PL-14-2018t
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-219764 Permit Number: PL -9-14-2018
Scheduled Inspection Date: September 25, 2014
Inspector: Diaz, Osvaldo
Owner: LUDICKE, ROBERT & ALLISON
Job Address: 526 NE 97 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: DESMAR PC INC
tsunamg uepartment comments
IRRIGATION SYSTEM
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number (305)754-2903
Parcel Number 1132060171530
INSPECTOR COMMENTS False
Inspector Comments
Passed EZ
Failed
Correction ❑
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Phone: (786)242-4930
September 24, 2014 For Inspections please call: (305)762-4949 Page 17 of 34
Y
MIAMI-DADE WATER & SEWER DEPARTMENT
METER OPERATIONS & MAINTENANCE
MIAMI - DE CROSS CONNECTION CONTROL UNIT
_ 1001 N.W. 11th STREET, MIAMI, FL 33136-9934
Phone (305) 547-3046 Fax (305) 5459555 sERve. CORS
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
ADDRESS OF DEVICE �
�0G r
OWNER OF DEVICE'y �f
1 IZ
OWNER CONTACT: v�
PHONE: 30.E ����
J ri I r
FA)r� p�y�v� 1®
S !o •�/
1
ADDRESS OF OWNER )', 1 j�
/��
ZIP CODE:
NAME OF TE ,_ ��� �� /
CERTIFICA;jOy%I�.:� 9 / _
V
EXPI�TIO DATE
�yO�iFy o e�
2
BUSINESS NAME: J
BUSINE
A¢� i ��� •
1 p0`�
All
3
TEST KR MAKE:
MODEL N0:SERIAL
NO:
DATA
DAV//A'/
SITE TUBE:
%II®�
YES /NO
T PLEASE �r "Trt.. -
MAKE OF ASSEMBL2�/ /*' N i
MODEL NO: "
SERIAL. NO: SIZE:
LOCATION OF ASSEMBLY: �
HAZARD/SERVICE L PETER NO3 3 R /-7 O 1
��
4
INITIAL TEST: ANNUAL TEST:
DATE OF TEST: L METER READING:
SHUT OFF VALVE #1:
SHUT OFF VALVE #2: y
V
CLOSED TIGHT:
CLOSED TIGHT:
LINE PRESSURE: PRESSURE STABLE: YES - NO
LEAKED:
LEAKED:
CHECK VALVE NO.1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE
N
Closed Tight:
Closed Tight:
FAILED TO OPEN:
FAILED TO OPEN: _
LEAKED:—
Leaked:
Leaked:
OPENED AT:
HELD AT:
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
OPENED AT: PSI.
,
' p PSI
PSI
PSI
PSI
3 11 ASSEIIB_=kl,IF {R
REMARKS / REASON FOR FAILURE (IF APPARENT):
p
:F�
C
r W
oa#EN1
.}a
CLEANED:
CLEANED:
CLEANED:
CLEANED:
CO)
I=
a
REPLACED:
REPLACED:
REPLACED:
REPLACED:
a
W
CHECK VALVE NO.1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
Closed Tight:
Closed Tight:
FAILED TO OPEN:
FAILED TO OPEN:—
LEAKED: _
UJI
OPENED AT:
HELD AT:
W
Leaked:
Leaked:
PSI
PSI
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
OPENED AT: PSI
PSI
PSI
TtIAT tIA TESTED A VE A B t t TH A VV,t A OSS ',t>NfidECTIt3N C NTI MANUAL t TEAT ALL- I IS
SIGNATURE OF CERTIFIED TESTER: JL4 DATE:
FOR OFFICE USE ONLY:
DATE:
EIVISed: 12/U8/2UU3
Miami Shores Village
Building Department SEP 17 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 JY:
INSPECTION LINE PHONE NUMBER: (305)762-4949
FBC 20 46
BUILDING Master Permit No.p/
PERMIT APPLICATION Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �Lca �rPP�r
Com: Miami Shores County: Miami Dade zip:
Folio/Parcel#: —C> `I —GBO Is the Building Historically Designated: Yes NO X
Occupancy Type oad: Construction Type F od Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): c1�
Address: j''� (a N L=,:9—/41�Jrtt-*ems%
City: bc\T � oe-:s State: Zip: 33 i 3
Tenant/Lessee Name: Phone#:
CONTRACT R: Company Name:
Addr s:
City:
i
IMIt
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: Z
e
Type of Work: ❑ Add�itionl ❑ Alteration
Description of Work: 7/t/AI/i
aaS-- -573517--73
Phon
!e
t Zip:
Phone#:
Certificate of Competency M
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ / Permit Fee $ l�� —f CCF CO/CC $
Scanning Fee $ c;w` 'C-9--) Radon Fee $ �' 2� DBPR $ �' Notary $ MoD
Technology Fee $ ( ~ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ 0
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 EgmTencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is iss d. I the ab ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
/ 0 day ofC'i7%b6( 20 l , by !;7— day of , 20 by
�111/SO� Z U.0iC / who is personally known to A&t10'r'd Gr lc pit o is personally known to
me or who has produced FLaRI,Dfi 1910 as me or who has produced ��® ���P �,
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
f OF FL,..•••
0 39&0153
NIVIA RAOUEL WALTO
MY COMMISSION #FF03488
EXPIRES July 9, 2017
identification and who did take an oath.
NOTARY PUBLIC:
Si
r5��
Print:
N State Of
��(
4 Seal: F P4� Notary Pu�iFeiia an
Joanna M y�
• s My Commission FF
4 op rti°�° E�cpitas oil
21201
+kik***�k*�k�k*�k�k�k�k&rie�k�kNe�kakak�k�k�k�k*�k**�k+k**�k�k**
APPROVED BY r� 5'-14 -/70 Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
012802
RICK SCOTT, GOVERNOR
�btkRTME
(;FC1427442
'
Tho,PLUMBING CONTRACTOR
Ufid4rjhejkoyjSjon -of-*Q.h'-6.ptet --i" '119&T_.
EXPH ae-AUGM-Zp*.
ANGEL "bu
C,
-_-64 -a" 36
A
ISSUED: 07/01/2014
-AT nib Fr�
bA
H
. .. ..............
KEN LAWSON,- SECRETARY
A -OVA
7
ey
XN�
DISPLAY AS REQUIRED BY LAW SEQ # L1407010001188
ACDRD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYWY)
09/12/2014
PRODUCER (305) 270-1424
Pan Am Assurance Agency, Inc
9100 Sunset Drive
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY NUMBER
Miami FL 33173-3433
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: NORTH POINTE CASUALTY INS
DESMAR PC, INC.
INSURER B: BUSINESS FIRST INS CO
6405 NW 36 Street
Shite #124
INSURER C:
INSURER D:
RAMI FL 33166—
INSURER E:
%.0
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'LPOLICY
INSRD
TYPE OF INSURANCE
POLICY NUMBER
EFFECTIVE
DATE (MM/DD
POLICY EXPIRATION
DATE MMIDDIYY)
LIMITS
A
X
GENERAL LIABILITY
AUTHORIZED REPRESENTATIVE
/ /
/ /
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
3094120082
01/07/2014
01/07/2015
DAMAGE TO RENTED 100 000
PREMISES Ea oxurrance $ i
MED EXP oneperson) $ 5,000
PERSONAL BADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN AGGREGATE LIMIT APPLIES PER:
X POLICY JELOC
PRODUCTS - COMP/OP AGG $ 2,000,000
AUTOMOBILE
LIABILITY
ANYAUTO
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
BODILY INJURY
(Per perm) $
HIREDAUTOS
NON-OWNEDAUTOS
/ /
/ /
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
ANYAUTO
/ /
/ /
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
/ /
/ /
EACH OCCURRENCE $
AGGREGATE $
OCCUR CLAIMS MADE
$
DEDUCTIBLE
/ /
/ /
$
RETENTION $
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
0521-03296-0
08/16/2014
08/16/2015
W T
TOC LIMITS X OER
E.L. EACH ACCIDENT $ 500,000
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
It yes, describe under
/ /
EL. DISEASE- EA EMPLOYEE $ 500,000
E.L. DISEASE- POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Plumbing Contractor
CERTIFICATE HOLDER CANCELLATION
(305) 795-2204 (305) 756-8972
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Miami Shores Village
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
10050 NE 2 Avenue
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Miami Shores FL 33138-
ACORD 25 (2001108)
INS025 (om)m
O ACORD CORPORATION 1888
Page 1 of 2
Prwared by. record and return to:
Steven W. Zelkowitz, Esq.
GrayRobinson, P.A.
1221 Brickell Ave, Suite 1600
Miami, FL 33131
Parcel I.D. No.: 11-3206-017-1530
WARRANTY DEED
(Space Reserved for Clerk of Court)
THIS WARRANTY DEED is made and entered into as of the day of September,
2014 by JAMES H. SAGE and JENNIFER M. TRECO-SAGE, husband and wife
(collectively, the "Grantor"), whose mailing address is '7 9 2 l L 1 r4co u%f i>jzl ✓rr—
in favor of ROBERT LUDICKE and ALLISON LUDICKE, husband and wife (collectively. the +-+4 191!
"Grantee"), whose post office address is 526 N.E. 97th Street, Miami Shores, Florida 33138.
Wherever used herein, the terms "Grantor" and "Grantee" shall include all of the parties to this
instrument and their heirs, personal representatives, and assigns.
WITNESSETH:
GRANTOR, for and in consideration of Ten and No/100 Dollars ($10.00) and other good
and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, has
granted, bargained and sold, and by these presents does hereby grant, bargain and sell to Grantee
and Grantee's successors and/or assigns forever, the following described land situate and being in
MIAMI-DADE County, Florida (the "Property"), to wit:
Lots 6, 7, and 8, Block 99, AMENDED PLAT OF MIAMI SHORES SECTION 4,
according to the Plat thereof as recorded in Plat Book 15, Page 14, of the Public,
Records of Miami -Dade County, Florida.
TOGETHER WITH all the tenements, hereditaments and appurtenances thereunto
belonging or in anywise appertaining.
THIS CONVEYANCE is subject to: (a) taxes and assessments for the year 2014 and
subsequent years which are not yet due and payable; (b) zoning, restrictions, prohibitions and other
requirements imposed by governmental authority, (c) restrictions and matters appearing on the plat
or otherwise common to the subdivision, if any, but this reference shall not operate to reimpose
same.
TO HAVE and to hold the same unto Grantee in fee simple forever.
GRANTOR hereby warrants the title to the Property and will defend the sante against the
lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, Grantor has hereunto set his hand and seal as of the day and year first
above written.
Signed, sealed and delivered in the presence of
these witnesses (as to both):
GRANTOR•
Witness: Yee 61 A 1 42,E
Print Name: &Y L I -H cje,s qAf
STATE OF !T-4 )
COUNTY OF '-PAJ14 ) SS:
The foregoing instrument was acknowledged before me this y of September 2014, by
JAMES H. SAGE AND JENNIFER Ni TRECO-SAGE, husband and wife, who (check one) [ ] are
personally known to me or have produced a valid r-Ln.e. 7/)4 driver's license as
identification.
Print or ttamp Name: o A�I-s l r
Notary Public, State of �Dh- at Large
Commission No.:
My Commission Expires:
1302525/1 - # 1504591 vl 0.0 4 OF PIENN V, NIA
NQ.TARIAL M +L
DEN Nl ` A °�YEI t ; Natary Pubfic
szon xpres �Aay 1;:2 9