOB ADDRESS: tSj P T 10 'S "r0 kj) 1 64kbi� °33 i'3 7.) City: Miami Shores County: Miami Dade Zip: !_-�2 3 1-2",b Folio/Parcel #: ( I -- 1"2D Is the Building Historically Designated: Yes / Flood Zone: OWNER: Name (Fee Simple Titleholder): z�L,4 "Cl P kz_l_ � Phone #: — lel ®, j.,5 2'0 Address: -02 1-1 1,4 l&o cg-. M l Arri 1 4 4% city: tt 1 PO-4 k Z'I i State: 4k_.1 Tenantlessee Name: Email: CONTRACTOR: Company Name: a;,5 U ti aG 6. /,/z- Phone #: % A. ° 02 J 6' Address: �9 <lcr All / ..r 2 G ? City: � -State: /' /oa Zip: Qualifier Name: Phone #: 7X .2 J% 2 Z % State Certification or Registration #: U 2 O J Certificate of Competency #: Contact Phone #: 2 r(e= 2 P(:� 2 z ID Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ —20o,, Type of Work: _❑Address .s _ ❑alteration, 0 Woiki ".u9f uare/Linear Footage of Work: "k?J A ,- r/!- //_ ❑New (/�� p {{p��► �URepL/aair1/�Replace /,��/�-A� rte¢ ❑IDeemmm000liti //ion l 1 �' - P O V d e7 V" — `I V t Submittal Fee $ 010 Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ l L C-16 Bonding Company's Nagle, {if applicable) _ Bonding Company's Address City State Mortgage Lender's Naine­(if applicable) Mortgage Lender's Address City State zip zip , I • t 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 absencgi of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �� Signature 4tict Owner or Agent The foregoing instrument was acknowledged before me this day of t)h C ,,.520 t >, by PA—Id cC fa- (/A-W-rd , who is personally known tome or who has produced i"OL-40—D The foregoing instrument was acknowledged before me this day of , 20 _, by , who is personally known to me or who has produced As identification and who did take an oath. as id tification ho did take an oath. NOTARY PUBLIC: \�������a�' p,,y NOTARY P C: °8`�l! ��' Sign:G ' Sign: Print: [. CA i 5 P&r nCt,,�.� _ �o : `9! �9 �o ~ = P My Commission Expires: i '1 ®�✓• � My �y'• :!'UN -State of Fiaida icy COMM. Ei pims Jul 7, 2018 Ualad �'��Itflll1{111���\ Commission # EE 182641 �' ieat`z,� 8o�edThrough National NolaryAssn. 4rk4eY4esY�Y4r4rYakak& 3eFraY�Y: Y�Y3ek3e& 4r��Y4rsYs+ e4edeoY3c3e�Y�Y�Yk3: �: R3e����Y3eic &9nY &Yk9FYY�YY�sYk &��Y aY 4e4e�Y�F�Y�Y9e� APPROVED BY ( L Yor-0 Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09) "'O' CERTIFICATE OF LIABILITY INSURANCE r DATE(MIWDDIYYYY) 12/09/13 - - - -- -------------------- - - - - -- - - - - --- -- 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 poll cW- es) must be endorsed. If SUBROGATION -IS--W- S 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 CONTACT -- - - _ First Class Insurance Market PHONE t _(305)441 -2997 A C No ; 305 1 -6443 C E -MAIL @ - - -- - -- - - (_ _. )441 __...._. 4101 NW 9th Street E-MAIL fcimc aol.com Miami, FL 33126 — - - - - -- __. _I INSURER(S) AFFORDING COVERAGE NAIC 0 Phone (305)441 -2997 Fax (305)441 -6443 INSURERA: WESTERN WORLD INSURANCE COMPANY INSURED INSURERS -- - - -- -- -- - - LUIS QUALITY PLUMBING INC. INSURER C: 245 NW 59 COURT INSURER D :_ -. _— MIAMI, FL 33126 IysuRER.E: _____ _ _ _____ -- - . -------- ---- --- - - -- -- ----------- .. -._ - -- INSURER F;- ------ _----- - -- -__ __-_ - - -__- -- - --._. .._. -_ COVERAGES CERTIFICATE CERTIFICATE NUMBER: _ _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INS_ URED 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. _ _ _..--- -- .- ,-- -- i GENERAL LIABILITY I EACH OCCURRENCE i $ - 300,000.00 d❑ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 _ PREMISES (Ep occurrent .0) $ 100,000.00 - ❑ ❑CLAIMS -MADE 0 OCCUR I I NPP1365799 j 10/18/2013 MED EXP (Anemone person) $ 5,000.00 1 10/18/2014 i ❑ - - - -- -- I PERSONAL 8 ADV INJURY $ 300,000.00 - ❑ _ -_ -, j GENERAL AGGRE_GATE $ 600,000.00 -- - -- GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP /OP AGGi $ 300,000.00 POLICY _0' PRO- a _LOC _ r- - —. _ .. . ---- -- - - -- -.- $ - -- - AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT Ea accAen )- - -_ _ =BODILY INJURY (Per person) $ ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS —. -. -- - -- -- BODILY INJURY (Per accident $ NON-OWNED ❑ HIRED AUTOS ❑ AUTOS PROPER DAMAGE Per apcintj _ - - - -L. $- .. ❑ UMBRELLA LIAR ❑ OCCUR EACH OCCURRENCE $ I ❑ EXCESS LU1B ❑ CLAIMS-MADE j AGGREGATE - ( $- - -- - ❑ DED ❑ RETENTION $ - -- - -i -- -- -i - -- - $ f - WORKERS COMPENSATION AND EMPLOYERS LIABILITY WC STATU- F--1 OTH F--1 ZQRY_ 1,1.M Eft YIN I ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? j (Mandatory in NH) El I NIA I _TS_ ; __ E.L. EACH ACCIDENT $ - - -- - - - -- - If yes, describe under _DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ i I INS R: TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR - -- SR.ylf1<D� POLICY NUMBER-- ____ -- MM/DDIYYYY MMIDDIYYYY LIMITS A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, FLORIDA 33138 ACORD 25 (2010/05) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE *HE -E* ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANV&WITH THE POLICY PROVISIONS. ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N STATE OF FLORIDA DEPARTMENT OF BUSINESS AND .PROFESSIONAL REGUL.ATIOP t CONSTRUCTION INDUSTRY LICENSING BOARD RF0037aos The PLUMBING'CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, Z. 5. ((INDIVIDUAL MUST MEET ALL LOCAL LICENSING. i� =ml tIRFMENTS PRIOR TO : C.O.NTRACTIN IN ANY AREA] CT C CondmioWn Tred� Qu�INying Board SINESS CERTIFICATE OF COMPETENCY 04P00000s As quA- L,ITY PLUMBI, i11tC B.A.; .. .. IS DOMINGO 245 ANY 58 CT Tl�I K i