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PL-17-2236Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -9-17-2236 Permit Type: Plumbing - Residential Work Classification: Repair Permit Status: APPROVED issue Date: 9119/2017 Expiration: 03/18/2018 Parcel Number Applicant 9305 NE 9 Avenue Miami Shores, FL 33138- 1132060010080 Block: Lot: ELLEN MOSS Owner Information ELLEN MOSS Address 9305 NE 9 Avenue MIAMI SHORES FL 33138-2903 Contractor(s) Phone MR C'S PLUMBING AND SEPTIC INC (786)586-7473 Cell Phone Phone Cell Valuation: Total Sq Feet: $ 2,000.00 60 Type of Work: REMOVE AND REPLACE SEWER LINE TO SE Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $9.00 $1.60 $166.70 Pay Date Pay Type Invoice # PL -9-17-65084 09/19/2017 Credit Card 09/15/2017 Credit Card Amt Paid Amt Due $ 116.70 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Plumbing In consideration of the issua pertaining thereto and in stric accepting this •_mit required for OWNERS A construction I assu ce to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In e responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are UMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. VIT: I c o u h -r that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating ore, I authorize the above-named contractor to do the work stated. September 19, 2017 AuthSignature: Owner / Applicant / Contractor / Agent Buildi g Department Copy Date September 19, 2017 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 ❑ ROOFING PLUMBING ❑ MECHANICAL PUBLIC WORKS Master Permit No. Sub Permit No. RECEIVED SEP' 11t5 2017 saA FBC 2014 11 - ;r3k)' ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF CONTRACTOR JOB ADDRESS: /S05 f\le City: Miami Shores County: Folio/Parcel#: Occupancy Type:' Load: l(- 3yo6—oo►-pogo ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: 331 3r Construction Type: OWNER: Name (Fee Simple Titleholder): I I Address: City: 3e>5 Ne. ct 'v - Tenant/Lessee Name: Is the Building Historically Designated: Yes Flood Zone: NO BFE: FFE: Phone#: 605-6?2..641-2S State: Phone#: Zip: 31 38 - Email: CONTRACTOR: Company Name: fir. Address: 0192- A C' City: /art.( State: rt---• Qualifier Name: � etz Cf (_ 1 2 S?-72`� Phone#: ' 7Rb 5g-61413 -73 State Certification or Registration #: Zip: Phone#: ILK- 5 2-C-7 ‘f-7. Certificate of Competency #: Phone#: State: Zip: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition [.J Alteration Description of Work: City: adod • ❑ 0-Cilus,)e f Square/Linear Footage of Work: New Repair/Replace n Demolition C b1/`'Kee.* • -17 •e • -1 -'44(..12 - Specify color of color thru tile: Submittal Fee $ y"' ^ Permit Fee $ — /37) «1.J Scanning Fee $ Radon Fee $ - el); Technology Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ 2— .7— S Notary $ Training/Education Fee $ Double Fee $ Bond $ v' ` C'\ TOTAL FEE NOW DUE$ ((G l„) %tit-iiuNr1Q___ 1 -IL ,s 6c( - 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 OWNER or AGENT The foregoing instrument ss acknowledged before me this day of " / J St , 20 11 , by �eel i, Md_5 ,who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: 1 n Print: "Itt"_ KEMBLE ETTRICK Seal: j ; ooh"_�'°a1; Seal: •t Notary Public - State of Flo: My Comm. Expires Sep 19, Commission # FF 05573 ° ,,, ,,,, Bonded Through National Notary Assn. Through National Notary A **************************************************************** Signature The foregoing instrument was acknowledged before me this day of , 20 11 , by ( GCC44.1 Ywho is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: A A A A AA w AA AA _...uu._ KCRARI r rTTRICI( Notary Public - State of Florida •_ My Comm. Expires Sep 19, 2017 Commission # FF 055732 :.ST. sus *... E:Lrz=• • \0 Y PVA", Notary Public - State of Florid? 4Eftygpmm. Expires Sep 19, 201 ". P= Commission # FF 055732 F ° ,,', Bonded Through National Notary Assr "f'10 X17 Plans Examiner (Revised02/24/2014) Zoning Structural Review Clerk ,20:1 fi• ,r. I vi fli V-4 ?.1 CI go 5 P6--- )1/-e-• (\(\.,•1 Nv1,-; + +11 c'eu2:C_CLi-ik-k- RECEIVED SEP 1 5 2017 Notes: 7 c; ‘-e ic•vc + P112 --'rts -,1-1+1c) 9 • • v\g,•-•:.) '1101 11 Miami Shores Village APPROVED BY .4' . 6 tld.3 F3LDG DEPT IMI C4419 // . , ( 1 r T"...... k -t) --i - - 'e ,1 -.2:... c; ,1" -i- .1- .---- • 49 • • • CO. 0 00 ----177 , NO• 006 • 011 • • , • • 1 I 1 • • • • • • • • -• 1 1 .. .k)) ...AO* • • • 000 00, 0 -• 16 • ....4.• 04 • '1 • .06,0 1 • •••• • IL • • 00000 • • • • • • •• • • 1 1 000164 • OODO • 1 • • 600,01 _„_ • •• 04100 - . 6 • • ww • • i - 51- -- ••111/1 Notes: 7 c; ‘-e ic•vc + P112 --'rts -,1-1+1c) 9 • • v\g,•-•:.) '1101 11 Miami Shores Village APPROVED BY DATE ZONING DEPT F3LDG DEPT IMI C4419 .1cr TO COMPUANCIt WITH ALL FEDERAL Ont INTY flII rs ANI) RFOULATIONS rc)LA 7 —Dam,(0 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 COCKING, MATTHEW S MR C'S PLUMBING AND SEPTIC INC 1425 NE 57 PLACE FORT LAUDERDALE FL 33334 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 range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. 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, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF DEPAR PROF CFC1428729 CERTIFIED P COCKING, M MR C'S PLUM FLORIDA -. F=USINESS AND `v- ULATION 18/02/2016 CERTLF1E.D.find erthe•provislons of 6.489 FS. ratbodete AU421312018 L1608020001225 DETACH HERE' KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER - .N.4 `.0 .Ct428729 . ,. j Named below IS CERTIFIED Under the provisions of Chapter 489 FS.... i. Expiration date: AUG. 31', 2018 ISSUED: 08/02/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608020001225 003508 Local Business Tax Receipt. Miami -Dade County, State of Florida -THIS IS NOT A SILL -11131401- PAY 2866482 BUSINESS NAME/LOCATION MR CS PLUMBING & SEPTIC INC 19932 NW 2 AVE MIAMI GARDENS FL 33169 OWNER MR CS PLUMBING & SEPTIC INC Worker(s) RECEIPT NO. RENEWAL 2999176 LBT SEC. TYPE OF BUSINESS 198 PLUMBING CONTRACTOR CFC1428729 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/11/2017 CREDITCARD-17-046199 This Local Business Tax Receipt only confirms payment of the Local. Business Tax. The Receipt is not a license, permit' or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on ell commercial vehicles — Miami—Dads Code Sec to -276. For mon information,visit www.miamidade.gov/texcofector 003508 Local Business Tax Receipt.. Miami—Dade County, State of Florida -THIS IS NOT A BILL Aycl NOT PAY 2866482 • BUSINESS NAME/LOCATION MR CS PLUMBING & SEPTIC INC 19932 NW 2 AVE MIAMI GARDENS FL 33169 OWNER MR CS PLUMBING & SEPTIC INC Worker(s) 1 RECEIPT NO. RENEWAL 2999176 LBT SEC. TYPE OP BUSINESS 196 PLUMBING CONTRACTOR SEP0061536 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED EY TAX COLLECTOR $45.00 07/11/2017 CREDITCARD-17-046199 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt Is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental Of nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Se -276. For more information, visit www.miamidade,govfaxcofiector MRCSS-1 OP ID: AL ACORO- CERTIFICATE OF LIABILITY INSURANCE 11....------ DATE(MM/DD/YYYY) 01/13/2017 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(ies) 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 Combined Underwriters of MiamiPHONE 8240 N.W. 52 Terr, Suite 408 Miami, FL 33166 RONALD M. LASTER CONTACT RONALD M. LASTER 305-477-0444 FAX (A/C. No Ext): (A/C, No): 305-599-2343 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:AIX SPECIALTY INSURANCE CO. COMMERCIAL GENERAL UABILITY INSURED Mr. C'S Plumbing & Septic Inc. Attn: Michael Cocking P.O.Box 693239 Miami, FL 33269 INSURER B : L1JA19162603 INSURER C : 01/11/2018 INSURER D : $ 1,000,000 INSURER E : INSURER F : X 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 LTRJNSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM(DDNYYY) LIMITS A X COMMERCIAL GENERAL UABILITY L1JA19162603 01/11/2017 01/11/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DMGORa EoNcTcuEnence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNEDT AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Septic Tank Systems -installation,... Plumbing. Qualifier: Matthew Cocking Lic # CFC1428729 CERTIFICATE HOLDER CANCELLATION I MIAMISH Miami Shores Village g 10050 NE 2nd Ave Miami Shores„ FL 33128 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WGO &) ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORU® � CERTIFICATE OF LIABILITY INSURANCE 441....---- DATE (MMIDDIYYYY) 11/15/2016 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 LRA Insurance 498 S Lake Destiny Dr Orlando FL 32810 CONTACT Nikki Alexander NAME: PHONE (407) 838-3445 FAX (407)838-3460 (AIC. No. Ex0: (A/C, No): ADDARLESS:NAlexander@lrainsurance.com INSURER(S) AFFORDING COVERAGE NAIC • INsuRERA Bridgefield Employers Ins Co 10701 INSURED Mr. C's Plumbing 6 Septic, Inc. 19932 NW 2nd Ave Miami FL 33169-2904 INSURER B : INSURER C: INSURER D: $ INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:16/17 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 ADE L o SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/CID YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (My one person) $ PERSONAL & ADV INJURY $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES -EC°T PER. LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY A)JTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (MandatorylnNH) If yes. describe under DESCRIPTION OF OPERATIONS below Y 1 N NIA Y 0830-54817 10/1/2016 10/1/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCPoPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Qualifier: Matthew Cocking Lic # CFC1428729 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 NE 2nd Ave. Miami Shores FI. 33128 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Brian Tomlinson/NIKKI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD