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PL-15-2996 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone.(305)795-2204 Fax:(305)756.8972 — 9(J:�) I Inspection Number. INSP-248592 Permit Number. PL-12-15-2996 Scheduled Inspection Date:January 27,2016 Permit Type: Plumbing-Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner. GUILLEN,KRISTINA Work Classification:Addition/Alteration Job Address:1298 NE 104 Street Miami Shores,FL 33138- Phone Number Parcel Number 1122320300100 Project <NONE> Contractor: NORTHWEST PLUMBING INC Phone:(786)686-5203 Building Deparbnent Comments REPLACE KITCHEN SINK 2 LAVATORY 1 TOILET 1 INSPECTOR COMMENTSSHOWER 1 TUB False pector Comments Passed ER""O' Failed 1(� Correction Needed Re-Inspection Fee No Addrdoornal lnspedons can be scheduled until re-inspecdon the Is paid January 26,2016 For Inspections please calk(305)762.4949 Page 15 of 62 Miami Shores Village _=n 10050 N.E.2nd Avenue NE Miami Shores,FL 3313&0000 . Phone: (305)795-2204 Expiration: 051312016 Project Address Parcel Number Applicant 1298 NE 104 Street 1122320300100 Miami Shores, FL 33138- Block: Lot: KRISTINA GUILLEN Owner Information Address Phone cell KRISTINA GUILLEN 1298 NE 104 Street MIAMI SHORES FL 33138- 1298 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 4,000.00 NORTHWEST PLUMBING INC (786)586-5203 (305)986-1157 Valuation: Total Sq Feet: 00 Type of Work:REPLACE KITCHEN SINK 2 LAVATORY 1 T Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# PL-12-15-57910 DBPR Fee $3.38 12/03/2015 Check*5047 $197.16 $50.00 DCA Fee $3.38 Education Surcharge $0.80 12/01/2015 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $247.15 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 ify thajAM the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin . the re,I authorize the above-named contractor to do the work stated. December 03,2015 Authorized S ture:Owner / Applicant / Contractor / Agent Date Building artment Copy December 03,2015 1 Miami Shores Village Building Department DEC 0 112015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201z BUILDING Master Permit No.&l�-- ZZ / PERMIT APPLICATION sub Permit No,?2 A--t-299K �JBUILDING Ej ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1298 NE 104 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-030-0100 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: NO BFE: FFE: OWNER:Name(Fee Simple Titleholder):KRISTINA GUILLEN Phone#:305-975-1070 Address:1298 NE 104 STREET City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: NOT APPLICABLE Phone#:N/A Email: KRISTIGUILLEN@GMAIL.COM// CONTRACTOR:Company Name: �, enc Phone#: 30'5'7 i� Address: /.2 114:50 C iQR/ � 1C/ City: 4/v/I/1 RAJ, State: /r-,z- Zip: 33/69 Qualifier Name: i-QO _a/Jf7ii1 err Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ -1�&J-0.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New !® Repair/Replace / ❑ Demolition /Description of Work.Aol ec A.,Ids!) Si�+rc �2 ,AvaTy2Y / 7/0.,/Y l / 540we2_ //0O/ Specify color of 1color th'fu tele Submittal Fee$ Permit Fee$ 2-Ss�Y CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ l (Revised02/24/2014) Bonding Company's Name(if applicable) NOT APPLICABLE Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) SPACE COAST CREDIT UNION Mortgage Lender's Address 15900 MIRAMAR PARKWAY city MIRAMAR State FL Zip 33027 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 OWNE or AGENT CONTRACTOR The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this day/of��C�>=/L 20 /� .by _ day of !��t-£r,ZsA 20 /5 ,by �VI'14 Gdi� __ ,who is ersonall known to who i ersonall nown 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 PUBLIC: NOTARY UC: Sign: Si n: XNMM Print. A MM Print: JIM A VETO Seal: STATE OF FLORIDA Seal: 30 STATE OF FLOMDA CORMW . Cwnm#EES83693 EES Eines 1/88017 s 1/88017 APPROVED BY /� �(�� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 001M4 � Local Business Tax Receipt Miami—Dade County, State of Florida 6632351 -THIS IS NOTA BILL - DONOT PAY tot BUSINESS IWAME/LOCATtON RECEIPT NO. EXPIRES NOMME9 PLUMBING INC MEWAL SEPTEMBER 30, 2016 9450 CARIBEAN BLVD 26 Must be displayed at ptace of business CUTLER BAY FL 33189 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED OW OW196 PLUMBING CONTRACTOR BY TAX COLLECTOR NER PLUA66MIG INC CFC1428177 $75.00 08/03/2015 Worker(s) 1 FPPU06-15-015426 Tbfs Local Bush"=Taxlb Only I �� pt� a fice�, .araeal� a eonnd t er � f oofnica � a mpi wdub apply business. The REcaPr I&above asist be dlsplayad as all coameretat vehicles-ryissil-Dada Cade Sec 8e-276. For am iarm1011fi .visit KEN LAWSON,SECRETARY RICK SCOTT:GOVERNOR STATE OF FLORIDA i Ar� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARDr The PLUMBING CONTRACTOR � 4 Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration data: AUG 31,2016 a o SABINA, EDUARDO NORTHWEST PLUMBING INC 10820 SW 200 DR.APT 281 SOUTH MIAMI FL 33157 ISSUED: 07!2912014 DISPLAY AS REQUIRED BY LAW SEQ L1407290001444 ACCOROCERTIFICATE OF LIABILITY INSURANCE �o7i16i2o1 O ® 8'C CATE 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 pollcy(tes)must be endorsed.if SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endarsementi A statement on this certificate does not confer rights to the certlflcate holder In lieu of such endorsement(s). PRODUCER CONTACTMAMLSarni Medina Emmanuel Insurance&Associates,Inc. FSE (30.5)693-0003 (305)691-4381 2370 E 8TH AVE ADDRESS sarah@ernmanuelinsurance.com IMMIRERMAFFORDINGICOVERAGE NAIL# HIALEAH FL 33013-4236 INSURER A: PREFERRED CONTRACTORS INSURANCE 12497 INSURED INS 0: RETAILFIRST INSURANCE CO 10700 NORTHWEST PLUMBING,INC. c: EDUARDO SABINA INSURER D: 9450 Caribbean Blvd E: CUTLER BAY,FL 33189 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. LTR TYPE OF INSURANCE INSR WVD POLICY FROAM% LIMITS GENERALLpUMM EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RMWrE[Y— COMMERCIAL GENERAL LIABILITY PREMISES(Esoommenoe $ 50,000.00 CLAIMS-MADE ®OCCUR MED EXP(any one r,9ma„) $ 5,000.00 A PCAS02184M 07/22/2015 07/22/2016 PERSONAL&novwjURY $ 1,000,000.00 GENERAL.AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PEM PRoDUCTs-Complop AGG $ 2,000,000.00 Pot= ZO LOC $ AUTOMOBILE LL40UM COMBINED 390GLE LUT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED U SCHED AUTOS AUT 1S LID BODILY INJURY(Per soddent) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS $ UABRELLALIM OCCUR EACH OCCURRENCE $ EXCESS LIAR C.AIMS,MADE AGGREGATE $ DED RETENTION$ $ "MuM COM PENSATION VYC AT I O - AND ENPI.OYEIIS'LIAINnYER ANY�AFn�VEXEC TWE YIN ANY N/A 0520 44652-0 05110/2015 05/10/2016 EL EACH ACCIDENT $ 1,�,�.00 B O�EXCLUDED? yty�� Y Midi) F.L DISEASE-EA EMPLOYEE $ 1,�,�•00 urww DESCRIP TIOPI OF OPERATIONS belaer E.L.DISEASE-POLICY LIFAT $ 1,0001000.00 DESCRIPTION OF OPERATIC!LOCATIONS I VEHICLES(ANN&ACORD 181,AdMMW R Schedukh D nears q=9 is rem COMMERCIAL&RESIDENTIAL PLUMBING CONTRACTOR. Any Changes or alterations Doyle to this domm mt after being Issued shall constitute it nun and void CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLIOS BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,FL 33138 ACCORDANCE WITH THE POLICY PROVm10NS. Tel:305 795-2204 Fax 305 756-8972 AUTHORUMD REPRESENTATNE �Z 15 ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD