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PL-12-1970 / r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225576 Permit Number: PL-10-12-1970 Scheduled Inspection Date:April 16,2015 Permit Type: Plumbing - Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner: WATSON,LEONARD Work Classification: Addition/Alteration Job Address:165 NW 99 Street Miami Shores,FL 33150-1742 Phone Number Project: <NONE> Parcel Number 1131010230390 Contractor: PLUMBING BY SALOMON Phone:305-935-9214 Building Department Comments PLUMBING WORK FOR NEW ADDITION OF KITCHEN Infractio Passed comments AND FAMILY ROOM INSPECTOR COMMENTS False Inspector Comments Passed El' CREATED AS REINSPECTION FOR INSP-180301. not ready Failed Correction Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until reinspection fee is paid April 15,2015 For Inspections please call: (305)7624949 Page 6 of 32 DO Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 [7NOV.46­2013 INSPECTION'S PHONE NUMBER: (305)762.4949 --- _ FBC 201 BUILDING Permit No. P(—12 19-70 PERMIT APPLICATION Master Permit No. IZC I Z--1 9(o 61 Permit Type: PLUMBING J t4.) qejr JOB ADDRESS: /6 6 /k City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): 1_.�� �-� 1�V� br:gb►t-' Phone#: Address: ,� L City: tuo S V uv-e-nQ- State: Zip:� "S I 5-0 Tenant/Ussee Name: Phone#: Email: CONTRACTOR:Company Name: \, ���G1 `��' ��1`' Phone#:1:V z�� S o 8q Address: LOG ® N City: PP State• Zip `q I �-a Qualifier Name: `� ��°� ��!GL_ Phone#: State Certification or Registration#: a:F(--Z Certificate of Competency#: Contact Phone#: �� ��� Email Address:-�"U!�—��k 15kG `, �Ki �L L% DESIGNER:Architect/Engineer: Phone#: &5zi 0 Value of Work for this Permit:$ � (�® ` �' Square/Linear Footage of Work: Type of Work: ❑AddressAlteration ONew ORepair/Replace ❑Demolition i Description off Work: .. ., t<_LT at e- 1 0jk Submittal Fee$ Permit Fee$ 7 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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. a "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 issu In the absence of such posted notice. the inspection will not be approved and a reinspection fee will be charged. Signature J Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me thi The foregoing instrument was acknowledged before me thi26 day of t J)-11' ,201-3,by x"10 (,l.'��S' day of 3�� r RI by who i sonally known a or who has produced who is personal l,}� or! o has produced As identification and who did take an oath. 'O IWq"Aicaljon dad who did take an oath. NOTARY PUBLIC: `\k11 NOTARY: F Sign: Sign: Print: � ®��w Print: My Commission Expires: = � `� 9:`d\ My Commission Expires: T APPROVED BY /Y'�-®5► Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09) A16.. , v� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/16/2014 FREPRESENTATIVE ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. TANT: If the certificate holder is an ADDITIONAL INSURED, the pol)Cy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to ms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the ate holder In lieu of such endosement(s). C TA T NAE: MantZa CLIefVD VO INSURANCE GROUP,INC. PHON305-956-9992CAYNE BOULEVARD c a No; 305 956-9727 E-MAIL ADDRESS: maruervo@bellsouth.net N.MIAMI BEACH INSURERS AFFORDING COVERAGE NAIC# INSURED FL 33160 INSURER A: GRANADA INSURANCE COMPANY PLUMBING BY SALOMON INSURER B: 1060 NE 212 TERRACE INSURER C MIAMI, FL 33179 INSURER D: INSURER E: COVERAGESINSURER F 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. TYPE OF INSURANCE 1 D R S B POLICY NUMBER POLICY EFF POLICY EXP GENERAL LIABILITY TYMM/DD MM/DOJYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurrence $ 100,000 CLAIMS-MADE ®OCCUR '4 MED EXP(An one person) $ 5,000 0185FL00038918 09/05/2013 09/05/2014 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 0 JECTAUTOMOBILE LIABILITY $ COMBINED IN L L MIT $ ANY AUTO Ea accident ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS RED HIRED NON-OWNED BODILY INJURY(Per accident) $ HAUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA UAB OCCUR EXCESS LIAR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY VUC STA�U- OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Mandatory In NH) It as.describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddlNonal Remarks Schedule,K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE A ORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd AVENUE MIAMI SHORES, FL 33138 A OR D REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD ' 7 ® TE Ibihf�DD.'T'YNl'I f ,4corro CERTIFICATE OF LIABILITY INSURANCE [JD� 212/201, THIS CERTIFICATEIS 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(les)must be endorsed. If SUBROGATIONIS 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 CONTACT NAME: NORTHEAST AGENCIES INC/PHS (AA/CNo,Ext): (866) 467-8730 A/C No). (888) 443-6112 210204 P: (866) 467-8730 F: (888) 443-6112 ADD ESS: 301 WOODS PARK DRIVE INSURER(S)AFFORDING COVERAGE NAIC# CLINTON NY 13323 INSURERA: Twin City Fire Ins Cc. INSURED INSURER S: SALOMON PALACIOS D/B/A PLUMBING BY INSURER C: SALOMON INSURER D: 1060 NE 212TH TER INSURER E: MIAMI FL 33179 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. INSR TIRE OFLISIR-I:N`CE A DDL SINR POLICTNIIIIBIER POLICS-EFF POLIC7'EAP LLIIITS LV-VRIi ID 0111/DD/1T1'1) 1 GLA£R-IL LLIBILITY EACH OCCURRENCE c DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence _ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) PERSONAL&ADV INJURY g GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG g POLICY PRO' LOC .41 70.110BILELL•IBILI7I' COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) c ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) ; HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LAB d OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DE(] RETENTION$ WORNERS'COMPENS.a T10A WCSTATU- OTH- AND E PLOFERS'MBUIYr X TORY LIMITS ER3 ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT ;100 x 000 OFFICERIMEMBER EXCLUDED? A (Mandatory in NH) ❑ NIA 01 WEC LT5452 11/25/2013 12/25/2014 E.L.DISEASE-EA EMPLOYEE s100r000 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ''55 0 0 0 0 0 D / DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(MAX Line Length is 79,Attach ACORD 101,Additional Remarks Schedule,if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shore Village AUTHORIZED REPRESENTATIVE 10050 N.E. 2nd Ave Miami Shores, FL 33138138 ©1988-2010 ACORD CORPORATION.All rights reser- ACORD eserACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD o DST 00071920 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY LBT.01 zzn;507 Cita)ANESS NAME/LOCATION RECEIPT NO. EXPIRES Pl .JMBING BYSALOMON RIENEWAL SEPTEMBER 30 1(60 NE 212 TERR"`"' 30, 2014 k -\,Al,FL 33179 231513, I 1, a Must be dis,�ta pd at�la,e of burin?�•:. Pursuant to County Code Chalxer 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS SALOMON PALACIOS 196 PLUMBING PAYMENT RECEIVED BY TAX COLLECTOR CONTRACTOR 86.25 11/21/2013 Worker(s) 1 CFC048483 0228-14-002016 This local Business Tax Receipt only confirms payment of the Local Easiness Tax.The Receipt is nota license, permit,or a certification of the holder's qualiticatioas,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 cammarcial vehicles-Miami-Dade Code Sec 8a-27G. MIAMI AADE Formoreh'formation,+isitwww.miruidade, ovLta�ts_ohe4lor