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PL-16-1330 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795.2204 Fax: (305)7564972 Inspection Number. INSP-258987 Permit Number. PL-5-16-1330 Scheduled Inspection Date: May 23,2016 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner BOYD,GRACIE Work Classification: Repair Job Address:8715 NE 4 Avenue Road Miami Shores,FL Phone Number Parcel Number 1132060460730 Project <NONE> Contractor. FLORIDA DELTA MECHANICAL INC Phone: (866)219-0880 Building Department Comments 30 GALLON ELECTRIC WATER HEATER REPLACEMENT mentisINSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re-Inspection Fee No Additional Inspections can be sdieduled until rednspecdon fee is paid �3 �_ a4Y• 1 �€ � �pt I Miami Shores Village 5 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 =v " F r Phone: (305)795-2204 ' " `' Expiration: ll/1512016 Project Address Parcel Number Applicant 8715 NE 4 Avenue Road 1132060460730 Miami Shores, FL Block: Lot: GRACIE BOYD Owner Information Address Phone Cell GRACIE BOYD 8715 NE 4 AVE RD MIAMI FL 33138-3135 Contractor(s) Phone Cell Phone Valuation: $ 1,243.00 FLORIDA DELTA MECHANICAL INC (866)219-0880 Total Sq Feet: 0 Type of Work:30 GALLON ELECTRIC WATER HEATER REP Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Review Plumbing Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-5-16-59800 DBPR Fee $2.00 05/19/2016 Check*500559 $166.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 05/17/2016 Check#:500551 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Work without Permit Fee $100.00 Total: $216.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accur a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the ed contr or to do the work stated. 2t — May 19,2016 Authorized Signature:Owner / Applicant / Cont ctor / Agent Date Building Department Copy May 19,2016 1 t Miami Shores Village g ETV'RID Building Department i4y f7 ale 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Bx. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20P4 S � BUILDING Master Permit NO.-PI,1(0— PERMIT APPLICATION Sub permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP 1 CONTRACTOR DRAWINGS JOB ADDRESS: -31 I C_) `�J F A-M kwd City: Miami Shores County Miami Dade Z10: �$ Folio/Parcel#: T -n4&- mw Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type. 11 Flood Zone: BFE: z FFE:77 OWNER:Name(Fee Simple Tltlehold Phone#: 305- Address• 7 City: State• L xofk�t SW65 Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: Addres C— City: State: r l_ Zp: = Qualifier Name: /� ! Phone#: /� � � State Certification or Registration#: l iFK; 512- 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: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: UA+6K Specify color of color thru tile: Submittal Fee 670,0d Permit Fee$ '� CCF$ CO/CC$ Scanning Fee$ /S Radon Fee$ 2. © A DBPR�$ Notary$ Technology Fee$ AD —,Training/Education Fee$- /P - 7 ® Double Fee$ 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 which occurs seven (7) days after the building permit is issued. n the absence of such posted notice, the Inspection will not be approved and a reinspection fee will be charged. Signature C Signature OWNER or AGENT C NTRACTOR The foregoing Instrument was acknowledged before me this The or going nstrument was cknowledged before me this 20 �i� by day of 20 �Cby ~ h Is personally known to p y ho is ersonally 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 PUBUQ NOTARY PUBLIC: Sign: Sign OP Print: St � �� Prin y C Seal: (407 38@07 23,2020 Seal: >r' , . `�- A HLEY NIC ZIEGtAnp p MY COMMISSION#FF12r EXPIRES MaY 7,2c; �`��8-ot� �Ioridallota Servt r APPROVED BY Plans Examiner Zoning Structural Review Clerk (ReWsed02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BOBEV, DIMITRE I FLORIDA DELTA MECHANICAL INC 2716 BROADWAY CENTER BLVD BRANDON FL 33510 �� rya become one of the nearlyolicensedy Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to bartoque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESMONAL REGULATION Every day we work to improve the way we do business in order to CFC1425917 k UE1 : 07/14/2014 serve you better. For information about our services,please Iog onto www.myftorldalloanse com. There you can find more Infonnatlon CERTIFIED PL C,ON'I about our divisions and the regulations that impact you,subscribeI'OR tointtlativep�ent newsletters and loam more about the Department's BOSEVFLORIDA DE Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serveou better so that you can serve your . M customers. Thank you for doing business in Florida, 18 CERTIFIED under the provisions of Ch.488 FS. and congratulations on your new license! ►doe:nuo 21,2018 u4071400=12 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION,INDUSTRY LICENSING BOARD ®+ CFC1425917 �i The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chr 489 FS. Expiration date: AUG 31,2016 BOSEV, DIMITRE IQ� 0 FLORIDA DELTA MECHANIr .INC 4522 MAPLE TREE L001k WESLEY CHAPEL +"3643 w, Opp . eras e�bcnYltbw lAA RtGfiWF*HM VALIDAIW. 2015-2016 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXplREg SEpTEM13ER 30,2016 188153 OCC.CODE ACCOUNT No 260.02WW Professional RENEWAL Receipt Fee 30.0 Hazardous Waste Surcharge 0.0 Law Library Fee 0.0 BUSINESS FLORIDA DELTA MECHANICAL INC 2716 BROADWAY CENTER BLVD BRANDON,FL .33510 2015w2016 NAME FLORIDA DELTA MECHANICAL INC MAILING 2716 BROADWAY CENTER BLVD ADDRESS BRANDON,FL 33510 Paid 14-0-222447 07/x/2015 30.00 BUSINESS TAX RECEIPT DoUG BELDEN,TAX COLLECTOR HAS HEREBY PNOAPRMLEOE TAX TO ENOAOE .iMiOFE86XHV.OR OCCWATfON�ECIFIED HEREON 81343"M THIS BECOMES A TAX RECEIPT WHEN VALIDATED. ACOR& CERTIFICATE OF LIABILITY INSURANCE 5212016 4252416 THIS CERTIFICATE E ISSUED AS A MATTER OF DUMNATION ONLY AND CONFERS NO IVAHM UPON THE CERTIFICATE RIDER THS CERTIFICATE DOES NOT AFFITNSATIMMY OR NEGATNEL.Y AMEND, EXTEND OR ALTER THE COVERAGE AFFOROD BY THE POLICIES MOM THE tERTF7CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNG DIENRER(B),AUTHORIM RN3ARESENTAThIE OR Pte,AND THE CERTIFICATE HOLDER R&OWANT N the certificate holder Is an ADDITIONAL.INSURED,the policy(les)must be endorsed V SUBROGATION IS MANED,subject to the term and wncMknm of the Policy,certain Policies may n qui a an andorsomeft A statement on this cortilleate does not confer rights to the cerillieate holo In Neu of such andorsommenlK CONTACT l ockton Compatties u m: 8110 li Union Avenue PHONE FAX Suite 700 1wraft (PJC-Kok Denver CO 80237 APORM (303)414-6000 DIMMERRAFFORMISCOVERAGE MAWs A:United Specialty Insurance Company 12537 Florida Delta Mechanical,Inc e s:Landmark American Insurance Commy 33138 1395995 Dimitre Bobev Lic#CGC1505862 elonasec: 42374 #EC13006120,#CFC1425917,#CAC1817901 ego:Berkshire Hathaway Homestate Img Co 20044 2716 Broadway Center Blvd Distow E, •tors Ince 42587 Brandon,FL 33510 COVERAGES CERTIFICATE NUNN3M 14020M 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 RESECT TO WHICH THIS CERTIFICATE MAY BE tWED 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 L TMTE OF INIRRANCEam JIM pOL[CY NtA08ER Lara A X MSL LI ORM N N BT0162RM 4212016 4212017 EAOH $ 1,000.0m CLARNIMDE Q OCCUR ES Ea m:cu nos $ 50.OW MED Exp y"am person) $ Excluded PERSONAL&ADV INMY $ 1 000 000 G&CL AGGREGATE UMTAPPLES PER: GENERAL AGGREGATE s2.000.000 POUCY OX iEROT ❑IAC PRonUcrs-compiwAw $2 000 000 OTHEM S E A<ucens"LL40L rY N N ACP 3007719788 Sn2016 S/712017INUEDIff— sackw1b $ 1,000,000 ANY AUTO BODILY KNRY(Pm perm) $ IIx ALL OWNED SCHEDULED BODILYINJURY(P-a-mad) $ XXX3xxX AUTOS AUTOS PROPERTY DAMAGE Ix tei�AUTOS X AUTOSamietent $ XXXXXXX $ XX3CX3C7CX C tnDRELLA uas OCCUR N N HISXC50451 4212016 5212016 EACHOCCURRENCE $ 10,000,000 X Ix LVA CLAUS-MADE AGGREGATE $ 10,000,000 DFD I I RETENTION$ o $XX3CUU C D aPLOVEW LaELnY YIN N DEWC705862 4212016 4212017 X 'SOTATUTE ER ANYPIMMETOMPARTNElVEXECUTiVE MIA E.L.EACH ACCIDENT $ 1,000,000 (I y In NH) E.L.MSFASE-EA EMPLOYEE $ 1,000,000 a ae�ibe radar E.L.DI3EASE-POCKY UNIT B ftvaty N N LHT421898 4212016 4212017 Scheduled Property Limier $12,778,900 D1 P7taN OF OPERATIONS I LOCATItNSI VERMES(ACOM 101.AddWmnd Raoemks Scbed d%mfr be attached N acme apace b regWted) Dimitre Bobev License#CFCI425917. CERTIFICATE HOLDER CANCELLATION 14020944 Miami Shores Village Bldg Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF. NOTICE WILL BE 91 ACCORDAMM POLIMiami Shores, FL 33138 VM THE � MIr1I0)� A ar�� N� ` t•,l 0 19W'2M4 ACORD TION. AN rWft reserved. ACORD 25(2014M) The ACORD name and logo are registered marks of ACORD