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PL-16-172 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,Fl- Phone: LPhone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251389 Permit Number. PL-1-16-172 Scheduled Inspection Date:January 26,2016 Permit Type: Plumbing- Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: MILVERTON,DAMIAN&SYLVIE Work Classification: Addition/Alteration Job Address:30 NE 104 Street Miami Shores,FL 33138-2027 Phone Number Parcel Number 1121360130900 Project: <NONE> Contractor: THE NEW MIAMI SHORES PLUMBING Phone: (305)751-2446 Building Department Comments INSTALL NEW WATER SERVICE infractio gassed comments INSPECTOR COMMENTS False Inspector Comments Passed E04 Failed Correction l Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection tee is paid January 25,2016 For Inspections please call:(305)762-4949 Page 25 of 41 -16,472 Miami Shores Village errttit,Tyke i ulmbing R85t)t Rtie1 10050 N.E.2nd Avenue NEditisntAltaian c+ # ltk5�0s '• ""'�' Miami Shores,FL 33138-0000 ' Phone: (305)795-2204 Pel 1t*� luS:l P1 R d �'CORNA t ;. �.; ue :1I016 Expiration: 07/23/201 Project Address Parcel Number Applicant 30 NE 104 Street 1121360130900 DAMIAN&SYLVIE MILVERTON Miami Shores, FL 33138-2027 Block: Lot: Owner Information Address Phone Cell DAMIAN$SYLVIE MILVERTON 30 NE 104 Street (443)570-0304 MIAMI SHORES FL 33138- 30 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,200.00 THE NEW MIAMI SHORES PLUMBING (305)751-2446 (786)553-5424 Total Sq Feet: 00 Type of Work: Available Inspections: Type of Piping: Inspection Type: Additional Info:INSTALL NEW WATER SERVICE Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# PL-1-16-58410 DBPR Fee $2.25 01/21/2016 Credit Card $50.00 $115.50 DCA Fee $2.25 Education Surcharge $1.00 01/25/2016 Credit Card $ 115.50 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $165.50 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 authorize the above-named contractor to do the work stated. January 25,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 25,2016 1 Miami Shores Villager FTVFD , Building Department JAN x,1.2016 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 200 BUILDING Master Permit No. PL A/6 " PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION DRENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: .�((� �� ° City: Miami Shores County Miami Dade zip: 3 `3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): C`_� Y 01(C- A '�-UU.VEr"I0i\J Phone#:7�� -717 _7L_ Address: �' l u-4.L- City: State: Zip: 3 re� Tenant/Lessee Name: Phone#:—xt Email: C�i �V0 ) C riC A 40ov1 CONTRACTOR:Company Na iami Shor-e101umbin �hene#. (ao5) 151 -294--0 Address: q 00 Nui 144 City: H i o W)l State: F—L— Zip: 33)Ly8 Qualifier Name: I?ennl S Mc uudi n Phone#: State Certification or Registration#: G;C 0 19 2.0 S 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/Reploce ❑ Demolition Description of Work: \\�I-'S 1��1 r4 e c j i iu tq_�z— Spec'ify color of color thru tile: Submittal Fee$ -'q®%/0 Permit Fee$ SelY6, .- CCF$ CO/CC$ ef Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r 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. n Signat4w Signature OWNER GENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2D+-h day of ran UQry ,20 1 L-f , by 21)4"1'' day of Tanuary ,20 1 Lo ,by Damian Mi y-er+en ,who is personally known to T}enniS McLaugdin who is personally known to me or who has produced f:�'l.-ID L as me or who has produced F L- D L_ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: \\\\�tllluuuu/h�/r�� \\\\�\�t111A 1Osp rrrr��' Sign: ;�\�AOS i', Sign: Print: Van eSSo QCpI nal � o , �•. Print: yQf�ZSSa �S�Ina ��' 2��24.2p&^* Seal: = ® * c Seal: IC ir Q �i��j •.; tee`+;. Q� `�� i��y9,�9y�'•�..... 0� `�� *x*** >k*****r*x****** **** L*11c. x***t***x* *** ***xxxx***s* ******* xx**"'r/j��C1�'�f1► '1k** IIIIIy`II��`\\ 1111111111111111\ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,'GOVERNOR LSA SO SECRETARY ................ 71 ........... LPROF EfAfTMENT-P.E. I ESS ANIO i�,SSIOPA -. ......... W0 S -BbA cp` A d M131 W --QK,CT J� 7 f ev Nv 4— .,N EN-J} lD N ct NAw 44 "R `F IN .-VA4iM- Z.-i OR �3 z z z z .9 ,0 _�..,.o t4,W"1'44O .V3."�u�U."""�.,i�,-�.*,. 3 k ISSUED: 07/01/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1407010001239 Lo ta I i3l u* s in S`S**'* *.Ta x Receipt Miami—Dade Coun*ty*` -.r,,i*d a -THIS .IS NOTA BILL ,DO NOT PAY. -_17301 SlNESS_NAr,4EzLocATJ0N ECE11T.N1. "g)(PIRES ...A41AMI_S4iDR-ES-.DW MBING tENEWAL W.1 T' : SEPTEMBER 30, 2016 .-: N44 S 17301. be..displayeo.�vbla �qpf b.0 sinesstam.111. Pursuant to County de* .OWNER' THE NEW iNIA'SHORES.*PLB*G-.:INC.-;'.*,.- MBING CONTRACTOR P.AYMENTYiECEiVEU BY TAX COLL $75 0901 X201,5 CHEC-K2 I L'5 .11;9189 w iness.rax...7Lhe-Receipt is not,fi dldemqustmpmpjy withornongoverrrmerttal regulatory laws and cegmrements which any governmental ebusjn6ss. ..0de Cqd6'S&c.8A 376 DVjtR)tcoIlector:- MIAMSHO-03 ONAPOLES ACORO' CERTIFICATE OF LIABILITY INSURANCE DAT /YYIYI � 1/221/20112016 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(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Collinsworth,Alter,Fowler&French,LLC PHONE 305 822-7800 FAX 305 362-2443 8000 Governors Square Blvd (AIC.No Ext): ) A/c,No:( ) Suite 301 E-MAIL Miami Lakes,FL 33016 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 11 INSURER A:Massachusetts Bay Ins Co 22306 INSURED INSURER B:Hanover American Ins Co 36064 The New Miami Shores Plumbing,Inc INSURER c:Hanover Insurance Company 22292 900 NW 144th Street INSURERD:Associated Industries Ins Co 23140 Miami,FL 33168 INSURER E: -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 CONTRACTOR 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 TYPE OF INSURANCE ADL SUB POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FKI OCCUR LDJ3841050 08/23/2015 08123/2016 PREMISES Ea occurrence $' 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PEP, GENERAL AGGREGATE $ 2,000,000 POLICY T PET F LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 $ X ANY AUTO AZJA042149 08/23/2015 08/23/2016 BODILY INJURY(Per person) $ ALL OS NED AAUTOESULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ X UMBRELLA UABX OCCUR EACH OCCURRENCE Is 5,000,000 C EXCESS LIAR CLAIMS-MADE UHJ3841053 08/23/2015 08/23/2016 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYX I STATURE ER D ANY PROPRIETORIPARTNER/EXECUTIVE YIN WC1050216 08/23/2015 08/23/2016 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) License #CFC 019205 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Pl 1 ©1988-2014 ACORD CORPORATibN. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD