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PL 14-1066Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217260 Scheduled Inspection Date: August 12, 2014 Inspector: Diaz, Osvaldo Owner: KENNETH A CHRISTIANSEN, XAVIER D0 F0 0 0 0 /"_I1 Job Address: 155 NW 94 Street Miami Shores, FL 33150 - Project: <NONE> Permit Number: PL -5-14-1066 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)801-4394 Parcel Number 1131010330700 Contractor: UNIVERSAL PLUMBING CORP Phone: (305)887-3131 tsunamg uepartment comments install plumbing for sink and shower in 1 bathroom Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-217162. remove old washing E2' machine connection and cap off old lines 6 Failed Correction (L E4 Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 11, 2014 For Inspections please call: (305)762-4949 Page 21 of 39 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Mail 29 2014 G r� FBC 20 LJ Master Permit Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL APLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1155 City: Miami Shores County: Miami Dade Zip: ✓3/50 Folio/Parcel#: /l —3101-032 -0100 Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple )Titleh Address: 1.55 W City: khF atom/ Tenant/Lessee Name: Email: Xperes CONTRACTOR: Company Name: Address: Construction Type: Flood Zone: BFE: FFE: �QVier ?4C'r_e5req0 Phone#: State: F1_ Zip: 331.5'0 o C CWA- �� [ e/vf Phone#: ?/ff®q�O City: State: Zip: < fQ/__S Qualifier Name: Phone#: State Certification or Registration #: ��� �G�.?�/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: State: Zip: Value of Work for this Permits V Square/Linear Footage of Work: Type of Work: 1:1 Addition Alteration New F-1 Repair/Replace Description of Work: ❑ Demolition Specify color f color thru tile: Submittal Fee � 6 Permit Fee$ CCF CO CC Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I� „ 36 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 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 reins tion fee will be charged. pr Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this a�40 day of 46�, 20 by �tROw, .� � who i Y pCson I y rulumn to m r who has produced as identification and did take an oath. NOTARY PUB LOURDES MA►RIN COMMISSION #FF009167 Sea I: CK011,11[7_Tyto] 0 The fof6going instrument was acknowledged before me this 190 day of 2Q`- by C- , who is personally known to me or who has produced identification and who did take an oath. NOTARY PU Print: Seal: LOURDES MARIN April 17, 2017 as APPROVED BY F� . Z : --f y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 6/02/2014 MON 7:55 FAX 2001/001 CERTIFICATE OF LIABILITY INSURANCE oATE06/02/1k YI ............ --------- --...... .._......... ....,........ __............ ............. ................. ....... ....... ... ............................ ...........,.....................,............ .......... _ .... _ _ THI CERTIFICATE iS ISSUED ASA 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 BEL W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPT .ESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. .............._..._._..._......._....._........_....._..h­-1-S----w---A-1V-ED, ._..._...-----..............._.........._.._.._....,..:_.....-...... ....._............tt IMPO iANT: If the certiFlcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to ! the toTns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certt rate holder in lieu of such endorsement(s). RODU ER_..__......................_.........._..._._......._...._._........__...,_......_.........._.............,....:._.:..................• —I-'CONTACT GRICEL GONZALEZ i,NAME:............ ....... ........-,.................._...... _._............_......... ............,......... ... ... ........... .................. - & E nsurance Cansultants,inc. I PHONE FAX " " 1880 S.w.40th Street !... AMANo,.Fxt):.._.._(305)228-8988 ..................... .._......_-_._-._...._...-.i...(9!� _I�1:._......_�305)228_8969 ricel5620 comcast.net Aiami, FL 33165 I..ADDRESS:....... ... ._9,..._......._......_...��......................................,..............................................................._............... I._.. __ ..__......_....... INSURERS) AFFORDING COVERAGE ......... .._... ...... ._................. ........__NAIC... H.......... 'honSURE e {305228-8988 U— Fax (305)228-8969 - �_- { INS RER A : GRANADA INSURANCE COMPANY -- - - - - ....... INSURER B INIVE SAL PLUMBING CORP ...... ...... .......... _.... .................. ...... .....:. ................. ... ........... ..... _..-.._..-............... ......... .............. 41 East 60 St 1NSUIRERt d F ..... .............................................. _... .......... I v............................................................... Iismi, FL 33013-:. INSURER E : (305) 804-5484 _..._.__._..__._....._... _...-_................ ._._.................. ...... ............ .............. ................. _....... ...................._................_.......- -... I INSURER F: 'OVE1 tAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS S 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH£ INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIC ATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERI`IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR' fADD r LID -- -.—._..._......_...._.........................................._............. _R I.•-._ _ -� TYPE OF INSURANCE TINS POLICY EFF POLICY EXP j _-�_...._.._._...y J!1iVI?}..._..............._POLICY NUMBER (MM/DF7/YYY-JY 1.tPOLI0 7. --•--- _... _LIMITS G NERAL LIABILITY i I j i EACH OCCURRENCE $ • 1,000,000.00 # COMMERCIAL GENERAL LIABILITY t 1 #c" RADAMAGE TO vst!rrencel.._..j..$.._ 100,000.00 ................ 1 __ : •',�! CLAIMS fv1A0E(_J OCCUR 0185FL00059289 i MED EXP (Arty orre rson g 5,000.00 500 DED ; 05/08/2014 :'• 05/0$/2015 ....................__..................1'e...... > .-----._..............._.......................j ...PERSONAL & AOV INJURY ?$ 1,000,000.00 .......... .........................._... .................. ..... ..,......_..� { - •• !.._....... .._......... .............._.--... ; GENERAL AGGREGATE .......$ 1,000,000.00... ................ ...... ... .................---........ ..... G N'L AGGREGATE LIMIT APPLIES PER: .......... 1- PRO I 4 I PR DUCTS- $ 1,000,000.00 j ._ POLICY...!- „_LOC.-.._.__...........................................................I -..... _ ._.. ...... SECT.......... A TOMOBILELIABILITY I_....._,.._..,....._, ................ ......... ........... ................ _............ ......... ... ... ;...................... .... ...... ... ................. E... _ _.._......._....INGLELMT,..$............. ANY AUTO ALL OWNED SCHEDULED;BODILY INJURY (Pet person).g '"I _......_................................ AUTOS �.,. 7 AUTOS I i BODILY INJURY (Per sccidentj NON-OHIRED AUTOS {-� II _...................... .. ............................ _ . 1... ! AUTOSWNED j f... {Pe PE%Y DAMAGE ............... `..$............. I I ;...._...................... :. ................. ....... ......_........ --.{_UMBRELLA LIAR OCCUR ...-.... .._........................... ............... EACH OCCURRENCE$ I I EXCESS LIAR �� er err.�c_r.e,.� t...... .......... ................. .......... ... ._...... . I WORKERS COMPENSATION t I I i; �FcTAT A�}O EMPLOYERS' LIABILITY Y / N ,.t IMT.S.,.-.._ER._.._................_.._.. .......................' i ANY PROPRIETOR/PARTNER/EXECUTIVE ` O FICER/MEMBER EXCLUDED? N / A i E.L_ EACH ACCIDENT.........................._..........._.......... _ (Mandatory in NH) i E.L. DISEASE - EA EMPLOYEE S It es describe under i D SL°RIPTION OF OPERATIONS befgw-------..._......-....._.___.._..._ .... i ;_._..................... .... - .__. -..._._............i.-....._..L_...,............_.....................- ---- i I E.L. DISEASE - POLICY LIMIT! $ 1 -,--.. _............. _.._.:......_...__......_................._..... 1 J ESCRI TION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 109, Additional Remarks Schedule, If mora epaco Is required) C #CiC1428421 TE HOLDER MIAMI SHORE VILLAGE 10050 NE 2 AVE MIAMI,FL33138 25 (2010/05) QF i .... ...... ,._............... .... ..._............... ... ..... ............ ....... ....... ................. ............... ................ _.................................... __ ........... .... ..... .... ...... ..... CANCELLATION ......................_M_......._...._..._..._._......._.._._........................................... .................. ... .... ........ I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '• { THE EXPIRATION DATE THEREOF, NOTICE VyltL BE DELIVERED IN E ACCORDANCE WITH THE POLICY PROVISIONy. j ........................... ........ ...... f/ AUTHORIZED REPRESENTATIVE ...............................:......................................................................................... ©1988-2010 ACO RPORATION. All rights reserved' The ACORD name a to are registered marks of ACORD