PL-14-2297Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-221993
Scheduled Inspection Date: October 22, 2014
Inspector: Diaz, Osvaldo
Owner: STOCKS, THOMAS
Job Address: 102 NE 108 Street
Miami Shores, FL 33161-7038
Project: <NONE>
Contractor: LASSETER PLUMBING CO INC
Isuiming uepartment comments
FLUE REPLACEMENT FOR HOT WATER HEATER.
Permit Number: PL -10-14-2297
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1121360090080
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
L
Correction
�.
Needed
Re -inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Phone: (305)525-5075
October 21, 2014 For Inspections please call: (305)762-4949 Page 22 of 29
Miami Shores Village -
r BuildingDepartment p OCT 7 2014
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 20
BUILDING Permit No.�
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: 1 (D 2 �\ 5A
City: Miami Shores County: Miami Dade Zip: 331 lo l
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): TO M Si 6 C f_s, Phonei ,, 0� Z9 614
Addressor: �102- W E 10%+ N S}
City: 1_►1 Q. `I` I State: S7L
Tenant/LesseeName: Phone#:
Email: -T HaMi\SMSTZ) Cl<S51a% 6 oMea.s
'tl
CONTRACTOR: Company Name: Lq 55e4e Y Pjum6A!�Phone#:
�0 5 �� 'I 190
Address: D (P 5 0 Vl
NA
City: 66 � gy 1 I a no State:
L
Zip: 331 to I — 4q43
Qualifier Name:t(
Phone#:
State Certification or Registration #: CFC ) T t0q to
Certificate of Competency #:
Contact Phone#: 3 '69 3 11 %Q Email Address: 1 Ck SSB
Ver R' V vn 6
n f a P
DESIGNER: Architect/Engineer:
Phone#:
®d
Value of Work for this Permit: $
age of Work:
Square/Linear 2epair/Replace
Type of Work:., --Address ,. ❑Alteration
❑New
., ••.
L
❑Demolition
Description of'Work: Q �eQ, a Cf? �
+-
�t_ Y1
r -
Submittal Fee $ Permit Fee $ CCF $ CO/CC $ C)
Scanning Fee $ (x�) Radon Fee $ 0 DBPR $ Bond $
Notary $ !S C k Training/Education Fee $ Technology Fee $
Double Fee $ 0 Structural Review $
TOTAL FEE NOW DUE $ (1 �o�
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 »d? be charged.
Signature>� _% Signature
Owner or Agent \ 1 Contractor
The foregoing instrument was acknowledged before me this
day of ()a 20 V4-1
by`( DM M , SJ0Qt-S ,
who is personally known tome or who has produced J (_ ,
LI�(�E As identification and who didtake an oath.
NOTARY
Sign:
Print:
The foregoing was acknowledged before me this I
dayof ®Q- ,20L�,by `�!O�N � / t, 14-S�
who is personally known to me or who has produced T- L-
.
. —lam �� as identification and who did take an oath.
NOTARY
Print:
!r 'f' Sindia Alvarez
My Commission Expires: My Commission FF 15570 My Commission Expire � Sydia Aivar�
p Expires 09/03/2019 �@ My Commission FF 158750
- 1 s eRnd' Expires 09/03/2018
APPROVED BY -La -Py Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
Oct 171412:36p
jq
OWNER' SEC_ 7 YPE. G BUSINE8MENT
S
LASSETERiPLUMBINGCO!NC ..196 PLUMBINGCONTRACTOR ': i;_'... ;3v AXCDtLEECTCS#;f''r
CFCOAI G98``'
?INofkisr: �) 7 ::;45.00 67/16/2 014
HEC 2'
7 . � 4�2 168
`�C K
This 1.1651 Business`fiax Receipt odly'Confirtas paytpent of the local Business Tax The Reealpt is not a {ii tedse:;;;
peniittb'r`acartificatigfi'atlhshotdeijualHicattdns,sodohusiness. Holder�nustcompiyltGltiianygavetnhi@niiitt
or isiiftg6vhrnmeatat regiitatory ia� i--Ahd requiramdins which aPply to the
`''YTtb'RECEIPT ND `above mustfifalspiayed aii` r(rSiitt§i
Rive Sec 88=278.
lit.' �^
Fariddteyuformaiian vilKSwyrtniamidade.auy)taucolletfir:>:*:; . 1'' .
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUC'T'ION INDUSTRY LICENSING BOARD
CFC041696
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
LASSETER, JOHN MARK
LASSETER PLUMBING COMPANY
13925 NE 1 STAVE
MIAMI FL 33161
ISSUED: 06/0212014 DISPLAY AS REQUIRED BY LAW SEQ # L1406020001091
Oct 171412:55p
P.1
'4� E' CERTIFICATE OF LIABILITY INSURANCE
DATE`"'""°°""4"''
DOCUMENT WITH
8/28/2Q14
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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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 endorsement(s).
PRODUCER
Mack, Nuck & Waltz Insurance Group, Inc.
S bUlitary Trail
CONTACT Melissa Rii>um
NAME:
PHONE . (954) 640-6225 FAX (954)640-5226
M19 No1211
L AOMESS.mrihm@mac]cinsuranGa.com
Suite LOO
Deerfield Beach FL 33442
INSURER AFFORDING COVERAGE NAIC4
INSURERAKIII-Continent Casualty Company
INSURED
Lasseter Plumbing Company, Inc
865 N.E. 13 0 Stx est
INSURERa:Ohio SEcurlt Ins. Co.
wsuRER c Brid efleld Z=Ioyexs Ins. Co. 10701
wwRERp-Merkley National Ins. Co
INSURER E:
Naxth Klami. FL 33161
INSURER F:
•.VI Vf� I�VI�1 csGr\.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US TED BELOW HAVE SEEN 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 WttICH 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.
ILT R TYPE OF INSURANCE; IAD POLICY EFF POLICY P
POLICY LIMBER MMMW=
LIMITS
GENERAL LIABILITY
X
EACH OCCURRENCE S
1,000,000
COMMERCIAL GENERAL LIABILITY
A CLAIMS -M F OCCUR D4GL000911236 /1/2014
1i-IREMSO mmm"OnceS
100,000
/1/2015
MED EXP one S
BXCLLFDED
PERSONAL S ADV INJURY S
1,000,000
GENERAL AGGREGATE S
2,000,000
GENLOLICYFT6LIMITAPPLIESPER
X PRO
PRODUCTS -COMPIOPAGG S
2,D00,000
POLICY LOC
S
AUTOMOBILE UIABILr Y
C061 LIMIT
B
X ANY AUTO
accident) S
11000,000
-OLE
BODILYINJURY (Per person) 5
AOWNED SCHEDULED
AUTOS' AUTOS
15562
() 72467
/1/2D14
/1/2015
$ODILYINJURY (Peraxrdenp 5
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE S
Unlnwed meMalsd cornbhed S
11000,000
UMBRELLALIAB
OCCUR
EXCESS LIAR
EACHOC(XJRREIVCE S
AGGREGATE S
CLAIMS -MADS
DED RETENTION 5
i
C
WORI(ERS COMPENSATION
S
AND EMPLOYERS LIABILITY
WC ST0.Tl)- OTH
X ' CR
Y 1 N
ANY PROPRIETORIPARTNER/EXECUTP.M
OFFICER/MEMBEREXCLUDED?
N/A
E.L. EACH ACCIDENT S
500,000
ddbwy
(Mauif
3021471
/25/2014
/25/2D35
>aeMR)
El DISEASE -FA EMPLOYE S
506,000
OESCRlPTI0 OF OPERAMONS beW
E.L.DISEASE- POLICYLIM.MIT S
3DQ 000
D
Contractors Equipment
9=002286
9/1/2014
/1/2015
SdwduledEquipimn►
$5,430
Deducible
$1,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (AMLeeh ACORD 109, AddlBonal Rema*s Schedule, 1I mwe space la mqulmd)
Plumbing contractor: License # CFC04I 616
CFrt'rlFlceT'G urn nvo _ _
(305)756-8972
Miami Shores Village
City Hall, Bldg Dept
10050 WE 2nd Avenue
Miami Shores, FL 33138
ACORD 25 (2010105)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
WaltzMELISS
@ 1988-2010 ACORD CORPORATION. All dahts reserved.
-V"" Gr:nF?" name a»r1 In r% ara rarw#--+ararl marlem of Attem 1