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PL-14-1514Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223582 Scheduled Inspection Date: November 20, 2014 Inspector: Diaz, Osvaldo Owner: IZOUIERDO, NICOLAS Job Address: 78 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: MILIAN PLUMBING INC comments Permit Number: PL -7-14-1514 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)231-5339 Parcel Number 1132060131330 Phone: (786)260-3123 BATHROOM AND KTICHEN REMODELING. FIXTURES I—. " ...... ' REMOVAL AND INSTALLATION SHOWER PAN INSPECTOR COMMENTS False INSTALLATION Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-215932. provide vacuum breaker at laundy sink relief line at water heater c.o. at shower remove use lavatory November 19, 2014 For Inspections please call: (305)762-4949 Page 24 of 31 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 r_jBUILDING ❑ ELECTRIC F� ROOFING JUL 15.2014 FBC 20 TO 1 6 Master Permit No. t� r Sub Permit NoTL I% -A ISI REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF E] CANCELLATION E] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: l - City: Miami Shores County: Miami Dade Zip: 3«45 Folio/Parcel#: l I - 3 2C)G - 6�' -- 133® Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):Zoev�.nPhone#: M- �2394P b Address: _4� N to � S�( e , City: d " ®V.AM&, (e. � State: F L Zip: 3S L Tenani Email: CONTRACTOR: Company Name: Address: /2- 7/ !� A) IlV Phone#: City: State: Zip: J Qualifier Name: /I • %16 L ✓ 4 Phone#: State Certification or Registration #: 4: 2- -7%-4' -7- Certificate of Competency #: 1,0`2 -76-9/Z DESIGNER: ArchiitteecLt/En�g�in%eer: � Phone#: � J� � ,��� - 04_1 Address: �, 7 l/I/ —: Lle£C City: �Q _q State: F Zip: _✓" C /C9 Value of Work for this Permit: $ 3occ)Square/UnearrFFootage of Work: Tvoe of Work: ❑ Addition ❑ Alteration ❑ New i(�il Renair/Renlare ❑ Demolition Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Permit Fee $ I 225' " Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 b d livered tovtj4 erson whose property is subject to attachment. Also, a certified copy of the recorded notice of commenc st b poste t b site for the first inspection which occurs seven (7) days after the building permit is issued. 1 e abse a of Jsuc osted otice, the inspection will not be approved and a reinspection fee will be charged. ,' Signature Signature ® - .� d✓U OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instr ent was acknowledged before me this �l1 day of , 20 1 by day of , 201 by P-3 i l Yln I�,I I� � ho is personally known to ,who is personally known to me or who has produced V!�-1 t :;) as me or who has produced R--- \ 3i as identification and who did take an oath. NOTARY PUBLIC: \\`\\`��I�Illlrllrrrr,������ ArlO��s''', Sign: - n ? y : C Print: _m identification and who did take an oath. NOTARY PUBLIC: 111111l1�r� Sign: Print: = ° •'��� c = Seal:DA Seal: 4u ��`�:: o ,k1111 III `��je*\it �kak�k�k�kakak�k�k�k�k�k�k�kak�k�k�k�k�k�k�k*+B�k�ki�kak�k�k APPROVED BY Z • /,S-/ '10 Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk Miami shores V Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. B. B. C. D. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER COPY OF LOCAL BUSINESS TAX RECEIPT COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. COPY OF LIABILITY INSURACE* COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 _ --Certificafie must specify i the description tion ofoperations 'or contractor license number. ......................... BUSINESS NAME: . ......... d 1 �- 61.b Ill&' //Yj- BUSINESS ADDRESS: �� � s`_vll 4n CITYWl;llre STATE ZIP CODE %31 1 —� BUSINESS PHONE: (La.L) -902 �7S-5,5 FAX NUMBER (--) CELL PHONE ( ) QUALIFIER'S NAME: � ��� /, �'`Z/��'° � 7 -P --- QUALIFIER'S LIC NUMBER: �`�� 9� _meq 411- A4 R®r CERTIFICATE OF LIABILITY INSURANCEDATSIMMID°'"M RLTR TYPE OP INSURANCE 07/14/2014 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), AUTHORED REPRESENTATIVE'OR PRODUCER; AND THE CERTIFICATE HOLDER. IMPORTANT. N the Certificate holder Is an ADDITIONAL INSURED, the po ft(ies) must be endorsed. N SUBROGATION IS WAIVED, subject to the berms and Conditions of the policy. Certain policies may require an endorsement. A statement on this certificate does not confer rights to the CerWicate holder In Ilau of such endoreemealjs PRODUCER ESTHER VIDAL MUTUAL INTEREST ASSURANCE 1295 CORAL WAY SUITE 3 MIAMI, FL 33145 PHONE 305-860-2003 ° 305�907 am MUTUALASOAOLCOM AFFORDING COVERAGE NAM A ar UMM :AMTRUST NORTH AMERICA INC INSURED wSUR&R B t MILIAN PLUMBING INC INSuC: 1271 CORAL WAY MIAMI, FL 33145 INSURERD: QWURIM Et INSURER F t PRODUCTS-COMPIOPAGG S VVv�GR..r.l:a■L .Y.1MRF..f_ OC./. ftff x.19 mmm. THIS IS 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 OROTHERDOCUMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PIVD CLAIMS. RLTR TYPE OP INSURANCE ----DYNU LIMITS COMMERCb1LGENERAL UABILITY CLAIMS -MADE ED OCCUR EACHOCCURRENCE S Ea a S MED EXP sae S PERSONAL & ADV INJURY S GENERALAGGREGATE S GENIAGGREGATE LIMIT APPLIES PER: POLICY LOC PRODUCTS-COMPIOPAGG S $ AYTOMOBII.ELIABILI Y ANY AUTO SCHEDULED ALL OWNED AUT08 SOS NEC H DAUTOS �-0W fladde BODILY MURY (Per peRanl S BODILY MJMum(Per aa�:q) $ P P S S HCLccu:-MADE EACH OCCURRENCE SEctaeLIA9 AGGREGATE $ DED NTIO S g A WORKEPioY LIABlUTCOMPENSATION ANY PROPISETORIP� Y I N OFFICERIMEMSER EXOWDED9 F (�detorY ItNq destLlba under PTION OF OPERATIONS beMw N 1 A AWC1027083 11/181201311/18/2014 A D E.L EACH ACCIDENT S 100,000 E.E.L.DISEASE - EA EMPLOYE S 100,000 E.L. DISEASE - POLICY LIMIT S 500,000 DiiBORIPTION OP OPERAT[ONS I LOCAMO MMUOLES (ANWh ACM 1D%AdMonW Rwmdm Soho& te, Nato° space N ro**ad) PLUMBING CONTRACTOR UC.# CFC1427947 MIAMI SHORES BUILDING DEPARTMENT 10050 NORTHEAST 2ND AVENUE MIAMI SHORES, FLORIDA 33138 FAX 305.756.8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION.. DATE- THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THEd+OLICY PROVISIONS. reserved. ACORD 26 (2018/061 The ACORD name and loon are realstered .rrraft of ACORD ® CERTIFICATE OF LIABILITY INSURANCEDA 07%14 14" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI N PRODUCER Florida Bankers Insurance 7278 SW 8 Street ONLY AND CONFERS NO RIGHTSUPON THE -CERTIFICATE O HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)266-6493 Fax (305)262-0679 INSURERS AFFORDING COVERAGE MAIC # INSURERA: SCOTTSDALE INSURANCE CO. INSURED Milian Plumbing Inc INSURER B: 1271 CORAL WAY INSURER C: MIAMI, FL 33145 INSURER D: (305) 915-0497 INSURER E: COVERAGES 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 OF 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE WDD/YYYY POLICY EXPIFIATION DATE UM LIMITS A ❑ GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITYGE ❑ ❑ CLAIMS MADE © OCCUR ❑ ❑ GEN'L AGGREGATE LIMIT APPLIES PER: 0 POLICY ❑ PROJECT ❑ LOC CPS 1911171 02/03/2014 02/03/201'5 EACH OCCURRENCE $1,000,000.00 TO RENTED PREMISES Ea occurrence $100,000.00 MED EXP (Any one person) $5,000.00 PERSONAL BADV INJURY $1,000,000.00 GENERAL AGGREGATE $2,000,000.00 PRODUCTS - COMP/OP AGG $1,000,000.00 ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Peraccident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/ UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yes describe under SPRIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERAMONS lLOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CFC 1427947 CERTIFICATE HOLDER CANCELLATION. ACORD 25 (2009/01) OF ©19118-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES BUILDING DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2 AVE THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES, FL 33138 AUTHORED REPRESENTATIVE�� FAX 305-756-8972 n71ffi4rrp ACORD 25 (2009/01) OF ©19118-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 000785 _ _ .., ,,.. „„ , �s 8-� f� �,.. � . + .. -- >: �a