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PL-18-2127�5µO1S y� Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 LORIt)p' Permit NO. PL-8-18-2127 Permit Type: Plumbing - Residential Perfill"t Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 9/512018 1 Expiration: 03/04/2019 Project Address Parcel Number Applicant 77 NE 105 Street 1121360060150 Miami Shores, FL Block: Lot: JESSICA SCHILLING Owner Information Address Phone Cell EZEQUIEL ZYLBERBERG 77 NE 105 Street (561)703-2510 MIAMI SHORES FL 33138- 77 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone V & D PLUMBING SERVICE INC (305)393-4126 Type of Work: NEW BATHROOM NEW MASTER/DRYER/TITAN Type of Piping: Additional Info: NEW BATHROOM NEW MASTER/DRYER/TITAN Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $3.00 DBPR Fee $4.28 DCA Fee $2.85 Education Surcharge $1.00 Permit Fee $285.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $303.13 Valuation: $ 4,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-8-18-68499 09/05/2018 Credit Card $ 303.13 $ 0.00 Avanaoie 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 AFFIDAVIT: I certify that all the foregoing infolnation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fut rmore, I authorize the �ve-named contractor to do the work stated. September 05, 2018 Authorized Signature: Owner Applicant Building Department Copy September 05, 2018 / Contractor / Agent Miami Shores Village RECEIVED AUG 0 9 2018 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 FBC 2014 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. P1 I _ — 2127- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL XPLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: `Construction Type: �Q^ ( Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleehholder):y�" C�v_ `� ` t:�K Phone#: � — � 2 �— 3 f a Address: �� `'� kc) City: ' " 1 Cady l I / V\ Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: State: .C-0 n V� D P ✓innl i^-5 Gf/V(,'LG f r&Ohone# , J ,' 63 q Zip:�y,2, 1� Phone#: of Competency #: Address: City: Value of Work for this Permit: $ �� Square/Linear Footage of Work: ER/Addition Type of Work:/EJ Alteration ❑ New ❑ Repair/Replace Description of Work: 4"j '9 l l%iQ""i , N�tU wkbZ02 A/T"J, Specify color of color thru tile:, Zip: ❑ Demolition Submittal Fee $ Permit Fee $ JAI- ` co, CCF $ ,! CO/CC $ Scanning Fee $ Radon Fee $ 2 - �� DBPR $ 44 ' z 9 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $J 3 (Revised02/24/2014) Bonding Company's Name (if applicable) 'Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zi 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 OJIvered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemen be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I senc such posted notice, the inspection will not be apprgveo and a reinspection fee will be charged. t Signature The foregoing instrument was acknowledged before me this G 1n day of `` J�' 20 by �o)isyytpe4-so ally known to me or who has produced s identification and who did take an oath. NOTARY PUBLIC: Sign. Print: Signature CONTRACTOR The foregoing instrument was acknowledged beforemethis 3 day of cJ 20 )y by OQ, kSE -- "' ho is personally known to me or who has produced T(-1D ,l VZ—C- (� - WR as identification and who did take an oath. NOTARY PU L Sign: Print: Seal: Seal: :aSiy'Y P�i�� Notary Public State of Florida Sindia Alvarez 41a �nfission FF 156750 ******************************************************************************* * OF f� * xpiree6�l�W/16'i?***** APPROVED BY —/G�� Plans Examiner Zoning Structural Review Clerk (RevisedOZ/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSIN CONSTRU THE PLUMBI PROVI FESSIONAL REGULATION EXPIRATIOWOAT, �� 31, 2020 Always verify licenses online at MyFloridaLicense.com UNDERTHE TES Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this docui Florida r) p 008638 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES V AND D PLUMBING SERVICES INC RENEWAL SEPTEMBER 30,2018 14266 SW 162 ST 7190465 Must be displayed at place of business MIAMI FL 33177 Pursuant to County Code Chapter SA - Art, 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED V AND D PLUMBING SERVICES INC 196 PLUMBING CONTRACTOR BY TAX COLLECTOR CFC058010 $75.00 07/03/201,7 Worker(s) I CREDITCARD—I 7042069 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permitVr a certification of the holder *s ualifications,todebusiness. Holder must comply with any.govenimental of nongoviarnmental regulatory laws requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac For more Information, visit WM,Mi Q® A I� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/30/2018 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 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: Xamet Barreras PHONNo,E WC.. (786) 539-5989 A C No): (305) 356-1235 Temax Insurance Inc ADDRESS: xamet@temaxinsurance.com 9370 SW 72 Street INSURERS AFFORDING COVERAGE NAIC # A214 INSURERA: WESCO INSURANCE COMPANY 25011 Miami FL 33173 INSURED INSURERS: ASSOCIATED INDUSTRIES INSURANCE COMPAI 23140 INSURER C : V & D Plumbing Services Inc INSURER D : 14266 SW 162 St INSURER E : INSURERF: Miami FL 33177 MVFROGFS 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. NOTVNTHSTANDING 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDfYYYY POLICY EXP MM /DDIIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR WPP1587420 10/03/2017 10/03/2018 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES(E. occu ence)$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC OTHER: GENERAL AGGREGATE PRODUCTS - COMP/OPAGG $ 1,000,000 $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A AWC1105416 05/20/2018 05/20/2019 PER OTH- STAT UTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE s 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing Contractor 1`I=0TIIZIr_ATI= Wnl nFR rONrFI I OTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138`s/ .> @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD