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PL-14-477I I. v Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-226806 Permit Number: PL -3-14-477 Scheduled Inspection Date: February 12, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner. LEONE, DEBORAH Work Classification: Addition/Alteration Job Address: 5 NW 105 Street Miami Shores, FL Phone Number Parcel Number 1121360050320 Project: <NONE> Contractor: Y & M PLUMBING INC Phone: (305)267-1676 rsunamg uepartment comments PLUMBING FOR ADA BATH ADDITION INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-208807. PROVIDE FLOOR Ej�/ BASE TILE AND GRAB BARS ALL TILE WORK SHALL BE NON POROUS Failed Correction Needed ❑ `�o l S f Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -Inspection fee is paid Ir February 11, 2015 For Inspections please call: (305)762-4949 Page 9 of 22 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: 5 NW 105 STREET MAR 12 2014 FBC 20 Permit No. Master Permit No. City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: 11-2136-005-0320 Is the Building Historically Designated: Yes NO X Flood Zone: X OWNER: Name (Fee Simple Titleholder): DEBORAH LEONE Phone#: 305-778-7774 AAA—_ 5 NW 105 STREET City: MIAMI SHORES State: FL Zip: 33150 Tenant/Lessee Name: NIA Phone#: Email: LEONENWSA@AOL.COM CONTRACTOR: Company Name: Y & M PLUMBING INC Address: 4601 SW 127 COURT 786-367-6187 City: MIAMI State: FL Zip: 33175 Qualifier Name: YAMEL MARTIN Phone#: 786-367-6187 State Certification or Registration #: CFC1426681 Certificate of Competency #: Contact Phone#: 786-367-6187 Email Address: YMPLUMBING@GMAIL.COM DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $% 5" Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace Description of Work: PLUMBING FOR ADA BATH ADDITION Submittal Fee $ Permit Fee $ 2 Z 5. Zy CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ ❑Demolition Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �.� l RIMMOO 1i Owner or Agent Signature Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 10 day of , 20 �, by I�r�1nor h 10.ia'e� day of MARCH , 20, by YAMEL MARTIN who is personally known to me or who has produced. who is personally known to me or who has produced As identification and who did take an oath. as identif tion and who did take an oath. NOTP L �, L®ry Mendez NOT UBL .�.. ,.•• rFU"�., Lory Mendez `pSl�f ,n"ARY ®, / .a. oCo1AMISSION #EE167083 gi n$COP:IMISSION#EE167083 / d °°� •'c� EXPIRES:,AAAR17 2016= EEXPIRES:MAR.17,2016 1YNW.AARONNOTARY.com 'o.,,°u;;WWW.AARONNOTARY.com Sign: oa„asp Sign: Print: My Co �' si n Expires: D 1 %1 I `%- Print: l 1 I Aron) hJle--<%- My Commission Expires: `3 1 n' L4 APPROVED BY �'�`� Plans Examiner Zoning Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. / OPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. 7 OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Y & M PLUMBING INC BUSINESS ADDRESS: 4601 SW 127 CT CITY MIAMI STATE FL ZIP CODE 33175 BUSINESS PHONE:7( 86 ) 367-6187 FAX NUMBER �) CELL PHONE7( 86 ) 367-6187 QUALIFIER'S NAME: YAMEL MARTIN QUALIFIER'S LIC NUMBER: CFC1426681 E-MAIL ADDRESS (IF APPLICABLE): YMPLUMBING@GMAIL.COM Created on 3119109 BY MLDV 1 RV 3126109 MLDV 03/10/2014 17:52 FAX 9 002 aoaar� Local Susi ness Tax Receipt Miami—Dade CoPnty Stat@ of Florida �n/y��w -nnWWtAMLI.-D0NOTPAY [LBT 55WO4 .r, UMS tit '"CM nom* K% EXPIRES v& M PLUMBING INC - 8EPT9MSER A 2014 1Z7 Cr Must ba dkpWad of pleas of buslnws 4601 5W MIAMI W 331 Punuam to County Cade eMpterBA-art.9 & 10 OWtrlRrr S� 4vM or wuntP es PAYMEWT r4nf "D Y v M R4uMBINC INC 186 PLUM81NO WNTRACTOR sY rax ct .R raw CFC1420M $75,00 08/26/2013 Worker(p) 1 EcHECK 13-906259 Ttlb teoe� eurimat Tae BW a1 me LacN Bedaa� Taq, Toe Baod t is sot a Naat�. n�ti tl a' �aniHadiae 0f rod . Y * �fM a . Haldu. m* a01B�iY a aa110� Mr {ffp?r 0 97AT6 OF Fi,CRIDA ���' "4 Ei 2 7 1 ?g i DPROFNS�SIOM R$G� C Y ATIOOr Buinss N CFC1426621 .08/15/12 128040714 r CERTILPIRD PzrMSING CONTRACTOR 31d'ARTINI YAM x & X plomwrNa INC is CRRTIFX= under the PYaviai,eno of 1:4,489 fe smat=atfoa data, AM 31, 2014 L19081502008 MMI CERTIFICATE 033/10/1_TE OF LIABILITY INSURANCE r °11011 °°"'"'° � 4 -_--� 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endowed. If SUBROGATION IS WAIVED, subject to j the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the 1 PRODUCER A❑ ! AME EJRIIS Gepero Nit —�}�GYE POLICY NUMBER —MAW TED -COMMERCIAL 10185FL00044843 04/15/2013 ij I Lopez Insurance Agency LIMITS --�— EACH OCCURRENCE PREMIS 9EE (Fa occurrence) r, (305) 24-3636- I 30.5 264-3357 ( .) ; 5755 W. Flagier Street #204 i $ 1,000,000 GENERAL AGGREGATE_ PRODUCTS -COMP/OPAGG! v 1$ $ — 1,000,000 _ Miami, FL 33144 -C i j ! !� ( --- (- -_� -i COMBINED SINGLE LIMIT i (Ea accldeM) _ BODILY INJURY (Per person) Phone (305) 264-3636 Fax (305) 2643357 i � ' ❑ ALL OWNED AUTOS ❑ SCHEOULEDAUTOS ❑ HIRED AUTOS ❑ NOWOWNEO AUTOS ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑- CLAIMS -MADE � INSURER(S) AFFORDING COVERAGE MAIC INSURED — INSURER A: GRANADA INSURANCE COMPANY $ Y & M Plumbing, Inc. 4601 SW 127 Ct. ❑ DEDUCTIBLE —^ ❑ RETENTION $ WORKERSCOMPENSATION T�--- AND EMPLOYEE LIABILITY y / ANY PROPRIETOR/PARTNER/EXECUTNE, (OFFICERIMEMBER EXCLUDED? I Y (Mandatory in NH) 1 Ryyas, deaxihe under DESCRiPTtON OF OPERATIONS below INSURER e: MADISON INSURANCE COMPANY I INSURER C: Miami, FL 33175 ! `---�---- I I 111110/2014 —• T- WCSTATU- nOTH MQSJ�E� --! _ -- E L EACH ACCIDENT _ --�-- EL DiSEASE - EA EMPLOYET COVERAGES TE NUMBER: NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE NULK;Y I hKluu 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. A❑ _ TYPEOF INSURANCE -- GENERAL LIABILITY — GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR _— ❑ — GEN'LAGGREGATE LIMIT APPLIESPER = �{Nglt �t�/p jll --) _ I n I ` —�}�GYE POLICY NUMBER —MAW TED -COMMERCIAL 10185FL00044843 04/15/2013 ij I �¢ 04/15/2014 ILII LIMITS --�— EACH OCCURRENCE PREMIS 9EE (Fa occurrence) t $ 1,000,0 100,000, j MED EXP (Any one person) : $ 5,000 PERSONAL &ADV INJURY i $ 1,000,000 GENERAL AGGREGATE_ PRODUCTS -COMP/OPAGG! v 1$ $ — 1,000,000 f i ❑ POLICY ❑PRO" ❑ LOC _ AUTOMOBILE LIABILITY ❑ ANY AUTO -C i j ! !� ( --- (- -_� -i COMBINED SINGLE LIMIT i (Ea accldeM) _ BODILY INJURY (Per person) S $ It i � ' ❑ ALL OWNED AUTOS ❑ SCHEOULEDAUTOS ❑ HIRED AUTOS ❑ NOWOWNEO AUTOS ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑- CLAIMS -MADE � I ' E ! ; BODILY INJURY (Per sodden DAMAGE PROPERTY D (Per accident) EACH OCCURRENCE AGGREGATE $� _-- Is �- $ -- S -- $ B I f ❑ DEDUCTIBLE —^ ❑ RETENTION $ WORKERSCOMPENSATION T�--- AND EMPLOYEE LIABILITY y / ANY PROPRIETOR/PARTNER/EXECUTNE, (OFFICERIMEMBER EXCLUDED? I Y (Mandatory in NH) 1 Ryyas, deaxihe under DESCRiPTtON OF OPERATIONS below 3 I I i N/ A I i ----?— - --- --- — {{ WCV000329102 ! i 11111012013 --� ! `---�---- I I 111110/2014 —• T- WCSTATU- nOTH MQSJ�E� --! _ -- E L EACH ACCIDENT _ --�-- EL DiSEASE - EA EMPLOYET S 100,000 $ ~- 500,000 1 E.L. DISEASE -POLICY LIMIT i $ 100,0 DESCREPTK)N OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORO 101, Additional Remarks Schedule, U mora specs Is required) j I Plumbing - CFC1426681 ' 1 CERTIFICATE HOLDER Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 ACORD 25 (2009109) QF _ CANCELLAT_ION 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 --T — ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD