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PL-15-2412 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244009 Permit Number: PL-9-15-2412 Scheduled Inspection Date: November 04,2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , Work Classification: Gas Job Address:652 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122310120140 Project: <NONE> Contractor: DELLA ROSSA PLUMBING &SOLAR LLC Phone: (954)479-4270 Building Department Comments RELOCATE GAS LINE IN KITCHEN FOR NEW STOVE Infractio Passed Comments LOCATION. INSPECTOR COMMENTS False Inspe for Comments Passed 1:0/ 6 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 03,2015 For Inspections please call: (305)762-4949 Page 6 of 39 5140 SW 20th St. www.DellaRossaServices24hr.com DELLRROSSR] Plantation, FL 33317 Office:(954)479-4270 04_1 � .... 0�t ` �4�L�t �c ,•� 4PLUMBING -AIR CONDITIONING -SOLAR Fax:(954)636-8198 24 Hours Service&7 Days ❑SERVICE WORK ❑CONTRACT ❑AFTER HOURS ❑WARRANTY Licensed/Insured CFC1427740 Backflow Lic.# 13366 WORK# = 45 8 4 Medical Gas-MedGas Lic.# 13-0220-04 - BILLING NAME '^ {�, f�<J�<` ; r 2l� DATE JOB NAME JOB ADDRESS '2 PHONE QTY. MATERIALS,EQUIPMENT,RENTALS UNIT COST TOTAL DATE LABOR PERFORMED BY HOURS RATE AMOUNT I have authority to do this work to be done by Delta Rosso Plumbing 8 Solar Services,I.I.C. It is agreed that the same shall remain personal property of the seller until final psymeM.The LABOR debt Is due and payable ten days from the above date.The sager shall not be liable for any defects In work or materials unless the buyer gives written notice of same within tan days from installation.In ease same is not paid In full within ten days from above dots,the debt CAMERA FEE Mail bear the highest legal rate of Interest upon default In case auk should be brought for the collection or enforcement here of or smse has to be collected or enforced upon demand of PERMIT/PROCESSING such collection.The buyer further consents and agrees to pay reasonable expenses for sled removal and storage of the above personalty,and that the above personally may be removed and stored by Dela Rosso Plumbing&Solar Services,LLC in ase suit or otherwise.Add-on MATERIAL �- charge after 30 days-grill be 2%. After-3-montha._a Ilea will be enforced. DEPOSITS ARE NOT1tEFUNDABLE. X -. MATERIAL SALES TAX ; Authenze Signature SUBTOTAL X Print Name TOOL RENTAL This work has been satisfactorily performed by Dela Rosso Plumbing&Soar Services,LLC. X TOTAL AMOUNT MATERIAL SUBTOTAL Authorize Signature THISTICKET LIC. CFC1427740 poia X15-2 1 Miami Shores Village irrMitTj ►1utbng .RBS{ etf8) 10050 N.E.2nd Avenue NE cn '•' Miami Shores,FL 33138-0000 �, [Nb11kG :SA +9ftl? f Gas Phone: (305)795-2204 P$rm!#Stettr 11 �E .;: "4oR1Df` Expiration: 03/28/2016 JOate s 15 P Project Address Parcel Number Applicant 652 NE 105 Street 1122310120140 Miami Shores, FL Block: Lot: KILUAN, INC Owner Information Address Phone Cell KILUAN, INC 652 NE 105 Street MIAMI SHORES FL 33138- 150 SE 2 Avenue MIAMI FL 33131- Contractor(s) Phone Cell Phone Valuation: $ 300.00 DELLA ROSSA PLUMBING&SOLAR 1 (954)479-4270 _.,... w,.. Total Sq Feet: 0 Type of Work:RELOCATE GAS LINE IN KITCHEN FOR NE Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning: 1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# PL-9-15-57172 $2.25 09/22/2015 Credit Card $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 09/30/2015 Credit Card $ 109.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 contr ctor to do the work stated. September 30, 2015 Authorized Signature:Owner / Applicant / ontractor / Agent Date Building Department Co September 30,2015 1 � r Miami Shores Village SEP 2 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Master Permit No. RC-4-15-833 PERMIT APPLICATION Sub Permit NJI ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ®PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 652 N. E. 105 St. City: Miami Shores County: Miami Dade Zia: 33138 Folio/Parcel#: 11-2231-012-0140 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Klluan. Inc. Phone#: Address: 652 N.E. 105 St. City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: Della Rosa Plumbing &Solar, LLC Phone#: (954)479-4270 Address: 5140 SW 20 St. City: Plantation State: FI. Zip: 33317 Qualifier Name: Joseph Della Rosa Phone#: (95-4)47974270 State Certification or Registration#: CFC 1427740 Certificate of Competency#: DESIGNER:Architect/Engineer: A$ I Associates Phone#: Address: 370 N.E. 101 St. city:Miami Shores State: Fl. Zip: 33138 Value of Work for this Permit:$ 300.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑X Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Relocate gas line in kitchen for new stove location Specify color of color thru tile: /2 iggl) Submittal Fee$ �v —Permit Fee$ f CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I� )C (Rev1sed02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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$2.500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Marco Bru ' ( Director Kiluan, Inc) �eph Delia Rosa Signature ignature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing' rument as acknowledged before me this r)C1 day of 120 by _ 3 of 20�J by �CAYCA 6YU Z.Z i who is rsonally know to J 01 s personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did tak a r CASANaRAMRRISM Notary Public,State of Florida NOTARY PUBLIC: NOTARY PUBLIC: Commission 4 EE 196163 My comm.expires May 14,2016 Sign: Sign: Print: Print: 't' ''` %� LUCIA G ISASI Seal: ts : Seal: MY COMMISSION#FF182628 ' o•! .,',�.��p EXPIRES December 10,2018 do,I,398Ot53 FbrkJallotaryServlce.com k+te drab ile &&iMe+kbk�fl«bk*86M48ffi�Si+Nbkk kskkak#a&akk Rik 9is+Y YssYetlbia+M A�s9eap 8ae t$a APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 09-22-`15 11:46 FROM-Freedom Insurance 954-792-3664 T-571 P0001/0001 F-400 CERTIFICATE OF LIABILITY INSURANCE ; oarr;l�ern/oo/YYYY) _ _ _ 09/22/15 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 ADpITIONAL INSURED,the p011cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to�the iemus 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 "-- ---- -- Freedom Insurance Agency 'v oNEe ryc �.�Ye};•,_•(954)792 3890 ` Tarr,.Not, _(954)791-6019 101 South State Road-/ EMaL >LDRESS info(MTreedominsurancefl.com Plantation,FL 33317 - INSURE%Sl AFFORDING COVERAGE— T� NAIL ti, Phone (954)792-3660 Fax (954),791-8019 INSURERA: �Pederated NationSl Irn„Urance Company ;10790 j INSURED "--' T---i INSURERS: Progressive Express Insurance Company -� Della Rossa Plumbing&Solar,LLC I INSkffL 5140 SW 20 Street ; INSURER D_RetailFirst Insurance Company IPlantation,FL 33317- I INSURER E: j 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES D88CRBED HEREIN IS SUSJECY TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ILTR TYPE OF INSURANCE ADDLSUSIX ( POLICY EFF 1 POLICY EXP -� POLICY NUMBER i IMMJ00/YYYY1 I(MMIDD/YYYY)I LIMITS I GENERAL LIABILITY I I I EACH OCCURRENCE 1 S 1.000,000.00 ffCOMMERCIAL GENERAL LIABILITY DAMAGE 70 RENTED 1 OO,OOO.00 —1 Cl ❑ C ! LAIMS-MADE ❑V OCCUR I PREMISES rEa arcurrenrel 3 A J I N N I GL-0000017593-02 I MEO EXP(Any one person) $ 5,000.00 ❑ 107/12/2015:07/12/2016 PERSONAL a ADV INJURY I $ 1,000,000.00 7, GENERAL AGORFOATE : $ 2,000,000.00 i LGENLAGGREGATE LIMIT APPLIES PEP_ I PRODu_CT_S COMP/OPAea: $ 2,000,000.00 JA ��OJNI_j POUCY O c LIAarLlt Y LOC ---�— -- f --- r COMAINEO SINGLE LIMIT I $ ! ❑ ANY AUTO I 1 BODILY INJURY(Per perr,on)! S 100,000.00 B bloorED SCHEDULED 04475507-5NONi ❑ AUTOE] AUTOS N ! 12/17/2014 i 12117/2015 BODILY INJURY(Per accident) $ 300,000.00 ❑ H1REDAUTOS ❑ AUTOS I I P OPERTYDAMAGE ^' ❑ ! I J L Iger aecitlanU 1 $ 50,000.00 I $ I l ❑ El UMBRELLA LIAR CCUR ❑O I I EACH OCCURREN $ 1❑ EXCESS LIAR 1 CE❑CtAIM5 MADE I i I-- -----— ! AGGREGATE1 El I $ DED RETENTf N WORKERS COMPF.,NSATION I W A,,, ❑6RH�. r AND EMPLOYp,W LIABILITY Misr 1 A S i IWYPROPRIEYOMF'ARTNER/EXECUTIVE/N 0520-022633 FEL,EACH ACCIDENT $ 1,QOO,OOQ.00 D OFFICER/MEMBER EXCLUDED? N/A. N : :09/16/2015 t 09/18/2016 (ManndatorYreNH) C,' ' CIL DISEASE-EAEMPLOyEd S 1,OD0,ODO.00 K descibe udder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT, $ 9 000 000.00 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if rrrore space is required) Plumbing Contractor License-OF01427740 f � CERTIFICATE HOLDER .. CANCELLATION I I - f SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I Village of Miami Shores Building Department I THE EXPIRATION DATE REOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TH OLICY PROVISIONS, 1 10050 NE 2nd Avenue -Mlaml Shore$,FL 33138AUTHORI:I0 ACORD 25(2010/05)4F CORD CORPORATION. All rights reserved. e and logo are registered marks of ACORN