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PL-15-993 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233416 Permit Number: PL-4-15-993 Scheduled Inspection Date: October 06, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LALANNE,VILBRUN Work Classification: Addition/Alteration Job Address: 190 NE 91 Street Miami Shores, FL 33138- Phone Number Parcel Number 1131010190080 Project: <NONE> Contractor: 1A FLORIDA PLUMBING INC Phone: (305)967-5037 Building Department Comments FOLLOWING THE PLANS PLUMBING THIS IS UNDER A Infractio Passed Comments MASTER PERMIT. BATHROOM WORK. INSPECTOR COMMENTS False Inspector Comments Passed E2/1 V V Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 05,2015 For Inspections please call: (305)7624949 Page 6 of 39 ^icy' 3 x5 � a 0� •i ...� d' ., ay 3 5 R p Miami Shores Village 10050 N.E.2nd Avenue NES° Miami Shores,FL 33138-0000 Phone: (305)795-2204 �ORIDp' �, �r \� i6 z�€:a T r 3 ..�t.,. ' �. Explratlon: 10125/2015 Project Address Parcel Number Applicant 190 NE 91 Street 1131010190080 VILBRUN LALANNE Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell VILBRUN LALANNE 190 NE 91 Street MIAMI SHORES FL 33138-2810 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 1A FLORIDA PLUMBING INC (305)967-5037 Total Sq Feet: 0 Type of Work:FOLLOWING THE PLANS PLUMBING THIS I 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 $1.20 Invoice# PL-4-15-55330 DBPR Fee $2.25 04/24/2015 Check#:81306 $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 04/28/2015 Credit Card $ 116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 thorize a above-named contractor to do the work stated. L April 28, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 28,2015 1 Miami Shores Village g cIv D BuildingDepartment p APR 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 —�— FBC 201b BUILDING Master Permit No.RC-314-528 PERMIT APPLICATION Sub Permit No - ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ■❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 190 NE 91 St. City: Miami Shores County: Miami Dade Zia: Folio/Parcel#:11-3101-019-08 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): vilbrun Lalonne Phone#:305-333-2870 Address:190 Ne 91 St. City: Miami Shores State: FI. Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 1A Florida Plumbing Inc. Phone#: (3005) 935-5037 Address: 426 Lakdeview Dr# 104 City. Weston State: Fl. Zip: 33326 Qualifier Name: Jorge J Paneque Phone#: (954) 336-3365 State Certification or Registration#: CFC 1428753 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ,a tf3m.o Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Following the plans Plumbing This is under a master permit u'_x-0s'e 6ZON ' ,mc ire V� b0&-X!CM fy-1 13 Specify color of color thru tile: r Submittal Fee$ • Cn Permit Fee$ F$ 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) 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 be posted at the job site for the first inspection which occ s seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a roved a d a reinspection fee will be charged. Signature Signature �� OWNER or AGENT CONTRACTOR The foregoing in ru/1m�ennt `was acknowledged before me this The foregoing instrument was acknowledged before me this a `T day of ft1�3 1 1 .20 I- by Z:�> day of Apr'�k ,20 6 by —T d 1b fUY1 LOA n f'Q who is personally known to ax- :S, QCineQ' -,who is ersonall knoOito me or who has produced LIcern!��_ 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: Sig a�,,&J a?Ld Sign" A Print: Print: f e f �N. Seal: MK2IEU.EEM Seal: cr WtyCOI MISSKA EE 867545 = EXPIRES January 22,2017 my OO ISSION t EE 867545 Balled ThN y Pu 22,2017 •' Notary Public Undeen (r. EXPIRES:January UndwAn s M Bonded TW Notary Fabric APPROVED BY Y L'� �S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1 '4 CERTIFICATE OF LIABILITY INSURANCE I DATE04/23wYYVYi 04/23/15 THIS CERTIFICATE IS ISSUED ASA 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 I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I i 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 i certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Luca Estrella ! Accurate PHONE 1 FAX II ler Suite 114 A(gq�Na. k (305)226-8727 i (AIC.No►: (305)226-8767 8300 West Fla ; 9 MAIC; luciaestrella@bellsouth.net f 7 Miami,FL 33144 INSURER(S)AFFORDING COVERAGE j NAtC/F Phone (305)226-8727 Fax (305)226-8767 INSURER A: Accident insurance Co. I! INSURED INSURER B: Progressive i---� 1A Florida Plumbing Inc. INSURER C. Ascendant Insurance Co J 423 Lake View Dr. #104 INSURER D: 1 Weson,FL 33326- I INSURER E: t + INSURER F: j 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 MAYBE 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 ( LTR 1 TYPE OF INSURANCE IN;RiYyVD I POLICY NUMBER POLICY EFF 1 POLICY EXP 1 ^I GENERAL LIABILITY '' (MMIDDIYYYY)i MM/DD/YYYY i LIMITS EACH OCCURRENCE is 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE T'R RENT i I P EMISES(Ea eu urrEDence) i S 100,000.00 A ❑ ❑ CLAIMS-MADE © occuR CGD00003786-01 MED EXP(Any one person) s 5,000.00 Y 104122/2015 104122/2!016 I PERSONAL BADV INJURY j S 1,000,000.00 ❑ GENERAL AGGREGATE j s 2,000,000.00 I GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG S 1,000,000.00 ! I POLICY 1:1 IE ❑ LOC j AUTOMOBILE LIABILITY J ( I EeM6 EeOMSINGLE LMArr i S ANYAUTO 103336596-0 BODILY INJURY(Per person) $ 10,000.00 ALL OWNED SCHEDULED 10/21/2014 10/21/2015 20,000.00 B ❑ AUTOS ❑ AUTOS ! Y BODILY INJURY(Per accident), 5 I ❑ HIRED AUTOS AUTOSNONONED I I I PROPERTY DAMAGE i ---f ❑ ❑ AUTOS i Per acodent 5 $ (❑ UMBRELLA LIAB ❑OCCURi I i I I i EACH OCCURRENCE i s ❑ EXCESS LIAB ❑CLAIMS-MADE ( AGGREGATE i$ ❑ DEC) ❑ RETENTIONS S ; I WORKERS COMPENSATION I I WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN 1 ! 1 I LrJ TOB1L(Jp�[S ❑E� ANY PROPRIETORIPARTNERIEXECUTIVE WC-66056-0 f C OFFICERIMEMBER EXCLUDED? (—�;N I A 10/02/2014 10/02/2015 i E.L.EACH ACCIDENT j S 100,000.00 I (Mandatory in NH) I_J 111 If yes,descnbe under I E.L.DISEASE-EA EMPLOYEES 100,000.00 DESCRIPTION OF OPERATIONS below I ! I I i EL DISEASE-POLICY LIMIT;S 500,000.00 I I I i 1 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Plumbing and CFC 1428753 r I i t , CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE.PELIVERED IN Building Department ! ACCORDANCE WITH THE POLICY RO. I \\ ; i i 10050 NW 2nd Ave AUTHORIZED REPRESENTATIVE Miami,FL 33138 305-756-8972 Lucia Estrella ©1988-2010 ACO TION. All rights reserved. ACORD 26(2010/05)QF The ACORD name and logo are registered marks of ACORD