PL-14-2164 r �
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-220820 Permit Number: PL-10-14-2164
Scheduled Inspection Date: September 01 2015
p
p Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo yp g
Inspection Type: Final
Owner: IOANNA KONIDARI,WILLIAM F HULME Work Classification: Addition/Alteration
m
Job Address: 196 NE 105 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1121360130630
Project: <NONE>
Contractor: DEL MAR PLUMBING Phone: (305)271-2800
Building Department Comments
REPAIR REPLACE PLUMBING AS PER PLANS 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
August 31,2015 For Inspections please call: (305)762-4949 Page 4 of 37
Miami Shores Village
Building Department ®CT 02 2014
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.RC-[A r Or-7
PERMIT APPLICATION Sub Permit No. L1'--1-7A (H
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
n/ QE-
City:
fn CONTRACTOR DRAWINGS
JOB ADDRESS: I_ t? DILE
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:[�'ZJ 3("' —ms— Is the Building Historically Designated:Yes—N O
Occupancy Type: Load: Construction Type:CP->�!> Flood Zone: BFE: FFE:
OWNER: Name(Fee oSimple Titleholder): I�`��LC 1 �. t (�� '�`"�`�`�' � 35— 5
Address: t�� 4 r
City: �-6 L �-5 State: �2, Zip: 33 (-
Tenant/Lessee Name: !`(/� ���.C11aT� Phone#:
Email: I *1
CONTRACTOR:Company Name: 1 M�4 f2 �1 Phone#:
Address: 9P/3 &L-0138 61- dq
City: f y,) / State: Uc zip:
Qualifier Name: G-e4 m M-9-7248(z 4� Phone#: 3®; / 2. ®�
State Certification or Registration M Certificate of Competency#:
DESIGNER:Architect/Engineer: [D a 641}! -A� Phone#: 307—��
Address: 1 O251 S,D `7 2. SCA.? ° 5rc- ICA City: " stated L- Zip: -33173
Value of Work for this Permit:$ 0'-�o Square/Linear Footage of Work:
Type of Work: ❑ Addition (Allte�ration ((�� E-1New � Repair/Replace [:1 Demolition
Description of Work: QY2 (OL AX PwW- G - PL"
Specify color of,color thru tile:
3C�C�. yc�
Submittal Fee$ Permit Fee$ CCF$ CO/CC$( p
Scanning Fee$ �j Radon Fee$ d DBPR$ Notary$
Technology Fee$ '5 -(n® Training/Education Fee$ I a 40 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
J
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.
Signatur Signature C� � <2
OWNER or AGENT C,�,e,em� CONTRACTOR
The ffore�ggoing instrume t was acknowledged beforemethis The foregoing instrument was acknowledged before me this
2"/ day of �'h�r 20 l by day of I�C:TZA' ,20 1 by
1�1�i�in , F ,who is ersonall know to &-4i rte �--_ C�uA ,who i ersonally know
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.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: 16�
Print: +v J(L Print:
Seal: NELSON Seal: ARY L JR.NO NO
STATE OF FLORIDA STATE OF FLORIDA
. Canto#FF103142 Ca mn g FF103142
AXPIIAW MMIDW
APPROVED BY / � V `CY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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091878
Local Business Tax #lece� t
Miami—Dade County, State of F1
—THIS THIS IS NOTA BILL —ID NOTPAY
598DIS5 •
DEL MM �u►�s c RE`sr4oREN EXPIRES
9013 SW 138 STA EWAL
6=745 SEPTEM13ER 34, 2015
MIAMI FL 33176' Must be-dismayed atp#am of business• .
Pursuant to County Code
Chapter aA-AMS&10
ovvmr-t S'�aC.TYPE iiF r3USIN5SS
DEL MRiZ Pt7lMBIN(;WC 196 PLUMBING CONTRACTOR PAYMEW RECSIVW
Worker(s) I CFC1427248 BY TAX COLLJWMR
$75-00 07/76/2014
s CHECK21—I4-=946
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yer�eEoa.vesit -
RICK SCOTT,GOVERNOR
KEN LAWSON,SECRETARY
0F FLOMA
DEpART� SiT OF BUSES.S AND PRO $K)ML
INDIi3STRY NOADTK)N
CF01427248
Tits PLUMBING CONTitACTOR
Named belo r IS CERTIFIED
Under the prcnriistolrs of
EWral�n data: AUG 3120Ifi 1183 FS_
ROLDAN.GERMAN E
DEL MAR PLUMBING INC
9013 SW 138 ST.#A •
ML4MI• FL 3317W •
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Wtgo: X74 DISPLAY AS REQUIRED BYLAW
Std# I.140622oo0'I1t18
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AepRibrCERTIFICATE OF LIABILITY INSURANCE � IGM14
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THIS CERTIFICATE IS ISSUIE D ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MLDER.THIS
CERTIFICATE DOES NOT AFIFMMATWEL.Y OR NEGAnVELY AME'W M(TEND OR ALTER THE COVERAGE AFFORDED BY TF1£'POUCES
MOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CO NTRWF BETWEEN THE ISSUING IKSUIWR(S) AUTHOR12ED
REPRESENTATIVE OR PF40DUCEFL AND THIO CERTIMATE HOLDER.
MPOWMT:N the ter iftaft holder Is SU ADDFTICINA.101SURIM.the Po1iLAIM)tares be VmJorsed.1F SUBROGATION IS VI1AIYIED,sWett to
tha tonne and eandPtlotta acme posey,certain poSdes may require an enttoreemeed. A statement an mIs artrleate does net ranter rhaht9 to the
errtTwate holder In seu of md%endossemerla(s).
PRnO>IIr Eddy Goya
G=Irmrame Agera y LIG PHCR4E (f 35 FAX (-fm 358-awa
128)5 SW 84 Aire Rd. 2nd Rwr f """`" e0goaftazahmrance.com
IU kinin.FL 33155 INSt)RERSIO NAIGti
P'hom 358.000 Fax 358-6086 1 INSURER A. Aseiderd Instaaace Company
INSURED 1194mmst a
DEL MAR P LUMBING,INC 'INSURER C:
W13 SW 1381h ST A INSURER!1: AmTncstNarllt Atm
MI.ANN.FI 3.317157ISR INSURER E:
INSLRER F:
COVERAGES CERTIFICATE NUMBER: RESI6SIOIi1 NUMB@R
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE ebb NP14ED ABOVE FOR THE POLICY PERIOD
114MCATED. NOTWITHSTANDING ANY REoulREww.TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENTTNITH RESPECT TO W-EH THIS
=RTFICATE:MAY BE ISGUED OR MAY PERTAIN,THE 114WRANC C AFFORDED 13Y THE PCtS+G S OCSORMIM HE MIN 13 31h3JMT rO ALL TI IC TCMAS.
EICCLUSICIVS AIS CO?ZXTKH4S OF SUCH POLICIES.L94M SMWN MAY HAVE SEEN REDUCED BY PAS CLAIMS.
1L R TIPECFINSURANCE P[)L1CY EBF POLICY E7(P LOWS
GENERAL L1A6iLiTY EACH COCIAINFAM S 1,8OO.a0E7.00
DAMAM
CCWJERCIAL GE AL UABS.1T'+' I YORENTED $ 50.01Q.00
❑ c�� of ® 'CPPOO1339M I�EIw[a�rtmepe�on S SAO=
A `, Pd € OAfT412J)14 li4�T�V2015 PERSDKW s Ally 94JURY $ 1.000.0m.00
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WORKERS=1049 3%%SATIOt1
ANOMPLOVED$•UMUlY YIN r
ANY PROPPRIETO UPA;UWR&-AECUYr.9E AVYC1 EL.EACH ACNP $ 1#)D.00Q.04
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CeWrWIGATe I1it)L17ER CANCLLATUM
SIIiAD ANY OFTW ABOVE OESCIMIED POLIOS BE CAPACELLIM BEFORE
Miami Shores Wage TFC E7dqATIO$I DATE THEIPWIF,NOT=VMJL BE ZXWVEREJ IN
10050 NE 2 AVE ACONWANCIF
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Miami Shores Wage,FL 33138 AUTIIORIZM REPRESENTATWE
I)1988-2810 A!ARfl CG' P4RATION. AI I rights deserved.
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