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PL-16-963 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL — 9 2 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268245 Permit Number. PL-4-16-963 Scheduled Inspection Date: October 03,2016 Permit Type: Plumbing - Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner: CARVAJAL,LINA M Work Classification: Addition/Alteration Job Address:390 NE 98 Street Miami Shores,FL 33138-2410 Phone Number (305)746-9959 Parcel Number 1132060135670 Project: <NONE> Contractor. APA PLUMBING CORP Phone: (305)992.4614 Building Department Comments PLUMBING FOR BATHROOM RENOVATION. ntractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-256596. no access 3:05pm Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. k Miami Shores Village ' Permit _Type:Plumbing-R41#t1W 10050 N.E.2nd Avenue NEpm Miami Shores,FL 33138-0000 Phone: (305)795 2204 x r ' °. �ioAmAIration: 1 /15(2016 Iss, .tate.� 1 P� Ex Project Address Parcel Number Applicant 390 NE 98 Street 1132060135670 Miami Shores, FL 33138-2410 Block: Lot: LINA M CARVAJAL Owner Information Address Phone Cell ..MLINA CARVAJAL 390 NE 98 Street (305)746-9959 MIAMI SHORES FL 33138- 390 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,375.00 APA PLUMBING CORP (305)992-4614 _.,.... Total Sq Feet: 0 Type of Work:PLUMBING FOR BATHROOM RENOVATION. 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 DBPR Fee Invoice# PL-4-16-59365 $2.25 04/18/2016 Credit Card $ 110.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 04/11/2016 Credit Card $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,PL jall CHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certi t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh orize the ab named contractor to do the work stated. April 18, 2016 Authorized Signatur .Owner Appli ant / Contractor / Agent Date Building Dep a men Copy April 18,2016 1 a Miami Shores Village C- AP P11 0� Building Department 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 S l� FBC20s BUILDING Master Permit No,V-0-I 6- PERMIT APPLICATION Sub Permit No-FL (6-(--)� ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 390 Ne 98th St City: Miami Shores County: Miami Dade Zip: �� Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Residential Load: Construction Type: Remodel Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Lina Carvajal Phone#:—b Os—7A Address:390 NE 98th St c;ty: Miami Shores State: FI Zip: 33138 Tenant/Lessee Name: Phone#:• Email: CONTRACTOR:Company Name: %� ' C t Phone#: [, I Address: y fVf City: � State Zip: S '� Qualifier Name: Gly i(—(A ' a� Phone#: C (� State Certification or Registration#: 1— I ( �02 F�g� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ i^ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: l' � � ` 11.E ' °��i�o�tyc>i' ly 6L-V-Q Specify color of color thru tile: Submittal Fee$ �0 Permit Fee$ r�® � CCF$ r� r CO/CC$ Scanning Fee$ • 03 Radon Fee$c�c 'c DBpPR$ Notary$ Technology Fee$ � Training/Education Fee$ ® ''-i® Double Fee$ Structural Reviews 0 Bond$ 0 TOTAL FEE NOW DUE$ (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection,which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not bZia ve nd a reinspection fee will be charged. Signature � Signature , �t OWNS or AGE T CONTR OR The foregoing instr ent was acknowledged before me this The ,forlegoing instrument was acknowledged before me this i'r✓n1 day of 1�r 20 (dP by a day of 1 p` &OL —'20 16 by A CA"A,A ,who is personally known to ��� AJCA( . CA who is personally known to me or who has produced ��91 'S 1..� °�� as me or who has produced D fly `.' L,1U'-1''e, as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: d Sign. Sign: Print: a Print: e ry Seal: . . fRabecara 8snni01tlo Seal. Rebecca L Sarmiento ,t a Canwilselon IFF 08617? My Cw=WWw is m E�Iru01rAn1$ E o1ro a "~Ji APPROVED BY ���1" Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �,.•� Policy Number. 00070840-0 Date Entered= 3/21/2016 CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDIYYYY) 3/21/2016 THIS CERTIFICATE 13 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 certfifimte holder is an ADDITIONAL INSURED,the poticy((es)must be endorsed. If SUBROGATION IS WANED,,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 CNAOME T PabloA 1 Your Options Insurance 7171 Coral Way Ef►PHO�a F,,: (305)392-1927 FAX No: (888)687-1926 Suite 319 A M&info@youropt tonins.com INSURER`S AFFORDING COVERAGE MAIC# Miami, FL. 33155 INSURER A:James River Insurance INSURED A.P.A Plumbing Corporation INSURER B: INSURER C: 7075 SW 461:12 St INSURER D: Miami, FL 33155 INSURERS: 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- LL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL Sty WV0 POUCY NUMBER MPOUCY EFF MMONYM MPS Y EXP UNITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,0000 CLAIMS-MADE Ix OCCUR DAMA TO RENTED C(Atl 00070840-0 03/25/2016 03/25/2017 PREMISES occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIAR APPLIES PER: GENERAL AGGREGATE $ POLICY❑JEC 7 LOC PRODUCTS-COMPIOPAGG $2 000 000 OTHER: S AUTOMOBILEUABILITY COMBMEDSINGLEUMfT S Ea acdtle.t ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS erautidern S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LU16 CLAIMS-AIADE AGGREGATE S DED RETENTIONS g WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'UY f N ABIUTY STATUTE ER ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? EJMIA E.L EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYES S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS f LOCATKINS I VEHICLES(ACORO 101,Addidonal Remarks Setredute,may be ettaehed N more space is required) PLOMBING RESIDENTIAL (98483) PLMffi NG CCNWMCIAL (98482) as per information with underwriter policy covers installation LPG equipment State of Florida Plumbing Contractors Lia# CFC1427783 CERTIFICATE HOLDER CANCELLATION Miami. Shores Village Hall 10050 Northeast 2nd Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, Florida 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C 4100 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Mu Lce&mftFamsBossPhzs wttwr.F 1977 ��-i^asy Col DATE(�AIDDiWM CERTIFICATE OF LIABILITY INSURANCE F11412016 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 celtifllcate holder is an ADDITIONAL_INSURED,the pollcy(iss)must be endorsed. I SUBROGATION IS WAIVED,sbbject to the terms and conditions of the policy,certain policies may require an endorsement. A statemerrt on this certificate does not confer rights to the certificate holder In Hsu of such endorsement(s). PRODUCER SUNZ Insurance Solutions,LLC. ID:(Ally) CONT"``T Melissa Ash c/o Ally HR, Inc. P" 904-739- M 904-26227609016 9016 Philipps Highw Jacksonville,FL 3226 ma mash matrixonesourc e.com INSu AFFORDING COVERAGE NADC# INSURERA. S NZ Insurance Company 34.762 INSURED INSURER B: Asw Re-London-Best Rating;"A" Ally HR, Inc. 9016 Philips Hwy INSURER c: Catrin Syndicate-Lt -Best Rafigg A" Jacksonville FL 32256 wsURER o: Brit Syndicate-U -Best "a f INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 27976156 REVISION NUMSM- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YOM 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 ADDL POLICY NUMBER 0POLICYBIT PC&gXV EXPYYYYI Lam 4 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S f CLNtdSOAADE DOCCUR DAMAGETO RENTED PREMI ES aaarmw= S AHED EXP(Anj one pert) S PERSONAL&ADV INJURY S GEML AGGREGATE LIMIT APPLIES PER GENERRm.AGGREGATE S POLICY U JC�T LOC PRODUCTS-COMPIOP AM S OTHER: S AUTOMOBILE LIABRnY COMBINSINGLE LtdAtT $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peracdde* s NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS S S C UMBRELLA LIASOAR EACH OCCURRENCE S EXCESS LUU3 HCLAIMS-MADE I AGGREGATE S DED RETENTIONS S A wowcERs co�tasAnox WCPE00000323 02 1/1/2016 1/1/2017 J EATER STATUTE O7 4 AND EMPLOYERS'LIABILITY YIN WCPE0000032301 1/1/2015 1/1/2016 ANY PROPRIEFORIP� OFFICERIMI ERCI.UDED? N I A EL EACH ACCIDENT s 1,000,00 (MYyandatwy In NH) E.L DISEASE-EA EMPLOYEES 1,000,wo DESCR OFOPERATIONSbalm EL DISEASE-POUCYLIMIT S 11000, B Workers CornpensaWn This is for Informational purposes C Excess Coverage and nothing shag create any right D under such ransurance. DESCRIPTION OF OPERATIONS I LOCATIONS i VEHOCLn(ACORD 101.AdMmW Rwwwks Sdwb te,may be attaehea E more space raquFredt Coverage provided for all leased employees but not subcontractors of:A.PA PLUMBING CORPORATION Effective date:3/10/2015 CERTIFICATE HOLDER CANCELLATION 9109 SHOULD ANY OF THE ABOVE DESCMED POLicDEs BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE VWLL BE DELIVERED IN Fax: 305 796 8922 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NW 2 AVE MIAMI SHORES FL 33138 AUIHOR¢EDREPRESENTATIVE I Glen J Distefano cA ©1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 27876256 1 Heater Certificate 1 Candice HcOoxell 1 1/4/2015 11:44:23 AM (FW) I Page 1 of-- 00168.2 Local Bus=nsss Taxci t Miami-Dade County, state of Florida -THM,IS NOTA BILL - DO NoT PAY 6287687 13UNNESS MAUS1LOCAMON i3ECElPT Nd. A P A PLUMBWG CORP 8�� �x�1� tot 7075 SW 46 s7 �� 85.7389 SEPTEMBER 30, 2016 WM[FL 33155 Must be displayed at place of business Pursuant to County Code Chapter SA-Arts&10 PL AOWNERPSEC.TYM OF SUSINaSS A P A PLUMBING CORP 196 PLUMBING CONMcroR :A=== Workers) i CFC1427M sY 875.00 09/14/2015 ,> tREDRCARD-15--045815 ThiParrott era 6o�aaffdis otao" FaY tofthe sigem usine imus Th plyw pt isaota l;ceusa, atpB�art�goaearmna�alr��mry,l��9�l�catioo�todobasfuess�Nofderamstoo�ptgwhb caWramemsvAlchappiytothe btraloom "YBuvera"lowel The AECEIPTNO.above mttstbe displayed oa all commercial vehides-Mlao i-Dade Code Sec Ba-27E �rrmara irdemmiioa,visit�utrmia+nd�a_....r.�....-tin,,, STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE,STREET (850)487-1395 TALLAHASSEE FL 3239"783 GARCIA, LUIS ALBERT© A P PLUMBING CORPORATION 8741A SW49THqTR;:=-r MIAMI FL ii-' 165-6701 Congratulations! Wath.s license you becorne one of the nearly One Million Floridians licensed by#*.Department Professional Regulation. of Business and from architects to yacht brour Professionals and okers , businesses range 'Ind they keep Florida's economy ftrn boxers to barbeque MsWranta, OMY strong. STATE OF FLORIDA Every day we work to improve the"y we do DEPARTMENT OF BUSINESS AND serve You better. For information business in order to PROFESSIONAL REGULA11ON .M dallcen".com. about our services,please log onto CFC1427783 about our divisions and the ..There you can find more Inforn-hidon "'SUED� to deP2rtrnent newsletters and lea^ s that Impact You,subscribe I- - 07/28/2014 in n'more about the Departrnents CERTIFIED PLUMBING CONTRA GARCIA,LUIS ALSEM CONTRACT r mission A P A PLUMBING CORPORATION at the E)eparbftnt is:License EfflcientkK Regulate Fairly. "a constantly`WV8 to serve you better so that you can serve your � Thank you fir doing business in Florida, and congratulations On Your new licensel IS CERTIFIED under the provisicns e-kV004data:AUG31.2016 Of C11,489 Fs. 7.540MODD301 RICK SCOTT,GOVej;�NOR DETACH HERE STATE OF FLORIDA KEN LAWSON,SECRETARY DEPARTMENT OF BUSINESS AND PROFESSIONAL CONSTRUCTION INDUSTRY UCENMW(; REWLATION a� BOARD OFC1427783 The PLUMBING Co 1�� Named belo0 IS w CE FIED CTOR Under the provisions Of Chapter 489 FS, Expiration date: AUG 31,2016 GARCIA, LUISAL13ERTO A PA PLUMBING CORPORATION 8741 SW 49TH STREET MIAMI FL 33-16"701 0712842014 DISPLAYAS RFO(IlRF:n Ry I AW cFn I 1AM71AnAnn0A.,