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PLC-18-3228Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 9440 NE 2 AVE, Miami Shores, FL 33138-0000 Contacts issue Date:10/23/2018 Permit NO.: PLC-1 0- 18-3228 Permit Type: Plumbing - Commercial Work Classification: Alteration Permit Status: Approved Expiration: 04/17/2019 Parcel Number Project 1132060132780-40 <NONE> MSVC LLC Owner MSVC LLC Applicant MSVC LLC MSVC LLC 2310 HOLLYWOOD BLVD, HOLLYWOOD, FL 33020 2310 HOLLYWOOD BLVD, HOLLYWOOD, FL 33020 PHOENIX PROFESSIONAL GROUP INC Contractor ARLENE WILSON 1830 N UNIVERSITY DR 254, PLANTATION, FL 33322 Business: 9546956491 Description: ADDING IN GREASE TRAPS, PLUMBING. FOR Valuation: $ 8,600.00 Inspection Requests: HANDWASH SINK. THREE COMPARTMENT SINK FKIIR TRAINS, 1305-762-4949 ICE BIN. Total Sq Feet: 600.00 Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $3.87 DCA Fee $2.58 Education Surcharge $1.80 Permit Fee $208.00 Scanning Fee $3.00 Technology Fee $6.45 Total: $281.10 Building Department Copy Payments Date Paid Amt Paid Total Fees $281.10 Credit Card 10/23/2018 $281.10 Amount Due: $0.00 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 th I work will ne iri compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contra: the d. Authorized Signature: Owner / Applicant / Contractor / Date October 23, 2018 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 19 2018 INSPECTION LINE PHONE NUMBER: (305) 762-4949 / "-`TI FBC 20 `1 n BUILDING Master Permit No. (- ( 8 - I PERMIT APPLICATION Sub Permit No.jmle . 2&-? ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL dPLUMBING [:]MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ^ h 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: Flood Zone: BFE: FFE: OWNER: Name (Fee Sim NU-1, lehold Address: D-,�d� City: Tenant/ essee Name: Email: V CONTRACMh ompa`ny N/aAme--4, Address: I 1 JINIF /State Certification or Registration #: State: � Zip: �•> � �� Z� Phone#: '18fm �Y►— DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ b 00 - 00 Square/Linear Footage of Work: _ 6so Type of Work: ❑ Addition ❑l Alteration ❑ New ❑ Repair/Replace ❑ Demolition X- Description of work: G'f &at L 4r �I W�. La Y' uq Sim - i-f Intl 0ov- +. Cl i n -T-- C p a i n. Specify color of color thru tile: Submittal Fee $ 0 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 0 % a ( U 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 is curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a proved a a reinspection fee will be charged. Signature Signature OWN -�'�'I U-r— CONTRACTOR The foregoing instrument was acknowledged before me this 14 day of OVfv Feit' 20 13 by ho is ners�nally known to 4�90r who has produced as identification and who did take an oath. NOTARY PUBLIC: n KATHERINE RODRIGUEZ MY COMMISSION # GG 193438 APPROVED BY The foregoing instrumepA was acknowledged before this day of 20 by S'V who is sonally known me or who has produced "t�as identification and who did take an oath. NOTARY PUBLIC: Sign: —:yJ2 Print: / _ Seal: TAMMY GRIFFIN MY COMMISSION # FF 936284 EXPIRES: December 10, 2019 srss***sstss#*sstssssssssssssssssssssssssssssssss*ssssrsr**t*s* Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND,PROFESSIONAL REGULATION CONSTRUCTiE3N"INDUB;LICLNSLNG BOARD THE PLUMBING CANT wx �' RACTE7f HEtEtN.fS CE�ZTiFf[) UNDER THE PR(7VtSttOltitS OF CHAPTER'489t=©RtDASTATUTES VNt1:S+Of�tgRL��:EP �*PHOE1Ltt*ph' kS�IONAC GROUP tNC:ti z ,,ter �} UCEtdSE �111M�3Eit.� C�C1�29565 EXPIRA O ,.DATE; -,"AUGUST 3l,-2020 ---' Always verify licenses online at MyFloridaUcense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. i BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA: Receipt #-182 - 2773 52 Business Name: PHOENIX PROFESSIONAL GROUP INC PLUMBING/LWN SP /CONTRACTOR Business Type: (PLUMBING CO CTOR) Owner Name:ARLENE WILSON Business Opened:05/31/2016 Business Location: 8725 NW 39 ST State/County/Cert/Reg:CFC1429565 SUNRISE Exemption Code: Business Phone: 9 54 - 6 9 5 - 04 91 Rooms seats Employees Machines Professional 2 Number of Machines: - Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cast Tof27 Paid 27.00 0.00 0.00 0.00 0.00 0.0.0 .00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINE THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward Cou non -regulatory in nature. You must meet all County and/or Municipality WHEN VALIDATED and zoning requirements. Tnis Business Tax Receipt must be .transfer the business is sold, business name has changed or you have m business location. This receipt does not indicate that the business is lec it is in compliance with State or local laws and regulations. V Mailing Address: ARLENE WILSON 8725 NW 39 ST SUNRISE, FL 33351 2018 - 2019 Receipt; #10B-17-00003917 Paid 07/31/2018 27.00 and is anning when ed the or that A� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDNYYY) 10/19/2018 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(les) 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 endorseme s . PRODUCER CONTACT ME: GreggGDitZian BONE cow (305) 653-7977 a No ; 305) 654-0293 Insure Smart E-MAII . info insure-smart.00m 20286 NW 2 Ave INSUR S AFFORDING COVERAGE NAIL 9 INSURER A: AIX SPECIALTY INS CO. 12833 Miami FL 33169 INSURED INSURERS: INSURERC: Phoenix Professional Group INSURER D : 1830 North University Drive INSURER E 0254 INSURER F : Coral Springs FL 33071 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 ADDL SUBR POLICY NUMBER M Ap EFF POLICY EXP VMS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR N N SIZGL1003A205720 07/1712018 07/17/2019 EACH OCCURRENCE $ 1,000,000 _ PR MI E O nce S 50,000 MED EXP ( one rson) $ 5,000 PERSONAL a ADv INJURY s 1,000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER: /� POLICY ❑ PRO- JECT ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OVIMED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per pemon) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per ac ident $ $ UMBRELLA LIAR LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ 1EXCESS AGGREGATE $ 1DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFRCER/MEMBER EXCLUDED? (Mandatory in NH) If yea, describe under DESCRIPTION OF OPERATIONS below N / A STATUTE ER E.L.EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached N more space is required) CFC1429565 Miami Shores Village Building Department 10050 N_E.2nd Avenue Miami Shores - 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 FL 33138 Grcgr�,f7itziuo _'C06OG9?3G 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD i�,t.a WE AMMY PATRONIS 0 CHIEF FINANICAL OFFICER STATE OF •_ r. DEPARTMENT OF .. . DIVISION OF s - - •, s . *'* CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERW COMPENSATION LAIN CONSTRUCTION INDUSTRY EXEMPTION This ceffms that the individual listed below has elected to be exempt from Florida Workers Compensation I EFFECTIVE DATE: 12/12/2017 EXPIRATION DATE:. 12/12/2019 PERSON: dVILSONSCOTT ARLENE P F©N: 371794343 BUSINESS NAME AND ADDRESS: PHOENIX PROFESSIONAL GROUP INC 1830 N. UNIVERSITY DR, SUITE 25.4 FORT FL 33322 LAUDERDALE SCOPE OF BUSINESS OR TRADE: Licensed Germat Contractor f3ONVwd Pk•vftV Contractor UMMd Roofing Contractor t� +# to44a05(7a), F.S., an atTKW o#a Corporation who elects ex mpft hom thb c hapt x by fi" a cetfcate of under MY not recover benefit or Can under this Chi. Pmmactt to Chapter M&OXi2), F &. Catficates of election to be exern apply MY wittan the scope of the twainesrs or trade timed on the noffm of eiectiat r rant and certificates ob he Pursusttt b Chap6er 440.0.5(13), F.S., t+iotioes of etectivsr be eperson n3ffmd rthe ice ar e to be no k*} w n ors the be sttbiect torevot�on if, at any+ time after the filing of the rt�e or t e issuance of the Cep .the CWftate at arty time false no Fof ttda section for issuance of a Certificate. The department sham revoke a Person named an ttv3 raa to Met ttte reM iremens of this section. DFS-F2-DWG252 CERTIFICATE OF ELECTION TO BE EKEMPr RE%ASED W13 QUESTIONS? PROFESSIONAL GROUP INC. October 20, 2018 State of Florida County of Dade Before me this day personally appeared Arlene P. Wilson who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at 9440 NE 2 Ave, Miami Shor , FL 33138 --Z4 Contractor's Signature Sworn to (or afiir d) d subscribed before me this ci l day of&W-2018. B LW Y Personally know Or Produced Identification Type of Identification Produced: Driver's License t, Type or stamp Name of Notary +v'il I�Ygfiro TAMMY GRIFFIN +� MY COMMISSION # Fr' 936284 o EXPIRES: December 10, 2019 'q0 AIL Randed Thru Notary PubPk Underwriters Notice to Owner -- Workers' Corn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 on Insurance Exemption Florida 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 (LL,C) in the construction industry may elect to be exempt if: 1. 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 fled or the exemption is revoked by the Division. Your contractor is requesting a permit tinder 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' compens surance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING ELOW COU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. k,a n Signature: _ l ,< C) nrr State of Florida iV County of .1 ianii-Dade The foregoing was acknowledge before me this ,,....___ day of_�.._. , 20_.11.._• By....... who is personally known to m r has produced as identification. N* t.."Um f ItATHERW RODMUEZ WCOt Ml$S10N It GG 1MM S&Ww Ttw t4owy Vubse Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-001495-2018 Permit Number: PLC-10-18-3228 Scheduled Inspection Date: November 08, 2018 Permit Type: Plumbing - Commercial Inspector: Massanet, Maykel Inspection Type: Plumbing Rough -In Owner: MSVC LLC Work Classification: Alteration Address: 9440 NE 2 AVE Phone Number: Miami Shores, FL 331380000 Parcel Number: 1132060132780-40 Project: Contractor: PHOENIX PROFESSIONAL GROUP INC Phone Number: 9546956491 ARLENE P WILSON Building Department Comments ADDING IN GREASE TRAPS, PLUMBING. FOR HANDWASH SINK. THREE COMPARTMENT SINK FKIIR TRAINS, ICE BIN. Checklist Item Passed Comments General Comments False Need DERM approval 3 inch for mop sink Inspector Comments Passed a Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 07, 2018 For Inspections please call: 305-762-4949 Page 9 of 38 HYDROMECHANICAL FOG CONTROL DEVICE (H-FCD) INSTALLATION INSPECTION' MIAMI-DIADE MIAMI-DADE COUNTY RER-DERM FOG CONTROL PROGRAM TO BE FILLED OUT BY THE APPLICANT Building Permit No.:CC_.5— 16 _ tq8 DERM Process Site Address: l q o n,— l I /G City/Zip Code: Folio: �— d I Contact Person: I1 1 Z `.G Title: Ph 186 f Email: FOR RER-DERM USE ONLY Date: / I P 00(8 Time: to,, 50 DERM Inspector: Nelson Martinez Ph: 305-372-6455 Email: Nelson. Martinez2@miamidade.gov DERM Supervisor: Laura Castillo Ph: 305-372-6443 Email: Laura.Castillo@miarHdadeWgov INFORMATION FROM APPROVED PLANS Number of FCDs : #1 #2 #3 #4• #5 Manufacturer: o�G2- Third Party Certifier:�i Model #: �q( —�. Ga— Capacity (5pm)5 -Lbs. of Grease Retention 99% removal efficiency: ( 00 Monitoring Alaem System: Solids Separator: ' MDC Code, Section 24-42.6(7)(ii) ON -SITE INSPECTION CHECK LIST GDO- # ITEM Yes No � No.Applicable 1 Are plans available on site with DERM approved stamp El ARE THE FOLLOWING PER APPROVED PLANS? 2 FCD location ❑ 3 Identification of the FCD visible EV, ❑ 4 Installation of the FCD (inlet/outlet) ❑ 5 FCD type 6 FCD size (gprri) - 1 El 1 FCD lbs. of grease retention 8 FCD accessibility ❑ 9 Sampling point installation El 10 Sampling point accessibility ❑ 11 Monitoring alarm system Ey Rf ❑ 12 Solids separator installation 11 El / 14 Inspection outcome2 - PASS: FAIL: ❑ . INSPECTION NOTES z If the inspection results show that the FOG Control Device (FCD) is not what was approved on plans, the applicant would have three options: a) Revise the plans to show alternative FCD, which would need to be approved by DERM and Plumbing; b) Obtain a letter from DERM Water & Wastewater Section Manager that the alternative is acceptable, which can be submitted to the inspector or supervisor for approval and documented with the permit records, or c) Replace the FCD to match the one on the approved plans. FOG CONTROL DEVICE (FCD) INSTALLATION INSPECTION MIAM ma DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Division of Environmental Resources Management (DERM) Water and Wastewater Section 1 701 NW 1 st Court ■ Miami, FL 33136 APPROVED FOR SHELL ONLY Future Buildout / Tenant shall comply with FOG 2.0. (Section 24.42.6 County Code).