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PL-16-39 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)7564972 Inspection Number: INSP-250578 Permit Number. PL-1-16-39 Scheduled Inspection Date:January 27,2016 Permit Type: Plumbing-Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: ONEIL,KEVIN Work Classification: Addition/Alteration Job Address:8813 NE 4 Avenue Road Miami Shores,FL Phone Number Parcel Number 1132060460510 Project <NONE> Contractor. A TO Z STATE WIDE PLUMBING INC Phone: (954)981-2133 Building Department Comments REPLACE CAST IRON STACK PIPE WITH PRE PIPE. Infractto Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed f Correctioncc�� Needed ❑ _�Ip r✓ Re-Inspection `'� S� Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 26,2016 For Inspections please call: (305)7624949 Page 24 of 62 Peri"tuO. Miami Shores Village M Pefmk T)pe. Pl mr)E iIdet' ` ty 10050 N.E.2nd Avenue NE e,ri 'Work Clas. lbagon. Astciitic�nr�t�t±�ra#iiof� Miami Shores,FL 33138-0000 Permit Status:APPROVIED, Phone: (305)795 2204 F�ORlDp" ° 00 :'i11v12t>16 Expiration: 07/13/2016 Project Address Parcel Number Applicant 8813 NE 4 Avenue Road 1132060460510 Miami Shores, FL Block: Lot: KEVIN ONEIL Owner Information Address Phone Cell KEVIN ONEIL 8813 NE 4 AVE RD MIAMI SHORES FL 33138-3177 Contractor(s) Phone Cell Phone A TO Z STATE WIDE PLUMBING INC (954)981-2133 Valuation: $ 1,800.00 Total Sq Feet: 0 Type of Work:REPLACE CAST IRON STACK PIPE WITH P Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1,20 DBPR Fee Invoice# PL-1-16-58261 $2.25 01/08/2016 Credit Card $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 01/15/2016 Credit Card $ 116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technolo��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 foi ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS.AFFIDAVIT: I certify thjt all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ning. nthe 7 I authorize the above-named contractor to do the work stated. January 15,2016 Aut rize ature: wner / Applicant / Contractor / Agent Date Building Department Copy January 15,2016 1 Miami Shores Village g AN 0 8 2076 16 Ls Building Department ., 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 1 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 14 BUILDING Master Permit No. �� PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION DRENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP `moo ^r CONTRACTOR DRAWINGS JOB ADDRESS: 15 6 .,� I `� Ave- CA. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: /Construction Type:: Flood Zone: BFE:n C FFE: OWNER:Name(Fee Simple Titleholder): keyIn' O'' IV ell Phone#:3KJ- jq 3- aNaf) Address: 5?S N e- 1 .'32�' '24. City: N . M t a.nr_ I -� State: E'1 . Zip: .331 (01 Tenant/Lessee Name: V el en& 11jr0MQ6 Phone#: Email: CONTRACTOR:Company Name: N-1v7_ G-64 2W VAe_ P I UM bl ly-A Phone#:"�I Q-3 I 7�2 B 3 Address: Qa 0- S 1,) 5 J -C!!.f0-. City: V esl Pr-r K State: Ft. Zip: 33 D a 3 Qualifier Name: I)O�tCA B l<L"e r, Phone#: q54 -9 9 )-213 3 /R+ State Certification or Registration#: 1,PC I'-1 a(0 3-SL4 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: — Zip: Value of Work for this Permit:$ 8�n Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 1❑ New ❑ Repair/Replace F-1Demolition Description of Work: e lace_ ,QS)- Iron 5_61'y 1'y �n 1 P&_ W Specify color of color thru tile: Submittal Fee$ Permit Fee$ r CCF$ ( ° CO/CC$ Scanning Fee$ /CO Radon Fee$;)- 0-5DB,�� R$� P//R$ O "� Notary$ Technology Fee$ �:/ Training/Education Fee$ 0• �1C J Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I 'RC1 (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 p� 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. Signature Signature WAv& OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of t 20 J by --I _day of 151> 20 1\�by ud 1,2M, ('� dew 1 who is personally known to m 1 a �� „ g�� who is personally known to Me or who has produced as me or who has produced as Me a who did take an oath. dentification an' o did take an oath. NOT Y PUBLIC: NO RY PUBLIC: Sign: Sign: Print Print m. 4- omm I ,�ti y FRANCES-DIXON Seal: Expires August 17,2018 Seal: Commission#FF 135893 ' OWN, Ra ded Tku Tray Fain Inewwma 800 3867018 Expires August 17,2018 Bwaed TW Troy Fdn lnamenaa 8003867018 7 ::::7* APPROVED BY r6Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ..ss Miami shores t(!a e Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33938 Certificate must specify the description of operations or contractor license number. rrssssrrrrsrrsrrserrrsrsrsssrrsarrsessssssrsrrsrssrrrrerrrrtserrsssrrsrrsesssssssrsterrrrrs BUSINESS NAME: R -FO .P1v _ BUSINESS ADDRESS: ( C �( SD err CITY _ (��(IL STATE_ZIP .3Oa3 BUSINESS PHONE: d-2-4-)AM- 3- 13 J FAX NUMBER! q - D CELL PHONE �o h n �- (--) � � QUALIFIER'S NAME:��d Ch _r) 1>s Isco i 1. QUALIFIER'S LIC NUMBER: L{ 3 �� Cj=C 9a as STATE OF FLORIDA 3 =za DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 WE 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 � ca .0ORRIERUCEIitSE CLASS E x7 K325-182-53-333-0 4 YEA M #CffC"M 9183 sw 97TH LAS KITCHEN, DONALD B DAW,FL 33324-4M ATO Z STATE WIDE PLUMBING INC OWW13 t983 sex:N 1483 SW 97TH LANE o+ter moa DAVIE FL 33324 G.x 3m:x rb;.,!T.'.'Ga':CRi'�.`@ltttilW^.ES laIFCI!tU 3R5•_tril'SOlq YE�Y ti S+:£:7^';:.... .i Congratulations! With this license you become one of the nearly - - - -- --- - — - - -one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, # _� DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC1426354 ISSUED: 08/06/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you, subscribe KITCHEN, DONALD B to department newsletters and learn more about the Department's initiatives. A TO Z STATE WIDE PLUMBING INC Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date AUG 31;2016 L1408M0001309 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1426354 The PLUMBING CONTRACTOR - Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 KITCHEN, DONALD B ATO Z STATE WIDE PLUMBING INC 1483 SW 97TH LANE DAVIE FL 33324 ISSUED: 08/06/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408060001309 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA:A TO Z STATEWIDE PLUMBING INC Receipt#:182 SPRNKL/CONTRACTOR Business Name: Business Type: (PLUMBING CONTRACTOR) Owner Name:DONALD B KITCHEN/QUAL Business Opened:02/09/2005 Business Location:2215 SW 58 TER State/County/CerUReg:CFC1426354 WEST PARK Exemption Code: Business Phone:954-962-9842 Rooms seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee FNSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State oriocal laws and regulations. Mailing Address: A TO Z STATEWIDE PLUMBING INC Receipt #1CP-14-00021348 2215 SW 58 TER Paid 08/13/2015 27.00 WEST PARK, FL 33023 2015 . 2016 City of West Park .- ��BUSINESS TAX RECEIPT FOR PER16D OCTOBER 1,2015 THRU SEPTEMBER 30,2016 ADMINISTRATIVE OFFICE Tax $100 ACCOUNT NUMBER 1965 SOUTH STATE ROAD 7 n �} BackTax 000120 WEST PARK,FL 33023 .2015,1-01# �ventory Not d 100 Required PH:(954)-9.89-2688 FAX:(954)-989-2684 ❑ NEW X RENEWAL ❑ TRANSFER BUSINESS LOCATION ADDRESS:- A TO Z STATEWIDE PLUMBING INC 2215 SW 58 Terrace JOHN DRISCOLL West Park,FL 33023 2215 SW 58 Terrace = LICENSE CATEGORY: West Park,FL 33023 850-Contractor-Specialty-Plumbing TMS LICENSE MUST BE CONSI'IEIJOUSLY72pT:AYED'»PUBLIC.VIEW AT THE LOCATION ADDRESS ABOVE _ A �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYYI 1/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS 'CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,ANb THE CERTIFICATE HOLDER. IMPORTANT; If the Certificate holder IS an ADDITIONAL INSURED,the pollcy(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 endorsemen S, PKODUCERNo E; KriStina Snellen Keyes Coverage Insurance PHONE 5900 Hiatus Road 964-724-7000 FA's s54-7247024 Tamarac FL 33321 a r"Ae ksnlepirlgtke escoverage.com INSURERISI AFFORDING COVERACC NA,O C INSURERA;De oshors Ins CO/Nationwide 42587 INsuaeD 5147 INSURER B:Hanover Amer Ins Co 36084. A t0 Z Statewide Bath Plumbing,Inc, INSURm c-Hanover Insurance Co n 2215 S.W.58th Terrace 22292 Hollywood FL 33023 INSURER D:BrideTreld Employers Ins Co 10701 INSURER E INS F: COVERAGES CE TIFICA NUMBER:432656000 REVISION NUMBER: THIS IS TO CLRTIFY 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 THF;TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL SR TYPE OF INSURANCR PoutVIEW B X COMMERCIAL GENERAL LIAMMY INSYD Y IiZJ 39529$3IC NUMBER LIMITS 9/1!2015 9/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR E X P EtAI Ea ommen $100,000 Al Per Ain Cont X ]( `Per COntract� MED E7(P Any mg Dereon $t 0,000 PERSONAL&AoV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLO:SPER; POLICY OENERALAGGREGATE $2,000,000 El JECT LOC OTHER: PRODUCTS-COMP/OP AGO $2,000,000 A $ AUTOMOSILE LIAEMU y Y ACP RAPD 5944997932 4/232015 4/29Ia018 X ANY AUTO (Es OMM nl 51,000,000 VA Y ED AlC1TOSULED 6ODILY INJURY(Per pm.) $ X HIRED AUTpg X AUTOS 13001LY INJURY(Per 2=kk p) $ $ Pv aaJdant C X UMBRELLA LAS X $ OCCUR UHJ 8348191-08 9112015 91i/2018 EACH OCCURRENCE $4,000,000 IXCESSLrgg CLAIMS-WADE AGGREGATE s4,000,00D DED REIEIVIT N D 11IORKER9 CDrrPENSATION 830 38657 $ AND EMPLOYERS,L�yTy Y/ll N 1/V2016 1/12017 X 9TA7UTE FOk ANY PROPRIeTOR/PARmE�j�ECUrIVr OFFICER/MEMgFJi EXCLUDED? NIA �F-L W"ACCIDENT $1,000,000 (amlddtoryin NII) �1116EAGE, EE-EA EMPLOYE $7,°00,000 It yed,dcrnyggpDE RI TION OF OPERATIONS POLICY LIMrr $1,000 000 DESCPJPTMN OF OPERATIONS/LOCATIONS/VEHICLFs(ACORD 101,Addisaml Remarke Schedule,may he ansched frmere spare is►vqulredl Donald B Kitchen CFC1426354 CERTIFICATE HOLDER CANCELLATION 30 days except 10 des nonpayment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept. THE EXPIRA17 N DATE TH pO1JC1(THEREOF, NOTICE YNILL BE DELIVERED IN 10050 NC 2nd Ave ACCORDANCE Miami Shores FL 33138 AUTNOMZED REPRESENTATIVE ACORD 252014101 ®1988-2014 ACORD CORPORATION. All rights reserved, ( ) The ACORD name and logo are registered marks of ACORD l h e fu4AI(C 9999 . . 0009 9000.0 9999.. TIE .1PO 9999.. . 9999.. 9999.. 9999.. 9999 9999 . . 9999 9999 9999. .. .. .. . 9999.. 9999.. 9999.. -�' --- vNITN Al�_MI IIAL. �{{ 1 r-,LIIn!.—