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PL-15-2358 3C � T- 2 2Z�Y� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243629 Permit Number: PL-9-15-2358 Scheduled Inspection Date: October 07,2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , Work Classification: Addition/Alteration Job Address:119 NW 110 Street Miami Shores, FL 33168-4320 Phone Number Parcel Number 1121360030550 Project: <NONE> Contractor: ROCKET PLUMBING CORP Phone: (786)663-9238 Building Department Comments KITCHEN SINK CHANGE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed �® Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid October 06,2015 For Inspections please call: (305)762-4949 Page 22 of 60 Miami Shores Village ° _:, Building Department SEP 10050 N.E.2nd Avenue,Miami Shores,Florida 33138- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 ` g Govt FBC 20 d"I BUILDING Master Permit No. l.5 z z � 7 PERMIT APPLICATION Sub Permit No. J,, (S - 2,3 5-8 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 12RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �� CONTRACTOR DRAWINGS JOB ADDRESS: /V 0/ // `� mm i City: Miami Shores County: Miami Dade Zio: a3/ ® Folio/Parcel#: 112-196 C0306,60 Is the Building Historically Designated:Yes NO� t� _ Occupancy Type: Load: ConstrucType: Flo Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 26ZOA c! �y Q /J J�0' Phone#: '796 311 3 Address: g 6 Z® z(_j) 2 -7Are I-V' I Ftoo K City: ,, 1 State: F Zip: 1✓ Tenant/Lessee Name: ® /V6 Phone#: Email: lj6s<' 4 ' xellne g e 99eyy CONTRACTOR:Company Name: C 044 7t ,Y A14;12!i Phone#: '71?6 Address: City: f y4141State: / Zip: r- Qual(fier Name: Rodr)Q0 C14 Phone#: State Certification or Registration#: CAC 14.2 99 A I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value' Work,for this,Permit:$ 0�= Square/Linear Footage of Work: Type of Work, + Addition,- 0 Alteratiln ❑ New ❑ Repair/Replace ❑ Demolition Description of Work l. C/�1m 1,9 �f� n Specify color of color thru tile: Submittal Fee$ Permit Fee$ 77CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ GO (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 attach nt. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which oc r seven (7) dayafte the building permit is issued. In the absence of such posted notice, the inspection will not be a oved n a reinspect'o f e will be charged. Y,— Signature Signature GEN CONTRACTOR The fore r ent was acknowledged before me this The foregoing instrument wa �cknn ledged before met is day of 20 I_�, by day of 1� �'"� ,20 P by =own d'g> ,who is personally known to -moi �--wh is personall me or who has produced as me or whAas produced as identification and who did take an oath. identification an ho di take an--tl- NOTARY PUBLIC: NOTA PJB .P" am RAOUEL GARCIA �� a• N : Notary Public-State of Florida o My Comm.Expires Jun 28.2016 Commission#EE 200530 S Sign a Print: t 1 (� Print: Seal: Nom, of Florida Seal: Tania DifAin My Commission EE 881535 pp Expires 02/27/2017 APPROVED BY Examiner Zoning Structural Review Clerk (Revised02/24/2014) J 002932 , Lt al us n s :K Romp M� m,i—DadelsCs NnTarslu.St ao�rloTa FI©t`Ida 7153901 Bust vlaSS NAMWLOCAT199 �e�a+�IPr NO. EXPIRES t t uuAl. Ep►T`gMBE� 30, X416 ROCL Et'PIWIVIBIN6 CORP 7"W62 Must be displayed at place of business 11310 51N 46 5T PumuanttoCounty Code, MIIA NI FL 331:65 Chapter sA-Art.9&10 BEC.TYPE OF BUSINESS PAYMENT RECEIVED OWNER 196 PLUMBING CONTRACTOR 9Y;TAX cou.ECTo�t ROCKET PLUMBING CORP 1DfC1428827 $75.00 08/28/2015 Wrutcer(s) 1' CRIEDITCARD-15-042924 i onl.:conflma payment at.AO Local BusineseTax TW Receipt a notovenuns9' Ia Local Business TaX-11t)ee pt 1Ek ink:Holder milt 01111Y.whh any B rn permit.aracermosholtdtbeboldett't-I lfloedone«toxo thebnaI eis.. or nongovoromental ragalstOW laws sn raquireme awhlch apply The RECEIPT N0.above must be displayed on ail cemmerofel vehicles-Miaml-llad,Cab Sec 88-2711- For arora-bdonaatioa visit "'id &00V�xcollectar AC DATE(NNA/DD/YYYY)ORL� �..- CERTIFICATE OF LIABILITY INSURANCE 09/01/2015 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 CONTACT NAME INSURE SAFE,INC. PHONE : 305-303-7080 F No; 305-267-4206 AIL 2246 SW 57th Ave ADDRESS: insuresafeinc@yahoo.com INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33155 INSURERA: Accident Insurance Company INSURED INSURER B: RetailFirst Insurance Company Rocket Plumbing Corp, INSURER C: 11310 SW 46 Street INSURER D: INSURER E: Miami FL 33165 INSURER F: 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 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. ?NSR ADDLTYPE OF INSURANCE INSR SUBR POLICY NUMBER M�MIIDU EFF MPOMfDDILICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RERTEIT- COMMERCIAL GENERAL LIABILITY PREMISES a occurrence $ 100,000 CLAIMS-MADE F—I OCCUR MED EXP Any one person) $ 5,000 A USA 4080331 06/04/2015 06/04/2016 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY j PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acciderd ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITYANY PROPRIETORIPARTNERIEXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMSER EXCLUDED? ❑Y N/A 520-48402 07/28!2015 07/28/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCIfdescribe under A RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFIED PLUMBING CONTRACTOR CFC#1428827 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shore Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 N.E.2ND Ave. Miami Shores,FL 33138 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD v Miami Shores Village M �Peil7tr�7`ype mit R inti { 10050 N.E.2nd Avenue NW ,AdO100111ARMIM Miami Shores,FL 33138-0000 m -Pont 5tatc h Phone: (305)795-2204 Expiration: 01/0112999 Project Address Parcel Number Applicant 119 NW 110 Street 1121360030550 Miami Shores, FL 33168-4320 Block: Lot: 2620 ACQUISITIONS LLC Owner Information Address Phone Cell 2620 ACQUISITIONS LLC 600 BRICKELL Avenue MIAMI FL 33131- 600 BRICKELL Avenue MIAMI FL 33131- Contractor(s) Phone Cell Phone Valuation: $ 500.00 ROCKET PLUMBING CORP (786)663-9238 Total Sq Feet: 0 Type of Work:KITCHEN SINK CHANGE Available Inspections: Type of Piping: LLInspectionpe: Additional Info:Bond RetumClassification:Residential Scanning:3 g Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee $2.00 Invoice# PL-9-15-57107 DCA Fee $2.00 09/24/2015 Credit Card $ 114.60 $0.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 k, In consideration of the issuan tom of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict c form' with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In E accepting this permit I assume sport ibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLU ING, ECHANICAL, DOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID I : I ce i t �11 he for Ding information is accurate and that all work will be done in compliance with all applicable laws regulating construction and i g FuI re,I au a the above-named contractor to do the work stated. September 24, 2015 j Authorized ig at wner / Applicant / Contractor / Agent Date Building partment Copy September 24,2015 1