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PL-15-3039 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250814 PermitNumber: PL-12-15-3039 Scheduled Inspection Date: January 13,2016 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: CLIFFORD, DEBORAH A Work Classification: Sprinkler System Job Address:300 NE 101 Street Miami Shores, FL Phone Number (305)335-6685 Parcel Number 1132060135330 Project: <NONE> Contractor: ALL FLORIDA KINGS IRRIGATION SYSTEMS INC Phone: (305)283-3330 Building Department Comments LAWN SPRINKLERS Infractilo Passed comments INSPECTOR COMMENTS False Inspector Comments Passed C Failed (G- Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 12,2016 For Inspections please call: (305)762-4949 Page 30 of 31 PermitNo PL-42-1840 9 Miami Shores VillageeJTt1TRsititntiai �S• 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000rJr�L` tr?rI Sirilttl+er ... ;i.: Phone: (305)795-2204 Permit v�`fatifS«AP�`ROV �toR� Expiration: 0712 16 Issue Date. 11!'1���I� p� Project Address Parcel Number Applicant 300 NE 101 Street 1132060135330 CLIFFS ON THIRD AVENUE LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell CLIFFS ON THIRD AVENUE LLC 1490 NE 103 Street (305)335-6685 MIAMI SHORES FL 33138- 1490 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,800.00 ALL FLORIDA KINGS IRRIGATION SY• (305)283-3330 O Total Sq Feet: 00 Type of Work:LAWN SPRINKLERS Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return Underground Sprinkler Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# PL-12-15-57980 $2.25 12/07/2015 Credit Card $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 12/10/2015 Credit Card $116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology 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 for ELECTRICAL,PLIJMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAV : certify th all t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an n' uthermore, u horize the above-named contractor to do the work stated. December 10, 2015 Authorize Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 10,2015 1 � Miami Shores Village --- -_ 1D Building Department e�� ®7 201 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 $Y: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20J/-/ BUILDING Master Permit No.; 21 3 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL [,PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: GMiami Shores County: Miami Dade Zip: Folio/Parcel#: /f 37-V ��H316 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: LC OWNER:Name(Fee Simple Titleh er). AVOVf4�one#:� � Address: C City: e� State: Zip: Tenant/Lessee Name: WIN-),� Phone#: �(X Email: o 114 CONTRACTOR:Company Name: V `40ghtk—`�� pn G14tt g `OL.Phone#: VS Address: 13A21 SW I5 5* ` City: AAfl _ State: Fi3rz0X Zip: � 3 Qualifier Name: ,J 0 Y !q C- CJL Phone#: 5 ZM 3330 State Certification or Registration#: C0 0003y Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ' 0 D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration r ® New ❑ Repair/Replace ❑ Demolition Description of Work: Loll f I✓) /�I e YS r Specify lor of color thru tile: $ �� Submittal F1 '' Permit FeeCCF � Scanning Fee$ Radon Fee$ 5& DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RevisedO2/24/2014) f , 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,. subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first i pection which occurs en ) days after the building permit is issued. In the absence of such posted notice, the inspection t be approved and reinspec ion fee will be charged. Signatu Signature OWNER or AGENT U CONTRACTOR The foregoing instrument was acknowledged before me t is The for oing instrument was acknowledged before this 13 day of [X(L mb-cy- ,20 1 ,by day of e— c 20 ,by J t Ieyl C`( MA' who is personally known to who is personally known to me or who has produced ��.NJ blly i« �as me or ho has produced�/ 1� I(oa as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: g Si n: �� Sign:g Print: J � Print: Seal: OLt3d9��M UOISSIWWO ,P••ifAO�`,'� •••a.uNq Seal: .•,►�"°�e•• BRITTANY KELLY L101'6t too 981163 VU100 IM ��� '`s Notary Public-State o1 Florida eplioN to ateiS-31mnd AMON ,, �;My Comm.Expires Oct 13,2017 A11311 ANVILIM9 �''a, ra° �•q'F�c•�p•0. Commission 0 FF 62370 &�k�kW�k�k�k�k�N�k�k �k�k�k�k�k�k�k�k�k Mc�e ye i��k�k+k�k ile�Ie* II"aN• ak�k ek 7k ik�k �k�k�k*�k#akMffi APPROVED BY Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) G�vadO" f C&AI l NAY "IFICPTE O 00 30 QOpo 3 �0SYSTOSINO �Dade cou DG jo ftGE.�ysio of ChaPtet ►a cf M,am TOc��d un�r the P'° Is Local Busi ness Tax Fbcd pt Miami-Dade County, State Of Florida -THIS IS NOT A BILI nn NAT PAY [(ST 5991949 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES ALL FLORIDA KINGS RENEWAL SEPTEMBER 30, 2016 IRRIGATION SYSTEMS INC 6251359 Must be displayed at place of business 13921 SW 75 ST Pursuant to County Code MIAMI,FL 33183 Chapter BA-Art.9&10 OWNER SEC.TY PE OF BUSINESS PAYMENT RECEIVED ALL FL KINGS IRRIGATION SYSTS 196 SPECIALTY PLUMBING BY TAX COLLECTOR CONTRACTOR INC75.00 09/30/2015 r`in RIr,0RFRT0 PINFRA GOP000330 0237-15-000971 Workers) This Local Business Tax Racelpt only con"rrrs payment ofthe local Business Tax.The Fmel pt is rota license, permit,ora card"cetfon of the hdcWs qudi"odors,to do business.Holder trust canply with any governmental or noMom"merlal regulatory laws and regdremmviswhich apply to the business The FSMPrrNOQ above mmt be displayed on all camsreial,vehicles-Mlaml-0ade03de Sec Ba-276, D Farmoreirdorn don,visit ® Municipal Gontractoes Tax %ceipt Miami-Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY m C CC NO: OOP000330 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES ALL FLORIDA I9NGS MGATION 96MS tNC 7473230 SEPTEMBER 30, 2 016 13921 SiN75 ST MIAMI,FL 33183 Pursuant to County Code See 10-24 OWNER TYPE OF BUSINESS ALL FL I9NGS IRRIGATION SYSlS INC S M ALTYPWMBING CONTRACTOR PA YM ENT RECEIVED C/O RIGOSERTID PINEPA PRESIDENT BY TAX COLLECTOR 175.00 09/30/2015 0237-15-000971 Tills receipt Is not valid in the following Municipalities:Avenhm Doral,Halesh,Key Biscayne, Mimi Gardens,Mlwa Lakes,Palmetto Bay,Plrwxest,Sunny Isles Beach,Town of Culler Bay. mFornurel.ft,, icn,visitwww.miamidad 4adtmmdledor DATE(MM/DD/YY) CERTIFICATE OF LIABILITY INSURANCE 12/03/15 PRODUCER Express Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 13754 S.W.84th St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33183 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)388-5650 Fax (305)388-4640 INSURERS AFFORDING COVERAGE NAIC# INSURED All Florida King Irrigation System, Inc INSURER A: GRANADA 13921 Csw 75 St INSURER B:INSURER C: Miami, FL 33183 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY IXPIRATION LIMITS T RD DATE M/DD DATE M/DD GENERAL LIABILITY EACH OCCURRENCE 1,000.000 d❑COMMERCIAL GENERAL LIABILITY 0185FL00033746 02/03/15 02/03/16 PREMISES F,occurence 100,000 ❑❑ CLAIMS MADE ❑ OCCUR MED EXP(Any one person) 5,000 A ❑ ❑ PERSONAL&ADV INJURY 1,000.000 ❑ GENERAL AGGREGATE 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 00 © POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS El NON OWNED AUTOS BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE 11 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- EMPLOYERS'LIABILITY TO MIT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 00P000330 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF MIAMI SHORES DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2ND AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MAIMI SHORES, FL 33138 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE PATRICIA DUQUE ACORD 25(2001/08)OF ©ACORD CORPORATION 1988 (MWO ATE ACW O' CERTIFICATE OF LIABILITY INSURANCE D yo3rto1�5» 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: PHONE A/C No Ext): 14MO-277-1620 x4800 FAX A/C N.): 72 797-0704 FrankCrum Insurance Agency,Inc. E-MAILADDRESS: 100 South Missouri Avenue INSURERS AFFORDING COVERAGE NAICB Clearwater FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum UC/F All Florida Kings Irrigation Systems,Inc. INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 335490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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. IISR TYPE OF INSURANCE ADDL SUER POLICY NUMEPOLICY EFF POLCY EXP LIMITS INSRD WVD (MWDUAry" GENERAL LUABDJTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES occurrence) CLAIMS-MADE F—IOCCUR MED EXP(Arty one Person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F7 PROJECT LOC $ AUTOMMOBp.E LIABILITY COMBitlED SINOLE LIMIT $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(PerPerson) $ AUTOS AUTOS BODILY INJURY(Per ecalderd) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per UMBRELLA U A13 OCCUR EACH OCURRENCE $ EXCESS LUAB HCLAINISAME AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC2015#411 f 01/01/2015 01/01/2016 X WC STAMORY ' A EMPLOYERS'LIABILITY Y/N LIMITS ER ANY PROPRIETORIPARTNEWEXECUTNE OFFICERIMEMBER EXCLUDED? Q N/A E.L.EACH ACCIDENT $I.M.OW 011srMelory In NN) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $7 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Affech ACORD 101,AddMonal Remarks,Schedule,M more spaw Is required) Effective 06/01/2015,coverage is for 100%of the employees of FrankCrum leased to All Florida Kings Irrigation Systems,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shore Village Building Department nurHOR¢e0ReP�� 2nd Avenue IVF Miami Miami Sho10050Nres,FL 33138 ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD