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PLC-18-974Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit IVO. PLC-4-18-974 Permit Type: Plumbing - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 7/5/2018 Expiration: 01/01/2019 Parcel Number Applicant 717 NE 91 Street Number: 2-B Miami Shores, FL 1132060440040 Block: Lot: MAFFE 1 LLC Owner Information Address Phone Cell MAFFE 1 LLC 3001 NE 185 Street AVENTURA FL 33181- 3001 NE 185 Street AVENTURA FL 33181- Contractor(s) Phone Cell Phone SYSTEMATICS PLUMBING & DESIGN (786)326-7354 Valuation: Total Sq Feet: $ 200.00 0 Type of Work: REMOVE AND REPLACE KITCHEN SINK & D Type of Piping: Additional Info: REMOVE AND REPLACE KITCHEN SINK & D Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Invoice # 04/12/2018 07/05/2018 Pay Type PLC-4-18-67146 Credit Card Check #: 3887 Amt Paid Amt Due $ 50.00 $ 58.60 $ 58.60 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground 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 AFFIDAV� a at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a . ore, I L the above -named contractor to do the work stated. ',� AK) Quo, e- Authorized S. n., eta: •wner / Applicant / Contractor / Agent July 05, 2018 Date Building epartment Copy July 05, 2018 1 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING ❑ MECHANICAL PUBLIC WORKS JOB ADDRESS: 71-3 NC 91 gT RFCF_TVF'D AP' 1 FBC 20 11 k°1-1) Master Permit No. C.C., Sub Permit No. r LC REVISION ❑ EXTENSION ❑ RENEWAL 18 lZ ❑ CHANGE OF CONTRACTOR City: Miami Shores County: Miami Dade Folio/Parcel#: it-3 ZO(O—O'4'(—GO eO Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: - 35 OWNER: Name (Fee Simple Titleholder): \kaki 1- UL Phone#: / Ol7-' 4.6 6' \aA't Address: tjE `c5S Sr 7 (D City: 1th11 r14- State: Zip: 3812) Tenant/Lessee Name: Phone#: PA/1,, kCAtire @ y a Abo : CO CONTRACTOR: Company Name: 5 Z1 ' 91 C Phone#: 4K0 r. 1 Address: `7�, l � W J2 c� epnir 23a City: \,_- I,� State: POZip: Qualifier Name: \( bia -y�G Phone#: - 32.6 4351 State Certification or Registration #: OTC AectCOD Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ OO .� Square/Linear Footage of Work: Email: Type of Work: ❑ Addition n Alteration ❑ New '1 Repair/Replace Description of Work: ❑ Demolition Specify color of color thru tile: " Submittal Fee $ O 1,� A i Permit Fee $ i6D CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 • q DBPR $ - ' O Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $�J8 . HOC) (Revised02/24/2014) • Bonding Company's Name (if applicable) Bonding Company's Address City State OWNER or AGENT me or who has produce identificati NOTARY Sign: Print: Seal: 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 Signature CONTRACTOR The fo going instrumentywas acknowledged before me this The fore oing in! u, ,e/nt was acknowledged before me this day o M4i2 , 20 t by /i¢ day of f `' Q.Q Q�, 20 4 1 ., by who is personally]]�known to H"0 kias me or who has . god d� f`NUW as NOTA, Ii� eX�IDAi A ho did take an oath. ********************* APPROVED BY Sr1AN MODERNELL NEVARIZ Sion # GG 34000 mission Expires mber 27. 2020 identifi I did take an oath. Prim�Ign411.11PM,tv;i77. \‘iARCELO SEBASTIAN MODERNELL 'EZ �j s Commission M GG 34000 My Commission Expires /p �P�i September 27, 2020 ************ * i19******as************** r * r r r**** r*****r*«ZWr� VA/1 4bL F;•�r.� l _ , who is personally known to • K� `f-iZ-tY Seal: Plans Examiner Structural Review ****** * Zoning Clerk (Revised02/24/2014) gaa000Zz989n # 03S AWl AS 031:1111098 SY AVldSICI \V\ I k \ urn -a ---1 '.' --0.:---..".z7,01:0Z-'1;C:OnNi -:!lip'1.10, ei!d3 S:1768P-.192de,40 lo-ttiOward oql JaPpil .,. , .„„-,—, a30.000 St Molog Rau:att., 9 toZrarso :03aSsi 't0 S.M Vt• =-*"- ONI NOIS3043, ONIEMITta ,solivveis AS, 131AVW/S3Ins*, • , 010VHINO0 ONISNOld eta re- 0096P OAO. CINVO$3 ONISN3011 idisnam NolioniusNO3 Ncp.raDMVANOISS:3A0lid,.ONV SS3tosna • '-vaniOlii AtiV132:03S 'NOSiNAV1 N3>i S. EIJOIAMN 3SN331-1 HOWMA00 11009 NO18 4 DATE(MMIDD/YYYY)' ACC 0' CERTIFICATE t F LIABILITY INSURANCE 9/28/20 7 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 certificate holder is an ADDITIONAL INSURED; the policy(Ies) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltl�ns of the policy, y;certain policies mayendorsement, require an endoement A statement on this certificate does not' confer rights to the. certificate holder in lieu of such endorsement(s). ' PRODUCER ADVANTAGE INSURANCE OF AMERICA 4520 NW 7th St. Miami, FL 33126 INSURED SYSTEMATICS, PLUMBING AND DESIGN INC 2211 W 52ND.ST APTO 202 MIAMI, FL 33016 - CONTACT NAME. tP/ vcONNa.Exti (305) 649-5566 (NC No) s no Essjaokiebatistai749@hotmail.corn IINURERISI AFFORDING COVERAGE. INSURER A, WESTERN WORLD INS -CO INSURER 8 INSURER C 05) 649-5559 NAICI INSURER D'; ( INSURER E { INSURER E; NUMBER: 'COVERAGES' Utt< I Itri,x I a . rvumacrs. . THIS IS TO CERTIFY THAT THE POUCIES 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 AWLSUBR MR MD POLICY NUMBER POLICY EFF (MMI DD/YYYY) POLICY EXP (MM)DO/YYYY) LIMITS LT R GENERAL I.--_ X LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE I O HEN I I U PREMISES occurrence). , $. 100,000 MED EXP (Any one person) 3 5,000 CLAlNiS-MADE R I OCCUR NPP8319298 09/12/17 09/12/18 PERSONALSADVINJURY $ 1,000,000 - GENERAL AGGREGATE $ 2:000000 PRODUCTS - COMP/OP AGG t$ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER , i-{ PRO- i.'_1 POLICY I 1 LOC _ 'LE $ AUTOMOBILE r j =— I JECT LIABILITY ANYAUTO ALL OWNED AUTOS HIRES AUTOS i L,___, ; SCHEDULED AUTOS NON -OWNED AUTOS (Ea eo ) ih LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per aaidenl) $ PROPERTY DAMAGE (Per accident) $, UMBRELLA LIAB EXCESS LAB OCCUR CLAIMSM,ADE EACH OCCURRENCE` $ AGGREGATE $ $ I I RETENTIONS WORKERS. AND ANY OFFICER/MEMBER (Mandatary Ifyes, DED COMPENSATION EMPLOYERS' LIABILITY YIN PROPRIETORIPARTNERIEXECUTIVE EXCLUDED?. �� 1n NH) describe under OF OPERATIONS below N/A T TORS LIMITS , ER E.L. EACH ACCIDENT $ El. DISEASE = EA EMPLOYEE $ .E.L.DISEASE - POLICY OMIT f D DESCRIPTION DESCRIPTION PLUMBING OF OPERATIONS / LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is equired) CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE- .MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE -EXP R TION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORD OE WITH THE POLICY PROVISIONS. AUTHORIZ 1 ACORD 25 (2010/05) ESENTATIVE t 1988-2010 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD 10/16/291 Detail by Entity Name D+VIsIora OF Co o{iivnoSia Department of State / Division of (oroorations / Search Records / Detail By DQsument Number / Detail by Entity Florida Profit Corporation FAB INTERIOR & EXTER Filing Information Document Number FEUEIN Number Date Flied State Status Last Event Name. 10R, INC. P00000027891 65-0992976 03/17/2000 FL ACTIVE AMENDMENT Event Date Filed 10/03/2011 Event Effective Date NONE Principal Address 1040 NE 93RD 6T MIAMI SHORES, FL 33138 Changed: 11 /10/201.5 Mailing Address 1040 NE 93RD ST MIAMI SHORES, FL 33138 Changed: 11 /10/2015 Registered Agent Name & Address CISTERNINO, FABIO 1040 NE 93RD ST MIAMI SHORES, FL 33138 Address Changed: 04/29/2013 Caw/Director Detail Name & Addres s Title P CISTERNINO, FABIO 1040 NE 93RD ST MIAMI SHORES, FL 33138 Title VP http://search.sunttiz.org/Inquiry/corp9rationsearch/SearchResutmetai17inquirytype=EntityName&directionType=nitial&searchNameOrder-FABINTERI.. 1 /2 Proof of Coverage Page 1 of 1 JIMMY PATRON'S FLORIDA'S CHIEF FINANCIAL OFFICER WC Mobile App %'C Home Search Our Data CFO Home Employer Detail Page This database was last updated Monday, July 02, 2018 12:08 AM. Carrier Location Information Return to Search Page Employer Information Employer Name Employer Type 'SYSTEMATICS PLUMBING & DESIGN INC 'CORPORATION Coverage History 1No Coverage History Exemption Listings Exemption Holder Name - Click on the name(s) below to view more detailed information BERNARDO GONZALEZ NAICS Code N/A FRANCISCO P GONZALEZ KAREL VALDES Owner Election Listings INo Owner Election of Coverage Listings Employer Name History Employer Name 'SYSTEMATICS PLUMBING & DESIGN INC Return to Search Page Name Type Change Date Legal 'Current https://apps8.fldfs.com/proofofcoverage/EmployerDetail.aspx?EmpID=X00139910 7/2/2018 Proof of Coverage Page 1 of 1 JIMMY PATRON'S FLORIDA'S CHIEF FINANCIAL OFFICER 111C Mobile. App Exemption Detail Page This database was last updated Monday, July 02, 2018 12:08 AM. Return to Previous Page Exemption Details WC Itontc Search Our Data CFO Home Name Title Effective Date 'Termination Date - Exemption Type ""Business Activities Employer Name KAREL VALDES Jun 28 2018 Jun 27 2020 Construction Click Here to View Activities Listed on Exemption SYSTEMATICS PLUMBING & DESIGN INC KAREL VALDES PR Jun 28 2016 Jun 28 2018 Construction Click Here to View Activities Listed on Exemption SYSTEMATICS PLUMBING & DESIGN INC "Termination may be through the revocation of the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption, Return to Search Page https://apps8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?prperson_id=X00150413 7/2/2018 Proof of Coverage Page 1 of 1 JIMMY PATRONIS FLORIDA'S CHIEF FINANCIAL OFFICER WC Mobile App Exemption Detail Page This database was last updated Monday, :July 02, 2018 12:08 AM. Return to Previous Page Exemption Details Name Title Effective Date 'Termination Date [Exemption Type **Business Activities !Employer Name I Click Here to View SYSTEMATICS Jan 18 2018 Jan 18 2020 1 Construction Activities Listed on PLUMBING & Exemption DESIGN INC 'Termination may be through the revocation of the exemption, or expiration of the exemption. "*The exemption only applies to the business activities listed on the exemption. FRANCISCO P GONZALEZ WC Hotue Search Our Data GPO Home Return to Search Page https://apps8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr_person_id=X00227412 7/2/2018 Proof of Coverage Page 1 of 1 JIMMY PATRONIS FLORIDA'S CHIEF FINANCIAL OFFICER WC Mobile App WC Hume Search Our Data CFO Home Exemption Detail Page This database was last updated Monday, July 02, 2018 12:08 AM. Return to Previous Page Exemption Details Name I Title I Effective Date ('Termination Date 'Exemption Type BERNARDO VP Dec 15 2016 Dec 15 2018 Construction GONZALEZ `"Business Activities Employer Name Click Here to View Activities Listed on Exemption 'Termination may be through the revocation of the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption. Return to Search Page SYSTEMATICS PLUMBING 8 DESIGN INC https://apps8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr person_id=X00174099 7/2/2018