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PL-16-794 rZC 14 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:1795-2204 Fax: {305756.8972 Inspection Number. INSP-255492 Permit Number PL-3-16-794 Scheduled Inspection Date:May 23,2016 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner CARTER,JONATHAN&NICOLE Work Classification: Addition/Alteration Job Address:350 NE 104 Street Miami Shores,FL 33138-2018 Phone Number Project: <NC>NE> Parcel Number 1121360130190 - Contractor. D'SHIN PLUMBING LLC Phone:(786)5164536 Building Department Comments REPLACEMENT OF INSTALLATION OF VANITY TUB AND SHOWER FIXTURES INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled unUI re-inspection fee Is paid. '� 5.. �'�,•� � S FEC! V3 Miami Shores Village ! 10050 N.E.2nd Avenue NE Miami Shores FL 33138-0000 y Phone: (305)79-r-2204 a Expiration: 10105/2016 Project Address Parcel Number Applicant 350 NE 104 Street 1121360130190 JONATHAN 8 NICOLE CARTER Miami Shores, FL 33138-2018 Block: Lot: Owner Information Address Phone Coll JONATHAN&NICOLE CARTER 350 NE 104 Street MIAMI SHORES FL 33138-2018 350 NE 104 Street MIAMI SHORES FL 33138-2018 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 D'SHIN PLUMBING LLC (786)516-5536 ��.__...........�,... ��..._......_�._.. ... � Total Sq Feet: 10 Type of Work:REPLACEMENT OF INSTALLATION OF VANI Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-3-16-59149 DBPR Fee $2.25 04./08/2016 Credit Card $ 110.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 03/24/2016 Cash $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 oning. Fu ore,I authorize the above-named contractor to do the work stated. April 08,2016 A orized Signature:Owner / Applicant / Contractor / Agent ate Bui ding Department Copy April 08,2016 1 Miami Shores Village RE Building Department =BY: --" 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4$49 FBC 20W. 5 ` BUILDING Master Permit No. 'RG1 (0 PERMIT APPLICATION Sub Permit No. (-0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP y CONTRACTOR DRAWINGS JOB ADDRESS: 35PP I U E /D 1 .- 'SA-Cd City: Miami Shores County: Miami Dade Zia: 33138 Folio/Parcel#: I-a2W- 013 " 0190 Is the Building Historically Designated:Yes NO_e Occupancy Type: s Load: Construction Type: 0 7Q. Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Jo4c.73fw. A,0L t Phone#:!(30yl Address: .35-1) A& AQV2 .5�t City:,N.;SIM, Ores State: Zip: 33/38 Tenant/Lessee Name: A 0. Phone#: �—"-- Email:. 1194&4,M o!>► H n nA CONTRACTOR:Company Name: t fT j Phone#: Address: 75/ City: Stte• Zip: Qualifier Name: (" Phone#: State Certification or Registration#: �s 1 _Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: tt Zip: Value of Work for this Permit:$ 02.0010 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration / ❑ New �R pair/Replace ❑ Demolition Description of Work: �eAl&«,.u.,� w,,d ,-,skil-At" O1 VoKs h . 244 AJ 'Skew f Aoe.5 Specify coQ Q f g0g1 ihrt)'tNe: Submittal Fee 5y• Permit Fee$ S� CCF$ CO/CC$ V% Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) � w Bonding Company's Name(if applicable) c. Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) /I /-C. 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 BEEORE.RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Appikant: As a condition to the issuance of a building permit with an estimated value ekceedino$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absepce,of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature x Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of MAVF 20 JC .by e9--P-" day ofHAIIA ,20 by �w� 'D�� ' 11C�`` ((Wv %ersonally��k,,�n'' fi own to r_J B 3 6 A 6S-k r,who is personally known to me or who has produced T� - UI _�s me or who has producedy� U.y L_ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: Seal: r ,; E �P* Notary Public State of Florida �: SindiaAlvarez ftft ° �$" moa EMy Commission FF 156750Now) � �y� " 30 APPROVED ***#******** I• f*� C . APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r , DATE(MWDDNYYY) A�o® CERTIFICATE OF LIABILITY INSURANCE 03/24/2016 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 endorsement(s). PRODUCER CONTACT Hendrickson Insurance Services,Inc. Franceska M Drnkovic Fax 1230 North Adams Street E I�AAIL M)878- No:(850)562-8298 wwP Tallahassee,FL 32303 ADDRESS: maria@hIsIns.net License#: L051931 INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A: Amtrust North America Inc. INSURED INSURER B: D'shin Plumbing,LLC INSURER C: 1150 NW 111 St INSURER D: Miami,FL 33168 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 00000000-517291 REVISION NUMBER: 25 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. INSR LTRR TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERALIIASILITY WPP1269109-00 04/15/2015 04/15/2016 EACH OCCURRENCE $ 11000,000 CLAIMS MADE I I AMAGE TO RENTED OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JEST LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY t'EAaMeBwIN I GLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracdde III UMMBRELLA I" OCCUR EACH OCCURRENCE $ EXCESS LLAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ /20150805/201X SERA woRKRCOMPENSATION AWC1050153 STATUTE 500,000 AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN N E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBEREXCLUDED? E-1 NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,desaft under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS' VEHICLES(ACORD 101,AdcHonal Remarks Schedule,may be attached if more space is required) Plumbing Work License#CFC1429053 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores,FL 33138 ENTATiVAO MD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marcs of ACORD Printed by FMD on March 24,2016 at 11:04AM Kit-11%bL.0 11,UUVCKNUK KEN LAWSON,SECRE IARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1429D53 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration data: AUG 31,2016 SHINHOSTER, DONNELL D'SHIN PLUMBING, LLC 1150 NW 111 ST MIAMI FL 33168 ® r ISSUED: 0711412014 DISPLAY AS REQUIRED BY LAW SEQ# L1407140001818 t Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY LBT 7177353 \_ j BUSINES&NAMF/L.OcAT7gN RECEIPT No. k EXPIRES D'SHIN PLUMBING LLC RENSW SEPTEMBER 30, 2016 1150 NW III ST 7450225 M�be displayed at place of business MIAMI FL 33168 Pursuant to County Code Chapter SA-ArL 9&10 otnrNER SSC.TYPE OF BUSMESS D'SHIN PLUMBING LLC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC1429053 Worker(s) i BY TAX COLLECTOR$75.00 08/02/2015 CRED1711CARD-15--039349 This Local Business Tax Receipt only canfin=payment of me local Business Tax.The Receipt is nota license, Pmnk m s t udffcatiun akbe holder s gcetiRoa6m s.to do hndmss.Holder mustwith a ny or uougovarmoantel mgubrtmy iam and r"oirementI which apply to the bagmess y 9evernauo�l The RECEIPT N0.above mast he dlsplayml on an commercial vWmks-9Ai M per Code See&,-2X Far more iabamation,visit wwwmiamida .+ » Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 0419 016 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 pollcypes)must have ADDITIONAL INSURED provisions or 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 REa ACT FranCeskM DrinkOVic Hendrickson Insurance Services,Inc. PHONE a FAX No): &50 ' 1230 North Adams Street E-MAIL Tallahassee,FL 32303 ma s: ria@hisins.nat License#: L051931 INSURER AFFORDING COVERAGE NAICd INSURER A: Amtrust North America Inc. INSURED INSURER B D'shin Plumbing,LLC INSURER C: 1150 NW 111 St INSURER D: Miami,FL 33168 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 0 -517291 REVISION NUMBER: 26 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 ��SUBR POLICY NUMBER PM/DD EFF POYYYYl MI DY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY WPP1259109 01 04/15/2016 04175/2017 EACH OCCURRENCE $ 11000,000 CLFUMS MADE OCCUR PREEMMISE3 EaEo nence $ 100,000 MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑SER El LOC PRODUCTS-COMP/OP A__GG $ _Z�000 OOO OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ac idem ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per acddeN $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per aoddern UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIM CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERCOMPSATION A AND EMPLOYERS'LLIABILTTY YIN AWCi1050153 08/05/2015 08/05/2016 X PTA ER 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACH ACCIDENT $ 500000 OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If Yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached If more space Is required) Plumbing Work License#CFC142NM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores,FL 33138 AUTHORRED RE RESENTATIVE r D ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by FMD on April 19,2016 at 04:15PM