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PL-16-3142Project Address 437 NE 102 Street Miami Shores, FL 33138-2452 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -11-16-3142 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 12/1/2016 Expiration: 05/30/2017 Parcel Number 1132060170800 Block: 92 Lot: 17 & 18 Applicant MICHELLE HEADLEY Owner Information Address Phone Cell MICHELLE HEADLEY 437 NE 102 Street MIAMI SHORES FL 33138- (305)793-3445 437 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) JAZZ PLUMBING INC Phone (786)572-7390 Cell Phone Valuation: Total Sq Feet: $ 1,200.00 35 Type of Work: REMOVE & REPLACE BATHROOM REMODEL Type of Piping: Additional Info: REMOVE & REPLACE BATHROOM REMODEL Bond Return : Classification: Residential Scanning: 1 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 $3.00 $1.60 $160.70 Pay Date Pay Type Invoice # PL -11-16-62090 12/01/2016 Credit Card 11/16/2016 Credit Card Amt Paid Amt Due $ 110.70 $ 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 th regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore Drize the above-named contractor to do the work stated. December 01, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 01, 2016 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 FBC201T BUILDING Master Permit No. :'INC/ I I— I rr6 -13030 PERMIT APPLICATION Sub Permit No. Pl.• 0BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL RECEP.; NOg 2016 BY: [VI PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: (—IS -A• 1.1 E, 162. S4cC72k- City: Miami Shores County: Miami Dade Zip: "3138 Folio/Parcel#: `1 — 3i.OLD • U4- - MOO Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �}1eiana(0 €a((C(QS tk &hc\ke 6.0411 Phone#: S 6- ct - 344455 Address: 45+ NxE tons k J City: ktionit .e1LsTes State: 'FL Zip: 3N Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: azz. Pkurnlenin Phone#: Address: V115 W • 35 Skomezi- City: WjOleaVI Qualifier Name: )'1e..‘ ,(26:145 Phone#: State Certification or Registration #: Cf C %y 1112%5 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ /1/ 2rX' , -- Square/Linear Footage of Work: rj� Type of Work: ❑ Addition 1 1 AlterationElNew �C•e____ State: f -L Zip: -SSC a. Description of Work: ❑ Repair/Replace ❑ em lition Specify color of color thru tile: rT, Submittal Fee $ E() C( Permit Fee $ /J v CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ O �� TOTAL FEE NOW DUE $ \\O (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." , .' 44 Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, th'e 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 th'e 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 `�_, ''�w, was acknowledged before me this 1' t10 day of 1 , ,20 (RC',by 11 M\1Q.. a2y , who is personally known to me or who has produced identification and who di NOTA Si Print: Seal: IC: L#km oath. 1 r Air.' Aram. ► it as **************** APPROVED BY (Revised02/24/2014); ,, REBECA M. PASTRANA 9 ^..OMMISSION N EE872624 Pthuary 07, 2017 Signature CONTRACTOR The foregoing instrument was �ackknowledged before me this 15 day of (haat er ;20 " ( to , by 02d.S who is personally known to me or who has produced 1 en ‘.5,e_ as identification and who did take an oath. NrRY Sig Print: Seal: .moi 0 • h' LIC: ******************************** Plans Examiner Structural Review PQ`t' REBECA M. PASTRANA t'M MY COMMISSION # EE872624 ' 4 '54).,.0mdziEXPIRES: February 07, 2017 * Zoning Clerk ACORI® CERTIFICATE OF LIABILITY INSURANCE ‘....►--- DATE(MM/DD/YYYY) 11/16/2016 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(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 Hiscox Inc. 520 Madison Avenue, 32nd Floor New York, NY 10022 CONTACT NAME: PHONE 855-970-8255 FAX (A/C. No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hiscox Insurance Company Inc. 10200 INSURED JAZZ PLUMBING, INC 1225 West 35th St. Apt. 50A Hialeah FL 33012 INSURER B : 32161755 -GL INSURER C : 06/04/2017 INSURER D : $ 300,000 INSURER E : INSURER F-: X COVERAGES CERTIFICATE 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 LTRINSD TYPE OF INSURANCE ADDL SUER WVD POLICY NUMBER POLICY EFF (MM/DDM'YY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY N N 32161755 -GL 06/04/2016 06/04/2017 EACH OCCURRENCE $ 300,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 300,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $ 600,000 PRODUCTS - COMP/OP AGG $ 600,000 AUTOMOBILE _ _ LIABILITY ANY AUTO 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 RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILfTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing contractor license # CFC -1429285 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores Building Dept. 10050 NE 2nd Avenue Miami FL 33138 ACORD 25 (2014/01) 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 Local Business Tax Receipt ;111�i;i 11 DAie County, State of Florida -THIS I5 NOT A 811„41„4(37 PAY• g3 7186546 t3USINESS NAME/LOCATION JAZZ PLLIM L%SNC !'W' EL ?°U1J OWNii1"t JAZZ PLUMBiNC• '`.0 C."0 ABEL GARCIA Worker(s) RECE#P1 NO RI-NEW/1,1. 746/»Ca, SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC 1428:`85 EXPIRES SEPTEMBER 30, 2017 r.!1,.1 Ise displayed at p1r„{ of s Pursuant to County Code Chapter 8A -- Art 9 & 1( PAYMENT RECEIVED in' TAX COLLECTOR 45.00 07/05/2015 `O202 16-001473 This Local Business Tax Receipt only confirms payment of the Local lissimessTax The Receipt is not license permit. or a certification of the holder's qualifications, to do business. Holder must comply with any gent -mental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Ser_ 8a-215. For more information, visit www.miamidade.gov/taxCellecter JEFF ATWATER CHIEF FIliANC AL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION' OF WORT ERS" COMPENSATION * CERTIFICATE OF ELECTION TO DE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 4• CONSTRUCTION: INDUSTRY EXEMPTION 1i ISS ertilies th.'. i tbo irdividuat listed hetw hes c' c cd Co be exernpl troth Fkoaitia Welters' Cb eri f'ion I , 'EFFECTIVE DATE: &(1t7,'2G15 EXPIRATIOIN':DAT►Eo 619=1 'PERSON: GARCIA ABEL M 'FEIN: 472652301 ;RuSIN'ESS :NAME AND ADDRESS: ,.tAZZ PLUMBING INC 1225 WEST 35 ST t 50A. I i'IALEAH FL 3301:2 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Putiuvn7 to Cr:me r 1311 141 F.•S., tin ofllocrcf corpn7tlanwho drtsii parr 'ran trrxn 191 titicter by frog m m 5licat 4f atecta imlefth"a section moyrol reccorcat ttitrrlS orE,cirV4Y17,frien unlet LHi.&oa'. 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