PL-14-29t
•
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
/o r
JOB ADDRESS:
City: Miami Shores County:
Folio/Parcel #: 1! ° 2-or - 3 C' 2 /1 C93 r
Is the Building Historically Designated: Yes NO -" Flood Zone:
FBC 2� _�
Permit No. I. % L/ q
Master Permit No.
13 -2260
Miami Dade Zip: 33 4
OWNER: N a (Fee Simple Title of er : Phone #:
Address: et ,14,4 I/
City: // t' 2- A44 12 State: �l �sE '� w°° Zip:
i 3,K
Tenant/Lessee Name: Phone #:
Email: � 1 " r9.rk-\ L)V' N\
CONTRACTOR: Company Name`
Address: get
jetit, 4)6,Liactrl 61-44„,
•
2-
Phone #:
City: He/
Qualifier Name:
State Certification or Registration #:
State:
�' CL Phone #:
Certificate of Competency #: 49("'00/ 9' 3 /I
Zip: 33/6
Contact ene#^ -.® 2'�� Email Address:
DESI EIS: Arc tectlEngmeer:�c
ed et4'/ . 4-4.) 4► a ( t?41 i4,
Phone #:
Value b -Work for this Permit $ 3 Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ONew ORepair/Replace UDemolition
Descrption-a!k. —. r1- 60��t .: L was` -- , �
******** ** * **�* * * * * **** * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * ** * * * * * * * ** * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 3 () 0V Permit Fee $ i 226' x
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ I qD `S&
Bonding Compaiy'i Name (if applicable)
Bonding Company's Address
City State Zip
i
r
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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 attach r so, a certified copy of the recorded notice of commencement ust be posted at the job site
or the first inspection which y--curs s„,:9,-!n (7) y after the building permit is is'ued In tie absence r suck posted notice, the
inspection will not be apps ed ands einspef'o "ee will be charged.
The foregoing instrument was acknowledged before me this;:
day of
/
e or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
c
The foregoing instrument was acknowledged before me this Z
day of IDc' c , 20 13 , by Fre 1—
k ., RJ e: fe
who is personally known to me or who has produced
KATIA A DEMEIRE °
MY COMMISSIONS EE108882
EXPIRES Febnary 06, 2016
(401) 36153 FIsnWtlabir 54MaAan
NOT
• A
�Mmmission li EE 14" • '�
y Commission Expig30
November 14, 209
Print: / i-tri c i a
My Co
oath.
***** ***** ** ************************k**** ** ***************k*8****
APPROVED BY
- 1 Plans Examiner
Structural Review
(Revised3 /12/2012XRevised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
: ;� � • • 4A CEPERO
•cE141550
.rpgl.' v •. •• Expire()
.r .vember 14, 2016
Zoning
Clerk
■• •
LIE.E.NBE NUMBER
- ,
•••
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or
FROM (THU)DEC 26 2013 10:41/ST.10:40/No.6830187551 P 1
Accomr, CERTIFICATE OF LIABILITY INSURANCE
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.
°ATE imMIINIYYYY)
�••� 12/26/13
IMPORTANT: It the Certificate holder Is en ADDITIONAL INSURED, the polcy(Iss) must be Indorsed. If SUBROGATION IS WAIVED, subject to
the terms end conditions of the policy, certain policies may require an endorsement A statement on this cedill does, net confer rights to the
certificate holder In lieu of such endorsement(,). r PRIpDUOER
P8t Del Vea hlo Insurance Agency
263 N.E. 6th St
Homestead, Fl_ 33030
Phone (305)248 -9600
_A°T N ANGULO
M&6ri13: (305)246-9500 I . ti,„ (305)246 -9502-
pstdelVGdelvecch oins.00m
eiSugerrim AFF nnom comma
Fax (305)248 -9502 I INSURER A_ GRANADA INSURANCE CO
INSURED INSURER s : BUSINESS FIRST INS CO
Dial Plumbing Corp uNSU I
9940 SW 22 Street INSURER o;
Miami, FL 33165 (305) 221.8569 INSURER s;
INSURER F ;
I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
TrUS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD --7
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 SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 111E TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NAIC e
„..__. TYPE OF INSURANCE i _ - , POLICY NUMBER - ' EFF POLICY ESP
GENERAL LIABILITY
IM I ,.,,
II COMMERCIAL GENERA. LWBILrrY
A 0 ❑ ci. it ,.MADE lid OCCUR
0
O _
GENL AGGREGATE LOOT APPLIES PER:
POLICY ❑ Zi LJ LOC
AUTOMOBILE LIABiLiTY
�] ANY AUTO
❑ AAuYOps te0 ❑ SiErSDULED
HIRED AUTOS n NON.OWNED
❑ D
I I usente IALWB r' OCCUR
El EXCESS U L, CLAIMS -MADE
Fri—E'D U RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LtABIuYY Y I N
ANY PRQPARTNERIExECUTIVE
OFFIC E XCWUtD?
pdendatory In N$)
AUTOS
gym describe non � OF OPERATIONS Lwow
NIA
0186M00051833
521 -07379
EACN OCCURRENCE
MANGE TO RENTED
SERE SES (P.g . • • -.
MED ESP (Any one
PERSONAL a ADV INJURY
GENERAL AGGREGATE
6 1,000,000,000.0
6 100,000.00
6 5,000.00
s 1,000,000.00
6 2,000,000.00
PRODUCTS - COMP/OP AGO s 2,000,000.00
6
{ MB G6MIT
RI
BODILY INJURY (Per person) S
BODILY INJURY (Per ) a
•Pg e a
07/29/2013 07/29/2014
EACH OCCURRENCE
AGGREGATE
I-1 WC STATU- pTH_
S.L EACH ACCIDENT it 100,000.00
E.L. DISEASE - EA EMPLOYEE $ 100,000.00
E.L. DISEASE - POLICY LIMIT 6 500.000.00
$
5
S
S
DESCRIPTION OP OPERATIONS / LOCATIONS I VIDEGLES (Attach ACORD 10t, AeamcnaI Remailm Schedule, H mere some Is )
PLUMBING CONTRACTOR
CERTIFICATE HOLDER
VILLAGE OF MIAMI SHORES
10050 NE 2ND AVE
M IAMI SHORES FL 33136
ACORD 25 (2010/05) QF
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE PILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
S19864010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
iLc I3_�6�
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756 -8972
Inspection Number: INSP- 205433 Permit Number: PL- 1 -14 -29
Scheduled Inspection Date: June 10, 2014
Inspector: Diaz, Osvaldo
Owner.
Job Address: 62 NE 109 Street
Miami Shores, FL 33161 -7040
Project <NONE>
Contractor. DIAL PLUMBING CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1121360110350
Phone: (305)221 -8569
Building Department Comments
RENOVATE 3 BATHROOMS AND KITCHEN ADD
LAUNDRY ROOM
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
v-aA
C'f
ott
June 09, 2014
For Inspections please call: (305)762-4949
Page 5 0145