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PL-16-320 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253632 Permit Number: PL-2-16-320 Scheduled Inspection Date: February 29,2016 Permit Type: Plumbing- Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: TORO JTRS,LUIS Work Classification: Sprinkler System Job Address:1270 NE 98 Street Miami Shores, FL 33138- Phone Number (305)733-3821 Parcel Number 1132050090310 Project: <NONE> Contractor: AFFORDABLE IRRIGATION, INC Phone:305-681-6322 Building Department Comments INSTALL, REPAIR&ALTERATIONS TO EXISTING tnfractlo Passed Comments SPRINKLERS. INSPECTOR COMMENTS False Inspector Comments Passed Failed v G Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 26,2016 For Inspections please call:(305)762-4949 Page 50 of 60 m /vL. Z 1,04, 2701 Miami Shores Village Pe� �r���'t ll1[f13(n - ee�ontial . „ M 10050 N.E.2nd Avenue NE �� �� tltatD1 Clod Sett kter &tBTTi •" Miami Shores,FL 33138-0000 a = �i , 'ermit status"AP� c 6 `ze Phone: (305)795-2204 j ..1.. F1,QRiD�` a s ., �$ lss ►�te: Expiration: 08/03/2016 Project Address Parcel Number Applicant 1270 NE 98 Street 1132050090310 Miami Shores, FL 33138- Block: Lot: LUIS TORO JTRS Owner Information Address Phone Cell LUIS TORO JTRS 1270 NE 98 Street (305)733-3821 MIAMI SHORES FL 33138- 1270 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 AFFORDABLE IRRIGATION, INC 305-681-6322 _.._. _,.. ..:,:. _.._..:... .,x ......._ . .:::... ...M. :._.._.::. Total Sq Feet: 0 Type of Work:INSTALL,REPAIR&ALTERATIONS TO EX 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 $1.80 DBPR Fee Invoice# PL-2-16-58572 $2.25 02/05/2016 Check#:19225 $ 118.30 $50.00 DCA Fee $2.25 Education Surcharge $0.60 02/04/2016 Check#:19223 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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 i ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam tractorto d the work stated. February 05, 2016 Authorized Signature:Owner / Applicant Wontractor Agent Date Building Department Copy February 05,2016 1 r Miami Shores Village 01� , Building Department artment 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 ►`-� BUILDING Master Permit No t'" K1. v 52-0 PERMIT APPLICATION Sub Permit No. BUILDING 7 ELECTRIC ROOFING REVISION D EXTENSION ❑RENEWAL [PLUMBING MECHANICAL []PUBLIC WORKS 7 CHANGE OF ❑CANCELLATION ❑ SHOP DRAWINGS jy CONTRACTOR JOB ADDRESS: Citv Miami Shores County Miami Dade Zip /3 Folio/Parcel#: // 3A O E 00 f-,0:3/0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1 lLr`s ?AGO Phone#: Address: /.2 2,9 W C ?A' 5;;"ow 7 City: ,1&01 A -11 moo.--CJ State: _ L. Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �64a 2/fiG i'9id 7'� Phone#:` -�I-637 Z Address: z 3 S' S 7 City:�A i' State: Cr Zip: Qualifier Name: '"4' Co a f� S' Phone#: State Certification or Registration#: Certificate of Competency* iv o00 ' zle DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration E] New E] Repair/Replace ❑ Demolition Description of Work: 4 G 7 Specify color of color thru tile: j� Submittal Fee$ .�� Permit Fee$ �S�a 1��'' CCF$ I � U® CO/CC$_ Scanning Fee$ .� �� Radon Fee$ r � DBPR$ J Notary$ Technology Feet b Training/Education Fee$ Q` W") 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 h' h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be p ed and a reinspection fee will be charged. Signature SignatureIV ZEIV g OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of e- 20 /y by .14r day of �//G��y ,20 4 by A�1�lo�v% sed ,Rwho is personally known to �4 t8 �Ze A4 ho is 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 take an oath. NOTARY PUBLIC: NOTARY PUBLIC: SignSign: p Print: Print: cJ Sea. ., Seal: _ ��" JORQETOLEDO i ' �''•• JORGETOLEDO MY COMMISSION N EE 224678 MY COMMISSION R EE 224678 August � 7'• ;- 16 EXPIRES:August 22,2018 "�; Phu Ny Public UndawrRers qF qy,.• Bonded Thru Public Und APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) *AC40 O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) it� 1 02/04/2016 T*118 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: Automatic Data Processing Insurance Agency,Inc. a/c°NN Ext): ac No): 1 Adp Boulevard E-MAADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE MAIC# INSURER A: Technology Insurance Company,Inc. 42376 INSURED AFFORDABLE IRRIGATION INC INSURER 8: DBA:Affordable Irrigation Inc INSURERC: Lic#SP2035 198 NW 139TH ST INSURER D: N.Miami,FL 33168 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 445321 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. 1�TR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F7 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL R ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT El LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident I L $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX PER 11TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? ® N/A N TWC3519790 01/17/2016 01/17/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space Is required) Contractor License:96P000219 Sprinklersystems CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores Bldg&Zoning Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 No 2nd Ave Miami Shores,FL 33138- AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Luis F.Toro 1270 NE 98"St. Miami Shores, FL 33138 305-733-3821 z 41w r s''rLlr'1® To whom it my concern, I the property owner, authorizes Mr.•AAce-R�ses Igigatiaa-to sign the permit application to allow Affordable Irrigation to pull the irrigation permit. Thank you for your cooperation in this matter. cn-0 - Luis F.Toro 1270 NE 98th St. J Miami Shore, FL 33138 305-733-3821 :ro`PRAp:�4c's Y)RGE TOMD 3 rNIF!"M,Avg ?, RF Ftp Poncik7 thr ' ,rye+htr'•Ur mt Mem SILLCR- L E&P,;-ao —LEAD N1RES TO CONTROLLER ..•.__ __ � NOTE: 1 _ ..may �y MOUNT RAMI SCNSCR ON AIIY WWACC W nC IT - ? `('.•°••^J•••••••-•.•• -•`•.- -•.,.•.Y..•,_•• 'id C 76' CG VnL K exnm TO UUQBSiRUCTEO RwAtL ACIZ�0 BUT NOT W ThE PAIN a SPPoNitLER SPRAY. R 71 T �.� '/ ---IX RAIN BIRD RAIN SENSORc r Fv X14°' Iv IF. 'ls a JORGE TOLEDO ....-..-- %.: MY COMMISPON#f EE 224678 , : EXPIRES:August 22,2016 �, s s ,°n° 'Bonded T Notary Public Undeturriters & k CC# 96P000219 Affordable Irrigation, Inc. )u V• , . 6 : r 198 NW 139 Street w , Miami, FL 33168 A 0114 vj T •'(305) 681-6322 � •, � iR 3 # G40 FA VV _ 1 e� N _ > 000 %s Goo �.r •• • • • • • • • is • • ••• • • • ••• • T