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PLC-14-504Inspection Worksh ee N Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209018 Permit Number: PLC -3- 14-504 Scheduled Inspection Date: April 03, 2014 Inspector: Diaz, Osvaldo Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9099 BISCAYNE Boulevard BURGER WIWI Miami Shores, FL 33138- Project: <NONE> Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110040 Contractor: TOTAL PLUMBING AND CONSTRUCTION II, LLC Phone: (407)435 -9807 Building Department comments ADD ADDITIONAL FLOOR DRAIN TO EXISTING FOR POSSIBLE FUTURE EQUIPMENT ADDITION. INSPECTOR COMMENTS False April 02, 2014 For Inspections please call: (305)762 -4949 Page 13 of 32 Inspector Comments Passed ER� Failed e,3 Correction Needed ❑ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 02, 2014 For Inspections please call: (305)762 -4949 Page 13 of 32 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 10 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 9099 Biscayne Blvd FB 1" LO( 1 I �-6 Permit No. i Master Permit Nom^^^^ . City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11- 3206 - 011 -0040 Is the Building Historically Designated: Yes NO NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Shore Square Properties Phone #: Address: 695 NE 125 St. City: Miami State: Florda Zip_ 33161 Tenant/Lessee Name: Burger I-ing Phone #: Email CONTRACTOR: Company Name: TOTAL PLUMBING AND CONSTRUCTION II LLC phone#: 407 - 435 -9807 Address: 1725 JESSAMINE AVE City: ORLANDO State: FL Zip: 32806 Qualifier Name: JASON SMITH Phone #: 407 -435 -9807 State Certification or Registration #: CFC1428063 Certificate of Competency #: Contact Phone#: 407 -435 *'9807 Email Address: DESIGNER: Archaect/Enginecr. Phone #: Value of Work for this Permit: $ 2,250.00 Square/Linear Footage of Work: 61 Type of Work: ❑Address DAltcration ❑New ORepair/Replace ❑Demolition Description of Work: ADD ADDITIONAL FLOOR DRAIN TO EXISTING FOR POSSIBLE FUTURE EQUIPMENT ADDITION. Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $J "j , 5 it. H Bonding Company's Name (if applicable) Bonding Company's Address City State Zip _I Mortgage Lender's Name (if applicable) ! Mortgage Lender's Address City ' State 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 i? Signature Owner or Agent The foregoing instrument was acknowledged before me/ this day of 20 A, by 4 A U4-n , 0'il , who is personally known to me or who has produced As identification and who did take an oath. NOTARY # FF 032722 2, 2017 soo�ama Sign: Print: G �' My Commission Expires: ( Contractor 1 The regoing instrument was acknowledged before me �this 'F day of N , 20 ,14 , by who is personally known me or who has produced as identification and who did take an oath. APPROVED BY "� �' Plans Examiner Structural Review (Rcvi-u:d3 /12/2012)(Revised 07 /I0 /07)(Revised 06110 /2009)(Revised 3/15/09) PUBLIC: Sign: Print: My Commission Expires: NOTARY PUBLIC STATE OF FLORIDA d' Comm# EE1470M 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 FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. XX COPY OF QUALIFIER'S STATE LIC CARD B. XX COPY OF LOCAL BUSINESS TAX RECEIPT C. XX COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. XX COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) 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: TOTAL PLUMBING AND CONSTRUCTION II LLC BUSINESS ADDRESS: 1725 JESSAMINE AVE CITyORLANDO STATE FLORIDA ZIP CODE 32806 BUSINESS PHONE: 4c o7 ) 435 -9807 FAX NUMBER 4t 07 ) 362 -9425 CELL PHONE 4( 07 ) 218 -1326 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: CFC 1428063 E -MAIL ADDRESS OF APPLICABLE): Created on 3M9109 BY MLDV 1 RV MOB MLDV JASON SMITH 0 STATE OF FLORIDA " DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET eoD ws q TALLAHASSEE FL 32399-0783 SMITH, JASON JAMES TOTAL PLUMBING AND CONSTRUCTION II, LLC PO BOX 568671 ORLANDO FL 32856 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you bett( For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that Impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly, We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new licensel DETACH HERE STATE OF `DEPARTr MOPE; CFC14280614: CERTIF14�i SMITH, TOTAL (850) 487 -1395 DA AC# 6 25 3 9 4 5 OF BUSINESS AND OAT,,, p aREGULATION 1i8 f 0�1'a/,12 120052672 UCTION IS CERTIFIED under the provisions of ch.489 Fs Expiration dates AUG 31, 2.014 L12080703632 AC #6253945 STATE OF FLORIDA DEPARTMENT OF. BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ #L72080703632 !8107/20' 12 120052672 CFC14280,6?' `�5��` ,,fj1.. The PLUMBING CONTRACTOR :�'`,` "AP '�\ �•1 I Named below IS CERTIFIED Under the provisions of Chapt�' 1 i Expiration date: AUG 31, 2014 H j' ,a �'d :_` SMITH, JASON JAMES TOTAL PLUMBING AND CONSTRUC'T?D�rf +t-1 :, rtT;LC' 1725 JESSAMINE AVE ,r_ ,,,;,,, },i,�•.. _••,.` ORLANDO FL 32806 �'r` RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY -LAW 'SC)C_'j Se its local business tax receipt is in addition to and not in lieu of any other lax required by law or municipal ordinance. Businesses are subject to regulation of zoning, health an(l otter mful authorities. This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty Is added October 1. ** *ORIGINAL * ** 2013 EXPIRES 9/30/2014 50001057211 5000 BUSINESS OFFICE $30.00 1 EMPLOYEE 1801 CERT BUILDING CONTR $30.00 1 EMPLOYEE 1803 CERT PLUMBING CONTR $30.00 1 EMPLOYEE TOTAL TAX $90.00 SMITH JASON JAMES PREVIOUSLY PAID $90.00 TOTAL DUE $0.00 TOTAL PLUMBING AND CONSTRUCTION II LLC SMITH JASON J P O BOX 568671 ORLANDO FL 32856 -8671 1725 JESSAMINE AVE (MOBILE) U - ORLANDO, 32806 PAID: $90.00 099- 00579534 7/10/2013 cott Randolph, Tax Collector Local easiness Tax Receipt Orange County, Florida tis local business lax receipt is in addition to and not in lieu of any other tax required by law or municipal ordinance. Businesses are subject to regulation of zoning, health and othe Nful authorities. This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty Is added October 1. ** *ORIGINAL * ** 2013 5000 BUSINESS OFFICE $30.00 1 1803 CERT PLUMBING CONTR $30.00 1 TOTAL TAX $90.00 PREVIOUSLY PAID $90.00 TOTAL DUE $0.00 1725 JESSAMINE AVE (MOBILE) U - ORLANDO, 32806 EXPIRES- -- /3Q1.2Q14 41 JC . BUILDING CONTR T .EE`!--- -`\ ('fA PAID: $90.00 099- 00579534 7/10/2013 This receipt is official when validated by the Tax Collector. 5000 - 1057211 $30.00 1 EMPLOYEE JASON JAMES TOTAL PLUMBING AND CONSTRUCTION II LLC SMITH JASON J P 0 BOX 568671 ORLANDO FL 32856 -8671 AMERI13 OP ID: LS T CERTIFICATE OF LIABILITY INSURANCE o 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 terns and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certifleate holder in lieu of such endorsement(s). PRODUCER: Phone: 770- 512 -5000 Brown & Brown Ins. of Georlits Fax: 770412 -5050 3463 Satellite Blvd, Suite 10 Duluth, GA 300M Clay Collins NA c FACT Tara Denning PHONE .770 -512 -5037 FAX No): 770412 -5050 E-MAIL tdonningMbatlantaxom INSU AFFORDING COVERAGE NAIL A INSURER A • Travelers bMmnatty Co 25658 INSURED Ameritech Services, Inc. 1500 Airport Drive Bell Ground, GA 30107 INSURER B: Great American Insurance Co 16691 INSURER C : Travelers Prop of America 2567,4 INSURER D : PREMISES EaocWTW INSURER E: MED EXP (Any one person) IN F: PERSONAL & ADV INJURY nwr_=0 f-=0' iCV_AT - AEI IMIRFR- RFVLSION NIIMRFR- 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 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. m TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER POLICY EFF E>B+ LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSAWE Fx� OCCUR X Miami Shores, FL 33138 DT4O-0D0737174ND•13 03J1112013 03N112014 EACH OCCURRENCE $ 1,000, PREMISES EaocWTW $ 300, MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000, JEMP Ben. $ 1,000, C AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED X AUTOS NON-OWNED X HIRED AUTOS X AUTOS DT410- =737- TIL -13 03/11/2013 03111/2014 ECOMBINEDSINGLE LIMIT $ 1,000, BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY B $ B X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X U025594701 03111/2013 03/11/2014 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 51000, DED X RETENTION $ 100 $ C WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETORIPARTNER/IXECUTrVEY� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OOF OPERATIONS below NIA TUB- fm07971 -7 -13 03111/2013 03N1t2014 X , WC STATU- O R LMr E.L EACH ACCIDENT $ 1, , EL DISEASE - EA EMPLOYE S 1,000, EL DISEASE -POLICY LIMIT $ 1,000, C Hired Physical OM Short Term 5082690038 03/11/2013 03/11/2014 Comp Ded 1, Coll Ded 1, DESCRWTMN OF OPERATIONS I LICAT[ONSI VEHICLES (Aftaoh ACARD 101, Additional Remarks Schedule. I more space Is required) 00 �)a� (2g r`CGTICIf -ATE unt nFR CANCELLATION --- -- --- - - - - -- - - - -- MIAMISI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg Dept 1005 NE 2nd Ave AUTHORIZED REPRESENTATIVE „ Miami Shores, FL 33138 „ A % V 1958 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD P?