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PL-12-2046f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone. (305)795-2204 Fax: (305)756 -8972 -- Inspection Number: INSP-196209 Permit Number: PL -10-12-2046 Scheduled Inspection Date: July 17, 2013 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type-, Final Owner: DENIS, CAMILLE AND MARIE Work Classification: Addition/Alteration Job Address: 10330 NW 2 Avenue Miami Shores, FL 33150 - Phone Number (786)426-7904 Project: <NONE> Parcel Number 1121360161090 Contractor: AB&K PLUMBING INC Phone: 305-563-3508 Building Department Comments REPLACE BATHTUB Infraictio Passed Comments INSPECTOR COMMENTS False 07/08/2013 - PERMIT EXTENDED PER LAST APPROVED INSP. Passed E�r 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-180882. on hold need qualifier 9EL-3 L00011000d Z65-1 -WOU9 6b:90 EZ, -81-L0 3 IL } 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: (,v�hl'1 kiv l am !I City: Miami Shores County: Folio/Parcel#: Is the Building Historically Designated: Yes NO NOV p�p1y FBC 20 �'b Permit No. � 7— -- 2 C7 '51Ci Master Permit No. VL ( 2— 2,C) 4 Zone: OWNER: Name (Fee Simple Titleholder): Phone#:��� Address: /0 Z —7 A //,C- City: ice City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: _ Address: City: A Qualifier Name: State Certification or Registration #: _ Contact Phone#: 9 7 -L -- DESIGNER: Architect/Engineer: _ vor'R Value of Work for this Permit: $ a�.o Square/Linear Foota a of Work: Type of Work: ❑Address OAlteration ❑New 0 epair/Replace Description of Work: a! z 13AA ISIZ L11 ❑Demolition Submittal Fee $ Permit Fee CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ J 's1 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 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 py of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject tachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection � 1; a rov and a reinspection fee will be charged. p Agent Contractor The foregoi g instru nt was acknowledged before me this �' The foregoing instrument was acknowledged befo me th' day of 0 20 /0, by day of V 20 Eby who ispersonally known to me or who has produced who is personally known to me or who has produced As identifreaaiion an d take an oath. NOTARYYIUBLIC: ---, \ NO Sign: r/ Sigr Print: grin M Y Commission Yr ' Judith -M-j4;;— My My COmmisbim EE 190720 9 Expires 04/16/2016 APPROVED BY !�' �'��� Plans Examiner Zoning Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk AB&KPLU-01 APENATE . '�' 'Iia.. ' RCERTIFICATE OF LIABILITY INSURANCE DATE 11/66/201212012 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(les) must be endorsed. 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). PRODUCER AIB, LLC 701 Wate 701 Waterford Way Suite 300 Miami, FL 33128 C NTACT NAME: xt : (306) 4"-8350 AIC No : ( )444'1 (AIC o E 650 No, E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A: Granada Insurance Company 7/27/2013 INSURED INSURER B:Aequicap Program Administrators, Inc. INSURER C : AS & K Plumbing Corp. INSURER D: 13427 SW 284th Street Homestead, FL 33033 INSURER E: INSURER F: COVERAGES 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. It"LTR TYPE OF INSURANCE A INS SU WVD POLICY NUMBER POLIO EFF MMID POLICY EXP MM LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 0185FL00002423 7/27/2012 7/27/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 IGEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F PROT- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 1 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDE It UMBRELLA LIAR -H EXCESS LIAR SUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA P760535002 10/11/2012 10/11;1013 WC STATU- OTH- TO MITS ER E.L EACH ACCIDENT $ 100,0 .. E.L. DISEASE - EA EMPLOYEE $ 100,Ow E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) CFRTIFICATF Hni nFR CANCELLATION ACORD 25 (2010/05) ©1988-2010 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 Miami Shores Village Building Department g 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shone:, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY 381620-5 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 398451-6 A B & K PLUMBING CORP STATE& CFCO20309 470 W 33 PL 33012 HIALEAH OWNER A B & K PLUMBING CORP Sec, Type of Business 196 PLUMBING THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DARE COUNTY TAX COLLECTOR: 08/13/2012 60000000441 000045.00 SEE OTHER SIDE WORKER/S CONTRACTOR 2 DO NOT FORWARD A B & K PLUMBING CORP ROBERTO HERNANDEZ PRES 470 W 33 PL HIALEAH FL 33012 111111It1111ItI11F}��1lliFtll�iflliitti ll�lf ill!lf 1�i11t �1117� I o f STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 • *1 TALLANORTH AS BSMONROE STREET LL 32399-0783 HERNANDEZ, ROBERT A B & R PLYING CORP 470 W 33RD PL HIALEAH FL 33012-5117 r STATE of Fr.ownA AC# - 6: 3D 01 Co With this license you become one of the nearly one million DEPARTMENT OF BUSINESS :ANI Floridians licensed by the Department of Business and Professional Regulation. -.,PROFESSIONAL REGULATION. ' Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CFCO20509 08/24/12 1200281 Every day we work to improve the way we do business in order to serve you Bette. For information about our services,lease Ioonto www.myfloridalicense.com. CERTIFIED PLIUkMING CONTRACTOR There you can find more information about our divisions and the regulations that � ::'HSRNANDEZ, ROBERT' impact you, subscribe to department newsletters and loam more about the A B `& K - PLUMBING-. CORP,- ' Department's initiatives. Our mission at the Department is. License Efficlently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. . cm�RTsgimm ,z =tag pAra= c>s.4e Thank you for doing business in Florida, and congratulations on your new licensetI IS ams=1:t aaea:_ AVG. 31:,' 2014 Li2os2aoi94 DETACH THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK'" PATENTED PAPER • 3 0.0 4 s 4 STATE OF •' r .TION SEQ# L].20s240I9 IGEN LAWSON SECRETARY eQc:cn 7T in d