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PL-15-2356 t Permit No. PL-9-15-2356 `SHgREs i, Miami Shores Village Permit Type:Plumbing-Residential g� 10050 N.E.2ndvenue NE ....„ APerill "t i work Classification:Addition/Alteration Miami Shores,FL 3313&0000 Permit Status:APPROVED Phone: (305)795-2204 FLORiDp issue nate: 111512016 Expiration: 07113/2016 Project Address Parcel Number Applicant 1055 NE 96 Street 1132060143710 Miami Shores, FL Block: Lot: PATRICE ROBINET Owner Information Address Phone Cell PATRICE ROBINET 1055 NE 96 Street MIAMI SHORES FL 33138-2551 Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 CASTELLON PLUMBING CORP 305-553-1490 Total Sq Feet: 00 Type of Work: PLUMBING FOR NEW GARAGE Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return: Top OutFinal Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# PL-9-15-57104 DCA Fee $2 25 01/15/2016 Credit Card $237.30 $0.00 Education Surcharge $0.60 Permit Fee $225.00 Scanning Fee $3:00 t Technology Fee $2.40 7 Total: $237.30 I t 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 AFFIDAV T: c ify that all the f 'ng in rmation is accurate and that all work will be done in compliance with all applicable laws regulating construction and z - g. thermore, I au rize t a ve a ed contractor to do the work stated. January 15, 2016 AutK6rized Signature• / Applicant / Contractor / Agent Date Building Department Copy January 15,,2016 1 Miami Shores Village if 8-- ',T'rI Building Department artment S&f G2015 By. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20/yam. BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. 2Z /<-I- 2 2 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1055 NE 96 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-014-3710 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Patrice Robinet and Elsa Gagnon Phone#:305-546-8088 Address: 1055 NE 96 Street City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: Patricerobinet@hotmail.com CONTRACTOR:Company Name: Castellon Plumbing Corporation Phone#: 786-255-5195 Address. 9841 NW 130 ST. City. Hialeah Gardens State: Fla. Zip: 33018 Qualifier Name: Giraldo Castellon Phone#: 786-255-5195 State Certification or Registration#: CFC 019059 Certificate of Competency#: DESIGNER:Architect/Engineer: Victor Bruce Phone#: 305-310-5030 Address:370 NE 101st Street City: Miami Shores State: FL Zip: 33138 Value of Work for this Permit:$ 3000.00 Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration ElNew ElRepair/Replace ❑ Demolition Description of Work: Plumbing for new garage Specify color of color thrd tile: �7 Submittal Fee$ Permit Fee$ �GS y CCF$ I ` 90 CO/CC$ Scanning Fee$ —5' ) Radon Fee$ �' � D B P R$ 3 V Notary$ 0 p Technology Fee$ c -46 Training/Education Fee$ G G Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 23-3`�O (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 1 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of J2�—,20 4f , by 03 day of Sep 20 15 by �G)'/rig2o—'2C5 6A, f -,who is personally known to Girald0 Castellon who is personally known to me or who has produced_mfr-�L— as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC:. Si Sign: Print: oda Print: / X" Tp, Z Iq- Nptary Pu p0 Seal: p� Joannamis F092753 Seal: r°` p �MaBU� c Ex C s ovl2i2o+s * MY co�e+4lsslart#FF 194794 EXPIRES:Apt9 7.2019 80MWft1BadgelNdUySel = APPROVED BY � �L`f Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) AC� DATE tM?AIODIYYYY) CERTIFICATE OF LIABILITY INSURANCE_ 12i10h4 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:It the certiftcete 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 certlflcate does not confer rights to the certificate holder in lieu of such endorsement(s). } PRODUCER �MEACT---------- —._.. First Class Insurance Market _PHONE,E,)• (305)441-2997 FAX Na): (305)441-6443 4101 NW 9th Street DoalEss: iG_mc�ao.com _ _ Miami,FL 33126 — INSURER($)AFFORDING COVERAGE__. -NAICN Phone (305)441-2997 Fax (305)441-6443 INSURERA: GRANADA INSURANCE CO INSURED INSURER CASTELLON PLUMBING CORP INSURERC: 9841 NW 130 ST INSURER o-;------------_-_--- INSURER E: HIALEAH FLORIDA 33018 CFC019059 INSURER F: _ I COVERAGES _ _CERTIFICATE NUMBER: _ _ _REVISION NUMBER: a THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND;NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WIIICH 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 ADDLSUBR POLI---EFF POLICY EXP TYPEOFINSURANCE ---. INS.R__MP—_-_POLICYNUMBER_ _(NN/DD/YYYY) tMMIDDM'iLYj LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000,000.100 COMMERCV.LGENERALLIABILITY DAMAGE 70 RENTED.. 100,000.00. u -PREMISES(Ea xcure^ce) S CLAW.S.I.IADE OCCUR 01034414 MED EXP(Any ore person) S 5.000.00 A 10129/2014 10/29/2015-- PERSONAL dAOV INJURY s 1,000,OOO.CO I! _^_�__ _ GENERAL AG3REGATE s 2.000,000.00 GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COt:P/Oo AGO $ 2.000,000.00- POLICY I JRECOS--_LOC_—. -- --S - —AUTOMOBILE UABILITY - ----------------�--' COMBINED SINGLE LIM T (Ea accident) S I^I ANY AUTO BODILY INJURY)Per person„ S -I_ PLLOWNED SCHEDULED - AUTOS AUTOS BODILY INJURY(Per.accidert) S NON-OWNED PjtOPERTY DAMAGE -+ J HIRED AUTOS i_I AUTOS (r�er s UMBRELLA LIAR l i OCCUR - -— EACH OCCURRENCE { EXCESS LIAB —'i CLAWS-MAD= AGGREGATE S - —- _ •_Li. DEO L_E RETENTIONS ________ S WORKERS COMPENSATION - OLT - 1—_ER YIN RY IhSAND EMPLOYERSLIABILITY -_.._._ ------ ANY PRO PRI-TORIPARTNER/EXECUTNE EL.EACH ACC'DENT S OFFICER/MEMSER EXCLUDED4 N/A - -- --- • -- (Mandatory In NH) E L DISEASE-FA EMPLOYEE S It yes,descrice under ULSCR'PTION OF OPERATIONS gelow -_--_---_- —_-_ _—_ __---E.L.DDISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) v — PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FLA.33138 --- ------- --- - -------- AUTHORIZED REPRESENTATIVE FAX:(305)756-8972 � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD 01 STAVE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CASTELLON, GIRALDO CASTELLON PLUMBING CORP 9841 NW 130 ST. HIALEAH GARDENS FL 33018 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals anc businesses range DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants, and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC019059 ISSUED: 05/29/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com, There you can find more information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you, subscribe CASTELLON, GIRALDO to department newsletters and learn more about the Department's CASTELLON PLUMBING CORP 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, IS CERTIFIED under the provisions of Ch 489 FS and congratulations on your new license! Exp,raticn date AUG 31 2016 1.1405290001726 I 1 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON;SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ?= - CFC019059 s 1,_ The PLUMBING CONTRACTOR Named below IS CERTIFIED Under,the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 CASTELLON, GIRALDO CASTELLON PLUMBING CORP 9841 NW 130 ST. ' HIALEAH GARDENS FL 33018 y ��16 wu'sui Local Ejusiness Tax Receipri-da Miami—Dade County, State of Fl° -TFHS IS NOTA BILL - DO NOT PAY 466748 EXPIRES aECEtPT No_ 30, 2015 BUSINESS MARAE"CATION RENEWAL SEPTEM� (,ASTELLON PLUMBING CORP 466748 Must be displayed at place of business 9841 IOW 130 ST Pursuant to County HIpLEAH GARDENS FL 33018 Chapter 8A-Art-9&10 SEC-TYPE OF BUSINESS B TAX COLLECTOR OWNER 196 PLUMBING CONTRACTOR CASTELLON PLUMBING CORP CFC019059 $45.00 08/07/2014 Workers) 10 CHECK21=-14-045693 ; rs aot � Tax Receipt only confirms Pay, of the Local Business Tsx. The B'�iy . This Local Basi"ess qualifications,to do business Holder crust coa►P ,, holder permit or a certi6catian thry laws sad rc9u. Gets which apply to tha buanam or sp�emmental req Sar ' The RECEIPT NO.above must ba displayed oo all corrxaercial vehicles _ For more iafots"ation,visit�OK+au CASTELLON PLUMBING CORP. 9841 NW 130 Street Hialeah Gardens. Florida 33018 Date: State of Florida ) ) County of Miami-Dade ) Before me this day personally appeared Glia.6� Cd S w�,eZla. ,who, being duly sworn, deposes and says: That he or she will be the only person working on the project locatedat 1055 NE 96 Street, Miami Shores, Florida 33138. Sworn to (or affirmed) and subscribed before me this _�_ day of September, 201.5 by Personally know ✓✓ OR Produced Identification Identification Produced Print, TyRg or Stamp Name of Notary d� •••.,t% BEATRV A.BURGOS MY COWNSSION#FF*734 F EXPIRES:April 7,2019 '+�r`or'�~ Boa�lituu8u�etNotarySpdCet Report Viewer '13 r 100% STATE OF FLORIDA FAIWAVER CER DEPARTMENT OF RNANC�SERVICES WMIDN OF WOii GM'COMPENSATION iIRC/1TE OF RECTION TO BE EXEMPT FROM FLORIDAWONOWCOMPENSATIONLAWDUSTRY E7(EMPTION e individual listed below has elected to be exempt from Florida Workers'Compensation law. E�CTNE DATE 11/22/2013 EXPIRATION DATE' 11222015 I PERSON' CASTELLON GIRALDO I FRN' 591676866 I 1 BUgwESS NAME AND ADORNS' I CASTELLON PLUNGING CORP 1 9841 NW 130 ST. HIALEA,H GARDENS FL 33018 SCOPES OF BUSIN BS OR TRADE' LICENSED PLUNGING CONTRACTOR �yyN� to-1-0 woobai tan IM •arMcrw d idor vOarlty�t aper^w' pvnafbClrPrNO.OQ(H1.FA. H d p=JoCNOW""aoX12).F.S.41daM" �arissdmidorb0i�i�rptddarnkrMd� rd r.oa.r 4.nit<a anpsrrilsr aTVLW can b Caps �d h mtk-ft N pssar rend-rr Mlw a ad a—* dmMrdwdit V18KxV� eel,rgdtrrdne rwd�rrosfla,MwMYnrbrJWkirsdOr i/dorb okr wO.h6 ftrgsll°rscralan d�aroleiaTlyd�rtnrlink �irwrrd awn M aMaY bowl h+pws+sd d fis awjwe QUESTIONS?(M4111609 OFS.F2.DWC•252 CERTIFICATE OF ELECTION TO 8E VCWT REVISED 07.12 t uarco-D1KIEA7%2PSZ5WWB)4T6 BESOpWV4NPOPN42XeirDRGXVW*i... 1/2