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PL-16-1798 Permit NO. PL-646-1 sµOR us y,{ Miami Shores Village Permit Type:Plumbing-Resid 10050 N.E.2nd Avenue NE WafkCi855t#CBtion:Addition/Alte Miami Shores,FL 33138-0000 Per "t Phone: (305)795-2204 Permit Statuar APPR FCORIOp' Issue Date:7/7120115 Expiration: 01/03/2]7 Project Address Parcel Number Applicant 1420 NE 103 Street 1132050310030 Miami Shores, FL Block: Lot: MARC AND ANNE LITZENBERG Owner Information Address Phone Cell MARC AND ANNE LITZENBERG 1420 NE 103 Street MIAMI SHORES FL 33138- 1420 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 7,000.00 Q'S CONSTRUCTION INC (786)229-5666 Total Scl Feet: 0 Type of Work:ALTERATIONS Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees DueLAmount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee Invoice# PL-6-16-60367 $3.68 07/07/2016 Credit Card $216.56 $50.00 DCA Fee $3.68 Education Surcharge $1.40 06/28/2016 Credit Card $50.00 $0.00 Permit Fee $245.00 Scanning Fee $3.00 Technology Fee $5.60 Total:. 266.56 C" In consideration of the issuance to me of this permi gree to the work covered hereunder in compliance with all ordinances and regulations pertainingthereto and in strict conformity with the plans, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting"this permit I assume responsibility for all w done by either myself, my agent, servants, or employes. I understand that separate permits are required for,ELECTRICAL,PLUMBING,MECHANICAL, INDOWS, DOORS,ROOFING and SWIMMING POOL work. V i OWN ERStAFFIDAVIT: 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. July 07, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date rel Building Department Copy i;, July 07;2016 1 Miami Shores Village --- Building Department ' '�• a ? 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 FBC 20M BUILDING Master Permit No. IS S PERMIT APPLICATION Sub Permit No. PL- b - 16 - 1798 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑`EXTENSION ❑RENEWAL -PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 "i Z D I E City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Y Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: I AA /� t OWNER: Name(Fee Simple Titleholder): A((Ci�Ajn jj L-t tzen l.(02 Phone#: Address: q `�-4 IV E City: kc/m, .sf'o&S State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: &.5 A Phone#: —2d Address: City: c e: Zip: Qualifier Name: Phone#: � State Certification or Registration#: C K c ��2 �3 Sd Certificate of Competency#: DESIGNER:Architect/Engineer: T fd 5-tdios � Phone#: ' i Address: City: State: Zip: mU Value of Work for this Permit:$ Square/Linear Footage of Work: r Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Descriptio of"Work:-­w 02 + r�?4P-:. � '1:1;i7E.!`.,r.i,� ;.,e.k'..4.`v, A1. '.rV..;�'.�+��✓�,.rkst ht'r _,.�,r. V.. Specifyo1d 'ofmlb�'>tii ►7e� ,. ,H - � s ?v:"+� 'Jt�.�;�.4YMYpVsn'r/•-.:.N,i..'j:T+mh:.ty n•s sY!ba,.•w Y+vv. Submittal Fee$ Permit Fee$ a/©• CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) + Bonding Company's Address City - - - State r 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 l 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,;r,PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... �, c C, 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 commen a ent muit be posted at the job site for the first inspection which occurs even (7) days after the building permit is issued. 1 t e bsence of such posted notice, the inspection will not be approved and r 'nspection fee will be charged. Signature Signature . O GENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this LO day of M e'` ,20 1 tO by &1:2,1- day of 20 J by pthn •GfZ*Y\berSwho is rsonally know to /Q/ who is ersonally know to me or who has produced 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: r Sign6z__ Q 2i56waz Si P c;S Print: .,. Print: r'ANN, RAW4 A SCAT FIOUGH CoaMllttbll O FF 01504 Seal: `: .: M1'commISSK)H 11 FF 242181 F Seal: : „� •i AEXPIRES:October 18,20111 . °.;¢�;l c` Bonded Thru No*Public UnOerwriters. t:,, r{ ############################################################################################################ APPROVED BY , Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �T. DATE(MM/DD/YY) ACORD . CERTIFICATE OF LIABILITY INSURANCE iJunelO,2016 , PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Florida Insurance Agency of Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 441340. HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FI.33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P;305445-9100 INSURER AFFORDING COVERAGE NAICS# INSURED INSURER A: United Spec Co Q,s Construction Inc INSURER B: 7005'N Waterway Drive INSURER C: Miami FI 33166 INSURER D: INSURER E: INSURER F: coverages THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT- WITHSTANDING 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL EFFECTIVE EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER (MM/DD/YY) (MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000.000 x COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $100,000 CLAIMS MADE aOCCUR MED EXP(any one person) $5,000 A PERSONAL&ADV INJURY 1.000.000 16-4654-00 6/122016 6/12/2017 GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 2.000.000 7POLICYF�PROJEC17LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS (Per Person) $ HIRED AUTOS NON-OWNED AUTOS (Per Accident) , , $ (Per Accident) $ ANY AUTO ALL OWNED AUTOS AUTO ONLY AGG OCURR ❑CLAIMS MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE $ RETENSION $ $ EMPLOYERS LIABILITY TORY LIMITS ER ANY PROPIERTOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? hL UlbEAULA- if yes describe under I=L UItiEAbt-_PU1M71MM_ SPECIAL PROVISIONS below L I Of LK DESCRIPTION OF OPERATIONS I LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS: General Contractor Lic CGC1508464 Plubming Contractor Lic cfc1427045 Underground&Excavation Contractor Lic CUC122413 x ICER11FICATE HOLDER I jADD'L INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BFORE THE EXPIRATION Miami Shores Village DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Building Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 10050 NW 2 ave IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURED,ITS AGENT OR Miami Shores FI 33138 AUTHORIZED REPRESENTATIVE Tony Zoghbi ACORD 25(2001/08) ACORD CO ORATION 1988 I - DATE M/DD1 fY) ACORD CERTIFICATE OF LIABILITY INSURANCE lJur.-_10,,2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Florida Insurance Agency of Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 441340 HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FI. 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P;305-445-9100 INSURER AFFORDING COVERAGE NAICS# INSURED INSURER& United Spec Co Q,s Construction Inc INSURER B: 7005 N Waterway Drive INSURER C: iamil FI 33166 INSURER D: INSURER E: INSURER F: coverages THE POLICI OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P ICY PERIOD INDICATED,NOT- WITHSTANDIN ANY REQUIREMENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH SPECT TO WHICH THIS CERTIFICATEMAX BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS AND ONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDU D BY PAID CLAIMS. INSR ADDq EFFECTIVE EXPIRATION LTR INSR PE OF INSURANCE POLICY NUMBER (MM/DD/YY) (MM/DD/YY) LIMITS GENERAL L IL1TY EACH OCCURRENCE 1.000.000 x COMMERCI GENERAL.LIABILITY PREMISES(Ea occurrence) $100,000 CLAIMS MA E x❑OCCUR MED EXP(any one person) $5,000 A PERSONAL�ADV INJURY 1.000.000 16-0654-00 6/12/2016/6/12/2017 GENERAL AGGREGATE 2.000.000 GEN'L•AGGREGATE LIMIT APPL S PER: PRODUCTS-COMP/OP AGG 2.000.000 x POLICY PROJEC LO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS (Per Person) $ HIRED AUTOS NON-OWNED AUTOS (Per Accident) $ (Per Accident) $ ANY AUTO ALL OWNED AUTOS AUTO ONLY AGG EACH OCCURRENCE OCURR ❑CLAIMS MADE w AGGREGATE DEDUCTIBLE $ �. t A�Q® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) 6/10/2016 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(ies)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). CACT PRODUCER SUNZ insurance Solutions, LLC. ID: (TLR) NAME: Workers'Comp Department C/o TLR of Bonita, Inc PHONE ,t: 727-520-7676 x 3 a/c No: 727-525-3862 700 Central Ave Suite 500 E-MAIL St. Petersburg, �L 33701 ADDRESS: Certs encorehr.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: Aspen Re-London Best Rating"A+" 1 ' TLR of Bonita, Inc EnterpriseHR INSURERC: Chaucer Syndicate-Lloyds-Best Rating"A+" 700 Central Avenue Suite 500 INSURER D: Faraday Syndicate-Lloyds-Best Rating"A+ St. Petersburg FL 33701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 30356912 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. I TR TYPE OF INSURANCE JUM WVD SUER POLICYNUMBER MD POLICY EFF APS POLICY EXP - LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F OCCUR DAMAGET RENTED PREMISES Ea occurrence $ i MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY FI PRO- ❑ ! JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCPE0000000112 6/1/2016 6/1/2017 STATUTE EORH AND EMPLOYERS'LIABILITY YIN WCPE00000001 11 6/1/2015 6/1/2016 ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) r E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Coverage Provided for all leased employees but not subcontractors of:Q'S CONSTRUCTION INC. Client Effective:2/10/2016 General Contractor Lie#CGC1508464 Plumbing Contractor Lie#CFC1427045 Underground&Excavation Contractor Lie#Cucl224136 CERTIFICATE HOLDER CANCELLATION 1086 - Miami Shores Village, Building De artment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NW 2nd Avenue g P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PROVISIONS. Shores FL 33138 ACCORDANCE WITH THE POLICY PROVJSIONS. 4 AUTHORIZED REPRESENTATIVE Glen J Distefano ' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 30356912 1 Master Certificate Kathleen Wilkes 1 6/10/2016 4:05:42 PM (CDT) I Page 1 of 1 1 DATE{MM/DDW) ACORD CERTIFICATE OF LIABILITY INSURANCE JunelO,2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Florida insurance Agency of Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE O. E ox 441340 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR' mi, Fl.33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P; 5-445-9100 INSURER AFFORDING COVERAGE NAICS# INSURED INSURER A: United Spec Co O,s Cons ction Inc INSURER B: _ - 7005 N aterway Drive INSURER C: Miami FI 3166 INSURER D: INSURER E: INSURER F: coverages THE POLICIES OF INSU NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO FOR THE POLICY PERIOD INDICATED,NOT- # WITHSTANDING ANY RE IREMENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOC ENT WITH RESPECT TO WHICH THIS f CERTIFICATE MAYBE ISS D OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICI DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS AND CONDlTlOt4S OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HA BEEN REDUCED BY PAID CLAIMS. INSR ADDL EFFECTIVE IRATION LTR INSR TYPE O�SURANCE POLICY NUMBER (MM/DD/YY) MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000.000 x COMMERCIAL GE RAL LIABILITY PREMISES(Ea occurrence) $100,000 CLAIMS MADE x OCCUR MED EXP(any one person) $5,000 PERSONAL&ADV INJURY 1.000.000 16-465"0 6/12/2016 6/12/2017 GENERAL AGGREGATE 2.000.000 GEN'L AGGREGATE LIMIT APPLI PER: PRODUCTS-COMP/OP AGG 2.000.000 x POLICY OPROJECT LO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS (Per Person) $ HIRED AUTOS NON-OWNED AUTOS (Per Accident) $ (Per Accident) $ ANY AUTO ALL OWNED AUTOS AUTO ONLY AGG EACH OCCURRENCE OCURR CLAIMS MADE AGGREGATE DEDUCTIB $ RETE ION $ $ VVUKI EMPLOYERS BILITY TORY LIMITS ER ANY PROPI TOR/PARTNER/EXECUTIVE OFFICER/ MBER EXCLUDED? EEAE1V if yes des he under L)15L-ASL-PU[rCT1TMTT`- SPECW PROVISIONS below 7 DESC TION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY EN ORSEMENT/SPECIAL PROVISIONS: x ICERTIFICATE HOLDER I JADD-L INSURED SHOULD ANY OF THE ABOVE DESCRI D POLICIES BE CANCELLED BFORE THE EXPIRATION City Of Miami DATE THEREOF,THE ISSUING INSURE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Building Dept NOTICE TO THE CERTIFICATE HOLDER kMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 444 sw 2ave IMPOSE NO OBLIGATION OR LIABILITY OFrY KIND UPON THE INSURED,ITS AGENT OR ! Miami FI 33130 AUTHORIZED REPRESENTATIVE Tony Zoghbi Z� ACORD 25(2001/08) ACOR CORPORATION 1988