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PLC-15-1881
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242598 Permit Number: PLC-7-15-1881 Scheduled Inspection Date: September 02, 2015 Permit Type: Plumbing - Commia Inspector: Diaz, Osvaldo Inspection Type: ercgh Owner: , Work Classification: Addition/Alteration Job Address:9823 NE 4 Avenue Miami Shores, FL 44 -7 Phone Number r Parcel Number 1132060170330 Project: RETAIL Contractor: KOENIG PLUMBING & MECHANICAL CORP Phone: (561)483-0404 Building Department Comments REPLACING BATHROOM FIXTURES Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed ?2, � S a Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 01, 2015 For Inspections please call: (305)762-4949 Page 34 of 47 f�t a & t�erMit NO P .,�C47-188fll `yKOREs yet Miami Shores Village ;, Perrnft Tyj F}111L1 biro-C, ,met t�N' 10050 N.E.2nd Avenue NE Ad Miami Shores,FL 33138-0000 IN�CtffitiSCB#tE7t1ditiQnrAtertibl7 ` rJr7it Cat =API � i '; Phone: (305)795-2204 Ex iration: 02102/2016 sue 16015 , p Project Address Parcel Number Applicant [-96823 NE 4 Avenue 1132oso17o330 MIAMI SHORES COMM CHURCF Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MIAMI SHORES COMM CHURCH INC 9823 NE 4 AVE MIAMI FL 33138-2402 Contractor(s) Phone Cell Phone r � Valuation: $ 5,000.00 KOENIG PLUMBING&MECHANICAL 1 (561)483-0404 Total Sq Feet: 00 Type of Work:REPLACING BATHROOM FIXTURES Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Classification:Residential Re Pipe Scanning:3 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 DBPR Fee Invoice# PLC-7-15-56485 $2.25 07/27/2015 Credit Card $50.00 $ 121.50 DCA Fee $2.25 Education Surcharge $1.00 08/06/2015 Check#:56585 $ 121.50 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $4.00 Total: $171.50 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 ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. ---� August 06, 2015 Authorized ure:Owner / Applicant / Contractor / Agent Date Building Department Copy August 06,2015 1 RE -— TVFD ` Miami Shores Village LBY: UL 2,7 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 2d y s BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No e [:]BUILDING ❑ELECTRIC ROOFING REVISION ❑EXTENSION []RENEWAL PLUMBING []MECHANICAL ❑PUBLIC WORKS []CHANGE OF ❑CANCELLATION [] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 ,VT n[ :Sky� f=l— City: Miami Shores County- Miami Dade Zip: 3 Follo/Parcel#: j3,2,01,o 13,0-'� 3.-0 Is the BuNding Historically Designated:yes NO Occupancy Type: Load: Construction /Type: ��,.� � Flr`ood)Zone: `�,` �B,FFE,:- FFE: OWNER:Name(Fee Simple Titleholder): 4''Tt�lE 4 `�fi:F iC { .i/��cl►t V TPhone# 3 (' Z OA�5 Address: !1 -a=; R/E� q= lq Frte► . 1ZL t7-- City: City: Mt Avr-( S State:.-- Zip: Tenant/Lessee Name- N A Phone#: Email: CONTRACTOR:Company Name: v4eyita, Phone#: mol=!n3 Address: IM->Y4 fQ9!4th T'619r5 314A 54e CQA City: 1rYA 1"w� State: Tip: Qualifier Name:Will torn 1 1 ;!Q'. Phone#: 0404 State Certification or Registration#: C.pC.ow-i 3a Certificate of Competency#: CM0 -7?3a DESIGNER.Architect/Engineer: Q►ft Phone#: 554 -$432 -1"T1 Address: . dMOC ► 5Wke 101( city- ;bbd lAnm5 _State: Zip: 'MO-41 Value of Work for this Permit:$ 5.0000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ER Repair/Replace ❑Demolition Description of Work BMb8*� Q 'V!5 Specify color of color thru tile: Submittal Fee$ C O n Permit Fee$ / � 9---Y CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ wry$ Technology Fee$ TrainIrWEduc xdon Fee$ Double Fee$ Structural Reviews S Bond$ 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: 1 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$250, 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"I not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRA The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _)3 day of Man .20��_,by 23 day of )— 20 15 by W i 1 Ay,-, QC >,,who is personally known to W 111%6yft k)e0►4T=who is personallyknownto me or who has produced Tl� )q Z - as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY P'UKIC. NOTARY PUBLIC: Sign: Ste. Print: �,j 1 Print: '^�r ►rLZ Seal: YNAATtI�A Seal. �pRy•o Notary Public State of Florida I�ogrYsottionda ?° Junior E Ramirez �EE16144ti N� My Commission EE148838 pprtgll 17 � 7,2018 or�o Expires 1112712015 **s*s****sss ss*ss*s*sss***ss*s*sss***ss**sss ss*sss** APPROVED BY L� �S Plans Examiner Zoning Structural Review Clerk i AL STATE OF FLORIDA DEPARTMENT OF BUSINESS ANO PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FIL 32399-0783 KOENIG, WILLIAM JOSEPH JR KOENIG PLUMBING & MECHANICAL CORP 10034 SPANISH ISLES BLVD. C-29 BOCA RATON FL 33498 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 CFC057732 ISSUED' 07/02/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED PI;UMBING CONTRACTOR about our divisions and the regulations that Impact you, subscribe KOENIG;WILLIAM'JU9EPH JR to department newsletters and learn more about the Department's KOENIG PLUMBING &;MECHANICAL CORP initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly. r 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 th 489 F8. and congratulations on your new license! I Expiration date! A4c3r;2016 L1407020001111 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC057732 y r The PLUMBING CONT RACTOR ^ Named below IS CERTIFIED Under the provisions of Chapter 489 FS. _. Expiration date: AUG 31, 2016 0. ' 0 KOENIG, WILLIAM JOSEPH JR KOENIG PLUMBING& MECHANICAL CORP 10034 SPANIDH ISLES BLVD, C-29 BOCA RATON FL 33498 ICRI Ir--n n7rn,>jgn1e. nigPI AV AC Pf=r)i iipt7n RV I AIN qrn i,!' I Un7ngnnn1111 ,, `>, A N.�V E M. G A N N O N P.O. Box 3353,West Palm Beach, FL 33402-3353 **LOCATED AT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel:(561)355-2264 SeraingPalm Beach County 10034 SPANISH ISLES BLVD C29 Serving yc7i'.c. BOCA RATON, FL 33498 TYPE OF BUSINESS OWNER I CERTIFICATION# I RECEIPT ft/DATE PAID AMT PAID BILL# 23-0105 CW PLUMBING CONTRACTOR KOENIG WILLIAM J JR I CFC057732 I B14.1387227'-08104/14 $264.60 840101932 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY B2-800 2014/2015 LOCAL BUSINESS TAX RECEIPT KOENIG PLMB'& MECHN CORP LBTR Number: 198801638 KOENIG PLMB & MECHN CORP EXPIRES: SEPTEMBER 30, 2015 10034 SPANISH ISLES BLVD C29 ST BOCA RATON, FL 33498 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. ANNE M G A N N O N P.O.Box 3353,West Palm Beach,FL 33402-3353 **LOCATED AT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel:(561)355-2264 Seizing Palin Beach County 10034 SPANISH ISLES BLVD C29 Serving you. BOCA RATON, FL 33498 TYPE OF BUSINESS OWNER CERTIFICATION# RECEIPT#/DATE PAID AMT PAIb BILL# 23-0069 PLUMBING CONTRACTOR KOENIG WILLIAM J JR CFC057732 B14.1387207-08/04!14 S27.5U 840101933 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY Bi -800 2014/2015 LOCAL BUSINESS TAX RECEIPT KOENIG PLMB & MECHN CORP LBTR Number: 198608419 KOENIG PLMB & MECHN CORP EXPIRES: SEPTEMBER 30, 2015 10034 SPANISH ISLES BLVD C29 ST BOCA RATON, FL 33498 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. '! i ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `...� 07/2312015 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: Jeri Ellett Roth Agency, Inc. PHONE FAX we No Ext)- (561)451-1900 �_(AIC,No): (561)451-4532 4755 Technology Way,Suite 104 E-MAILS -- Boca Raton, FL 33431 ADDRES _ jelleft@rothagency.com _ License#: R025430 _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Depositors Insurance C0000mpany 42587 INSURED INSURER B: Mercury Insurance Company of Florida Koenig Plumbing and Mechanical INSURERcT Markel Insurance Company 1 10034 Spanish Isles Blvd#C29 INSURER D: Boca Raton, FL 33498-6381 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 56 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 SUBR - POLICY EFF POLICY EXP LTR V POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY ACP5935296937 111/07/2014 11/07/2015 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED CLAIMS-MADE COCCUR PREMISES(Ea occurrence) $ 100,000 _ MED EXP(Any one person) _$ 5000 _ PERSONAL_&ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY_Xj PES LJ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ B AUTOMOBILE LIABILITYFLC7019318-5 06/20/2015 06/20/2016 EoacccdeDSINGLELIMIT I$ 300,000_ JXANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED —}— AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS Per accident �$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE j$ EXCESS LABCLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION PER OTH- C MWC0012761-04 09/23/2014109/23/2015 X STATUTE ER �__ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? NIA (Manes,datory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 (DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMdescribe under IT $ 500,000 III DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Plumbing/State of Florida CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Ave Miami Shores, FL 33138 AUTH ED REPRE E TATIVE (JLE) ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Printed by JLE on July 23,2015 at 09:39AM