PL-16-1663 Inspection Worksheet
Miami Shores Village � C
10050 N.E.2nd Avenue Miami Shores,FL 1
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-270881 Permit Number: PL-6-16-1663
Scheduled Inspection Date: November 09,2016 Permit Type: Plumbing - Residential
Inspector. Hernandez, Rafael
Inspection Type: Final
Owner: MARKUS,DAVID Work Classification: Addition/Alteration
Job Address:1190 NE 92 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050270460
Project: <NONE>
Contractor: JENCO PLUMBING SERVICE INC Phone: (954)720-5838
Building Department Comments
REMODEL MASTER BATHROOM RELOCATE LAVATORY n ractlo Passed Comments
NEW WHIRPOOL TUB ASS A ROLL IN SHOWER INSPECTOR COMMENTS False
Inspector Comments
Passed 1:2 CREATED AS REINSPECTION FOR INSP-260994.water hammer noise
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
®
ACERTIFICATE OF UABLI INSURANCE F � I� 118/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA71ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, DMEND 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 tlarnls and conditions of the policy,cartain poikles may require an endorsement. A statafniant on this Certificate does not confer fights to ffm
certificate holder in Hsu of such endorsornent(s}
PROOIICER
NATAE: .. 6rif>�ia
_
Tho Fairway Insurance Groin, LLC 'OHONE F.ntl(954)772-9819
5461 1,+lorth Federal Highway ' I �IaettJag@tfigins.coffi
Fort Lauderdale, Florida 33308 Iraafl al&]A�r-a me�tr � oaAIcu
----- INSU RAY-596K InMranCe COMPall
OBSURM
INSuRERB:Fl Citrus Bus4nesa & Ind. d
Jeno Plumbing Service, Inc. INSURER C;
_._ . _... _..__
1544 Std 7th Avenue INSURER 0:
Pompano Beach, Florida 33060 INSURER E:
INSURER F:
COVtERAGE$ CERTIFICATE X015 COX - 1L & we 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
INDICATI=D. NOTVATHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V TH RESPECT TO M ICH THIS
CERTIFICATE MAY OF,ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOVOI MAY HAVE BEEN REDUCED BY PAID CLAOAS_
�___. ._._.. . BR_ -
I TYPE OF POUsx CUMBER �.02=4%�siaml LIMITS
R COMWRCIAL GMERAL IJAiSHM I EAOH OWURRENCE 3 1,000,000
A J CAMISAMM 7C OCCUR
IxaMAGE7ro/IFffrED-- - 100,000
� E1-3owurte)___ $
3AA104994 10/15/2015 14/16/20$6 IAEDE)4-PCAa ulapareaeo} 5 5,000
_ �P®ONAL&ADV INJURY 5 1,000,000
GEPTL AGGREGATE LIMIT APPUES PER GENERAL AGGRE:ATE $ 2.
Imo.POLICY
J _ _ ooa,000
S 'POLICY n JECT [ LOC E pq! E TS-COSAPWAGG 5 1,000,000
OTHER: S
AUTOMOBILE LIABILITY (IEa MRINBD SINGDE LIMITT 5
I .
ANY AUTO BODILY INJURY(P-P--)
ALLOWN5
_
AU 1 OS �
E0 EpULED I( BODILY IPIJURY(Pa accldenC)'S
KRIM AUTO$ EVON4DV IE43 I PROPERTY nABJAGE - 5
AUTO$ fPLit t d
$
UNIBRELLA LEAB IOWUR E14Ck1OC JRREhCC $
EXCESSLIAB
CBA6PdS 116ABE
AGGREGATE_ __ $
DEP RPTEMION S 5
BNORKERS OUMPENSATTON PER TH-
AND EWCOYER4'11 ABItJ1Y Y I N I S ----
ANY PROPMETCRIPARTN(WD(ECUTIVE � } E.L.EACACIB ACCIDENT 5 1 000 000
R OFFICERIdE NEER EXCLUDED? I"��1 INIIA —--i- __�_____s._1-_
{It&u►datory Ea NN) 106571.83 10/16/2015 10/16/2015_EL.D13Eh6E-EA kMPLOY5 1. 000 000
iB yas,d�aita undw .
Om 0F0PERATI M I Sbabo E.LD)SEASE-POLIGYUMW S 1,000,000
DESCRIVIR(W Of OPERATIONS I LOCATIONS/VENECLES(ACM 101,Add&tlan d R=Wft Sdmdtft miry be RUWAW Rom a ks mglawd)
Lieause # CFCOSSO86
Certificate is subject tO the t)BkYRs, conditla.1, & exclusa.ons of the Policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY Or THE ABOVE DESCRIBED POL#CIES BE CANCELLED BEFORE
Miami Sho Village all ldisng Department: THE EXPIRATION YA0.T1E TKU(EOF, NOTICE Vr7LL BE D9LIVERED IN
10050 NE 2nd Al7E3YIue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores V13.1ag, FL
AUTHORIZED REPRESENTATIVE
Edward Brown/JAI � �--- '7, �._.✓
9988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014f01) The ACORD name and logo aro registered marks of ACORD
INSBT25 nm4mi
Miami Shores Village AUG
Building Department BY;
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 `TO
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 '-/ b
BUILDING Master Permit No. P2=1 i�`f rob I
PERMIT APPLICATION Sub Permit No. ''LI ( Ir.G�3
BUILDING F-1 ELECTRIC ROOFING F-1 REVISION Ej EXTENSION RENEWAL
A; ❑ MECHANICAL [:]PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
061 C� CONTRACTOR DRAWINGS
JOB ADDRESS: �/ /
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#:�� - 3 a - 6 1/� 0C'6 0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
,iot- 96 L/- 6611
OWNER:Name(Fee Simple Titleholder): t'OAc/ �{ S Phone#:
Address: Mo Alf 9 2- 4T
City: State: Zip: 33/13
Tenant/Lessee Name: Phone#:
Email: ce CA»,o21G�� G®
CONTRACTOR:Company Name:=�� /''� � /��� Phone#: i
Address: 1��� �IAj ((*�(w
City: MKOt (L 'I yState: Zip:
Qualifier Name: t hiyr�8F C: W&. Phone#:
�
State Certification or Registration#: � Certificate of Competency#: Q �p
DESIGNER:Architect/Engineer:-'y am `���E� '� Phone#:
Address:�7s� WJ Ul � T�`�V"/ City: l tate: Zip: W ,b
a
Value of Work for this Permit:$ 03 300- J Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New / ❑ Repair/Rgplace ❑ Demolition
Description of Work: f .am vr�tl Z /7xse /Lzl�
. 4 / L ` rI C .A!/A� %ubx. A /��
IV
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ • CCF$ CO/CC$
Scanning Fee$ CN4 Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
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 beCappa reinspection fee will be charged.
Signatu Signature -1AGENT CO RACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of /57— ,20 L , by fday of j�j,�37J�T 20 16 by
� who i ersonally known ��A� who' ersonally know 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 PUBLIC:
Sign: Sign: - ��.,,0O-
Print Print: (S-' � � Z)4 �
Seal: Seal:
J LAKE
,. •: DENYSE DENYSE J LAKE
MY COMMISSION#FF9W995 :
•• MY COMMISSION#FF996995
!�• = EXPIRES May 30,2020 y.
30.2020
�
7)39"153 FWWNM?ySenke•
APPROVED BY - � Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
S�OREs �i Miami
shores Village
BOB Building Department
ALO 810 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. C- 194
Owner's Name (Fee Simple Title Holder):-tit-3 (h'�Tzy-1 Phone#:')VS
Owner's Address: /v2—:— S�99 "
City: ( (( 'S'�t � State : Pcd24-W�- Zip Code: 303
Job Address (Of where work is being done): 1190 ME— 9-1 S�IM�f
City: Miami Shores State:—Florida Zip Code: S S�
Contractor's Company Name: Aj:.L JZQU770/" Phone#: �-q YL 19(Pa
Address: ler r) /1/t pe->� WY Sln�Ao
City: �l� State: G�:= Zip Code: 33!Xt(
Qualifier's Name: CH-(4i cdw6w, Lic. Number:
Architect/ Engineer of Record Name: v M 6 Phone#: 6?94� k-9
Address: S� / W LLJL-T S� q'f +'7
City: Qy-6 a;r- CAefc-r- State: Zip Code: X30,1
Describe Work: A-7�"M -AQ, ce¢ —
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Mia hores harmless of all legal in Iv nt.
. i
Signature Signatur
Owner bt-A� ontractor o Architect
The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged�before
`me
this ay of %,,by -(d1c7/- this day of ,20%6 by f- Td -C, (ME (—
Who is ersona ly known to me or who has produced who is personally kn wri; q or w LAKE
as indentification. •: pq i���� .
Nota P lic: 0'�• EXPIRES May 30,2020
Notary Public: ►"Y wo>> y
Sign: Sign
Seal: Seal:
! rwv oENYSE.D LAKE
COMM )N#FF8969g5 icy i_t'nA�.:1tS y5
EXPIRES May 30,2020 ' T
� •0 S3 FiorldeNotarygerWce.00m 'Fpde o E.XPRC-.• `itr 3
te07'�+98-0?53 FlMidaNa, ;,dre.•
.0c.
soon Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)75&8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. -.-! —COPY OF LIABILITY INSURANCE"
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. ___ COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE"
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
"YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS 14AME:
BUSINESS ADDRESS: N s ,4 STATES ZIP
BUSINESS PHONE: %,'s --:1%e cj.;2 FAX NUMBER jq*�j_j *-,6 a ig t.3
CELL PHONE(5a�3-j-www - j& QUALIFIER'S NAME: L&2
A I 11-10-ekleft I I& Sol tRIMP-M
LL,. C � gRECEIPT
115 S.Andrews Ave_, Rm. A-100. Ft. Lauderdale, FL 33301-1895—!954-831-4000
VALID OCTOBER 1,20JL6 THROUGH SEPTEMBER 30, 17 i
DBA:
Receipt :PLu ti1ING)LUIN sPRN-KL/C0NTkACTn1
Business Name:J'ENCO PLU141RIN s SERVICE INC Business Type:(PLUMBING CONTRACTOR'
Owner Name:11AYN k J='Ns BusinessOpened:5 o,F tI s r t s 9 s
Business Location:1544 sw 7 AVE State/County/CertlReg:CPC056886
vOMPANO BE€MC~i Exe,lsstpliott Gabe:
Business Phone:954-720-S83
Rooms Seats Employees Machines Professionals
1
rorvendilg sminiss only
Number of Machines: Vending Type:
Sax Arnosan4 Tran sfer fat NSF f Penalty Prior Years Coiiection Cost r�atei raid
_. t
27.00 0.0n 0.00 ` fl.00 T O� 0.00 27.00
THIS RECEIPT MIST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business Ah n Drovvsrd County and is
non-regulatory in nature.You must meet all county andior municipality planning
WHEN VALIDATED and zoning requirements,This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location.This receipt does not indicate that the business is legal or that
it is in compliance with State or local laths and regulations.
Mailing Address:
6YAYIdE 7I JRiI S Receipt; #013-15-00001768
1544 St? 7 AVE Paid 07/19/2016 27.00
POVIPAhO BEACH, ="L 33060
2016 - 2017
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONS` CT INDUSTRY LIGENSING BOARD
A ,� a
GfC056986
s" tai
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2818
HE
JENKINS, WAYNE SCOTT
JENCO PLUMBING SERVICE INC �
16144 SW7TH AVENUE
POMPANO BEACH FL 33080
ISSUED: D71OW016 DISPLAY AS REQUIRED BY LAW SEQ# 1-16070 50001151
Fomw—f P.9T4
ANCE "Myyyy,
CERTIFICATE OF LIABILITY INSUIR
THIS CERTIFICATE IS ISSUED AS 44A MATTER OF INFORMAT40M ONLY AND CONFERS NO RIGHTS UPON THE GERTIMCATE HOLDER,THIS
'CERTIFICATE DOES NOT AFFIRMATIVELY OR MFGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICAM OF INSURANCE DOES WOT CONSTITUTE A conTRACT SEMEEN T14E ISSUING INSWAFR(S), AUTHORIZED
REPRESElirTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: it the certfficate holder is an ADDMONAL INSURED,the pollcy(ivs)must be endorsed. If SUBROGATION IS WAIVED,su to
tho wrens and candivens,of the policy,coftain policies may irequire an ondorsamont A statement on this coetificate does not confer ARMS W tile
corMcateriolder in lieu of such endor-mornont(s).
ITIDNTACT hnnett�e
PR012UCER WA 41 F: CraFsFa as
Tha Past wyTrarce roC PROME (956)772-981
FAX
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INSUNERA-2151SON Insurancim Comp- a�n
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154A sn; 7th AvQnuo
Pompano 2- each, Flov1da, 33060 1 INSURGR F;
INSURER F,
COVE-RAGES CERTIFICATE NUMBER:2015 C01 GL Z TITC RM BION NUMBER:
THIS IS'10 CFRTIFY THAT THE POL'CIFS 01• iNSURAXCE LISTED BIFf-OW IIAV I-SLEN ISSUED TO TFIF INSURED&-%N2ED ABOVE FOR THF-POLICY IRCRIOD
IMnICAT=0 N0T'v/-Jj'IHS-t-ANDJNGANY RE0UfRFMr.N*T,TERM OR CONDITI(IIN OF ANY CONTRACT OR UTHFR DOCUrtAkINT VWTH RESPECT TO 1,M-IJUI-1 lals
O'FRTIFICATE WAY 13L ISSUED OR rAAY PERTAIN. TIFF INSURANCIF AFFORDED BY THE MAWS DESCRIBED HLREIN IS e-UBJr--rT To ALL n4l= I-pj-r
EXCLUS1,0MS AKU MWMkkQ%SUI''.Ur-h POMIFS.LVATS ShIQ'd41:TJMAY HAVFRF.F-%REDUCLU BY PAID C1,A;1-AS-
Sff7- JYPE OF INSUPIANCf P nPo"r I
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D'EMCRIPMN Or CIVEMnONS I LOCATIONS i VCHICLES (AGOND,1101,AdiMatul oatv Do anacrina it more spmca 29 requgrvid;
ie aubjeca-t to tbz, t:--:Ems, co-aditiona, & oxctvmi-ona ox the policfy-
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF 7ME AaOVE DESCRiBIED POLICIES BE CANCELLED BEFOPIE
THE EXPIRATION DATE THEREOF, 90MCE MILL W DELIVERED IN
Y-Lani SM-wres Villlage 3-,aildi.ig Depar-t:mqnt ACCORDANCF WITH YKE POLICY PROVISIONS.
3.0050 NE 2nd Avonuo
Faam:L Shores villaq
IAUB HORMFD REPRESENTATIVE
C
C;)1988-2014 ACORD CORPORATION. Ali right'.
ACORD 25(20i4M) 7 he ACORD name and logo are regisiarad ivorha.of A,CORD