PL-18-2234y��
Miami Shores Village
�sr+ORES
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
�'toRroA
Permit NO. PL-8-18-2234
Permit Type: Plumbing - Residential
Work Classification: AdditionlAlteration
Pen ot Permit Status: APPROVED
Issue Bate: 8/27/2018 1 Expiration: 02123/2019
Project Address Parcel Number Applicant
289 NE 104 Street 1121360130610
GOODNIGHT MIAMI LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
GOODNIGHT MIAMI LLC 289 NE 104 Street (305)898-9085
MIAMI SHORES FL 33138-2015
289 NE 104 Street
MIAMI SHORES FL 33138-2015
Contractor(s) Phone Cell Phone
MICHELINE DIONNE (954)520-5693
Type of Work: REMODEL MASTER BATHROOM, INSTALL S
Type of Piping:
Additional Info: REMODEL MASTER BATHROOM, INSTALL S
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$3.75
DCA Fee
$2.50
Education Surcharge
$0.20
Permit Fee
$250.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$260.85
Valuation: $ 1,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-18-68629
08/27/2018 Credit Card $ 210.85 $ 50.00
08/21/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground �J�
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: rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni hermor, I authorize the ab -named contra for to do the work stated.
/1p ��yj� August 27, 2018
Authorized i ature: Owner / Appli ant / Contractor / Agent Date
Building Department Copy
Miami Shores Village D )%A
Building Department 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 `1
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. Pary2c�
PERMIT APPLICATION Sub Permit No. PL I� - 22,3
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: _� C r o �SS �f -
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 Simple Titleholder): PC f L t 1G V z0 Si/"Ck Phone#:
Address:n,, �`( k) 1 D'T-
City: State: Zip: 31
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: %j?!�-� a ��, .y t�rc.>�,• Phone#: 45q .5'Z6 SGf
Address: 8 (7 ( N %0 .2A -6� C'=
City: State: zip: 3332-2-
Qualifier Name: 1{ /� G�C' ) i r►� rf ; p 0 . Phone#:
State Certification or Registration #: Certificate of Competency #: Ut C-61A VT Qi
DESIGNER: Architect/Engineer:
Address:
Phone#:
Zip:
Value of Work for this Permit: $ ZDGb Square/Linear Footage of Work:
Type of Work: ❑ Addition � Alteration El New ❑
New ❑ Repair/Re p Demolition
Description of Work: ALti.- f1�1.a.o-C��, /ja4-&'rn�
City:
Specify color of color thru tile:
Submittal Fee $ Skald Permit Fee $ d 'SO CCF $
Scanning Fee $ Radon Fee $ '-Z!- 1� DBPR $
Technology Fee $
Structural Reviews $
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ -z(y - WE
(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 reinspection fee will be charged.
Signature Signature r�%C��J� iCIGE
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
�Akl/\ day of k 20 PJ by
P GCS 938 l0 who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC-
Sign
Prin
Seal
The foregoing instrument was acknowledged before me this
—day of AI.A0CtS-� 20 /�' ,by
e l f n f &6,7,17 N , who is personally known to
m.e or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �✓
�-4�-
Seal: I .�
APPROVED BY y ^_ ;y/J �'9 Plans Examiner
Structural Review
ANNt i I E- ' - Pun11
State of Florida Notary
Commission # GG 203?es
My Comm�n3! 2022on p
as
*****************************
Zoning
Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2OAD
T8A01 BLAIRLLAHAASSEETONE FLL323MO783
pIONNE, MICHELINE
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STATE OF FLORIDA
DpgpSSEIONTOF BUSINESS NAL REGULATION D
CFC045967 "1'LgSUED 406242016
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CERTIFEO PLUhWAQ COWRACTOR
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DETACH HERE
KEN LAWSON. SECRETARY
RICK SCOTr. GOVERNOR
STATE OF FLOIOOA - --"--"
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BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave.. Rm. A-100. FI. Lauderdale, FL 33301-1895 - 95,"31-4000
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30.205518
D"MICHE-11:: ;:i _E R°G°tPia'`'LIIMpING%LMN 6PRHKL/fONTpP'^,.gyp Business Nam: Business Typs .PLUM6I NG COaiPI
Owner Nam: MICatLIME DIOMME Business Opened:'.1 /O1 /1987
Buci nest Location:B471 I4M 24 COURT StetNCounty/Cert/Rep:CFC045967
BUNRIBE Exemption Cod.:
Business Phone:954-S20-5693
Rooms a— faylrysse elecanrs orraessmw.
I
N.O. Ms/ailYww _ TM:
Te.Amwee Tester Fee Mi Pes Pew _...PrWr Yews Ca1Mpr C. TwwPstl-
27.00 0.00 0.00 2.70 0.00 0.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PEACE OF BUSINESS
THIS BECOMES A TAX RECEIPT TIPsa .1inied fur N,e prnasped` CmeA9anda
ran reguNlmy ti metre. Yau *,
WHEN VALIDATED and Lonelp te41wwrwrNs. Ties Be Mga 1MIMIened -lees
Ole Dlwbwq Y grid, auslarR (Ylla 1Mi es "41 II f sea male sis
Duswes 1o01s10rt. Ti" 1—sipt does nott NN1a1a tls11M0IMiMu M IpM a that
a is n omlp9wce e+On State a bcM MM aitdepwYgong.
MaiNna Address:
MICHELINE DIONNE Ree"Pt aa.Y-17-f "Sm
8471 NM 24 COURT seussO/os"MI M.70
SUNRISE, FL 33322
2017 - 2018
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, FL Lauderdale. FL 33301.1895 - 954-831-4000 -
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018
Racelpl a: 192-167 3
Business NOSA'.NICHELINE DIONNE Bus,
Type: YLVMgIM9/LYN 9M8KL/COMTRA''TeR
YLaNBlMO CCNTPI
Owner Narne:MICNELIME OtONHL Business Opened:."':/01/1981
BuslMss Locat10r1:8471 NM 24 COURI StatelCounty1Cgrl/Rey:':'."145981
SUNRISE Exemption Cods:
Business Phone: 954-520-5693
Regime aside Er owl'eee Muni,Ms Pkwens"
I
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N,en k M MsetelMs: PHor Y CeesesaN CaM low Pew
0.00
Te. Amount iraMNr F SK NaT Fes Reines1.--7
arestpt foL-LT-aspI1D04s
seed 30/0]/YOlT 4s.70
ACbR CERTIFICATE OF LIABILITY INSURANCE
D11TE (MMIDWYYY)
osMrrzol6
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 B an ADDITIONAL INSURED, the policy(iss) .imst be endorsed. ftSUBROGATION IS WAIVED, subjecttD
the teems and conditlons of the policy, certain policies may require an endorseneent A statement on this cerdficata does not confer rights to the
certificate holder in lieu of such endorseme a
PRODUCER
REEL INSURANCE AGENCY
DIB►X COVERALL INSURANCE
5600 W. ATLANTIC BLVD.
MARGATE FL 33063
CONTACT
PHONE 956.0006 FAX "6.0555
fair. an
- Md1nSUMn OO-COM
AFFORDING
NAIC E
INSUM A • CRUMI d FORSTER SPECIALTY INSURANCE CO.
44520
INSURED
MICHELINE DIONNE D1WA!
A-1 DEPENDABLE PLUMBING SERVICE, INC.
8471 NW 24TH CT
SUNRISE FL33322
INSURER 0: FRANK WINSTON CRUM INSURANCE COMPANY
11600
INSURER D:
I INSURER
CAVFRAIMES 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
LTRX
TYPE OF INSURANCE
L
UB
POLICY EFF
POLICY EXP
LIMITS
A
COMMERCIAL GENERAL LUMLTTY
I CLAIMS-MAm a OCCUR
BAK 235114
211412M8
2M4f2019
EACH OCCURRENCE
s 100 000
DAMAGE TO RENTED
a 1011po
TEED M one nron
5 000
PERSONAL a ADV INJURY
$11,01ANO
GOft AGGREGATE LUfT APPLIES PER:
POLICY � JECTT 7 LOC
GENERAL AGGREGATE
2 000
PRODUCTS - COMPRW AGG
s2MMO
a
A
AUTOMOBILE LIABLITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOSI NUTOS
AO OWNED
HIRED AUTOS H
HIRED AUTOS AUTOS
BI( t8j11_2
2H4016
2 I4019
COM IrI!M SINGLE LMIT
a 1 000
BODILY INJURY (Per person)
S
BODILY INJURY (Per ao iderd)
a
PROPERTY DAMAGE
a
a
UMBRELLA LIAR
EXCESSLIILB
OCCUR
I CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE
a
B
WORKERS COMPENSATION
AND EMPLOYERS' LABLITY YIN
IVE
OFFlCER1MENBER A ECUT r ' J
(Mandatary Ira NH)
r 0. desurbe R under P
NIA
FCWC70266901
5J15J2018
5M5ri2019
X PER OTH-
E.EACH ACGDEN7
L.E.L.
S1000000
DISEASE - EA EMPLOYEE
a 1000 000
E.L. DISEASE - POLICY LIMB
a 1 000 000
DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES WARD 101, AddlOenY Remarks Sdraduls, any be aftadred Or wlme apse* 7a requfreo
PLUMBING (COMMERCIAL& RESIDENTIAL)
CFC045987
Village of MMml Shores
10050 NE 2nl Avenue
Miami Shores FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N
ACCORpANCE WITH THE POLICY PROVISIONS.
All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD