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PL-17-2155Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe mit Permit°NO. L-8-17-215 Permit Type: Plumbing - Residential WNork'Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/31/2017 Expiration: 04/29/2018 Parcel Number Applicant 731 NE 95 Street Miami Shores, FL 1132060142130 Block: Lot: FENTON FIVE GROUP, INC Owner Information Address Phone CeII FENTON FIVE GROUP, INC 731 NE 95 Street MIAMI SHORES FL 33138- (305)796-5460 731 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) LASSETER PLUMBING CO INC Phone CeII Phone (305)525-5075 (305)893-7180 Valuation: Total Sq Feet: $ 2,500.00 50 Type of Work: INSTALL TWO TUB TWO TOILET BOWL TW Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $3.38 $2.25 $0.60 $225.00 $3.00 $2.40 $238.43 Pay Date Invoice # 08/24/2017 10/31/2017 Pay Type PL-8-17-64991 Check #: 1104 $ 50.00 $ 188.43 Check #: 1084 $ 188.43 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Top Out Final 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, ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDA : I certify tha constructi. : . ' ng. Futherm A h. ized Signa II th Ia oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating orize the above -named contractor to do the work stated. pplicant / Contractor / Agent Build! g De.artment Copy October 31, 2017 Date October 31, 2017 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 [UMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 7' 3 / iv E ?S 7 f% S T City: RECEIVED AUG 2 4 2017 501 FBC20N Master Permit No.1? CA 1 2 13 Sub Permit No.PLfl 2 �5 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Shores County: Folio/Parcel#: 1/ -- 320 6 - 0 /9 - 2 /3 0 Occupancy Type: Load: Miami Dade Zip: Is the Building Historically Designated: Yes Construction Type: Flood Zone: NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): /-&-1`l/wE�i - l/, Phone#: gb.//( S Y6 9 d Address: 7C , J 5 //07;if...tr � City: / fS -yAf/- /�3 � State: / L- Tenant/Les�se,e Name: Email: /-e7SJ7 ) tfLJ e-/eou/'%@ /Y7/ 'L, GOAI CONTRACTOR: Company Name: LASSekir'T Ufl' b1v CO (nLI Phone#: Address: $lo6 Nf 130 Sire& City: t\SD14h IQIM 1 State: 'Flo�ri a. Qualifier Name: LIsf'7- Phone#: zip: 3_3/6 / Phone#: ,7R0 -5 ?q-e SY5® 3:13s -332s) Zip: 331(0 l State Certification or Registration #: Cf-C V4 tocku Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ..1.5VP Type of Work: ❑ Addition ❑ Alteration ❑ New Et Repair/Replace ❑ /� Demolition / Description of Work: /� -,,a/0 �vif •-Xat,0 '74/ , /y"I.`./L �40 cipc' do t Square/Linear Footage of Work: 5 V ,e C% 2 -, sip L /or..ap/ !✓4.4_ - 601 t ea-5 -(9 AV 44,14, trey 62 4q/ 94u. 4r4£ Zi Specify color of color thru tile: ScJ. Submittal Fee $ cry Permit Fee $ ��� Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ ' 75 r NER or AGENT Nif1'Ugie. / M » /.T%Zwho is persona I own to 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 clone 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. Signatur CONTRACTOR The -aforein of as acknowledged before me this y The fore?�•TT': instr ent was acknowledged before me this 0 dayof ,20 n , b i •a of ,20 n by, " (FR, who is personally known to me or who has produced as me or who has produced'4�v��;� as identification and who did take an oath. l identification and who did take an oath. NOT ,LY PUBLIC: NOTARY PUBLIC: Sign: �f a Via Sign: � Prin : VOA `1..A Print: C-t"t Seal CARIDAD VILA NOTARY PUBLIC STATE OF FLORIDA Comm# FF223862 APPROVED BY Seal: / Plans Examiner . a Pc LA e� AD AIL �., NOTARY PUBLIC STATE OF FLORIDA L)11_ •�''�•• �', ` Comm# FF223862 Expires 6/22/2019 Zoning (Revised02/24/2014) Structural Review Clerk ACORUJ CERTIFICATE OF LIABILITY INSURANCE `..... DATE(MM/DD/YYYY) 11/3/2016 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 Mack, Mack & Waltz Insurance Group, Inc. 1211 S Military Trail Suite 100 Deerfield Beach FL 33442 CONTACT Gina Salvat NAME: PHONE (954) 640-6225 (A/C,No): (954)640-6226 AE-MAILDDRESS: g salvat@mackinsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A:Ohio Security Ins. Co. 24082 INSURED Lasseter plumbing Company, Inc 865 N.E. 130 Street North Miami FL 33161 INSURER B Bri Employers dgefield Em to ers Ins. Co. 10701 INSURER c Berkley National Ins. Co 38911 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:CL1682935156 V 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POUCY NUMBER POUCY EFF IMMIDD/YYYY) POLICY EXP (MMIDD/YYYY) UMITS A X COMMERCIAL GENERAL LIABILITY BLS 56272467 9/1/2016 9/1/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MEDEXP(Anyoneperson) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED BAS 56272467 9/1/2016 9/1/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per ( ) $ PROPERTY DAMAGE (Per accident) $ Uninsured motorist combined $ 1,000,000 UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 83021471 5/25/2016 5/25/2017 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Equipment Floater M1M1002286 9/1/2016 9/1/2017 Scheduled Equip. Limit 5,430 Unscheduled Equip Limit 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License #CFC041696 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, 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 Greg Waltz/GSALVA ACORD 25 (2014/01) INS025 0014011 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RICKSSCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 LASSETER, JOHN MARK LASSETER PLUMBING COMPANY 13925 NE 1ST AVE MIAMI FL 33161 ISSUED: 07/04/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607040001563 ctir X1954 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 922097 BUSINESS NAME/LOCATION LASSETER PLUMBING CO INC 865 NE 130 ST NORTH MIAMI FL 33161 OWNER LASSETER PLUMBING CO INC Worker(s) 7 RECEIPT NO. RENEWAL 922097 EXPIRES SEPTEMBER 30, 2017 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC041696 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/26/2016 CHECK21-16-100929 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commerciai vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.govJtaxcollector