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PL-17-2823Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 390 NE 104 Street Miami Shores, FL 33138- Owner Information CHRISTIAN & DREIRDRE DUNHAM Address Permit ■ Issue Da Parcel Number 1121360130160 Block: Lot: 390 NE 104 Street MIAMI SHORES FL 33138- 390 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone 5 STAR PLUMBING SERVICES CORP (305)796-3607 CeII Phone Permit NO. P L-11-17-2823 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Expiration: 05/30/2018 Applicant CHRISTIAN & DREIRDRE DUNK Phone (305)804-2767 Valuation: Total Sq Feet: CeII $ 5,000.00 400 Type of Work: NEW KITCHEN & BATHROOM NEW KITCHEN Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $3.00 $3.38 $2.25 $1.00 $225.00 $9.00 $4.00 Total: $247.63 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-11-17-65770 12/01/2017 Credit Card $ 247.63 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing LUnderground 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. OWNERAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construeoning. Fumore, I authorize the above -named contractor to do the work stated. Autho ' ed Signature: Owner / Applicant / Contractor / Agent December 01, 2017 Date Building Department Copy December 01, 2017 1 Miami Shores Village REeety€p BUILDING PERMIT APPLICATION 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. 'k\,‘ \A \-) Sub Permit No. /1-1 1- 2n-3 BUILDING 0 ELECTRIC 0 ROOFING 0 REVISION 0 EXTENSION 0 RENEWAL PLUMBING MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CANCELLATION 0 SHOP JOB ADDRESS: City: Folio/Parcel#: KO NC Ua'f s Miami Shores County: 11- 21z (v013- OI le tD Occupancy Type: Load: Construction Type: CONTRACTOR DRAWINGS Miami Dade Is the Building Historically Designated: Yes Zip: 331-2451 NO Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder):Chy s-haa. t j(d.K 1nh Y Phone#: Address: City: D 1V (( s -r i nti Shfrcs State: Zip: FFE: Tenant/Lessee Name: Phone#: Email:.Si 2- ? /"� 47 `/a h» c CONTRACTOR: Company Name: 5 Sir I)I -4 l'u-1"31 Address: I 11 I 0 0 SV l �T City: )'4tn ,State:QualifierName: JV1JflUd p4 f ) Phone#: 3D5 ' -29 . 3 (Q01 Zip: r/ _ Phone#:3DS ��3(001 State Certification or Registration #: G Pl, v- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: e1 City: State: Zip: Value of Work for this Permit: $ �''' ' Square/Linear Footage of Work: Type of Work: ❑ Addition ( Alteration (❑ New ❑ Repair/Replace of Workx-NAJ: lil! 1 bect- h Descriptionl\I-C.. NOV 2 9 2017 FBC 2011 s ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ .2 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $4_ 1•`o✓ (Revised02/24/2014) 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: 1 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. Signature caA OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 � 0-41" day of � •(,#_' i 20 by 2-6 day of 0 CALZAOPX by (4 14 t-t v`', t w me or who has me or who h. produced identification a d wh did take an oath. identificatio and who did take an oath. NOTARY PUBL N . ARY PU . LIC S Print: Seal: ,_ePpALJ LORETTA COMES MY COMMISSION It FF 954664 ' um, EXPIRES: Mardi 21, 2020 m''Nop rtsfii Bonded Thnj Budget Notary Serstces APPROVED BY 1/.-30- I Sign: Print: Seal: 0 as Plans Examiner *`" •;° LOR w * MY COMMISSION 4 FF 954664 EXPIRES: March 21, 2020 *f''FOFF`�•�F BondedlhruBudgetNotary Bentz Zoning (Revised02/24/2014) Structural Review Clerk 5 Star Plumbing Services 11710 SW 180 Street, Miami, FL 33177 October 26, 2017 State of Florida County of Miami -Dade Before me this day personally appeared Manuel Pampin who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 390 NE 104 Street Miami Shores, FL 33138 Sworn tQ and subscribed before me this 26th day of October, 2017 by Manuel Pampin Personally known O' roduced Identification Type /Identification Produced Print, Type or Stamp Name of Notary r6`:R=:°8et, LORETTA COMES * * MY COMMISSION 0 FF 954664 EXPIRES:Marc,20 �°e 8ondedThruBudgetNotah21rySe20rvies IVilami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel': (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption ,! -' fx..F. .= i':.n p+,',s=dYp'�.`s +,x...s. "F �j.r°'�..a94'T"itd X E� •;! Horida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla, Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner; must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3 The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this By .1 Y1Ym, 11. ,. • Not SEAL: as identification. pAY PV N, LORETTA COMES *t,� * MY COMMISSION 1 FF 954664 EXPIRES: March 21, 2020 le or has produced Acc:30R� CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) DATE 11/29/17 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 USA General Insurance Corp/USA Insu 13631 SW 26st Miami, FL 33175 Phone (305) 386-3305 Fax (888) 330-1123 CONTACT Evelyn Sanchez (A//CNNo. ): (305) 386-3305 FAX No): (305) 386-6778 ADDRl evelyn@usageneralinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : United States Liability Insurance Company INSURED 5 Star Plumbing Services Corp 11710 SW 180TH STREET MIAMI, FL 33177 (305) 796-3607 INSURER B : 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 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY N N CL1709153A 07/02/2017 07/02/2018 EACH OCCURRENCE $ 1,000,000.00 V COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE V OCCUR ❑ PREMISES ( ( TO occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1 ,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ IFST ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ NON -OWNED AUTOS ❑ ❑ COMBINED SINGLE LIMIT .JEa accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) n If yes, describe under DESCRIPTION OF OPERATIONS below N / A n • WCSTATU- OTH- TORYIIMITS • ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space is required) State Licensed Plumbing Contractor CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 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 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) OF ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 64m Local Business Tax Receipt Miami -Dade County, State of Florida -THISIS NOT A BIU. - DONOT PAY BUSINESS NANIE/LOCATiON 5 STiMPLUMBINGSSIVICEKORP 1 1 7117 SW -MOST FL 33177 OWNER 5 STAR PLUMBING SERVICES,CORP Worker(s) 1 REcesior RENEINAL SEPTEMBER ab, 20 7236391 SEC. TYPE OP BUSINESS 196 PLUMBING CONTRACTOR CFC1429573 EXPIRES Must be displayed at place ot busimess Pursuant to Count), Code Chapter BA - Art. 9 & 10 This Local Business Tax Receipt only continue pqtrent of the LotaHltmluesa itytN or mmgovernmentai regulatory laws pd. requirements which apply ,r the rot. .44 omit or certification of** holdoesquilifions.te do business. . , The RECEIPT NO. above must be displayed on all cotherplathefliclesplecoulefelialill For more Informatioa, visit ;1•°•1•° t'A;,i• •