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PLC-12-2272Miami 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 JOB ADDRESS: ( LS' PAA-A. Ri 0 e, FBC 20 eI Permit No. Master Permit No. ;\ 0- 7ml t City: Miami Shores County: Miami Dade Zip: 3 3 13! Folio/Parcel #: t13 2.0(O NI 35-0 Is the Building Historically Designated: Yes x' NO Flood Zone: OWNER: Name (Fee Simple Titleholder): .0 t ti l Iv 1� , L • L C • Phone #: Address: G 4 GP/. �w scat_ City: V\ >Ct State: Ft.- In • Zip: 33 1 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: V 1X 1 t L. 4 4 ) 85C E Phone #: n . is -' S1e0 Address: / o4 *b A/ id / 13 c-1 City: M iddakt, 0 State: T/ Q'yt 4Q- Zip: 3317' M Qualifier Name: ( 6I t e.! 6 lViJ N Phone #: State Certification or Registration #: Certificate of Competency #: Zr X J/ )�1� rip 6.cifxie. lawtd F@.. cosA4 DESIGNER: Architect/Engineer: Phone #: Contact Phone #: 3037, .. /G -5-0-6/ Email Address: Value of Work for this Permit: $ C�J, 1? 0 Q o Square/Linear Footage of Work: Type of Work: ❑Address� —" � ❑�All-tyeration ❑New ❑Repair/Replace ❑Demolition Description of Work: 11ST _ 1 "(\ A- `'`� a Q..s ek � t a LL..) €.LC c sc-zd Lektv..3 eiLA C U..•\ Nil CV Pp *****: x******* *:x***************** * *** **Feed:* :**** *: x********* *:x:x**** ******* ****** * * * *** Submittal Fee $ Permit Fee $ 67 O ? CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 Z71:" ��% Biding Company's Name (if applicable) Bonding Company's Address City State Zip 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 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 b .c -1 ed. Pt Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _, by , day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Ca ''''''q. Yessica Ortega sCOMMISSION #EE 224097 '.1 2 'IRES:AUG. 09,2016 .AARONNOTARY.com as identification and who did take an oath. Y PUBLI Sign: Print: My Commissio ** * * * * * * * * * * * * * * * * * * * * * * * * ** ;; ************************************************ * * * *** ********* **** *** * ******** APPROVED BY Plans Examiner Zoning Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 (Ao D Inspection Number: INSP- 182974 Permit Number: PLC -11 -12 -2272 Scheduled Inspection Date: January 24, 2013 Inspector: Hernandez, Rafael Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project <NONE> Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Sprinkler System Phone Number (305)785 -8990 Parcel Number 1132060141350 Contractor: DIXIE LANDSCAPE CO INC Phone: (305)884 -5700 Building Department Comments NEW SPRINKLER SYSTEM Infractio INSPECTOR COMMENTS Passed Comments False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS RE I PECTION FOR INSP- 182274. January 23, 2013 For Inspections please call: (305)762 -4949 Page 12 of 26 OP ID: EA '`'k�,. -- RO' CERTIFICATE OF LIABILITY INSURANCE DA 11 27/1D 2 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 POUCIES 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 305- 270 -2100 FILER INSURANCE, INC. 305 - 270 -2195 9440 S.W. 77 Avenue Miami„ FL 33156 Mark A. Bluh CONTACT PHONE FAX INC. L. Extl: (NC, No): ADD�REESS: PRODUCER DWE03 CUSTOMER ID 0 INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED Dixie Landscape Co., Inc. Snapper Creek Nursery 12950 NW 113 Ct Miami, FL 33116 INSURER A : Allied P&C Insurance Co 42579 INSURER S:Bridgefleld Employers Ins. Co. 10701 INSURER C:Allied P&C Insurance Co 42579 INSURERD:Allied P&C Insurance Co 42579 INSURER E : 1,000,000 INSURER F : PREMISES (EaEoccurrence) CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 S_ UCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR', POLICY NUMBER -(MMM/DD/YYYTYJMM/DDIYYYY1 LNG A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR ACPGLP05905437134 XCU LIAB. INCLUDED BROAD FORM PD 04/01/12 04/01/13 EACH OCCURRENCE $ 1,000,000 X PREMISES (EaEoccurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 X Contractual PERSONAL BADV INJURY $ 1,000,000 (Blanket form) GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n LOG PRODUCTS - COMP/OP AGG $ 2,000,000 7 POUCY r i $ C C C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ACP5905437134 ACP6905437134 ACP5905437134 04/01/12 04/01/12 04/01/12 04/01/13 04/01/13 04/01/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ D X UMBRELLA L1 EXCESS LIAB X OCCUR CLAIMS -MADE ACP5905437134 04/01/12 04/01/13 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 0. $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPRROPRIETER EXRTNER E (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS Y N / A 0830 -22969 02/01/12 02/01/13 X TORY UMIT-S ER E.L. EACH ACCIDENT $ 1,000,000 CUTIVE N E.L DISEASE - EA EMPLOYEE $ 1,000,000 below E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule K more apace is required) CG7246(09/08), CG7323(11/11), AC0101A(03/08) , WC000313(04)84) Job: Dr. Reisch Office 9165 Park Drive Miami Shores, Fl CERTIFICATE HOLDER CANCELLATION I KENCO03 Ken Constantino Builders Inc. 221 W. Hibiscus Blvd #128 Melbourne, FL 32901 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE "/Jr,`/ /j /i ELENA ANDRES - A006035 ACORD 26 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD fu 5 QUALIFYING TRADE( 0003 LAWN SPRINKLER Chalks Danger P.P. Sweaty of the Board 4. • 342565- to BUSINESS DIXIE: RAW ANDSCA E� CO: IN 12950_ NW: 113 CT... ".. 33178 UNIN DADE COUNTY:... owNER DIXIE LANDSCAPE CO INC ::: FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS; NOT A BILL -DO. NOT PAY RENEWAL 'Icu 357750 -0 CC' #_ 95P000217 X196 SPE� ALTY • TIER: IS ONLY A LOCAL BUSINESS TAX RECEIPT. DOES NOT PEnE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING. LAWS OP THE COUNTY OR CITE. NOR DOES', 'IT. EXEMPT. THE HOLDER FROM ANY. OTHER PERMIT.. OR LICENSE RECURRED BY LAW. THIS Rl NOT A CERTIFICATION OP THE HOLDER'S QIMURCA- PAYMEN'RECEIYED MIAM .DADE COUNTY TAX COLLECTOR: . 08/17/2012 60000000481 000075.00 SEE OTHER SIDE WORKER /S PLUMBING:CONTRACTOR... .. 1 : DO NOT FORWARD DIXIE LANDSCAPE CO INC JEFF REAMER P 0 BOX 160328 MIAMI FL 33116 IIIIIIIIIIIIili ILll1Il1IIfltiilII Fi1:1*0UIll11II)1I1I1IIlIO2