PL-16-768 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-255387 Permit Number: PL-3-16-768
Scheduled Inspection Date: May 11,2016 Permit Type: Plumbing- Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: IRAIMA FLORES, MICHELLE BATISTA Work Classification: Gas
Job Address:6 NW 107 Street
Miami Shores,FL 33168-4307 Phone Number
Parcel Number 1121360070010
Project: <NONE>
Contractor. R8d PLUMBING SERVICES CORP Phone:305-823-6911
Building Department Comments
GAS LINE FOR A NEW RANGE. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
May 10,2016 For Inspections please call: (305)762-4949 Page 13 of 26
r, Miami Shores Village
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
3
Phone., (305)795-2204
� �3
Project Address Parcel Number Applicant
6 NW 107 Street 1121360070010
Miami Shores, FL 33168-4307 Block: Lot: ROBERTO MARTIN
Owner Information Address Phone Cell
ROBERTO MARTIN 6 NW 107 Street
MIAMI SHORES FL 33168-4307
6 NW 107 Street
MIAMI SHORES FL 33168-4307
Contractor(s) Phone Cell Phone Valuation: $ 850.00
R&I PLUMBING SERVICES CORP 305-823-6911
Total Sq Feet: 0
Type of Work:GAS LINE FOR A NEW RANGE. Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Final
Bond Retum: Press Test
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-3-16-59122
DBPR Fee $2.25 03/28/2016 Credit Card $165.10 $0.00
DCA Fee $2.25
Education Surcharge $0.20
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contra do the work stated.
March 28,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date-
Building
a eBuilding Department Copy
March 28,2016 1
� 1
Miami Shores Village - ' - r'�ZD
Building Department M R ? ots_
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762.4949 7�VA
FBC 20 ,k4
BUILDING Master Permit No. G 9
PERMIT APPLICATION Sub Permit Not _
[:]BUILDING ❑ELECTRIC ROOFING REVISION ❑EXTENSION ORENEWAL
PLUMBING 0 MECHANICAL (PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑SHOP
// CONTRACTOR DRAWINGS
JOB ADDRESS: �o �� �O Sr
City: Miami Shores County: Miami Dade Zia: 3 3 1,6 8
Fo#o/Parcel#: 1 1 Z l3 600 '>aOoC is the Buiiding Historically Designated:Yes NO
Occupancy Type: load: Construction Type: Flood Zone: SFE: FFE:
OWNER:Name(Fee Simple Titleholder): I' lilt& �� `� � Phone#: /" ✓`'" �7;-
Address: l0'-4 'St
City: 1- ///�q l l y*kta state: zip: cS 3
1
Tenant/Lessee Name: Phone#: f ->SS
Email:
CONTRACTOR:Company Name: jr W1000 40 Phone#: *-30'� Z t
'� � �� ♦ 7V ; 0--
city:.
T— T
Address: �$ ..ryt�c�.
City: f✓W1eae.4' State: '7l - Zip:
Qualifier Name: ye Phone#: `� ^3E' `�6 OF
State Certification or Registration#: Certificate of Competency#: ®34L'^80450 *2 t�-
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Repiace ❑ Demolition
Descriptkm of Work: hr B s /T ale eg,66
Specify color of color thm We.-
Submittal
ile:Submittal Fee$4 Permit Fee$ CCF$�s LCO/CC$
Scanning Fee$ CZ Radon Fee$ �' DBPR Notary$
Technology Fee$ Training/Educatlon Fee$ o Double Fee$ Q
Structural Reviews$l0 v��_ Boal$
TOTAL FEE NOW DUE$ IQ
(RevbedO2/24/2014)
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. 1 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: 1 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$2500, the applicant must
promise In good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property as subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the Job site
for the first inspection which occurs seven (7)days after the building permit Is issuedin the absence of such posted notice, the
Inspection wall not be pproved and a reinspection fee will be charged.
Signature— f!U re natuf� '�" '�
OWNER or AGENT CONTRACTOR
The foregoing instruwas a nowiedged before me this The foregoing instrument was acknowledged before me this
men
day of ,20 . i� .by Z5 day of 4-1141UA) ,20 J 4 .by
wh,, Is 1 personally known to Gd f fJ .who is personally known to
me or who has produced N as me or who has produced as
Identification and who did take an Jath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC-
Sign: S
Print: _ CCNU(i rel G �D(�1 A r) Print:
Seal: Seal: Ai EJANDRO
KIN
sJioAROCLINA ROMAN elf, Myra N
Commission M FF 208856 ��$ ��Z01'•
March 1,% 2010'
APPRO Plans Examiner Zoning
Structural Review Clerk
(Rev1sea02/24/2014)
CERTIFICATE OF LIABILITY INSURANCE 0er11
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 CwTIFICATE 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. H SUBROGATION IS WAIVED,subject to
the terM and conditions of the poil@y,certain poles may require an endorsemern. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(e).
PRODUCER =FT JORGE CASTILLO
World OF Insurance Agency MV E (3o5)231-1111 305 231-0711
18800 NW S7 Ave Unit 113 worldofinsuranoanet
Miami Lakes,FL 33015 INsu AFFORDING COVERAGE e
Phone (305)231-1111 Fax (305)231-0711 INSURERA; SECURITY UNDERWRITERS
INSURED INSURER 8:
R S I PLUMBING SERVICE CORP
7895 NW 174TARRACE INSURER D:
Matti Lakes,FI 33015 305 INSU
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.
R TYPE OF INSURANCE POLICY NUMBER "AIM UMTS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000-00
QDAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Me or $ 'C)0,000-0()F-1 ❑ CLAIMSaNADE [:] 08J07/Z015 OBJO%@016 OCCUR 10203317 MED EXP(Any one parson $ 5,000.00
A PERSONAL a ADV INJURY $ 1,000,000.00
❑ GENERAL AGGREGATE s 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP Am $ 2,000,000•00
❑ POLICY ❑ PRO- ❑ LOC DEDUTIBLE $ 500,00
AUTOMOBILE LIABILITY BIND LIMIT
e IN
❑ ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per amara) $
❑ AUTOS ❑ AUTOS
NON-OWNED PO AMAGE $
F] HIRED AUTOS ❑ AUTOS
❑ UMBRELLA LIAO ❑OCCUR EACH OCCURRENCE $
EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $
El D $
WORKEW COMPENgATION 0 WC STATU• TH
AND EMPLOYERS'LIABILITY Y I N
WUMn
ANY PROPRIETORIPARTNEfMDMCUTIVE N f A EI..EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYE $
DyyESdesaft under
CRIP N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACach ACORD 101,Adm Rerand a Sewbft if more spare Is requbed)
Contract Number:PLB-15-1957
Ilicense Contractor Number:03POOD074
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 Ave ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES FLORIDA 33138 AUTHORIZED REPRESENTATIVE
JORGE CASTILLO
®1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD
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Plumbing Sere, C010.
78 NW 174 TERR o
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ani, FL 33015WWI
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TEL: (3 525-5217 t
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TABLE 402.4('1) kVI RUB= LMW ItM 2 psl
SCHEMJLE 40 iETALLIG PIPE PPMO a OMP 0.3 h w.M
Spwft
fl 4
I
2 2'd 3 4 3 6 B Ohn 0824 1.040 1.380 1_6To 2.067 2469 3,068 4!028 5.047 4400 7.981 1 046104 Rat uI Go iw hour131 273 514 I'm 1,380 3060 4,800 5,380 17,504 31,700- 54304 1010000 191,4814 30300090 188 353 726 1,1:10 2.480 3.340 UM 12,010 21,504 35904 72AW 132.440 2118.004
72 151 284 583 873 1!180 2,tr81M 4,740 9.660 17.504 28,304 59-VD 111fel3IMD� 10,000
62 129 243 499 747 1,440 '2.290 4.050 8.270 15004 24.204 49,504 W.400 14308455 114 215 442 662 1.280 2,070 3,300 7,330 13:304 21,_''100 44,IOD S0,Y04 127.010
50 N1d 1% 4114 6410 1,160 1.840 3.260 6,640 12.004 19.500 4D00D 72.604 IISM
46 95 179 31108 532 1.4760 1,694 3000 6.110 11,100 17,904 3fMO "AM 1116,OOD
S0 42 99 164 30 514 W 1380 2390 56rlr<1 111,304 14-M 38.,704 62.104 98.404
90 40 83 157 322 482 9128 1,480 2.610 5110 9,M MOD 32,104 58..100 9,700
100 38 79 148 303 43:10 877 l A G 2.470 5,040 9.110 HAD 30200 55104 87,204
123 33 70 131 2% 403 777 1,240 2,190 4,460 8,063 MOD 26;904 49.$00 77400
150 30 63 119 244 366 701 1.120 1010 41160 7.320 14900 24,700 44,200 711.004
]T3 28 58 109 224 336 648 1,0.10 1,820 3,720 6.75? 1490D 22,104 40,704 MAD
29D 26 54 102 209 313 fim Qw 1.700 3.460 6260 10.100 MAD 37.900, 59410
250 23 48 90 185 277 534 851 1,500 3.070 5.350 8.990 IRM 73_404 33,100
300 21 43 82 168 251 484 771 1,300 2,780 5.030 5.150 16.700 30AG 414104
350 19 40 73 134 231 443 749 100 2.560 4.630 7.490 15;400 28,00D 44.300
400 18 37 70 143 215 414 660 LII 2.380 4.310 6.970 14.300 26.ODD 41.204
440 17 33 60 13S 202 389 619 LINO 2.230 4.040 040 13.400 24,404 MW
540 16 33 62 137 191 367 58S 1.030 2.110 3.820 6.1€0 12.700 23,104 MM
55D 15 31 59 121 181 349 556 982 2.000 3;620 5.870 12 IOD 21,900 34,700
600 14 30 56 114 173 333 530 937 1.910 3,460 5.600 I1.50D 20900 BAD
Mo 14 29 54 114 165 318 50S 897 1.830 3,310 5.361 1LOOP 2741CM 31,70D
700 13 27 52 1116. 159 X* 483 862 1.760 3380 5.150 ID6M 19,20D 30.400
750 13 26 50 102 153 295 470 830 1.690 3.060 4.960 10204 INJiM 29,101
400 12 26 48 99 14B 285 434 802 1.640 2.9W 4.790 9:840 17904 28,304
5511 12 25 46 9S 143 275 439 776 1.580 2.41060 4,6x0 9.330 17_744 27.440
9140 11 24 45 913 139 267 424 752 1.530 2.780 4,300 9.240 16,800 MAW
!150
11 23 44 40 135 259 413 731 1.490 2,700 4,370 8,970 WOO 2-V*9 00 *Go::*
1,000 11 23 43 87 131 252 4112 711 1,450 2620 4,250: *7% IS67D ISlut
I,IIID 10 21 40 83 124 240 382 675 1,380 2,490 4,1130 8 . 13.ft.•lboo ••••i•
I.2W NA 20 39 79 119 229 364 6" 1,310 2.350 3.830 41 14.400 •22.7414 • •
I'M NA 20 37 76 114 219 349 617 I-W 2,230 fi80 •714 13.700 XJM • •
1,4114 NA 19 35 73 109 M 334 592 1,210 2,190 3 540••0*110 13230 241.900 ••••s
1,500 NA IN 34 70 106 210 323 571 1,160 2,110 3.410 12 OD
IAM NA 18 33 68 102 196 312 SS1 1,120 2,0:10 1x90 •fa'1 M 12AD 19,300 ••
1,700 NA 17 32 66 98 119 302 M I'M 1,970 3.190 • • 11.900 18484 •
• ••••••
1,8110 NA 16 31 64 95 I84 293 517 1.0x0 1,910 .31190 ("Mit • �11�4 • •
1,900 NA 1G 30 62 93 179 284 502 1.050 1850 3000 170• 11,2410 j'&W �••••�
2000 NA 16 29 60 90 173 276 483 LOW 1.NOD 2-WM 64100 10 •17.3180
Far Sl. 1 imb=2`r.4 mm,l da A=304.8®au,l pawW per squw bwh=6,MWv I-kKh haler c ou m=112488 kft
I Irisb 16e9iaal wail par Eau=11.2931 W.I ad&fait per h==O.0283 41'16.1 rfi =0.101745 m&
IVak�