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PLC-15-1407 N 00- /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-249765 PermitNumber: PLC-6-15-1407 Scheduled Inspection Date: December 30, 2015 Permit Type: Plumbing - Commercial Inspector: Diaz, Osvaldo Inspection Type: Final Owner: SLMB LLC,LFNG LLC C/O CJ LAW Work Classification: Addition/Alteration Job Address:651 NE 88 Terrace Miami Shores, FL 33138- Phone Number (305)200-8696 Parcel Number 1132060120020-651 Project: <NONE> Contractor: BOB'S PLUMBING CO INC Phone: 305-229-9932 Building Department Comments PLUMBING WORK FOR INTERIOR RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-249589. h/c toilet 16-18 EP/ d.fou ain not per plan Failed 6 Correction L'3 Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 29,2015 For Inspections please call: (305)762-4949 Page 19 of 34 r ; Perri PL.0 Miami Shores Village �r1 Vy im, ` t Oi ` 10050 N.E.2nd Avenue NE ii ic� � � I+yc t�ssiatrc�n;AdciIc�NAlterltion' Miami Shores,FL 33138-0000 �� Phone: (305)795-2204 �CORLIP' g r, /12/2t�15 Expiration: 12/09/2015 Project Address Parcel Number Applicant 651 NE 88 Terrace 1132060120020-651 Miami Shores, FL 33138- Block: Lot: LFNG LLC C/O CJ LAW SLMB LI ; Owner Information Address Phone Cell LFNG LLC C/O CJ LAW SLMB LLC 651 NE 88 Terrace (305)200-8696 MIAMI SHORES FL 33138- 651 NE 88 Terrace MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 18,000.00 BOB'S PLUMBING CO INC 305-229-9932 (305)796-4225 Valuation: _.... . Total Sq Feet: 0 3 Type of Work:PLUMBING WORK FOR INTERIOR RENOVATI Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Classification:Commercial Re Pipe Scanning: 1 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.80 DBPR Fee Invoice# PLC-6-15-55912 $8.10 06/09/2015 Credit Card $50.00 $538.00 DCA Fee $8.10 Education Surcharge $3.60 06/12/2015 Credit Card $538.00 $0.00 Permit Fee $540.00 Scanning Fee $3.00 Technology Fee $14.40 Total: $588.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: Ice . t t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and d zon' u e re,I authorize the above-named contractor to do the work stated. June 12, 2015 Authorized Sig I ature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 12,2015 1 Miami Shores Village PZFcFD Building Department JUN 0 015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 : INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 (0 BUILDING Master Permit No. c'—- ! " t 5 ' i�s PERMIT APPLICATION Sub Permit No.-RP'I �a'`1409 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL E?OILUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: LTJ ( 1 V E-- 8 0 City: Miami Shores County: Miami Dade Zip. 3 l 3$ Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):_ -&8> g; pv �' _pi one#: '30S 2-0c- 1614 Address:_1101 �i �t City:_ H i i f State: -°2 '`� Zip: 3 3 1 �i ) Tenant/Lessee Name: rtne-%L-LA pi'v—V-0y,g Lftz Phone#: ?�a ,5 '3q ?,.-53W. Email: CONTRACTOR:Company Name: -Bcz'.& S -�?L'J440.twC ' � Phone#: 2" -(�It 9 3 Z, Address: --S-'J % City: t State: TL.Q Zip: 3-3k U,5 Qualifier Name: Phone#: State Certification or Registration M r` Cc' S'S +2 Certificate of competency#: 9A t 'T DESIGNER:Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit:$ t �o Square/Linear Footage of Work: Type of Work: ❑ Addition ° Alteration ❑ New ❑ lace Re air/Re p p F-1 Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ X- CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a pr ed and a reinspection fee will be charged. nature Si .r.._. �� Signature g a /OWNER or AGENT CONTRACTOR e m The foregoing instrument was acknowledged before this Th foregoing instr nt was acknowledged before me this day of20 ,by day of 20 )5 by who is personally known to Sohl ��SSe-fL- who is personally known to moriwah'o"I,as pro'dUVice /7J 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- Print:�r ,�`'�U C" Print: e`'*0. Casa S Seal: SHARON ANN COX Seal: Elisha Car~sals 1pnY p„B � , '�i MY COMMISSION#FF124989 cmmsmo 1 EXPIRES:MAY 20,2018 3* s YVWtAt. NOTARY CON! APPROVED BY ,��r��S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) BOBSPLU-01 SSIMEON ..ACORN` `,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1r) 11/26/2014 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 8,French,LLC PHONE 305 822-7800 Fax 8000 Governors Square Blvd a No Ext:( ) Arc No:(305)362-2443 Suite 301 E-MAIL ADDRESS:Miami Lakes,FL 33016 INSURER(S)AFFORDING COVERAGE NAIC @ INSURERA:Arch Specialty Insurance Company INSURED INSURER B:National Trust Insurance Co 20141 Bob's Plumbing Co.,Inc. INSURER C:FCC[Insurance Group 10178 4055 SW 89th Ave. INSURER D: Miami,FL 33165 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 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. INSR TYPE OF INSURANCE ADDL B POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMID MM/D A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS MADE X occuR X X GL0019833-00 11/28/2014 11/28/2015 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ]PEC LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY Ce a�deMSINGLE LIMIT $ 500,00 B XANY AUTO X X CA00227363 11/28/2014 11/28/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS LIABILITYSTATUTE ER YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE 001 WC14AS9071 09/01/2014 09/01/2015 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addidonal RemaHcs Schedule,may be attached K more space Is required) Master Permit#RC 10-259PIumbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 'S a, CONSTRUCTION INDUSTRY LICENSING BOARD CFC055672 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 L BLOSSER, JOHN EMMETT 16 BOB'S PLUMBING CO INC 4055 SW 89 AVE • MIAMI FL 33165' ■ ISSUED 06/23/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406230000532 000245 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - OG TJOT PAYzz9534 \.-LBT111 BUSINESS NAMBILOCATION RECEIPT NO, EXPIRES BOBS PLUMBING Co INC RENEWAL SEPTEMBER 30, 2015 4055 SUV 89 AVE 229534 Must be displayed at place of business MIAMI FI,33165 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS BOBS PLUMBING CO INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC055672 BY TAX COLLECTOR Worker(s) 10 $75.00 07/18/2014 CHECK21-14-025311 This local Business Tax Receipt only confirms payment of the Local Business Tar. The Receipt is not a license, permit,or o certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental►egulatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Bade Code Sec 8a-D6. For more information.visit www.mlamidada.govkaxcelle qt