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PL-17-2420Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -1 0-17-2420 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/1612017 Expiration: 04/14/2018 Parcel Number Applicant 78 NW 96 Street Miami Shores, FL 33150- 1131010330520 Block: Lot: CORNELIUS WHITFIELD Owner Information Address Phone Cell CORNELIUS WHITFIELD 78 NW 96 Street MIAMI SHORES FL 33150-1753 Contractor(s) Phone MARTIN MARTIN RENOVATIONS, INC CeII Phone Valuation: Total Sq Feet: 1111111111/11 tak $ 5,700.00 15 Type of Work: INSTALL LINER AND WALL MADE OF ACRY Type of Piping: Additional Info: INSTALL LINER AND WALL MADE OF ACRY Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $3.38 $2.25 $1.20 $225.00 $9.00 $4.80 $249.23 Pay Date Pay Type Invoice # PL -10-17-65308 10/11/2017 Credit Card 10/16/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 199.23 $ 199.23 $ 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 Fptherm reyl'authorize the above-named contractor to do the work stated. -Authorize nure: Owner / Applicant Building Department Copy / Contractor / Agent October 16, 2017 Date October 16, 2017 1 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 BUILDING PERMIT APPLICATION 0BUILDING ❑ ELECTRIC ❑ ROOFING XPLUMBING ❑ MECHANICAL El PUBLIC WORKS JOB ADDRESS: 78 N �?I`� 77•/ St t'ECE3 VED 1 OCT 1 017 FBC 20 14 Master Permit No. PL 1 1-2420 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF 0 CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: / CO Folio/Parcel#: /1— 3/49/---19.;*""" 0520 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 2M-AVS(//1.7s eAMi r% t iO Phone#:-9/qqZ — 4(O7 Address: 78 Aftd i4 7// Sr City: ,-//i2)77/ /1-4)/ts State: Zip: 33/.S -Z) Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 14-4141- /41 10-4 a44-3:- ti f/ (Phone#: Address: 59s4, L) 2-y -kyr 706--s/7-g& q? City: 2 raf Qualifier Name: State: 4o6er/ 9 •►/led/' QP us(/' 840 State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: Zip:: 33/7Z Phone#:i'✓/ 4 ' "- Certificate of Competency #: Phone#: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: /6 Type of Work: ❑ Addition ❑ Alteration 17 New IN Repair/Replace ❑ Demolition Description of Work: LAy/4// L/i?er Ge'iLL &4///rade oFac/Wile Ole( e �c.e- hkkie.gay Specify color of color thru tile: Submittal Fee $ 7Q d Permit Fee $ Scanning Fee $ Radon Fee $ 2 ' - 5 CCF $ CO/CC $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ _ Bond $ --- TOTAL FEE NOW DUE $ I I J • •2. (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 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 commencement must he posted at the job site for the first inspection which occurs seven (7) days after the building pennit is issued. In the absence of such posted notice. the inspection will not be approved and r be charged. Signature Owner or Agent Signature v 1� L± Contractor The foregoing instrument was acknowledged before me this ID The foregoing instrument was acknowledged before me this/0 slay ot`L t , 20r% , by eptile,tivs LAvivwc.M, avw0 fr u ENT darn O ( rn Pcj 0 Olen: o w >- Print: personally known t� V or who has produced Sf /Lb•— S identification and who did take an oath. RY PUBLIC: Aid (4 fez mmission Expires: day of 20 / ?, by `i . b etT who is personally known to me or who has produced as identification and who did take an .ath'•: NOTARY PUBLIC: m�:t• ""..441PG% rn C /mud - L My Commission Expires: N a% X c D Sign: Print: ********************************************************************************************** APPROVED BY !,'l1 -l3 Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk 190303 / ,® ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 8/30/2017 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 have ADDITIONAL INSURED provisions or 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 Commercial Lines — 800-868-8834 Wells Fargo Insurance Services USA, Inc. 6100 Fairview Road Charlotte, NC 28210 NAME: CONTACT Nancy Davis PHONE r FAX (A/C, No, Ext):_ 704-556-2761 f (A/C, No): 866-332-3051 __ E-MAIL .davis2 wellsfar o.com ADDRESS: Y 9 _Want INSURER(S) AFFORDING COVERAGE i_ NAIL q -_ INSURER A: Amerisure Insurance Company 1 19488 INSURED Martin Martin Renovations, Inc. dba Bath Fitter (ID472408) 8200 Unit G, Arrowridge Blvd. Charlotte, NC 28273 INSURER B_: Amerisure Mutual Insurance Co. 23396 _ INSURER C : INSURER D : E:_ 9/01/2018 _INSURER _ _ _ `J INSURER F : COVERAGES CERTIFICATE NUMBER: 12191828 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE ADDL SUBR1 INSD WVD I POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL CLAIMS -MADE LIABILITYEACH — X I OCCUR CPP20563890901 9/01/2017 9/01/2018 OCCURRENCE _ _ DAMAGE TO RENTED PREMISES (Ea occurrence) 5 1,000,000 $ 300,000 MED EXP (Any one person) $ 10,000 GEN'L AGGREGATE LIMIT APPLIES PER PERSONAL. 8 ADV INJURY GENERAL AGGREGATE S 1,000,000 $ 2,000,000 POLICY X JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 OT HER: 5 AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY I I COMBINED SINGLE LIMIT (Ea accident) $ I— I BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S $ B I X UMBRELLALIAB EXCESS LIAB I X OCCUR CLAIMS -MADE CU2056388 9/01/2017 9/01/2018 EACH OCCURRENCE S 2,000,000 I AGGREGATE $ 2,000,000 DED ( RETENTION $ 0 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY ANYPROPRIETOR/PARTNER!EXECUTIVE OFFICER!MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS / N NIA PER OTH- STATUTE ER E.L EACH ACCIDENT 5 E.L. DISEASE - EA EMPLOYEE S below E.L. DISEASE - POLICY LIMIT 5 I I I DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is an Additional Insured regarding their interest in the operations of the Named Insured, as it relates to the General Liability coverage in accordance with the terms and conditions of the policy. Plumbing Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Departmentr 10050 NE 2nd Ave Miami Shores, FL 33138 I 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 The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) jt2 { r i �Fti I CORNELIUS WHITFIELD 78 NW 96TH STREET MIAMI SHORES, FL 33150 ACRYLIC OVER EXISTING TUB AND RECEIVED WALLS REPLACE VALVE WITH OCT 017 DELTA 1400 SERIES FBC 2014 15 SQUARE FEET FAMILY ROOM • • • • • .. • • • KJTCNEti • . • .. • • .••• • • •••• • • FV_DGDEPT 6 CC MPLIA CE (H ALL FEDERAL 8Nu C^ 'NN RULES AND RECULAT C `S LIVING ROOM • • • • • • • • • • .. • • ••• • • • .. • • • • • • • • • DINING ROOM • • • • • BATH FITTER® PRODUCT SPECIFICATIONS • • .. •• ••• • • • .. •• .. ... ••• •• • • • •• •• • • ...... • ••• • . • • • •• .. • • ... • •• .• •• • • •• ••• • •• • •• • • .... ••••••• • • • • • • • • • •• • ••• • • • • •••• • • • .. . . .• •• • • • ••. ••• • • • ••• • • _BAT FITTER® BATH FITTER® ACRYLIC BATHTUB LINER SPECIFICATIONS A Bath Fitter® acrylic bathtub liner is manufactured from a co -extruded .240" thick sheet that consists of a pigmented acrylic surface reinforced with a blend of high -impact plastic material. The liner is secured to the existing tub using a proprietary adhesive and installation technique. Bath Fitter® acrylic bathtub liners are certified by C.S.A., Inc., an independent, intemationally recognized testing laboratory, to be in compliance with the requirements of the ANSI Z124.8-1990 standard for plastic bathtub liners. EXISTING WALL See Detail 3- PART SEAL EXISTING TUB ACRYLIC BATHTUB LINER EXISTING WALL EXISTING TUB SILICONE 3 - PART SEAL ADHESIVE • • ACRYLIC BATHTUB LINER NP1 .• ••• • • ---• •-"`• •.--r • •••••• • • • • • • • •• • Detailed view •.• •.• •. . • • •• •. • • • • .•• ••• • .•. • .• • • • • • •• • • . •. • • • . • • •• •• • • •. • • • • Bath Fitter( Rev. 04-30-09 Product Specifications • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • •.• • • FITTER® BATH FITTER® ACRYLIC BATH WALL SPECIFICATIONS A Bath Fitter® custom -formed, one-piece acrylic bath wall system is manufactured from a co -extruded sheet that is approximately 1/8" -thick and that consists of a pigmented acrylic surface reinforced with a blend of high -impact plastic material. Bath Fitter® acrylic bath walls are seamless and can cover the existing walls from tub to ceiling. They are secured to the existing walls using a proprietary adhesive and installation technique. Exposed edges are capped with an extruded molding that is trimmed on site for an exact fit. Sample panels of the material used to form Bath Fitter® acrylic bath walls have been tested and found to be in compliance with Standard CSA B-45.5-2011 / IAPMO Z124-2011, Clause 5.12. /" /� • • • • •% • • • • •• i • • • • • •• • •• • ••• • • •�•�• • • • • • ••• • • • • • • • • •• ••• • ••• ••• • ••• • • • • • • • • • • • • • • • • •• •• • • •• • • • • EXIST INS WALL ADHESIVES ONE PIECE ACRYLIC WALL Bath Fitter Rev.03-19--12 ••• • • • • ••• • • Product Specifications • • • • • • • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • ■ w • ■ 'Moir . s ... . Tax Description: Local Business Taxes Account Number(s): 6312953 Payment Timestamp: October 02, 2017 02:07:04 PM Amount Paid: $45.00 Payment Type: Order Number: Credit Card MASTERCARD 22113208 Processor Reference Number: 021017A15• E3B21 E70 791 5•-4212 934A 3D1 7233A54CD Account Holder Name: Rocio La Rosa 1