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PL-12-2387Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183124 Permit Number: PL -12 -12 -2387 Scheduled Inspection Date: March 06, 2013 Inspector: Hernandez, Rafael Owner: WILKINS, ROLAND JAMES Job Address: 726 NE 92 Street 6 -L Miami Shores, FL Project: <NONE> Contractor: LAMANNA PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)610 -5113 Parcel Number 1132060440440 Phone: (561)756 -0240 Building Department Comments BATH REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 05, 2013 For Inspections please call: (305)762 -4949 Page 17 of 43 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 20 t. l� Permit No. 171--) Master Permit No. c Permit Type: PLUMBING JOB ADDRESS: 7c 3 / t - 9c) 6 L. City: Miami Shores County: Miami Dade Zip: 3 3 ( 3 Folio/Parcel #: 0-3a06- Oqq 02 ( q c Is the Building Historically Designated: Yes NO .� Flood Zone: OWNER: Name (Fee Simple Titleholder): Y.A'LQ�IQ S 1(ICt4'Phone#: O3 --Z S-6 - S /1 3 Address: -20 6 iii g '� j l .P6 6 ,. Q City: / 1 r rte=, / S ho / .5 State: f:----6- Zip: 3 �J' /3 O Tenant/L,essee Name: Phone #: Email: CONTRACTOR: Company Name: 6(1-m i -r� fit. A pCUM 61 i15 fv& �. Phone#: - 6/-' R-56 - 02-1(0 Address: 3 c /7) I LowSoy ■ 8( v c.3 3 City: (r ( (�ecacC-% State: P L_ zip: 3 3z-I 515 Qualifier Name: 6r3 �Y mac'. r £'.� Phone #: 53/ —75‘ —621(0 State Certification or Registration #: CPC -14 Z 6 8 Certificate of Competency #: Contact Phone #: 6(--.R 56 - 0 24.0 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ °e› Square/Linear Footage of Work: Type of Work: Address °Alteration °New ORepair/Replace °Demolition Description of Work: /2. , e 1.1 e... �4 \ ,� •e. 0 �c/e--/" 1 r^l tit �c� 01- 1 n-o-i„.., 0—r, ci, f'e 9 �� .S' Il ^ �: ��x�x��x���: x�+ x��x�: �* �x*** ���x�x* �:** ��x�xFees*: �x��xx�* �x�* x:: x��x: �x��x��: x��: xx�x� *�xx� *��: *��x:� *��x� * *+� *�:� Submittal Fee $ v(�,p�,�� Permit Fee $ , ®0 CCF $ CO/CC $ Scanning Fee $ 1 ' ' '- Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ �! �� uCeP Technology Fee $ 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 installa ons 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 FT.ECTRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Ro%c - Wdd4tir. O ef or Agent The foregoing instrument was day of Signature Contractor wledged before me this s .__" The foregoin instrument was acknowledged before me th' 0/ by , day of known to me • -; ho has produced NOTARY PUB C Sign: Print As identification and who did take IC° 19_ My Commission Expires: n o me or who has produced as identification and who did take an NOTARY PUBL, C: °➢ Sign: El 8 Print: a ED ii 2 A' L o- 1 J xlp �A nil ©v0o0 �8�aX My Commission Expires: 8 ** *** ******** ***** * *:* **xis: ; ****************:********************************** ** * * ** *** * ** * * *** ** * ** * * ******* APPROVED BY Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk NOV -16 -2012 09:30 RUSTIN INSURANCE 1 561 222 2018 P.01/01 A p�ry� i•� CERTIFICATE OF LIABILITY INSURANCE DATE KIMUDD/YYYYI 1ineao 2. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY NY D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS}, AUTHORIZED REPRESENTATIVE Off PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, th$ pollcy(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 Rile certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PR SLICER Austin Insurance Agency, Inc. 1080 E. Indiantown Road Suite 101 Jupiter FL 33477 CONTACT 'Eft, (551) 8274304 AiG. Idol, (581) 222-2018 E -MAIL ADDRESS CUSTOMER ID: iNstatcP4s) AFFORDING COVERAGE NAIL # ..... INSURED Lamanna Plumbing, Inc. 3821 Lawson Blvd, Delray Beach FL 33445 IN$URER A: Capacity Insurance Company INSUR B; Castlepoint Florida Insurance Company _ CLM01002092A INSURER 0: 07101/2015 INSURER D: $ INSURER E: P EB ( oeeau gr,ca) INSURER F: 100,000 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES QF 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 11115 CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS QF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. *r. r TYPE OF INSURANCE 1r,.: INSR -.I . - WED POLICY NUMBER .,.7f - a M • ...W,A1 MM10 LIMITS A GENERAL V LIABIU Y COMMERCIAL GENERAL LIABILITY !CLAIMS -MADE III OCCUR CLM01002092A 07701/2012 07101/2015 EACH OCCURRENCE $ 1,000,000 P EB ( oeeau gr,ca) $ 100,000 MED EXP (Any one person) 5 5,000 GEN'L PERSONAL & AOV INJURY $ 1,000,000 GENERAL AGGREGATE s $ 2,000,000 2,000,000 AGGREGATE LIMIT APPLIES — POLICY ECT' PER: LOC PRODUCTS - COMP/OP AGO AUTOMOBILE — — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) 5 BODILY INJURY (Par aceidont) 5 PROPERTY {PeraccidenDAMAG6 t) 5 5 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE - EACH OCCURRENCE 3 AGGREGATE $ DEDUCTIBLE I RETENTION $� 5 $ WORKERS COMPENSATION AND EMPLUYERS' LIABILITY Y 1 N ANY PROPRIET0RIPARTNERlEXEGUTIVE oFFice IMEMBEN EXCLUDED? (Mandatory In NH) II 8, IP1i N Oltlar DESCRIPTION OF OPERATIONS below N! A WCP784330902 0710112012 07/0112015 if WO STATU- OTH- V TORY LIMITS . _ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA $ '100,000 E,L, DISEASE +POLICY LIMIT $ • 500r000 !LOCATIONS 1 VEHICLES . .. s—<., (Attach AcORD 101, Add►U4nal Remarks scheduia, vra.w if mere apace *.++— is required) "mss. - -... -. . DESCRIPTION OF OPERATIONS Miami Shores Building Department 10050 NE Second Avenue Miami Shares FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED PCuCIES BE CANCELLED BEFORE Tit ExPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AtrraCtvoza0 REPRESENTATiVS Austin Insurance Agency -- Andrea Sanford t)at 1988 -2009 AC RD CORPORATION. All right reserved. ..,-_ • 'r,ra ..�e.....�.J 1 - -- ...,.....a..a.....a ...,.r4.. w! AtY1Dl1 TOTAL P.01 CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 LAMANNA, GREGORY LAMANNA PLUMBING INC 3821 LOWSON BLVD DELRAY BEACH FL 33445 : ongratulationsl With this license you become one of the nearly one million 9oridians licensed by the Department of Business and Professional Regulation. Dur professionals and businesses range from architects to yacht brokers, from )oxers to barbeque restaurants, and they keep Florida's economy strong. =very day we work to improve the way we do business in order to serve you better. or information about our services, please log onto www.myflorldalicense.conL (here you can find more information about our divisions and the regulations that mpact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: license Efficiently, Regulate Fairly. We onstantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487 -1395 DOCUMENF HMI COLO ED BACKGROUND • MICIROPRuNT, I;I2O514006 DATE BATCH NUMBER CENSER' RECIORED. Oct. 15. 2012 $:28AN1 Tax Collector Dointown Branch ANNE M. A ti t7 [ P.O, Box 3353, West Palm Beach. FL 33402.3353 CORSTVJTIQNAiT*XCOMM$ wonv.texcollecttrpb tmTet {561)355 -2272 ierrieg Paha Roza County TVPEO? HUSINE98 � 23-0✓�8 Pightorn v COI *A T R OWNER LA MAIVHAUCE0011, This document is valid billy when recelt►tad by the Tax Collerotor.' Mice. LA MANNA PLUMBING INC LA MANNA PLUMBING INC 3821 LOWSON $LVID DELRAY BEACH, EL 33445 -5848 : 1linnrllTrlulrinnt�l .l�.l11�s1iunllnllnl+ No. 5122 "LOCAreo AT'* 3821 LOWSON BLVD DELRAY BEACH. FL 33445 C E R T I P t C A 1 I O N 4. 1 RECE1FE Q ATE Ma 1 Azar Pam 1 a u CfCt42982a StL410242•CT105ne 4 $227.9. a4 2t2 STATE OF FLORIDA PALM BEACH COUNTY 201212013 LOCAL. BUSINESS TAX RECEIPT LBTR. Number: 200012020 EXPIRES: SEPTEMBER 30.2013 This receipt does not oon 1i1uIe a trams. agreement, permission of authority to perform the services or operate the business described herein when a franchise, agreement or other county commission. state or federal permission of authority is required by county. state of federal taw.