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DEMO-18-720Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address mit Parcel Number Permit NO. DEMO-3-18-720 Permit Type: Demolition Work Classification: Plumbing Permit Status: APPROVED Expiration: 10/10/2018 Applicant 1421 NE 103 Street Miami Shores, FL 33138-2625 1132050310150 Block: Lot: VILMA QUINTANA Owner Information Address Phone Cell VILMA QUINTANA 1421 NE 103 Street MIAMI SHORES FL 33138- (305)527-3904 1421 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) CORAL REEF PLUMBING INC Phone Cell Phone (305)361-6769 (786)298-6853 Valuation: Total Sq Feet: $ 666.00 0 Type of Demo: Plumbing Additional Info: INTERIOR DEMO, REMOVE KITCHEN. Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO-3-18-66856 04/13/2018 Check #: 1144 $ 58.60 $ 50.00 03/21/2018 Check #: 7918 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final i 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. April 13, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 13, 2018 1 Miami Shores Village AA.A i 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 ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS GTtk JOB ADDRESS: \ `''12 \ N, E K ca C• City: Miami Shores FBC 20(� Master Permit No.i - MQ\ (& - "4( 9 Sub Permit No.D E-O ( $ -20 County: Miami Dade Zip: -=2,3\38 Folio/Parcel#: \\-3Z05 - 03\ - al Sr) Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �j OWNER: Name (Fee Simple Titleholder): \. \\N�C> QV\ r..��a. Phone#: (,;()57-A- -5 \O -\ Address: \ ` L \ 1\ L 1D 9 c;k S--"\-- • City: 1'-\\cam ' \ 5\CDC _i 5 State: �k.._ Zip: 5 \2 3V Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: CU(a \ N� r-Y\MU Address: TDC)X Z�C5).4-4 City: M \cam M \ State: VL.- Qualifier Name: l��ie \U‘C..) �'�\e LC' On State Certification or Registration #: C DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ feb4o I Type of Work: ❑ Addition O. Alteration Description of Work: Phone Phone#: Zip: 33 \ 57— Certificate of Competency #: Phone#: State: Zip: Square/Linear Footage of Work: El New � ❑ Re, p��r/ place 0-121144 tGf n Demolition Specify color of color thru tile: Submittal Fee $ i Permit Fee $ /0 Scanning Fee $ Radon Fee $ 2 • C72, CCF $ CO/CC $ DBPR $ Z Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ J� 'So (Revised02/24/2014) f 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, 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 reinspectiop.,fee will be charged. Signature OWNER or AGENT The foregoing instrument�(was acknowledged before me this —44- day of A� L`� , 20 I , by \mE V ‘r ti, who i lly known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Notary Public - State of Florida Commission: GG 120541 My Comm. Expires Jun 29, 2021 Bcrdedthrough National Notary Assr. * ** *** * * ** * * Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of ,Ai ( L , 20 \ B , by \I `(,k O ✓ .( ho 's personally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: HRISTINE STEVENS Notary Public - State of Florida Commission: GG 120541 My Comm. Expires Jun 29.2021 Bcrded through National Notary Assr. ************************************************************************* APPROVED BY —2 —(F Plans Examiner Structural Review * ***** * * ********** Zoning Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LEON, OSVALDO JAVIER CORAL REEF PLUMBING INC 5985 NW 110 STREET HIALEAH FL 33012 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional onals and from architects tot yacht brokers. fromion, Our boxers es range boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in orde r to serve you better. For information about our services, please log onto www.myfloridalicense.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 cense Efficiently, eglate Fairly. IWe constantly ssion at the etrive to serve partment is: fyou better so thaty ouucan serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER CFC1426671 STATE OF FLORIDA PROENT OF BUSINESS A FESS PROFESSIONAL REGULATION ND CFC1426671 ISSUED: 06/22/2016 CERTIFIED PLUMBING CONTRACTOR LEON, OSVALDO JAVIER CORAL REEF PLUMBING INC IS CERTIFIED under the provisions of Ch 489 FS. Erpuaton 0a'e . AUG 31, 201E L1606220000800 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSRUCT ON INDUSTRY LICENSING BOARD The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 LEON, OSVALDO JAVIER CORAL REEF PLUMBING INC' 5985 NW 110 STREET3012- —. HIALEAH FL DISPLAY AS REQUIRED AY LA SEQ # L1606220000800 005922 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS l5 NOT A BILL - DO NOT PAY 5545331 BUSINESS NAME/LOCATION CORAL REEF PLUMBING !NC 7301 NW 12 ST MIAMI FL 33126 OWNER CORAL REEF PI..UMBING INC Worker(s) 1 RECEIPT NO. RENEWAL 5785861 EXPIRES SEPTEMBER 30, 2018 Must be displayed al place of business Pursuant to County Code Chester 8A -. Art. 9 Si 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING CONTRACTOR CFC1426671 .. PAYMENT RECEIVED BY TAX COLLECTOR S75,C0 07/06/2017 CREDITCARD-1 7—C43737 This Local Business.Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, pormit, or a certification of the holder's 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 commercial vehicles - Miami -Dade Code Sec 8a-278. For more information, visit www.miamidade_gov(taxcellector . 1?.1 CERTIFICATE OF LIABILITY INSURANCE tr..... - DATE(MM/DD/YYYY) 03/14/18 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 pollcy(les) 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 Procom Insurance Underwriters 4909 SW 74th Ct. Miami, FL 33155 Phone (305) 740-4460 Fax (305) 740-4469 CONTACT NAME: ISIDRO L. GUILLAMA PHONE FAX Arc. Na(A/C,. Ext): (305) 740-4460- C, No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED - CORAL REEF PLUMBING INC. 7301 NW 12 STREET MIAMI ,FL 33126 305-361-6769 INSURERA: WHITE PINE INS. CO. 11932 INSURER B : ASSOCIATES INDUSTRIES INS 23140 INSURER c: Ascendant Commercial Insurance, Inc. 13683 INSURER D: INSURER E ; INSURER F: 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 TYPE OF INSURANCE ADDL INSR SUBF WVD POLICY NUMBER POLICY EFF (MM/DO/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR n 2,000 BI/PD DED Y Y WPCP005656 12/13/2017 12l13/2018 EACH OCCURRENCE $ 1,000,000 PRMTORENTED PREMMI E SES ((Eaaoccurrence) $ 300,000 MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 I♦ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: II POLICYijPRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ C AUTOMOBILE LIABILITY ❑ ANY AUTO Y Y CA-34482-4 - 03/25/2017 03/25/2018 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 100,000 1111 ALL OWNED AUTOS BODILY INJURY (Per accident) $ 300,000 Q SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ 100,000 II HIRED AUTOS ❑ NON -OWNED AUTOS PIP $ 10,000 $ El ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB II CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ 1.1 DEDUCTIBLE $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY EXCLUDED? EECUTIVEIY�N OFFICER/MEMBER (Mandatory In NH) [(yes, describe under DESCRIPTION OF OPERATIONS below N!A Y AWC1089415 09/23/2017 09/23/2018 WC STATU- OTH- TORY LIMITS ER E.L, EACH ACCIDENT $ 1,000,000 EL, DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C COMPREHENSIVE/COLLISION CA-34482-4 03/25/2017 03/25/2018 ACTUAL CASH VALUE WITH 500 DED, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Plumbing Contractor CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED C 05 chevrolet express 1GCGG25V551176277 /06 chevrolet express 1GCGG252761241010 / 12 chevrolet express 1GCWGFCA2C1144256 /07 chevrolet express 1GCGG25V971154172 /13 chevrolet slIverado 1GCNCPEX8DZ410588 / 17 gmc/chevy 2500 1GCWGAFF5H134S230 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE 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. ACORD 25 (2009/09) QF AUTHORIZED REPRESENTATIVE , r ISIDRO L GUILLAMA © 1988-2009 ACOR CORPORATION. I rights reserved. 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