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PL-16-2912 P =�04 X2912 Miami Shores Village !" Pe1Tf?t!Tye `(1i)'#1b(t( - esident)ti)' 10050 N.E.2nd Avenue NE 1/4Wkf�S0` /fib Addltl6n/Alt titflM�. ; Miami Shores,FL 33138-0000 Phone: (305)795 2204 f�BhT ft Status:APPROVED L RNp' t�at+�:1111128'16 Expiration: 0413012017 lssu� Project Address Parcel Number Applicant 45 NE 103 Street 1121360130950 45 NE 103RD STREET LLC Miami Shores, FL 33138-2126 Block: Lot: Owner Information Address Phone Cell 45 NE 103RD STREET LLC 1801 S FEDERAL Highway BOCA RATON FL 33432- 1801 S FEDERAL Highway BOCA RATON FL 33432- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 MG PLUMBING&SPRINKLER SERVI( (305)525-9236 __.......... _.. Total Sq Feet: 0 Type of Work:REMOVE AND REINSTALL VANITY AND WAT 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 $0.60 invoice# PL-10-16-61791 DBPR Fee $2.00 11/01/2016 Check#:2217 $58.60 $60.00 DCA Fee $2.00 Education Surcharge $0.20 10/26/2016 Check#:2195 $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 andAdning. Futhermore authorize the above-named contractor to do the work stated. November 01,2016 Authorized Signature:Owner Applicant / Contractor / Agent Date Building Department Copy November 01,2016 1 Miami Shores Village RECEIVED Building Department artment OCT 262016 � - 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 rr� INSPECTION LINE PHONE NUMBER:(30S)762-4949 `j FBC 2014 BUILDING Master Permit Nola) I -1� PERMIT APPLICATION Sub Permit No�L ( �o - ( 2.. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL E24UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: J, ✓�� L l'�-' Com: Miami Shores g \County: Miami Dade Zip: Folio/Parcel#: /z- 2/j D��S b��U Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: / FFE: OWNER:Name(Fee/Simple Titleholder):�d��(,s �[e�+��/, � Phone# Address: Dd ! S L��L L Wc,-e!Z�� G City: State: Zip: �- Tenant/Lessee Name: n 11A Phone#: Email: ,t�� CONTRACTOR:Company Name:�-/C7 'L"'''/� �,�Ji�' s�1Kc ��1�✓l one#: ��S�zs�-SZ3� Address: City: State: Zip: -?-3r✓�� Qualifier A) R��^�7 Phone#: rYOJ-1 Zr-723 State Certification or Registration#: 0 Certificate of Competency#: DESIGNER:Architect/Engineer: S Phone#: &2u)'?t'S--S8't6 Address: S' cD. 168 d'/e City:/3?,�„�,' State Value of Work for this Permit:$ ==, =Q (0m"oz� Square/Linear Footage of Work: / Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ILe Itj c3 Q LtA 4 chi 7 r6TIJ �'-� 3 Specify color of color thru tile: Submittal Fee$ Go, M Permit Fee$ ��e� CCF$ � CO/CC$ Scanning Fee$ Radon Fee$ 'Z DBPR$ Z . Notary$ Technology Fee$ $® Training/Education Fee$ z0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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�a0C� uftw V' Signatures--- 4''-'`'-� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -7— day of DC 020/6 by �_ day of s [- � ,20 i 6 ,by h4111erT1-,4 who is personally known to 7i`11AC_'S g�: �L'�e/��,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"hOISSI NOTARY PUBLIC: �� ''� TARBHAIAKNOWIFg NOTARY PUBLIC: � "*-4, F:'hjy w W COMMISSION A FF 05318'2 S:January"A 1,2018 S:January 31,2018 ��.o: dltro8adg9Na"5 Miens Sign: TAruBud�tNoterySsvleN Sign: // Print: � ��f ,l(�LA0,z)Z= Print: Seal: Seal: APPROVED BYlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 10/26/2016 14:43 3056512429 PAGE 02/03 r , i RICKsc©TI GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA t3EPART�tlI:.AiT E3N+=N3tfSiI IFSS AW PROFESSItML REGULATION IG®N57RUL" 4N IAt#3Lis'FRY# tIIBlNG ?ARD n s The ide:P LVitiRi UNG CONTRACTOR Named below IS CERTIFIED � Under the provisiaris of Chapter 489 FS. j Exoration date. AUG 31,2018 NYCUK JAMES I3 WARRED V • tf G P NG&SP " SE'RVICE INC 1265 Nom`203 ST MIAMI FL'33444,' is tea: Et8�16►4LptI; 01;P AY AS.REQUIREDRYLAW SF-Q# 06W110002 s Local Bus:nee; S Tax f1ecelptLB• Miami-DadeCourity, State of Florida -7M IS NOT A BHC-DO NOT PAY 5871935 BUSINESS NAM VLCCATION RECEIPT NO, EX P1RES SERVlCtw INC RENEWAL PLUMI3N &SPRINKLER RENEWAL SEPTEMBER 30, 2017 6124368 1265 NW 203 ST M ust be displayed at place of BtwnesS MIAMI GARDENS,FL 33169 Pwrata K to County Code Chapter 6A-Art-9 a'{o OWNER BEC.TYPE OF BUSINESS MG PLUMBING&SPRINX1, 2SER 1913 PLUMBING PA YM FNT RECEIVE D INC CONTRACTOR EIV T/►X COLLECTOR 45.00 07/14/2016 Worker(s) 1 CFC056920 0233-16-000973 VaLogl6tarin�sTex;Fbwiptaalyoa,"+�rePeYmerltm91elaoael&lSiI1 Ta1LTile}iocdptisriotalfcer� Per►rit,ar a eatl"calionvf Ins fdd9�•'s qui^a�nrre,LoAotvs}rle9s,ti�IEcrrrxut clxlptywi�anY9wa►,trfbrafet ofnonr�YnreluF9l rgRua�Ilawssr�aregla,an•�whlrhspprytoft�eaus{,aa� • 71te I+�F7'NQ atiwemuet bedlaptayedon all wrrr►�rclal vrliraes�iVran;-D�aet�dasgc aa-zrR PRAWranteit>F m3ZaRvsitwwwsrjm dsdagev&NMg,eeNx 10/26/2016 14:43 3056512429 PAGE 03/03 MGP.L1.114 OP ID:MA i4COR0" DATE IMNwDlYYYY) CERTIFICATE Off' LIABILITY INSURANCE lo/zslzols THIS CERTIFICATE IS ISSUED'AS A MATTER OF INFORMATION ONLY AND CONFERS NO MaHTS 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 T30T CONSTITUTE A CONTRACT BETWFEN:THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICA-it HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONA4 INSURED,the policy(les)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain policies May require an endoreemant. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CCOONNTACT Graham Troyer The John Galt Insurance Agency PNaNE 6300 NW-6th Way,Suite 100 j 954-281-7070 ac No.954-281.7090 Ft.Lauderdale,FL U309 ! AaD ss.Commerela ohn- alt eom Graham Troyer INSUOERM AFFORDING COVERAeE NAIC N INSURERAeWBSCOInsurance Company M G Plumbing St Sprinkler INSURER a:Technology Insurance Company Services 1266 NW 203rd Street INSURER*: Miami,FL 33169 INSURER A; i I NSURFR O: . i INSUgER F COVERAGES CERTIFICATE NUM13 R: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR 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 INSI*RANCE 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 CP INSURANCi' POLICY 'POLtCY NUMBER MMlD D UNIR8 A' X COMMERCIAL'GENeMLIABRfrY EACH OCCURRENCE 81,040,004 CLAIMS-MADE 0 OCCUR WPP1407237 01 09/23/2016, 09/23/2017 P M Eaa rranGa $ 100,000 MED EXP one ceroon) . S 81000 j PERSONAL&ADV INJURY 1,000,000 GEMLAGGREGATE LIMITAPPLIEBPIER; GENERAL AGGREGATE $ 2,000,000 F-oucY❑JJEEC:T 0 LOC I PRODUCTS-COMPIDP AGO $ 2,000,000 OTHER- i S AUTOMOBILE LUMM rY COMBINSINGLE LIMIT ��(I0� Ilia $ A ANY AUTO PP1407237 0 �Id 1 09/2312016 09/23/2017 BODILY INJURY{Per person) f x ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per aaaidwt) $ X HIRED AUTOS X AUTOS ED PR a cru MAUI= X $ UMBRELLA LM OCCUR EACH OCCURRENCE S EXCESS LIAS CLAIMS MAOE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AEMPLOYERS'LIAB0.nY 3TA B tm ANY PROPRIETORIPARTNERIEXECUTIVE YIN TWC3583079 10/12/2016 10/12/2017 E.LEACH ACCIDENT S 100,000 OFFlCE�EM NER EXCLUDED? � N I A Mantle nd E. DISEASE-EA EMPLOYS $ 100 000 If yea,tlaediNe antler , ISCRIPr10N OF OPERATIONS be E.L LNSFAS6-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS r LOCATIONS 1 VENICLPS(ACORD 101,AdtEd6nW Rem Ms ftMdtile,may OQ RtbCNatl tr mora space fs required) Residential and Commer'ciail Plumbing Contractor,Uitense no.CFC056920 CERTIFICATE HOLDER CANCEL • TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA'T'ION DATE THEREOF, NOTICE VALL HE DELPJERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050NE 2nd Avenue• ' Miami Shores,FI_33138 AUTHo> m PResPaIrATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD