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PL-15-117 t IC r us Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226733 Permit Number: PL-1-15-117 Scheduled Inspection Date: September 10, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: PUGLISI, MICHALE & SANIBRINA Work Classification: Addition/Alteration Job Address: 1020 NE 104 Street MIAMI SHORES, FL 33138- Phone Number Parcel Number 1122320290250 Project: <NONE> Contractor: LONCUS PLUMBING CONTRACTORS INC Phone: (305)218-1004 Building Department Comments PLUMBING WORK FOR BATHROOM AND CLOSET Infractio Passed Comments RENOVATION. INSPECTOR COMMENTS False Inspector omments Passed 1 f Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until �) re-inspection fee is paid. September 09, 2015 For Inspections please call: (305)762-4949 Page 1 of 30 Miami Shores Village MEcr a.n Building Department JAN 2 2015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY: f Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 200 BUILDING Master Permit No.yc— PERMIT APPLICATION Sub Permit No.:�?L. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL QPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1020 NE 104 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-029-0250 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):MICHAEL AND SABRINA PUGLISI Phone#: Address: 1020 NE 104 STREET City: MIAMI SHORES State:'FL Zip: 33138 Tenant/Lessee Name. NIA Phone#:N/A Email: CONTRACTOR:Company Name: Q C a 5 Ph vn b 1'r?q Phone#: Address: X1"1 M M 1�0D S14 C �— c `L City: � / /� State: / L Zip: �-3 Qualifier Name: fleInb-e-'� Rel 0 / Phone#: �o�i'– State Certification or Registration#: L FC f IV Certificate of Competency#: DESIGNER:Architect/Engineer: jrfo re 2 G�Pe l T C�� Phone#: 3 7-3 3)6 3 j Address: 2 5� �'E 2 *V C jkt- '90.e), City: IM/141W / State:F(– Zip: 3_-_'5/3 Value of Work for this Permit:$ J.5 Square/Linear Footage of Work: 5Z? �)C: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: BATHROOM AND CLOSET RENOVATION ��y��lc�(G Specify color of colorthru tile: Submittal Fee$ `bV Permit Fee$ L25 t 3�CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I (Revised02/24/2014) 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 an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abs ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature (\m NER or AGENT CONT +R The foregoing instrument was acknowledged before me this The foregoing instrument llwas acknowledged before me this d� day of �0��ho i 20 )Z4 by � day of 1�d 20 JY by �r ��/ �✓l� is personally known to Z/YJ i�`frj who is personally known to me or who has produced as me or who has produced 04 C-1 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI : NOTARY PUBLIC: Sign: Sign: Print: Print: 4M 7A Seal: Seal: r Notary Public State of Florida Jr NO Zaida Tamayo Wy PIIbIiC"$ Of FIOriQf My commission EE 157361 zM, My Comm.Expire Sp 26.2018 w Expires no5/201 s ***** a . . amna APPROVED BY I-Lt1`i S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BELLO, REMBERTO LONCUS PLUMBING CONTRACTOR INC 1300 SW 70 AVENUE MIAMI FL 33144 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range �.. STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, "'} DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC 1428066 ISSUED: 05/29/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you, subscribe BELLO, REMBERTO to department newsletters and learn more about the Departments LONGUS PLUMBING CONTRACTOR INC initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch 489 FS, and congratulations on your new license! Expiration date AUG 31 2016 L1405290031718 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1428066 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 ❑� BELLO, REMBERTO ti LONGUS PLUMBING CONTRACTOR INC 1300 SW 70TH AVE MIAMI FL 33144 ♦• S •. ISSUED: 05/29/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1405290001718 :03711 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT BILL - DO NOT PAY LBT 5918736 7__j BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES LONCUS PLUMBING CONTRACTOR INC RENEWAL SEPTEMBER 30, 2015 1331 SW 84 CT 6174155 Must be displayed at place of business MIAMI FL 33144 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS LONCUS PLUMBING CONTRACTOR INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC1428066 BY TAX COLLECTOR Worker(s) 3 $75.00 08/18%2014 CREDITCARD-14-033006 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-278. For more information,visit www,miamidade.aovftaxcoilectoc ® CERTIFICATE OF LIABILITY INSURANCE 70T E/MM/2015Y) 1/08/2015 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 CONTACT NAME: Pablo M Conde _ A&A Underwriters, Inc. �A/C"N EU;--305-220-7447_ FAC No: 305-220-4821 -)- ------- ---- 8778 SW 8th St EMAIL me aaunerwriters.com_ _ADDRESS: _ p d � _ Miami, FI 33174 _ lNSURERIS)AFFORDINGCOVERAGE NAIC# INSURER A_Scotsd_ale Insurance Company 003292 INSURED INSURER B: BuslnessFirst Insurance Company 012629 Loncus Plumbing Contractor Inc. INSURER C: INSURER D: 1300 SW 70 Ave INSURER_E: u — Miami FL 33184 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 ADDL SUER POLICY NUMBER MMIDD(YYYY (MM/DDIYYPOLICY EFF POLICY YY LTR TYPE X COMMERCIAL GENERAL LIABILITY EA,_ItlOCCURRENCE $ 1,000,000 � DAMAGE TO RENTED 1 QO,000 CLAIMS-MADEEn OCCUR PREMISES Ea a;currence $ ---- A _ _ MED EXP(Any one person) S 5,000 CPS2068515 111/16/14 11/16/15 PERSONAL SADV INJuRY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 qPPOLICYPOLICY PR F ] LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED n SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS rPe;arcldent) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS 1 $ WORKERS COMPENSATION IX PER OTH- I AND EMPLOYERS'LIABILITY STATUTE ER B vrN 521-01010 08/13/14 08/13/15 _ELEACH ACCIDENT 1,000,0_0_0 ANY PROPRIETOR/PARTNERIEXECUTIVE . $ _ OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory in NH) EL DISEASE-EA EMPLOYE $ 1,000,000 �if yes,desenbe a rder -' 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Plumbing Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. 305-795-2204 AUTHORIZED REPRESENTATIVE ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD 25(2013/04) The ACORD name and logo are registered marks of ACORD