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PL-14-526 i 6- Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795.2204 Fax: (305)756-8972 Inspection Number: INSP-243015 Permit Number: PL-3-14-526 Scheduled Inspection Date:January 212016 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Type:Inspection T e: Final P Owner: BUTLER,JACQUELINE Work Classification: Gas Job Address:1461 NE 102 Street Miami Shores, FL 33138-2621 Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor: SKYLA PLUMBING INC Phone: (954)773-5323 Building Department Comments GAS Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-209198. need to drop 46s below E�/ ceiling and provide escutcheon around vents Failed Correction Needed ❑ i� l Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-Inspection fee is paid January 20,2016 For Inspections please call: (305)762-4949 Page 6 of 32 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 M 201 INSPECTION'S PHONE NUMBER:(305)762.4949 $Y. BUILDING Permit No.P1 l`�' - 6N4, PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: /I/�17/ /I/,F /0, cS 7 City: Miami Shores County: Miami Dade Zip:A Folio/Parcel#: i/362 ®SVofeo 1(0 Is the Building Historically Designated:Yes NO /Aff Flood Zone:. OWNER.Name(Fee Simple Titleholder):A `la2a t'/VE d3U''-e4&z Phone#: Address: /!/'6* l0a2 4 city: A&,& hm (5160-12-ES: State: 3 313 a' Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �'�f�� f�LC1M�_ °N f /✓f e . Phone#: 3,0X- 9�?o Address:,22 30 Po G& 92VEr'Z' City:_ ®a3 State: 06i�• Zip: ®� Qualifier Name: Phone#: State Certification or Registration#: 6P- 6 /t�2 g2a/ Certificate of Competency#: Contact Phone#: 3 0t 4-90- Z(!77 " Email Address: DESIGNER:Arch(tect/Fingineer: Phone#: 3tc��©o Value of W06 for Skyoxmit:.$ SquarelLinear Footage of Work: Type of Work: DAddress OAlteration e ew ORepair/Replace ODemolition Description of Work. %W P^. ,-C i47 f�i� p�y x, j 7'ca a ' �,✓ �a/ 7®re Submittal Fee$ O-C6 Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ • 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 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. Signature c Signa Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 2 7 ,20 y by va JSy'�'L�' day of A 20 A by4 x who is personally known to me or who has produced who is&personallv known to me or who has produced As identification and who did take an oath. a an oath. NOTARY PUBLIC: NOTLlRODMM & eEEMM .kora 22,2015 � Thru Pu1�c 1&�v�as Sign: k&X% Sign: Print: S Print: My Co 'on Expires: �y�� My Commission Expires: 3�t .o1W s�kPy 2ot� APPROVED BY �3—i&/Y Plans Examiner Zoning Structural Review Clerk (Rmised3/12/2012XRevised 07/10/07XRevised 06/10/2009)(Revised 3/15/09) t ,aci Rr�® CERTIFICATE OF LIABILITY INSURANCE PRODUCER Annette Willis Insurance THIS CERTIFICATE 13 ISSUED AS A MATTER OF iNFORMATlO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4759 N.W.183rd St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,wEXTEND OR Miami,FL 33055 ! ALTER THE COVERAGE AFFORDED BY THE POiCiES BELOW. Phone (305)626-8131 Fax (305)625-3694 INSURERS AFFORDING COVERAGE` MAIC# jj 1 i INSURER A.- GRANADA INSURANCE ------ -- INSURED SKYLA PLUMBING INC INSURER B: . 3315NW 213 TERRACE INSURER C: MIAMI FL 33056 INSURER D: --- - -- -' - INSURER E _ _ - -- - - ----—r----- - COVERAGES {INSURER F: THE POLICES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH£POLICY PERIOD INDICATED. NOTWrrHSTA NDING 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.AGGREGATE_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'1 POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR ADD L:... TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIM . DATE(MMIDOM) . EACH OCCURRENCE - 1,000,000 GENERAL LIABILITY 'DA-WA—GE- GENERAL O R NTED 100,000 COMMERCIAL GENERAL LIABILITY '018&100028013 07/22/13 ffrM14 PREMISES(Ea axurence) I - __ ?MED tD(P(Ane(78[$WI} 1 5,0 G CLAIMS MADE ❑ OCCUR i PERSONAL&ADV INJURY 1,000,000' m GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOP AGG 2,000,000: GEN'-AGGREGATE LIMIT APPLIES PER: POLICY -.-PROJECT _ LOC AUTOMOBILE LJABILnY - — - COMBINED SINGLE LIMIT - 1 ANY AUTO E $ _--- I�] ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS - BODILY INJURY HIRED AUTOS (per accident) NON OWNED AUTOS PROPERTY DAMAGE (Per accident)- ' AUTO ONLY-EA ACCIDENT GARAGE LIABILITY , - OTHER THAN -- C 7L-1 ANY AUTO AUTO ONLY: AGG _._-- :.._ EACH OCCURRENCE EXCESS/UMBRELLA LIABILITY AGGREGATE OCCUR CLAIMS MADE 13 - I DEDUCTIBLE i C RETENTION WQRKERS COMPENSATION AND �^ WC S7A - OTH- EMPLOYERS'LIABILITY ! TORY $__ E 'ANY PROPRIETOR I PARTNER f EXECUTIVE E.L.EACH ACCIDENT —_ OFFICER/MEMBER EXCLUDED? E.L.DISEASE EA EMPLOYEE: if yes,describe under E.L.DISEASE-POLICY LIMIT SPECIAL PROVISIONS_ below OTHER F --- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS_ :PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AS SCRIBED PO CIES BE CANCELLED BEFORE TH E Miami Shores Village EXPIRATION DATE TH F,THE ISSUIN SURER N9LL ENDEAVOR TO MAIL 30 DAYS WR N NOTICE TO CERTIFICATE HOLDER NAMED TO Building Department THE LEFT,BUT F URE TO DO SO S IMPOSE NO OBLIGATION OR LIABILITY nd OF ANY KIND ON THE INSURER AGENTS OR REPRESENTATIVES. 10050 N.E.2 Avenue - Miami Shores,Fl.33138 A REpRESENTA ORATION 1988 ACORD 25(2001108)QF 115 S.Andrews Ave., Rm.A-1 00, Ft. Lauderdale, FL 33301-1895—954-831-400 i VAUD OCTOBER 1,2013 THROUGH SEPIEMBER3e,2014 { DBA:sxYLA PLt7mnfG INC Receipt PLor�sIi G LWN sPi =lco Crox Business Name: Business Type:(CERT PLUMB= corrr�,cT Owner Name:sArtrlsm McDONALD Business Opened:10/23/2007 Business LoCatton:2230 POLK ST 20 StaftjC0ttfttylCerVReg•CFC1427071 i HOLLYWOOD Exemption Code: Business Phone:954-773-5323 r Rooms seats Empioyees Machines Professionals 1 i For Vending Bm to m Only Number of Machines. Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years collection Cost Total Pail i 27.00 0.00 0.00 0.00 1 0.00 0.00 27.00 1 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS } THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is +: non-regulatory in nature.You must meet an County and/or Munidpak Planning t and zoning requirements.This Business Tax Receipt must be transferred when WHEN YAUDATED the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that It is in compliance with State or local laws and regulations. ding Address: SAMUEL MCDONALD Receipt #138-12-00012680 2230 POLK ST #20 Paid 09/27/2013 27.00 HOLLYWOOD, FL 33020 E 2013 - 2014