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PL-16-2306Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -$-16-2306 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 1119/2016 Expiration: 05/08/2017 Parcel Number Applicant 67 NW 92 Street Miami Shores, FL 1131010170140 Block: Lot: VERO HOMES LLC Owner Information VERO HOMES LLC Address 701 BRIECKELL AVE MIAMI FL 33131- 701 BRIECKELL AVE MIAMI FL 33131- Contractor(s) Phone Cell Phone DAY AND NIGHT PLUMBING INC (407)402-0408 Phone (305)902-4660 Cell Valuation: Total Sq Feet: $ 1,500.00 0 Type of Work: REPLACE KITCHEN AND BATHROOM PLUMBI 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 $1.20 $3.38 $3.38 $0.40 $225.00 $3.00 $1.60 $237.96 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -8-16-61003 11/09/2016 Credit Card $ 237.96 $ 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 t II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and / .e above-named contractor to do the work stated. November 09, 2016 ate Author' Building Applicant / Contractor / Agent epartment Copy November 09, 2016 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 RECEIVED UG 162016 FBC 20 I 4 - Master Permit NoZO 1 G-- Sub Permit NoPj--1 f 2306 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: t / /(74/ L s% City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO •Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: LQWNER Name (Fee Simple Titleholder): -e,PF' 6i1/e S / J- i- C Phone#:36,r; 9 7 2 ` LI.44° Address: 70/ gQj /( ,4 — .54,'7 (J City: M'*4ff State: / G Zip: -33/5/ Tenant/Lessee Name: / Phone#: C_ Email: `i47,c ¢� .SG c p �Qd OiyC d CONTRACTOR: Company Name: ?4y i///,p,'--/- Phone#: *'7- yo$ Address: ,36/e7 ��.r7 ,4' City: zit, A% State: Z. Zip: 32 -7c2.3 Qualifier Name: cAIA.,7 /,",Ai'SZ-ewSKI Phone#: State Certification or Registration #:GAG - r9Ag y '7Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ /5-672? ' Square/Linear F,oniage of Work: Type of Work: ❑'Addition 1:12- Alteration ❑ New ❑..Repair/Replace ' 0 Demolition Description ofiWork: ' if)..o"1 fc 7[r�'/ "C �.r - T57,40-1,4 .(moo orci /��te.sr Ai,a, ' Specify color of color thru tile: Submittal Fee $ Permit Fee $ �� CCF $ r 20 (jj CO/CC $ !" Scanning Fee $ 3 `• Co rt Radon Fee $ 3.3-0 DBPR $ 3• 39 Notary $ 0 1 Technology Fee $ • GO Training/Education Fee $ 0 - LK) Double Fee $ P 4 Structural Reviews $ 1 Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 23. • q -G 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 was acknowledged before me this ' 5 day of 7 -Gr ,20 (( ,by Pcto,ede4.4 C�y�� ( , who is personally known to me or who haS produced identification;§nd NOTARY PUttLIG; Sign: take a,ptp .p mum MY Commis EXPIRES: FEB 23, IDE Bonded through 18tStt♦tg • J 1 arzii' Print: ]-f./2v� , 5 ,•� c) -1i € Seal: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of. /� 4 , 20 7 ' , by Ci•c>71, ,s2-. - isI me or who has produced as identification and • • • .. e an oath. , who is personally known to NOTARY PU Et :; 11Yr:: :telt: :ref!, Sign: Print: Seal: • .40 ANTHONY DItelitON MY commtssationew EXPIRES: FEB23, ION ended Through let Sub Ingegge ******************************************************************ssss********ssss************************** APPROVED BY (Revised02/24/2014) /1Gi 4+_(4". Plans Examiner Zoning Structural Review Clerk Proof of Coverage Page 1 of 1 `` l JEFF ATWATER, CHIEF FINANCIAL OFFICER 4fr: FLORIDA DEPARTMENT OF FINANCIAL SERVICES WC Rome WC llatabarrs CFI) Rance Exemption Detail Page Ibis database was last updated Monday, November 23,2015 12:12 AM. Return to Previous Page Exemption Details Name Title Effective Date 'Termination Date Exemption Type "Business Activities Employer Name CRAIG M U81S7FWSKI PR Oct 15 2015 Oct 14 2017 Construction Click Here to View Actvities Listed cn Exemption DAY AND NIGHT PLUMBING INC CRAIG MAND UBISZEwsKI PR Oct 7 2013 Oct? 2015 Consruclbn ClickClickFM'e to View Acrhelles Uste0 on Exemption DAY NIGHT PLUMBING INC 'Termination may be through the revocation or the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption. Return to Search Page 1%IVt% VVV I ., ..iV VL/t1.V1♦ KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY UCENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LIBISZEWSKI, CRAIG MICHAEL DAY AND NIGHT PLUMBING INC 513 OAKHURST STREET ALTAMONTE SPRINGS FL 32701 ISSUED: 08/13/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408130001516 https://apps8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr_person_id=X00030343 11/23/2015 SEMINOLE COUNTY BUSINESS TAX RECEIPT RAY VALDES, SEMINOLE COUNTY TAX COLLECTOR PO Box 630 a Sanford, FL 32772-0630 o Telephone: 407.665-1000 www.seminoletax.org DAY AND NIGHT PLUMBING INC 513 OAKHURST ST ALTAMONTE SPRINGS, FL 32701 CRAIG LIBISZEWSKI (OFFICER) VALID THROUGH 09/30/16 Account #:179366 REGULATED License # - CFC1428472 Qualifier- LIBISZEWSKI CRAIG Receipt #: OLHS2015082802425 Amount Paid: S 45.00 Date Paid: 08/28/2015 BUSINESS OWNER, PLEASE NOTE THE FOLLOWING: o DISPLAY THE ABOVE RECEIPT PROMINENTLY: This Business Tax Receipt shall be displayed conspicuously at the place of business in such a manner that it can he open to the view of the public and subject to inspection by all duly authorized officers of the County. Upon failure to do so, the business shall be subject to the payment of another business tax for the same business or profession. o RENEW THIS TAX BEFORE IT EXPIRES: Pursuant to Florida Statutes, all Business Tax Receipts shall be issued by the Tax Collector beginning July 1" of each year, and it shall expire on September 30`'` of the succeeding year. Those Business Tax Receipts issued as renewal accounts beginning October shall be delinquent and subject to a delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter until paid; provided that the total penalty shall not exceed 25% of the business tax for the delinquent establishment (Florida Statute (FS] 205.053111). A 25% penalty shall be imposed on any individual engaged in any new business or profession without first obtaining a Seminole County Business Tax Receipt. (FS 205.053 (21) This Business Tax Receipt is only a receipt for business taxes paid. It does not permit the taxpayer to violate any existing regulatory or zoning laws of the state, county, or municipality, nor does it exempt the taxpayer from any other required licenses, registrations, certifications, or permits. Business Tax requirements are subject to legislative change. o REPORT ALL CHANGES: The holder of this Business Tax Receipt is required to report a change in the following: Ownership., Business Location, Mailing Address, or any other information that would alter the status of the current year's taxes. This includes, but is not limited to, the loss of or a change in a State License which was used to qualify for the business activity and/or occupation identified on the current County Business Tax Receipt. If you have any changes to report, contact the Business Tax Department at 407-665-7636. DAY AND NIGHT PLUMBING INC 3610 PALM AVE APOPKA, FL 32703 County Services Building Casselberry Office Oak Groves Shoppes ShelMar Prot1 Building Commons at Primera 1101 E First Street 104 Wilshire Blvd. Unit 1000 995 N SR 434 Suite 505 1490 Swanson Dr #100 345 Primera Blvd Sanford, FL 32771 Casselberry, FL 32707 Altamonte Springs, FL 32714 Oviedo. FL 32765 Lake Mary. FL 32746 �� - 411/5 DAYAN-2 OP ID: LM ACORL7" `,,,„r, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08!1812016 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 Eagle American 1855 State Road 434 Longwood, FL 32750 r Lina E Mancinik CONTACT NAME: Linda Mancinik PHONE 407 FAX -998-5587 (A/C, No. Ext): (A1C, No): 407-771-4248 E-MAIL AODREss: Lmancinik@ipofcf.com INSURER(S) AFFORDING COVERAGE NAIC / INSURER A: United Specialty Insurance Co COMMERCIAL GENERAL LIABILITY INSURED Day and Night Plumbing Inc Craig Libiszewski 3610 Palm Avenue Apopka, FL 32703 INSURERB: USA4106452 INSURER C: 10/24/2016 INSURERD: $ 1,000,000 INSURER E : $ 100,000 INSURER F : 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. LTR TYPE OF INSURANCE INSD yyVD POLICY NUMBER EFF (MMIDDIYYYY) (Y EXP MMIDDIVYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY USA4106452 10/24/2015 10/24/2016 EACH OCCURRENCE $ 1,000,000 PREAMAGE MISES occurrence) PREM $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO -LOC PER: PRODUCTS- COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS AONGS OWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ P(PROaPERdT ntDAMAGE $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHCLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Craig libiszewski C FC1428472 __ CITYMIS Miam i Shores Village 10050 NE Second Avenue Miami Shores, FL 33138 1 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 n ACORD 25 (2014/01) @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Report Viewer 5/9/16 8:22 PM 1 JEFF AIWATER 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: 10/15/2015 EXPIRATION DATE: 1W142017 PERSON: UBISZEWSKI CRAIG M FEIN: 451536735 BUSINESS NAME AND ADDRESS: DAY AND NIGHT PLUMBING INC 3610 PALM AVE APOPKA FL 32703 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pawl to Chapter 44085(14) F.B., en dicer d a cupaadan who cants oats: on tan this dug*, by tibg a orotate ddection under leis section mallnetPeeper boob acanmensatlmunderthisdolor_Pin to Chapter 440.05(12).F_S.,Cerilatesdetection Lobeenact_ oily may vrihki the scope the business or trade listed on the notice ardedian to be exempt. Pursuant to 440.05(13). F.&, Slices Mambo to be exempt end caciticates of dance the person named at the nonce aabcatl�e�io lager mshaN be easle requirements of at aman fur after issuance _ Thear nab= cr the iisurace of the depaunat shell rrwkea DFS-F2-0WG252 cER11FICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413.1809 https://apps8.fldfs.corn/crreportviewer/reportViewer.aspx?data=kdvp...LNPm%2f8b%2frigF%2fe3RpWQ)kY61%2f13jcxtwgw6himj52962bs2%2Mg%id%3d Page 1 of 2 Day and Night Plumbing 3610 Palm Ave. Apopka, Florida 32703 Date: 1167(0 State of RO 44 kb (4 - County of l O 4t Before me this day personally appeared Craig Libisztfski who, being duly sworn, deposes and says: That he or she will be the only person working on this project located at: 6I e 1 s.L/ a-? ; S( --r Sworn to (or affirmed) and subscribed before me this l' day of �`' .20 ((o ,by c(fer,� L� 60 2. fl5Ci Personally Know OR Produced Identification Type of Identification Produced ANTHONY SOON Myco EXPIRES: FEB 23 e Br, mu*A 1st state morns Notice to Owner — Workers' Com p Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 County of Miami -Dade The foregoing was acknowledge before me this C7 day of /El 9' By _7 g cJ � c.4.4,,-/ 1 ko r Notary: SEAL: 20/L. who is personally known to -me or has produced identification. _ANTHQNyprfs STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (85 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 LIBISZEWSKI, CRAIG MICHAEL DAY AND NIGHT PLUMBING INC 3610 PALM AVE APOPKA FL 32703 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 learn more about the Departments 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 FLORIDA DEPARTMENT OF BUSIN PROFESSIONAL REGULA, CFC1428472 ISSUED: 08 CERTIFIED PLUMBING CONTRACTOR L1BtSZEWSKI, CRAIG MICHAEL DAY AND NIGHT PLUMBING INC 487-1395 S AND ON 1/2016 IS CERTIFIED under the provisions of C ' 89 FS. Expiration die : AUG31.2018 Ll 0002949 DETACH HERE KEN LA ON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 LIBISZEWSKI, CRAIG MICHAEL DAY AND NIGHT PLUMBING INC 3610 PALM AVE APOPKA FL 32703` ISSUED: 06/21/2016 DISPLAY AS REQUIRED BYLAW SEG # 1_160132'x0002949