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DEMO-16-2569 06 Miami Shores Village 1 t3tTC*Type Demo 10050 N.E.2nd Avenue NEUM, Plumbing_ Miami Shores,FL 33138-0000 Phone: (305)795-2204 > Pe Stag A P t ED. Issue Date. 10125/2016' Expiration: 04/23/2017 Project Address Parcel Number Applicant 29 NE 95 Street 1132060130690 Miami Shores, FL 33138- Block: Lot: DEUTSCHE BANK NATIONAL TF Owner Information Address Phone Cell i DEUTSCHE BANK NATIONAL TR CO --- - - -- - - --- .._..._ . . - FL 1661 WORTHINGTON Road WEST PALM BEACH FL 33409- Contractor(s) Phone Cell Phone Valuation: $ 300.00 ENTERPRISE PLUMBING INC (772)341-9992 Total Sq Feet: 0 Type of Demo:Plumbing Available Inspections: Additional Info:DEMO PLUMBING FIXTURES/CAP OFF PIPE Inspection Type: Classification:Residential Final Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-9-16-61376 DBPR Fee $2.00 10/25/2016 Check#:1208 $58.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 09/16/2016 Check#:1184 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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. Futhermore,I authorize the above-named contractor to the ork stated. October 25,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 25,2016 1 • � Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ��' �P � 6 016 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20( L4 BUILDING Master Permit No. d//i(0��9 PERMIT APPLICATION Sub Permit NoT�0 (b' 2CSG9 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION Ej RENEWAL [APLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 29 NE 95th st City: Miami Shores County: Miami Dade Zia: Folio/Parcel#:11-3206-013-0690 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Deutsche Bank National TR Phone#: Address: 1661 Worthhington RD#100 City: WPB State: FL Zip: 33409 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Fri- prlor�o-_e � rnloin Phone#: �'�lTZ-�41 -'q99 2,, -19 X50 ��oA� �'�� City: 61- � . 1_L.Ir.le State: FL_ Zip: _34q 53 Qualifier Name: henne-Ah alr,rri C Phone#: State Certification or Registration#: CFL I!i221(n-1 S Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition Description of Work: ,►_� C�So cs�a9®oVtv�a G�g��r _� i ap SCI iPEP_; Specify color of color fhru tile: Submittal Fee$ _Permit Fee$ ®0 ' CCF$_ coo CO/Cc$ Scanning Fee$ Radon Fee$ 2- DBPR$ 21 Notary$ Technology Fee$ 8 Training/Education Fee$ ' Z (0 Double Fee$ ®� Structural Reviews$ Bond$ ®G� TOTAL FEE NOW DUE$ O V (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. Signature Signature M�La G ► 1[� OWNER AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 day of 20�(�J by 1.3 day of LliFpE ,20 1(0 , by C hn,-An pher &- L;Qrwho is personally known to Kp nP1P1 mbrn S who is personally known to me or o as produce _6&_Zas me r who has producec fl i b as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: �Zc Print: Print: i ` MRICY C410819 �� Seal: _ _ &S�OF181185 Seal: D�UKE&: Oft. 4. 2018 I1'1811" WM Da 4, 2018 �AAADIMOTAAY.�M � •`` wYYYU.AO,RQB`t'AIM) ��. APPROVED BY Plans Examiner Zoning /1e2A Structural Review Clerk (Revised02/24/2014) y�0S Al son "no Miami shores Village y� Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION 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 DADE 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. maammavammvemvmmmmvvavvmavavmvmmavmmmmvaevmvmamvvmvvmmmmmvvmavmammmmvvamvmvvmmvmmmmmvamamae BUSINESS NAME: n�-ernr � t� .y,h►�� BUSINESS ADDRESS: 441 91.1 iahvlc�ri CITY Pr} SF, Ili_STATE j( ZIP 34963 BUSINESS PHONE: ( 7-7?-_) 341-919R 2 FAX NUMBER(_) CELL PHONE(—_) QUALIFIER'S NAME: 6naA nnnrri 5 QUALIFIER'S LIC NUMBER: C,FC l ll- 1 1 S a " "=i►i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1427675 I tSSUED: 07/04/2016 CERTIFIED PLUMING CONTRACTOR MORRIS, KENNETH LLOYD ENTERPRISE PLUMBINGEINC-' IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31.2018 L160704OW1579 'CHRIS CRAFT ` TAX COLLECTOR 2016 - 2017 S A L U C 6 E C C T Y St. Lucie County Local Business Tax Receipt Facilities or machines # Rooms # Seats # Employees #1 Receipt #1012814 Type of business 1711 AIR COND/PLUMBING CONTRACTOR Expires SEPTEMBER 30, 2017 (Plumbing Only) DBA name Enterprise Plumbing Inc Business Kenneth Morris Mailing address: Kenneth Morris Business location: 4473 SW Babylon St 4473 SW Babylon St Port St Lucie, FL 34953 Port St Lucie, FL 34953 RENEWAL City of Pt St Lucie CFC1427675 Original tax: $12.35 3420-660-0421-000/4 P06000019428 Penalty: Collection cost: Paid 09/06/2016 12.35 0130-20160906-002210 Total: $12.35 Law requires this Local Business Tax Receipt to be displayed conspicuously at the place of business in such a manner that it can be open to the view of the public and subject to inspection by all duly authorized officers of the county. Upon failure to do so,the local business taxpayer shall be subject to the payment of another Local Business Tax for the same business, profession or occupation. Pursuant to Florida law, all Local Business Tax Receipts shall be sold by the Tax Collector beginning July 1 of each year and shall expire on September 30 of the succeeding year.Those Local Business Tax Receipts renewed beginning October 1 shall be delinquent and subject to a delinquency penalty of 10 percent for the month of October. An additional 5 percent penalty for each month of delinquency Is added until paid, provided that the total delinquency penalty shall not exceed 25 percent of the Local Business Tax for the delinquent establishment. In addition to the penalty,the Tax Collector is entitled to a collection fee of$1 to$5.This fee is based on the amount of Local Business Tax, which will be collected from delinquent taxpayers after September 30 of the business year. This receipt is a Local Business Tax only. It does not permit the local business taxpayer to violate any existing regulatory or zoning laws of the state, county or city. It also does not exempt the local business taxpayer from any other taxes, licenses or permits that may be required by law. Pursuant to Florida law, Local Business Taxes are subject to change. Kenneth Morris 4473 SW Babylon St Port St Lucie, FL 34953 A09/112/2018�®® CERTIFICATE OF LIABILITY INSURANCE DATE( 2/2016 Y) 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 polky(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 We" Le Ile Desbiens Great Florida Insurance Port St Lucie &W y . (772)398-2333 FIAIC.NO: (772)398-3444 787 S.E.Port St.Lune Blvd Rm; sl®greattlorida.com INSURERS)AFFORDING COVERAGE NAIC 0 Port St Lucie FL 34984 INSURERA: SCOTTSDALE INSURANCE INSURED INSURER B: ENTERPRISE PLUMBING INC INSURERC: 4473 SW Babylon St INSURER D: INSURER E: Port St Lude FL 34953 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. LTR TYPE OF INSURANCE POLICY NUMBER 10 F CY LmaTs X COMMERCIAL.GENERAL LIABILITY EACH OCCURRENCE S 1.000.000 DAMAGE TO RENTMF— CCLAIMSWWE ❑OCCUR PREMISES $ 100,000 MED EXP one parson S 5,000 A CPS2430357 04/24/2016 04/24/2017 PERSONAL BADVINJURY s 1,000,000 GEN'L AGGREGATE LMT APPLIES PER: GENERAL AGGREGATE s 2,000,000 X POLICY❑JJEEC¢T ❑LOC PRODUCTS•COMPlOP AGO $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY Bao S LIMLT $ ANY AUTO BODILY INJURY(Per person) $ ALS D SCHEDULED BODILY BODILY INJURY(Pereis NOMNED P r Tirt0AMA0 HIREDAUTOS AUTOS UMBRELLALIAR OCCUREACH OCCURRENCEEXCESSLI1B CLAIMS�MADE AGGREGATE DED RETENTIONS $ WORium COMPENSATION TA EOR AND EMPLOYERS'LIABILITY VIN ANY PROPRIETOR(PARiNERfEXECUTIVE ❑N!A E.L.EACH ACCIDENT S OFFICERMWASER EXCLUDED? (Mm,detmy In NH) EL DISEASE-EA EMPLOY $ DE>3GRId POTION OF OPERATIONS below EL DISEASE-POLICY LpNIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddB *nW Remw1w Schedule,mey be nWched N more space M required) LICENSE NUMBER CFC1427675 PLUMBING RESIDENTIAL S DOMESTIC COMMERCIAL&INDUSTRIAL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICDS BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES,FL 33138 AtRHOR¢ED REPRESENTATIVE ®198 8-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 'a JEFF A1'WATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 7/17/2015 EXPIRATION DATE: 7/16/2017 PERSON: MORRIS KENNETH FEIN: 043843489 BUSINESS NAME AND ADDRESS: ENTERPRISE PLUMBING INC 4473 SW BABYLON STREET PORT ST LUCIE FL 34953 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13).F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the caitificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 e 5g0 �r AIR se.. �enMowliami shores ills e Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner workers, Compensation Insurance Exernption 777 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. I. 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 before me this�_day of�� 20�. BY ��nr►S"�"oo��p Ln�; who is personal' own to me or has produ F t as identification. Notary: ¢� &my Calm SEAL: p► ON/FFt811� ��: Dec. 4. IIOt9