The URL can be used to link to this page

PL-17-231`,SNORES LI y—�gr 6 F�01RlOp Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. PL-1-17-23'1 Per ■ Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 1/10/2018 1 Expiration: 07/09/2018 r1 VJC _UU,UDD Parcel Number Applicant 1050 NE 96 Street 1132060143520 Miami Shores, FL Block: Lot: JOHN CAMP Owner Information Address Phone Cell JOHN CAMP 1050 N. E., 96 ST. (305)530-0050 Contractor(s) Phone Cell Phone LASSETER PLUMBING CO INC (305)525-5075 (305)893-7180 Type of Work: RE-ROUTE WASTE LINES AND SUPPLY LIN Type of Piping: Additional Info: RE-ROUTE WASTE LINES AND SUPPLY LIN Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 Valuation: $ 1,100.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-1-17-62761 01/10/2018 Credit Card $ 110.45 $ 50.00 01/30/2017 Credit Card $ 50.00 $ 0.00 Avauame Inspections: Inspection Type: Top Out 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 information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo g. Futhermore, I pufffdrife the above -named contractor to do the work stated. January 10, 2018 Au or' a ure: Owner Applicant / ctor / Agent Date Building Department Copy January 10, 2018 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village JAN 3 0 2017 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 V. INSPECTION LINE PHONE NUMBER: (305) 762-4949 6-'k FBC 20 � Master Permit No. 9-� C �-1 - ZS Sub Permit No. L 1"2-31 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: i0r50 Nam- q 11 A S �� City: Miami Shores County: Miami Dade Zip: 3313`� Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): To 141-1 A • CA. 4-P Phone#: '30°3. 5-3'3. 5 7 1'9 Address: tol5p N'E a l p STIZ� T City: MI /fir I 51.4oVr-5 State: FL Zip: '5-51-5'9 Tenant/Lessee Name: one#: Email: ; ram.WAD C�rI k-cm iitl A,5• COLM CONTRACTOR: Company Name: L(jSSC4.I- P1LAm6ir,)Q Col04. IAC. Phone#:305-Saci3-TIf3O Address: Y(O'S S-4r2e:k City: KbOlh State: t-lpyidA Zip: 35itol Qualifier Name: j06-N LQsSewtr Phone#: 3()5--t3G3 -u30 State Certification or Registration #: C'FCO'4 11PG10 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ % . 4 OD Square/Linear Footage of Work: Type of Work: El Addition ❑ Alteration ❑ New - Footage Repair/Replace El Demolition Specify color of color thru tile: -� Submittal Fee $ �br ! � Permit Fee $ 1 5-c7 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 DBPR $ 2 2 Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ �( _ TOTAL FEE NOW DUE $ 1 (o - r (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 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 r§;wipection fee will be charged. Signature OWNER or AGENLged The foregoing nstrument was acknowle)bne me this t 3'ItL day of 1 GSM c �riry 20 14 by Ti�1nd1 A. cfb-- 1iJ1 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: n Sign: E�— Print:ROCCO „ e Seal: °r.• ��: Notary Public . State of Florida Commission #F FF 228812 �`;r My Comm. Expires Jul 7, 2019 eonard titroup, 0 Nd Ablery Assn. APPROVED BY Signature The foregoing instrument was acknowledged before me this day of- a r 20 by ,� c�h r1�`J�,✓ , who is personally known to Sq me or who has produced L 2 9(0 " (433 -i0 Z - las identification and who did take an oath. NOTARY PUBLIC: * .*; MY COMMISSION # GG 044602 Print: %�pf F�qP Seal: Bonded Thru Notary Public Underwriters Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 5806923 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ACE CONSTRUCTION RENEWAL SEPTEMBER 30, 2017 11950 W DIXIE HWY 6054738 Must be displayed at place of business MIAMI FL 33161 • Pursuant to County Code ` Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS EGERT CONSTRUCTION INC 196 GENERAL BUILDING CONTRACTOR PAYMENT D CGC1511239 By TAX CORECEIVED Worker(s) 15 $100.00 07/21/2016 CREDITCARD-16-042794 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is note license, permit, or a certification of the holders qualifications; to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. i j The RECEIPT NO. above must be displayed on all commercial vehicles — Miami -Dade Code Sec 6a—a6. f I For more information, visit www.miamidade.gov/taxcollector RICK SCOTT, GOVERNOR STATE. -OF FLORIDA--'- DEPARTMEN 'AA\I KEN LAWSON, SECRETARY LATION The,GENERAL CONTRACT(-)K- ` Naimed-below S CERT.IFIED_ Under,tlie.prowsi6hs of•Chapter`489-FS.----- Expi`ration'date:' -AU_G 31,.2018- IT I [oil E6ERT,ALAN•SCOTT CONSTRUCTIOiV; ��,*� 11956 WEST'DIXIE:H.WY ,MIAMI -_ `,.•FL 33161E i w ISSUED: 07/14/2016 DISPLAY AS REQUIRED BY LAW SECT # L1607140001021 �J The,GENERAL CONTRACT(-)K- ` Naimed-below S CERT.IFIED_ Under,tlie.prowsi6hs of•Chapter`489-FS.----- Expi`ration'date:' -AU_G 31,.2018- IT I [oil E6ERT,ALAN•SCOTT CONSTRUCTIOiV; ��,*� 11956 WEST'DIXIE:H.WY ,MIAMI -_ `,.•FL 33161E i w ISSUED: 07/14/2016 DISPLAY AS REQUIRED BY LAW SECT # L1607140001021 �J ACECO-3 OP ID: KE ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 10/31 /2016 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 endorsements . PRODUCER BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite#200 CONTACT NAME: Matthew Seese PHONE ,305-364-7800 ac No: 305-714-4401 E-MAIL ADDRESS: Miami Lakes, FL 33016-5869 Matthew Seese INSURERS AFFORDING COVERAGE NAIC # INSURERA:Ohio Security Ins. Co. 24082 INSURED Egert Construction, Inc. INSURER B : Berkley Assurance Company 39462 DBA Ace Construction 11950 W. Dixie Hwy Miami, FL 33161 INSURER C:COMP Options Insurance Co 10834 INSURERD:Scottsdale Insurance Company 41297 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 LTR TYPE OF INSURANCE ADDL SUB POLICYNUMBER POLICY EFF MM D/YYYY POLICY EXP MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE K OCCUR VUMB0086861 05/10/2016 05/10/2017 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ exclude PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY JECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO BAS1757097556 05/10/2016 05/10/2017 ALL OW NED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A 14299 10/30/2016 10/30/2017 X PER OTH- STATUTE X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 D Equipment Floater CPS2471520 05/10/2016 05/10/2017 Leased/ 100,00 Rented DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) State license CGC1511239 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Brown and Brown of Florida, Inc. C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD