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PL-18-1019Permit NG PL-4-18A 019 !OR€,s LMiami Shores Village Permit Type: Plumbing - Residential 00 ON 10050 N.E. 2nd Avenue NE I Work Classification: Addition/Alteration Miami Shores, FL 33138-0000 P r Permit Status: APPROVED Phone: (305)795-2204 - �CORiDA Issue Date:412612018 1 Expiration: 10/23/2018 Project Address Parcel Number Applicant 133 NE 100 Street 1132060132050 Miami Shores, FL Block: Lot: ROBERT STOUT Owner Information Address Phone Cell ROBERT STOUT 133 NE 100 Street (954)789-4173 MIAMI SHORES FL 33138- 133 NE 100 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone PROFESSIONAL PLUMBING CORP (305)822-8282 Type of Work: PLUMBING FOR INT RENOVATION Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $3.00 DBPR Fee $3.38 DCA Fee $2.25 Education Surcharge $1.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $241.63 Valuation: $ 5,000.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due Invoice # PL-4-18-67203 04/26/2018 Credit Card $ 241.63 $ 0.00 Avauaoie 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 assum •respon ' ility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PL MBING, ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I f e fy pat al t oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin ut r r thorize the above -named contractor to do the work stated. April 26. 2018 Authorized Sig to wne / Applicant / Contractor / Agent a m nt Copy Building De 1 Miami Shores Village RECE�,. Building Department A R 1 7 of 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BYL INSPECTION LINE PHONE NUMBER: (305) 762-4949 11 FBC 20 I�rev BUILDING Master Permit No. — 0 r. PERMIT APPLICATION Sub Permit No! -�—' (8" 10 () ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [,PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I -� 1" 0 D STV ' City: Miami Shores County: Miami Dade Zip: �� I Folio/Parcel#: 2 O(o . CA5 • Za Y-0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ag* �kAA S-rW-)" Phone#: 1 SL4• 799 • `1 t7 Address: 1 13 ►V E LO O S I �— City: VA( &v-% i S AVAAKiS State: T:11_ Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: PI'etisj ana 1 Plum 6'a fie 4D .QPhone#: Address: I Z. .5- LQ 3 01 f 4- City: 1' 1 0. � State: Zip: fj3 G `Z Qualifier Name: M c1 n. oq V rZ . A to nso Phone#: � q 6 b State Certification or Registration #: GfjL**—' OSOS(mO Certificate of Competency #: DESIGNER: ngineer: P j-:: pr �O�C j& ML— Phone#: 3yS rchite JUM Address: 3 l� L �- �-\\ City: �' State: fit-- Zip: 33 l Value of Work for this Permit: $ W Square/Linear Footage of Work: Type of Work: ❑ Addition 1�1 Alteration ❑ New n� �❑ Repair/Replace ❑ Demolition Description of Work:-Z'Z-0 r A0' Uv G Specify color of color. / Submittal Fee $ Permit Fee $ garCCF $ CO/CC $ Scanning Fee $ Radon Fee $ Q ' :) DBPR $ Notary $ Technology Fee $_ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ a L4I ' �3 (Revised02/24/2014) IC-1 y, r-* %'.I 1 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 occur seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved an; reirAspection fee will be charged. 4, Signature_ ER or The foregoing instrumentVas acknowledged before me this —210 day of 201 �D_, by J V ha is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing.instrument was acknowledged before me this _ day of _t !j4 20 by &f� who is personally known to me or who has produced identification and who -did take an oath. NOTARY BUBLIC: Sig Sign: Print: MY COMMISSION#GG044602 Print: EXPIRES: November 2, 20 s Seal: "'.;Fo;;to" Bonded Thru Notary Public Underwriters Seal: STATE OF FLORIpq CMVTW GG046721 t Expires 11/13/2020 APPROVED BY —( as Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. 1z COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: P102 �eSSj 0Z7 nZ 6&& BUSINESS ADDRESS: % s,- CA) ."g eZ CITY 9 / STATE FG ZIP eT6 IoL BUSINESS PHONE: ( 1705- ) Lq44 9Z4Z FAX NUMBER 0 ? CELL PHONE ( ) ? 1I 6 �o cl �� QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: G �G D j-*-O S 60 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - CONSTRUCTION INDUSTRY LICENSING BOARD tiQ we 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ALONSO, MANUEL R PROFESSIONAL PLUMBING CORP 5305 SW 186 AVE SOUTHWEST RANCHES FL 33332 Congratulations! With this license you become one of the nearly�-- one million Floridians licensed by the Department of Business and I Professional Regulation, Our professionals and businesses range 4 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. 1 ON) Every day we work to improve the way we do business in order 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 mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT'OF BUSINESS AND yy PROFESSION kCREGULATION t t r I CFC050560 CERTIFIED ALONSO, N PROFESSII G '1618UEt)%1.07/24/2016 J(My1B1NG'GON'Ef� `CTOR � � r��►!Jr•nN �r^ IS CERTIFIED under the.provisions of Ch.489 FS. u Expiration dale +AUG 31, 2018 _ _ L160724000i792 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC050560 + f , The PLUMBING CONTRACTOR Named below IS CERTIFIED Under'the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 ALONSO, MANUEL R PROFESSIONAL PLUMP , ;'GORP 1755 W 39 PL _ -HIALEAH _ _ t ; _lei-- ', � •:3•• �� ... if. k ` ISSUED: 07/24/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607240001792 000179 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO -NOT PAY 451666 BUSINESS NAMEILOCATION PROFESSIONAL PLUMBING CORP 1755 W 39 PL HIALEAH FL 33012 I� RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2018 451666 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 V OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED PROFESSIONALIkUMBING'CORP 196 PLUMBING CONTRACTOR BY TAX COLLECTOR CFC050560 $105.00.07/28/20.1.7. Worker(s) 30 CHECK21-17-073631 This Local Business Tex Receipt only confirms payment of the Local Business Tex, The Rocelpt is not a license, permiontal regulatory laws and requirements tgovernmenqualifications, lwhich apply to heo do business. lbus busder must iness, with any governmental nongovernmental The RECEIPT NO, above must be displayed on all commercial vehicles -Miami -Beds Code See 0n-270. For more Information, visit vvww mlemidade aovhexoollsotor MARTON f7:te]JUMIE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDmYY)03/19/2018 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(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 Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT Teresa Garrido NAME: PHHc No, Et): (305) 822-7800 ac, No :(305) 362-2443 - AEDDRMAILEs : tgarrido@caffllc.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Gemini Insurance Company 10833 INSURED INSURER B :Old Republic General Insurance Corp24139 INSURER C: AGCS Marine Insurance CO 22837 Professional Plumbing Corp INSURER D : 1755 W. 39 Place Hialeah, FL 33012 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 INSD SUBR D POLICY NUMBER POLICY EFF / D POLICY EXP MMID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR NGP001384 12/12/2017 12/12/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREM SES Ea occ rr n 100,000 $ MED EXP (Any oneperson) $ Excluded GEN'L PERSONAL 8 ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY F—x1 PEn LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITYCOMBINED X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A4CA11621700 12/12/2017 12/12/2018 SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per erson $ BODILY INJURY Per accident $ PerOaccidentDAMAGE $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU011535420 12/12/2017 12/12/2018 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ (Mandatory in NHR EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N / A A4CW11621701 12/12/2017 12/12/2018 PER X STATUTE I ERH E.L. EACH ACCIDENT 1 ,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 11000,000 C Installation Floater MX193079409 12/12/2017 12/12/2018 Lmt at any one locat 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FL Certified Plumbing Contractor CFC050560 I1�:[tlM�]a:l Miami Shores Village Bldg Dept 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 4-1— ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD