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PL-17-281Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -2-17-281 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 2/21/2017 Expiration: 08/20/2017 Parcel Number Applicant 75 NE 92 Street Miami Shores, FL 33138- 1132060130270 Block: Lot: JARED ZECH Owner Information Address Phone Cell JARED ZECH 75 NE 92 Street MIAMI FL 33138- (347)899-6579 Contractor(s) Phone MODEL PLUMBING CONTRACTOR CC (786)356-1986 Cell Phone Type of Work: KITCHEN AND LAUNDRY RENOVATION Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $4.20 $3.25 $3.25 $1.40 $5.00 $217.00 $3.00 $5.60 $242.70 Pay Date Pay Type Invoice # PL -2-17-62813 02/21/2017 Credit Card 02/02/2017 Credit Card Amt Paid Amt Due $ 192.70 $ 50.00 $ 50.00 $ 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. February 21, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date February 21, 2017 1 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 RECEIVEf tgoly, FBC 2011 4-1 Master Permit No. QJi I. 6 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: —45 N q ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: I w Flood Zone: BFE: FFE: vl OWNER: Name (Fee Simple Titleholder): I a krl7, Address: City: -c��.l 5\c2V GS State: Phone#:C3 "l p d9 �Sl zip: 3`z7 ( 58 Tenant/Lessee Nani e: Phone#: Email: (cAV e LLL e_ 5uut.all I • co ‘,v1 moad- elumi 6a CONTRACTOR: Company Name: Address: )4 10 3q ST Phone#: '9-90 —366-14436 City: VY) 1 ;9v• 1 r j , State: I"/l- Zip: 3'� a' - �+ / Qualifier Name: v 11Si YAv1iik1'I.TV�Y`) Phone#: b .-S-6-18,4 State State Certification or Registration #: Q.. C--C..--C..- 14 -i1 - 2.A b52 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: 6,',(30- Value jc3oValue of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration _ 111 New Description of Work: 4 1 L *&) ef-) )O v44 DW Ni Repair/Replace ❑ Demolition 12(e.,ro v oKS • .w. Specify color of color thru tile: Submittal Fee $ Permit Fee $ 0-6 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ 5 Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Bel..:/C, (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 OWNER AGENT The foregoing instrument was acknowledged before me this day of tF-Fil4 , 20 1- , by , who is personally known to me or who has produced _ �-- 11g-'lL'y L- as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************************* APPROVED BY (Revised02/24/2014) 11IIIN/11 �•/ 0, / `P C C�NscSj a: sAroe 9 �S47 p j:..o-f`•.•...�,\? pc' Fi 0\-",N! .<• ************** �i******* ****p * Signature °I. Vt __ CONTRACTOR The foregoing instrument�DDwas acknowledged before me this 1 day of -1'e- h7 , 20 �' , by U 1 I S e S MO Ya'( Of who is personally known to me or who has produced Ma, S 5 " -IO ` 92 Inas ^ identification and who did take an 0+t1;®r Id A L IG�/►�- NOTARY PUBLIC: Sign:,_� \ Print: Seal: MAHARAI I(GONZAI F2 MY COMMISSION # GO 044602 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters +•T ************************** *************************** 1 11 Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MORATON, ULISES MODEL PLUMBING CONTRACTOR CORP 14910 SW 39TH STREET MIAMI FL 33185 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.myflondalicense.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 _-- DETACH HERE KEN LAWSON, SECRETARY MAT- tt0lEGISIN6�AD y . DISPLAY AS REQUIRED BY LAW SEQ# L1605310000762 ISSUED: 05/31/2016 otsese,. _ Local Business Tax Receipt Miami -Dade County, State of. Florida THIS IS. NOT A BILL —DO•NOT.PAY. .7189790 BtifSWESS: NAME/LOCATION MODEL P U.MBING CONTRACTOR .CORP 1491:,0. SW 39 5: . M IR 33.185 RECEIPT'NO.. RENEWAL 7471166 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to .County Code Chapter8A — Art 9 & 10 OWNER. SEC. TYPE. OF BUSINESS MODEL PLUMBING CONTRACTOR CORP 196 PLUMBING CONTRACTOR C/O:ES MORATON PRES CFC1429352 Woricer(s) 1 PAYMENT RECEIVED BY TAX COLLECTOR • $75.00 07/18/2016 CREDRCARD-16=041563 TbisiocafBusiuess Taxaeceipt onlyconfirms payment nitre Localansiness Tax. The Receipt:is nota license. • mandt.tietertificationoftheholdersqualdications,todobusiness.:Holder mast coin* witbanygovero t or riongoVernmental regulatory laws and requirements which appiyto'the business. The RECOPT NO.: above mast bedisilayed on all Commercial vehicles —M.,.: Seca-�6i _. • For more fnferutatioa. visit www:miami To: Page 4 of 4 2017-02-01 16:50:08 (GMT) 18883301123 From: Gretell Gonzalez AC7.1130RIT CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 02/01/2017 THIS CERTIFICATE IS ISSUED ASA 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 Ileu of such endorsement(s). PRODUCER Usa General Insurance 13631 SW 26st Miami, FL 33175 Phone (305) 386-3305 Fax (888) 330-1123 CONTACT Gretell Gonzalez NAME: a/ccO Mo em). (305) 386-3305 L�a/c, NR): (888) 330-1123 ADDRIEss• grelellgonzalezOyahoo.com INSURER(S) AFFORDING COVERAGE NAIC M INSURER A : United States Liability Insurance N INSURED Model Plumbing Contractor Corp #CFC1429352 14910 SW 39 Street Miami FL 33185 INSURER B : 06/15/2016 INSURER C : ACH INSURER D CLAIMS -MADE Q CCCUR DAMAGE MAGETORRENCEENTED DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person INSURER E : INSURER F : 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MMlDDlYYYY) POLICY EXP (MMlOD/YYYY) LIMITS A 0 COMMERCIAL GENERAL LIABILITY N N CL1706266A 06/15/2016 06/15/2017 ACH $ 1,000,000.00 CLAIMS -MADE Q CCCUR DAMAGE MAGETORRENCEENTED DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person 5 100,000.00 S 5,040.0 r-� L j PERSONAL & ADV INJURY S 1,000,000.00 GEN'L AGGREGATE LIMIT APPLES PER' GENERAL AGGREGATE S 2,000,000.00 MI POLICY inPE 2 ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 • OTHER S AUTOMOBILE LIABILITY • ANY AUTO COMBINED SINGLE LIMIT (Ea accident) 5 BODILY INJURY (Per person) S ALL OWNED SCHEDULED ES AUTOS = AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS = NON-OWNED III U -OWNED PROPERTY DSAMAGE ,_,Ter accident) S • UMBRELLA LIAB • OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB El CLAIMS -MADE AGGREGATE 5 ❑ DED III RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1N NIA i$ IE.L. PER _ - STATUTE • ER ANY PROPRIETOR/PARTNER,EXECUTIVC{ i OFFICER/MEMBER EXCLUDED? I , (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below E.L, EACH ACCIDENT S DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is requlred) Re: Certified Plumbing Contractor CERTIPICATFHnt F P _--.__.. -_._.. Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores Village, FL 33138 ACORD 25 (2014/01) QF 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 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/24/2015 EXPIRATION DATE: 8/23/2017 PERSON: MORATON ULISES FEIN: 473680323 BUSINESS NAME AND ADDRESS: MODEL PLUMBING CONTRACTOR CORP 14910SW39ST MIAMI FL 33185 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14). F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if. at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certirrrate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Model Plumbing Contractor CFC # 142 9352 State of Florida County of Miami -Dade Before me this day personally appeared Ulises Moraton who, being duly sworn, deposes and says: That he will be the only person working on the project located at 75 NE 92nd St. Miami Shores. FL 33138. worn to (or affirmed) and subscribed before me this 4/ -day of y U/;tsar /Yla NIA ih Signature Personally know OR Produced Identification Type of Identification Produced Jesse Walters Notary Public - State of Florida Commission #GG 32294 Expires 9/21/2020 Print, Type or Stamp of Notary 9620 NE 2nd Ave, Suite 207, Miami Shores, FL 33138 p (305) 333 3169 Miami Shores VHIage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner —Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to: work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida Ow County of Miami -Dade The foregoing was acknowledge before me this a day of Arg , 2017 . By 111€1,03' A' 2 -ECA -i 00111111% j `ayp�•*• .... e ./ersonally known to me or has produced • o (_ ralVic{? _:-''s- 'dent' .in __CD Ft., --09' o• r_ • Notary: - ..P . 0 %rn m- o k: SEAL: .- • °• ;.: 5 • `\��