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PL-14-748Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214866 Permit Number: PL -4-14-748 Scheduled Inspection Date: June 30, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: GLINN, MacDAM &DENISE Work Classification: Addition/Alteration Job Address: 1201 NE 102 Street Miami Shores, FL 33138- Phone Number Project: <NONE> Parcel Number 1132050250160 Contractor: ACTION PLUMBING OF MIAMI INC Phone: (305)278-6900 tsunamg uepanment comments REPLACE ALL PLUMBING IN KITCHEN AND ADD Infracti° Passed Comments PROPANE GAS LINE FOR NEW GAS RANGE INSPECTOR COMMENTS False nspector Comments Passed DY CREATED AS REINSPECTION FOR INSP-210862. no one home Failed ❑ �� Correction ❑ � � `� Needed Re -Inspection 0 Fee No Additional Inspections can be scheduled until re -inspection fee is paid June 27, 2014 For Inspections please call: (305)762-4949 Page 21 of 35 DROP TEST REPORT Date: June 12, 2014 Name: MacAdam Glinn Address: 1201 NE 102 Street Miami Shores FL 33138 Water Column: 14 Duration: 1 hour 0 -� ❑ Failed Signature: kI,, t , C, tk/yv? Notarize Here PO Box 900067 Homestead FL 33090 Phone: 305-278-6900 Email: actionplbg@aol.com CFC 1428021 Date: &Z 13 lel Miami Shores Village j 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 1: ArK 10 211,114 FBC 20 10 Permit No. P� % (-iy Master Permit No.9•C 14 JOB ADDRESS: 1401 1%11E 10.E &A • S . - City. Miami Shores County: Miami Dade Zip: Folio/Parcel#: 3 �L 0 0 4f, 0 Is the Building Historically Designated: Yes NO Flood Zone:. AZ / A /� p� �� : sem- � 1 a. 99.)L S0 6 0 OWNER: Name (Fee Simple Titleholder): t ltir_ �tY ccs (� �d Phone#:_7,®i Address: 1 ® O 4 fi City. li" L + a � , _( % State: 1 319 f TenanvUssee Name: ?,j A Phone#: NIZA Email: e-.,4 CONTRACTOR: Company Name: S% a r./� — hone#: -SOT 6 00 Address: \ 1aC ;e a 00 ®C�i ��t C ,.� o ��1 e°�� l �-. • , r�L City: SkO OL i State: F Zip: 3 ® C Qualifier Name L Phone#: '77 k -SSS d1o^ c. State C'ertificationior Registration #:! G.�� % C cate of Competency #: Contact Phone#: t �% �'�q 61 Email Address: L IL DESIGNER: Architect/Engineer: C�j rkk— 0 V c.� O S, Phone#: 3b!� Value bf Wu;foY this Perm$" ®� /iit: Sgnare/Linear Footage of Work: o { Type 04, "�Vor Ac cjress:` g*tefaft�orr-,, ONew l 4epair/Replace ODemolition � ` " Descri tion of Work" " �e' A `91 � c e J �Q Y'�.. - ISG ., p �� u��u�,��•x��,��x��r��Fees��r��x,xu��,��,r�u�,��,��,u�u��ru Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ r TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) C IL Mortgage Lender's Address City S State I% L 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 vyhich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be qproved and a reinspection fee will be charged. Signature. Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 k Q by m of (A � L ► c�ui , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 9680 My Commission Expires: �"� WIRES: $Qa 014 EXPIRES: April 19, X14 Bonded Thru o urns v Signature Contractor The foregoing instrument was acknowledged rL 20 before me this da ,by wl_01�1 C who s personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print:'r 64 0114'tt. My Commission Expires:,O'! ':.,�•o J. CWAQETTA * MY COMMISSION#EE 840819 EXPIRES: February 4, 2017 r"'0a,ao�°� Bow ThruBudgdNowysrkm APPROVED BY (,K I Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) INSPECTION RECORD STRUCTURAL INSPECTION DATE INSP Foundation Stemwall Slab Columns 1 st Lift Columns 2nd Lift Tie Beam Truss/Rafters Roof Sheathing_ Bucks Windows/Doors Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Ca Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA corn liance DOCUMENTS Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS Final Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Under round Footer Ground Wall Rough Ceiling Rough Rough Telephone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With 03/28/2014 15:21 FAX. 11003 CERTIFICATE OF LIABILITY INSURANCEDATEIMMINYM) THIS CERTIFICATE is IssUED AD A MATTER OF WORMATION ONLY AND CONFERS NO RtQM TKA THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFO MATNOLY OR NEGATIMV AMEND. EXTEND ON ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT MMM THE ISSUING INSURER($), AUTHORIZED REPRE89NTATIW OR PRODUCER, AND THE CERTIFICAT9 HOLDER, MWORTANTI K the clot call holds h an AD INatiltED. the p eliey(lea) eturet ! lndorsec#. B lUIRROGATION N WAIVIA M&P W to the !!rens and co/nttyons of the polley, Csrtaln polk s may require m aRlone MmL A statement on Ods esrdflcate does trot colla rights to the certtticAe holder In lieu or such sndarowneht(s). PRouvCt R WPOUTO ROMANO Br1sr Bay Insure me A@aloy(_*51251-.5W x51 •q47 14229 S DWS HM7 IlrewarmQbrlarwm4n arm=s n Nsulo Epr a APfORDg10 CDVlRAO MAIC e Mi ml, FL 33176 Pham 251 -SM Fax 2614)947 GRANADA INSURANCE COWANY 1NSWeso A01ION PLUMBING OF MIAMI INSURER o Im 18648 $W 104 Avs INAWM S., MIAMI, FL 33157- (305) 2784M s 100,000.00 �a om tion s 5,000.00 PERSONAL s My, INJURY i 000 000.00 R COVCRAt3F.S GBRTIF(CATE; NUM130tt REVISION NUMBER: THIS Is To MRTIPYIMT THE POLI=8 OF INsURANCE LISTED BELOW [PAVE SMN 18SUED TO THE INSURED NAMW AHM FOR THE POLICY PERIOD A HO INDICATED. NOTWITFISTANDWG ANY REQUIREMENT. TERM OR CONDITION OF ANY COWRAOT OR OTHER DOCUIMIENT WITH RESPECT TO WHICH THIS 017E MAY BE 13UM OR MAY Pec TAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SIMMOT TO ALL THE TERMS, gCCLUSKM AND CONDITIONS OF SUCH POLICIES. Lwrs SHOWN MAY HAVE 9M RED(IM BY PAD CLAM, TYPE oP LN RANC!! D kuArs<fll LIMITER 05MMAL MAIRL" 1000000.00 A ® commmtouLGmmmumutY 0 ElCLAIMS�ma 52 occur! ❑ N 01SSFL0003I5489 04/1412013 04H4/2014 s 100,000.00 �a om tion s 5,000.00 PERSONAL s My, INJURY i 000 000.00 OR4w . ACCRecAI s 2 000 WD.DD PRoDL)=.ccwmp ACG s 2,000,000.00 OWL AWREGATE UWAPPLU PM P sy- ❑ ❑ LOG i IWTOMOMLEUASILITY U T Q Aw Avro ORM � gGH ❑ AU ❑ AvreSa ❑ MW AUTOS ❑ RODdY INJURY (Wt {Noon) i SOMY NAM F* eddsnt} i MEP a s waeRaLuuae ❑OCCUR axcaas LllldCLAIMSWM kACKQCWRRENCE i ACORMATIF i NTION 5i WORKMW ~190ATM ANO RMPLOYE W Ll"JurY YIN MOSEX E ❑ (m.."am to Nw,d.r Ro .`R ioNOP oPGw�Ums bdow WC 3rATU. B N / A EL. EACH ACGOENr = E.L. 018EAIM. EA EMPLOYE: S E.14saw.PaJCY Unit $ D5601119110M OPWWRATiON91 LOCATIONS I V4NICLss 1Atdon ACORD 501, AdeG(ioMd RepMHI+aalfatlule, a mans epaem !• rpcddrsef PLUMBING GERTiFtG TE _ fAER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 1WW NE 2 AVENUE* MIAMI SHORES FL 33138 ACORD 26 (2019186) QIP "UW ANY OF THE ABOVE 0E111CRIBEO POUCILB N'1E CAWELLED mWoRB THE WtP(RMVON W1TE THEREOF, NOTION WILL BE DEUVERW IN AOCORMAW A WITH TWE POLICY PAOV01ONs. IPP'OLITO ROMANO Thi'ncan. �o CORPORAMON. All Tiphta mverved. WOO an rsgb* W marks o(ACORD 03/28/2014 15:44 FAX 0 002 f Y JEFF ATWATER CHIS FINANCIAL OFFIMR STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICE:$ DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERV COMPENSATION LAW • • CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the Individual listed below hags elected to be exempt from Florida Workers' Compansadon low. EFFECTIVE DATE: 3/28/2014 EXPIRATION DATE: 3/27/2018 PERSON: COLLINS HARLIN FEIN: 550121782 BUSINESS NAME AND ADDRESS: ACTION PLUMBING OF MIAMI 18545 SW 104TH AVE MIAMI FL 33167 SCOPE$ OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pun wa to Chapter 440.08(14). F.S., an ollicar of a Corporation who alert awnplion from va dwpter 4Y"a oerallcato of slect{on under thla wclon msy not rewysr baraQ6F or pgrnpsnaa8ee under Utla dmptar. Porsuam b aMOW 440.08(42), F.S.. CNINICRtae of alsotimo to W sxempf... apply"WWn dm amp& of the trualnsas or trod• fisted *4 the natlre o1 ataclhm to be sxampL Purnnnt to ChOW 440.08(i3� F.S., Nodosa af alecdon to be exempt arxt owafl w" of elaction to ba exempt •hell bs aubleet to rwooa0on M, aH +r1Y tbna alter tlu AHnp of the notlCs or the tauanCe or the CeefNtCafa, the person named on the rrodos a ow0cste no k*W meat• the raqutrenenm of 11113 section for 1sMarm of a aallfi ML The depWVrWR atraY revoke a certHicats d ally tans for f0ours of Vw person named on ttn cstt bde to meet UN Noftw" to of this Motion. DFS-F2-DWC 252 CERTIFMATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1 ON ' '�"� CERTIFICATE OF LIABILITY INSURANCE DAT TYPE OF INSURANCE 04/15D/YYYY) 04/15/14 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. 0 SUBROGATION IS WAIVED, subject to the tamha 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 endomement(s). PRODUCERCO Briar Bay Insurance Agency 14229 S Dixie Hwy NT NAMEACT )ppOLITO ROMANO PH NE , (305)251-5546 FAx No • (305)251-9947 L Insurance@briarvWnsurance.com INSURERS AFFORDING COVERAGE NAIC C Miami, FL 33176 INSURERA: WESTERN WORLD INSURANCE COMPANY Phone (305) 251-5546 Fax (305) 251-9947 INSURED INSURER B; INSURER C: ACTION PLUMBING OF MIAMI INSURER 0: 18545 SW 104 Ave INSURER E: MIAMI, FL 33157- (305) 278-6900 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOWNED ❑ SCHEDULED ❑ AUTOS HIRED AUTOS ❑ AUTOSWNED ❑ ❑ INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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. INSR TYPE OF INSURANCE ADD UBO POLICY NUMBER MMOLICY EFFYYM PLDICY LIMITS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE 0 OCCUR ❑ N JOGGR-N 04/14/2014 04/14/2015 EACH OCCURRENCE $ 1,000,000.00 PREMISES ( DAMAGE TO aaENTED $ 100,000.00 MED EXP (Any one $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ SET ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOWNED ❑ SCHEDULED ❑ AUTOS HIRED AUTOS ❑ AUTOSWNED ❑ ❑ SINGLE LIMIT Ee acci en � BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ P OPER AMAGE $ $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ B WORKERS COMPENSATION❑ AND EMPLOYERS' LUABILI Y Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yyea describe under DES4�RIPTION OF OPERATIONS below N I A WC STATU- O OTH- E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addidonal Remarks Schedule, K more space Is roqulmd) PLUMBING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATIVE ! IPPOLITO ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD