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PL-14-775Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 �C 1� — LD Inspection Number: INSP-210958 Scheduled Inspection Date: August 26, 2014 Inspector: Diaz, Osvaldo Owner: GOMEZ-BASSOLS, ISABEL Job Address: 137 NE 92 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: NAVARRO PLUMBING & MECHANICAL CO Permit Number: PL -4-14-775 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132060133170 Phone: (305)244-5832 tsunaing uepartment comments GAS LINE FOR STOVE AND WATER HEATER, DRYER Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed I?f- 6 Failed C&t,`'� Correction Needed ❑ L P� Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 25, 2014 For Inspections please call: (305)762-4949 Page 6 of 39 s r TH SIS TO C�ERTIFY A DROP TEST W PERFORMED ON f3..L..I .�..K.....AT...1.3��.�1� 8' F i.7UIF ION OF...- 0... MINUTE. THE RESULTS OF THE TEST WERE . NO LEAKS WHERE FOUND. LOCK UP PRESSURE FOUND ...1 �.......... LOCKUP PRESSURE LEFT ......... RESPECTFULLY YOURS, c so GA18 PLUNBiNG.C®RP MM LANKA # 25976 GAM QUEEWR s* W COtu�i1SS10N i FF 022971 EXPIRES: September 29, 2017 -°4. F�-o 8ffdW 11w Budge Noary kn I, i r TH SIS TO C�ERTIFY A DROP TEST W PERFORMED ON f3..L..I .�..K.....AT...1.3��.�1� 8' F i.7UIF ION OF...- 0... MINUTE. THE RESULTS OF THE TEST WERE . NO LEAKS WHERE FOUND. LOCK UP PRESSURE FOUND ...1 �.......... LOCKUP PRESSURE LEFT ......... RESPECTFULLY YOURS, c so GA18 PLUNBiNG.C®RP MM LANKA # 25976 GAM QUEEWR s* W COtu�i1SS10N i FF 022971 EXPIRES: September 29, 2017 -°4. F�-o 8ffdW 11w Budge Noary kn ,W)p e Miami Shores Villa ` g 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 RBC E11" r rD APR 18 20% BY: FBC 20 L� Master Permit No. � � " Sub Permit No. r ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION F-1 RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: I 3 i IU t " Z City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Consyucti?n Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): City: State: Phone#: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: r- Address: �a ' 2 6Z 7 City: / �/ Qualifier Name: _ _�� /l/OPLe, f `v p: ne#: $0 5 2 50?, Zip: 5.312? - hone#• 50 5 Z 0161 State Certification or Registration #: (:--' Fr LQ 2 ?Z 9 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: ® Square/Linear Footage of Work: _ Type of Work: ❑ Addition- Description ddition Description of Work: Specific color of color thru tile: Zip: ❑ Demolition Submittal Fee $ �° Permit Fee $ 2,5 CCF $ ' CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 `� S� 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 Zi M 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 11the cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issuedabsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature l Signature v Owner or AgentO The foregoing instrumen was acknowledged b ore e t is 7 this day of 20 by "' who is personally known to me or who has produced As identification and who did take an oath. NOTARY PU IC: Sign: Print: tt My Commission Expires:70y- Contractor 1 The foregoing instrument was acknowledged before me )4 day of 49rd 20 y by �✓ gpa/ A1lil laY� who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: My Ccm aliciano mission FF 082783 Expire# 01/12/2018 1i _ �k�k�k�k�k�k7}N�1kNe�k7k�kek�k��k�k+k�k+ eYje3�e�e�effi�b�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k7R�kekek7k�F�k�k�k�k�k+k�k�k�k�k�k�k�F�F�k�k�R�k�k&�k7k�k�k�te�k#ik+jl�I�e7k1k7k7kokok�k�k�k�k7k�kek�k7k�k�k�ktk�k�k APPROVED BY C Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) 0411612014 12:50 TAX) P.0011001 �►��a�� CERTIFICATE OF LIABILITY INSURANCE 4116/14 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 AM1=ND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE'T'WEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: B the certiflaets holder Is on ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 18 WAIVED, subject to the temm and conditions of the policy, certain policies may require an endoreament. A statement on this certiflcata does not confer rights to the cartlflcate holder In Ilau of such endorsem#nt(s). PRODUCER NfCT Lucia Estrella Accurate PH8.1305)228-8727- (305) 228-8757 8300 West Flagler Suite 114E -MAIL luciaestrelia0bellsouth.net Miami, FL 33144 M116ITMQUORLMA 3018 Phone (305)228-8727 Fax (305)228-8767 INSu S APPORDWO COVERAOE NAIL 6 INSURED mauRBRA: State National Insurance Company Navarro Plumbing & Mechanical Contractors Inc INSURER,,: Ascendant Insurance Co. P.O. Box 226288 MURER o : Miami, FL 33222-6288 INSURER D: A 8 OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE -- --- POLICY NUMM R M ISIi� �r LIMITS OKNERAL LIABILITY EACH OCCURRENCE 6 COMMERCIAL GENERAL LuaLrry ffic*$ ❑ Q MAM0 MADF ® OCCUR r-1 OS111264-2 12/18/201312/18/2013 12/18/2014 MED EXP (Any ens teen)6 PERSONAL b ADV INJURY $ CQ GENERAL AGGREGATE 6 40FPrL AGGREGATE LIMIT APPLIES PER 0 POLICY ❑ PIPIP, Q LOC PRODUCTS • COMPIOP AGO S $ AUTOMOBILE LIABILITY r-1 ANY AUTO COMBINED SINGLE LIMIT (E4k aeeide:u) BODILY INJURY (Per person) 6 F] ALL OWNED AUTOS BODILY INJURY (Per scolds $ ❑ SCHEDULED AUTOS PROPERTY DAMAGE $ (Per eaddant) ❑ HIRED AUTOS ❑ NON -OWNED AUTOS $ ❑ UMBRELLA LIAR ❑ OCCUR p 01 -MO LLIAB p CLAIMSMADE EACH OCCURRENCE S AGGREGATE S ❑ DEDUCTIBLE _ LIABILITY N r A 1 153828-1 03/20/2014 103120/2015 E.L. DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD Jot AddhlonAl Renwits Schedule, If more w"gro is required) ~ Certificate holder is listed as additional name Insured. Plumbing,Eleotrieal and Mechanical CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2nd Avenue Miami, FI 33138 Fax:305-756-8972 ACORD 26 (2006109) OF CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR® Lucia Estrella ®1988-2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD