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PL-14-422L Inspection Worksheet G Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214273 Permit Number: PL -3-14-422 Scheduled Inspection Date: June 18, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Owner: MIAMI PROPERTY SOLUTIONS LLC, U1AM1 00n0G01ry ani I ITif%ma 1 1 f` Job Address: 122 NW 110 Street Miami Shores, FL 33168-4321 Project: <NONE> Contractor: MG PLUMBING & SPRINKLER SERVICE Building Department Comments Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)344-6463 Parcel Number 1121360030.100 Phone: (305)525-9236 REPLACE TOILETS AND VANITY INTERIOR REMODEL I ' ' ' `"" �" "'"�""" INSPECTOR COMMENTS False y Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-208376. CANCELLED BY INSPECTOR ROLLED OVER Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 17, 2014 For Inspections please call: (305)762-4949 Page 17 of 26 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 MAR 0 6 2014 F'BC 20 Permit No. P/ ✓ L/ ^ z'&2 Master Permit No & l Z_/ !k& JOB ADDRESS: I Z_ 111. w- 1 lO-M* s7, -X6* City: Miami Shores County: Miami Dade Foho/Parcel#: Is the Building Historically Designated: Yes NO � Flood Zone: OWNER: Name (Fee Simple Titleholder): !'`'di (�ih,( ,`N ,� �) PuA L!� Phone#:.30 ,� �b-7 IlS- Address• 116 6 AJ. E. 1 !/70 city: )-V A04 S S State: Fe • Zip: 3� 1( I TenanVI-essee Name: Phone#: Email: 6T W_z h3.4 CONTRACTOR: Company Name: S v 01 61 ' Phone#: Address: �7 %(%C.c� ) �} S-- 24 City: Qualifier Name: State Certificatic Contact Phone#: 341-- $�� Email Address: DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 1_ is 5-6— c -O Square/Linear Footage of Work: Type of Work.Addres�. gAlteration ONew ORepair/Replace Description of Work: V1/LawA��.�� 5E] .3309 Submittal Fee $®• d�Z 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 $ ODemolition Bonding Company's Name; (if applicable) Bonding Company's' Address City State 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 afier the building permit is issued. In the absence of such posted notice, the inspection will not be appro d ang q reinspection fee will be charged. Signature Signature Owner or Agent el -Contractor The foreg ing mstrument was acknowledged before me this day of YkA , 20 (61, by who is personally known to me or who has produced The foregoing instrument was acknowledged before me this day of j*JA eJ,�- , 20 �, by -1— =77Q ,_._, ,4 , who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. APPROVED BY CE2t� .3-46,/-c f Plans Examiner Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 to Master Permit No. ?-(, - /qr LJ26 Sub Permit No. PL- /N -/K&2 - BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLICWORKS CHA CONTRACTO ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: I Zz_ l Ccs- City: Miami Shores County: Miami Dade Zip: 33161 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Jky. m- .6mm H su; rt -j Phone#:305- irro -YoY.- Address: I l 0 iJ • 6• / / / 5 City: State: Zip: 33t Tenant/Lessee Name: Phone#: Email: 51M Q, i'� i�l Al CONTRACTOR: Company Name: `/LS �Clscs�9/� � Fd�AC I/&_a Z��-,= Phone#:.�D.�� -� Address: / 2-C�' A-44,)- 2-4 City: 41WW r- e9AState: 7 Zip: �— Qualifier Name: State Certificath DESIGNER: Architect/Engineer: e#: Address: City: State: Value of Work for this Permit: $__5 1 Z-0 y Square/Linear Footage of Work: _ Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: i-tJt�..- Submittal Fee Scanning Fee $ Notary $ Permit Fee $ 42 ?. 5� CCF $ CO/CC $ Radon Fee $ Training/Education Fee $ DBPR $ Bond $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name ,3-ta" hcable) Bonding Company's Adgress City f State Zip Mortgage Lender's Name (if applicable) Mortgage Lenceds ddress I "I's 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 pe mit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONITIONERS, 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 reinspee will be charged. Signature Signatureor L Owner or Agent Contractor The foregoing instrument was acknowledged begin 2— day of �(,% , 20 by 1i1/4d 1A who is personally known to me or who has produced As identification and who did take an oath. The foregoing instrument was acknowledged before a this Z day of J(/X e . 20f by V u�,�° S P q G!�� who is personally known to me or who has produce as identification and who did take an oath. NOTARY PUBLIC: NOTARY ELIC: 4Sign: 1C.�f , 1-14, Sign: Print: 1Cx9 r-1. t( Print o.Ri My. °r mt gn Efblf3D0 IRIARTE My I E r SA a'e A n �� 1 'P MY COM d` 738 ,e MY COMMISSION #FF088738 ;ry�r EXPIRES February2.2018 EXPIRES February 2.2018 `" ^' "� oWa,. (407) 398.0153 FlorldMo Service.com APPROVED BY Plans Examiner Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) r• 4 2W Zoning Clerk Permit N. ! l - Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Owner's Name (Fee Simple Title Holder): - N' � l SOCA' %A-6 Phone #: 30 T' �-o - q'6 /Y - Owner's Address: 6 - XI)O 54 - City: �t: State: Tip Code: 3C�/ Job Address (Of where work is being done): I Z. Z iv -GJ- do /7-/ 51% — City: Miami Shores State,—Florida Zip Code: 313S - Contractor's Company Name: Pow Phone Add less: 1 24s` - 2-0 -2 City: State: . Qualifier's Name : r��-ca tA) v C-4� Lic. Architect/ Engineer of Record Name: Address: Zip Code: Number. C-t�-C- cb-6S Z-40 Phone #: City: State: Zip Code: Describe Work: Cz-) , (Z) )G = rs I -- /Z wi— i hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Mlaml.S s� r all legal Involvement. Signature ' Signature JJ oroihePor--Aged �:c�racGor orArdegd The foregoing instrument was akncwledged befo � 2 this day of �(/°�20 ,by Wdg— Who is personally known to me or who has produced as indentific ation. Notary The foregoing instrument was aknowledged- before me this JvAt day of ?= 20 I rby Jif who is personally known tom who has pmduced a as indentifiaft Notary Sign -vi °"T ' RICAPsOO IRIARTE ON MY COMMIISSI*FF085M Seal: �' EXPIRES February 2. 2018 [, MY COMMISSION #FF088736 e EXPIRES February 2. 2018 PSG Plumbing Service Inc. 3892 NW 125 Street Opalocka, Florida 33054 June 4, 2014 RE: 122 NW 110 Street — P T* ?L ! y' I Z.Z Miami Shores Village Building Depart: This letter service as a release of contractor for the above mentioned property owned by Miami Property Solutions LLC. Sin r y, 1 o zman, CEO STATE OF FLORIDA Subscribed and Sworn To (or affirmed) before me this Owner - Personally Known /orroduced ID Signature dNotary T day of ��i? , 20A Type of ID Produced: Serial Number Print Name of Notary Expiration Date Rafl tats of FloridaietoNotary Stampn EE1121022015 Policy Number. CA -24753 Date Entered: 9/21/2007 CERTIFICATE OF LIABILITY INSURANCE °ATvwm mv) 1 3/14/2014 THIS CERTIFICATE 18 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 cartif►cate hotder is an ADDITIONAL INSURED, the Policy(les) mast be endorsed. If SUBROGATION IS WAIVED, Subject to the tetras and conditions of the Policy, certain Policies may require an endorasmenL A statement on this Certi1'ioaW does not cofffer rights to the certificate holder in lieu of such endomement(s). NRoNwoER KEY KNOWLEDGE INSM;M'NCE, INC, ' 9101-C S. W. 19TH. PLACE c I PHONE S (954)382-5259 EMAIL PaX Na: (954)3$2-00$0 FORT LAUDERDALE, FL. 33324 0!�7a1e@ke7k=w1edgoin9.cam INSURER A : � OPECTA1a'1'Y IIVSUfiANCE C lPlratgy INSURED W -G. PLUMBING & 3PRINGRLLR$ SVCS., INC. INSINRERB:Ascendant a! insurance, Inn. MWIIN TROY GORDON INSUNER C : 1265 W 203TH STREET MIAM , FL 33169 INSURER D . COVERAGES CERTIFICATE NUMBER: w" i THIS IS TO CERTIFY THAT THE PAI 11'9RC nr REVISION NUMBER: .� v�—IN nrivc ar T Ib3UtU IU IHI: INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAYBEISSUED OIi ANY R PERTAIN, THE EN INSURANCE ARM OR FFORDED BY THE POLICIES DESCRIBED T OR OTHER OCUMENT WITH RESPECT TO HEREIN IS SUI3JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP: SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LiRR TYPE OF INSURAp,CESUBN LISA WVD POLICY NUMBER POLI EFF PO CY LiMnS SAL LIABILITY PARZL A. RYALS, AGENT. SACH OCCURRENCE $1,000,000 A COMMERCIALGENSRALLIABILITY CLAIMS -MADE X OCCUR AU09182013M 324272 /23/2013 /23/2014 n�R PREMI ES Ea �rrtaroe $ 100, 000 MED EXP ons 111 5, O00 wDED1000 AOP PERSONAL & ADV INJURY $1,000,000 OEN'LAC3(3REQA7ELlMII'APPLIESPER: POLICY PRLOC O GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OPAf3G $2,000,000 SN/A JAUTOMOIIIUH LIABLLITY ANYAUTO ALROO$ ED SCHHEDULED NON MOWED HIRED AUTOS AUTOS I DHD50 CO DPD 50 CA -28016-4 /23/2013 /23/2014 � lNED SINGLE LIMIT BODILYINJURY{PArpereon) $50,000 BODILY iNJURY{PBfelxitleMj $lOO, O00 accloemt $50,000 $ UMBPE . A LIAR EXCESS !IAB 000UR GIMME -MADE N/A EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EWLOYWV LUUMJW YIN ANY CFFlCBR/ME 0133R EXCLUDED? {Marrdatcry in NM} 1frA` FMOOM.0 OPERATIONS tielaw N/A N/A $ WC 8TATU- EL, EACH ACCIDENT 8 E.L, DISEASE - EA EMPLOYEE $ EL,D18EASE-POLICY LIMIT $ DESCPJnMM OF OPERATMB 1 LOCA71ONS / vEHm LES iAttaeh ACORD 101, Atltlifianai ROrMeAs SchmUr If mon: qmm fs r*gLd tl) RESIDEN XAL AND• COIMRCTAL PLumwwG CONTRACTOR LICENSE SFCOS6920 .•►asvrrenwr� u.�. r.�w W 5U99-AVI V AMVKLJ tiVKr'VF:ATiUN. Att ngnft reserved. e LORI) 25 (2010/05) The ACORD name and logo are registered marks of ACORD Pru&msd using Forma Boas Plus software. www.i:orlrls9VACOM; ftnwim Publiehmg 800-202-1977 Village of wami Shores 10050 NS 2ND AVE Miami. Shores, L7,,33138 3NOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCEL IF BEFORE THE fsMIKATION DATE THEREOF. NOTICE WILL BE DELFARED IN ACCORDANCE WITH THE POLICY PROVISIONS. 305-756-8972 AUTHORf;tWr REPRESENTATIVE PARZL A. RYALS, AGENT. W 5U99-AVI V AMVKLJ tiVKr'VF:ATiUN. Att ngnft reserved. e LORI) 25 (2010/05) The ACORD name and logo are registered marks of ACORD Pru&msd using Forma Boas Plus software. www.i:orlrls9VACOM; ftnwim Publiehmg 800-202-1977