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PL-18-765ACC-IR.& CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) 10/26/2018 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 have ADDITIONAL INSURED provisions or he 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 Suarez & Associates P.O. Box 661008 Miami Springs, FL 33266 Phone (305) 884-8664 INSURED ARMANDO PENA INDIVIDUAL 8120 SW 11TH ST MIAMI , FL 33144 Fax (305) 884-6977 CONTACT NAME: PHONE (A/C, No, Ext) E-MAIL ADDRESS: GREISY VERDUGO (305) 884-8664 framar69©bellsouth net INSURER(S) AFFORDING COVERAGE FAX No): (305) 884-6977 NAIL 0 INSURER A : SCOTTSDALE INSURANCE CO INSURER B : AMTRUST NORTH AMERICA INSURANCE CO INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 WIIICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I iEREIN 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 ADDLSUBR LTR _INSR WVD N/ COMMERCIAL GENERAL LIABILITY 1 1 CLAIMS MADE k/. OCCUR A 1 11 GEN'I AGGREGATE LIMIT APPLIES PER. POLICY PRO- , LOC JECT 1 OTHER AUTOMOBILE LIABILITY ANY AUTO - OWNED J AUTOS ONLY i I HIRED AUTOS ONLY I L 1 L UMBRELLA LIAB OCCUR EXCESS LIAB SCHEDULED AUIOS NON -OWNED AUTOS ONLY I I CLAIMS -MADE DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIEI OR/PAR TNER/EXECUTIVE B OF EXCLUDED? (Mandatory in NH) If yes descnte under ULSCRIP1 ION OF OPERATIONS below NIA POLICY EFF POLICY EXP POLICY NUMBER (MSIIDD/YYYY) (MMIDDTYYYY) CPS-912943 10/17/2018 10/17/2019 TWC-336036 09/23/2018 09/23/2019 DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PLUMBING CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AS1T ORIK ZED REP ENTAtIVE CANCELLATION LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea osurrence) MED EXP (Any one person) PERSONA. 5 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 5 1.000,000 s 100,000 s 5.000 s 1,000,000 s 2,000,000 s 1,000,000 COMBINED SINGE E LIMIT (Ea accident FiODILY INJURY (Per person) W BODII Y INJURY (Per accident) 5 PROPERTY DAMAGE (Per accdent) EACH OCCURRENCE AGGREGATE PER OTH STATUTE —. ER E L. EACH ACCIDENT $ 500,000 E I. DISEASE - EA EMPLOYEE s 500.000 E I- DISEASE - POLICY LIMIT s 500.000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ELIVERED IN I 1 / 88-20TACORD CORP ATI$N. All rights'reserved. ACORD 25 (2016/03) QF The ACORD name and logo registered mara of ACORD BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL JOB ADDRESS: City: 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 Master Permit No. ❑ ROOFING ❑ REVISION ❑ PUBLIC WORKS 55-• 1 VO /02; Miami Shores County: Folio/Parcel#: // 3206 0/1 0 f ra Sub Permit No. ❑ CHANGE OF CONTRACTOR Miami Dade FBC 20 I LI 29 ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: Is the Building Historically Designated: Yes NO Occupancy Type: Load: /Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): �—d0/11 Address: SDI fr (02-S-fr-- City: A /clt/►Z S Gflyxxs: State: Tenant/Lessee Name: Email: BFE: FFE: Phone#: Phone#: % S 7 -¢96-a Zip: yJ CONTRACTOR: Company Name: Address: 9 / 2 U S vt, / / 7< S /--- City: / L4 1 '4 I State: Qualifier Name: /`7 _ d U A.- ,c Phone#:.�? f t -2 , s--S Y7'7 y Phone#: zip: 33/yV State Certification or Registration #: C/— ( 0 S C/ 3 7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ COO Square/Linear Footage of Work: Type of Work: ❑ : Addition ,r❑ Alteration Description of Work: ' 2 1 4s e-eit, p laiv, ❑ New ❑ Repair/Replace ❑ Demolition�� 5 hgK/ J i2• Specify color of color thru Submittal Fee $,vim W Scanning Fee $ Technology Fee $ Structural Reviews $ tile: Permit Fee $ !v CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I Z oS (Revised02/24/2014) ' -- ;1 Bonding Company's Name (if applicable) \; / Bonding Company's Address j4City.— - `• t Zt( 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 allworkwill 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 approveand a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknpwledged before me this day of //1"14 /, , 20 (-7011 me or who has produced identification and who di NOTARY PUBLIC: Sign: / V Print: Seal: , who is as Signature CONTRACTOR The foregoing instrument was ackn.wledged before meGthis z3 day of /QK ,a , 20 /a , by 71Ci i 0 e et, who is p • o . own to me or who has produced as �Rbp� DFfNA CRUZ_ Nota y, Public `State of Fioiida` # FF 204543 , •� �°Gomm. Expires Apr 7 2O'49,, �'""'"� ,Bon�tlth.rough National Notary' ---identification and who di O4TARY PUBLIC: datKft - -"" r !zuuuy ,iotary Public - State of Florida' 3 ..r inmission # FF 2045v.�; 'mm. Expires Apr 7, through National Print: DV,i)i - (° /I.al Z.- Seal: **********************************************ssssss******************************************:************* APPROVED BY // Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-3-18-765 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED ROAM oats: 4/3/2018 Expiration: 09/30/2018 Parcel Number Applicant 551 NE 102 Street Miami Shores, FL 33138-2454 1132060170980 Block: Lot: CORY & LISA GITTNER Owner Information Address Phone CeII CORY & LISA GITTNER 551 NE 102 Street MIAMI SHORES FL 33138-2454 Contractor(s) ARMANDO PENA Phone (786)255-5474 CeII Phone Valuation: Total Sq Feet: $ 2,500.00 0 Type of Work: PLUMBING FIXTURES IN KITCHEN, RELOC 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: ti Amount $1.80 $2.25 $2.00 $0.60 $150.00 $3.00 $2.40 $162.05 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-3-18-66907 03/26/2018 Check #: 1149 $ 50.00 $ 112.05 04/03/2018 Credit Card $ 112.05 $ 0.00 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 responsibil' for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, HANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFF construction a regoing information is accurate and that all work will be done in compliance with all applicable laws regulating rize the above -named contractor to do the work stated. Authorized Signature: Owner / /Applicant / Contractor / Agent April 03, 2018 Date Building Department Copy April 03, 2018 / 1