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PL-15-435 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229951 Permit Number: PL-2-15-435 Scheduled Inspection Date:June 29,2016 Permit Type: Plumbing-Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: PALMISANO, INGRID&ERIC Work Classification: Sprinkler System Job Address: 1035 NE 96 Street Miami Shores,FL Phone Number Parcel Number 1132060143730 Project <NONE> Contractor. LAWN SPRINKLER WIZARD Phone: (305)948-8818 Building Department Comments new partial irrigation system with 5 zones 30 spray heads Infractio Passed Comments and 504 feet of drip INSPECTOR COMMENTS False Permit was on hold pending the pool. Inspector Comments Passed CREATED AS REINSPECTION FOR INSR-229142. ROUGH INSPECTION REQUIRED EXPOSE PIPING Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid MIAMI-DADE WATER&SEWER DEPARTMENT M�QADE METER OPERTATIONS&MAINTENANCE CRO ONNECTION CONTROL UNIT 1001 N.W. 1 STREET,MIAMI,FL 331303-2209 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM Phone(3q 547-3046?Fax(3p5)545-9555 ADDRESS OF DEVICE: © , S� OWNER OF DEVICE / OWNER CONTACT: L 1 PHONE:: ADFAX: DRESS OF OWNER: NAME OF TESTER: ZIP CODE:: CERTIFICATIOrN,#-:_ q E�XPII 7II N DAT • 2 (� K t�C7v��Zg� '7 d-7 PHONE:: BUSINESS �� (�j 306 1111?`Uol -`n+ ���` BUSINESS ADDRESS: T 3 TEST KIT MAKE:: „v- 30-29 :5(A) ;�.� � ZIP CODE: MODEL#: SERIAL#: -3(j� DATE.LASTCAI SITE TUBE: 3 30735 YES ..-MAKE OF ASScM Y :^` ec. MQ�a+sa -z sz.Z. .,.,>._F.,.�+ n SERIAL#: `yy ��j///���J// ? /� /� SIZE: LOCATION OF ASSEMBLY: /—�' ` � / RD/SERVICE:4 t METER NO. INITIAL TEST: �,� ANNUAL TEST: DATE OF TEST: $HMETER READING: UT OFF VALVE: SHUT O� FFV_ Q � CLOSED TIGHT LEAKED CLOSED TIGHT LEAKED LINE PRESSURE: clPRESSURE STABLE: CHECK VALVE NO.1 CHECK VALVE N0.2 DIFFERENTIAL RELIEF VALVE i AIR INLET CHECK VALVE C13Closed Tight: �_ Closed Tight: _ _ FAILED TO OPEN: FAILED TO OPEN: LEAKED: W Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: HELD AT: PSI PSI OPENED AT: PSI. _s PSI MPSI REMARKS/REASON FOR FAILURE(IF APPARENT): CLEANED: CLEANED: CLEANED: LEANED: REPLACED: REPLACED: uj REPLACED: REPLACED: CHECK VALVE NO.1CH ^.'�'•'°i �tzG '� "'= ECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE Closed Tight: Closed Tight: W FAILED TO OPEN: FAILED to OPEN:— LEAKED: H — W Leaked: Leaked; OPENED AT: HELD AT: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI SI I PSI PSI P Ps SIGNATURE OF CERTIFIED DATE: FOR OFFICE USE ONLY: Revised: 01/10/2005 DATE: www.miamidade.gov/wasd/bacicflow.asp Miami Shores VillageT�lcT--;71,® uilding Department FEBE2 7 2 15 10050 N.E.2nd Avenue, Miami Shores, Florida 3313E BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20((:) BUILDING Master Permit NO.']Q C1 41—3, 49 PERMIT APPLICATION Sub Permit 10.I -5 I ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION E] EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �y � CONTRACTOR DRAWINGS JOB ADDRESS: /Dc�,S A-) { C9 J! ea-t City: Miami Shores County: Miami Dade Zip: �343g Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: D Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): F-6 G 4- l n Id !�I M/J C \0CY\0 Pho,ne#: Address: /o3S NL 1Io sh-ta-�-- City: Ay r 47'Y7 1 State: �— Zip: .33 13 Is Tenant/Lessee Name: _/ Phone#: 3I S r-25 a pA�� Email: C�(. M1 S Cf-1 ✓ylIGL✓ C-�d) dki1, L e- • U✓ CONTRACTOR:Company Name: 50-3R Ll//Z.4 R,4, i Phone#:206�9 ��8 Address: �� City: M l a tY1l State: FL Zi p:133// .. Qualifier Name: k e i°L L I Phone#: -3a3 State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: �-,kjd-Ch Ik�,O Ly [fid'AIV-12 - e Phone#:&�3,2��fes' 37 Address: fT-3wF ,� . City: A2;12� State F— Zip; Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Z New ❑ Repair/Replace ❑ Demolition Description of Work: Z aa ! S / Specify color of color thru tile: j -boy(". I Submittal Fee$ Permit Fee$ a ®.iZY CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 11 3 •�t n (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 NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _�day of a I ✓ i`Y ,20 i`; by �day of r t �i (J oh t ,20 is , by 1 4izi� -P4z-1411 54_ y-e ,who is personally known to �1 GA]L A10i, who is personally known to me or who has produced as me or who has produced Ti% b('x-1 V&ZS L/Cegd L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: f � � Sign: 02 � Print: ZcA£i2r A,JVjF_1714e Print: [ A Alte Seal: Seal: a" � Notary Public State of Florida ya Robert Murphy te of Florlda4�Ro�' Expose o6n2Commissiaosaoloss E 20108818 +k M � * APPROVED BY -2.-/S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 05P000573 LAWN SPRINKLER WIZARD INC. D.B.A.: NOE RENEL Is certified under the provisions of Chapter 10 of Miami-Dade County VALID FOR CONTRACTING UNTIL 09/30120/5 Municipal Contractor's Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-Du NOT PAY EM- C] CC NQ. 05F'0005 7 RECEIPT NO. EXPIRES -7-- BUSINESS NAERW1.D RTaN SEPTEMBER 309 2015 L�;��TI SPR';�r;+�RL�:vRD INC NEW BUSINESS 15414 NE 2 AVE 7456339 Must be displayed at place of business MIAMI,FL 33 162 Pursuant to County Code Chapter SA-Art.9&10 TYPE OF BUSINESS PAYMENT RECEIVED OWNERr SPECIALTY FILUIM3tWCt C(>%9RrCfCR BY TAX COLLECTOR LAWNS, NKL E R IVCARD'NC 175.00 10/09/2014 0229-15-0001 BE MAM For more inform often,visit www®iawade�oetar )13356 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5595666 \� LBT-1/ BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES LAWN SPRINKLER WIZARD INr RENEWAL SEPTEMBER 30, 2015 15414 NE 2 AVt 5835880 Must be displayed at place of business MIAMI FL 33162 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS LAWN SPRINKLER WIZARD INC 196 SPECIALTY PLUMBING CONTRACTOR BY TAAX COLLNT EEIVED CTOR Worker(s) 3 05P000573 $75.00 08/13/2014 CHECK21-14-050077 This Local Business Tax Receipt only confirms payment of the Local Business Tan.The Receipt is not a license, permit,ora certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec U-276. For more information,visit www.miamidade.aov/taxcollector From:Casualty Systems 305 551 0857 02/27/2015 11 :48 #525 P.001 /001 CERTIFICATE OF LIABILITY INSURANCE1' 2/28/D28/NDD/Y2015 5 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(ies)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 coTAC d®Or9j.ria Blanca Casualty Systems Inc. PHONE (305)551-0590 FAX .(305)851-0857 3331 SW 107 Ave -MAIL .admin@casualtyeystems.Coat PRODUCER Miami IPL 33165 INSURERS AFFORDING COVERAGE NAIC 8 INSURED INSURERA:Scottsdale Insurance CO. INsuRERs:Pr ressive Insurance C y Lawn Sprinkler Wizard Inc. INSURER C: 15414 NE 2 Ave INSURER D North Miami FL 33162 INSURER E: R F: COVERAGES CERTIFICATE NUMBER:CLO921300714 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 DIS NSRTYPE OF INSURANCE' L POLICY EFF U U EXP LIMITS POLICY NUMBER GENERAL LIABILITY CH EIX (AnRyKaRto:ENcNITaCFrEUre nce) $ 11000,000 r. X COMMERCIAL GENERAL LIABILITY p $ 100,000 A CLAIMS-MADE F OCCUR S1999750 /19/2014 5/19/2015 MED , onearson $ 5,000 PERSONAL 8 ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 11000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABIIJTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 300,000 B ALL OWNED AUTOS 01833792-0 9/13/2014 9/13/2015 BODILY INJURY(per persan) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE $ (�,��) NON-OWNED AUTOS PIP-Basic $ 10,000 Uninsured motorist BI split Hmit $ UMBRELLA LL48 OCCUR l E ACHURRENCE EXCESS UAB CLAIMS-MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY TATU.ANY LIMITS OTH- O ICER/MEMBER�EXCUDE�D?��iVE Y N N/A E.L.EACH ACCIDENT $ (Mandatory In NH) NSW descNbe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLE License 0 CSPPODOS73 S(Attach ACORD 107,Additional Remarks Schedulo,ifmore space Is required) Class Code 97047 lawn Irrigation Systems-Installation and Service CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OP' MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MYAMI SHORES, IPL 33138 AUTHORIZED REPRESENTATIVE .Tuan Hernandez/YOYI ACORD 00 (2009/09) INS025(a� ©1988-2009 ACORD CORPORATION. All rights reserved. os) The ACORD name and logo are registered marks of ACORD Aa® CERTIFICATE OF LIABILITY INSURANCE DATEIMMWDIr" 2/27/2015 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), AuTHOR=n REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the Palicy(iss)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 cartifioate does not confer rights to the certificate holder In lieu of such andorsetnent s. PRODUCER SUN Z Insurance Solutions, LLC. ID: (Impact) CONTE: T Grid et Grimes C/o Impact Staff Leasin Inc. PHONE PAX 250 W. 111dintawn Rd. 108 -743.00$5 iwc.Not: Jupiter, FL 33458 Abbkijs01 bridget@Algnaturestaffin inc,com INaURER(g)AFFORDrNq COVERAGE_ NAIC 0 rNSURERAt SUNZ Insurance Compapy 34762_ INsuR® .._ Irnact Staff Leasing, Inc. INERSURa t Aspen Re-London-Sept Retina 259 W. Indiantown Rd. Suite 108 IN8URER C 1 Catlin Syndicate-Lloyds-Said Rating"A" Jupiter FL 33458 INSURER D: BrIt,S_yndicate-Lloyds-Pest Rating"A" _ INSURER E t INSURER F: .... COVERAGES CERTIFICATE NUMBER: 23627566 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 OR SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCP- b�'�EFF POLID LI1NIT3 POUCYNUMeER COMMERCIAL GENERAL LIABILITY IYYYYI EACH OCCUR E $ CLAIMS MApp OCCUR MED I;XP(Any am Roman $ PERSONAL 8 ADV INJURY $ GEN'L AUDREGATE LIMIT APPLJP4 PER; - POLICY El",poor 7 LOC CIENERAL AGGREGATE $ PRODUCTS-COMPIOP AG $$ orHE�: .� AUTOMOBILE UAINLPTY S Ea o BINCiLE LIMB $ ANY AUTO BODILY INJURY(Psr pgrgp0) g AUTOS ED .SCHEDULED _` AUTOS BODILY INJURY(Faraeoldont) $ HIRED AUTOS NON-0KNED pR ERTYDAMAGC" AN �9pU_ UmaREL'LA LIAR OCCUR $ EXCESS LIAR CLAIMS MADE EACH OCCURRENCE $ _F1 DED RET NTIO $ AGOREOATE $ A WORKER$COZY S'LJ A ION iLrr 1wC PE000o0046 05 8/15/2014 8/95/2015 ✓ PER $ AND ROPRIEERS'LI RTNE Y YIN S ANY PROPRIETDR/pARTNERIEXECUTIVE n - OFFICEl InNH) ' i NIA E.I.EACH ACCIDENT $ 1,000,000 (RUatlgaldey In NH) It GIPTION under E.L.DISEASE.EA:;.- $ 1,000,000 It sf:RIP11oro of OPER4 pNg ,, —_ B Workers Compensation E.I..DISEASE-POLICY S 1,000,000 C Excess Coverage This for informational purposes D and nothing shall create any right under such reinsurance, DEaCRIPTION OF OPERATIpNS(LOCATIONS)vEMCLES(ACORD 1of,Adoiftttar;t.BF*s Sc Mule,may bo sttaanod rr mpea sltseo Is roqulrvd) Coverage provided for all leased employees but not subcontractors of,Lawn Sprinker Wizard,Inc. Client Effective:11/19/2013 CERTIFICATE HOLDER 1363 CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE Wn.L BE DELIVERED IN Miami Shores FL 33138 ACCORDANCE WITH THE POLICY PRO IONS. AUTHORIZED REPRE39NTATFA a, Glen J Distefano ACORD 2S(2014101) The ACORD name and logo are registered marks A14 ACORD CORPORATION. All rights reserved. CEftt NO,: 2362756f Pnm Toombs "12712015 5:25:9n W, ICST/ Ppkgr 1 0! 1