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PL-15-1379
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-236274 Permit Number: PL-6-15-1379 Scheduled Inspection Date: March 03,2016 Permit Type: Plumbing- Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: MUSTAD,KRISTEN Work Classification: Addition/Alteration Job Address:1260 NE 94 Street Miami Shores, FL 33138- Phone Number (305)661-6633 Parcel Number 1132050100180 Project <NONE> Contractor: SEROTA PLUMBING CO Phone: (305)672-7252 Building Department Comments NEW BATHROOM ADDITION(EXISITNG SQUARE Infractlo Passed comments INSPECTOR COMMENTS False FOOTAGE) REMODEL KITCHEN Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 02,2016 For Inspections please call:(305)762.4949 Page 2 of 44 No-PL-6-45-1379 , �e°R � Miami Shores Village ; Pelt Type: >iilE"! t)t!) - 04) Ia! 10050 N.E.2nd Avenue NE A+l�dift lfA) 10oh rM Miami Shores,FL 33138-0000 ' '-' pal i��IfE1u« � Phone: (305)795- 2204 R 305)795 2204 R Issue t� : 3195 Expiration: 12/09/2015 Project Address Parcel Number Applicant 1260 NE 94 Street 1132050100180 Miami Shores, FL 33138- Block: Lot: KRISTEN MUSTAD Owner Information Address Phone Cell 3 KRISTEN MUSTAD 1260 NE 94 Street (305)661-6633 MIAMI SHORES FL 33138- 1260 NE 94 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 8,500.00 SEROTA PLUMBING CO (305)672-7252 _ Total Sq Feet: 130 Type of Work:NEW BATHROOM ADDITION(EXISITNG SQU Available Inspections: Type of Piping: Additional Info: Inspection Type: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground �JE Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 DBPR Fee Invoice# PL-6-15-55878 $4.46 06/12/2015 Credit Card $329.82 $0.00 DCA Fee $4.46 Education Surcharge $1.60 Permit Fee $297.50 Scanning Fee $9.00 Technology Fee $7.20 Total: $329.82 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I cert' th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh ore I horize the above-named contractor to do the work stated. June 12, 2015 Authorized Signatur 'Own pplicant ! on ra r / Agent Date Building Dep , ment Copy June 12,2015 1 03103/2016 08:18 3057542362 PAGE 01/01 DQ-No T:AAY..:Vt.......,y.. f.:� y ^ pit='•"��.if.+.Y' �i.�'�•;t$<t,VM•�• '' � v;' :4,yh� • +,K .4Y.' :'';v"'.y� �.'i;�kl'.e.Y.y: ;�;��).."��.•w: '4v�r'''4�`r '-' v �•r�••"•''• !�' Vii.._ •4tl�?' `, �•„'„^a•,.,3" •.1:iy'�i�Tk. •^r ��JJJJ,,,,,�� S`�h.`..J +r�r'• ' :�,•:u w; �i7!•,� '�fF` `1�"..4` :.+is°. :'MFS% `�a'i. N,;.; �£,z4tte�+s' '�.�'... YreZw:�(a:zx :,•�. r�!'��e, .):..•,:%�.;';,.1'�'�a�n��,•,:,+.:'s;.�;..:,�,'•1>dp�R1� �i+ .. 1a/t11 r:.je4;••.......... >usrn►c co SEC.* of ;y„ '• : �;, . Is.��,�•.-; 10 `` PLt MBING AYME���' ` FC74a623 ,RECIE a::,•.+•. .:.r;. ':y,: :::: fs rA7( $45. 07j09j2015 v,. gin . , E00 S BaSInaS6�:,f C~' •�.�Y'Z`: w•'Y .M`o 4!^� ^.' Pemtl'or n certi{� ax; ece;pt cary+coafirms pa . .:�;.:M.� 83218 • c50q of the ha $ ya ebt afthe Lola!ausf z as Te 8bverDmentgl fiegaiato 9valificatbne efo da d T s fleveWS act a lice ry Wl d.re9uire . kolaTerm, C 1 ase, rM-aaJm °1zK1r�laa ort a►I c th¢h ",;-' i•8 YjwOaay 9ovgntsl �ercral v ,c7es—Mhry ,pa�e _` Far•'fdP6rl<y"hpormatlon,VlsaiC'w .k.,k.. d6,Sec'88-278. .; r I II 1 , Miami Shores Village �c Building Department JUN 0g 2015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 $Y: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No& IK— ?--? 0 �- PERMIT APPLICATION Sub Permit No. 2z ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 2f/PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP y� ,,// CONTRACTOR DRAWINGS JOB ADDRESS: ld - q4 51,- City: 1 Ci : Miami Shores County: Miami Dade zip: Folio/Parcel#: d- %&5 - 010 ' 01 f® Is the Building Historically Designated:Yes NO Occupancy Type: Pr-5. Load: Construction Type: '-54- Flood Zone: BFE: FFE: r, OWNER:Name(Fee Simple Titleholder): ��-'�� �-"' IA'���6� Phone#: � ��-1 '�6 Address: ((IT bo (/ V� City: ki Cls State: Zip: 1$ Tenant/Lessee Name: Phone#: Email: �eA4 VI �tustu.,U . Cctt.,i CONTRACTOR:Company Name: G 0 '1u rhG Phone#: 3o 4-2 7� Address: 393 OF I S-t . ` City: lei IAIAI \\ State: FL Zip: 331 Qualifier Name: ROysIdA ywk-o Phone#: 305" G 72 -7�5 2 State Certification or Registration#: C 6L 14 Z 60 2 S Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ IF,Soo Square/Linear Footage of Work: 13th Type of Work: Addition ation ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: RQQ{hICO 1K1 A��VVN I ReMOW K%% CLQ Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) W r. 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature_��-' V° J�-111 W AG T CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this daLKy of I Lt�tL '20 1,5 by 7 day of 1�JU.n,Q, .20 15 by 1. , S A 4d /� who is personally known to J/)Oh4/d V U1 JU ,who is personally known to me or who has produced 01�Y 2 '3-516-70•Do6aLD me or who has produced k•#(15& '720' Yee —6Af-0 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign AAA Si n: 44" Print: IAC �. (� Print; Rebez4 ur n Seal: �'pi' ,, REBECAI. TUU3Hd om Seal: , ?k. x MY CrAWSSION#FF 130252 ,,.`' 'PY REBECA L AR -TURNER EXPIRES:August 24,2018 =+: MY COMMISSION#FF 130252 ;R OF 8or&d Tin notary Pubic Underwiitera ���. r EXPIRES:August 24,2018 •;��1 eondW mm rotary Pubto undernrbm APPROVED BY 6 5 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN_LAWSON,SECRETARY - d pAS �I T.O�•E�I�S���55/�,D I�' � ��>�10PI �.�t� ! ✓Yf re's ^I°„ *hV ti a , ,' �., N.I M.'.. . � ♦� t w ''N- f',%d'�I .fid-liE IFI••.1.0,., ..�..�.!•... """`•y, ."�.'.,� !"^'• ,,yam'° Off\. Y w,�''•'+ 'v �`.'``°` w ,. A •ty` ��+n.v.��q „ \yam \.„y'+,R�'`. �1 �, ndprjh rogl'sndi'i, ofl � It t~d81�.,F5f': -;:y�`,.,•a�: �^.. ��; ` � 5cj5ir tib d e:;:AUG-1 w? 16.r.w ',��w�.".v.. �, '^`>, «.r d\!b -'•'i w.yam, +yy�,,1.��"'. \'•y, ��i .w� �r,,...,�� ..w.MY ter';,°�' w,..ra,.ww..w •�...M. "ryA K � a .I'J+ •• PA I .,n•...w k„'HnmM►.s..w»... �'� ytapl4 .�'`��,,..��•'���, 'tL � '1..,`t' i �i�tip, • "� ISSUED: 0851/2014 DISPLAY AS REQUIRED BYLAW SEQ# L1408310004063 00126 Pf � 1 i P '{ aLtq� ,,..5 r ep!?'� . P� �ffa'H6� P.1i* '}.'. ,� �i.,�i e .•i J,�k•. SEC.TV BUSS MES PAY11d6 RECEIy 1 *a: SER0T1 MING CO �Yi 96 PL CO.4HAC , Y TAX LLECY � Ifh. .y. •,;+�" FC142 :ie �; wti� - .d lll, , 0 Irk I; �'� '. :. f 5.00 �/04j2 HEC i C C i•�..d ' 1 :: 14-'0 y 9 1—16 usine weipt o ( ” firms all en1 of t if M at BusiTax.The Re s not a I pop cortific the hol alifloat to do business. Ifoldo• I 1 all gov ;�P t dIy monta l to la o uiuom is which a 1 to the bu�9 a t ro f q �P V Ne CEIPT tl r0hove musqj.d played op"iji�°QO�tp ai vehiol Is Sec r` For f'muttion,visit° sds ' •.1t-��'• f.;.r.; ...• _ SEROT-1 UN►u: um TE .d►C CERTIFICATE OF LIABILITY INSURANCE D 05118 22i 015 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: 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 endorsements). CONTACT PRODUCER NAME: EDUARDO R PORTAS Global Risk LLC PHONE 305-455-7250 aC No:305-455-7251 5959 Blue Lagoon Dr Suite 101 Arc L Ext Miami,FL 33126 ADDRESS: EDUARDO R PORTAS INSURERS AFFORDING COVERAGE NAIC# INSURERA:MAPFRE INSURANCE COMPANY OF FL 34932 INSURED Serota Plumbing Company INSURER B: Ronald Vento INSURERC: 893 NE 79 St INSURER D: Miami,FL 33138 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ITHIS IS TO ERIFY THAT THE POLICES OF NDICATED.CNOTTWITHSTANDING ANY!REQUIREMENT, TERM OR CONDICE LISTED BELOTION OFHAVE BANY CONTEEN RACT OR OTHER DOCD TO THE INSURED NUMENT WITED H RESPECT TOFOR THE LPERIOD 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. rAGGREGATE ADDL UB POLICY EFF POLICY EXP LIMITS E OF INSURANCE POLICY NUMBER MM/DD MM/DD 1,000,00 AL GENERAL LIABILITY EACH OCCURRENCE $ GL0000757355000 05/18/2015 05!18/2016 PREMISES Ea occurrT RE ence $ 100,00 S-MADE a occuR 10 00 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000100 GENERAL AGGREGATE $ 2,000,00 ATE LIMIT APPLIES PER: 1,000,00PRODUCTS-COMP/oP AGG $JEC LOC $ COMBINED SINGLE LIMIT $ ABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED SE.L.DISEASE-E! NJURY(Per accident) $ AUTOS AUTOS NUT ON-OWNED TY DAMAGE $ HIRED AUTOS AUTOS ent CURRENCE $ UMBRELLA LIAR OCCUR ATE $ EXCESS LIAB CLAIMS-MADE DED C'UT' NTION$ LITE O H WORKERS COMPEION AND EMPLOYERS' Y r N H ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTNE N/A OFFICER/MEMBER EXCLUDED? ASE-EA EMPLOYEE $ (Mandatory In NH) If yes,describe under ASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached K more space is required) Plumbing-commercial&residential Ronald Vento CFC 1426023 CERTIFICATE HOLDER CANCELLATION MIAMI11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 Northeast 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACVRCERTIFICATE OF LIABILITY INSURANCE DAT 05/20/1 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: If the certificate holder is an ADDITIONAL INSURED,the policy((es)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 nCAONEACT Ariel Ajo Interassurance PHONE (305)758-8322 1 FAc Nol: (305)758-4456 9190 Biscayne Blvd.,Suite#201 AE-MAILDDRESS-. ariel@interassuranc.com Miami Shores, FL 33138 INSURERS AFFORDING COVERAGE NAIC# Phone (305)758-8322 Fax (305)758-4456 INSURER A: INSURED INSURER B: Serota Plumbing Company,Inc INSURER C: 893 N.E.79th St INSURER D. BRIDGEFIELD EMPLOYERS INS. Miami,FL 33138- (305)672-2585 INSURER E: INSURER 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. ILTR TYPE OF INSURANCE ADDINSRUBR WVD POLICY NUMBER MM/DDYLICEFF MMLI QI EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ED F-1COMMERCIAL GENERAL LIABILITY PREMISES GE ToEaEccu"..ee $ ❑ ❑ CLAIMS-MADE ❑ OCCUR MED EXP(Any one person) $ ❑ PERSONAL 8 ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ❑ POLICY O JFCT PRO ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ [iALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ❑ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ El ❑ AUTOS P"r...dent O ❑ F $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ©WCSTORYTATU-S ❑OTH- AND EMPLOYERS'LIABILITY Y/N ER D ANY OFFICER/MEMBERPEXCLUDED EXECUTIVE N/A 830-04907 04/01/2015 04/01/2016 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE$ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Ronald Vento CFC 1426023 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ItIR Vie. . Arid Aja ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD