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PL-15-1888 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242361 Permit Number: PL-7-15-1888 Scheduled Inspection Date: August 27, 2015 Permit Type: Plumbing - Resident" Inspector: Diaz, Osvaldo Inspection Type. Owner: Work Classification: Addition/AI eration Job Address:265 NW 91 Street ryo-ye, Miami Shores, FL33138- Phone Number (305)7930592 Parcel Number 1131010331320 Project: <NONE> Contractor: DPAUL PLUMBING INC Phone: (305)332-1402 Building Department Comments KITCHEN REMODEL REMOVE AND REPLACE SINK DISH Infractio Passed Comments WASHER WATER LINE AND LAUNDRY INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 26,2015 For Inspections please call: (305)762-4949 Page 41 of 44 WO .ya ► s y' Miami Shores Village iE tlt 10050 x N.E.2nd Avenue NW �t� s� l�o i dit nl v rat Miami Shores,FL 33138-0000 ' t 1E � 3 Phone: (305)795-2204 '` f RWeINC- t1"3 ., Expiration: 02/01/2016 Project Address Parcel Number Applicant 266 NW 91 Street 1131010331320 GG PROPERTY HOLDING LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell GG PROPERTY HOLDING LLC 1203 ASTURIA Avenue (305)793-0592 CORAL GABLES FL 33134- 1203 ASTURIA Avenue CORAL GABLES FL 33134- Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 DPAUL PLUMBING INC (305)332-1402 Total Sq Feet: 100 Type of Work:KITCHEN REMODEL REMOVE AND REPLACE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# PL-7-15-56493 $2.25 08/05/2015 Check#:1648 $ 118.30 $50.00 DCA Fee $2.25 Education Surcharge $0.80 07/28/2015 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for ail work do a by either myself, my a ent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANIC WINO S,D RS,ROOFI and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoi g info ion is a urate and at all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize th abo n ed co t orVtoo t work stated. August 05, 2015 Authorized Signature:Owner / Applicant Conlriftdv Date. Building Department Copy August 05,2015 1 1 Miami Shores VillageTv ED Building Department "yo 8 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �/INSPECTION LINE PHONE NUMBER:(305)762-4949 �_ FBC 201Y `�r , 160 BUILDING Master Permit NOtA_ PERMIT APPLICATION Sub Permit No,.' ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP (� CONTRACTOR DRAWINGS JOB ADDRESS: � J C, I !�;T � City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): QV_ Phone#: e Address: 120 City: State: is Zip:71�L3± Tenant/Lessee Name: Phone#: Email: ' CONTRACTOR:Company Name: / !�/ v �i�� s L Phone#2-Q 3.5&,., Address: , r / City:� Stater Zip: Qualifier Name:_0e 6 2246?-_'!!5' 110�6z�'l G Phone#:_32:;:. v ly�07-- State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 4 Square/Linear Footage of Work: ATh Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition D cription of Work: ` to r ik-6 LQ div :ey 7 Specify lay of color thru tile: ; Submittal Fee$,. c) „v Permit Fee$ 36, CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) L i r Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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 on estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must b posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. n the absence of su posted notice, the inspection will not b roved and a reinspection fee will be charged. 8 , Signature Signature l VVV NWN,P or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �U L` ( dayof 20 1 ,by lS> � (--2 cx1 TTF-#"'who is personally known to y ��"1 ,who is personally known to me or who has produced �� as me or who has produced L - as l.�1 �%i identification and who did take an oath. identification and who did take an`ga`t`�1 ,,�� NOTARY PUBLIC: ��.•' = , d0/d NOTARY PUB Sign: Sign: Print: ',��i3o° .. ..• e'�P.�` Print: Seal: ''��i� i��`` Seal: It wyPublic-SUteMF loft My Comm.Expires Mar 17.2010 s'•$}�a.��.•` Commission#FF 102787 APPROVED BY n e-/-5 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A CERTIFICATE OF LIABILITY INSURANCE DATE(¢68VDD1YYYY). �.� 07/09/2015 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(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 AC A ALL SOUTHWEST INSURANCE INC PHONE 1827 NE MIAMI GARDENS DRIVE E-MAIL ------- -- �oL•'J05-fi9.2-9213 NORTH MIAMI,FL 33179 PD—D.—'*AMNSJJRANCE@BELI_SOlnB-NEEP___ _.--- cu�'rR ro rr. ---- --- -- ------ _..._. ._--- .•—_—�_ IN SURIEKSJAFFORDINGCOVERA6E INSURED INSURER A:GRANADA INSURANCE COMPANY DPAUL PLUMBING INsuRER B: 1710 NE 139 ST -- — — MIAMI,FL 33181 INSURER C: _--•-- INSURER D: E • INSURER > - 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. IN—LL•IR I TYPE OF INSURANCE . LIMITS ------ - INMPOUCYNUMBER A GENERAL LULBILITY ? !06/07/2015?06107/201$ EACH OCCURRENCE $ Y X COMMERCIAL GENERAL LIABILITY O185FL00036779 �`ZSAI�A aZ fO (- PREWS IEa T CLAIMS-MADE 'L OCCUR i -- �— i MED ERP(Any mre Person) 5 5 000 P€f?SONAL&ADV INJURY_ $ ^..^. ,0�.. —. - GENERAL AGGREGATE $ _ 2.000.000 G_EN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S ~ !POLICY I X PRO- LOC . ._-__.—_—...- $ JECT AUTOMOBILE LIABILITY ; COMBINED SINGLE LIMIT _ ANY AUTO $ �...�.,_ ;ALL OWNED AUTOS B BODILY INJURY(Per parson) $ BODILY INJURY(Per accident � i ) S i SCHEDULED AUTOS � _ HIRED AUTOS PROPERTY DAMAGE $ (Per—dent) _ NON-OWNEDAUTOS i $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MAGE - --' — AGGREGATE $ DEDUCTIBLE — - i RETENTION 5 WORKERS COMPENSATION lR9C STATU- , OTH $ AND EMPLOYERS,LIABILITY I _.-LDRY LIMITS 1 ; ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN ff _— OFFICERIMEMBEREXCLUDED7 NIAIF (_E_L EACH ACCIDENT �S — (MendatDrp In NH) I E L DISEASE-EA EMPLOY r tPyes,desarbsundar EE _ ' 1 E L-DISEASE POLICY UMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addidonal Remarks Schedule,It more space Is required) PLUMBLING CONTRACTOR-LICENSE#CSC1428259 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10050 NE 2 AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED HJ ACCORDANCE WITH THE MIAMI SHORES,FL 33138 POLICY PROVISIONS. FAX 305 756 8972 AUTHORIZED REPRESENTATIVE W KENNEDY ©1988-2009 A-CORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD DPAUPLU-01 HUBBARDS f'fC�>I�►� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/9/2015 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 pollcy(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 CONTACT NAME: Eagle American Insurance Agency,LLC PHONE 407 788-3000 FAIAXc No: 407 788-7933 1855 West State Road 434 A/c No Ext:( ) ) Longwood,FL 32750 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:RetailFirst Insurance Company 10700 INSURED INSURER B: D Paul Plumbing Inc INSURERC: 21005 NW 14th Place#146 INSURERD: Miami Gardens,FL 33169 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- ❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION XOTH- AND EMPLOYERS'LIABILITY AND ER YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE 520-48040 06/06/2015 06/06/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Plumbing Contractor License#CFC1428259 CERTIFICATE HOLDER CANCELLATION 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 Village of Miami Shores 10050 NE 2nd Ave. Miaml Shores FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD