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PL-13-486Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 187202 Permit Number: PL- 3- 13-486 Inspection Date: March 14, 2013 Inspector: Hernandez, Rafael Owner: THOROGOOD, DANIEL Job Address: 635 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: SEROTA PLUMBING CO Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122310120070 Phone: (305)672 -7252 Building Department Comments TIE IN NEW SEPTIC TANK TO SEWER CONNECTION Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments 'i ( Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until March 14, 2013 For Inspections please call: (305)762 -4949 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 205 Permit No. Master Permit No. BY: 000 evmeemeoovem Permit Type: PLUMBING JOB ADDRESS: Ce . (e. ° \ 0 gal City: Miami Shores County: Miami Dade Zip: 8 .. Folio/Parcel #: B I ® 23 ° 0 12. - 6 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: Ca S Phone #: 3 6 ,�- 3 9 4SZ3 City: V-A...4.1stAAA,L, State: Zip: la V �� Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: a Phone #:.lo to)1_ Address: City: VA Ate State: Zip: Qualifier Name: cxa.9 \Lie—v -71—o Phone #: 30S— Iti'1 t l 7,c 2 State Certification or Registration #: C.- F Certificate of Competency #: Contact Phone #: 36 ��.� ®") 2S `_ Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 0 Square/Linear Footage of Work: Type of Work: DAddress Description of Work: DAlteration DNew :_ - LEIRCPair/Replace DDemolition ******** * *** * * * ******** **** ** ******* *** Fees************* *** * **m********** ***** ***** * * ** Submittal Fee $ Permit Fee $ / 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. "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 �` ate-. _ Signature c Ownerkk Agent Contractor The foregoing instrument was acknowledged before me this ' The foregoing instrument was acknowledged before me this day of 2 Via, by TV to o , day of Ws .AC.1— , 20 l ? , by 'V.-el ° personally known to or who has produced who i . erso ally kno me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY NOTARY PUBLIC -STATE- OF FLORIDA " Barry Charles Cerrato Commission #DD985968 . Expires: APR. 26, 2014 }HRII ATLANTIC BODING CO,WC. Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: `- tt My Commission Expires: firROPALtitATE OF FLORIDA "" Barry Charles Cerrato Commission #DD985968 ,..p....� Expires: APR. 26, 2014 BOND= THRII =Arum BONDING co,,U C, Zoning Clerk SEROT -1 OP ID: KR '`,4.... -;- R °m CERTIFICATE OF LIABILITY INSURANCE DATE 12/10DJYYY1t7 12/10/12 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 certiflcmte 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 305- 384 -7800 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Sulte#200 305 -714 -4401 Miami Lakes, FL 33016 -5869 House Accounts carer BONE FAX :uric,. Extl: I (A/C, No): E-MAIL ADDS` INSURER(S) AFFORDING COVERAGE NAIC S INSURER A : *Colony Insurance Company 39993 INSURED Serota Plumbing Company, Inc. 893 N.E. 79th Street Miami, FL 33138 mum B : *Brldgefield Employers Ins Co 10701 INSURER C INSURER D : GL3917438 INSURER E : 05/18/13 INSURER F : $ COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER' WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LOUTS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL3917438 11/18/12 05/18/13 EACH OCCURRENCE $ 1,000,000 X DAREMSES ER EoN nx I � urren) $ 100, 000 CLAIMS -MADE X MED OW (My one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L —1 AGGREGATE LIMIT POLICY n 781, APPUES PER PRODUCTS - COMP /OP AGO $ 2,000,000 PU I 1 LOC $ AUTOMOBILE LIAB1UTY ANY AUTO ALL OWNED AUTOS AUTOS A D MBI SINGLE LIMB — BODILY INJURY (Per person) $ — SCHEDULED AUTOS BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE accident) $ $ UMBRELLA LIAR EXCESS LUU3 OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If describe undo DESCRIPTION OF OPERATIONS Y/ N N / A 83004907 04/01 /12 04/01/13 X I WRY UAT - I I T ER EL EACH ACCIDENT $ 100,000 EL DISEASE - EA EMPLOYEE $ 100,000 below EL DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Village Of Miami Shores Building Dept 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) O 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IS`DOCUSSlf4r HAS A Co1 OI�FC BACKGF#OUND ;.MICRO' BulA0 / LOCATION SEROTA PLUMBING CO 893 NE 79 ST 33138 MIAMI FIRST-CLASS U.S. POSTAGE 1 PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY RecispArcpEWAL 026434-1 STATE* CFC1426023 OWNER RJ$aBING CO. TMIS NESS TAX ID bA:6 AIL,r - � BING CONTRACTOR DUSI ^;< DOSS NOT FERRET 117E HOLDER TO VIOLATE AMY DR ZOTER EXISTING LAWS OF ME COUNTY LAWS ES THE COUNTY OR CITIES. N011 COLD IT E77RYT THE PERIOT PROM ANY OMER PEAMT OR LICENSE REWIRED 6Y LAW. TES NOT A IS NOT A CWW1CAY1ON 01 WON& MOLDER'S QIMUNCA- PAYWSPT QISEIVED M1A-OADE COUNTY TAX COLLECTOR: 60130000140 000045.00 SEE OTHER SIDE WORKER /S 10 DO NOT FORWARD SEROTA PLUMBING CO 893 NE 79 ST MIAMI FL 33138 1 lIlf171I11II1. 0. 1If 11i1I,I17If11117I1i1I,hIu,J/III 1111' 209 62749 4.(3 DEPAR RYNTiNG, L!NEMARK PATENTSp PAPER, STATE OF FLORIDA a J ;g E C G BT REGULATION .1ND TRY LaENS N OA SEQ# L12081601753 The PLUMING CONTRAC'ro Named: below IS art Under the provisions of 'Chap Expiration date: AUG ..31, 2014'' VENTO IRONALD;. r3 SEROTA NEE 79tSTREETOO MIAMI. EFL: 3,3141 RICE SCOTT DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY