PL-17-1866 i f it't 3L447-1'47-1 SISI►
snw° y� Miami Shores Village
A"IwOlwe. Olutn6in4-R riflaU
�,. 10050 N.E.2nd Avenue NE
Work CfssOcad6n.AddRion/Alteration
Miami Shores,FL 33138-0000
PefTttt Statin APPROVED
h=e � Phone: (305)795-2204
�'xOR'Nf'
8 /2017 Expiration: 1201
Project Address Parcel Number Applicant
1561 NE 105 Street Number: 2-5 1122300530640
THERESA MOOREHEAD
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
THERESA MOOREHEAD 1561 NE 105 ST#2-5
MIAMI SHORES FL 33138-2115
Contractor(s) Phone Cell Phone Valuation: $ 150.00 '
MARTIN MARTIN RENOVATIONS, INC Total Sq Feet: 15
_. _.
s
Type of Work:REPLACE VALVE WITH DELTA 1400 SERIE Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Underground �JE
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-7-17-64642
DBPR Fee $2'25 07/20/2017 Cash $50.00 $115.10
DCA Fee $2.25
Education Surcharge $0.20 08/09/2017 Cash $ 115.10 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 zon' g. ermore,I authorize the above-named contractor to do the work stated.
��..ve August 09, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
August 09,2017 1
Miami Shores Village RECEIVE®
Building Department JUL 2 017
g p
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
` INSPECTION LINE PHONE NUMBER:(305)762-4949 S
FBC 201 -
BUILDING Master Permit No. P -��S
PERMIT APPLICATION Sub Permit No. VL !-9 — l S
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1.561 A4' )a-1 S-t
City: Miami Shores County: Miami Dade Zip: 3-3/_38
Folio/Parcel#: 11223005306110 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder)7—1,& p
�e5A 1 /0OY f_keacj Phone#:
Address: 156/ Ali 105 5-f
' /
City: 1A/1'd 1 –5A0rL.5 State: �/0'-1 ob Zip: -773131?
Tenant/Lessee Name: Phone#:
Email: �y J �1 �1
CONTRACTOR:Company Name: Y/p��r J1,V I�/A AW 840A V(1 i MAS Phone#: 7 J� 7�� 9
Address: 9956 !VU �7 ier%
City: IQ r 0 1 State: F l o 1 J4 Zip:
Qualifier Name: ®bee- S h 1 ns kk Phone#:
i
State Certification or Registration#: clyG ®5 Ll RG Q Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ /37C) Square/Linear Footage of Work: IS-
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: At0t WA I t?I - 10 Ill- 229-3-4
Magwr RC 14 -zz-�5
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ b CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1
(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.
re h
�—fi"-9-1-*a
Signature Z �, [ Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of S kd 20 J byday of Uzy 120 ( by
))
ho is personally known to Ur who is personally known to
me or who has produced as me or who has produced 5520-36/-y9' y y6- O as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign. Sign:
Print: Kocta1 $ Print: IO /14
Seal: th !''• ROCI®DLA ROSA Seal:
.
MY COMMISSION#GG013348 ROCIO 0 LA ROSA
!� r EXPIRES July 19,2020 a 4` MY COMMISSION#GG013348• - Fyp1p C qe .
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
V131
1
` I
114
Miami Shores Village
Building Department - _---
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 200
BUILDING 'A Permit No�
PERMIT APPLICATION F�OMaster Permit No.A
Permit Type:
JOB ADDRESS: 5I°1 d" l 0T, 5
City: Mi9ami Shores County: Miami Dade Zip:
`
Folio/Parcel#: ' �a30 J ()r,3 C)64 U
Is the Building Historically Designated:Yes` NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): 1 h'ert'stf\ I OU A� PhNn
Address: 60 IV (U5 1A `� _G M- ,
City: jA_t(AK S�LfeS State: Tt Zip: 331
T5nan44essee Name: 7
E �. C
C(SIACTOR:Company Name: �� N' }'� L^Q�Uy/�f��'�S Phone#:
Ad�Z k Q> )O
City rte` State: `L Zip:
c
Qui Name: `�15�` // Phone#:
State Certification or Registration#: ' l7 Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ 150 Square/Linear Footage of Work: le
Type of Work: ❑Addition ❑Alteration /ONew ❑Repair/Replace ❑Demolition
Description of Work:_Place Vfn1y2 DeliOL 14 00 '5ef es
Color thru tile:
Submittal Fee$ Permit Fee$ 15�'�'�"T CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ �� . !V
Alk
K�
i»� ■
�
=
.�
_�
Banding 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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 conimeiucement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th`e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur�t,41 /J-tip / LJC Signature /
Owner or Agent V Contractor
The for i i trimer sack ;ownledgpe'd bef re me this he foregoing ins rumens w�a k e befor met i
day of "`''I- 20 by�rUC/► day of ® 20 was
® r �/�
Y
who is personally known tome or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification an who did take an oath.
NOTARY P a�PNpBEL � �a`,�� NOTARY
4 e•a00000 •°O °o
S °
Sign: o J May oq��2°e p Sign:
Print: —° _
Print-
My
Print•
M Commission Expires: MyCommission_.n
e
�a •o�n�u a �;�
p � S(1�.1!^-p ° G��o„ 1d4 17�` ••o°°o•0°°1oQ•1,0�.
'F°/ n soo mow° 'fit;. P• i C1,C`�*eF:�
aft T�f, F•v�,,b: sr'qTE C F ' r e,
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
•'" ,� 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
SHINS" ROBERTANTHONY
MARTIN MARTIN RENOVATIONS, INC.
10505 NW 37 TERRACE
DORAL FL 33178
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 rangeSTATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT,OF BUSINESS AND
and they keep Flor!da's economy strong. 11' PROFESSION`AIrREGULATION
Every day we work to improve the way we do business in order to CFC054868 ItSUED 07/01/2014
serve you better. For information about our services,please log onto _
www.myfloridalicense.com. There you can find more information CERTIFIED PLUMBINGjCONfTRACTOR
about our divisions and the regulations that impact you,subscribe SHINSKY,ROBERTANITHONY
to department newsletters and learn more about the Department's
initiatives. MARTIN MAR7�IN RENOVATIbNS.INC.
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.488 FS,
and congratulations on your new license! Expvmimndate AUG 31,2016 1-1407010001261
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION `T�"��►
CONSTRUCTION INDUSTRY LICENSING BOARDe�
CFC054868 � x
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
SHINSKY-RO_BERT-ANTHONY •• • �� '` '
/MARTIN -,I'WCF-TIN:RENOVATIONS, INC. '
1:0505 NW 37 TERRACE +
y ADORAL FL 33178 •
lociien• n711%4MMA r%1001 AV AQ 00r11 IIDCn i2V I AIA/ eCn-H 11en7n4nnn1')r4
e
Loc"ai I a Ta►x 'Mmwt
Miami--Dade County, State of Fkdb
THIS IS NOTA BILL-OO'NOT PAY
6312953
BI�tNEss realtgwLocAnoN FLB T-
AC r No. EMPIRES
ViliTIN MARTIN RENOVATIONS RENEWAL BER 30, 2016
INC 6579321 ��
10606 NW 37 TERR Must be displayed at playa of business
Pucouairt.to County Gode,
DORAL,FL 33175 Chapter•11A-Art 9&10
OWNER SEC TYPE OF BUSINESS PAYMENT RECEIVED
MARTIN MARTINI RENOVATIONS INC 196 PLUMBING BY TAX COLLECTOR
CONTRACTOR 4500 09108;2014
Worker(s) 1 CFC054868 0229-14006617
This Local Business Tax Reaeipt only ces6tms payment of the Local Bagiaoms Taa.Ths Reeelpt is not a license,
permit.or a eertilicatio0 of the holder's gualiRcadoas,to do busineas.Holder meet comply wild any 9110610311101111or sougovernmgmal regulatory laws and requirementsiivbicb apply to the basinsas.
"a RECEIPT N0.above must be displayed anon commercial vebioles-Mismi=lado Code Sec Ba-276.
MIAMI For more information.viefl oww mismidade aovlMceollsetor
305 12:50:32 p.m. 02-04-2015 1 /1
190303
�'►�!��® CERTIFICATE OF LIABILITY INSURANCE OA 2/3 /2015)
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 ileu of such endorsement(s).
PRODUCER CONTACT
Commercial Lines—800-868-8834 NAME: Judy Suarez
PHONE., 704-556-2580 Nei.866-332-3051
Wells Fargo Insurance Services USA,Inc. Oa Juditil.suarezQwellsfargo.com
8100 Fairview Road INSURERISI AFFORDING COVERAGE NAIC B
Charlotte,NC 28210 INSURER A: Amerisure Insurance Company 19488
INSURED wsuREn B: Amerlsure Mutual Insurance Co. 23396
Martin Mahn Renovations,Inc.dba Bath Fitter(ID472408) INSURER c• Builders Mutual Insurance Company 10844
8200 Unit G,Arraw ridge Blvd. INSURER D:
INSURER E:
Charlotte,NC 28273 INSURER F:
COVERAGES CERTIFICATE NUMBER: 8695769 REVISION NUMBER: Seebelaw
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.
ILBR ADD SURR TYPEOFINSURANCE POLICY NUMBER POLICYEFF POLIp EXP YYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY CPP20563890501 9/01/2014 9101/2015 EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR PREMISES(Ea-cmumllcal
S 300.000
MED EXP(Arty one pemoni S 10,000
PERSONALS AOV INJURY S 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000
POLICY JE LOC
PRODUCTS-COMPlOPAGG 1i 2,004000
OTHER: I
A AUTOMOBILE LIABILITY CA20563900501 9/0112014 9/01/2015 cO D MI g 1 000 D00
X ANY AUTO BODILY INJURY(Par parson) E
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Peracddont) $
X WREDAUTOS x AUTOS D PROPERTY DAMAGE S
x $500 Dad Co x $500 Dad COLI S
B x UMBRELLALIAS x OCCUR CU20553880302 9/01/2014 9/01/2015 EACH OCCURRENCE S Z,000.Doo
X EXCESS LIAa CLAIMS-MADE
AGGREGATE s z 000,000
DEO RETENTION S o $
WORKMS C EMPLOYEs�tIfNY YIN WCP1036266 11/29/2014 11/29/2015 x R OETH
ANY PROPMeMRIPARTNEWEXECUTNE --II EL EACH ACCIDENT $ 500.000
OFFICERIMEMBER EXCLUDED? NIA
(Mandatary In NH) E.L.DISEASE-EA EMPLOYEE S 500Ao0
If describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 500000
DESCRIPTION OF OPERATIONS LOCATIONS I VEMCLES(ACORD tat,Additional Remarks Schedule,may be attached if more space ICI required)
Coverage provided for Martin Martin Renovations,Inc.a
Plumbing Contractor-license number CF0054868
CERTIFICATE HOLDER CANCELLATION
Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Bldg.Dept THE EXPIRATION DATE THEREOF, NOTICE VIIILL BE DELIVERED IN
10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Fl 33138 AUTHORIZED REPRESENTATIVE
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ®1988-2014 ACORD CORPORATION. All rights reserved.
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