PL-15-2303 (2) Miami Shores Village
MF7
Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 5 f
FBC 201 L( pyo
BUILDING Master Permit No. 'RC- tS 2Z l I
PERMIT APPLICATION Sub Permit No.FL i S- 236 3
[-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�j CONTRACTOR DRAWINGS
JOB ADDRESS:_6"y /V lJ
City: Miami Shores 3l��'
County: Miami Dade Zip:
Folio/Parcel#: oa 3 -DD 1//0o Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):_ zm o S 7'7f GSGd Phone#: 34:6 -216 fiAW
Address:_f'oy �w ?97% ,S
City: Jptrynl Sl-nr"e_ S State: fi�_ zip: 33 ISO
Tenant/Lessee Name: Phone#:
Email: Q �� CSS lzZ . Cam
CONTRACTOR:Company Name: �i/l I2 to1c1(_7zzz j Phone#: �r 211q,*0
Address: ?5S,5" 4�
City:Wim) State: 77- Zip:
Qualifier Name: Thom 0 S "T • &-`we i' Phone#: e3(!<2 2q-g11zP1
State Certification or Registration M_CFtT(}2, Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: ��,�,,�� -7 City: State: Zip:
Value of Work for this Permit:$ 75'-� � . /S� Square/Linear Footage of Work: �00 S
Type of Work: ❑ Addition nn❑ Alteration ❑ New R[ Repair/Replace ❑ Demolition
Description of Work: p��,r, ,r-��"CA2L-4 �&O�jinn G(r-1sl/'e
Specify color of color thru tile:
Submittal Fee$ �V�o Permit Fee$ 7, 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.
7 Signature x Signa ure
OWNER or AGENT Wentwas
The foregoing instrument was acknowledged before me this The foregoged before me this
—rte day of Q 9 20 1 S by /04
day Ir O 20 � by
I YX�rr-- .S TC 6CP ,who is personally known to /yX.1 J-60l,/a who is personally known to
me or who has produced 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: Sign:
Print: Print
CHRISTINA MARIE FARIAS ► ,;'� CHRISTINA MARIE FARIAS
Seal: ^, *_ Commission#FF 897808 Seal: �; *? Commission#FF 897808
M ya ,_My Commission Expires
Y Commission Ex Expires
March 12, 2018 March 12, 2018
************************************************************************************************************
APPROVED BY `/•2-3-6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET {850) 487-1395
TALLAHASSEE FL 32399-0783
GOWEN,THOMAS J
ELITE PLUMBING SEPTIC& SEWER INC
1800 46TH AVENUE
VERO BEACH FL 32966
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation Our professionals and businesses range
from architects to yacht brokers,from boxers to barbeque restaurants, � '�`- STATE OF FLORIDA
and they keep Florida's economy strong. DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to
serve you better. For information about our services,please log onto CFCfl226fl2 ISSUED: 08113/2414
www.myfloridalicense.com There you can find more information
about our divisions and the regulations that impact you,subscribe CERTIFIED PLUMBING CONTRACTOR
to department newsletters and learn more about the Departments GOWEN,THOMAS J
initiatives. ELITE PLUMBING SEPTIC&SEWER INC
Our mission at the Department is: License Efficiently, Regulate Fairly,
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulationsonyournewl:cense! Is cErzrrFiea under the prnvi9 orsa c# Ch 499 FS
E■�.,rarcnae:P AUG31 I�t+� Lta0p13J�[lt505
DETACH HERE
RICK SCOTT,GOVERNOR
KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
• � -t �1
CFCO22602
The PLUMBING
,ON I f
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
GOWEN. THOMAS J Q
ELITE PLUMBING SEPTIC &SEWER INC
7555 SW 38TH STREET_
MIAMI FL 33155
ISSUED. 0811W014 DISPLAY AS REQUIRED BY LAW SEQ# .1-1408130=566
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
7159247 tLRT
BUSINESS NAMEILOCATION RECEIPT NO.
ELITE PLUMBING SEPTIC&SEWER INC RENEWAL EXPIRES
7555 SW 38 ST 7436524 SEPTEMBER 30, 2015
MIAMI FL 33155 Must be displayed at place of business
Pursuant to County Code
Chapter BA-Art,9&10
OWNER SEC.TYPE OF BUSINESS
ELITE PLUMBING SEPTIC&SEWER INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED
Worker(s) 1 CFCO22602 BY TAX COLLECTOR
$75.00 07/22/2014
CHECK21-14-030154
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license.
permit ora certification of the bolder's qualifications,to do business. Molder most comply with any govemmetrcaI
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above most be displayed on all commercial vehicles-Miami-Dada Code Sec sa-276.
For more information,visit www,mipV da e.nov[taxcoilector
W2612
Local Business Tax Receipt
_., ,Miami Dade County, State of Florida
-THIS IS NOTA BILL - OO NOT PAY
7159247
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
ELITE PLUMBING SEPTIC$SEWER INC RENEWAL SEPTEMBER 30, 2016
7555 SW 38 ST 74361£24 Must be displayed at place of business
MIAMI FL 33155 Pursuant to County Code
Chapter BA-ArL 9&10
OWNER SEC.TYPE OP BUSINESS
ELITE PLUMBING SEPTIC&SEWER INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED
CFCO22602 By TAX COLLECTOR
Worker(s) i $75.00 08/19/2015
CREDITCARD-15-041560
This local Business Tax Receipt ugly confirms payment of the Local Business Tax The Receipt is nal a license,
permit erg cettification of the holders qualifications,to do business.Holdetmust comply with any soveremsntal
or noggovarametdal repalatory lava and re"immeats which apply to the business.
The RECEIPT N0.above most he displayed on all commercial vehicles-Miami-Dade Code sec fie-M.
For more information,visit www miamidade.govMxcollector
•4►c a' CERTIFICATE OF LI _
ABILITY INSURANCE
IS rREPPREESE
TEFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER?THIS
H isATE DOES NOT AFF(RMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED T THE POLICIES
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTiUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
NTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
NT: H the ceo f the o hOMer Is an ADDITIONAL INSURED,the polcy(ies)mustbeendorsed, N SUBROGATION IS WAIVED,aub)oct to the
end conditions of the poilcy,certain policies may require an endorsement. A statement on this certificate does not confer rights�the
certificate holder In Neu 0f such endorsements)
PRODUCER
BORBOLLA INSURANCE AGENCIES NAME: NATALIA
324 SEVILLA AVENUE,SUITE 202 E-MAIL ak
CORAL GABLES,FL 33134 Ag
CAlCEDO@AEJ STA1'E.f:t)M_..,.,....�.._..,,.._..._
INSURED COVERAGE wueN
ELITE PLUMBING SEPTIC AND SEWER INSURERA SCO DALE INSURAtNCE COMPANY
7566 SW 38TH STREET INSURER e LL ATE INSURANCE COMPANY
MIAMI,FL 33156 Me,
INSURER D
INSURER E• — -- -
COVERAGES CERTIFICATE NUMBER: SMURERF,
THIS IS TO CERTIFY THAT THNG ANY E POUClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMIED AB252!711R THE POLICY PERIOD
CERTIFICATE MAY ISSUE DI O MAYEPERT�. IN� EONDDFTION�OF ANY ED BY THE CONTRACT
TR EOR OTHER S DESCRIBED MERMEN IS SUBJECT 70
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UM1TS SEIRAN MAY HAVE BEEN REDUCED BY PAID DESCRIBED
WITH RESPECT TO WHICH THIS
wsR ALL THE TERMS,
TrreDPRmrRAHCEAtM
ME-
A GEt1ERALLtABiLitY bIB1�
X COMMERCIAL GENERAL DUTY �y�`' CPS2006680 08127/2015 ��w
t
CLAIMS4UIDE Q ac" i"_t a.S
5,000
ERSONAL i ADV INJURY =
GENLAGGREGATE UMR APRA$PER GENERAL AGGREGATE f 2.000,00p
POUCY LAC STB-COMPIOPAGO f
B AUTOMOBILE L mm" f
000
ANYAUTO 648670876 0826t241S 0628!2018
COMBINED
BISLW
ulOV �DA1OX $
1000.O0
SODILYr UL RY(per prw S
X SCWDULEDAUfOS BODILYB"my(Pr 9 f
MREDAUTOS (PROPERTYOMAAGE f
X NON-01M OAUTOS
1MMtREi LA LIM OCCUR f
exeeur.w OArM=.MADEEAWoccuRrREwcE i
DEDUCTIBLE F r AGGREGATEANDEMPLOYeW _
TNM4
s
YAaLLRY
ANY YIN p
rO"ICEERRAIE1M8E�RyEcMUOM 4VIAF SlfZ1CLYlTI
kYK�MablbI,utder E.L EACH ACCI NT f
E.L EA MMPI f
EL DrSEASE-pOLICY UMR =
[C7ontractor
OF OPERATIONS!LOCATIONS/Vp1lCtis tAldeh ACORD 101,AddWOM Remarks
TE HOLDER IS LISTED AS ADDITIONAL INSURED
'd"I It monsp.e,b
icence CFG022602
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHARES VILLAGE BUILDING DEPARTMENT =MOULD ANY OF THE ABOVE
EXPIRATION DATE THEREOF.HOME LED CANCELLED
10050 NE 2ND AVENUE M R p BEFORE THE
POUCYPROVISIOHB ACCORDANCE VATH THE
MIAMI SHORES,FL33138 _
AUTN
A"�.
AC ORD 25(2009t09) `
�`'19 -2009 ACORD CORPORATION. Al!rights reserved.
The ACORD_name and 1090 are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE _
DATEtMMroD/rYYYl
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 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 certiAcab holder is art ADDIT70NAL INSURED,tho poligr(1es)must t»endorsed.ff SUBROGATION IS WAIVED,subject to
the term and conditions of the policy,CuMn policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In Hsu of such endorsement(s).
►RODUCER 7AB
CT
BIA d Company P CafCedo
— –_`—
(788 458-1400 FAX ""
320 Sevilla Ave Suite 201 ! No• 86)458-1410
ss-recOPUO�iaandooxom _
Coral Gables ......—--AFFORDING COYERAea t NM s
FL 33134 PMRErtA: CASTLEPOINT INS CO.
INSURED -i
ELITE PLUMBING SEPTIC A SEWER INC t s
7555 SW 38TH STREET elsuRERc:
INSURER D:
MIAMI suUR6R a
FL 33155 INSURER F:
COVERAGES CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED NUMBER,
FOR THE POLICY PERI00
INDICATED:NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC
IN.
CERTIFICATE MAY BE ISSUED OR MAY PERTATHE INSURANCE AFFORDED BY THE POLICIES DESCUMENT WITH RESPECT TO WHICH THIS
RIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAN CLAIMS.
JI TYPE o►OAR —^---
r imm
POLICY NUMB cotter��v"3`Dcr^oT'
COMMERCIAL GENERAL LIASILtry ��-_.A LIMITS
❑ �DAI7�t�TO 6 S
aAIMs MADE OCCUR
PREMISES(FLS. $
j MED 0(P N(�ans�pwam
$
0MPRO-
AGGREGATE LIMIT APPLIES PER:
II rER3pNAL a ADV NJURv s
POLICY (''�� GENE PAL AGGREGATE
OTHER:
i
❑ I�Loc
ER: PRODUCTS.COMP/ AGO s
AUTOMOBILE LIABILITY I It
ANY AUTO ;
I
AAU70OWNED 3 SCMgijLED BODILY Will ft Person) 't
## ngN�oIVNED BODILY bUURY Aper eodeN,ll s
HOtEDAUTOa t AUTOS
7'e
S
YMBRELU UAB OCCUR i
110=33 LIAR CLAIMS•MAtl tRENCE S
OED RETENTION AGGREGATE _ $
WORKERS COMPEHSATIMI S
AND EImLDYERe�LIABILITY Y I N
._ ER
A OFFICERMEMI AW ER EXCLUDED? y MIA A
(Mrbafey in wo ❑ TWC3430392 �10/31/2014 10/31/2015 E1.EACH ACCIDENT Is 1.000,000
mDISEASE-F.A
d OPERATIONSbelar
er
al _ EMPLOYEES 1,000,
D Ob0
E L t)13E/iSE-noLICY LOrR f 1.000 000
OF
SCItlPTiON OF OPERATKINS/LOCATIONS/
YElet:Lae(ACORD'101.AddE1wW Rrnrlp .My be alhcMd N wars
Contractor Licence CFG022602 •paee k Mcill
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ASOyE DESCRIBED POLICIES BE CANCELI.EO BEFORE
THE Ee
REOF, NOTICE WILL BE DELIVERED W
MINI Shores Village ACCORY PROVIaN)NB
Building Department
10050 NE 2nd AVENUE AurI1oR¢Warm Shores,FL 33138
ACORD 25(2014101) The ACORD name and I o sn ORD CO O TION.All rights reserved.
og ngistered marks of ACORD
OR
�SNNc rEs G
.•-�- g " � Miami
Shores
Village
0 910 9 p
°`� Building Department
l
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
CONTRACTORS' REGISTRATION Fax: (305) 756.8972
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE* _
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADS COUNTY CERTIFICATE OF COMPETENCY:
A• COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME:
BUSINESS ADDRESS:
► STATE F ZIP_
BUSINESS PHONE: � LI y --LJj L-� 1 FAX NUMBER( v c l
CELL PHONE( i QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: