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PL-16-206 Permit NO. PL-1-16-206 `geORES Miami Shores Village Permit Type.Plumbing-Residential 10050 N.E.2nd Avenue NW ' Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Pen "tPermit Status:APPROVED Phone: (305)795-2204 FLORIDA Issue Date:2/8/2016 r Expiration: 08/06/2016 Project Address Parcel Number Applicant 13 NW 108 Street 1121360110310 Miami Shores, FL 33168-4311 Block: Lot: READ HOLDINGS LLC A - Owner Information Address Phone Cell READ HOLDINGS LLC 3850 BIRD Road MIAMI FL 33146- 3850 BIRD Road MIAMI FL 33146- Contractor(s) Phone Cell Phone Valuation: $ 5,000.00 RJ QUALITY PLUMBING CORP (954)919-8382 Total Sq Feet: 0 Type of Work:PLUMBING FOR REMODELING OF TWO BATH Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 DBPR FeeInvoice# PL-1-16-58449 $3.38 DCA Fee $3.38 02/08/2016 Credit Card $ 192.76 $50.00 Education Surcharge $1.00 01/26/2016 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 r Technology Fee $4.00 Total: $242.76 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 for ity it the plans,drawings, statements or specifications submitted to the prof er authorities of Miami Shores Village. In accepting this permit I ass e e on i'y for all work done by either myself, my agent,, servants, or employes I understand that separate permits are required for ELECTRICA L N , CHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI I cert ' t t the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo i g fou er r I authorize the above-named contractor to do the work stated. / February 08, 2016 Autho z ignature.Owner / Applicant / Contractor / Agent Date Building � epartment Copy February 08,2016 1 Miami Shores Village REC. Building Department JAN 26 Z 16 _ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY'- _ -_ �J INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (q BUILDING Master Permit No.V_( .I�; rZ81 PERMIT APPLICATION Sub Permit No. —pj(� —2_6k ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 7 JOB ADDRESS: J At W) I VE S, City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Ty Flood Zone: BFE: 1�"5-FFEE: OWNER: Name(Fee Simple Ti lehol ): 4 S Phone#:3D5 3yn6 f Address:.�Os� City: 0�''*A State: F1 Zip: a�j!v 4 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: U 1AV Phone#: Addr s: City: State: FI. zip: Qualifier Name: //�� `' �] Phone#: _L✓Y�I I' D o� State Certification or Reg stration#: l:F' , 1 Y�A Certificate of Competency#: DESIGNER:Architect/Engineer: T� Phone#: Address: ,�R.�,1 City: State: Zip: �-� Value of Work for this Permit:$ .�,UUV1u V Square/Linear Footage of Work: Type of Work: ❑ Ad ition Alteration ❑ New ,Repair/Replace ❑ Demolition Description of Work: Sped 016t of:co/or thru tile".• ..�� � .�� Submittal Fee$ y� , Permit Fee$ 22. "= CCF$ �p CO/CC$ Scanning Fee$ r�� Radon Fee$ �''✓" y DBPR$ ' �O Notary$ Technology Fee$ _y Training/Education Fee$ 1 ` C'o Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address T 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. Signatur ' Signature O NER or AG T NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this d,'5day of \QnLr Y!J 20 ) ( by a,,�day of 20 / 6 by eCA-0,2 �00450 bl0vho is personally known to 2A y ✓C=C J-4C-AS who is personally known to me or who has produced Y1Ve I Ce-I Q 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: /✓1e*1 60 G Print: p'• � DAB.PANDO :•. . Notary Public-State of Florida Seal- Comm.SUNENCOW�ZO Seal: '• ` :• My Comm.Expires Sep 14,2016 *: MY COMMISSION N EE 874940 = , `o`•' Commission#r EE 832218 ,.; EXPIRES:April 14,2017 %°,`„`,� ' Banded Through National Notary Assn. ........ f. Bonded Thru Notary Pudic Ur&fw ere ********** *** ************************************************************************************* APPROVED BY �.,.. / Z� I� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) t i RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, ; CONSTRUCTION INDUSTRY LICENSING BOARD CFC1427987 The PLUMBING CONTRACTOR V Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 JACAS, RAYVEL J-•..- ,u RJ QUALITY PLUMBING CORP 8416 NW 103RD ST #105 HIALEAH GARDENS FL 33016 ■ ISSUED: 05/18/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405180001231 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY L B Ir 64888$6 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES RJ QUALITY PLUMBING CORP RENEWAL SEPTEMBER 30, 2t}16 8416 NW 103 ST APT 105 6758818 HIALEAH GARDENS, FL 33016 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art,9& 10 OWNER SEC.TYPE OF BUSINESS RJ QUALITY PLUMBING-CORPPAYMENT RECEIVED.. 196 PLUMBING- BY TAX COLLECTOR I' CONTRACTOR WW y rkegs) 1' CFC1427987 45:100 09.124/2015 0229-15-000 352 w F This Local Business Tax Receipt only confinees payment of the local Business Tax.The Asceipiis a lktae,_ V permit,ore certification o!the holders qualifications,to do business.Holder must comply wide a y'loverar w"W F or nonBw+enmentai regulatory laws and repuiremant=which apply to the bvsinms The kwpT N0.abeam must be displayed on all camarcial velecin Mismit-Dade Cods 30e;>W-27T,, � r MIAMI For more inlorrntliion,visit mid Scanned by CamScanner �+ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01120/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SOUTH FL COMMERCIAL INSURANCE PHONE(AIr No 305 819-861$ FAx C.Nola 305 819-2543 15165 NW 77 AVENUE#1004 E-MAIL MIAMI LAKES FL 33014 INSURERS AFFORDING COVERAGE NAIC# INSURERA: SCOTTSDALE INSURANCE COMPANY 41297 INSURED INSURER B: RJ QUALITY PLUMBING CORP INSURER C: 6170 NW 173RD STREET,#434 INSURER D: HIALEAH FL 33015 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 ADDL SUB POLICY EFF POLICY EXP LTR I=JIM POLICY NUMBER MMI YI (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CLAIMS-MADE 7 OCCUR CPS1879907 10/01/2015 10/01/2016 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 2,000,000 X POLICY PIFr.T F-1 RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I RETENTION $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N ARY I IMITR ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) COMMERCIAL AND RESIDENTIAL PLUMBING CONTRACTORS State License Number:CFC1427987 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE <OV> MACNEILL GROUP INC ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD nc R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) l 01/20/2016 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 NAME: Sarai Medina Emmanuel Insurance&Associates,Inc. VHCONN Ell: (305)693 0003 n/c,No): (305)691-4381 2370 E 8TH AVE E-MAIL ADDRESS: sarai@emmanuelinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# HIALEAH FL 33013-4236 INSURER A: RetailFirst Insurance Company 10700 INSURED INSURERS: RJ QUALITY PLUMBING,CORP INSURERC: RAYVEL JACAS INSURER D: 8416 NW 103 St#105 INSURER E: Hialeah Gardens FI 33016. 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/MY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PE� LOC $ AUTOMOBILE LIABILITYC Me B.1 SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBER EXCLUDED? ❑ N/A Y 0520-45605 09/01/2015 09/01/2016 (Mandatory in NH)and E.L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Plumbing Contractor. Any Changes or alterations Done to this document after being issued shall constitute it null and void. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL,33138 AUTHORIZED REPRESENTATIVE Sa�.ao ZY�aciiit2 @ 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD