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PL-14-2404Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222696 Permit Number: PL -10-14-2404 Scheduled Inspection Date: January 06, 2015 Permit Type: Plumbing Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: NOVAK, DAVID Work Classification: Addition/Alteration Job Address: 735 NE 91 Street 4-E Miami Shores, FL Project: <NONE> Phone Number Parcel Number 1132060440200 Contractor: SEROTA PLUMBING CO Phone: (305)672-7252 comments INSTALL NEW SINK AND FAUCET TO REPLACE ------ EXISTING -- - '� INSPECTOR COMMENTS False January 05, 2015 For Inspections please call: (305)762-4949 Page 14 of 45 Inspector Comments Passed Failed��' Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 05, 2015 For Inspections please call: (305)762-4949 Page 14 of 45 BUILDING PERMIT APPLICATION Miami Shores Village Building Department OCT 3 1:2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBc Zo /0 Master Permit No. E c - i O _ 14- 2203 Sub Permit No. _P I / _��(/7 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF M CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /VIE I- ! 1 S City: Miami Shores County: Miami Dade zip:3 i si Folio/Parcel#:) (' �20Cy 44 -Ltc) i Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Nwe_ NO JIXCA'4U:� Phone#: - y Address: J �� l� S f i City: 1 otM ► S6nre S State: l.- Zip: 3 3 1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: � c: \v'1 �U'ryN t i n i t Phone#: - �z - 7 2-S Z Address: _ 911 -79 S f . City: 1C.iYY, i Stater-- Zip:3 i3 Qualifier Name: kohafn l� Vyo Phone#: 3o5-671 ' 225-z State Certification or Registration #: G rC- 14 br 0 Z� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ )00.00 Square/Linear Footage of Work: 4 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: ThS�q� � �(1e� �,1Y1 �� Gn� 4VCC� +o reotact_ due k Y)S Specify color of color thru tile: Submittal Fee $ Permit Fee $ "`'" CC �J <i CO/CC $ _ Scanning Fee $ _ Radon Fee $ DBPR $ Notary $ Technology Fee $ 0 �`1 > Trainin cation Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) _ Bonding Company's Address City I 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 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. Signature .� Signatur12� OWNER or AGENT The foregoing instrument was acknowledged before me this c�7 day of. & ' '20 . by JJ01/ ' 9 0 � who is personally known to me or who has produced identification and who did take an oath. as CONTRACTOR The foregoing instrument was acknowledged before me this day of r . 20 14— 1 by a. 3 1.% �.C.0 \ who i rsorially kno to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: t (/� GC Sign: Print: CTS �c 15et l� �c Print: i�fli>` tl ai (L XC:C Seal: Seal: BARRY CEMATO NOTARY PUBLIC `'"� $TATE OF FLIORID�A leo .- HEIKE GISELLE KUHN " "` My COMMISSION #FF004428 I1aa060 4 11 -YA (ReAsed02/24/2014) Plans Examiner Structural Review Zoning Clerk ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408310004063 000126 _ ; wn & Brown Miami Page: 004 SEROT-1 OP ID: MY CERTIFICATE OF LIABILITY INSURANCE1 03128014 °"TE(MWOO YM 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 pciicy(,es) must be endorsed. If SUBROGATION LS WAIVED, subjectto the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not Confer ruts to the certificate holder In lieu of such endorsemen s . PRODUCER Phone: 305-364-7800 NAME: BROWN 8 BROWN OF FLORIDA INC PHON u 14900 NW 78th Court SulteirAo Fax: 305-714.4401 Ne: Miami Lakes, FL 33016.5868 E Rr House Accounts ADDRESS: INSURED Scrota Plumbing Company, Inc. 893 N.E. 79th Street Miami, FL 33138 COVERAGES-ICDTIM.�Ax a„—sc --mcvrswN NumtsiM THIS IS TO CERTIFY THAT THE POLICIES OF WSURANCE 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 susiECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ACCORDANCE WRH THE POLICY PROVISIONS. TYPEOFINSURANCEINSP AUTHOR= REPRESENTATIYR: VWVnPOLICYNUMBER POLI VMRS LITY GENERAL LIABIMAM EACH OCCURRENCE S COMMERCIAL GENERAL, LIABILITY nY CLNMS-MADE � PREMISES Ea O[turtBnts s — MED EXP (Any Dna paten) S OCCUR PERSONAL6ADV INJURY S -- GEWAk AGGREGATE s GENL AGGREGATE LIMB APPLIES PER: O• PRODUCTS -COMPIOP AGG IS S MUCY LOC AUTOMOBILE LIABILITY NGLELIMIT ANYAUTO am'ant1 s BODILY INJURY (Perpns011) S NED SCHEAUTOS BODILY BODILY INJURY (PW SOLI Ent) $ AUTOS HIRED AUTOS AM� NED S acdtlant S UMBRELLA UAB OCCUR EACH OCCURRENCE s EXCESS LUU3 CWMS-MADE AGGREGATE s DED I s WORKERSCOMPENSATION AND EMPLOYM LUBIL(TY WC ST TU- X T V M ER A ANY PROPRIETOR,PARTNERIMCUTNE YIN OFFICERIMEMBER EXCLUDED? ❑ NIA 004807 04/01/2014 04/01/015 E,L. EACH ACCIDENT $ 100,00 (" M NM Kms. tlesRi�unCer E.L. DISEASE - EA EMPLOYE S 100,00 DESCRIPTION OF OPERATIONS Dnpv ELL DISEASE . POLICY LIMIT S 5001 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (AttuO ACORD 101. AdtliCOnm Ranaka SM*CUI. If mac apap IS ragWrgM Plumbing -Commercial & Residential Ronald Vento CFC 1426023 nceT,ore-rr un. nes 01888 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105} The ACORD name and logo are registered marks of ACORD Bro v,. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WRH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHOR= REPRESENTATIYR: Miami Shores, FL 33138 r� 01888 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105} The ACORD name and logo are registered marks of ACORD Bro ACS SEROT-1 OP ID: DM �-; CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/20/2014 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), 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 endorsamranmal PRODUCER Global Risk LLC 5959 Blue Lagoon Dr Suite 101 Miami, FL 33126 EDUARDO R PORTAS INSURED Serota Plumbing Company Ronald Vento 893 NE 79 St Miami, FL 33138 rnveown_r� EDUARDO R PORTAS INSURER B: INSURER E: Arch Co 305-455-7251 NAIC # --' ""`• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED KtViblUN NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ALL THE TERMS, CLAIMS. INSR ADD[ S LTR TYPE OF INSURANCE POLICY EFF LICY EXP POLICY NUMBER MM/DD MMJDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR AGL0,0081301 EACH OCCURRENCE Eoccurrence) $ 1,000,00 05/18/2014 05/18/2015PREMISES(Ea $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER ❑ PRO- GENERAL AGGREGATE " $ 2,000,00 POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 1,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT _ $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N /A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NN) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Plumbing - commercial & Residential Ronald Vento CFC 1426023 M1AM111 Village of Miami Shores Building Dept 10050 Northeast 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �1 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD