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PL-14-7290 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-210734 Permit Number: PL -4-14-729 Scheduled Inspection Date: September 11, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: OBERMEYER, JOSEPH & JULIE Work Classification: Addition/Alteration Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Project: <NONE> Contractor: JENCO PLUMBING SERVICE INC Building Department Comments REMODEL MASTER BATHROOM Phone Number Parcel Number INSPECTOR COMMENTS False 1132060171310 Phone: (954)720-5838 September 10, 2014 For Inspections please call: (305)762-4949 Page 3 of 31 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 10, 2014 For Inspections please call: (305)762-4949 Page 3 of 31 ju % Miami Shores Village.. Building Department APR I 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 201 BUILDING PERMIT APPLICATION Permit Type: PLUMBING Permit No. I - yt C�� Master Permit No., C 14 —I JOB ADDRESS: 3909 City: Miami Shores County: Miami Dade Folio/Parcel#: 1� '3w (p 613- 1z) I b Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): .3 `]u fit 000?,n eRPhone#: Address: �RQfi �C 1 " uc- City: t4ia (k Sboaf S State: - L Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: c l nc-o Phone#:954 320 -5 Address: rJ 30 —'s'g", Ave'n o c—, City: C) wm. n 'i2acir-" State: Zip: ?�'OQ Qualifier Name: W ��� ��� J�i'� Phone#: State Certification or Registration #: CSP CQ Certificate of Competency #: Contact Phone#: Email Address: %eYK ®j2I U r"J:i1 KQ Q -f DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ L 6 ® ®, Square/Linear Footage of Work: 1031 Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 1ZPJf1'j (�11QS 't hl�Qpp1 !Q, Xl5hn . a,r�-I��IC1�. xx�2-h ►tern llS P.� { 1 uml�.rc�ca -�►� 5 { arie hand l and eco inn y . !A 010"ye N-,ew PMN j -r -Moa -n combincwn on1vm Submittal Fee $ Q . Permit Fee $ AJC®" CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ JW a 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 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 be charged. Signature4Signature Owner or ent ontractor PI The foregoing instrument was acknowledged before me this2K day of MO RLb,20W,by-J�lPh 0-2 who issonally know _Dne or who has produced As identification and who did take an oath. NOTARY PUBLIC: r Sign: /9LA, Lryi, 0 Print: ! S My Commission Expires: BOOT"o The foregoing instrument was acknowledged before me this day of KAQ120h , 2014 by W CL&Ine, Jffl)tAS , who isI85rsonally kno to me or who has produced as identification and who did take an oath. APPROVED BY �) Plans Examiner Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: i Sign: Print:�- My Commission Expires: EXPIRES; Se �j9 McUgr`.°. Bo aerbmw s b9r9,�e+l 7 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. A. CDPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: BUSINESS ADDRESS: SW -=[A" Ptejk2 CITY 99�j� STATE ZIP CODE BUSINESS PHONE: O -AZO E636 FAX NUMBER ) _989®� CELL PHONE () 1 ?bb QUALIFIER'S NAME: WaAw k - QUALIFIER'S LIC NUMBER: E-MAIL ADDRESS (IF APPLICABLE): _p Created on 3119109 BY MLDV 1 RV 3126109 MLDV 04/08/2014 14:22 9547882803 JENCO PLUMBING PAGE 01/01 oRb® CERTIFICATE OF LIABILITY INSURANCE 4i3i(4 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 OOVERA©E AFFORD90 By THE POUOIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(St AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, tho policy(i®s) 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 thls certificate does not confer rights to the certificate holder In lieu of such endorseMent(s). PRODUCER Park 6 Associates IrICPNoroE 5255 Worth Federal Highway 2nd Floor Boca Raton FL 33487-4907 Anna Fookes (563.Y994-0880 I F 9.56210,94-11140 E'I . a,fOOKSBaparxasaaciMto<s. c0M IIRURE AFFORDING COVERAGE -NAI -C-1111 INsuReRA-Old Dominion insurance C2meM 40231 INWRO JeCCo Plumbing service Inc 1530 SK 7th Ave ponpano Beach >r'L 33060 1NSURERpj;Tech=l2= Insuraum CozopanNr 2376 INSURER C NSURe INSURER E ; INSURMRF: COVERAGE5 Cthi771 1GNTE A1UMtltN:1�J 1r+ m./ 1�- �� x..scw rva ,•r•x•••• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE I-ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VWTH 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. AND 15100YERW LMILnY Y I ro ANY PWRiEToR1PARTNQRIEXE0jrW 4�a�a!' In BER EXCLUDED? S IN 1 A it ves. 4esrloe under 1/2014 OQSCRIm" of apa"7MG I LOCATIOND O VEHICLS6 ~h ACOAO'04, AA6 O"' Rel"As suMdtde. it "m ep86e 1e tEQulred) Per Policy Terms and Conditions. RE.- Plumbing Contractor Miami. shores Village Building Department 10050 ME 2 Ave Miami Shores Village rL 33138 ACORD 26 (201 )N5026 (z %a st a+ C SHOULD ANY OF THE ABOVE DESCRIBED POLICIt3 6E OANCEL1,I_0 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be DaNWIED IN ACCORDAN05 VATH TNB POLICY PROVISIONS. AUTWORM90 REPRESENTATINFE Anna rookes/AF ®1988-2010 AC( The ACORD name and logo are registered marker of ACO#W All fthts reserved. GENERAL LIABILrIY eACH OCCURRIME $ 1,000,00 EM( m e 5 500-' 00 x CWMERCIAL ®ENERAL LIABILITY A CLAIM -MADC ® OCCUR 4PG74112 10/16/2013 0/16/2014 roeo Mtp ( o, $ 10,00 PERSONAL & App INJURY 6 1,000,00 06NERALAGGREGATE $ 2,000,00 GEN L AGGREGATE UMIIT APPua Pt --R! POLICY X OO PRODUCTS. COUP/OR AGS S 21000,00 $ ED 31 AUTOMOBILE LIABILITY c e ®ODII,YINJURY (Pot perwri) 5 ANYA..VTO ALLOWN60 SCH60Vk.ED BODILY INJURY(per occident, I AUTGS AUTOa HIREDAU'rO$ AUTOS ON-OWNEDPe/asst DAMAG $ uMreR61.U1 LIAe O=vk EACH OCCURRENCE $ AGGREGATE $ IMCES9 LIAO CLAIMS -MADE AND 15100YERW LMILnY Y I ro ANY PWRiEToR1PARTNQRIEXE0jrW 4�a�a!' In BER EXCLUDED? S IN 1 A it ves. 4esrloe under 1/2014 OQSCRIm" of apa"7MG I LOCATIOND O VEHICLS6 ~h ACOAO'04, AA6 O"' Rel"As suMdtde. it "m ep86e 1e tEQulred) Per Policy Terms and Conditions. RE.- Plumbing Contractor Miami. shores Village Building Department 10050 ME 2 Ave Miami Shores Village rL 33138 ACORD 26 (201 )N5026 (z %a st a+ C SHOULD ANY OF THE ABOVE DESCRIBED POLICIt3 6E OANCEL1,I_0 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be DaNWIED IN ACCORDAN05 VATH TNB POLICY PROVISIONS. AUTWORM90 REPRESENTATINFE Anna rookes/AF ®1988-2010 AC( The ACORD name and logo are registered marker of ACO#W All fthts reserved. 431091201? 13:18 ....... . 10/08/2013 06:34 9547882803 JEr PLUMBING PAGE 01/01 ME wmw r 116 $. Andrews Ave., Rm. A 304::rt. �l�ud+erd le 'FL 333.09-01805 — 95 31 00 VAUD OCTOBER IR20 THROUt�H :��PTENIBLR 34,.2014 i DBA: Racslpt :. Lumnla w SPEM/ Busing" Mame: JENCO PI►LiMBIivCi s>r�VTCE zNC BUS11e0 Type: SE1.ttMILIG OOTRACPORI ! Owner Name: w4yla jMKINas Business opened:10/05/1995 Business tion:153.0 SW 7 AVE 8taWC0tj*lC6fUR9q:CFC056886 POMPANO BBACH Exentivilan CCadw. i309ineae Phene: 554 -?2o- 5 e 3 s Roame Sam Employees Machbw Pr~onws { 1 s Far Ve RdkW Number of Machines- VandMn Tyve: Tawknount-1 Transfer Fee NSF Fee penaNy ars Pdor ye Cv14e�lOn Gast Total Fad 27.0a 0,00 0.00 rJ.AO, ©,00 0•o0 27.00 THIS RECEIPT MUST BE POSTS®► CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This ter is Levied for the pdWhVe of doing burin ass wittttr+ Srowwd County and is non -regulatory in neturs. You must mw so County ondbr MurddWlty ptannhtg MEN VALIDATED and zoning requirements. Thio Business Tax Relpt must be Irandeaed when the business is odd, business name has changed or you twa moved the ' business towtion. 'this receipt does not indicate that ft bu$W*m is legal or that '. it is in comptience with stats or focal tears and ragumoons, L • Maiting.Addres: WAYNE JSNXINS Receipt #033-12-00008944 1530 SW 7 AVE FaLd 97/08/3-023 37.00 POMPANO BEACH, F1, 33060 � 2013 -2014 � fig � �� r