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PLC-18-1187Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit No. PLC-5-18-1187 Permit Type: Plumbing - Commercial Work Classification: Repair Permit Status: APPROVED Issue Date; 5/812018 Expiration: 11/04/2018 Parcel Number Applicant 9705 NE 2 Avenue Miami Shores, FL 1132060134230 Block: Lot: COCHRAN MIAMI SHORES LLC Owner Information Address Phone Cell COCHRAN MIAMI SHORES LLC 1800 ELLER Drive FT. LAUDERDALE FL 33316- 1800 ELLER Drive FT. LAUDERDALE FL 33316- Contractor(s) Phone MR C'S PLUMBING AND SEPTIC INC (786)586-7473 Cell Phone Valuation: Total Sq Feet: $ 2,400.00 0 Type of Work: SEPTIC TANK ABANDONMENT Type of Piping: Additional Info: SEPTIC TANK ABANDONMENT Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $1.80 $2.25 $2.00 $0.60 $150.00 $3.00 $2.40 Total: $162.05 Pay Date Pay Type Invoice # PLC-5-18-67411 05/04/2018 Credit Card 05/08/2018 Check #: 1408 Amt Paid Amt Due $ 50.00 $ 112.05 $ 112.05 $ 0.00 Available Inspections: Inspection Type: Final Review Plumbing 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 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. Futhermore, I authorize the above -named contractor to do the work stated. is Q.\eee Col I Aut orized Signature: Owner ! Applicant / Contractor / Agent May 08, 2018 Date Building Department Copy May 08, 2018 1 Inspector Address C'ommen �i,« � t1Jt11;1t/�1 f1F Environmental Florida Wealth Miami -Dade County OSTDS/Well Division 11805 SW 26th Street • Miami, F1, 33 eber 0 A tido r 110, Oppp, Date 6-;g--te OSTDS # BUILDING PERMIT APPLICATION 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 FBC 20r Master Permit No. PIC17-2983 Sub Permit No. p ,l,1U — Icy) ❑BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL •PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9705 NE 2nd Avenue City: Miami Shores County: Folio/Parcel#:11-3026-013-4230 Occupancy Type: Load: Construction Type: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Cochran Miami Shores, LLC Phone#: 954-760-4360 Address: 1800 Eller Drive, Suite 212 City: Fort Lauderdale State: FL Tenant/Lessee Name: NA Email: Phone#: Zip: 33316 CONTRACTOR: Company Name:"Mr. C's Plumbing & Septic Address: 19932 NW 2nd Avenue Phone#: 305-651-7859 city: Miami - , State: FL Zip: 33169 Qualifier Name: Matthew Cocking Phone#: 305-651-7859 State Certification or Registration #: CFC1428729 Certificate of Competency #: DESIGNER: Architect/Engineer: NA Phone#: Address: City: State: Zip: Square/Linear Footage of Work: Value of Work for this Permit: $ 2400.00 Type of Work: ❑ Addition ❑ Alteration Description of work: septic tank abandonment n New ❑ Repair/Replace n Demolition Specify color of'co/or,thr-u tile::... Submittal Fee $-. S i(- " __Permit Fee $ /F6 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ a DBPR $ a ' a� Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ _ TOTAL FEE NOW DUE $ t't 2 - U, (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's{Address City '' State Zip Mortgage Lender's Name (if applicable) N/A 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. OWNER or AGENT The foregoing instrument was acknowledged before me this day of/1ay ,20 /R ,by �� ► \ . (»c1/ r'cc v' , who is personally known to me or-whe-liras-produced as identification and who did take an oath. NOTARY PUBLIC: V Sin. ,z4 g r Print:" KJv V '.1 ipt �4 r �(�% 7J; • Seal i ;.a r' •.,ifs' **s***********i******************************* APPROVED BY The foregoing instrument was acknowledged beforee me this ��,A/, day off��� j /y41 , 20 //� , by NO& 6611f, who is per�eulsonally knoto me or who has produced/as identification and who did take an oath. NOTARY PUBLIC: Sign: ' vc.r✓vv� Print: l male{ a .� Seal: 4 DONALD MARTIN MY COMMISSION # GG102743 EXPIRES May 09,2021 off. nor ***********************************,************************* 7.' :: gyp..• � . Plans Examiner Zoning / s Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: (Cochran Miami Shores LLC) PEST #: 13-SM-1842057 APPLICATION S : AP1341094 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1104092 PROPERTY ADDRESS: 9705 NE 2 Ave Miami, FL 33138 LOT: 13-14 BLOCK: 31 SUBDIVISION: Miami Shores Sec 1 Amd PROPERTY ID #: 11-3206-013-4230 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS ,AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1 D R A I N I E L D 0 T H E R SPECIFICATIONS BY: APPROVED BY: [ ] SQUARE FEET [ ] SQUARE FEET SYSTEM SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.00 ] INCHES [ ] BED I 1 I II / ] DOVE / BELOW ] BENCHMARK/REFERENCE POINT I 1I / ][ABOVE/ BELOW] BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The tank shall be filled with dean sand or other suitable material, and completely covered with soil. Have the system inspected by the health department after it has been pumped, ruptured and filled with sand and covered. DATE ISSUED: Erlande Omisca 04/25/2018 TITLE: TITLE: Engineering Specialist II DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Dade EXPIRATION DATE: 07/24/2018 CHD Page 1 of 3 v 1.1.4 AP1341094 SE-1 MRCSS-1 OP ID: DR ,d►TE `C--- CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) DA01/16/2018 01 /16/2018 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 Combined Underwriters of Miami 8240 N.W. 52 Terr, Suite 408 Miami, FL 33166 RONALD M. LASTER CONTACT RONALD M. LASTER (A/C. N , Ext): NE 305-477-0444 FAX No): 305-599-2343 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC it INSURER A:AIX SPECIALTY INSURANCE CO. INSURED Mr. C'S Plumbing & Septic Inc. Attn: Michael Cocking P.O.Box 693239 Miami, FL 33269 INSURERS: INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE 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. INR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER. POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYY' LIMITS A X COMMERCIAL GENERAL LIABILITY L1J A191626 04 • 01/11/2018 01/11/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 • MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE _ LIABILITY _ SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A - PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Septic Tank Systems -installation,... Mathew Cocking State Lic. CFC1428729 CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village 10050 Ne 2nd Ave Miami Shores FI. 33128 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 Ge ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORLf CERTIFICATE OF LIABILITY INSURANCE iii•—•----- DATE(MMIDDIYYYY) 9/28/2017 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 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 LRA Insurance 498 S Lake Destiny Dr Orlando FL 32810 CONTACT Elizabeth Rivera NAME: PHONE (A/C, No, Ext): (407) 838-3445 FAX (AIC, No): (407)838-3460 E-MAIL ADDRESS: erivera@lrainsurance.com INSURER(S) AFFORDING COVERAGE NAIC • INsuRERA:Bridgefield Employers Ins Co 10701 INSURED Mr. C's Plumbing & Septic, Inc 19932 NW 2ND AVENUE Miami FL 33169 INSURER B : INSURERC: INSURERD: INSURER E : INSURERF: OVERAGES CERTIFICATE NUMBER:17/18 • 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 J[VSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE 10 REM I ED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER. LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY _ SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peracddent) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ i DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y! N N !A 0830-54817 10/1/2017 10/1/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 $ 500,000 E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) State Contractor - Mathew Cocking CFC1428729 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Ne Ind Ave Miami Shores FI. 33128 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 B Tomlinson/COHLER ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD