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PL-16-687 4 Permit NO. PL-3-'16-887 Miami Shores Village Permit Type: Plulnting'-Residential 10050 N.E.2nd Avenue NE 'Per I Work C/assificatibn:Addition/Alteration Miami Shores,FL 33138-0000 Permit5tatus:APPROVE Phone: (305)795-2204 CORIOp' issue nate:3/1812016 Expiration: 09/14/2016 4 Project Address Parcel Number Applicant 9879 NE 13 Avenue 1132050090490 Miami Shores, FL Block: Lot: JACQUELINE BARRANTES t Owner Information Address Phone Cell JACQUELINE BARRANTES 9879 NE 13 Avenue (917)698-2863 MIAMI SHORES FL 33138- 9879 NE 13 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 18,900.00 B&N PLUMBING CONTRACTOR COF (786)236-1256 ._ . �,.._. _...�._.__.... ...,... . ._.,,. Total Scl Feet: 0 Type of Work:PLUMBING FOR INTERIOR REMODELING. Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $11.40 DBPR Fee Invoice# PL-3-16-59029 $9.93 03/16/2016 Check#: 1972 $50.00 $669.76 DCA Fee $9.93 Education Surcharge $3.80 03/18/2016 Check#: 1975 $669.76 $0.00 Notary Fee $5.00 Permit Fee $661.50 Scanning Fee $3.00 Technology Fee $15.20 Total: $719.76 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 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named contractor to do the work stated. i March 18, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 18, 2016 1 1 ` Miami Shores Village cr Building Department artment MR1 X416 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY, ` Tel:(305)795-2204 Fax:(305)756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 (�s� FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.�I w BUILDING ❑ ELECTRIC ❑ ROOFING- [:].REVISION EXTENSION EJRENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS i JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: F Folio/Parcel#: Is the Building Historically Designated:;Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: P FFFEE: OWNER: NamePhone#: :Simple Fee Sle Titleholder ( 1 p ) v� � Address: ? City: A)-,<G(�U A, U State: �'(y,,_ Zip: 1531 Tenant/Lessee Name: Phone#: Email: d ,S 'JC12G11�1_ CONTRACTOR:Company Name: d�oW .'�/r Phone#: ��� 5e-v l�5�2 Address: r Lor City: /L2,GG�-U State: Zip: Q g c� � t . Qualifier Name: Phone#: State Certification or Registration#: � ���O�'f Certificate of Competency#: DESIGNER:Architect/Engineer:, .. Phone#: Address: q City: State` Zip: Value of Work for this Permit:$ ( � Square/Linear Footage of Work: 4 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description•of Work:—.., �� �(�[JI�C.�i' «• � � A _ , 1 P(M1 - lJ.+rya:l!':f .9,•`.'� i'bl •°r t .3_ E - Kr.,4�°v'�.✓4..;'b . Specify color,of,colorvtlil'ii`tile .,._............»...• .,,i..•..�.... .......+.. :... ....,..,.... r' • rn f 1ySubmittal Fee$ ( Permit Fee$ c� /® CCF Scanning Fee$ Radon Fee$ CJ �b DBPR$ (� Notary$ Technology Fee$ IJ ' Training/Education Fee$ 90 Double Fee$ Structural Reviews$ 0 Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) l —7 Bonding Company's ptName(if applicable) i hi! Bonding Company's Address City _ `M1 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 inning. (. "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." L 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 absen o such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur r1l Signature O ER or AGENT CO T CTOR The foregoing instrument was acknowledged before me this The foregoing instrumen ads"acknowledged before me this _ day of e fir 20 6 by 3 day of�,, ,,(""I�LY1 20� by j�( e liAg PAffaah ,who is o Iaaa4 v^^���,to �C(�,(.� QU(/l(,(I1 ,who is personally known to me or who has produced 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: Sign: Sign: rint: Print: Se Notary Public State of Florida Seal: MY COMMISSION#FF201726 aP00 Joanna M Feliciano EXPIRES Fob iary 19.2019 My Commission FF 082753 •Oi Jib-0tSJ ib Swie�.com oris Fxpires011t2120t8 *** * ************************************************************************************ APPROVED BY 7 s Examiner Zoning i Structural Review ' Clerk (Revised02/24/2014) I O I 9 r C 5 { r r { I "-."RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY y STATE OF FLORIDA"`- y DEPARTMENTOF,BUSINESS,AND PROFESSIONAL REGULATION .' CONSTRUCTION INDUSTRY LICENSING BOARD FC1428 C699 .�. .� �„�,... ..o.... _ ,,, ,�:.,. '�-,.3' .� ,M+..< �v"' •n...�. ,..._,�_^ ��,.., �, '�e `"w. -mak 'fie q.� .w nThe PLUMBING::C,ONTRACTOR � ,. � �,«s _- ��. .1�«• ;,� � �.4� ��,�,�`�' � ',a ', ' �4,• F`Named-U61ow.IS.CERTIFIED `* «. . = �: ry goown Under the provisionsof Chapter 489 FS " ;�`-`�► �"` `` $ Expiration date AUG 31 2016;" �. +� `" � MAGADANz,R,AUL . ~` -- . , "' ,. `�. �'r�` � B & N PLUMBINGsCONTRACTOR:CORPb- q �4600`SW135 `""� ti FL 33175 ISSUED: 07/01/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407010001238 f r t 004800 Local Business Tax Receipt fKami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 7078736L,,,-BT .y BUSINESS NAME/�.00ATION RECEIPT NO. EXPIRES B&N PLUMBING CONTRACTOR CORP RENEWAL ' SEPTEMBER 30, 2016' 4600S W 135 AVE 7356587, Must b_ adisplayed at place of business MIAMI k 3317.5 Pursuant to County Code Chapter BA,-Art.9&.10 Fa—_ I OWNER SEC.TYPE OF B(j-ST14 SS 196 PLUMBING CCINTRACTOR` CPAYMENTI RECEIVED =B$N t?LUMBING CONTRALTO CORP f` O LECTOR CFC1428699 Worker(S) 1 $75.00 07/30/2015--'N A Ily � � EfHECK-1I5-1590()6 (j This`Locsl�Business Tax Receipt confirms payment of the Local Business Tax:The Recoldis not a license, permita certification df the holder's qualifications,to do business. Holdermustcompl¢with any governmental ,or nongovernmental regulatory laws and'requirements which applito the business. It The-RECEIPT N0.above must be displayed on all commercial vehicles-Miemi-Dade Code Sac M-276. - For more,iut9rmation,vi;i[www.miamidade."xcollector_.__� t I CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 033/08/1/08/16 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 CONTANAME: Rene E.Samayoa Acceptance Insurance Services PHONNo,E . (305)740-0515 n/c No): (305)740-0518 6887 S.W.40th St. E-MAIL rene@accepatnceinsservices.com Miami,FL 33155 INSURERS AFFORDING COVERAGE NAIC# Phone (305)740-0515 Fax (305)740-0518 INSURER A: Scottsdale Insurance Company 41297 INSURED INSURER B: B&N Plumbing Contractor Corp. Lic# CFC1428699 INSURER C: 4600 SW 135 Ave INSURER D: Retail First Insurance Company 10700 Miami,FL 33175 786-236=1256 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1 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 TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR IN R WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $1 1,000,000.00 DAMAGE TO RENTED ,100 000.00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $- ❑ F—] N N 11/14/2015 11!14/2016 CLAIMS-MADE R OCCUR CPS2313513 MED EXP(Any one person $ 5,000.00 A Q Contractual Liabiity . PERSONAL&ADV INJURY $r 1,000,000.00 ❑ Primary Non-Contributory GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ElPOLICY ❑d PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $, 1 ❑ ALL AUTOS OWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ AUTOS F-] ❑HIRED AUTOS NON-OWNED' PROPERTY DAMAGE $ AUTOS Per accident ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $I ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ t ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATIONWC STATU. OTH- AND EMPLOYERS'LIABILITY Y/N ❑] TORY LIMITS ❑ ER t ANY PROPRIETOR/PARTNER/EXECUTIVE 520-52967 E.L.EACH ACCIDENT $ 100,000.00 D OFFICER/MEMBER EXCLUDED? F-1N/A N. 01/06/2016 01/06/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i PLUMBING CONTRACTOR LIC#CSC1428699 I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL,33138 � �' 305-756-8972 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)CIF The ACORD name and logo are registered marks of ACORD