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PL-15-165Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229945 Permit Number: PL -1-15-165 Scheduled Inspection Date: March 12, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Typ Owner: ADSIT, DANIEL Work Classification: Additi on/Aft Job Address: 68 NW 93 Street Miami Shores, FL Phone Number Parcel Number 1131010170030 Project: <NONE> Contractor: PLUMBING BY SALOMON Phone: 305-935-9214 3unaing Department comments COMPLETE WATER PIPING RE PIPE FOR ONE BATHROOM, KITCHEN AND LAUNDRY. INSPECTOR COMMENTS False Inspector Comments Passed EE' / C./ Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 11, 2015 For Inspections please call: (305)762-4949 Page 27 of 32 Miami Shores Village At 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 JAN 2 Q 2015 FBC 2016 Master Permit No -PL- I�_ 1 C25 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL r ERfLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ,, , ` CONTRACTOR DRAWINGS Q JOB ADDRESS: 6; C) " W q City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: bcv�Constructio�n Type: Flood Zone: BFE: FFE::OWNER: Name (Fee Simple Titleholder):t , G� 4 Phone#: v'1 C� � Address: 6'y ti (,1 `'(teA 1 City: MIG X"-i_ k S k t State: PL--- Zip: 3-? 1 � Tenant/Lessee Name: Email V CONTRACTOR: Company Name: v t,�'Ili� ��eo Phone#_j%(z_ �Ipjo j Address: ti?a City: State: Qualifier Name: G WPhone#: q State Certification or Registration #: (�;r C-0 T ? q 06 '_1 Certificate of Competency #: DESIGNER: Architect/Engineer: %/ fj Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Gi '5 '© 0 Type of Work: ❑ Addition ❑ Alteration Description of Work:�-�-- rP-� L�..1 �(� G � ?L -o � 1s -i► r Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition c, T c? �v��, o `fie Cftio,ad a t.� Specify color of color thru tile: Submittal Fee $,5 y - clo Permit Fee $ % ' y CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ V� 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 0a 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will noupe approveAand a reipispection fee will be charged. Signatu OWNER or AGENT The �fore "oyrfg instrument was acknowledged beforemethis —1 l' 1 day of. I? f' •t1,1f1� 20 1 �f , by -Lwho is Cersonally known to me or who has produced �(" iU`Si� d�� as identification and who did take an oath. NOTARY PUBLIC: Signature, CONTRACTOR The foregoing instrument was acknowledged before ftm this _ day of 20 175 p� 9114-41" L31>o is personally known to me or who has produced �" l as NOTARY and who did take an oath. 10 Sign: ' r , Print: '` '� , ✓� 1 2 l L.-f-� Print: ( (PC, C, l bZ) Seal: �� ,„ ' qtr. •. RCSEMARYPLASENCIA Seal: MY COMMfS51�1 M FF 130T/8 \\\\\\\\\\��NUuirrU�� • •'' �; •• ca r EXPIRES: June 9, 2018 \ • �� Ri,tt• Bonded Tin Notary pubNc Undenvdtan = rTy cT c3'CP _ APPROVED BY 2 -2-S-/5 Plans Examiner 1QM4 ; Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR Vr-K1 I AtArcnAI 0r t1M=Aov ISSUED: 09/18/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1409180001703 a ess lax r cation tal re/l N0. al max, SEC_ T.i,�-$USINESS°YIiAEI 196LBIhiG"@3 BY TAX paym;g,,*r Lrca ratirn� Yo�es Ft s ar =teas. my 9, neeea� reAerfsvSlr ti apply"f business. z " i on an commercial vski eh Sec „ .. as ` w ACM>7® CERTIFICATE OF LIABILITY INSURANCE l)1 ,``"�' 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: It the certificate holder is an ADDITIONAL INSURED, the policy(hes) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer right to the certificate holder in lieu of such endorsement(s). PRODUCER NORTHEAST AGENCIES, INC. TAPCO UNDERWRITERS, INC. PETERSEN INSURNACE AGENCY INSURED .... SALOMON PALACIOS DBA PLUMBING BY SALOMON 1060 NE 212 TERRACE MIAMI FI 831751 = CT LISA HATCHER PHONE305-653-0333 FAX N.005-651-2391 EMAIL ADDRESS: SFL14803@ALLSTATE.COM s AFFORDING COVERAGE NAIC0 INSURER A: Twin City Fire Ins Company/Hartford INSURER B INSURERC: INSURER0: INSURER E: INSURER F: rn1/C0Af-`CC f VffriCIr ATF M"UMPD• REVISION NUMISER: 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. INSR TYPE OF INSURANCEADDU- 10050 N.E. 2nd Ave. U POLICY NUMBER MAY EFF NYYYI POLICY EXP Lions GENERAL LIABILITY EACH OCCURRENCE S PREMISES occurm e $ COMMERCIAL GENERAL LIABILITY MED EXP (Any one men) $ . CLAIMS -MADE M OCCUR PERSONAL s ADV INJURY $ GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC S AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT Ea accrd�t BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY(Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOSAUTOS PROPERTY DAMAGE S Per - --- UMBRELLA LIMB OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETE .o"$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERMXECUTNE Y t N n EXCLUDED? N (( In N ! A 01 WEC LT54 52 11125(2014 11125/2015 ✓ a STATU- OT"- E.L. EACH ACCIDENT $1 Ol),000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE -POLICY uMIT S 500,000 Nye5, desalt under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEWRCLES (Attach ACORD 101, Additional Remarks Sdvedule, IT more spate is nMulmd) Plumbing Contractor. f ALI/ =! r IP l W ACORD 25 (2010105) The ACORD name and logo are registered arks SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village. THE EXPI TE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2nd Ave. ACCORD CE POLICY PROVISIONS_ Miami Shores, Fl. 33138 AU E :I_ w ACORD 25 (2010105) The ACORD name and logo are registered arks f DATE(MSMICOA-^;) CERTIFICATE OF LIABILITY II SUF;ZA SCE 01/2312 1 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T?!!S 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), AUTHOI?i3I:D REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE BOLDER.. I ' IMPORTANT- If the certificate holder is an ADDITIONAL INSURER, the policy(ies) 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 ._ - - - CONTACT NAME: Maritza Cuervo MA CUERVO INSRUANCE GROUP, INCPHcoN No. 99), 305 956 9992 No):. -305 956 9727 159 27 BISCAYNE BOULEVARD E-MAIL N. MIAMI BEACH, FL 33160 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: GRANADA INSURANCE COMPANY INSURED- I I PLUMBING BY SALOMON INSURER B: ,PRODUCTS - COMP/OP AGG G g INSURER c 1060 NE 212 TERRACE LIABILITY ANY AUTO OWNED (-1 :SCHEDULED - _ III AUTOS }—� AUTOS HIREDAU'FO$ ! .ANON-OtrLPtED UTOS1 # i I( ( INSURER D MIAMI. FL 33179 j - ! 'Ea M INED SINGLE LIMIT accidentl INSURER E: INSURER F: - -rnt r�o a n_�c 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. INSRI , - D LISUBR _ LTR 1 TYPE OF INSURANCE INSR 1 � POLICY NUMBER I DUCY EFF - PdLICY EXP OMITS GENERAL UABILRY - - .EACH 1'00()'000 0i A ` -MMERCIALGENERALI CUR f I I i _ II 10185FL00038918 �- ( 09/05/2014 ' 0910512015 AM PREMISE$l)O,OODCO,CLAIMS-MADE MED EXP (Arty one person) S 5,000 , PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE-- 5.1,000,000 I I I I GEN -L AGGREGATE LIMIT APPLIES PER:S PRO_ n LOC 1 POLICY JE ,PRODUCTS - COMP/OP AGG G g - - -AUTOMOBg.E �ALL LIABILITY ANY AUTO OWNED (-1 :SCHEDULED - _ III AUTOS }—� AUTOS HIREDAU'FO$ ! .ANON-OtrLPtED UTOS1 # i I( ( - i - ( I j - ! 'Ea M INED SINGLE LIMIT accidentl �- -.BODILY- INJURY (Per person} I $ + BODILY INJURY (Per accxtent) S rP D R4YDAMAfiE g - -UMBRELLALWB OCCUR EXCESS LUIB I I CLAIMS NIADEJ:AGGREGATE -r EACH OCCURRENCE S S - DED RETENTION S —- - 5 - WORKERS COMPENSATION, 1 AND EMPLOYERS' LIABQ..ITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE1 OFFICERIMEMBER EXCLUDED? �I (Mandatory In NH) 1 _ I N ! A I ! I I I - f (E.L- OTN- - - T y M(T$ _ IEa E.L. EACH ACCIDENT . 5 - - I ii yes, describe under DESCRIPTION OF OPERATIONS below - _ L_____-. - DISEASE - EA EMPLOYE - S E.L. DISEASE - POLICY LIMIT s II� f fI- I f� i 1 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) - PLUMBING CONTRACTOR ..4+. c Hour ucrc CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN kPANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd AVE. - MIAMI SHORES, FIL 33138- U 4(?wzED`REPR-SENTATiVE - - - FAX: 305 7568972 I I ACORD 25 (2010105)S 4ARR_I)nIA srnc�n The ACORD narne and Ic o ares registered marks of ACORD It