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PL-18-72 Permit NO,. F L-1-1 -72 Miami Shores VillageM Permit Type:Plumbing-Residential 10050 N.E.2nd Avenue NE erml Work c ClasSfiCation:Addition/Alteration Miami Shores,FL 3313&0000 Permit'Status:APPROVED Phone: (305)795-2204 F�RiDA Issue Date: 1/26/2018 Expiration: 07/25/201$ Project Address Parcel Number Applicant 575 NE 95 Street 1132060140760 Miami Shores, FL Block: Lot: THOMAS N CONWAY Owner Information Address Phone Cell THOMAS N CONWAY 575 NE 95 Street (786)218-2757 MIAMI SHORES FL 33138- 575 NE 95 Street MIAMI SHORES FL 33138- Coritractor(s) Phone Cell Phone Valuation: $ 1,500.00 AA MASTERS MECHANICAL AIR MOV (305)244-0667 Total Sq Feet: 250 Type of Work:NEW POWDER/LAUNDRY RELOCATION Available Inspections: Type`of Piping: Inspection Type: F Additional Info:NEW POWDER/LAUNDRY RELOCATION Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground r Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee InvOiCe# PL-1-18-66091 $3.38 01/10/2018 Credit Card $50.00 $186.83 DCA Fee $2.25 Education Surcharge $0.40 01/26/2018 Credit Card $ 186.83 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $236.83 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: Icertify-that all the c icing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.�uthermore;I auth raze the above=h med contractor to do the work stated. _ --`— January 26, 2018 Authorized Si ature: er / A gaff---/ Contractor / Agent Date Building Department Copy January 26, 2018 1 Miami Shores Village F Building Department SAN 10 201 _nA 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 by _ Tel:(305)795-2204 Fax:(305)756-8972 f \ , INSPECTION LINE PHONE NUMBER:(305)762-4949 Y FBC 20115"" BUILDING Master Permit No. 9)c 1n1— 11"26-11 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP +� / C� CONTRACTOR DRAWINGS JOB ADDRESS: t S V-1 1 /T ` y City: Miami Shores County: Miami Dade zip: Folio/Parcel#: —v./11-0760 Is the Building Historically Designated:Yes NO—'X Occupancy Type: Load: ^Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Yf 'WK Phone#:�57G�2 Address: ,Z!�' l F_ 115�5 7W City: 1414?AT <140 8 d—ES State: ��— Zip: 33/13 8 Tenant/Lessee Name: Phone#: Email: /' CONTRACTOR:Company Name: /OK �� T6-0 /1EC1.1giUICf9G "}2 R Phone#: 165 2'7�06�N /[ Address: 55E1 (i;- W /td `i 7.66 3 qcr- 0 Ary r S26- City: l ` State: �L zip: Qualifier Name: fa L-rX V6 TE-505 6o J C—di ti�'1 tq- Phone#: 305 2 Zf ©6 6 '7' State Certification or Registration#: 6FC, 17 Gs'161 Certificate of Competency#: DESIGNER:Architect/Engineer: Z01�86 9, f?lA✓lOilLL14 Phone#:�45 915 46�T Address:_1 D/f !!2W C,3 City Qay'1,tT#gi%l State:&VZ Zip: S Value of Work for this Permit:$ Y500 % Square/Linear Footage of Work: q- 5(9 Type of Work: ❑ Addition ® Alteration - ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: „z C ul P'0 w t)1�7 I ZA dr) �0 h z�L4<d 71 O.,C/ Specify color of color thru tile: Submittal Fee$_50 Permit Fee$ •Z Zr' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2• ZS DBPR$ 3 • Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) a 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 inspectioA which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection 4note a proved and a reinspection fee will be charged. SignaturSignature OWNER or AGENT CONTRACTOR The foregoing i strument was acknowledged before/me this The f oing instrument was acknowledged before me this, a day of ©_ 8 LI-7 13 20 /I � by � day of 2 � 20,1-+_ by TffOLM5 C0,1VtV R Y,who Enally know to ki-. (IAL-� (� evmyais personally known to me or who has produced as me or who has produced fic� � A � `'�' as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY ; %�; NA CECIHE NUNEZ o•......... J?a: 'f COM #FF166669 fI Sign: ber 7�2018 ' Sign: 11rC 390-01 W n o a ice.com Print: , !� _ Print: i Seal: ►.. EXPIRES Oclober 15,2019 Seal: � wc�iioe��s� c a«rw.can APPROVED BY (' �'�0 Plans Examiner Zoning i Structural Review Clerk (Revised02/24/2014) t t ,AcoRL)l CERTIFICATE OF LIABILITY INSURANCE , DATE(MM,DD,YYYY) �..�/ 12/22/2017 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 have ADDITIONAL INSURED provisions or 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 SUNZ Insurance Solutions, LLC. ID: (TLR) �,�, Workers'Comp De artment c/o TLR of Bonita, Inc PHONE 727-520-7676 x 3 FAx No); 727-525-3862 700 Central Ave, Suite 500 E-MAIL°` St. Petersburg, FL 33701 p use certsAencorehr.com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA: SUNZ Insurance Company 34762 INSURED — INSURER 8: TLR of Bonita, Inc II EnteTriseHR INSURER C: 4 700 Central Avenue Suite 500 INSURER D: St. PetersburgFL 33701 INSURER E: INSURER F —�— COVERAGES CERTIFICATE NUMBER: 39457405 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. INSR I TYPE OF INSURANCE ADD L B R ^— POLICY NUMBER M ,M DDY EFF MM /JCY EXP LIMITS LTR{{ COMMERCIAL GENERAL LABILITY I EACH OCCURRENCE S- !t —� I CLAIMS-MADE OCCUR j f 6 I PREMISES(Ea occurrence) MED EXP(Any one art!_- 5 11 I PERSONAL&ADV INJURY S 'I G_EN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY I I EC L 1 LOC ! PRODUCTS-COMP/OP AGG S _ i (OTHER: l $ 007NAUTOMOBILE LIABILITY a adEent I LIMI $ ANY AUTO BODILY INJURY OWNED f SCHEDULED `_-- r etxldent) S AUTOS ONLY I_- AUTOS i BODILY INJURY(Pe — HIRED I JOI:-OWNED i i PR PERTYDAMAGE— $—_ — _ AUTOS ONLY I--.�AUTOS ONLY l l S I UMBRELLA UABI OCCUR i I I EACH OCCURRENCE I_ I EXCESSSLIAAB CIAIMS-MADE( I. I AGGREGATE DED I !RETENTIONS I � S A iWORKERSCOMPENSATION WCPE0000000113 6/1/2017 6/1/2018 PTAT O H- ILJ�_I�T.€. ER -- I AND EMPLOYERS'LIABILITY YIN 11 1 I I ANYPRCPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT_ $100000000 t l OFFICERrMEMSEREXCLUDEDT �'N,A I (Mandatory In NH) f i , E.L.DISEASE-EA EMPLOYEE E .Q>�_QQ0.00 ,ifes.duscnbe wider - O SCR:PTION OF OPERATIONS balow , E.L.DISEASE-POLICY LIMIT ..S 1,000,000.00 _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) Coverage Provided for all leased employees but not subcontractors of:AA MASTERS MECHANICAL AIR MOVING&ENGINEERING SYSTEMS CORP Client Effective: 11/6/2017 CAC 057226 and CFC 1426169 CERTIFICATE HOLDER CANCELLATION 2597 Miami Shores Village Building Dept, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g g h THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ',///�'� Of Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 3'i57.ID5 I TI.P. V: avnita, :nC FE-0 001 :.ASTER CERT I xndreF 4:B 1+iCCi•:i 12/121d Cly 4:14:1? Aad iCST) I Page 1 of 1 I d ----- ... .... E � usness Tax R�ece�pt � . �M:ami-fade G•aunty, Stateof FbrldaLBT k S tS N4T+A 81IL NOT PAY j r RECEIPT NO. EXPIRE Mi!�STER5.14 ECFiAMICALAIR MOVING AN'ENGINIBROAPMMS TEMBER 3 X15541 SW 105i7ER5z5 5667754 0, 2018 MAU' 1`331 j6 Must be displayed at,place of business Pursuant to County Code Chapter 8A—'Art.9&10 OWNER' SEC.TYPE OF BUSINESS AA MASTERS MECH AIR MOVING ENGR 196 PLUMBING CONTRACTOR PAYMENT,RECEIVED ylarl (5) 1 &C1426169- sir TAX COLLECTOR • M �. $75.00 09/23/20.17 ,J CREDITCARD=17061538- �•µ This!seal Business Tax Receipt only confirms ' i"k ora certificatiao efths holder:qualification,t do business,Noider.must omply witTax. The h is any govelrnmental or nenmenl regulatory Iews and requirements which apply to the business, The RECEIPT N0.above must be displayed on aH commercial vehicles-Miami-Dade Code Sec 8a{Z711. For more intormation,visit i i F f 1 f r t y 1