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PL-16-1021 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (306)756-8972 Inspection Number. INSP-257062 Permit Number. PL-4-16-1021 Scheduled Inspection Date: October 17, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: TADDEO,FRANK Work Classification: Addition/Alteration Job Address:341 NE 92 Street Miami Shores,FL 33138- Phone Number (305758-7493 Parcel Number 1132060136380 Project: <NONE> Contractor. ISLAND PLUMBING CO Phone: (305)361-2929 Building Department Comments PLUMBING FOR KITCHEN ASPER PLANS. Inftactlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed a Correction ❑ Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. �M7 �� yxts y�� Miami Shores Village x r lnrr�T!pe �ii�iri€ we 10050 N.E.2nd Avenue NE _ � '06n--Add Miami Shores,FL 33138-0000 pEnt�PhAPP Rte D .: Phone: (305)795-2204 Expiration: 10/30/2016 Project Address Parcel Number Applicant 341 NE 92 Street 1132060136380 FRANK TADDEO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Ceti FRANK TADDEO 341 NE 92 Street (305)758-7493 MIAMI SHORES FL 33138-3133 Contractor(s) Phone Cell Phone Valuation: $ 2,749.50 ISLAND PLUMBING CO (305)361-2929 m.e .. . Total Sq Feet: 0 Type of Work:PLUMBING FOR KITCHEN ASPER PLANS. Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return: Top OutFinal Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# PL-4-16-59431 $2.25 05/03/2016 Check#:10274 $ 162.30 $0.00 DCA Fee $2,25 Education Surcharge $0.60 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 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. OWNEWAuthorrzed I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru . F ermore,I authorize the above-na ctor to do the work stated. May 03,2016 gnature:Owner / Applicant / Contracto / Agent Date Building Department Copy May 03,2016 1 • ' Miami Shores Village 7BY: �� ' 15 016 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)79572204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �-�-� FBC 20(`4 BUILDING Master Permit No.p �„( �—(? PERMIT APPLICATION Sub Permit No. ' j 4�,— ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �j-�- CONTRACTOR DRAWINGS JOB ADDRESS: 34t 1 Y R?, l� City: Miami Shores /- County: Miami Dade Zip: 3313-9 Folio/Parcel#: ` 3ZPCo—®l3'CO3 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: --� Flood �Zone: BFE::f FFE: OWNER: Name(Fee Simple Titleholder): FOfW� U r .1��div Phone Addre'sss:/�1 / -� F 2 c� City: fl &I AM) 5kp Stater Zip: 331 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: I ain¢ G,'VA t Ctrl�l Phone#: u - -3 Address: .3 1� C r-,,wl n, G I u <?v),-? City: S C Ldp State: 0 r `c�, Zip: 33 , V q Qualifier Name: Lu I f r "c C� i c1� Phone#: State Certification or Registration#: �1= L _G 7 4 Aa Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: r7 j10 .50 City: State: Zip: Value of Work for this Permit:$ 21 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: r,` o' JOS Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$_I aJ�_ CO/CC$ Scanning Fee$ .a- Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ - 60 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ r (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 atta ent. A o,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh' ccurs seve (7) days after the building permit is issued. In a bsence of such posted notice, the inspection will of be a o nd a rei pection fee will be charged. Sig ture S' ignatur NER or AGENT CONTRACTOR e foregoing instru nt was acknowledged before me this The foregoing instrument was acknowledged before me this day of dIA%1 is- ,20 byday of by ,who is p sonally known o �t 1 k'�j !vk t A cNa ,wh is personally knowb 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 4 Sign: �? d Print „oar":° c.� R�RTCOLLIER Print: Ute° r Jr W COMMISSION#FF 190711 Seal: * EXPIRES:March 26,2D19 Seal: ; p� +r �OF WedThroBudBtNobry SetYheB ROBERT NERIO PEREZ Fop Wo� MY COMMISSION OFF044933 °jFOF,tioa: EXPIRES August 12.2017 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT GOVERNOR KEN LAWSON,SECRETARY , STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC044147 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 Lu e+ REYES.JUAN CARLOS ISLAND PLUMBING COMPANY PO BOX 490984 KEY BISCAYNE FL 33149 r ISSUED 05/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290001794 - - KEN LAWSON,SECRETARY -ICK SCOTT,GOVERNOR STATE OF FLORIDA S DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 7Te c�s-sasLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31.2016 0 BERGOUIGNAN,LUIS ANTONIO ISLAND PLUMBING COMPANY 328 KEY BIISCAYNESLVDFL 33149 227 SEQ# L1406100001137 ISSUED: 0611 012 01 4 DISPLAY AS REQUIRED BY LAW 000875 ` Local Business. Tax Receipt Miami—Dade County, State; of FloridaBT -THIS IS NOTA BILL - DO NOT PAY 4464889 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES ISLAND PLUMBING COMPANY RENEWAL SEPTEMBER 30, 2416 328 CRANDON BLVD 205 4661303 Must be displayed at place of business VILLAGE OF KEY BISCAYNE FL 33149 Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OR BUSINESS PAYMENT RECEIVED ISLAND PLUMBING COMPANY 196 PLUMBING CONTRACTOR BY TAX COLLECTOR CFC05748Fi Worker(s) 10 845.00 07/06/2015 CREDITCARD-15-033355 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license. permkoracortificationofthe holder'squalifications,todobusiness. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the bu sinum The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code See 8a-278. For more Information,visit www.miamidadea /tax eotor ISLA 10 OP ID:MR TE CERTIFICATE OF LIABILITY INSURANCE DA ` ' 03/30/2016 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 pollcy(Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terrre 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 endorseme s wmDUCERT SUSAN SANCHEZ-ARMENGOL Combined Underwriters of Miami PHONE EM 306477-04" arc wo:306-699-2343 8240 N.W.52 Tarr,Suite 408 rw Miami FL 33166 ;stisargacombirtedmiamixom SUSA SANCHEZ-ARMENGOL misuRERts AFFORDING covERacE wac a INSURER A:NAVIGATORS INSURANCE CO. INSURED ISLAND PLUMBING CO IwsURm B:TRAVELERS INS COMPANY Attn Natalie Bergouignan wsumR c:EVANSTON INSURANCE CO. P.0.Box 490984 KEY BISCAYNE,FL 33149 INSURER D: INSURER E: 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 POUCY NUMBER 96&AS% LIMITS A X COmmERctAL aBotAL LABILITY EACH OCCURRENCE $ 1.000+ DAMAGE TO RENTED CLAIMS-MADE XX OCCUR H016CGL1489191C 01/10/2016 01h012017 PREMIs 0=vw= $ 100,004 MED EXP(Any ale person) $ EXC PERSONAL&ADV INJURY $ 1,000.00 GEN L AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE $ 2,000,00 POLICY a JPECT a LOC PRODUCTS-COMP/OP AGG $ 2,000,00( OTHER AUTOMOBILE LIAMUTY MBI UM $ 11000,00 B X ANY AUTO BA9A320892 01AIS 016 01MIM7 BODILY INJURY(Per P-w) $ ALL OYYNED SCHEDULED BODILY INJURY(Per aa�n) $ AUTOS NOON-0 AIED OPERTY—"-!! ANA E $ X HIRED AUTOS rx AUTOS of aCdd�rt UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ C X EXCESS UAB I CLAI ApEMKLV20LE103837 09/22/2016 01/10/2017 AGGREGATE $ 11000,000 DED I I RETENTION$ 0 $ WORKERS COMPENSATION I SS AR 'ER AND EMPLOYED'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y❑N 1 A E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mantlatwy In NH) EL DISEASE-EA EMPLO S I yysMOPEE L DISEASE-POLICY UMIT $ DESGLRIPTION ORATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addlta d Remarks Sclmduk%rimy be a1 I more space kt required) Plumbing license number #CFC057486. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 100b0 NE 214D AVENUE AITHORMW REPRESENTATIVE MIAMI SHORES„FL 33138-2382 ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Aco CERTIFICATE OF LIABILITY INSURANCE DA-mm°Dmm W3012016 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 CORE=holder IS an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on Nils certificate does not confer rights to the certificate holder in lieu of such endorseme s. PRODUCER WorkComp Solutions, Inc. P.O. Box 24987P' ENE &63 46.4642 FAX 863-646-3521 Lakeland, FL 33802 UV AD' aD INSU AFFORDING COVERAGE NAIL s www.workcornpsolubonsfl.com INSURERA: Associated Industries Insurance Co Inc 23140 INSU Island Plumbing Co., Island Power&Lighting, Inc. ��t6' Island Fire Protection Systems, LLC and Island INsuRERc: Construction Group, Inc. INSUReRD: 328 Crandon Blvd. Suite 227 INSURERE: Key Biscayne FL $3149 INSURER F COVERAGES CERTIFICATE NUMBER: 29231381 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. ADM SUM POLICY EFFLIR iYPEOFWSURANCE POLICYNUMBER POUCYt Lam COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE F1 OCCUR PREMISES $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEWL AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE $ J� r LOC PRODUCTS-COMP/OP AGG $ POLICY❑ OTHER: $ AUTOMOBILELIABILITY COMBINEDSINGLELIMIT(Ea acCkWM $ ANY AUTO BODILY INJURY(Per person) $ OED UTTOS ONLY �OS LED AAUBODILY INJURY(Par acdderd) $ HIRED NON-OWNED PROPERtYDAMAGE AUTOS ONLY AUTOS ONLY Per $ $ UMBRELLA LIARHCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTION$ $ A aNEMPLOYERS' SA=N IABILITY Y r N AWC1048838 7/23/2015 7/2312016 A ANYPROPRIETOR/PARTNER/EXECUTIVEE.LEACHACCIDENT $ 1,000,000 OFRCERNEMBEREXCLUDED4 F N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 It yyeess desnbe under DESCRIPnON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATE I LOCATIONS!VEHICLES(ACORD 101,AddMonal RamarM schedule,may be attaehed it more apace 1s required) 30 Day Notice of Cancellation applies. Plumbing license number#CFC057486 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTNORrzEOREPRESENTATIVE . . Darrell J.Mills ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 29231381 115/16 WC I Michael nergouignan ( 3/30/2016 11:02:12 AM (ROT) I Page 1 of 1