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PL-15-712I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232963 Permit Number: PL -3-15-712 Scheduled Inspection Date: April 21, 2015 Permit Type: Plumbing - Residenti Inspector: Diaz, Osvaldo Inspection Type: Owner: TOTH, CHRISTOPHER Work Classification: Addition/Altetio Job Address: 95 NE 98 Street Miami Shores, FL 33138- p m Phone Number Parcel Number 1132060131170 Project: <NONE> Contractor: COASTAL PLUMBING OF SOUTH BEACH INC Phone: (305)532-2199 comments REMOVE AND REPLACE EXISTING HORIZONTAL ""'---- ------ PIPING -----PIPING AND CONNECTIONS TO SEPTIC TANK UNDER INSPECTOR COMMENTS False HOUSE Inspector Comments Passed Ea" Failed Correction Needed Re -Inspection Z1 Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 20, 2015 For Inspections please call: (305)762-4949 Page 56 of 66 11 Project Address Parcel Number Applicant 95 NE 98 Street 1132060131170 CHRISTOPHER TOTH Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CHRISTOPHER TOTH 95 NE 98 Street MIAMI SHORES FL 33138-2334 Contractor(s) Phone Cell Phone COASTAL PLUMBING OF SOUTH BEJ (305)532-2199 Type of Work: REMOVE AND REPLACE EXISTING HORIZON Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due Miami Shores Village CCF 10050 N.E. 2nd Avenue NE DBPR Fee Miami Shores, FL 33138-0000 DCA Fee Phone: (305)795-2204 Project Address Parcel Number Applicant 95 NE 98 Street 1132060131170 CHRISTOPHER TOTH Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CHRISTOPHER TOTH 95 NE 98 Street MIAMI SHORES FL 33138-2334 Contractor(s) Phone Cell Phone COASTAL PLUMBING OF SOUTH BEJ (305)532-2199 Type of Work: REMOVE AND REPLACE EXISTING HORIZON Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due Amount CCF $3.00 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $1.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $170.50 Valuation: $ 4,200.00 Total Sq Feet: 50 Pay Date Pay Type Arnt Paid Amt Due Invoice # PL -3-15-54981 03/30/2015 Cash $ 50.00 $ 120.50 04/17/2015 Credit Card $ 120.50 $ 0.00 AvailaDle IInspection Type: TOD Out In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRAAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID IT I certify that all the forep6ijg information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z n_ _ g. Futhermore, I autho ' e abovq-named contractor to do the work stated. April 17, 2015 Owner // Applicant" / Contractor / Agent Building' Department Copy April 17, 2015 1 Miami Shores Village Building Department artment� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 3 0 2015 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 LBY:_ FBC 20 [t-3 BUILDING Master Permit No. PL l S ---I I PERMIT APPLICATION Sub Permit No ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL UMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: __ �"�' �% �� /• City: Miami Shores / County: Miami Dade Zip: i✓ Folio/Parcel#:1/ —2e&2e -?713 '`I ZAP Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name LFee Simple Titl,,ehhc Address: � a 4- City: lotto� a /' Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: City: a® q Qualifier Name: State Certification or Registration #: BFE: FFE: one#: p: Zip: "c� o Phone#:��'�/ :ificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Address: City: State: Value of Work for this Permit: $��®� ' .fC Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration U New a&air/Replace Description of Work: Zip. ❑ Demolition Specify color of color thru tile: Submittal Fee $ V /� Permit Fee $ Scanning Fee $ `� �� Radon Fee $ �1 Technology Fee $ Training/Education Fee $ _ Structural Reviews $ (Revised02/24/2014) c 5 3•oD co/cc $ _ DBPR $ Z--15 Notary $ S -00 ( '0-> Double Fee $ Bond $ TOTAL FEE NOW DUE $ 124 " S( -'i Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City .s— State �— Zip _o 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 theabs of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this t—day of t!!l 201� b ,y oa i 5 -To a4 rs( who is personally known to me or who has produced FC_ I as identification and who did take an oath. NOTARY PUBLIC: The foregoingInst day of me or who has produced CONTRACTOR was acknowledged before me this ,2005 by who is personally known to a identification and who did take an oath. NOTARY Sign: ,) Sign:� o 5.5 Print: :�`�o: _� °� ` Print: Seal: Seal: tP, I��\\\\� APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) C, ROBIN mCCI.USKEY �RE� y 12E20155 Notarf Publlc UMWMdM Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH AAONROE STREET TALLAHASSEE FL 32399-0783 RANDALL, ZACHARY ERIC ` COASTAL PLt1M8lNt3 OF EOLITH BEACH INC X17 SYLAMINGO ROAD COOPER CITY FL 33330 a s RICK SCOTT, eOVEMOR TB8 FLUMMNU UMTRACTOR Nooledbelaw,CER7lFIED Under rl flfe dClWoW40 FS. A MRM CERTIFICATE OF LIABILITY INSURANCE 1-030TE"/27/201SMDNYYY) ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A&D ALL -LINES INS ASSOC INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5600 SW 135 Ave Ste 106 ALTER THE COVEI Miami, FL 33183 POUCYEX 1 TIONLIMITS 91-9791 INSURERSAFFORDING COVERAGE MAIC # INSURED COASTAL PLUMBING OF SOUTH BEACH, INC. INSURERA INSURER B NORGUARDI INS CO INSURER C: �y 5722 S. FLAMINGO RD. # 217 INSURER D: EE COOPER CITY, FL. 33330 INSURER E I 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 SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR N8RD 10050 NE 2ND AVENUE POUCYNUMBER POLI YEFFECTIVE POUCYEX 1 TIONLIMITS AUTHORIZED REPRESENTA !2!��.., GENERAL LIABILITY OCCURRENCE $ 1. 00,000 COMMERCIAL LITY jtygg $ t CLAIMSMADE OCCUR orte eleon S 5,000A LE VI JURY 8 1,000.00 14-0298 11/18/14 11/18/15 GENERAL AGGREGATE $ GEMLAGGREGATELIMITAPPUESPER: PRODUCTS- compmpAm Is 2,000,000 POLICY M P O rl LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (EeiM $ BODILYLNJURY (Perp—)$ 10,000 ALL OWNED AUTOS SCHEDULED AUTOS BoDILYINJURY S 20,000 (Pori wem C HIRED AUTOS NON-OWNEDAUTOS 13-0089 09/17/14 09/17/15 PROPERTY DAMAGE $ 10,000 (PeraccduM H GARAGELIABIUTY AUTO ONLY -EA AC (DENT OTHER THAN EA ACC $ ANYAUTO AUTOONLY: AGO EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE 5 AGQREGATE OCCUR rl CLALMSMADE S DEDUCTIBLE RETENTION $ A WORKERSCOMPENSATION AND E.L. EACH ACCIDENT is 100,000 EMPLOYERS' LIABILITY ANY PROPRIETOWIETOR/PARTNER/EXECUTNE 13-0078 04/08/14 04/08/15 O100,000 B OFFICERIMEMSER EXCLUDED? E I DISEASE- L I , deslxibeurMer AL OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL. PROVISIONS PLUMBING CONTRACTOR AAM^M■swAM ACORD 25 (2001108) y KU GUK"KA I Icor *lVf0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF MIAMI SHORES DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL 10050 NE 2ND AVENUE IMPOSE NO OBLIGATION OR LIABILITY OF ON T URER, ITS AGENTS OR MIAMI SHORES, FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENTA !2!��.., ACORD 25 (2001108) y KU GUK"KA I Icor *lVf0 BROW R13 COUNTY LOCAL BUSIN SS "I' RECEIPT - 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 – 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA:- Receipt#'pi2-1599 Business Name: COASTAL PLUMBING OF SOUTH BEACH Business Type: LUMBIwrr sPRNia,/c (PLUMBING CONTRACTOR) Owner Name: RANDALL ZACHARY Business Opened:03/11/2008 Business Location:11510 S OPEN CT State/County/CerfiReg:CF-C1427608 COOPER CITY Exemption Code: Business Phone: Room Seals Number of N[achines: Employees Mad*Ns Professionals 2 ending Bushum Only area Tvoe: Tax Amount Transfer NSF Fee Penalty PriorYears Collation Cost Total Paid 27.00 3.00 0_00 0.d0 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: RANDALL ZACHARY 5722 S FLAMINGO RD #217 COOPER CITY, FL 33330 2014 -2015 Receipt t#108-13-00003409 Paid 07/17/2014 29.70 %• • 1111• • • • 1111• 1111 • • • •• • • 1111. • ••• (3,�cotur� �P`ss+nb% • • • • a • • 1111• ••• a5- 32-2199 1111... •• •11. 11• . 1111..... . •; :106 �eGj, Industrial, siaenW it 'and Medical Gas APR o a 015 BY: � J JOB ADDRESS: PERMIT NUMBER: z� Plumbing Drawings submittal Coastal Plumbing of South Beach Inc. �\ e 5846 S. Flamingo Rd. Suite#217 Cooper City, F1.33i3- 0) Office: (305) 532-2199 QUALIFIER: ZACHARY RANDALL — CFC 1427608 WITNESS WHEREOF, I have hereunto set my hand and seal this 0 day of 206-. BY: Theforgoin instrument was acknowledged before me this day of who is personally kn w to me or who has produced as i en r Y who did take an oath. NOTARY PUBLIC C SEAL M N��10182b l 205 �tpRE3: JufY STATE LICENSED & INSURED STATE CERTIFIED PLUMBING (CFC1427608) & MEDICAL GAS CON'T'RACTORS (#06-0625-16) www.cowWplumbingofsouthbeach.net LOX �'-� rd °fes' �'',,�0„�'�.r� �/ � ., It" 00,� zv� 5ie-, loop ZACHARY RANDALL Office: 305.5312199 s MoMir 954.540.7742 E -mak vandcHGcoastulOumblnp&AieadLnef 4�04 UcenW Insured, CK ii2T7ii-'UW0G9 (edified i"gi —6- WO UdW A3695 A 001W PLUMBF0 PLAM Approved 4,e- 9 -/,- Disapproved rite e • dO PLUMBF0 PLAM Approved 4,e- 9 -/,- Disapproved rite e 04/09/15 02:13PM COASTAL PLUMBING OF SOUTH BEACH INC. 9545895655 P. THE POLlCI$S OF INSURANCE UST ED ANY REQUIREMENT TERM OR ION HAVE BEEN MED TO THE INMMED MAY PERTAIN, THE INSU CONDITtpN OF ANY CONTRACT OR OTHER NAMES FOR THE POLICY'0400INDICATED. NOTNATHSTANDlNO POIJOIES. A RANCE AFF RM BY THE DOCUMENT NRTH RESPECT TO V iiCN T►U5 CC'RTIFlCATE MAY lTANW OR (3OREGATE UMITg SHOWN MAY HAVE SEEN Q gy pglp CLNUS.HEREIN� SUBJECT TO ALL THE TERMS. QCCLUUW TR SIONS AND CONDITIONS OF SUCH (GENERA( UAOIUTY Y N CLAIMS I Og UI C) TY CU EACH OCCURRENCE A CLAIMSMADES OCCUR 14-0299 11/18/14 11/18/1�a mE Exp oma N%A UMtTAPPUEgpFta• OMOBLEUAWFTY ANYAVTO ALL OWNED AUTOS COMBINED SINO(.E LIMIT (Ea eaWera? 6 SCHEDU M AUTOS C Hl�ls AuTos 13-0089 (°_ ' s 90,OOq t�oNOwN DAuros 09/17/14 09/I9/15 BODILYINJURY (Per 8 �® 000 I �MAiiECImI.ITY PROPERTY DAMAGE (PBregdEr>np s 10,000 ANYAUTO A Y T OTHER THAN EA ACC 8 EXCESWUMBREU,A IJABILITY AUTOONLY. OCCUR Ot,AtMgMAPE EACH OCCURRENCE i PEDUCTIKE $ a RSCOAIPBNSATIONANO +.oYeRe•uA60.TlY ••�••••�••• ANY PROPR►I:olEX WDEDtl}cQGVTIVE13-007804/06/15 B ORmEi:mpi 13XCLUDFJi7 04/08/16 E.LEACHACCIo;NT daeG'Iba ; own OTHER t .1 O18PASE.3+�rcv Harr s .r n n n w .. PLUMBING CONTRACTOR CITY OF MIAMI SHORES BUILDING DEPARTMENT 10050 NB 2ND AVENUE MIAMI SHORES, TL 33138 ACORD 26 (2007/0$) SHOULD ANY OF THE ABOVE DESCRISW POLICIES SE CAN( B&FORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER T _ DAYS WRITTEN NOTICE TO THE CERTIN PTO THE T FAILURE TO DO DD SHALL IMPOSE NO OBLIGATION OR R , ITS OR REPRESENTATWES, AUTHORIZED REPRESENTATIVE CORPORAMN7988