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PL-15-2303 Miami Shores Village RECF,IVED Building Department MAR 0 . 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 01 Tel:(305)795-2204 Fax:(305)756-8972 7"Y: INSPECTION LINE PHONE NUMBER:(305)762-4949 wu -- FnBC 2014 S BUILDING Master Permit No. 45-- 22�y PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 2PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS >Q CHANGE OF ❑ CANCELLATION ❑ SHOP L CONTRACTOR DRAWINGS JOB ADDRESS: �!F N•u. 99 S7 City: Miami Shores County: Miami Dade Zip: o Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: /6y OWNER:Name(Fee Simple Titleholder): /0n4 GP I/Qy'fy Phone#: 3,0-5--2 (( -. Address: 64 ✓V•�.� 9 9 sf City: S; cry State: 1-7 Zi p: 3 3 Tenant/Lessee Name: Phone#: Email: /�// //� LL CONTRACTOR:Company Name: Srd& 1�` ,,14�1r/o C�c�lrc,c�o/ LL C Phone#: _?'©S 322 -2 g4Z Address:" City: //�� State: �l Zip: 3.3' /8 Qualifier Name: S esz;.t aL4 hil Phone#: State Certification or Registration#: Certificate of Competency#: G.FG 11.4-2 9(06 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ . o o d Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Xa Repair/Replace ❑ Demolition Description of Work: f «. elr u ' Z u Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 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 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. Signaf� ture 1 �� Signature 19• //da-14 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �C Q day of ( ,20 /6 by L� day of fi�-b .20 by jFyca who is personally known to _&nfj: (7 {LJf 3 J\Jo vale/ ,who is personally known to me or who has produced /tiff as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC:) NOTARY PUBLIC: Sign:-Zi 2 Sign: _ (t*Rk� 4a- 1-1'Print: Print: .s Seal: """ JENNIFER MORALES Seal: " ""' ,,.��a„�8,, �p,..ro,�,, CHRISTINA MARIE FARIAS •°��= Commission s FF 77775 =� Commission q FF 897808 og My Commission Expires � *° My Commission Expires December 18, 20173Nr�or�„d;;o� March 12, 2018 ******* ************************ ********* APPROVED BY SU� 7`16o Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) . TE LESCO CONSTRUCTION Feb 9,2016 / ` ✓ '� Elite Plumbing Septic& Sewer Inc 01, P Moises Ferro, President , 7555 SW 38TH ST sent via overnight mail/return receipt Miami, FL 33155 . 'g4 Sub: Change of Contractor Re: 64 NW 99TH ST; Miami Shores,FL Moises, As discussed,we are terminating our plumbing agreement with you, including the plumbing permit you have pulled and is currently open for 64 NW 99TH ST, Miami Shores.The sanitary rough-in you installed for the washing machine is installed level and has no pitch,which is required by code and necessary to drain the sanitary line to the septic tank and field beyond. Because of this,we have to remove and replace this work to comply with code and have a working system.We thank you for your help but we are going to finish this work with another plumbing contractor since the work you performed is unsatisfactory and has to be re-done. Truly Yours, TELESCO CONSTRUCTION CO INC Tom Telesco q4 President Cc: File JENNIFER MORALES +° Commission M FF 77775 Y R. Q a My Commission Expires ...... December 18, 2017 1111 Kane Concourse,Ste 303,Bay Harbor,FL 33154■T 305-390-0250•F 305-390-0251 FecEx 0 February 23,2016 Dear Customer: The following is the proof-of-delivery for tracking number 775608365949. Delivery Information: Status: Delivered Delivered to: Residence Signed for by. T.HWANG Delivery location: 7555 SW 38TH ST MIAMI,FL 33155 Service type: FedEx Priority Overnight Delivery date: Feb 10,2016 12:27 Special Handling: Deliver Weekday Residential Delivery Direct Signature Required r f h .. Shipping Information: Tracking number. 775608365949 Ship date: Feb 9,2016 Recipient: Shipper. Moises Ferro Tom Telesco Elite Plumbing Septic&Sewer Inc 1111 Kane Concourse,Suite 303 7555 SW 38th St Bay Harbor Island,FL 33154 US MIAMI, FL 33155 US Thank you for choosing FedEx. ♦SNOcRES r'�t Miami shores Village 11111111011 1111111" Building Department -�-IViezlo-00 an 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. cii✓ 6 ` at Owner's Name (Fee Simple Title Holder): 1/�Q,`Q C——0 Phone#: ,�b/ �✓` Owner's Addr(�ss: fie z flap f City:. s dr �, cT— State Zip Code: 1 / Job Address (Of where work is being done): City: Miami Shores State:—Florida Zip Code: 32 t 576 Contractor's Company Name: I'f �n Phone#: -3a5-- -?2 .7--Z24--z Address: City: State: Zip Code: 3s,(8 Qualifier's Name : S' psz v,u u s�/c3/c�► Lic. Number: C i=c fLF.? a 6 Architect/ Engineer of Record ame(d IRy1�a�V� CM t 44C Phone#: f sq" � Address: C! ?fi` 4vi, '+ftt.3 C. City: yawit $ State: r4 Zip Code: 3 33 Describe Work:-96V(4 1tK")r4f f-1 rZ10C- ( ki Id'o 4 5'1-A Kt-.4ar ,cl" e a C�ci a/ er' ji vC !h ,es - l hereby cert'�fy that the worWhas een andoned And/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the mi Shores harmless of all legal involvement. Signature I–Signature /I4are.I in Owner or Agent Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrumentwas aknowledged before me this day of 201(,by�7rpaeSCO this o —day of R-c— - , 2016 by,50_0hCt,/a></'t,''II� 911"' Who is personally knownL to me or who has produced who is personally known to me or who has produced N� as indentification. AA4 as indentification. Notary P Notary P Sign: Sign: Seal: Se . " ;,�o;:ar•�.;; JENNIFER MORALES JENNIF==F77 Commission # FF 77775 COnlml °• +_ _.®• ssoc My Commission Expires y'•yrF OF c�.��; My Commpecember 18, 2017 Decem 1 ♦5NORFs r? ..,. ..,.,� Miami Shores Village Building Department ORIDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 ........................................................................................... COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: S !Y) N 10/u-1 BUSINESS ADDRESS: 14k" s• u 12 6 e--� CITY /kl"u.vlj STATE F1 ZIP CODE .33 t s 3� BUSINESS PHONE: (-jos- ) 322 -z Stf 2 FAX NUMBER 096- CELL r9GCELL PHONE 3 22 -2 842 QUALIFIER'S NAME: 4 4PAYly QUALIFIER'S LIC NUMBER: C i c ( �_ 9 o x E-MAIL ADDRESS(IF APPLICABLE): S M�1/>°lurv►,�rho (0 coot • cdw) Created on 3119109 BY MLDV 1 RV 3126109 MLDV ,- - - - - - - - - - - - - -- - - - - - - - - STATE OF FLORIDA PIMPORTANT Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation I DEPARTMENT OF FINANCIAL SERVICES I who elects exemption from this chapter by fling a cerificate or I DIVISION OF WORKERS'COMPENSATION F elect;on under this section may not recover benefits or CONSTRUCTION INDUSTRY EXEMPTION `� �' Ii -0 compensation under this chapter. CERTIFICATE OF ELECTION TO 9E EXEMPT FROM FLORIDA �L Pursuant to Chapter 440.05(12),F.S.,Certifieates of election to 1 ' WORKERS'COMPENSATION LAW i D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: fO/15201S EXPIRATION DATE: 1 011412 01 7 listed on the notice of electron to be exempt. PERSON: NARAIN SEENAUTN M FEIN: 767226707 (H Pursuant to Chapter 440.05(1,3),F.S.,Notices of election to be BUSINESS NAME AND ADDRESS: E exempt and certificates of election to be exempt shall be sub)ectto revocation if,at any y time after the filing of the notice SMN PLUMBING CONTRACTOR LLC E or the issuance of the certificate,the person named on the not or certificate no longer meets the requ:mments of this 7444 SW 128 CT section for Issuarce of a certificate.The department shall revo<e MIAMIa Certificate at any time for failure of the person named on the FL 33183 certificate to meet t'1e requirements of this section. f� SCOPES OF BUSINESS OR TRA 'LICENSED PLUMBING CONTRACTOR — — — - - — — — — -- - — — — — — — — — — — — — — — — — — — — — — — — DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC 1428106 ISSUED: 07/1'/2014 CERTIFIED PLUMBING CONTRACTOR NARAIN, SEENAUTH M SMN PLUMBING CONTRACTOR LIMITED LI IS CERTIFIED under the provisions of Ch.489 FS. Expirat on date AUG 31 2016 1-1407`i0001094 003658 Local Business Tax Receipt Miami-Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY LBT 6992953f_j BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SMN PLUMBING CONTRACTOR LIMITED RENEWAL SEPTEMBER 30, 2016 7444 SW 128 CT 7268527 Must be displayed at place of business MIAMI FL 33183 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS SMN PLUMBING CONTRACTOR LIMITED 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CFC1428106 BY TAX COLLECTOR Worker(s) 1 $75.00 09/24/2015 CREDITCARD-15-049112 This Local Business Tex Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,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 commercial vehicles—Miami—Dade Code Sec 8a-276. For more information,visit www.miamidade.govhaxcollector ACC)RV CERTIFICATE OF LIABILITY INSURANCE 0ti11,"9 g' THIS CERTIFICATE 15 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: M the Certificate holder is an ADDITIONAL INSURED,tha policy(les)must be andomed. If SUBROGATION 13 WAIVED,subject to the terms and conditions of the Policy,certain Policies may require an endorsement. A statement on this certificate don not confer rights to the Certificate holder in lieu of such endorsome s). PRODUCER (866)396-9140 (954)343-5152 WQNTVcT Insurance Medics Insurance Medics P"O"E 866 396-9140 P : 954 -5162 5450 S.State Road 7 ft1L Lou InsuranceMedies.com _ Suite 35 INSU 8 AFFORDING COVERAGE D2v1@ F"3 _14--- INSURERA: 1 INSURED 305-322-2842 INSURERS: SMN PLUMBING CONTRACTOR LIMITED LIABILITY COMPAt INSURERC: 7444 SW 128TH CT. INSURER D: MIAMI,FL 33183 INSURER I_: _ IN F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS-110 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 WHICHTHIS V.RTIFICATE 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. us_RT_,__._ POLI EFF P TYPE OF INSURANCE ma" POLICY NUMBER MN M LIMITS A �GENERALUABILffY EACHOCQIRRFI�ICE $1,000,000 '✓ .COMMERCIAL GENERAL LIABILITY P s 100,000 CLAIMS-MADE❑OCCUR CPP001076"2 11/01/2015 liMI12Dt6 MEDE%P(Anyene mn $6.600 �• PERSONALSAOW1000 $1.000Z00 •' GENERAL AGGR0OGENL AGGREGATE UNIT APPLIES PER: PRODUCTS-COOOO 000POLICYPRLOCAUTOMOBILE LIABLITY fC I D SINGMIT BODILY INJURY ANY AUTOALL ONMED SCHEDULED I BODILY INJURY AUTOS AUTOS •,J HIREDAUTOS AUTOSO ED ROP RTY DAMAGE $ - - I � 'I141MtlRELLA UAB OCCUR I EACHOCCURRENCE f EXCESS UAB CLAIM84ADE AGGREGATE S OED RETENTI e WORKr":COMPENSATION WC.8TATLL _ TH• _... ANQEMPLOYERS LUBILfTY YIN _ -ANY PROPRIETORIPARTrDEWD7 ECUTME a NIA E.L.EACH ACCIDENT S OFFICERMOdBER EXCLUDEIT (Mendsbry h NN) E.L.DISEASE-EA EMKOYEE S .ttppee ONOr'tlesar OEBLIRIPTI OF OPEpA 8 bebw E.L.DISEASE-POLICY OMIT $ OEaCIePTION OF OPERATIONSI LOCATIONS I VE ICLES WUM ACORD 101;AdMio"Pemsrn gOwdul!B mae space Is.,.I sQ/ Plumbers CERTIFICATE HOLDER CANCELLATION lams ores 1 age Building department SHOULD ANY OF THE AWV!DESCRIBED POLICIES BE CANCELLED BEFORE 10050 n.6 2nd ave THE EXPIRATION DAVE THEREDF, NOTICE 1vn1 BE DELIVERED IN Miami Shores,fl 33138. ACCORDANCE WfrH THE POLICY PR01 mms. _ Fax 305756 8972- AUTHORIZED REFRESE,TATNE ®1988-2090 A D CORPORA ON. AN rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Plumbing Contractor, LLC 7444 SW 128th Court Miami,FL 33183 Ph: 305-322-2842 Date: /V" 2 oz Ql State Of /C/"a County Of Dade- Before me on this day personally appeared S-A)A I'H A/OYWI N who being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Sworn to(or affirmed)and subscribed before me this 0? day of /'"(�✓� ,2016, by Personally Known to me Or Produced Identification I- ilo P-4 ilA, elf AA- C-12--de— Type e— Type of Identi 'cation Produced '4� RESN P 8HETH •� •'= MY COM1iAm=N 0 FF936M EXPIRES JWWWY 08.2020 qo���so'sa e°"' Print,Type or Stamp Name of Notary Licensed & Insured-CFC 1428106 Email:smnplumbing@aol.com `SgOREs 'Ile Miami shores Village 111111111v"t .., . Building Department 10050 N.E.2nd Avenue ORiDp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exempt on Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of _,20 . BY � Tele who is personally known to me or has produced as identification. Notary: SEAL: JENNIFER P::�, '7[ SCommissio • empires Dec e m e d, 2 01 7