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PLC-15-2396 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243990 Permit Number: PLC:-9-15-2396 Scheduled Inspection Date: September 24, 2015 Permit Type: Plumbing -Commercial Inspector: Diaz,Osvaldo Inspection Type: Final Owner: HERMELEE,BRUCE Work Classification: Addition/Alteration Job Address:9020 BISCAYNE Boulevard Miami Shores, FL Phone Number Project: <NONE> Parcel Number 1132060110120 Contractor: TROPICAL PLUMBING AND SEPTIC INC Phone: (407)568-0111 Building Department Comments REPLACE EXISTING FAUCETS (4) Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed O Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid September 23,2016 For Inspections please call: (305)762-4949 Page 20 of 34 y 11Y Miami Shores Village 3 3 1t 1, p pIutt11Ik11 F ? 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 M 01 Expiration: 03121/2016 Project Address Parcel Number Applicant 9020 BISCAYNE Boulevard 1132060110120 Miami Shores, FL Block: Lot: WAL MIAMI LLC Owner Information Address Phone Cell WAL MIAMI LLC 275 MADISON Avenue NEW YORK NY 10016- 275 MADISON Avenue NEW YORK NY 10016- Contractor(s) Phone Cell Phone Valuation: $ 1,600.00 TROPICAL PLUMBING AND SEPTIC It (407)568-0111 ::--- Total Sq Feet: 0 Type of Work:REPLACE EXISTING FAUCETS(4) Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Classification:Residential Re Pipe Scanning:1 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground Fees Due jAnPay Date Pay Type Amt Paid Amt Due CCF DBPR Fee Invoice# PLC-9-15.57154 09/21/2015 Check#:119 $50.00 $110.70 DCA Fee Education Surcharge 09/23/2015 Check#: 118 $110.70 $0.00 Permit Fee Scanning Fee Technology Fee Total: 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 informatio i a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na d ractor to do the work stated. September 23, 2015 Authorized Signature:Owner / Applicant / Cont ct r / Agent oate Building Department Copy September 23,2015 1 Miami Shores Village Building Department SEP 2 12015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 [--- -- _---- INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 BUILDING Master Permit No.C 6"7- l 5- 07 2- PERMIT APPLICATION Sub Permit No. p Qc k'�;" 2-39 G ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 0`PLUMBING 7 MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9102-0 IJ f S C N�e&j EVu A City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_M2 0! 5-0 13 -7 q `/7 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1 ®�l�®t f.,1�G�115 14 Phone#: 7 q q-7^ 0 3 96 Address -I0b k- Cyoye, Orr -e fd�. a City: 0 Q�Gt State: Zip: 72 3c, Tenant/Lessee Name: A � ) Phone#: Email: 624v CoA 1 CONTRACTOR:Company Name: l ��/C/�. P(0"t 0L.c Ie�. o� Jns��e J hone#: tiD ?.5(o &'c-W T Address: I Lf �' �. C016AofA / QA City: //)AeclPJ State: /� L- Zip: 3Z 1'2G Qualifier Name: LyA.,dol, 0F/(^ Phone#:e/G ''S��• /!l State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: G� Value of Work for this Permit:$ 9 Cam Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New R/Repair/Replace ❑ Demolition Description of Work: 13/5 /z 6 X/ S/I A.. y C f2 Specify color of color thru tile: Submittal Fee$ w Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 1[o . (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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur 4tv- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1yo ,20 /, , by o71 * day of 20 l.; , by /`�742 S ,who is personally known to Win" els eeig __,who is personally known to me or who has produced 14:7-9L-- as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: (J C:L ,fill Int: Print: �.. Joanna M Feliciano -4 4Z41 Seal: N^O My Commission FF 082753 Seal: �r Notary public State of Florida Expires 01/12/2018 � Vickie L Clayton My Commission EE 162962 Expires 03/28/2016 ***�k*�k APPROVED BY �. R VLA31114 Examiner Zoning Structural Review Clerk (Revised02/24/2014) 03/10/2010 08:23 FAX 00002/003 POWER OF ATTORNEY Date: G Z/ 1 hereby name and appoint 1t 1 A of C K k A Co ti S JYarc�t`d m to be my lawful attorney In fact to act for me and apply to the /-1t a ent/ SLt®R r.Sy t �zg Building Department for a permit For work to be performed at a location described as: Section Township Range Lot Block Sulxiivision � �.(c I Fr2Mr��r2 ( 62U (Owner of Property and Address) and to sign my name and do all things necessary to this appointment- L..v,��l��.- �Ftir /s bye ` C f—C /C4Z 0;;, Type or ' t Name of Register or Certified Contractor and Coatractoes License Plumber All Signature of Register or Certified Contractor The.foregoing instrment was acknowledged before me this:e day of .of 20 L2C Byrlo�sri Who is personally known to metwttepmdmed As identification and who did not take oath. Sta:e of Florida County Of v L #v py Notary Public State of Florida ; Vickie L Clayton t My Commission EE 162962 4 �Ro�@ Expires 03/28/2016 Notary Public,Orange County,Aorida 7 mass M. Miami shores Village r Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33938 Tel: (305) 795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ✓ COPY OF QUALIFIER'S STATE LICENCES B. tZ COPY OF LOCAL BUSINESS TAX RECEIPT C. c/ COPY OF LIABILITY INSURANCE D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit} IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE' (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Cerlifificate Holder. MIAMI SHORES VILLAGE BLDG DEPT 94050 NE 2ND AVE MIAMI SHORES,FL 33138 Cerdficate must specify the description of operations or contractor license nrnnber. ■■■■■■■■■■■■■■■■��ase®®s�rs��•e®a■s�a■��®■a��■■■s■■��a■s��■ s��aa�s�■s�ess��■�a�■ c� BUSINESS NAME: C� e/� �c�� y r of �, AFP BUSINESS ADDRESS: ( �Lf Cy�b�(/ Cln i �- STATE F(- zIP 3 BUSINESS PHONE: 0(t l FAX NUMBER(�®Z) S�(o 9S— 0/(9 CELL PHONE f�d?j_�� 7 QUALIFIER'S NAME:t U/6, �v w 0o�NlF C SA rc k QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1425621 48SUEM. '06/29/2014 CERTIFIED PLUMBING CONTRACTOR DENELSBECK,LYNDON G TROPICAL PLUMOING AND SE70 INC IS CERTIFIED under the provisions of Ch.489 FS. Expit flan date:AUG 31,MIS L1408290001174 M cotf Ranoolphs Tax Collector -- Local Business-Taxitecewt orange-Count;FI is local business tau receipt is in addition to and not in lieu of any other tax required by law or municipal ordinance.Businesses are subleet to regulation of zoning.health and oft dul authoritles.This receipt is valid from October 1 through September 30 of receipt year.Delinquent penalty is added October 1. 2015 EXPIRES 913012016 1803-0962349 1803 CERTIFIED PLUMBING C $50.00 27 EMP ® '"A SINESS OFFICE $30.00 10 EMPLOYEE TOTAL TAX $80.00 PREVIOUSLY PAID $80.00 ® ELSBECK LYNDON G QUALIFIER TOTAL DUE $0.00 � OPICAL PLUMBING&SEPTIC INC DENELSBECK LYNDON G 19468 E COLONIAL DR 19468 E COLONIAL DR U-ORLANDO,32820 �,®�' g ORLANDO FL 32820-3707 PAID: $80.00 009940686576 81712015 This receipt is official when validated by the Tax Collector. SEP-21-2015 15:52 P.01/02 ' DATk(IY(ld1OD1YYY'� ACO—Ra, CERTIFICATE OF LIABILITY INSURANCET09/9112015 PRODucER (407) 365-5656 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Winchester InsuranceNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance, Inc.Ina. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1425 W. Broadway (S.R. 426) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.O. Box 620969 Oviedo FL 32762-0969 INSURERS AFFORDING COVERAGE NAIC 9 INSURED INSURER A:AVTO-00MR9 INS CO 18988 Lyndon G. Denelsbeck a usURgRB!Amorican. Interstate Ins 31895 Tropical Plumbing&Septie Inc. INsuREc Foremost Signature Ins Co 41513 19468 Z. Colonial Drive ILYSaia Ik Orlando FL 32820- INsuI�ERE: COVERAGES THE POLICIES OF INSURANCE L187ED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NNSR POLICY 13FFLCTIVE POLICY OMRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER GATE DATE L ffam A X GENERAL LlAmu'IY / . / / / EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY Pman 8 ;_.300,000 CLAIMS MAGE 7OCCUR 092382-72714753-14 12/31/2014 12/31/2015 MEDW(Any dna pSM $ "q-4'-10$000 PERSONAL&ADV INJURY $ 'U000,000 GENERALAG%WGATE S `s 00,000 _ WNL AGGREGA7ELIMITAPPLIESPER; PRODU $-COMPJDPAft S i'Lq,200,000 ri POLICY X JPERCaT LOC / / / / 1IMM '11k 0,000 A X AUTOMOBILEUAIILITY 41-599-932-00 12/31/2014 12/31/2015 COMINNSPSINWZLIMIT $ !,000,000 X ANY AUTO (Fe a-M-Q ALL OWNM AUTOS /' ' / / / BODILY INJURY $ SCHEDULED AUTOS (Pat P—) X HIRED AUTOS / / / / BODILY INJURY $ X NON-OWNED AUTOS (Ppra=fdm) / / / / PROPERTYGAMAGE $ (Poraradenq GARAGE IJABILITY AUTO ONLY->=AACCIDENT $ ANYAUTO I I I / OTHERTI•IAN EA ACC E AUTO ONLY: AGO L E)(CESSIUMBRO i A LUUMJ Y /•:'•'/. / / EACH OCCll R $ OCCUR CLANS MADE AGGREGATE S .:, DEDUCTIBLE RETENTION S B WDRKm COMPENSATION Am AVIIcn2355912014 12/31/2014 12/31/2015 X is NTi ln�s X IJMPLOYERS'LIABILITY ANY PROPRISTORIPARTNERIMM M EI.EACH ACCIDENT $ f10 .0,000 O FNCER1MEAdt3�F.XCLUDED? /.. / / / Ell DISEASE-EAEMPI0 8 '*0 1000 SPECIAL PROVISIONS hrlew 9A-DISEASE-POLICY LIMIT S T, P 0,000 C QT= "rated/laaced laquip BCP 03325612 12/31/2014 12/31/2015 Pantad ane r..saed 5,000 /•• / / / Ceneractor�s tools/ E t MM, 500 DESCRIPTION OF OPERATIONSILOOA-noNShMHICLESWCLUMNS ADD®BY ENDORSEMENrWEC14L PROVINON8 Re: CFC1425621 Ni.eali shores Village is listed as additional insWced with regarda to N.mexa7. Liability policy. CERTIFICATE HOLDER CANCELLATION (305) 795-2204 (305) 756-8972 SHOULD ANY OP THE ABOVE APSCRIB® POugIS 136 CANCF.I.LFD B3;OR9 THE EVIRATION DA*M THEREOF, THE MM INSURER WILL I NDFAVOR-moi AWL 30 -DAYS WW nFA NQsi1OE TO THE CERTIFICATE HOLDER HAYED TO Wif I;M 8W Miami ShOrea Village BLDG Dept FAILURE'TO DO$0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY WND•UPON THE 10050 NE tad Ave IN fTSAOENT5ORREPa.ME 1rATNVES. AUTHORgEOREPRESENTATNVE�. Miami shores FL 33138- ACORP 25(2001/08) E+AGORD CORP 710N 1988 INS029(0105).06pop - ax SEP-21-2015 15:53 P.02/02 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing,"..- Insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively.. amend,extend or alter the coverage afforded by the policies listed thereon. ACOM 25(2001108) IN8025(oimoa AMS Page 2 d 2 TOTAL P.02