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PLC-18-955Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit NO. PLC-4-18-955 Permit Type: Plumbing - Commercial Work Classification: Addition/Alteration PermitStatus: APPROVED Issue Date: 6/1/2018 Expiration: 11/28/2018 Applicant 1540 NE 105 Street Number: B-12 Miami Shores, FL 1122300530240 Block: Lot: FREIDHELM SCHOCK Owner Information Address Phone Cell FREIDHELM SCHOCK 1540 NE 105 ST UNIT B-12 MIAMI SHORES FL 33138-2116 Contractor(s) Phone Cell Phone KINGS PLUMBING SERVICE INC (305)625-5450 (786)251-9810 Valuation: Total Sq Feet: $ 7,200.00 0 Type of Work: RENOVATION OF BATHROOM AS PER PLANS Type of Piping: Additional Info: RENOVATION OF BATHROOM AS PER PLANS Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $4.80 $3.78 $2.52 $1.60 $252.00 $3.00 $6.40 $274.10 Pay Date Pay Type Invoice # PLC-4-18-67126 06/01/2018 Credit Card 04/11/2018 Credit Card , Amt Paid Amt Due $ 224.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground 1 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 ELE TRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI'j VIT: I - .t all the foregoing jnformation is accurate and that all work will be done in compliance with all applicable laws regulating constructs- - : :. o Fujhermo authorize the ove named contractor to do the work stated. 1 4 iaPll :-owner / Applicant / Contractor / Agent June 01, 2018 Date Building Department Copy June 01, 2018 1 � 0® AccoRb® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 05/03/2018 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 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 Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland, NJ 07068 CONTACT NAME: (aG NO, Ext): FAX No): IL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : NorGUARD Insurance Company 31470 INSURED KINGS PLUMBING SERVICE INC 14050 NW 6TH CT N Miami, FL 33168 INSURER B INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 891510 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TORtNiED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER EXCLUDED?(ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N Y N / A N KIWC907121 05/09/2018 05/09/2019 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contractor License: CFC1428219 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 Ne 2 Avenue Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑■ PLUMBING ❑ MECHANICAL JOB ADDRESS: IC 40 N E Miami Shores Village 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 ❑ ROOFING RECEIVED APR 11 2018 Am rec 2ot�- Master Permit No. CC 6CIS Sub Permit No. Pic t8-C . S ❑ REVISION ❑ EXTENSION El RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION El SHOP CONTRACTOR DRAWINGS {OS s't' T. Ull T 13- t2 City: Miami Shores Folio/Parcel#: County: 1 I - 2230 - 053 - 0240 Occupancy Type: Miami Dade Zip: Is the Building Historically Designated: Yes NO X Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 'WGI) SC Phone#: Address: 16-4-0 tO ST • C9ti,fr T3-12 City: Ml b % S- k017-e ' State: T (.-• Tenant/Lessee Name: Phone#: Email: Zip: 3 313 Y CONTRACTOR: Company Name: KING'S PLUMBING SERVICE, INC Phone#: 305-685-5773 Address: 14050 NW 6 CT City: NORTH MIAMI state: FLORIDA Zip: 33168 Qualifier Name: DIENER KENNETH Phone#: 786-251-9810 State Certification or Registration #: CFC1428219 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: El Addition ❑ Alteration j` Cl New Description of Work: "C'/L'�'tdG " �'v!� e f /godireey..7 ❑ Repair/Replace ❑ Demolition 4• 5 ye /r�.f Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $0... 2 CCF $ CO/CC $ DBPR $ 3 .� Notary $ Training/Education Fee $ _ Double Fee $ Bond $ TOTAL FEE NOW DUE $ , (d (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. Signature OWNER or AGENT CONTRACTOR The foregoing instrumentmwas acknowledged before me this The foregoing instrument was acknowledged before me this day oof' Alpe IL , 20 1 v by \ day of �1`'» ��. 20 by £f°c-led ie-lm -CYICV Crk,, , who is personally -�klno�w/ to ��.�i�o \'C:�.ZVwk , who is personally known to me or who has produced (ill. L- Ska• � a.)1O �a'? me or who has produced as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: t►�VP° BARBARAZEEMAN * MY COMMISSION # GO 0611. ` 4: EXPIRES: February 15, 2021 For . Bonded ibru Budget Notary Woo Sign: Print: L`J ‘S ‘i Seal: ******************************************************************* APPROVED BY Plans Examiner Structural Review ``W11,4„, LUIS BARIAS `�/__State of Florida -Notary Public ,�� Commission ?• GO 157779 ,;z of My Commit "on Expires 1,?", A;``` Novem'-.:;: i,. 2021 f' ri Zoning Clerk (Revised02/24/2014)