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DEMO-15-2049 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-243014 Permit Number: DEMO-8-15-2049 Scheduled Inspection Date: September 22, 2015 Permit Type: Demolition Inspector: Diaz,Osvaldo Inspection Type: Final Owner: LITZENBERG,MARC AND ANNE Work Classification:.Plumbing Job Address: 1420 NE 103 Street Miami Shores, FL Phone Number Project: <NONE> Parcel Number 1132050310030 Contractor PSG PLUMBING SERVICES, INC Phone: (305)796-7304 Building Department Comments DEMOLITION OF EXISTING HOUSE 1420 NE 103 ST infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-242854, need to demo and provide hrs 45sIr � � ` eA 94=� � Failed Correction Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 21,2015 For Inspections please call: (305)7624949 -- Page 24 of 44 �s°Rs rt Miami Shores Village y Pt3171t }# ' 0 #t# 11,; 10050 N.E.2nd Avenue NE .. ;. W0*Cftrat Plumbing Miami Shores, FL 33138-0000 Permit Status:APPROVED u Phone: (305)795 2204 L O �<OR1DP` '• '' I�stI�atel20'l Expiration: 03/01/2016 Project Address Parcel Number Applicant 1420 NE 103 Street 1132050310030 Miami S hores, FL Block: Lot:: MARC AND ANNE LITZENBERG Owner Information Address Phone Cell MARC AND ANNE LITZENBERG 1420 NE 103 Street MIAMI SHORES FL 33138- 1420 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 200.00 PSG PLUMBING SERVICES, INC (305)796-7304 Total Sq Feet: p Type of Demo: Plumbing Available Inspections: Additional Info: DEMOLITION OF EXISTING HOUSE 1420 N Inspection Type: Classification:Residential Review Plumbing Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-8-15-56708 DBPR Fee $2.00 09/03/2015 Credit Card $ 108.60 $0.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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,ROO and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is a and that a1I work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-name for to do the work stated. September 03, 2015 Authorized Signature:Owner / Applican1#0r for / Agent Date Building Department Copy September 03,2015 1 Miami Shores Village � E � Building Department AUG 13 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:-­­& Tela{305}795-2204 Fax:(305)756=8972 - -- INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2019 BUILDING Master Permit No. 1 J j7 PERMIT APPLICATION Sub Permit No.pc-Ko - t 5-2Q qq ❑BUILDING ❑ELECTRIC ❑ ROOFING © REVISION ❑EXTENSION ❑RENIEWAL ZPLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_ �Q3�" &r City: Miami County: Q1111-p—, !~db/Part�alJF; Is the Building Historically Designated:lies NO Occupancy Type: Coad: Construction Type: Flood Zone: BFE: FFE. OWNER:Name{Fee Simple Titleholder}; *%&rL L%± Phone#: Address: . :. City: Miam;% State: ,,..zip: �?ls Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: P54- )0W"#0 i N C i o C Phone# d ,?fr'd`73 O Address: 77 City: /� G GC, #s State: ZIP. Qualifier Name: S 6 uW K,10 Phone#: &'Of_fid ­2 State Certification or Registration#: L"r�'l''/ 5 Certificate of Competency#: DESIGNER:Architect/Engineer Phone#: Address, City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ";' Zpemol€tion Description of Work Q ID Specify cd1ozb/eolottkw file. Submittal Fee$ Permit Fee$ �""• �`� CCF$ CO/a$ Scanning Fee$ Radon Fee$ DBPR$ Notary Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE (Revind02/2412014] 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 perforated to meet the standards of ail 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 Applica t. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good" ith at a dopy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is bf to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first Inspection occurs seven (7)days after the building permit is issued. In the absence of such posted notice, the inspection will not a e nd a reinspection fee will be charged. Signature ""� 0 � ' Signature OWNER or AGENT CdNT CTOR The foregoing Instrument was acknowledged before me this The foregoing Instrument was acknowledged before me this 13th day f !� 20. by day of � �xv 20 _/ff�.by 5p Cz , who is personally known to A1A �, ._ who is personally known to me or who has produced as a or who has produced 1-42 as identification and who did take an oath.' identification and who did take an oath. NOTARY PUBUC: NOTARY PUSLI Sign: rl � Sign; Print. u i Print: , Seal: "w NiKAFiiiltAt Notary Public Sts18 of Fl-W8 Seal. �,: MY CC>WASS)ON i�F2XV! Michael Ruiz EXF Jill*S.2010 +� My Commission FF 078890 San wrMUNaMsitlableoftvan orw Expires tyls/2017 ######! # iMwi##?�+1###i####*�k*1*Mkt##M�ra►i►#E##o+ktiR#*#i*#+k#t#####*t�Ur#l4#*##ii�Ms�#�aeK# APPROVED BY � � .. Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) 3 .k f i j s ar A7$OF R-OMOA DRA--R?xxmT or AAD C 4.14.242,2 f 1.11p - 06/07 /xs 120418692 ! CRRTZnw PLS ? GUZUR, 6 =G COMACTon ;k Zs C`RTIPX= ✓S.Maf 1T♦f�n�' r: rMrnay.Rass os c�. 8*J s CERTIFICATE OF LIABILITY INSURANCE °"12,15114' - Px+7Di,cE�ey MAtT'ER OF#NFciMeil7t4le 3 3801 SW 107 Avenue ONLY AND CONFERS NO fUGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT ASM EXTEND OR i Mlemi FL 33165 ...., ALTER TK.COVERAGE AEECom, Phone(30592649M Fax(305)M3997_..._..___. R*WRIM AFFORDING COVERAGE PWC# IR r1#URER A Scott$daie l _...� Y _._ 41297 3 OWN" Audi tTIrBrTce CSnY 11 T38 Ascendant Commercial Insurance Co. Oka,FL 33054 41395 __ tMl$tIRER£ , , COVERAGES THE POLICtLr3 OF IIdT#,e'tANCE LIST£D NAPE SEEM 158t1EEi TO THE FOR THE POLICY PETigO NNML'IC1EII.-t�iWiTitSlJtt�tlG ANY REQUIREMENT.TERM OR CONDOM OF ANY CONTRACTOR QT ER OOCkA"T VATH PEST TO WfACH THIS CERTIFICATE MAYBEISSUED OR MAY PERTAIN,THE INSURAMM AFFORDED BY THE POUC*S DESCRIBED THIN IS SUBJECT TO ALL I HE WINS,ExcLUSMS AND CONDOMS OF SUCH POLICIES.AGGF*rATE LMYTS SHOWN MAY HAVE 9ESR REDUCED BY PAID CLAM. AWL i TYPE DF YtSURANGE Poticyomem tPW]C7f EiFEGTfiiF PCRICY EYRM*T" l,,,d;MJE LIMTTS SiENEitAi L IABB rTY a EAOH OCCURRENCE T 34-M.00 p CCS GENERAL tiA[#LITY CPS1854001 11114016E To ktNTED 02114 08MiS PR9116E8 QEe300 0001 CLAMS MADE OCCUR j MED EXP WW omponson) 5 Ot?#fl T'ERSONALLLADVINJURY _ 1 i1GENERAt 3.000,000; GEIrL AGGREGATE LiMR APPLIES ! P DUCTS-00M OA AGG POLICY il ...,�..__..,....�.. _ 3,0000001 ( LOC EL&ABILITY CEDSING L r _ im ,000_. 1T 7(01 07194 071015 AU OWNED AUTOS B L BODILY INJURY SCHEOULEDAUTOS ROVED AUTOS BOIXYNAW 4 NON OWNED AUMS i tPe+accraantl i GOnp M-00 Ded COP $500.00 De¢! ; t1t0PFFfTY DAMAGE GARAGE:-Llowsajw � � AVi°pflPiT.Y-EAACC1tiE3dT � >- j ANY AUTO i OTTIERTWW 1„., _..._. ._._ AUTO ONLY- AGG sx OCCUR t LIABILITY 'CPS1MAM 08112/14 1)8!22115- ( FENCE 2.000,16.0 A CLAM$AMOEoATE # tO6OUCTeLE 'WOMOMS OFFICE C?01�6i5A710NAPTfl r uAeKIrY C TOR I PARTNER I EJtinCUTTtIE MEMBER EXCLUDED? N ; + ` E.L.EACH 1000 000# . i M iia:dna under E.L,DISEASE-EA EMPLOYEEf 1000 000; a --0 [ 4 SPE dAL_ .__. below d E.L.DISEASE POLI.rYLIM�T 1.000,000,?OTHER _ r DESCRIPTION aF OPERATK"ILOCATONSIVERtCLESI"CLLISIOMSAODEDiVENDORSEMOCTISPECLAL.PROVIS MIS Plumbing Contractor-CG2033 Blanket Additional Insured-Included I CG2404 Waiver of Subn jatlon-Blanket coverage included per writtenagreement;GCS-295,PrimarY and W g—lricluded as applicable to CG 20 33,GG2503 113esignated ConStruclJon Project(s)General Aggregate Limit—Included f r CERTIFICATE HOLDER CANCELLATION __. ANY OF Tw ABovE oe PouCES BE CANCELLED BEFORE THE � EXPIRATION DATE THEREOF,THE asu&Na MISURER WILL EW*AVOR To MAA. i Miami Shores Village&Adding J)” 30 DAYS WWTEK NOTICE To The CEWVWXTE HOLDER NAMED TO 10050 PIE a Ave THE til,BUT FAILURE TODD 50 SNALL 000 OKAATMOR UABLITY Nliarw Sign,FI 33138 OF ANY KIND UPON THE ITS AGMTSOR RE+RESENTATWES.. f AUTHokf? O SEMTATA t Fax 305x-7,66.8972 j f ACtTdTO 25{ 1/Q8} 0 ACORD CORPORATION 1988: -- Ines Mirn colpt 4 NOTA SU, -PPMTPAY, 5.35261 ��.125 .. cElpr SEPITIA1MustS ER 36, 266 d, alp, Pur�u�ractr,lur�cy. OWNER `. IM81N{;$ERYE(ES MCsac,T"B OF suaft 88 PLUMBING SING PAVTAEWRECEIVEO + r3 By TAX COLLECTOR 445.00 07/0912015 iECK21-15--M5049 a1M ��tusn� �