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PL-16-1592 s � Miami Shores VillageRItll 10050 N.E.2nd Avenue NE ' Work la �� W AR" ' Miami Shores,FL 33138 0000 Ne� "� k�• I-ffi€ Phone: (305)795-2204 e1ta�AP�RQ�t3 Expiration: 01/14/2017 Project Address Parcel Number Applicant 10433 NE 6 Avenue 1122310120180 Miami Shores, FL Block: Lot: CAROL INVEST USA INC Owner Information Address Phone Cell CAROL INVEST USA INC 990 BISCAYNE Boulevard MIAMI FL 33132- 990 BISCAYNE Boulevard MIAMI FL 33132- Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 J&J DAVIS PLUMBING SERVICE INC (954)680-6543 Total Sq Feet: 63 Type of Work:INSTALL 2 LAVS,1 TOILET, 1 BIDET A 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 $2.40 Invoice# PL-6-16-60114 DBPR Fee $3.38 07/18/2016 Credit Card $ 191.16 $50.00 DCA Fee $3.38 Education Surcharge $0.80 06/08/2016 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $241.16 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 accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F e ore,I authorize the above-named contractor to do the work stated. July 18, 2016 Au ignature:Owner / Applicant / Contractor / Agent Date Buildleg Department Copy July 18,2016 1 Miami Shores Village ° Building e artment JU 082016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 lis BUILDING Master Permit No. (o— IJP I PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL FX-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10433 NE 6 Ave City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: 11-2231-012-0180 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Carol Invest, USA Phone#: Address: 990 Biscayne Blvd. City: Miami state: Florida zip: 33132 Tenant/Lessee Name. Phone#: Email: CONTRACTOR:Company Name: J &J Davis Plumbing Phone#: (9 54) 680-6543 Address: 5101 S.W. 111th.Terr. city: Davie State: Florida zip: 33328 Qualifier Name: John Davis Phone#: (954) 680-6543 State Certification or Registration#: CFC 057602 Certificate of Competency#: DESIGNER:Architect/Engineer: Victor Bruce Phone#: (305)310-5030 Address: 370 N.E. 101 St. city: Miami Shores State: FI. Zip: 33138 Value of Work for this Permit:$ 4,000 Square/Linear Footage of Work: 63 Sq. Ft. Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work. Install 2 lays 1 toilet 1 bidet. 1 shower Specify color of color thru tile: Submittal Fee$ �-OZ) Permit Fee$ �� CCF$ off,. 1 u CO/CC$ LI Scanning Fee$ 3-6-z� ____ Radon Fee$ Z�DBPRR�$ 3. r Notary$ Technology Fee$ 2, (�� Training/Education Fee$ 1 1. C� Double Fee$_ (2)Structural Reviews$ X' Bond$ G /� TOTAL FEE NOW DUE$ (Rev1sed02/24/2014) 411 Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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. Carol Invart TA, finc. eSignature Davi Plumb' g Signature WNER or AGENT ' CONTRACTOR The foregoing instrument was acknowledged before me this m n was ac nowledged before me this —74" day of J0I-� 20 I(D by 20 by Ca► i0, I�1CX�YCa who is personally known totn�frD isersonallyknown 7;°' ��"o��, me or who has produced as me or who has produced as w ,qO4••'.'CO,. identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: m n 3 Sign: Sign: vi Z Print: L.U� 10 C4 L�0I S) Print: � N '* Z n S Seat: g o a' ! � `° a� LUCIA G ISASI w '1.. JQ MY COMMISSION#FF182828 �'• (407)3980153 F{pridaNptery APPROVED BY -Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICE1VSiNG BOARD (850)487-1395 A� 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DAVIS, JOHN WALLACE J&J DAVIS PLUMBING SERVICE INC 5101 SW 111TH TERRACE DAVIE FL 33328 Congm 'T"ons. ais tce� me onelion Florihesed orrre�ofitlrc nearly _. __._. _ by Department of Business and - Professional Regulation. Our professionals and businesses range - SA-E�017. 0 �q:;' from architects to yacht brokers,from boxers to barbeque restaurants, and they keep Florida's economy strong. ".DEPAI ." s SIN€SS AIVI3 ..PRD • tJtATION- . - Every day we work to improve the way we do business in order to CF£05-7602 , .f5F201 .. serve you better. For Information about our services,please log onto M . www.myfloridalicerme.com. There you can find more information r-crr= about our divisions and the regulations that impact you,subscribe to department newsletters and learn more about the Departments IriltlatlV@s. J DAV4S'P 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, kS.e trtF rz" exxse�YoV.Isiens of 488-ES and congratulations on your new license! x ;_V�zpt date- AU�•31 29'18 �" . _. L�4tl8�001236 ' .- ,�. ..-'=._a.. :fir.'.�, _,.-�.,.,.•-•.� :-.,,,••- - ... :: ..... . . DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY DE E A> I iY#J!l�t�N _ �;�11tS _ - Nept''ti,@101ATta:L'`Ef�TaFkE© - _:•-a -�. , Ug]d6 #fie avrsion -ba 489 FS. .6tpi'cafio>"f.da� AFJG�1-s°301_F•-µ: " ,� _ _. 'rte'`�.''`.'b+"�•..�.+..it`.m1'--'•`�L�� '.,.ti'"'.`.". a ,.. " `1.�1 °+, 4+.�°,� qy 5� ■ .�F,.�.dam! ~• ^`P+ � ,`�'y `�'•1 � •r` '� 4 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 3-3301-1895—954831-4000 VALID OCTOBER 1,2015 THROUGH ScPTEMBER 30,2016 DBA: Receipt#:182-83 7 Business Name:J & J DAVIS PLUMBING SERVICE INC Business Type: SPRNKL/CONTRA OF ype:(PLUMBING CONTR) Owner Name:JOHN W DAVIS Business Opened:o5/03/2000 Business Location:5101 SW 111 TERR State/County/Cert/Reg:cFC057602 DAVIE Exemption Code: Business Phone:954-981-3666 Rooms Seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid _ .27.00 0-0.04. . ._.._ _.: -n oQ 0.40 ._ 0.00 _.. 0 QO 27.00 M7 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning t4 WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when i• the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and 4 p regulations. ;.. Mailing Address: JOHN W DAVIS Receipt #ICP-14-00019801 5101 SW 111 TERR Paid 08/04/2015 27.00 DAVIE, FL 33328 { 2015 - 2016 JUDAVI-01 ZGONZALEZ ACOR/fl�° CERTIFICATE OF LIABILITY INSURANCE FDATE(MY1/) 5127/120201YY16 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 CApAATE CT Zoraida Gonzalez Collinsworth,Alter,Fowler&French,LLC PHONE 305 822-7800 FAX 8000 Governors Square Blvd ac No Eml:( ) A/c No):(305 362-2443 Suite 301 E-MAIL z onzal caffllc.com ADOREss: 9 �@ Miami Lakes,FL 33016 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Gemini Insurance Company 10833 INSURED INSURER B:Philadelphia Indemnity Ins Co 18058 J&J Davis Plumbing Service,Inc. INSURER C:Scottsdale Insurance Company 41297 5101 SW 111th Terrace INSURER D:Brldgefield Employers Ins Co 10701 Davie,FL 33328 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 S POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER D WDD UBBTS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMSMADE 1XI OCCUR VIPG017083 09/14/2015 09/14/2016 PREMISES Ea occurrence $ 50,00 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY FX]E T E] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO PHPK1393348 09/14/2015 09/14/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ XX NON-OWNED PRBOaPE�RdTYMDAMAGE $ HIRED AUTOS AUTOS X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,00 C EXCESS LIAR CLAIMS-MADE XBS0055622 09/14/2015 09/14/2016 AGGREGATE $ 4,000,00 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN ER Y f N D ANY PROPRIETOR/PARTNER/EXECUTIVE 063054430 04/05/2016 04/05/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 "r describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Plumbing and Gas;CFC057602 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 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD