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CC-13-1818 p r , fit 2 6, i PY d 3 Miami Shores Village -:�_,(_�_Z Building Department NUV 0 8 2013 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BY:=4P INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No.e'e_ Permit Type: PLUMBING JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcelk Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): v(.( � Phonek Address: City: zAiState: Zip: .3I3 l3 Tenant/Lessee Name: Phonek Email: CONTRACTOR:Company Name: king's Plumbing Service, Inc Phonek 305-625-5450 Address: 14050 NW 6 CT City North Miami State: Florida zip. 33168 Qualifier Name: Diener Kenneth S. Phone#: 786-251-9810 State Certification or Registration#: CFC 1428219 Certificate of Competency#: Contact Phonek ,e . Email Address: kpsmiami@yahoo.com DESIGNER:Architect/Engineer: Phonek Value of Work for this Permit:$ 7, Sk' Square/Linear Footage of Work: Type of Work: ❑Address {Iteration UNew ❑Repair/Replace ❑Demolition Description of Work: gmova 610A3' xxxxxxxx�x��axu��xnxx�xx�xx�Feesxx�uxxxxxx�xxx�x��x�xx��xx�nxn��xxx�x��x� 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 raen. a certified copy of the recorded notice of commencement must be posted at the job site for the first tnspe hick occurs s ven (7) s after the building permit is issued. In the absence of such posted notice, the inspection wil t be prove a r nspection will be charged Signature Signature Owner or Agent Contractor 4-4-- The foregoing instrument was acknowledged before me this ko — The foregoing instrument was acknowledged before me this 6 day of dqVern6e,;20 l 3,by `Fiegarvt 1-4c day day of November ,20—,by Diener Kenneth who isCpersonally known�o me or who has produced who is personally known to 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: 4- �� Sl ►�- Print: D.-GfI IqL o Print: Luis Barias My Commission Expires: OLGA ALVARADO My Commission Exp' p my Co1w>ti11ss1ON a FF056162 LUIS BARIAS E"1M: �2017 MY MEScoMMIS ctobION# 4,201 37 or EXPIRES:October 04,2017 APPROVED BY /'3 Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) STATE COF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC1428219 ` The PLUMBING CONTRACTOR .� Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 DIENER, KENNETH S T KING'S PLUMBING..SERVICExINC - - M�; "- - 14050 NW 6TH CT- NORTH T NORTH MIAMI FL 3316.8 VIVA` - A fI09I05Q0. RICK SCOTT ISSUED: 08/15/2013 SEQ# L1308150001982 KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY City of North Miami 776 N.E.125 Street • North Miami, FL 33161 305-893-6511 TH MIAMI Business Tax Receipt/Certificate of Use Issued Date: 10/1/2013 PLUMBING CONTRACTOR Expiration Date: 9/30/2014 Business Tax Receipt#: BT-000931 Business Name/Address: KINGS PLUMBING SERVICE INC - 14050 NW 6 CT---- KINGS PLUMBING SERVICE NORTH MIAMI, FL 33168 KINGS PLUMBING SERVICE INC 14050 NW 6 CT Michael A.Etienne,Esquire,City Clerk NORTH MIAMI, FL 33168 OR SOLD. NON-TRANSFERABLE POST INA CONSPICUOUS PLACE • NON-TRANSFERABLE MMl A CERTIFICATE OF LIABILITY INSURANCE DA„i,06,209°3'"/' 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 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 CONTACT Xamet Barreras Temax Insurance Inc PHONE(AIC No �86)539.5989 FAX (305)356-1235 7990 SW 117 AveE-MAIL AppgEs&, xamet@temaxinsurance.com Suite 113 INSURERS AFFORDING COVERAGE NAIC# Miami FL 33183 INSULA: Capacity Insurance Company INSURED INSURER B Kings Plumbing Service,Inc INSURER C: 14050 NW 6 Ct INSURER D: INSURER E: Miami FL 33168 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED nQw $ 100,000 CLAIMS-MADE FIOCCUR MED EXP(Any oneperson) $ 5,000 A CLM01001065B 2/12/2013 2/12/2014 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT'APPLIESPER: PRODUCTS-COMP-OPAGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY CO(EaMBIaccNED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALLOMED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS $ UMBRELLA.LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION $ WORKERS COMPENSATION we STATU- OTH- AND EMPLOYERS LIABILITY YIN ITOR ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? F-1 N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOY $ ' d”' describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 1(1,Additional Remarks Schedule,If more space is required) Plumbing Contractors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 Ave ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988 2010 ACORD CORPORATION.All rights reserved.. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i�ack.' sa ` CERTIFICATE OF LIABILITY INSURANCE X0/03/20133°'�' 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 policy(les)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 CONTACT Paychex insurance Agency Inc E. PAYCHEX INSURANCE AGENCY,INC. PHONE FAX 150 SAWGRASS DRIVE . 877-266-6850 . 585-389-7426 ROCHESTER,NY 14620 E-MAILESS. Certs@paychex.com AD R INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NorGUARD Insurance Company 31470 KINGS PLUMBING SERVICE INC INSURER B: 14050 NW 6 CT NORTH MIAMI,FL 33168 INSURER C: 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. INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MWDDNYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CCLAIMS-MADE[�OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PEWLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG' POLICY =PROJECT='LOC $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ^_]ANY AUTO (Ee accident) ALL OWNED � BODILY INJURY * I SCHEDULED (Per person) $ Auros ^AUTOS NRpwNEo BODILY INJURY HIRED AUTOS I�A OS (Per accident) $ !� PROPERTY DAMAGE $ (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ ' WORKERS COMPENSATION AND X WCSTATU OTH- EMPLOYERS'LIABIUTY KIWC422009 05/09/2013 05/09!2014 E.L.EACH ACCIDENT $ 100,000.00 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERINIEMBER EXCLUDED9E.L.DISEASE-EA EMPLOYEE $ 100,000.00 In NH) -YIN- (Mandatory N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yes,describe under ti 1=11N QF 11PPRATICINR 1,11— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If 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 ACCORDANCE WITH THE POLICY MIAMI SHORES VILLAGE BLDG DEPT PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 10050 NE 2ND AVE LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE -)'71 ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 003352 Local Business Tax Receipt a Miami-Dade`County, State of FloridaLB THIS IS NOT A BILL-DO NOT PAY � �7 MM 5637831 �/ BUSINESS NAME/LOCATION RECEIPT NO EXPIRES KINGS PLUMBING SERVICE INC RENEWAL SEPTEMBER:30, 2014, 14050 NW 6 CT !6880894 Must be displayed at place of business ; NORTH MIAMITL 33168 Pursuant to County Code . Chapter 8A—Art.9&10- OWNER, SEC.TYPE OF BUSINESS PAYMENT FlL EIVED KINGS PLUMBING SERVICE INC 196 PLUMBING CONTRACTOR BYTA:X,0114�CT slt CFC142821$ Worker(s) 8 $45.001 .. 3 60 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Rer"ipt OR permit,ora certification of the holders qualifications,to do business.Bolder must comply ,ssemetttal or nongovernmental regulatory laws and requirements which apply to the business The RECEIPT NO.above must be displayed'on all commercial vehicles, MI R de,"ipc ea 276.- For more information,visit www'min