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PL-15-1629Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Protect Address 1090 NE 105 Street Miami Shores, FL 33138-2106 2 g.- Residential I nlAtteration APPROVED ........................................... Parcel Number 1122320280100 Block: Lot: Expiration: 06/30/2016 Applicant FIRST MB PROPERTY LLC Owner Information FIRST MB PROPERTY LLC Address 1951 NW 7 Avenue MIAMI FL 33158- 1951 NW 7 Avenue MIAMI FL 33158- Phone CeII Contractor(s) UNIVERSAL PLUMBING CORP Phone (305)887-3131 CeII Phone Valuation: Total Sq Feet: $ 8,000.00 0 Type of Work: BATHROOM REMODEL Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $4.80 $4.20 $4.20 $1.60 $280.00 $3.00 $6.40 $304.20 Pay Date Pay Type Invoice # PL -6-15-56169 12/02/2015 Credit Card Amt Paid Amt Due $ 304.20 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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. December 02, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 02, 2015 1 cL-- 1s59 ?c_ J62,51 CERTIFICATE OF LIABILITY INSURANCE j DATE 1xhIMID° 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE BELOW. THIS CERTIFICATEOFNOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ( (S), NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDS) BY AIJ POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lithe ate holder Is an ADDITIONAL INSURED. tie Policy(les) must be endorsed. t SUBROGATION l8 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate dorm not carder rights to the certificate Midst In MU of such end ment{s). PRODUCER Floridan Choice Insurance Group It 11401 SW 40 stele 307 Mlaml, FL 33185 Pimm (305) 857-8880 INS UNIVERSAL PLUMBING CORP 141 EAST 60 ST HIALEAH FL 33013 Fax (305) 8 7i 9836 CONTACT NAM= FERNANDO PEREZ NE Ego: () 305-359-3380 tomfgalinsumacaus 1 lA1C. Ne). (305) 350-3307 lNSUREfOSIAEREDIRG COVERAGE INSURExA: GRANADA INSURANCE INSURER B : INSURER C: INSURE2D: WERE INBUR 1.: MBE COVERAGES CerKiWLL/ah1Cnontr®Crl: - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW 4STANDING ANY REQUIREMENT, TERM OR CONDiT(ON OF ANY CONTRACT OR OTHER DOCINIENT WffH RESPECT TO W UCH THIS CERTIFICATE MAY BE SUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND COMMONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS itiffl PCLJCY NUMBER ( lr RA Ur�Y i LIMITS A TYPE OF INSURANCE '+2 COMMERCIAL GENERAL L IABt.RY I N lADDLSUip N 0185FL00 9-2 05/082016 05108/2017 EACH OCCURRENCE $ 1MONACO $ 100,000.00 DAMAGE RENTED OCCUR 0 CLAIMS -MADE U OCCUR PREMISESTO MED EXP (Any one Person $ 5,000.00 a Mum( $ 1,000,000.00 © PERSONAL a AIN GENERAL AGGREGATE s 1,000,000.00 GER'L AGGREGATE UMW APPLIES PER PRODUCTS .CONPIOP AGO $ 1PAW= • POUCT 1 • LOC JEt;r El OTHER $ AUTOMOBILE LIABILITY a ANY AUTO KMBEgkEigaSINGLE Lffi TT BODILY INJURY(Per Foram) $ BODILY INJURY (Peraadde4 $ Q wrap wros ■ AUTOS- $ ❑ r EACH OCA 1 UTAB .W U . OCCUR $ EXCESS UM ❑CLNM&AtiADE AGGREGATE $$ ❑ 0 D» RETBVnON WORKERS COMPENSATION AND EMPLOYES MEM �y� y / NNANY OFndatci BERR EQy—,-_-_� I (wry In NH) LJ Eyes, describe under DESCRIPTION OF OPERATIONS below NIA O ❑ P AAIiTE ❑ ER EL EACH ACCIDENT 1 EL DISEASE - EA EMPLOYE $ EL QIScASE- POLICY Loos$ DESCRIPTION PLUMBING UNIVERSAL OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks SChedala, tt mans wce Is regufredi COMMERCIAL. AND RESIDENTIAL SERVICES PLUMBING CORP CFC1428421 .......�......... f CERTIFICATE HOLDER MIAMI SHORES VILLAGE 1013:0 NE 2 AVE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE D THE EXPIRATION DATE THEREOF ACCORDANCE WIm THE POLICY AUTHORED REPRESENTATIVE ACORD 20 (2014101) F 01st -201 The ACORD POLICIES WILL BE CORPORA' :2N. AB rlohts logo are registered marks otACORD BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 JUN 3 0 2015 FBC 201.0 e r'' Master Permit No. 15 - fssr3 Sub Permit No. ILt S ^ 4CO2,9 El BUILDING ❑ ELECTRIC D ROOFING ❑ REVISION [I PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: 1090 NE 105 STREET ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 122320280100 Occupancy Type: SFR Load: Construction Type: CBS Flood Zone: Is the Building Historically Designated: Yes NO X OWNER: Name (Fee Simple Titleholder): FIRST MB PROPERTY LLC Address:3400 NW 7 AVENUE City: MIAMI State: FL Tenant/Lessee Name: BFE: FFE: Phone#: 786-340-5694 Phone#: Zip: 33127 Email: CONTRACTOR: Company Name: 64PQI Z 5/4 ` &gif4V L lm f (f/ is �O57 Address: City: (6,7 f State: 4(-----Z Qualifier Name: .� 4" ( ��d ey 41/64 State Certification or Registration # /1/42q 2/ DESIGNER: Architect/Engineer: ARSHAD VIQAR, P.E. Address: 13876 SW 56 STREET #452 Phone#J//D C( s'/ 5' ®l 3 Phone#: 5/ % 5/3 Certificate of Competency #: Phone#: 305-316-1957 City: MIAMI State: FL Zip: Value of Work 'for this -Permit: -$- g*,Oa) Square/Linear Footage of Work: Type of Work: 0 Addition 0 Alteration 0 New Description of Work: 0 Repair/Replace 0 Demolition (bo U. rejukorQiii Specify color of color thru tile: - ------ Submittal Submittal Fee $ Permit Fee $�JyC- 0 CF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 1. 20 (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 appr• ed and a reinspection fee will be charged. Signature NER or AGENT The foregoing instrument was acknowledged before me this 16dayof JUNE AMALFI GAYOSSO , who is personally known to ced FL DRIV. G200-012-87-623-0 as , 20 15 • by me or who h identifica NOTAR Sign: Print: Seal: id take an oath. APPROVED BY (Revised02/24/2014) No. FFF 020/7 03809 • by �i�rI�OF, it" Signature CONTRACTOR The foregoin: it "trumenj s acknowledged before me this day of b/le1� , 20 , by "41:67,4 e(C4efr" s / who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLI Sig Plans Examiner e.,. LOURDdViiii1 � 87 MY C0(ONMMIS64F?Q0167 ma, M*****MM**********■ 1151 Ootidaftt t szan Zoning Structural Review Clerk Detail by Entity Name Page 1 of 2 1:.0 R 1 .D A IDE1't.R'T'MENT O1 `fS .C) S)i CORP .) �.+f itN ; Detail by Entity Name Florida Limited Liability Company FIRST MB PROPERTY, LLC Filing Information Document Number L09000098832 FEI/EIN Number 271114007 Date Filed 10/13/2009 Effective Date 10/13/2009 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 10/05/2011 Principal Address 3400 NW 7 AVENUE MIAMI, FL 33127 Changed: 04/11/2015 Mailing Address 3400 NW 7 AVENUE MIAMI, FL 33127 Changed: 04/11/2015 Registered Agent Name & Address GAYOSSO, AMALFI 3400 NW 7 AVENUE MIAMI, FL 33127 Address Changed: 04/11/2015 Authorized Person(s) Detail Name & Address Title MGRM AMALFI GAYOSSO 3400 NW 7 AVENUE MIAMI, FL 33127 Annual Reports http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 5/6/2015