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PL-05-140BUILDING PERMIT APPLICATIO FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address /(- b City 4-1 .D State Tenant/Lessee Name Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shor:', Florida 33138 Tel: ,(305).. 5:2204 Ftaz: (�305, 756.8972 .rti`I ot 0 3. Electrical UUL H. (o sy Permit No. '2(05 —1610 Master Permit No. 'writhing Job Address (where the work is being done) City Miami Shores Village is Building ilistorically Designated Contractor's Company Name Contractor's Address City Qualifier State Certificate or Registration No. /10 1Vlechanieal hoofing Phone # Zip 3313 g - Phone # 46 cu.f. 10 sr County Miami -Dade Zip 33 1 3 $ - YES NO 1� d a Wii/c4-5- M f// 57 State one # 1Y/6/ 22/ (/fr._1 07-) 9yw. 7 Pt (I Zip /45- (-re o fj � . Certificate of Competency No. Architect/Engineer's Name (if appl'cable) Phone # $ Value of Work For this Permit Type of Work: ❑Ad ttion Describe Work: Square Footage Of Work: ❑Alteration ['New 7 Repair/Replace p(fie__ ❑ Demolition ****************************Fees*� **************************** Submittal Fee $ Permit Fee $ /,S0 CCF $ CO/CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Total Fee Now Due $ Structural Plan Review. $ (Continued on opposite side) .o1,W,:t6 , Amy Pesante = Commission #DD28982 Expires: Mar 22, 2008 Bonded Thru Atlantic Bonding Co., Inc. APPLICATION APPROVED BY: chc 05/13/03 _ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 mu .e post •d at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In tj bsence of such osted notice, the inspection will not be approved and a reinspection fee will be charged. Signature k. Owner or Agent The foregoing instrument was acknowledged before me this day of ,20 ,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signature The foregoing instrume day of who is person Sign: Print: was acknowledd edbef ne this 3 NO , 20/,%S by -a known to me or who has produced identification who did take an oath. (\ 4,4 L Qc-j A24.-e- 4-‘ My Commission Expires: My Commission Expires: O' 7 _na.T 07 ************************************************************************** ** * ** ************ ****** liiit Clarke %a ` YPI C°rni►ustton DD207170 ************************************* ***** **************************************n' *270*************** (i-_4j—c> t— Plans Examiner Engineer Zoning ACORD�, CERTIFICATE OF LIABILITY INSURANCE DATE/YY) 04/15/05 PRODUCER Superior Insurance Group, Inc. 13311 S.W. 42nd St. Miami, FL 33175 (305)220-2500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED EDDIE ROJAS PLUMBING 880 NE 111 St Biscayne Park, FL 33161- INSURER A: ROEHRIG MACDUFF INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY TIVE DATE (MM/DD/YY) DATE (MM/DD/YY) POLICY EXPIRATION LIMITS 4 ❑ GENERAL LIABILITY ElCOMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE ❑ OCCUR ❑ 504-0210 04/14/05 04/14/06 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurence) 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 1,000,000 ❑ :.,, AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY r EA ACCIDENT; OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION t EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ❑ WC ER TATU-❑ EORH- TORY LIMITS E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PLUMBING I f i. ATE HOLDER CANCELLATION CITY OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES, FL 33178 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHED REPRESENTATIVE ©ACORD CORPORATION 1988 rt. Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795-2204 Printed: 5/10/2005 Applicant: KAREN Owner: PUMA JOB ADDRESS: 46 Contractor ROJAS EDWARD Local Phone: Parcel # 1132060131360 NE 101 Plumbing Permit Permit Number: PL2005-140 PUMA KAREN ST Contractor's Address: 880 NE 111 ST Page 1 of 1 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 7 & E1/2 OF LOT 8 BLK Fees: FEE2005-5725 FEE2005-5726 FEE2005-5727 FEE2005-5728 FEE2005-5729 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $150.00 $1.20 $0.20 $3.00 $3.00 $157.40 Total Fees: $157.40 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 10/30/2005 Construction Value: $1,500.00 Work: RE -PIPE OLD BATHROOM Signed: (INSPECTOR) Vi (0 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: