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PL-16-1993 (3)BUILDING PERMIT APPLICATION El BUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL 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 ST± FBC 20 N Master Permit No. 6—' 98q Sub Permit NoTL-16' (99-3, ❑ ROOFING ❑ REVISION ❑ EXTENSION E RENEWAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS X06 ADDRESS: 445 NE 94 ST, Miami Shores, FL 33138-2845 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-0520 Occupancy Type: Load: Is the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): DARREN OCKERT Address• 445 NE 94 ST FFE: Phone#: 917.573.9022 City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: n�"-1...e_ •' 4F� t0 /�,Vnein r 3 Address: / 68 �� .I�i�-�`� ? {` City: Q>1. 11(vr t tT State: Qualifier Name: �C1/} State Certification or Registration #: CPC O a7 (0 Phone#:s�' - Zip:3/,37'0�7�� Phone#: 9 `� -SY7 to Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ 41000 Type of Work: ❑ Addition 7, Alteration Description of Work: IL) CIAh i (n W o Nie'r A IrA4 (144--( City: State: Zip: Square/Linear Footage of Work: R air/Replace Specify color of color thru tile: ( x,45. co Submittal Fee $ 5O' Q Permit Fee $ CCF $ 28. 2.0 co/CC $ 0 Notary '$ •5 • Q Scanning Fee $ Radon Fee $ • " SOS DBPR $ 2'T' + 9 Technology Fee $ • Go Training/Education Fee $ c:f • TO Structural Reviews $ (Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ II92.�•s, 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 approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was,acknowledged before me this The foregoing instrument was acknowledged before/me this t 8 day of SSV 7 , 20 (-6 , by [_ da _ G 20 G by �C`W� (�C',K�' 1 , who is personally known to —�� ;Gz l , who is personally known to me or who has produced f__c2.& Ac• me or who has produced as Sign CONTRACTOR identification and NOTARY PUBLIC: Sign: Print: Seal: 1 414 did take an oath. 44111M07; ak, *************** 0 VV Or 4� Notary Public State of Florida Sindia AlvareZ ` My Commission FF 156750 Expires 0010312018 ***** identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ; Notary Public - State of Florida • My Comm. Expires Nov 14, 2018 � Commission # FF 161435 '''°ri too Bonded through National Notary Assn. • *********************************************************************** �� APPROVED BY -0%-! Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 D'ADDIO, RICHARD L R L`D'ADDIO PLUMBING CO INC 22345 SIESTA KEY DRIVE BOCA RATON FL 33428 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 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 LICENSE NUMBER DETACH HERE it (850) 487-1395 W 3r , _ ,:sem . STATE OF FLORIDA DEPARTMENT_OF BUSINESS AND PROFESSIONAL'REGULATION CFC057296 ,' brtj }.ISSUED:- .08/18/2014 CERTIFIED PLUMBINGCONTRACTOR D'ADDIO, RICHARD F'� R L D'ADDIO PLUMBING COINC • IS CERTIFIED under the provisions of Ch.489 FS. Expiration date ; AUG 31; 2016 - • 11408180001398 'KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 D'ADDIO, RICHARD L _- R L D'ADDIO .PLUMBINGCO-"INC' 22345 SIESTA KEY DRIVE?rr¢ ' :. BOCA RATON'";F:1233428.-:- -7-24"'""` FL`33428 :,.. ISSUED: 08/18/2014 • DISPLAY AS REQUIRED BY LAW SEQ # L1408180001398 ANNE M. GANNON CONSTITUTIONAL TAX COLLECTOR Serving Palm Beach County Serving you. P.O. Box 3353, West Palm Beach, FL 33402-3353 www.pbctax.com Tel: (561) 355-2264 'LOCATED AT** 968'ALLENDALE RD WEST PALM BEACH, FL 33405 TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AMT PAID BILL # ' 23-0105 CW PLUMBING CONTRACTOR D' ADDIO RICHARD CFC057296 B15.870365 - 09/01/15 $264.60 B40104575 This document is valid only when receipted by the Tax Collector's Office. 61 - 1750 R L DADDIO PLUMBING CO INC R L DADDIO PLUMBING CO INC 968 ALLENDALE RD WEST PALM BEACH, FL 33405 IIIII,JLuIuIIIIIlIIJJu STATE OF FLORIDA PALM BEACH COUNTY 2015/2016 LOCAL BUSINESS TAX RECEIPT LBTR Number: 200008003 EXPIRES: SEPTEMBER 30; 2016 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public: ANNE M. GANNON CONSTITUTIONAL TAX COLLECTOR Serving Palm Beach County Serving you. P.O. Box 3353, West Palm Beach, FL 33402-3353 www.pbctax.com Tel: (561) 355-2264 **LOCATED AT*" 968 ALLENDALE DR WEST PALM BEACH, FL 33405 TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AMT PAID BILL # 23-0069 PLUMBING CONTRACTOR 0' ADDIO RICHARD CFC057296 B15.868343 - 08/28/15 $27.50 B40104576 This document is valid only when receipted by the Tax Collector's Office. B2 - 843 R L DADDIO PLUMBING CO INC R L DADDIO PLUMBING CO INc 968 ALLENDALE RD WEST PALM BEACH, FL 33405 IlIIIIIIIIuIIIIII,unIIII STATE OF FLORIDA PALM BEACH COUNTY 2015/2016 LOCAL BUSINESS TAX RECEIPT LBTR Number: 200008002 EXPIRES: SEPTEMBER 30, 2016 This receipt grants the privilege of engaging in or - managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. 1 RLDAD-1 OP ID: MH Rµ r d 4OO `C �..rrr� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 0711512016 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' Atlantic Pacific Insurance -PBG 11382 Prosperity Farms Rd #123 Palm Beach Gardens, FL 33410 Paul Regan Finley CONTACT NAME: AIC, No, Est): NE 800538-0487 FAX No 561-626-3153 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Conifer Insurance Com pany 29734 INSURED R L D'Addio Plumbing Co Inc 968 Allendale Rd West Palm Beach, FL 33405 INSURERB:• CIGL013335 INSURER C 04/17/2017 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. INSRLT TYPE OF INSURANCE NSD UBR VYVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMlDDNWY) LIMITS . A X COMMERCIAL GENERAL LIABILITY CIGL013335 04/17/2016 04/17/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREMISEDAMAGES (Ea Ta-RENTDoccurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PES PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ 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 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 1 N N 1 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) Contractor License #CFC057296 • CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village g Building &Zoning 10050 N.E. 2nd Avenue Miami Shores, FL 33132 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 ACORD 25 (2014/01) © 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: 6/5/2016 EXPIRATION DATE: 6/5/2018 PERSON: D'ADDIO RICHARD L -FEIN: 650931531 BUSINESS NAME AND ADDRESS: R L D'ADDIO PLUMBING CO INC 968 ALLENDALE RD WEST PALM BEACH FL 33405 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 certificate 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 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: 6/3/2016 EXPIRATION DATE: 6/3/2018 PERSON: LANDRESS ROBERT FEIN: 650931531 BUSINESS NAME AND ADDRESS: R L D'ADDIO PLUMBING CO INC 968 ALLENDALE RD WEST PALM BEACH { FL 33405 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 certificate 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 1.