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PL-17-494Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. PL2494 --17- Pennit Type: Plumbing - Residential Work Classification: Addition/Alteration Perna Status: APPROVED it Issue Date: 3/21 /201.7 Expiration: 09/17/2017 Parcel Number Applicant 94 NW 94 Street Miami Shores, FL 1131010340230 Block: Lot: SANTIAGO JIMENEZ ANTONEL/ Owner Information Address Phone CeII SANTIAGO JIMENEZ ANTONELA 94 NE 94 Street MIAMI SHORES FL 33150- (561)596-7146 94 NE 94 Street MIAMI SHORES FL 33150- Contractor(s) Phone SOUTH BEACH PLUMBING CONTRAC (786)337-1582 Cell Phone Valuation: Total Sq Feet: $ 2,200.00 0 Type of Work: REPLACE MASTER BATHROOM KITCHEN SIN Type of Piping: Additional Info: REPLACE MASTER BATHROOM KITCHEN SIN Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $3.38 $3.38 $0.60 $225.00 $9.00 $2.40 $245.56 Pay Date Pay Type Invoice # PL-2-17-63075 03/21/2017 Credit Card 02/24/2017 Credit Card Amt Paid Amt Due $ 195.56 $ 50.00 $ 50.00 $ 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 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 AFFID constructi and certify teat all t 'foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating Futher• .re, I a_f orize the above -named contractor to do the work stated. uthorized Signature: Owner / pplicant / Contractor / Agent March 21, 2017 Date Building Department Copy March 21, 2017 1 Address: City: Qualifier Name: /C'%7�i't/i /✓.�QV • State Certification or Registration #: DESIGNER: Architect/Engineer: Address: 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 T\T' f FEB242017 1 FBC 20 Master Permit No. Sub Permit No. P t k -Ltk L( ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: i T N�1 61471 W City: Miami Shores County: ❑ EXTENSION RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: n Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ✓ vlQ (C \1T D at3/4- Nw Cka `-`, s - Phone#: Sb 1- Slip 'VS City: k&,1()JIA ;•1 sv C State: Y L Zip: 37)1,c b Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: •ciWGIA 6`-4— 1 " - Phone#: �330 ,S( +� tate: Address: Value of Work for this Permit: $ Type of Work: ❑ Add' ion Description of Work: Phone#: Zip: 3,31 Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work:: •i I ^Txe air Replace''' '`'" ❑ Demolition •: ❑ Alteration _ ./rlao~ Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ .2 2 5 — CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ s(0 O 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 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, theapplicant 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 approvgd and a reinsplection fee will be charged. 4 / 1 Signature OWNER or AGENT 1 .1 Signature • CONTRACTOR The foregoing instrunn t was acknowledged before me this The foregoing instrume t w.s acknowledged before me this 4.� 20 ` 9- , by eeC/tl , ho is personally known to 44onel A eaiveno , who is personally known to me or who has produced as identit Cats* NOTA*r' v. ,r4 DANIEL MONTOYA IP : . •., MY COMMISSION M GG 011304 114T- , ice' Sign: Print: '•14)$1 1„(pn'brek Seal: me or who has produced identification and who • NOTARY PUBLIC: Print: Seal: d take an ooth. • YANELIS MARTINEZ MY COMMISSION #FF089481 EXPIRES: FEB 04, 2018 Bonded through 1st State Insurance as ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) UEI'AK I M1 N I Uh bUSINtSS ANU rkurCa t.►tvh�. ncvv'an'i two, CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 , I BELLO, REMBERTO SOUTH BEACH PLUMBING CONTRACTOR INC 1300 SW 70TH AVE MIAMI ' FL 33144 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myflortdallcense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER CFC1428669 - The -PLUMBING , CONTRACTOR Narned,below IS CERTIFIED Under•the-provisions Of Chapter 489 FS. Expiration-date:-AUG 31, 2018 r'sI43,f (850) 487-1395 STATE OF FLOR,IDA DEPARTMENT.OF BUSINESS AND PROFESSIONA REGULATION CFC1428669 a e iSS EDt)5/18/2016 CERTIFI ED PLUMBINGFCO RACTOR BELLO,`REMBE,RT`'` SOUTHIBEACH,FLUMBINGS9.NTRACT9R IN IS CERTIFIED. under the provialon5 of Ch.489 FS. fi Expiration lots : AUG 31, 2018 L1605180000782 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD BELLOrREMBERTO fSOUTH'BEACH PLUMBING CONTRACTORINC ::1300 SW 70THAAVE NIIAWII _ FL 33144- ISSUED: 05/18/2016 DISP YAS REQUIRED BY LAW SEQ # L1605180000752 • 006636 Local Business Tax Receipt Miami —Dade County, State of Florida j -THIS IS NOT A BILL - DO NOT PAY 7029200 BUSINESS NAME/LOCATION SOUTH BEACH PLUMBING CONTRACTOR INC 5330 SW 7 ST MIAMI FL 33134 RECEIPT NO.' RENEWAL 7305436 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code S Chapter BA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINES SOUTH BEACH PLUMBING CONTRACTOR18QCPLUMBING CONTRACTOR C/0 DENIS 1 GUERRERO PRES CFC1428669 iNorker(s) 3 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 08/09/2016 CHECK21-16-110317 This Local Business Tax Receipt only confirms payment of the Local Busi less Tax. ,The Receipt Is not a license. penult, or a certification of the holders qualifications, to do business. Helder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to lc business. The RECEIPT NO, above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-776. For more information, visit www.miamidadJ.gov/axcolleclor ACO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/21/2017 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 CONTACT NAME: Univista Insurance- Little Havana PH(A/C. No. Eat)... _ (786) 953 5338 FAX Noi' (786) 953-7029 E 2610 NW 7 st MAIL ADDRESS:_.. info(cuniv+stalnsurance com . _,,....... ... _._. ........a.,,-____ _._..__.. _..........__.._._-_. Miami, FL 33125 INSURER(S) AFFORDING COVERAGE NAIC s Phone (786) 953-5338 Fax (786) 953-7029 INSURER A: GRANADA INSURANCE INSURED INSURER e : SOUTH BEACH PLUMBING CONTRACTOR INC INSURER 2610 nw 7 st INSURER D : INSURER E : MIAMI FL 33125 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 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 ADDLSUBRPOLICY EFF POLICY EXP I LTR,i A I TYPE OF INSURANCE 'tJ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE ❑ OCCUR GI�EN'L AGGREGATE LIMIT APPLIES PER. t POLICY ❑PRO. ❑ Loc JECT IY OTHER !NM :WVD ,_........__._.._POLICY NUMBER __-..,,.. _,.... ;(MM/DDIYYYY) (MMJDDIYYYY). LIMITS 0185FL00032818 01/09/2017 01/09/2018 ;EACAMHAGOCUCRRERENTENCED s 1,00.�O,OOO.000,00.0.00 ' DE TO PREMISES jEa orn,rrence),___S—..__..__.........._.._.... MED EXP (Any oneperson) .. _. $_ 5,000.00 PERSONAL 8 ADV INJURY I $ 1,000,000.00 GENERAL AGGREGATE $ 200,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO I --I ALL OWNED LJ AUTOS ❑ HIREDAUTOS ❑SCHEDULED -; AUTOS i J AUTOSWNED UMBRELLA LIAB D OCCUR EXCESS LIAR ❑ CLAIMS -MADE D£D ❑ RETENTIONS i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N I ANY PROPRIETOR/PARTNERIEXECUTrVE--•.- OFFICER/MEMBER EXCLUDED? N 1 A i (Mandatory in NH) 3 If yes, describe under DESCRIPTION OF OPERATIONS below COMBINED1SINGLE LIMIT i $ BODILY INJURY (Per person) + 3 BODILY INJURY (Per accident) $ ............. PROPERTY DAMAGE i $ (Per accident) $ EACH OCCURRENCE $ AGGREGATE S $ PER " OTH-. STATUTE . ER.., i.,,.. E.L. EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT s DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) CFC-1428669 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2014/01) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A ' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDITYY► 02/24/2017 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 endorsoment(s). PRODUCER rw A&A Underwriters Inc. 8778 SW 8st Miami FL 33174 CONTACT NAME: Pablo M Conde PHONE (305 , Nei: (305) 220-4821 TacU: 220-7447 Jac E-MAIL ADDRESS$: pmcaaunderwriters.com INSURER(RAFFORDING COVERAGE NAIC # INSURER A: BUSINESSFIRST INSURANCE COMPANY 11697 INSURED SOUTH BEACH PLUMBING CONTRACTOR INC 2610 NW 7th Street Miami FL 33125 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : r. a ne 'nu en iast$CD. COVERAGES uttt I IFlI.A 1 c NUmvcr. THIS IS TO CERTIFY THAT THE POLICIES OF NCE LISTED BELOW HAVE BEEN ISSUD TO THE INSURED NAMED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTERAC TABOVE POLICY 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 ADOL INSD SUBR WVIZ POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED PREMISES (Ea occurrence) S CLAIMS -MADE OCCUR MED EXP (Any one person) S PERSONAL & ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED COMBINED NEDii.ItlGLE LIMIT $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (emi�nl) S S — UMBRELLA UAB EXCESS LIAO OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ S A DED I I RETENT ON S A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under OF OPERATIONS below NIA 521-09194 08/31/2016 08/31/2017 X STATUTE OTH ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT S 1,000.000 D DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) SOUTH BEACH PLUMBING CONTRACTOR INC CERTIFICATE HOLDER MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD