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PL-15-1714 Pte ° ' , L- , -17147r,!10 Miami Shores Village Permit Type:Plumbing-Residerirtial �n 10050 N.E.2nd Avenue NW 1"GtaS'" Wa`iUr? C{ditlli til�AIteration Miami Shores,FL 33138-0000 _ IPROVE ermit Stakm Phone: (305)795-2204 " ffNyEp M$ �toRmA Fxpiration: 3/07/2016 Issue Dam;91912015 Project Address Parcel Number Applicant 10326 NW 1 Avenue 1121360131430 JG 10326 LAND TRUST Miami Shores, FL 33150-1270 Block: Lot: Owner Information Address Phone Cell LJG10326 LAND TRUST 560 NE 103 Street (786)436-0329 MIAMI SHORES FL 33150- 560 NE 103 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,800.00 STAR PLUMBING 305/949-9749 Total Sq Feet: p Type of Work:NEW BATHROOM,REMODEL KITCHEN AND S Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PL-7-15-56282 DBPR Fee $3.38 DCA Fee $3.38 07/09/2015 Credit Card $50.00 $189.56 Education Surcharge $0.80 09/09/2015 Credit Card $ 189.56 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $239.56 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 th a the bregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhe a o ize the above-named contractor to do the work stated. September 09, 2015 Authorized Sig;=;I��Y / Contractor / Agent Date Building De September 09,2015 1 12� (' I ��- � 4�L Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249477 Permit Number: PL-7-15-1714 Scheduled Inspection Date: January 19, 2016 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: RABINOVICH, IVAN Work Classification: Addition/Alteration Job Address:10326 NW 1 Avenue Miami Shores, FL 33150-1270 Phone Number (786)436-0329 Parcel Number 1121360131430 Project: <NONE> Contractor: STAR PLUMBING Phone: 3051949-9749 Building Department Comments NEW BATHROOM, REMODEL KITCHEN AND SECOND Infractio Passed Comments BATHROOM INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-238676. PROVIDE P+T FOR WATER HEATER AS PER TITAN MANUFACTURE WHEN CPVC IS USED PROVIDE P-TRAP AT AIR HANDLER FOR CONDENSATE Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 15,2016 For Inspections please call: (305)762-4949 Page 8 of 20 Miami r JU M ®� 215 iBuilding Department 1 ,�,�: 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 i " BUILDING Master Permit No. PC --4 - 0- PERMIT APPLICATION Sub Permit No.--F�--I BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL `PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ® CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 10"�Zb I� � I e% • city Miami Shores County Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: .S-Tc.,-­ OWNER: S-T�­ OWNER:Name(Fee Simple Titlehoider):a o-sc�e• c:.'ZZ , .'Se; iciz(, Phone#: 4 316-c3 Z-S Address: IR- 0 Q& IOS ZT City: ri°- ° - e�'- State: ��- Zip: G L Tenant/Lessee Name: Phone#: Email: C rc pr. c 'I CONTRACTOR:Company Name: _5_(0XL (n0"' k""c �3C Phone#: _-M -.4Zci 34iZ Address: d Sq 2.Z i5 is 2( 9CV a City: Pe State Qualifier Name: Phone#: lzu- `E -5"7 - 3-YA-Z State Certification or Registration#: CFC 6),, 3®(6 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: [E Addition ❑ Alteration ❑ nNew i E] Repair/Replace ❑ Demolition Description of Work: = , iz,rL.�Ote( s_ Specify color of color thru tile: Submittal Fee$ Permit Fee$ 2ZS• 7 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I 99 • SC (Revisedo2/24/2014) + r Bonding Comparti(5 Addininis City State Zip Mores Lendees Narm(if apphcaW a ? t 4.. MY Sim TED ae tm aftmh a pmmrft to dm ate lairRiZIRL 0 rT blutainmron has -. Ife&W -'A:&�VWWtw-A wem-WM-Amautmis of alf;.laws'.rffadating k M EW— OWNEWS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all aingrli!cable Azws negmlaltirng a aarnstQ�atd a OWYANNAR V*' , ^y :f "' X 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 NOTME OF CDAIMINCRUENTf promise in good yi th char a copy of the nonce pf commencement and'consttruc(hon 60n Yaw hrocWre vwW be 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 17) days after the building permit is issued. Ap the absence of such posted notice, the inspection wiff not be approved and a reinspection fee wiff be chaWd- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this f. �UL`? n2M) I S 6 ad J L waw- 11 {�I I I(1�n — me or who has produced I K-i lel W-las me or who has produced as identification and who did take an oath. identification and who did t/ke an oath. f ZNOT V NOTARY PUMM Print- Print• goy vye Notary public State of Florida ro o ry u tate of Florida Seal: Sindia Alvarez Seal: Q Antony Quiroga e My Commission FF 156750 N My Commission or Expires p Expires 09/03!2018 a moo• Expires 07/13!2015 APPROVED BYPlans Examiner Zoning s� �7 a' SNo.RFs�t � 4••�" Miami shores Village l Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FIO.RIDA-§jAjE CERTIFIEn 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 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: 9-T/7t P2-G 1'1 / f� c . BUSINESS ADDRESS: Vr' Lt 2 '2 ).1 4Vi� . cri-4 d aO9i/ SCM STATE FZ- ZIP �� 162 �� BUSINESS PHONE: ( 7 S-1 FAX NUMBER CELL PHONE( ) QUALIFIER'S NAME: &t:j Q(-,t` Z,01) V I A 4 QUALIFIER'S LIC NUMBER: e� o s- -� 0 6 `J- RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC057062 The PLUMBING CONTRACTOR Named below IS CERTIFIED ` '' Under the provisions of Chapter 469 FS. � Expiration date: AUG 31,2016 LEDVINA,GEORGE STAR PLUMBING INC 15422 N.E.21TH.AVENUE NORTH MIAMI BEACH FL 33162 ISSUED: 08/10/2014 DISPLAY AS REQUIRED BY LAW SEQ* L1408100002197 Luca! Business Tax Receipt Miami—Dada County,Stain of Florida THIS IS NOT A BILL-DO NOT PAY 3875898 %.L BTJ. 10488"w""LAMBIt aV-01TAN Rer-awr am F.���$ STAR I"LLU �ld3 WC RENEWAL SEPTEMBER�0,��� N N MIAMI 29 AVE 4046181 diaptavad at plata oft Weinman. MIABEACH,FL 33 462 M,�bePumerst to County Caft Chapter SA-Art.9&10 OWN@R SEC.TYPE OF RUSINESB STAR PLUMBING INC18S PLUMBING PAYaa6NTREC TVW CIO GEORGE LEDVIFHI FRES BY TAX CAXLACM CONTRACTOR 45.00 08/08/2014 Worker(s) 1 CFC067062 CREDITO RD-14-032019 TWO Lord Btalasss Tex BeUIP1 ORN esa*ma Psymcr8 of Lbs Local tivataeaa Tax.Tlw Ilmstpt to Rot a BOOM WINIL or s oartlBcetlen of Bm hoWWS tlWlWxd m.to do baWmL NoWOt am am*vAM my aosstwMMW ar non"mmoaai r phwv'am=d mqammft which ap*to @a btadam. Tim BECEnW0.ah-ambe disgaVad tophi tomamentalivoWdu-) -Dula Code Esaft-VL Foe morn Icio a8rtt STARPLU-01 KKENNEDY .a►��Kv CERTIFICATE OF LIABILITY INSURANCE O`9/8/2015 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: B the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. It 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 andome s). PRODUCER NAnA: Diane Traynor Collinsworth,Alter,Lambert,LLC waNEPAY 23 Eganfuskee Street N. B,n.(561)778-9001 to W4.(561)427.6730_ Suits 102 Jupiter,FL 334T7 – ---- INS B.AFFPOR4INO COVERAGE NAIL A INSURER A:Ohio Security Insurance Company 24082 INSURED __..._ wsuRER s: Star Plumbing,Inc. INSURER C: ----- 16275 Collins Avenue -�- 91203 INSURER D: Sunny Isles,FL 33180 INSURFIt E: INSURER F: COVERAGN 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 VMTH 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. LTR TYPE OFMSURMNCE ---__._-POLICY NUMBERIMAM LIMITS A X MWFIRCNL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, _ qAINISMADE T OCCUR i BLS(18)55886727 07130f2015,o7130/2018 pSEMLSEs IE,=L;' g 300,000 _ MED EXP(Any one pe�am�) $ _ PERSONAL d ADV INJURY $ 1.000, M OENL AGGREGATE LTAPPUV PER: GENERAL AGGREGATE S 2,01110,0011 POLICY U LOC PRODUCTS-COMP/OP AM $ 2,000,0 OTHER: : AUTOMOBILE LIABILITY j m-wo SINGLE LIMIT S ANY AUTO , I BODILY INJURY(Per Poems) $ ALL OWNED SCHEDULED UT� BODILY INJURY(Pm awk!00 S F4RED AUTOS D m $ S U LIAB OCCUR EACH OCCURRENCE S �s CIaIMs�wDE AGGREGATE S ED DRETENTION: --_ $ WORKERS COMPENSATION AND ENPLOVEW LJABUTY STATUTE ER ANY PROP EMBER IPART'NEWEXEC VTIYE Y I N OFFICEWBEMBEEXCLUDED? ��NIA E.L.EACH ACCIDENT _-- Uy demPoeIA H) E.L.DISEASE.EA EMPLOYEEI$ DE3C IPTION OFOPERATIOPL4 below E.L.DISEASE•POLICYLWT S I j ORSCRIPnON OF OPERATIONS I LOCATIONS f VEHICLES(ACORO 101.Adeitlmlal Remaft SchedW.may bs attached H mom space 1s raglW*M Plumbing Contractor CFC057062 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd.Ave. Miami Shores,FL 33132 AUrhTHORREMB REPRESENTATIVE/✓"r 9 0 id ee ®1988.2014 ACORD CORPORATION. A8 rights mefved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD • 3052358606 ALL AI-RICAN INSLRAE PAGE 01/i �at� CER'TIFICAT'E OF LIABILITY INSURANCE M ccA As A MAT OFTION O&V j5b C NOMMwwTwafR 0TIE CPSIVICATE Dols NOT AFFIRMATIMY OR NE"TNELY APRNB.EIITEND OR ALTER THE 601fE tW AFFORDED all IM Maws aeLow Tme CERTiFNCATE bE munAwr ows NOT COMMUTE A CONTRACT 99TVZEN THE 18StM MISL ORM AUT#gRlM R04ESMATIVE OR PROOWK AND THE C MVICATE HOLMR. �e r� Tt"'-/1 is Tn+ea��`fssa+ �1mua-6e' .wlyeesto no tow anal eoudRraq aid*poky,ce1IBIPi pa9aNea may cogdm an or4arwmM.A ataTameslt on oda r llasba does no!tseldw ePght+to91e ;. eertlee+Ma Aelder q+Oau a ouch a} 4744 ._ ionwwcaw XWMM I AN Ammty Inuram 2M!2. s s037 sw lu m St. - M%n,FL 33157 i Phm_ j3n 23S-MG ESIML23"SMIX WARWA: WNCO OdURAM2 COMPANY !rinReq� �• .� {5twPRen►g.Irw t ISM Colitis Ave Ste 1203 rr' 0 Swmy Mee,FL 33190- COVERAGES CERTIFICATE HUMOR: RIEIRBION NlNAew THIS E TO t THAT THE PCLIOU OF 6dllU W=LISTMD OROW HAVE TO Tt NSD AMM FOR-TMI FOlXY drdCAT ).NOrMTHSTANRM ANY .TEW OR CONMTtON OF ANY CONTRACTOR OTHER DOC[#I WT Ytl"MVECT TO WHICH THG i CEttiIFlCATB MAY 89 DORMAY PBRTAa1,TrN INIIANIANCE AFFORIM BY THE FOUM OEMNSED"SM a 94asCTTCALL THE Tena, t EXCB,USE M AND CONOMM OF SUCH POLMS.UWS SMOM MAY HAVE 89AN REDUCO BY PAID CLAiAG. _ . TIIPl CIP elatalAliC11ICY Y, ❑ eare�eeut.aeR:eeA;uAeaarr ! 1 ! I � � pw9onarreeoAl ! a ❑a.A © gyp � �t��an. T j i�— � � �sscr+eRAL naaRedAns, l i � �MiiDiE0AT6uwTAPPue3>�. I � � � 1 rRouuCTs.co�a�, T�"—T — �urto�aaentLlAMilTY �i• _ 1� ANr At+�o I � � � i j DODnr rArAYY f�Rr Pa..eo�R_'�.f__ If A ❑ l` Ta i� I i 187onvBaMJR`�tw'swidl!s { I❑ rwm AUTOS ❑ AUTOS }•-�Q WMRm1ALOS Q�VAMUAMI =mum AGG"RATS -- — E ! lwwcmmim ! fi4EACHASd�>JT a 500.O�D.00— i A IAWLITY M w/A a�'13J2D14!tMP13nO1S{ ' INVANAM ,a+e� 1 a:oteeAee.eACIs1D,7< x70000000 1 �'rpIATtOwe,�ew i '�.......r.��. —�..__.t__ i r�.al�As�•±�ol�v ram{: x.10.000.06 i t l aa8=1`10a a UPMMTWM tLOVATIO115I Y®rx (Almh AOM tat,Adeez"RWW%n dub,a ewa ofte IS tpvkoA) THE PARTY LISTED BELOW IS RECOGNIZED AS A CERTIFICATE HOLDER Licence t CFC 057082 i CERTIFICATE HOLDER CANCMLLATWN � sAO .,es ANY of 7Hs Aiove DweR1EW Fora 0e eAerosLeO emoae 7118 IMUTwN 0472 INNIREOF MOT101 VMD,BE CGLNWM IM Miami Shoran Village ACCORDANCE VOW 718 POLICY PRIN000RM. OWkM*Dant Miami N.E.2nd.Avco. Mlaml !Armtaa� ,• Shores,FL 83130 i I KINO loso eRR rosh4e�As ItgglB id ACM 25 PWA"QF Ttk ACOFW nom 811d Off ACO ARleNlox CO