PL-16-514Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253550 Permit Number: PL -2-16-514
Scheduled Inspection Date: October 24, 2016
Inspector: Hernandez, Rafael
Owner: DAIDONE, GLENN
Job Address: 339 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: D & D PLUMBING CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (305)788-2711
Parcel Number 1132060135360
Phone: 305-379-0516
Building Department Comments
2 TOILETS, 3 LAVATORIES, 2 SHOWERS, 1 WATER
HEATER, 14 WASHING MACHINE, 1 SINK
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
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Horida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
City:T'
Folio/Parcel#:
Occupancy Type:
FBC 20M ti
Master Permit No. P --C-1 S '" 3 alio
Sub Permit No. PLS (o — 514
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Shores County:
Miami Dade Zip:
j l —3zc -01`3 --c 3Gto
Load:
OWNER: Name (Fee
Simple Titleholder):
Address: .0 l ci9 Sfr
ill f
City: av,m State:
Tenant/Lessee Name: Phone#:
Email:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone:
(eAuti
BFE:
1 35
NO
FFE:
c_ Zip: 3315S'
"1" S �/ ) 0S -14 -,)CONTRACTOR: Company Name: `-
C , Phone#: US
Address:
City: ,/4 Vi'k) / - State: r -Z_ Zip: �_ �G/
Qualifier Name: '-- 7A -J `T D Ixe__ , / Phone#:
Y'�
State Certification or Registration #: rl yZ ' /7.S Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �-7 . / City: State: Zip:
Value of Work for this Permit: $ /7 `� 93 Square/Linear Footage of Work:
Type of Work:
ri Addition r,ZLiklteration ❑ New n Repair/Replace ❑ Demolition
st —Q [ urr- i (/ TO (i
2 t i 1,w)'S-K/J s
Description of Work:
JA/A0-((/ 6_
Specify color of color thru tile:
Submittal Fee $ TO • 03 Permit Fee $ 3P0 ' e� CCF $ ► CO/CC $
Ifj
Scanning Fee $ 34C) Radon Fee $ 1 sa DBPR $ 4,5-0 Notary $
6
Technology Fee $ .�� p
v Training/Education Fee $ I • 60 Double Fee $
Structural Reviews $ V Bond $
5-6V
(Revised02/24/2014)
go
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. 1 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 b
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement
for the first inspection which occurs seven (7) days after the building permit is issued. in th
inspection will not be approved and a reinspection fee will be charged.
Signature //-
ONVNER or AGENT
The foregoing instrument was acknowledgedlebefore me this
day of at7L" ( 20 ILS ,by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Si n•
Print:
elivered to the person
be posted at the job site
such posted notice, the
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
0--- by
ersonally known
day of
PF) n a
A -b.)
as e-or.who has produced _ as
identification and who did take an oath.
NOTARY PUBLIC:
S
IL..
v}t a Notary Public State of Rondar. Joanna M Feliciano
My Commission FF 082753
o ° Expires 0111212018
Sign:
Print:
Seal:
atitv.rpk. ALICIA L YANDAMA
gt, _•
11 MY COMMISSION # FF 024555;
.....4a,: E, 201 /
48f,th`' BondedThruNotaryPublcUndXPIRES: October19envrders
#+R#################i##########4#########R###:k#**** kfr##3#########i############i####*ki#######t#####DRi##K#####
APPROVED BY
(RevisedO2/24/2014)
Z ZS —L ,41ans Examiner Zoning
Structural Review
Clerk
• -,
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNVYY)
11/30/15
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 DR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lithe certificate holder Is an ADDITIONAL INSURED, the polIcy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subiect to
the terms and conditions of the policy, certain pofides may require an endorsement A statement on thls certificate does not confer rights to the
certificate holder in lieu of such endorsements).
PRODUCER
Accurate
8300 West Flagler Suite 114
Miami, FL 33144
Phone (305)226-8727 Fax (305)226-8767
7 Cp�
NAMEACT Lucia Estrella
Wm pol, (305)226.8727 1Mac. Not: (305)226.8767
ADORESS q>CkleMn31100000Sou0tnet
NURs) AFFORDING COVERAGE
RAC e
LIMITS
INSURER A : United States Liability Insurance Comp
INSURED
Co d D Plumbing Corp
3890 NW 2 Terrace
Miami, FL 33126 (305) 979-0516
INSURER B :
Y
INSURER C:
11/26/2015
INSURER O
EACH OCCURRENCg
INSE:
DAMAGE TO RENTED
Ma 1
INSURER F :
EXP (Any one person)
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 CLAIMS.
VP
TYPE OF INSURANCE
MIAMML
POLICY NUMBER
yyBYFPAID
/MMI DKD EYY1Fn
OIBP AAWYYY�YYI
LIMITS
A
GENERALWABIUTY
® COMMERCIAL GEVERAL UABLITY
• 0 CLAIMS -MADE ® OCCUR
0
Y
Y
CL167g197AMED
11/26/2015
11/26/2016
EACH OCCURRENCg
S 1,000.000.00
DAMAGE TO RENTED
Ma 1
s 5,000.00
EXP (Any one person)
$ 100,000.00
PERSONAL aACV INJURY
S 1,000,000.00
•
GENERAL AGGREGATE
$ 1,000,000.00
GENT. AGGREGATELIMITAPPLIES PER
❑ POLICY ❑ /ECT • LOC
PRODUCTS - COMP/OP AGG
S 1,000,000.00
3
AUTOMOBILE LABILITY
• ANY AUTO
❑ ALL AOWNED • SCHOSULED
❑ HIRED AUTOS ❑AUT O
0 0
EZVitSlNGLE LIMIT
f
BODILY INJURY (Per person)
S
BOOBY INJURY (P• swam)
S
Per sac elACE
S
S
w UMBRELLA UAB 0 Occ11R
EACH OCCURRENCE
S
❑ BXCPSS UAB • CLAIMfrMAOE
AGGREGATE
S
• DED 0 RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY Y / N
PROPRIETOR/PARTNER/EXECUTIVE
ARTEXCLUDED?
Y
Y
WCV01600510-0O
11/26/2015
11/26/2018
❑ T� GARS ❑ ER
EL EACH ACCIDENT
S 1,000,000.00
(M yeeensed,etery N NH) ®
0Rdesattm
OESCR LoderOF OPERATIONS below
EL DISEASE -EA EMPLOYEES
1,000,000.00
EL DISEASE - POLICY UMR
$ 1,000,000.00
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (AMB ACORD 101, Additional Remarks Sahsdule, I mon space is regrind)
State Plumbing Contractor
CFC 1426173
CERTIFICATE HOLDER
Miami Shores Village Building Department
10050 NE 2nd Avenue
Miami Shores, FL 33138
SHOULD ANY OF THE AB
THE EXPIRATION DATE
ACCORDANCEWITH ;?
POUCIES BE CANCEL.ED BEFORE
WILL BE DELIVERED Rd
ONS.
ACORD 25 (2010/05) QF
01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -2-16-514
Permit Type: Plumbing - Residential
work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 3/11/2016
Expiration: 09/07/2016
Parcel Number
Applicant
339 NE 100 Street
Miami Shores, FL
1132060135360
Block: Lot:
GLENN DAIDONE
Owner Information
Address
Phone
Cell
GLENN DAIDONE
54 NE 97 Street
MIAMI SHORES FL 33138-2331
(305)788-2711
54 NE 97 Street
MIAMI SHORES FL 33138-2331
Contractor(s)
OZ CONSTRUCTION SERVICES GROL
Phone CeII Phone
(786)467-7200 (305)216-0236
Valuation:
Total Sq Feet:
$ 7,450.00
0
Type of Work: 2 TOILETS, 3 LAVATORIES, 2 SHOWERS,
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.80
$4.50
$4.50
$1.60
$5.00
$300.00
$3.00
$6.40
$329.80
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -2-16-58811
02/24/2016 Credit Card $ 50.00 $ 279.80
03/11/2016 Credit Card $ 279.80 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is - u =te and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -name • •ng ..r to do the work stated.
March 11, 2016
Authorized Signature: Owner / Applicant / r • t ac : / Agent
Building Department Copy
Date
March 11, 2016
1