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DEMO-15-2342 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 � ('flC� 2 Inspection Number: INSP-243505 Permit Number: DEMO-9-15-2342 Scheduled Inspection Date: September 29, 2015 Permit Type: Demolition Inspector: Diaz, Osvaldo Inspection Type: Final Owner: Work Classification: Plumbing Job Address:9055 BISCAYNE Boulevard Miami Shores, FL 33138- Phone Number Parcel Number 1132060110051-55 Project: <NONE> Contractor: SUNCOAST PLUMBING & ELECTRIC INC Phone: (352)628-6608 Building Department Comments PLUMBING WORK FOR INTERIOR DEMO Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 6k Failed Correction ❑ Needed Re-inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 28, 2015 For Inspections please call: (305)762-4949 Page 25 of 44 Miami Shores Village �cpjv Building Department S�: 15 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BI'; Tel:(305)795-2204 Fax:(305)756-8972 ' INSPECTION LINE PHONE NUMBER:(305)762-4949 - FBC 201y BUILDING Master Permit No.afan /S— �Z PERMIT APPLICATION Sub Permit No.f, ,/)') 2=3 yZ BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL Q■ PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9055 Biscayne Blvd. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: M Load: 345 Construction Type: 11 Flood Zone: BFE: FFE: OWNER: Name(Fee simple Titleholder): IMC Property Management & Maintenance Phone#:305-893-9955 EXT-107 Address:696 N.E 125 Street North City: Miami State: Florida Zip: 33161 Tenant/Lessee Name: Dollar Tree Stores Phone#:757-321-5218 Email: cgomez@dollartree.com CONTRACTOR:Company Name: Suncoast Plumbing & Electric Phone#: 352-628-6608 Address: PO Box 2290 City: Homosassa State: Florida Zip: 34447 Qualifier Name: Todd Workman Phone#: 352-628-6608 State Certification or Registration#: CFC058041 Certificate of Competency#: DESIGNER:Architect/Engineer: RRMM Architects Phone#: 757-622-2828 Address: 1317 Executive Blvd. Suite 200 City. Chesapeak State: VA Zip: 23320 Value of Work for this Permit:$ 1,200 Square/Linear Footage of Work: 12,477 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ■❑ Demolition Description of Work: PL VM j w-rFSE R r a6Z D RO Specify color of color thru tile: Submittal Fee$ 36 C Permit Fee$ � G'-<>"—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) Bonding Company's Name(if applicable) N/A 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 certifyl'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 ELECTOIC, 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. %Wpture Signature OWNER or AGENT CONTRA(*TOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 !S by 2p /day of 7a 11� 6-- 20 / - by Z who is personally known to ©Oo' &V4K�f r�'1 AP7 hvho is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. Y PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: G CI C.,I L t 0 Print: vG 4, Seal: lo ��'•Pbe LUCYCICIU0 Seal: .. .• x MY COMMISSION#EE 164923 �o " Nota Public State of Florida + EXPIRES:April 19,2016 Duc Phan �9TFov c�oP�: Bonded Thru Budget Notary Services My mission FF 232517 ort Exi so5/19/2o19 *******************************************<<************************** * * * ** * ** * *** ****** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) w ♦5�{OR�S Gj :... ..,.. Miami Ewaikhores Village Building Department OR1U 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 758.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. V COPY OF QUALIFIER'S STATE LIC CARD B. V COPY OF LOCAL BUSINESS TAX RECEIPT C._/COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES V[LLAGE BLDG DEPT) D. f COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI BADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33938 ■■■r■.•■■.■r■■r■r.■■.■■■..srr■.■�.■...■■■..�■■■■i■.v■r■.■r■■■e■r■�■■■■a■���■rr.si■a.rr w.■■■■■.r COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: fu BUSINESS ADDRESS: } _ CITY-b- Gfi STATE FL. ZIP CODE 344 BUSINESS PHONE: (�5a ) ZS FAX DUMBER( 3 CELL PHONE s ) cr — rfu QUALIFIER'S NAME: - QUALIFIER'S LIC NUMBER: �;� �t __._ .... E-MAIL ADDRESS (IF APPLICABLE): C rt`�`,1_{� AtllY Created on 3119M9 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTIONINDUSTRYLICENSING BOARD CFC058041 , � "^ The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2.016 WORKMAN,TODD MURRAY 1.. SUNCOAST PLUMBING & ELECTRIC INC 6970 W GROVER CLEVELAND BLVD HOMOSASSA FL 34446 lJ,r� ISSUED: 07/28/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407280000923 1 2015 CITRUS COUNTY BUSINESSRECEIPT State of Florida 210 N Apopka Ave, Suite 100, Inverness, Florida 34450-4298 352-34'1--6500 EXPIRES SEPTEMBER 30, 2015 ACCOUNT # 19449 RECEIPT# 171102S4026 Business Name: SUNCOAST PLUMBING & ELECTRIC INC Loc6tion: 6970 W GROVER CLEVELAND Owner Name: TODD WORKMAN - FRES/QUAL,TENNI WORKMAN -SEC/TR, ROBERT RICHARD/El BLVD Mailing Address: PO BOX 2290 HOMOSASSA, FL 34446 HOMOSASSA SPGS, EL 34447 Business Phone: 352-628-5608 Exemption: Business Type: R100 CST-CERTIFIED PLUMBING CONTRACTOR R120 CST-LP GAS INSTALLER R120 CST-REGISTERED ELECTRICAL CONTRACTOR _ For Vending Machine Business Only Number-of Vending Machines: Vending Machine Type: Tax Amount Transfer Fee HazMat Sub-Totat _...- Penalty Prior Years Collection Cost Total Paid 75.QQ 0.Q0 20.QQ 95.00 0.00 Q.QO 0.00 95.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BUSINESS TAX RECEIPT DOES NOT CONFIRM THAT REGULATORY OR ZONING REQUIREMENTS HAVE BEEN MET. IT IS THE OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE: This section to be completed by the owner of the above named business. Business has been sold to: -.- --._ Signature of current receipt holder upon transfer or ownership change Date Date Business Closed: _ Signature: _ Paid 010-13-00003945 49/16/2014 95.00 �-» SUNCO-1 OP ID:DC DATE'I M/DDlYYYY) .- CERTIFICATE OF LIABILITY INSURANCE 09/4212015 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 andorsement(s). PRODUCER CONTACT The Hagar Group-Crystal River MAMEDebby Coulson 2121 S.E.Hwy 19N Ex52-419 7574 ( c_No ... Crystal River,FL 34429 E-MAILEMAIL Greg Hagar ADDR Ss:dcoulson@thehagargroup.com -- iNSURERISI_AFFORDiNGCOVERAGE _ , NAIC# __ .._.__-___ ___...____ fNSURERA AutOOwners Insurance ....118988 ... INSURED - $uncoast Plumbing&Ejectric-.._ ......_ ..._. ___- ._ ........ _ ._._ ._..._.. ... Inc. INSURER B - ............... ............. - _..._.._ ...�..__ ..... Todd Workman INSURERC: P 0 BOX 2294 INSURERD Homosassa Springs,FL 34447-2290 ..__._ INSURER E INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE "LISTED BELOW HAVE BEENISSUEDTO 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 DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR�_. .-,._ _-.__._ _.__..,.. ADDLuria _._.—...... ....._ _ LTR - TYPE OF INSURANCE INSR, Lit POLICY NUMBER .MMIDDDYlYYFYY' M�MIUDD�ri LIMITS GENERAL LIABILITY i EACH OCCURRENCE=. $ 1,000,000 6:MAC�'6RENTED A X )COMMERCIAL GENERAL LIABILITY j785D6488 01120/2015 0712012016€PRF_MISES_{Ea,exE rgrce s 300,04 _ I ..__._..CLAIMS-MADE X OCCUR � ._. ,.. i MED EXP{Any one Person) $ 10,00 - PERSONAL&Aov NJi $ 1,000,00(- X Liability Plus _ I ..._ —.. CENFkAt AGGRE'CATE $ 2,000,00C .......... GLN'i AGGREGATE LIMIT APPLIES PER PRODUCTS COM?{ P AGG S 20. 00,00 PRO- i POLdCY X - �! LOC AUTOMOBILE LIABILITY I COMBINE .INGLE LIMIT ANY AUTO INJURY -..__. jEaacc�de,�l) BODILY INJUR person) S ALL OWNED. .........SCHEDULE6 -. - ..- ....... G AUTOS AUTOS FSODI LY IN URY(Per accident,'S NON-OWNED _ HIREDAU'r05 , PROPERTY DA;AGEAUTOS "_ I z (PC_ft ACc,I W i UMBRELLA GAB OCCUREACH OCCURRENCE S EXCESS UAB CLAIMS-MADE'. ' I AGGREGATE ;S DEED RETENTIONS WORKERS COMPENSATION COMPENSATION AND EMPL.OYERS'.LIABILITY Y i N I ` ::TORY A,TU- y OTR} _ MantlaANY to in NH)EXCLUDED?ECUTIVE❑1N l A ; E t EACH ACCIDENT ....., l S _ ... _._.. ... ( �` - ,. E.L.OtSEASE-EA EMPI VYE✓;;S .... .. I, es,describe under .....___.-,„,.. _ .....- D SCRIPTION.OF OPERATIONS betow E DISEASE-POLICY LIMIT S A iEquip Floater 78506489 01120/2015 01120f2016.'Rented Eq 25,04 Ded 54 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES{Attach ACORD 101,Additional Remarks Schedule,it more spare is required) PLUMBING -- RESIDENTIAL OR DOMESTIC/COMMERCIA.L CERTIFICATE HOLDER CANCELLATION MIAMMI3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shares,FL 33138 AUTHORIZED REPRESENTATIVE 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD DATE(MMMDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/0212015 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(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 NT A Andrew Atsaves c/o Artex Risk Solt/tions,Inc. PHONE — — FAX 8800 E.Chaparral Rd,Suite 230 t Vc,N�FT SL 951-4177.. . __ {A c NoJ: 4f3�_951 4266 ...-_.. E-MAIL Scottsdale,AZ 85250 ADDRESS,;—_ INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Zurich American Insurance Company 116535 INSURED INSURER B.: .................. ............ . ................ ..I .._..___ DSK Group,Inc.et al Alt.Emp:SUNCOAST PLUMBING AND ELECTRIC INsuRE . INCRc ._ _..__.._ .___... 6715 W Grover Cleveland Blvd INSURER D Hornosassa,FL 34446 INSURER E; INSURER'S; '. COVERAGES CERTIFICATE NUMBER:14FLO76785644 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI..ICY 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.... _.--"'- ADOLTSUBR. ._._........-.. ........._ ...... "_..._._...___..._"I'll'—,............ ._._......, .....,.......... ... .........__. '. POLICY EBF ...Pfl1.1CY EXP ....__. LTR TYPE INSURANCE i POLICY NUMBER MmootyYYY Mwr)or YYY LIMITS COMMERCIAL GENERAL LIABILITY I, ( EACH OCCURRENCE f S DDA AGC Tb RI—ENTEED j L'LA1MS-MAS _ ._.�OCCUR I PRLMI$c.$.ii=.a gcq.Yr r�ce2.... f$ ........ ....... :.._ _.............._.._ MEDEXPIIAny_oneperson,.,, 'i . t ` P..E....R...SO.N.AL..&_..A....D..V IvJURY S ............ ... _.... ...... GEW-AGGREGATE LIMrf APPLIES PER I GENERAL AGGREGATE S POLICY ...j J GT )Lam. l r i PRODUCT COMP OP AGG I S - -- - OTHER: i AUTOMOBILE LIABILITY C 5 S a I fEaaccldsntZ_ — , I ANY AI'T!"? E30DIL11NJ.3ftY IPer person) $-...-_--- _, ALL OVvrIED SCHEDULED j BODILY I€vJURY Per accldenE AUTOS AUTOS i ..__..,t .....,,...,. ........_ _._ NON-OWNED k GR4f ERTY OR9AGE _ „tPer a uxisvlr �' _ I HIRED AUTCS ��AUTOS 5 UMBRELLA LIAR OCCUR EACH QCCURR_E. 'E S ......... .......... ..aC. ............ .f ..._. .... EXCESS LIAB CLAIMS MADE } ., GREE 1-E DED ! RETENTION 5 I S t WORKERS COMPENSATION PER I OT=E { X sTA?U'rE i_..._ ER:—� —.. - AND EMPLOYERS LIABILITY ....... .ANY PROPR€E tOR;PAR TNtW'EXEC UT WE YIN E L.EACH ACCIDENT S 1,000,ODO p+ OFF 10ER ME..Mf SR ExC1_uoED? N t A WC 40-51-066-07 10/25/2014 : 10125/2015 _ - (mandatory In NH) E_ t3, S€-ASE-.EA EMPLOYEE. S 1,000,000 ifyyes,describe under DESCRiPTICN OF OPERATIONS below E L.DISEASE-POLICY IM;T S 1,000.000 Location Coverage Period. 1(7/25/2014 110125/2015 Client# 340-Ft- DESCRIPTION OF OPERATIONS ILOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule may be attached If more space is required) SUNCOAST PLUMBING AND ELECTRIC INC Coverage is provided for 6970 GROVER CLEVELAND BLVD only those co-employees of,but not subcontractors HOMOSASSA,FL 34446 W CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I.0 r " J 1889-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/011 The ACORD name and logo are registered marks of ACORD