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PL-14-2253r Fy Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-221564 Permit Number: PL -10-14-2253 Scheduled Inspection Date: November 05, 2014 Inspector: Diaz, Osvaldo Owner: EDMISTON, SUE Job Address: 790 NE 95 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: DOUGLAS ORR PLUMBING INC comments Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060141860 Phone: 3051887-1687 INSPECTED WATER TANK ON ROOF, DISCONNECTED AND REMOVED FOR ROOFERS TO CONTINUE INSPECTOR COMMENTS False REPLACEMENT OF ROOF AS NEEDED. Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 04, 2014 For Inspections please call: (305)762-4949 Page 20 of 31 t__40N(OACII 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: (30S) 762-4949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING a= OCT 2M i LBY o �, ppFBC 20LO Master Permit No. 10 F - A -10 -1 (p ' "I Sub Permit No. V(-- (4— ❑ REVISION ❑ EXTENSION ❑ RENEWAL [LUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -� i c �",1 e, I, �,r �A • City: Miami Shoresrr--yy County: Miami Dade zip: �a Folio/Parcel#: l 9 - -32 (2, iki ` G, 6 Lpp Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):'�ijit 1 ! . ilii Address: City: U 1 J, l I'i (, � 'W State: Tenant/Lessee Name: o I 0 - Email• �AKAcr� __8 da&Gc6lis CONTRACTOR: Company Name: i 1 (• Address: :nE,� �� ,� ' City Qualifier Name: 4'r�(!! �'� (IL" )L Nil • b y State Certification or Reeistration #: i F Va of Competency #: DESIGNER: Architect/Engineer: m n, Phone#: -M-7SIT �_ Address: City: State: Value of Work for this Permit: $ V J i� • �' i') Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New �epair/Replace Description of Work: , r e (1 , �, � 01 � �� t ' Specify color of color thru tile: AL� Zip: ❑ Demolition Submittal Fee $Permit Fee $ 3 0. CCF $ O (OC) CO/CC $ CA Scanning Fee $ Radon Fee $ DBPR $ Notary $ �n Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ p TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) I �1 Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) P Mortgage Lender's Address city State 0, 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 reinspection fee will be charged. Structural Review Clerk (Revised02/24/2014) Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this dayp �, I 20 �� by �11 day 20 I; by ofd ofd y� !,J H,f� Li Lin h . . who i ersonally kn Wn to �� �,�� JL,who i�personally known)to me or who has produced as me or wKb has produced as identification and who did take an oath. identification and who di NOTARY PUBLIC: NOTARY PUBLIC: Via;:;.; MONICA ALVAREZ Commission # FF 70091 _. .: My Commission Expires October 22. 2016 �✓�� Sig Sig Print: Print: Z 'tul I l" p0.r v"il Seal: ;+o. �e,., MONICA ALVAREZ Seal: Commission # FF 70091 My Commission Expires October 22, 2016 APPROVED BY/® -/`1 f� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 10/14/2014 12:13 3058880678 DOUGLAS ORR PLUMBING PAGE 03/03 RICK SCOTT, GOVERNOJ� KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL. REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC052664 The PLUMBING CONTRACTOR Named below IS CERTIFIED Urider the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ORR, WAYNE •MACNIVEN..u• bOUGLAS•'ORR PLUMERNG 301 •FLAGLER.DRIVE MIAMI. SPRINGS"" FL•63166 ISSUED: 08103/2044 DISPLAYAS REQUIRED BYLAW X SSQ #f L,1408030003270 10/1412014 12:13 3058880678 DOUGLAS ORR PLUMBING PAGE 02/03 w. -- - - ----- rri�m ,�`� y.� .�•��iy �c� a�� ` V •• •: `- �, .. •r i�'J I iii l 17�C1G. -C, ri t rltyl., 6,09 IA get.'—''©r��Z''�lAi• S.e :"r�xd.,J �: 'i•. . r: ?sem• ' .i { ."� 'Nl- J SC "i'ir:�+ :�.,'?:.6? . ' . ..1 •?'• •r• �..•I �.�j r~" �' •�.I. eon riT! • - • .. � :y'• ' ... '•:'. • ;.4 •:::fix''' ' ' � r f' i "•:::L• - lsWaurR.'1,0NAIGi"406.aM06 � 1 ,:i.: r 1(.L.�:Yir J:,•,r. Rlaµvts,'�tuigih�ti-, 6fi1LEGL1=R"Dk'..4i93.#;+''.:. ti ..,..,.. �. rl Nig si iru s. L 3ies Aa �� � are. TYPE'?bp BUSINESS PAnmrwr ORR'DOUGLAS PLUMBING INC TAxYucroRl' :CONTR4bTORI':' . -'400 912014 Workers) 7 CFC052884 r 'CNECK21L[d-037478 _ TfrisLoeal:Bosilte Ta>,Ae04 ant�eonQrt+fsPaT!ItirR�T'theloe>91Bu9t�hlls7ac16trR6mktisa1ftl1flcense,': . r' pomttt oroeoilifrintlon dffllot:foldefs gaelHieatioris id da hasFndi Holder must cm; i,Rywilh a trutr maum1• • or 000go,"maoarlregoiatof j lrtvra Aad rfairarnen� xbia6 applylo tttvhbsinQaa: .::.: . '� ThaP�EGE1FTNt3rahbwlam�aedapra�dvn�lF,oommme+nryvn�iiy��l+�bAdoiCv�ivSobd3P-2yG, . MLAM Fariwmlrrlor itoili4 h�pts'.v.Arla 10/14/2014 12:13 4 . * ACORO� 3058880678 DOUGLAS ORR PLUMBING PAGE 01/03 DOUGORR-02 TGARRIDO CERTIFICATE OF LIABILITY INSURANCEDATE:IMMIDDIYYYY) 7=12014 11114 Vp= I IrIUATE 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 THS POLICIES BELOW. THIS CERTIFICATE OF .INSURANCE DOES NOT CONS'T'ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 1f the certificate holder Is an ADDITIONAL INSURED, the policy([") must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorserhent A statement on this certificate does not carrier rights tD the certificate holder In 11OU of such endorsemen a . PRODUCERc�6 cT Teresa Garrido __ Collinsworth, After, Fowler & French, LLC PHONE 30 B22-7800 3D 362 BODO Govenlore Square Blvd Arc. No earl: .. 5i tare, ( 5j -- -2443 Miami Lakes, FL 33016 : �arrid*�caftllc.conn __ INWRIM(el AFFORDING COVERAGE NAIL A 10URED Douglas Orr Plumbing, Inc. 301 Plaglar Drive Miami Springs, FL 33166 CnVIRRArEES i-m-new-ATa ueuaaan. 1NsuRp k. Liberty Mutual Fire Insurance Cc_rnpany 23039 INSURER a: Liberty Insurance Corp. _ 42404 INSURER C :Ohl* Casually Com any 24074 INSURlKill - THIS 1S TO CERTIFY THAT 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 AFFOROED BY THE POLICIES DESCRIBED HERSIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 'MR _ LTR TYPE OF INSURANCE POUCY NUMBER Mrb M uw ITS GENERAL LU1BRItY EACH OCCURRENCE S � rOVO,OO A X COMMERCIAL 13ENERAt, UABILnY X X T$7Z91462848024 OP,r =14 W=015 _ PREMISES Ma er mmmeel S 300,00 J, CLAIAIS.h41DE I X OCCUR ! I MED £XP (Any mio Prion) 1 D,OD X Broad Forth PD Incl PERSONAL Ml, AoV rNJURY 1,000,00 X Contractual loci eeNtgPALAGGREGATE Is 2,0 110,00 eEnrl A121MR80ATE LIMIT APPLIES PER,PR00U ,CTS - COMPIOP AGO S 2,000,00 POLICY X Spat LCC _ Deductible S 25,00 AUTOMOBILE LIABILITY i CamBINED DSINGM LIMIT I 1,000,00 A X ANY AUTO X X :A52Z91462848014 SPM014 8/712015 BODILY INJURY (ParPornonl I I ALL OWNSOHEi)ULED AUT78ED AUTOS BODILY INJURY (Per aWRWM 18 X - HIRED AUTOS X AUTOSWNED PROPERTYDAMAG" $ .IP_er_r<gcida_n41 UMBRELLA LIAN X OCCUR .X • I EACH OCCURRENCE S 5,000,0 B ®terms LIAR CLAIMS MADE X X 7291462848044 JIM2014 8/212015 Aw;q=ATE $ S,000,6 oral X RaTENTIgN a 10.000 AND EIAPLO DMQ'R LIABILnY ANDAWN'YIM L OOthP6�A ILR WC STATU- OTH• I TORKUMN A OFFlCR° CER EXCLUDED? YIN N I A X C2ZS14B284803d 9t?Jit014 il=015 6L MRACCIDENT ' S 1,008,01 - Itdo�r M NH) L'"I ifyt� d,mcrlbo,mdet ELL DISEASE- EA EMPL $ 1,000,0 _... DESCRIPTION OFOPERATONS below E.L, CISEABE • PC ICY UMrr S 1,000,0 C LasaedlRentad Equipt 8MOSS219312 8=014 ! 1112/2015 w1$1,000. Dud 100,00 C IInstallation Floater SMO56219312 802014 &1.112015 w/51000 Dad 25,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES (Attach ACORD ton, AddtdanW Rwmuft admi le, B rl m „per h n mdmdl *Except 10 days notice for Non -Payment of Premium RE: Plumbing Contractor No. CFCO21462 Village of Miami Shores Building & Zoning 10050 N,1.2nd Avenue Miami Shores, FL 33154 SHOULD ANY OF THE ABOVE DESCM060 POLIOMS BE CANCELLED HEFORB THE ExPIRATION DATE THEREOF. N0110E WILL 50 DELIVERED IN ACCORDANCE VM THE POLICY PROVISIONS. AUTHORRED REPRESEWArnE --4w ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD