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PL-15-2896 _. w Mn Inspection Worksheet Miami Shores Village �® � , 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax(305)75&8972 Inspection Number INSP-247907 Permit Number. PL-11-15-2896 Scheduled Inspection Date:April 14,2016 Permit Type: Plumbing -Residential Inspector Hernandez,Rafael Inspection Type: Final Owner: CARLA GRISONI,CANOR PATO Work Classification: Gas Job Address:162 NW 109 Street Miami Shores,FL 33168-4317 Phone Number Parcel Number 1121360100220 Project <NONE> Contractor. MANNrS PLUMBING SERVICE INC Phone:(305)219-5625 Building Department Comments meats RELOCATE GAS W.H AND DRYER TO BE NEW. 1INSPECTOR COMMENTS Fade Inspector Commen Passed Failed Correction ❑ Needed Re-inspection Fee No Additional inspections can be scheduled urd re-inspection fee Is past. mac.•- �� - �o � � SUBURBAN PROPANE Vk-, CONFIRMATION OF DROP TEST Date 2- ,- Permit Number Address (O�— N i'J g�-�.� -�- AA;,-,,; Sl or,21, L 3 l b EQUIPMENT USED: ✓ MANOMETER TIME: START '�-55 A--� FINISH -1 . S AAA WC: I have completed the above drop test in accordance with NFPA 54 and Florida Building Code(Fuel Gas) and by signing this statement,I declare under penalties of perjury that the test performed to be true, correct,and complete. STATE OF FLORIDA,COUNTY OF MIAMI-DADE Si n ture Print Name Sworn to and subscribed before me this 11,Lk day of A , : 2016 Signature of Notary Public_State of Florida Y N ROGEl10 OUEVEOo Seal: ,,< �,e.` Notary Public-State of Florida ' . My Comm.Expires Jul 4,2017' Roo-°o` Commission#FF 20675 '--'OR, Bonded 7hrou h Personally known_ Produced Identification a 9 National Notary Assn. Type of Identification Produced SUBURBAN PROPANE 3800 NW59TH STREET,MIAMI,FL.33142 (305)635-4427 a t� Miami Shores Village � N.E. 10050 2nd Avenue NW . Miami Shores,FL 33138-0000 y �r Phone: (305)795-2204 Expiration: 5/15/2016 Project Address Parcel Number Applicant 162 NW 109 Street 1121360100220 CANOR PATO CARLA GRISONI Miami Shores, FL 331684317 Block: Lot: Owner Information Address Phone Cell CANOR PATO CARLA GRISONI 162 NW 109 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 MANNY'S PLUMBING SERVICE INC (305)219-5625 Total Sq Feet: 0 Type of Work:RELOCATE GAS W.H AND DRYER TO BE NE Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Retum: Press Test Classification:Residential Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 invoice# PL-11-15-57782 DBPR Fee $3.75 11/16/2015 Credit Card $50.00 $188.70 DCA Fee $3.75 Education Surcharge $0.40 11/17/2015 Credit Card $188.70 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $238.70 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 and zoning. Futhennore,I aut rize the above-named contractor to do the work stated. � 9�-: November 17,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 17,2015 1 Miami Shores Village Building Department Nov 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 C T FBC 20 �q J BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.71 _ti;;z` LD ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: OV LA-) / ;2 S City: Miami Shores County: Miami Dade zip: 3 i 3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type:_gC_ Load: Construction Type: r== 35 Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): P �.rd r�G Phone#: 3m-f Address: -P!F, City: State Zip: Tenant/Lessee Name: Phone#: Email: a CONTRACTOR:Company Name: 'A W 3\P'S L�wbi +ec, rj' @jzV%Cc Phone#: Address: 3`'%V1- 1�>Ny 1'S02,- A City: \�r�LzY�h State: VI-1 Zip: 3'3 0 �Z Qualifier Name: R';-YLpo V-,b Phone#: State Certification or Registration#: C_ F C, I!A TS 9�t to Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City State Zip: Value of Work for this Permit:$_ /�`�®• e� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1Z��ycl�� (,t9, /f AA-,7> 4§5e Ile Speclfy color ofcolorthru tile: Submittal Fee$ w Permit Fee$ J 2-5 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$_ I �� •�C� (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. In the absence of such posted notice, the Inspection will not be approved and a reinspection fee will be charged. Signature � � Signature OWNERorAGENT I CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —day of � 1N� .20 16 .by 110 —day of A�WN43Qe[ .20 %J .by c-'� rk M a► ,who is p rsonally know �Cd�UVY�a .who is personally known to me or who has produced ` as me or who has produced t�kL (M 11 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign• ��` Print: Print: v REBECA X k9fit NA Seal: MY cmaussioN 4 EM7�4 Seal: ` REBECA K PAMANA EXPIRES:Fly 07.2017 MY COMMISSION R EErr 4 a EXPII M MMNY07.2017 ############################################################################################################ APPROVED BY �� v/1&13 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5_.?-,�r-9� c s--t 6 zOP ID:MAC A b CERTIFICATE OF LIABILITY INSURANCE °"i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORmAT10N 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 THIS ISSIANG 04MENU AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the Rkiew hokler Is an ADDITIONAL INSURED,the pofiWes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of Ow policy,certain policies may require an ermlomrsemeriL A staftamd on this date does rwt conkr.rWft to the cicate holder In lieu of suchPRODUCER C014TACT enda> s Made Insurance Group albs PHONE ASI , 7171 Coral Way , Ess Mhun FL 33155 JOW Pena,PIAM CPIA #p a,MA1'�tNY 1 - ...._....._......_........ _ $ Manny Plwnbkgrv# a IrisA tib bm INSURER ONURBR 1631 36 PI #1502 A e T� Y Itlnc�anc.e s _A. Hialeah,FL 33012 c ........ .... INSURER E RER F: COVERAGES CERTIFICATE NUMBER: REVISION RUN ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 1IIHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ ...... __ TYPE OF IfOUNtANCE € EACH CURREE S 1strA [7jCCO1:ER7LGENEI�t "o rrY CL1727645 11 15 11 18; 100.664— I CUUMS-MADE i'Xi OCCUR MED EXP IASW ares P yrs Daf) $ 5, s ADV 0 3 1:� ..... _._.. _; .... _..... GE AGGREGATE $ 2s e _ _...... . ... GENE AGGREGATE LIMIT APPLIES PER. �TS•C W A G�$ +Ps t t Pt ,iGY I LOC p AUVOMOEME UABLITY COMBINED BOGLE L r ffi IEg ANY Aura R(ULY INJURY(PO.P )....�. # ALL OWNED AUTOS BODILY INJURY(pot sowdom $ SCHEDULED AUTOS ., . PROPERTY HIRED AUTOS (PER ACCIDENT) NONwIED AUTOS UAS OCCUR EACH OCGURRB EXCESS UJB CLAIMS ; MATE $ _.........._..........._................_.— _... . r7dOUCTff)tE _ ...._.... ..... ......... RETENTIONg WORKS" TION A AND SINPLOVERS'taA98AtV X P B ANY PROPRIETOPARTNERiEXECUTIYE Y f N TWC3509577 11 15 1IMGF 8,E.L.EACH ACCiDEW i 3 1,11!X}, OFFICER AA EXCLUDW? ;rd f A { in tax) e L glsEAse EA t9 S 11000 t3ES�RIPTtON OF OPERATIONS besm E.I.,D POLICY LIMIT S 11000, � f I ("wh ACORD 101.A�Ftk�nai ,ff oa Ile c°"fie damo g'eon n noz a egexciuded tram WC coverage anus CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLXM BE CANCELIJIM BEFORE OTILE E XP'IRATIOPH DATE? TWRE OF, BE DELIVERED IN FAX MIAMI SH3flO �RES VIVILLAGEE ACCORDANCE WITH THE POLICY PRO BUILDING DEPARTMENT 10060 NE 2 AVE 6ZEq REPREBEl1TJ1i19ta MIAMI SHORES VILLAGE,FL 33138 0 108-2009 ACORD CORPORAIM AR rights reswvscL ACORD 26( ) The ACORD name and logo are regithwodmarks of ACORD OP IV:MIAC .a t x�►.. CERTIFICATE OF LIABILITY INSURANCE " THIS CERTIFICATE 18 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($h AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: N the Certificate holder.Is an ADDITIONAL INSURED,the pollcy(ka)must be endorsed. It SUSROSATION Ni WAIVED,tlubod to do Farms ars!condltlarrs of ft policy,certain p®Ocies may rewire an andoreenw rt. A statement on tha certificate does not cony rift to the cortilleaft hokler In[Leu of such s PROMM CONTACT Florida ranc®anoe Group duo NAME. ASI PHONE Way ANaml,L.33f66 ADORM: JoW Pena,PIAM CPiA Pwd*UC#* MANNY 1 INSURED t5iffiR A:United.�PiabNZatB$L In6. Manny Penrdome _ 1631 W 38 PI #IS02 A >n R s Technology insurance Company,t 42376 .._ -.. -.._ .__ t111 I-**** ...- _ Hialeah,FL 330'12 ROU"Rc awsi,aEn o R�IdRER k RF COVERAGE$ CERTIFICATE NUMBER: RmallON NUMeR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN#$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR ZITHER 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 mAVE BEEN REDUCED BY PAID CLAIMS. 7YP2 IP U NCeMt�ER UIII" (ia£gERAL UAaM IrY EACH OCCURRENCE A -X COuaERCtM.ORAL.LMIL" CLIT27846 1f101S 1110612010,19M=TORENTED 00 1 CIANS-OlAI7E .CtGCUR Mi?MO rslQ�tAar an9 moa} ffi �+ a _Q. .- _._ .. &A01d INJURY 11000, S _ _ .... AGSWGATE $ 0001 OEM ACQWGATE LIMITAPPLIE$PERPROIXrCTB COt��ACC $ 2,000+ X ; POLICY. 1ECTL+?C AMMOSME I IABUtrf COMOtNED SLE LUT $ ANY AUTO BODILY r4JURY WN S - ALL OWNED AUTOS __............._.....,.. .- SCHEDULED AUTOS $DAILY IN kkRY i a q $ HIRED AUTOS PROPERTY OAA9ACEE $ tPER ACCIDEW) --# D AUTO$ $ S 'UiLiAIJAa ;......, r---- OC(:k/R ,EACH OCCURRENCE.. S L... H7tCE98 tJAa CRAWS-MADE __. ..AGG GATE $ DFOMME _._... i RErENridt $ WOMFUSCOMPENSATtON XWWO TSR�Y..LI TL6 + .=�M AkIO a1tPLOYalI> tJAaR frY 8 ANY PROPPJETL ARTta;ROWCUTIYEYti! > TWC3l 77 fttl}8t,'XIt6 IIAM IS OFr-C€ftwAwR1xCu*EO? .MIAEMPLOYEE S 6.t.ERCNACCBOENr .5.,,,,..�..._ MAW"ON E.L.eg§! -POMY L"T 1 1,000, a dF L�T tyEkE$iAtta�kC6tRD tt)t.A Remarks Sd�Ae.U Ie�e spaxe�ragtrbedl omme erdomoel I yIisamurlozmar"excluded Isom K coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF. NOTICE WILL. BE 0904ERED MI FAX 111:306-7564072 ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AttTt�R�ffD aEPRE$ENrkTNE 1t�ME2A'VE MIAA8 SHORES VILLAGE,FL 33138 01988.200$ACOAD CORPORATION. All rights reserved. ACORD 25(200M) The ACORD nano and Ingo are registered marks of ACORD