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PL-17-1185 ^ Miami Shores Village t Permit-Type,Plumbing-Residential 10050w.E.2nd Avenue NE Work Classification:Addition/Alteration Miami Shores,FL ou�� Pow Permit Status:APPROVEID Phone: (305)7e5-2204 I I ssu I e Date:61161,2017 FExpiration: 11112/2017 Project Address Parcel Number Applicant 1160 NE 98 Street 1132050180390 ---Miami Shores, FL 33138- Block: Lot: FRANCES P ALLEGRA&MARYI Owner Information Address Phone Cell MIAMI SHORES FL 33138- 1160 NES8Street MIAMI SHORES FL33i38' Contractor(s) Phone Cell Phone Valuation: 1,850.00 WESTLAND PLUMBING CORP (305)863-6223 (786)236-0198 Type of Work:NEW WATER SERVICE LINE Available| Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Feis Due Amount Pay Date Pay Type Arnt Paid Arnt Due CCF $1.20 Invoice# PL-5-17-63861 DBPR Fee $2.25 05/01/2017 Check#: 18469 $50.00 $ 115.70 DCA Fee $2.25 Education Surcharge $0.40 05/16/2017 Check#: 18497 $ 115.70 $0.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $165.70 ' In consideration of the issuance to me of this permit, | agree to perform the work covered hereunder in compliance with on ordinances and regulations pertaining thereto and instrict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this m:nnn | assume responsibility all work done uveither myself, my agent, oonmnm. or employes. | understand that separate ponnxv are required for ELECTRICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. I { • Miami Shores Village M Y 012017 4� Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ` INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. G �� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP 3 CONTRACTOR DRAWINGS 10B ADDRESS: 1164016 E City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):r 444XIS�'ll: IMAlf-VA-C hone# A `L O� Address: � City: t l� s=4/ .S' e? � 3- /:�State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �O VV%6F Phone#:305 863 42,23 Address: City: t State: �.p�-t l7Gt Zip: 3250 l D Qualifier Name: Phone#: 7A6 z:-viv iom St$ten or Registration#:.G�G ® �7 G ertificate of Competency#: �_., f_ 4, .l DESIGNER:Architect/Engineer: Phone#: 1 Address: City: State: Zip: Valu—eWfW5—rWf6rtlii9'P'ermit:$ �� d�O Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New 1 Repair/Replace ❑ Demolition Description of Work: A,•�,`� 6 c- L%na. Specify color of color thru tile: A -K! ,rr.'e^' Submittal Fee$ W Permit Fee$ 1 CCF$ Scanning Fee$ Radon Fee$ DBPR$ Notary$I - Technology Fee$ 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 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 be approved and a reinspection fee will be charged. f Signature Signature Ow ERorAGENT CONTRACTOR t _ ... l.ye. 4 The foregoing instrument was acknowledge )fore me this The foregoing instrument was acknowledged•before me this �j "`aay of. (1Lr .� 20 I b CJ R �� y day of 20 by ►"Iwt'��Q��1�t D who i'personally kn o Q AP—L3t 1v WUIE4— (O who is personally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take-an-oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig I Sign: .. . w . l Print: Q � Print: C1q> a-3J4, '?, Seal: DANIELLE MRSAR0 NOTARY PUBLIC Seal: STATE OF FLORIDA =o00%, Notary Public State of Florida Cam*FFIll" 1 Sindia Alvarez yioa My Commission FF 156750 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) May 16 2017 1:37PM HP Fax page 2 WESTPLU-01 ACaRv° MWDWWM CERTIFICATE OF LIABILITY INSURANCE DATE 05 0912017 `—� 05/09/2017 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 pollcypes)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cerililcote does not confer rights to the cerflficate holder in 9eu of such endorsement(s). PRODucER License 9 LOT 730 CT Assured Risk Solutions PH NE PAx 1000 Sawgrass Corporate Parkway,Sults 552 uC Na Eul: 888)830-4396 No;(954)346-0244 Sunrise,Fl.33323 MURER($1AFFOR INO COVEFLAGE NAIC INSUR R ARCH Sp9claity Insurance Co 21199 INSURED INSURER 0: Westland Plumbing Corp 101 w 2a street INSURER D, Hialeah,FL 33010 INSURER E• COVERINsuneR r• AGE 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, ILIR NSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY Eff � Y P UMrrB 'A X COMMERCIAL GENERAL LIABILITY EACH 1,000,000 CLAIMS-MADE 7X OCCUR at0012B15503 05/09/2017 05/09/2018 RAK*a%J?4ENTED 3occurrencel 100,000 MED P 10,000 PERSONAL&ADYINJURY S 11000,000 GENL AG3R ATE LIMIT APP I S PER: GENERALA R CIATE 2,000,000 X POLIOYJECT LOC P 2,D00,000 OTHER:- AUTOMOBILE LIABILITY OOMBNEDSINGLE LIMIT ANY AUTO BODILY INJURY Par OWNED ONLY ryp�pyUyLEEDp BODILY INJURY Par acci4en( AUT03ONLY AMMO �iOPERa AMAGE UMSRELLAIUAB HOCCUR EACH OCCURRENCE EXCESS UAD CLAIM"ADE DED RETENTION= AGGREGATE Z?F'KERSC01aPENSATION R TH- AND EMPLOYERe'LIABILITY y/ISI ANY PROPRIETOFWARTNERIEXECUTNE L. H ACCIDENT FI ERRIIryMME.W EXCLUDED? NIA If ea describe under D RIPTI N F 01PERATIOM bolom-- { -POLIC I Y LIMIT OMCWPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlUonel Ren arks Schedule,may be aftolied it owde apace is requbmed) LIoelese#CFC037110 HOLDERCERTIFICATE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami,FL 33338 AUTHORIZED REPRESENTATIVE ACORD 25(2010/03) 01986-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD e