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PL-17-298 ,. F"' 1v --;-17-298 - $ �--; Miami Shores Village ��� 4TPlumbing + twill i ` 10050 N.E.2nd Avenue NE 2 t �_Gta atm tAltit Miami Shores,FL 33138-0000 . Phone: (305)795 2204 Pp �t a'd`a PPROVE01,;;, R'40R1DA ��� Issue 217120 Expiration: 08/06/2017 Project Address Parcel Number Applicant 1036 NE 95 Street 1132050120060 Miami Shores, FL 33138- Block: Lot: DANIEL JORGE AGUTAR Owner Information Address Phone Cell DANIEL JORGE AGUTAR 1036 NE 95 Street (786)797-4041 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 300.00 DIAL PLUMBING CORP (305)221-8569 (786)412-6720 Total Sq Feet: 0 Type of Work:INSTALL FAUCET AND DISHWASHER AND W Available Inspections: Type of Piping: Inspection Type: Additional Info:INSTALL FAUCET AND DISHWASHER AND W Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# PL-2-17-62846 $2.00 02/06/2017 Credit Card $50.00 $58.60 DCA Fee $2.00 Education Surcharge $0.20 02/07/2017 Credit Card $58.60 $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 do the work stated. February 07,2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 07, 2017 1 r - + Miami Shores Village Building Department FEB r01' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F BC 20 10 BUILDING Master Permit No. 1`7— (67 PERMIT APPLICATION Sub Permit No. P 11_� - z CM ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �y� `CONTRACTOR DRAWINGS JOB ADDRESS: 10;3(, M(o tJ'►r�7 City Miami Shores County: Miami Dade Zip: 93 13 Folio/Parcel#: X 3 zcxs�— ®I ?_o 00 6 O Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ^( u �tI Phone#: Address: pp f 03b AfF ? City: KIcim 1 l)V cwxe State: RL Zip: /3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 1J Phone#: p� Address: Q1,% �S'v City: li-N ySCNN A Apte: Zip: Qualifier Name: Phone#: ` State Certification or Registration#: ! I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ goo Square/Linear Footage of Work: Type of Work: ❑ Addition . ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: , arLv_ CV14 1**JakVP iA Si A ua:.4- Specify color of color thru tile: Submittal Fee$ Permit Fee$ / ® 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) M � A 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 ail 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 ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature r Signature OWNER or AGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 36AVAN 120 1'7 by t� day of _�SC►rku604 ,20 by 06Ai6 AQLA &J who is personally known to �j( C ttco hk¢.�°� ,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: Si� g Miter -late• " C IST COSTAS print: Print: ' Commisslon+p FF 954327 t rii;i�iuri�t n tJ has Seal: �,'g , ,•r Ny Comm.Expires Apr 6,2020 Seal: .•;�" , 'g �" ::° ,o, Notary Public Siete u'Flontla ���, IhrtwptrNr►elNelsr>rAan, Commission # FF 954327 My Comm.Expires Apr 6,2020 APPROVED BY `L �� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ® ' DATE(MM/DD/YYYY) Ac�o!zDCERTIFICATE OF LIABILITY INSURANCE 02/02/2017 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 Barbra Gonzalez Rodriguez Tadeo Insurance Agency Inc M.Extl: (305)553-1760 ac No): (305)553-1762 8201 SW 24 st ADDRESS: tadeoinsurance@live.com INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33155 INSURERA: GRANADA INSURANCE COMPANY 16870 INSURED INSURER B: DIAL PLUMBING CORP INSURER C: 9940 SW 22 STREET INSURER 0: INSURER E: Miami FL 33165 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 L S B POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD/YYYY MWDDMIYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1-1 OCCUR PREMISES Ea occurrencel occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 0185FL00061941-2 08/15/2016 08/15/2017 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ O JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NO OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE EH R ANY PROPRIETOR/PARTNER/EXECUTIVE F7 NIA/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 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 if more space is required) Plumbing Contractor CFC license#1499207 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.Second Avenue AUTHORIZED REPRESENTATIVE Miami Shores,Florida 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ' �► Miami shores Building Department L� o�e 0050 N.E.2nd Avenue �L0R1pA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner ® workers' Compensation Insurance Exemption 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: 1. 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 part--time employees or subcontractors I'm you p-rojeet The--contractor-has-provided-an a#-davi"tating-that-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 7 The foregoing was acknowledge before me this day of Feb-,20 f / . By DQni t.1 hmickirwho is personally known to me or has produced as identification. Notary: Notary Pudic-State of Florida SEAL: ;. Commission#F FF 954327 s, My Comm.Expires Apr 8,2020 ' `' Sanded Mro*NatioaatNotay Asan. Dial Plumbing Corp 9940 SW 22nd St, Miami FL 33165 2/6/2017 State of Florida County of Miami Dade Before me this day personally appeared 6SC6 !�A who, being duly sworn,deposes and says: The he or she will be the only person working on the project located at 1036 NE 95 Street, Miami Shores, FL 33138 Sworn to (or affirmed)and subscribed before me this VI day of .2017, by Perso uYn_ OR Produced Identification Type of Identification Produced N Print,Type or Stamp Name of Notary CHRISTOPHER COSTAS Hetary Puellc-State o1 FloNdta Commission I FF 950327 r MY Comm.Expl►es Apr 6.2020 Bold tNougA I+►�►atl�tsry Assn.