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REV-16-2927 ` Miami Shores Village RECEIVE-0 27 ?,11`; Building Department ,ee- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 SPECN�IAt HF�ONE NUMBER:(305)762-4949 FBC 2014 BUILDING I :IIa$ter ermit No.r�C�^-q) /2'►`.� 3I.�� PERMIT APPLICATION u Permit No. PDyM(o `�L`4— ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ;IPLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS:-9301 N -D( City: Miami Shores County: Miami Dade Zip: 3.513 9 Folio/Parcel#: 0— ' 20S-ND—0560 Is the Building Historically Designated:Yes NO >,- Occupancy Occupancy Type: Load: Construction Type: Flood Zone: BFE:��/ FFE: OWNER:Name(Fee Simple Titleholder): �'1(�� ��� � t io l LkAI aV0&�Phone#: �1S b �J� 9� PG Address: "13Q i N e?cAms�o rQ, 9 K City: &A, cw 1 cy)orts State: F11 Zip: `J S)JOE Tenant/Lessee Name: Phone#: Email: N CONTRACTOR:Company3AW Trey� 4 N Name: , Phone#:�5A) Address:_ '___20nS� 5&a)bA-, ` 5T 332QuCity: P� h(&K- PlW State: '- Zip: 3 3352— Qualifier alifier Name: "� —TD70 p Phone#: State Certification or Registration#:OFLJ q2$9p`i 1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��d Square/Linear Footage of Work: Type of Work: ❑ Addition N Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1S10/\ tp r 1 XMbin , CLQ pig( )4414 ci Specify color of color thru tile: Submittal Fee$ Permit Fee$ � Ll CCF$ I 7- CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ z- Notary$ ler Technology Fee$ jQ Training/Education Fee$ + Double Fee$ 101 Structural Reviews$ Bond$ llew TOTAL FEE NOW DUE$ (Revised02/24/2014) 4 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. _Iltul �— Signature V Signature , 1 ' Uewa"s ER or AGENT CONTRACTOR The foregoing instacknowledged before me this The foregoing instrument was acknowledged before me this day fof 0C+1 120 10 by 11151 day of (��9�Qir '20 )( by whois personal"ly�known to C�UbQ,1(�b c I� —,who is personally known to me or ho has produced � D✓l �^' as me or who has produced PUSQAaUo tAlaA)'1as identification and who did take an oat . identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: pp Si Print: W li S) Print: t � 'i'•,, ANA LUCIA SIERRA � �"i'' ANA LUCIA SSIERRA : Seal: ,•;�: Seal: .. MY COMMISSION#FF 224104 MY COMMISSION#FF 224104 a EXPIRES:April 23,2019 EXPIRES:April 23,2019 '�od d` Bonded Thru Not Public o:V,° Bonded Th.Notary Public Undernriten Wary Undemriters APPROVED BY l —Z✓ V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) x STATE OF FLORIDA J DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 TOTH, ROBERTO CARLOS BENJAMIN FRANKLIN PLUMBING -WESTON 17814 NW 74 COURT HIALEAH FL 33015 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 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbequeDEPARTMENT OF BUSINESS AND restaurants, and they keep Florida's economy strong. ' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CFC1428899 ISSUED: 08/14/2016 to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more CERTIFIED PLUMBING CONTRACTOR information about our divisions and the regulations that impact TOTH, ROBERTO CARLOS you, subscribe to department newsletters and learn more about BENJAMIN FRANKL.IN.PLUMBING-WESTO the Department's initiatives. 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, IS CERTIFIED'under the provisions of Ch 489 FS. and congratulations on your new license! Expu.non date AUG 3,,sore C16W140W3456 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �I. CFC1428899 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 TOTH, ROBERTO CARLOS BENJAMIN.FRANKLIN PLUMBING-WESTON 20956 SHERIDAN'ST FORT LAUDERDALE FL 33332-2311 — e 1GCI IFf) n8/14/2016 DISPLAI AS REQUIRED BY LAW ' SEQ# L1608140003456 MEP HOME SERVICES, LLC./BENJAMIN FRANKLIN PLUMBING 20956 SHERIDAN STREET FT. LAUDERDALE FL 33332 CITY OF PEMBROKE PINES 10100 PINES BOULEVARD, PEMBROKE PINES, FL 33026 LOCAL BUSINESS TAX RECEIPT -7 E 2'017 -A:C�861�� =26 3'4 0 1'- RECEIPT�YEAR:�zOCT08E)�-17, -2016 thru,SEPTEMBER 3 :RECEIPT-4ZOT-1:64-484- z. 13 NAME-,,:---MEP; ROME 896ICES, -LLC./BENJAMIN 'FRANKLIN PI;UMBINGI'n,--,thi',-6ve�h't--t�h-e-"b�iu!sii-,6:§'� -iss�46� the-receipt FT 'LAUDERDALE EL; receipt �rap L qpange��:,�ianci�7, z null-1-and.-void-An oplA6at3.6 n6w--rece3. p;�.must' e made:._ BI CTOR RECEIPT TYPE: REGULAR -LICENSE ]3i�SiNE§§'-CUSiiFICATI - -z- 6�TS E:E'FECTtVE'--',-EFFECTIVE_.,-PiPl4IT-�'NUi-tEjR/COMIAENTS,.-RCT-TYPE`l.I ON- -CPL , CONTRACTC- R PLUMBER-- —0 -10/01-/2 016� P/P fines 'SIGN BUSINESS SIGN- !L2olh2df6-- --- P%Eines:.. 7 Z 7:, % �e Z Z� z f -z— :3 4: 7� 7�1 z zz Slt AC ® DATE(MM/DD/YY" CERTIFICATE OF LIABILITY INSURANCE 8/30/2016 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(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 Wilson,Washburn&Forster Insurance PHONE FAX 16505 NW 13th Ave .305-666-6636 .305-662-7778 Miami FL 33169 E-MAIL .certificates@wwfins.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:WESCO Insurance Company 25011 INSURED MEPHO-1 INSURER B: MEP Home Services INSURER C: dba Ben Franklin Plumbing INSURER D: 20956 Sheridan Street Fort Lauderdale FL 33332INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1978168703 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 rypE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM DD MM DD A X COMMERCIAL GENERAL LIABILITY WPP1400868-01 8/20/2016 8/20/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR DAMAGE (RENTED PREMISESS Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JECT POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY I I $ Ea accident ANY AUTO BODILY INJURY(Per person) $ AUTOS NED AUTOSULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) License#CFC1428899 CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village FL 33138 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) 05/11/2016 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(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 NAME: FAX Automatic Data Processing Insurance Agency,Inc. PHCNNo Ext): A/C,No): 1 Adp Boulevard E-MAADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Retail First Insurance Company 10700 INSURED INSURER B: BENJAMIN FRANKLIN PLUMBING-WESTON DBA Benjamin Franklin Plumbing-Weston INSURER C: 20956 Sheridan St INSURER D: Fort Lauderdale,FL 33332 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 489729 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 INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F�OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F—]JECTPRO ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? -1 N/A N 0520-50465 04/20/2016 04/20/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contractor License:CFC1428899 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Building Departrment ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Ne 2nd Ave. Miami,FL 33138 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD