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PL-13-2240Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-200429 Permit Number: PL -10-13-2240 Scheduled Inspection Date: February 26, 2014 Inspector: Diaz, Osvaldo Owner: LLERENA, MARK Job Address: 1550 NE 103 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: YERBILLAS SERVICES INC comments Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)981-1301 Parcel Number 1132050310110 INTERIOR REMODEL FOR 4 BEDROOMS AND 4 BATHROOMS INSPECTOR COMMENTS False February 25, 2014 For Inspections please call: (305)762-4949 Page 8 of 28 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 25, 2014 For Inspections please call: (305)762-4949 Page 8 of 28 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: I S`7 C �jE loS �4 CrT 0 3 23.3 ----------------- FBC 20 20 L® Permit No. s Master Permit No. RQ -3 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 91-K L%rzAp" Phone#: ft 2610 6051 City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 7 �� l� A4VIrOS, Phone#: '760 yij?6 ,5212 Address: 24 2- 5W qq PL City: 6c Qualifier Name: State Certification or r� State: _PL Zip: `�`j% `2 Phone#: W& 'I �� 5212 #: C r 6-14 27 216(43 Certificate of Competency #: Contact Phone#: Email Address: 1 CPQ • (9 -en DESIGNER: Architect/Engineer: Phone#: 1 4 <tc Value of Work for this Permit: $ ��' Sqnai®inear Footage of Work: ®b'e Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demo 'tion Description of Work: Submittal Fee $ Permit Fee $_A!. 3 C • — CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ k 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 app oved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was ackngWledged before me this The foregoing instrument was acknowledged before me this day of .�, 20 11 , by 6Lr '1` Z 1 � day of , 20 I , by T 1�� , who is ersonally known to w who has produced who is personally known tome or who has produced 1l^ As identification and who did take an oath. NOTARY Sign: My Commission Expires: APPROVED BY NOTARY Sign: Print: vr MY COMMISSION # EE 066066 My C EXPIRES: April 1, 2015 Bonded Thru Notary Public Underwriters �AJ "> /. Plans Examiner Structural Review (Revised3/12/2012)(Revised (Y7/10/07)(Revised 06/10/2009)(Revised 3/15/09) identification and who did take an oath. IC: .'w "P�a4 DAYMA DIAZ • `�*1 MY COMMISSION #FF022546 rvice.corn ..39,8-0 3 i 1 Zoning Clerk '4+.__4C>' CERTIFICATE OF LIABILITY INSURANCE °A EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO o2,"1°D"'r' 13 PRODUCER First Commercial Insurance Agency Miami, FL 33138 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P.O. Box 295 Cassadaga, FL 32706 Phone (386)775-1781 Fax (386)775-3666 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI IES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Yerbilla Services, Inc. 2423 SW 99th Place INSURER A: Canal Indemnity Company 27790 INSURER B: Associated Industries Ins. Co. 15954 INSURER C: Miami, FL 33165 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 ADO N TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMOOPPO POLICY EXPIRATION DATE MM/DD LIMITS A ❑ GENERAL UABILITY �COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE 0 OCCUR ❑ GL104361 03/21/13 03/21/14 EACH OCCURRENCE 1,000,000 PREMISES R(Ea xu-D— 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: k POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 1,000, 000 AUTOMOBILE LIABILITY [I ANY AUTO ❑ ALL OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) ❑ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) ❑ NON OWNED AUTOS El PROPERTY DAMAGE (Per ardent) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO ❑ EXCESS/UMBRELLA LIABIUTY ❑ OCCUR ❑ CLAIMS MADE EACH OCCURRENCE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ 13 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? Y2S K yes, describe under SPECIAL PROVISIONS below OTHER AWC1019567 03/30/13 _T_ 03/30/14 g © TN Y LIMIT ❑ ER E.L. EACH ACCIDENT 1,000, 000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMrf 1,000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS f�L��TIC1/� �Tr • w• www _ - - __.. JtiEw�' U ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Ave THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Miami, FL 33138 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE OcnRn 9F MnMrnoi Ae U ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AGORD 25 (2007/08) QF