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PL-16-3175r Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Perrrait NO. PL-11-16-3175 0 e t Permit Type. Plumbing - Residential Work Classification: Additlon/Alteration Permit Status: APPROVED Parcel Number Issue Date:1218t2016 1 Expiration: 06/06/2017 Applicant 1037 NE 91 Terrace 1132050010050 ALISON HARKE Miami Shores, FL Block: Lot: Owner Information Address Phone cell ALISON HARKE 1037 NE 91 TERR MIAMI SHORES FL 33138-3401 Contractor(s) Phone Cell Phone J C PLUMBING SERVICES INC 305-796-4663 (305)970-1612 of Work: NEW KITCHEN, NEW BATHROOM, WET BA of Piping: onal Info: NEW KITCHEN, NEW BATHROOM, WET BA Return : ,ification: Residential Scanning: 1 Fees Due Amount CCF $10.80 DBPR Fee $8.10 DCA Fee $8.10 Education Surcharge $3.60 Permit Fee $540.00 Scanning Fee $3.00 Technology Fee $14.40 Total: $588.00 Valuation: $ 18,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-11-16-62130 12/08/2016 Check #: 1605 $ 538.00 $ 50.00 11/21/2016 Credit Card $ 50.00 $ 0.00 Avaname inspections: Inspection Type: Top Out IReview Plumbing 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 fo going information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Future nze the above -named contractor to do the work stated. December 08, 2016 Author Sig�re:Owner / Applicant / Contractor / Agent Buil ing Department Copy December 08, 2016 1 Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING RECEIVED pPR 2'810b es� FBC 20NS�� Master Permit NA, I & 1 '-)-n Sub Permit No. � �O ^ 3 ( LJ ❑ REVISION ❑ EXTENSION ❑RENEWAL feuMBING ❑ MECHANICAL ❑PUBLIC WORKS OCHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / os 4 � C // T"eny_ 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):oAI, I !2nn A Phone#: A. Address: �� � a ���-t(� City: State: Zip: Tenant/Lessee Name: Email Phon CONTRACTOR: Company Name: *&&4 Se12kAe_03. 11-, C_ Phone#: Address: City: Al (a'"yl State: -P-, L Zip: 33l(O� Qualifier Name: r— n se, l fP,C�Veaj Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: �) City: State: Zip: Value of Work for this Permit: $`� a7J "� Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration" 5 _ _❑ New ❑ Repair/Replace , ❑ Demolition Description of Work: ki .2(�J UAA�1 2 Zvi ` Q�� �iVt `� G 2�y t_zAy.Q_ ► -leW )C Fi_ PA,• . QP.W F Irtccc tA vle_t arc `3r36 s(v►1� : �_Ww c atiJ�- Specify color o color thru tile: Submittal Fee Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ -:4S; 0 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 b approved and a r inspection fee will be charged. Signature Signature —.,�=Jk OWN AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of lh g rt" A , 20 / 7 by h 'At k4 , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Pri : I( t0(., Seal: ***************** APPROVED BY (Revised02/24/2014) as The foregoing instrument was acknowledged before me this Z� day of l� OYCk-1 20 � -T by �� \I f Yb �r� ,q wh/o iiis��personally known to me or who has produced q `QSZ i a9— 30 identification and who did take an oath. koroc NOTARY L � iCCr15�- Sign: h I� Print: �•r'-M.'i,; MAHARAI K. GCNZALEZ j° °� SANDI PENA Seal: +�'7 MY COMMISSION#GG044602 MY COMMISSION *FF163783 0:• EXPIRES: November2, 2020 -N ' ° F r ;nBonded Ttku Nota Public Underwriters EXPIRES September 28, 2018 P, ry (ao7 3960153 FloriclallotarvSerme.corn Plans Examiner Zoning Structural Review Clerk ACCORD® CERTIFICATE OF LIABILITY INSURANCE Ill DATE(MM/DD/YYYY) 04/6/2017 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 endorsement(s). PRODUCER CONTACT NAME: Tony CannlZZaro First Commercial Insurance Agency P.O. Box 295 AICNNo Eld : (386) 775-1781 A/C No): (386) 775-3666 E-MAIL nsurance u ADDRESS: ig y@Cfl.rr.COm INSURER(S) AFFORDING COVERAGE NAIC # Cassadaga FL 32706 INSURER A: CAPITOL SPECIALTY INSURANCE CO INSURED INSURERS: ASSOCIATED INDUSTRIES INSURANCE CO Yerbilla Services Inc INSURER C: 2423 SW 99th Place INSURER D: INSURER E : Miami FL 33165 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION Nt1MREIZ 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 S BR POLICY NUMBER MM DD/YYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 21 OCCUR PRIMARY NON CONTRIBUTOR EACH OCCURRENCE $ 1000000 PREMISES Ea occurrence) $ 100000 X MED EXP (Any one person) $ 5000 CIS 2037 PERSONAL &ADV INJURY $ 1000000 A X x X CS17002100-01 03/21/2017 03/21/2018 AGGREGATE LIMIT APPLIES PER: POLICY II PELT 171 LOC GENERAL AGGREGATE $ 2000000 GEN'L PRODUCTS - COMP/OP AGG $ 2000000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑Y (Mandatoryin NH) If yes, describe under N /A x AWC1079178 036/30/17 03/30/18 PER X STATUTE EORH E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYE $ 1000000 E.L. DISEASE - POLICY LIMIT 1 $ 1000000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED REGARDS THE GENERAL LIABILITY POLICY PLUMBING CONTRACTOR LIC # CFC1427286 l.Ar1it rLLA 1IUIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 ME 2nd Avenue Miami Shores, Florida 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): Phone #: Owner's Address: /m 3 :7- N4, mil 7 v/ cC— City: S- Job Address (Of where work is being done):_ City: Miami Shores State : Zip Code: -33 y383 State: —Florida Zip Code: Contractor's Company Name: \� 16'11-"174 � 6tr Phone #: -2746 Address: 0,0 2!f- - f-u e-<- City: 2 cu v °o State: -/�L Zip Code: , a i Qualifier's Name : `o /I Lic. Number: CFC i K24 Z 2 7 Architect/ Engineer of Record Name: Address: City: State: Phone #: Zip Code: Describe Work: }, w K= EAdUPSI , � w�.t�ry� r,Qek `i p. rt- kew CA-la4 Af A - hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold a Bu' ing Official and the Miami Shores harmless of all legal in of em n Signatur-signature 4ner or gent A c C tr r or hitect The foregoing instrument was aknowledged beforeme The foregoing instrument was a owledged before me thisZ3_ day of AAreA ,20/7,by d1, SOIt WA kC this .3 day of 2017 by Udg- Who is personally known to me or who has produced as indentification. Notary blic: Sign: ° , Seal: SANDI PENA '••.�'oF MY COMMISSION #FF163783 ner:' EXPIRES September 28, 2018 la27) 2!2 53 Floridallota Service.corn who is personally known to�e_or who has produced as indentification. Notary,Public: Sign: Seal: IV MARIA VELAZOUEZ MY COMMISSION #GG080751 , EXPIRES: MAR 14, 2021 °► Bonded through tst State Insurance Miami Shores Village -A `1"`" 1 .11 Building Department NOV 2�1 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �Y' Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 5_t�r l FBC201 T BUILDING -48 Permit No. �C lb — I� PERMIT APPLICATION Master Permit No. L 11-16 -- 3115 Permit Type: PLUMBING JOB ADDRESS: lO =5 T X�2 4:g� / 5± l C__ Q . City: Miami Shores County: Miami Dade Zip: 3 / Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):t Z o vl ✓ �p Phone#: Address: �F_ C% s� TL ✓ ✓t.�Cft . City: ' "1 j ea L4A e -c— State: 1— L Zip: 3 3 ► 3 $ Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: JC PLUMBING SERVICES, INC. Phone#: 305-970-1612 Address: 312 BOUGANVILLA TER. City: HOLLYWOOD State: FL Zip: 33019 Qualifier Name: JUANCARLOS LEON Phone#: 786-251-8027 State Certification or Registration #: CFC-1426227 Certificate of Competency #: Contact Phone#: 786-251-8027 Email Address: INFO@JCPLU M B I N GSERV. COM DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ _6E , O 0 IF3 Square/Linear Footage of Work: Type of Work: ❑Address - ❑Alteration ❑New ❑Repair/Replace ODemolition I\ e Submittal Fee $ r U Al Permit Fee $ d 7 �� � CCF $ a ® CO/CC $ __` 1 i Scanning Fee $ Radon Fee $ DEi'E $ -Bond $ --�' Notary $ Training/Education Fee $ —s . leachnology Fee $ ( L1 Llic) Double Fee $ Structural Review $ 0 TOTAL FEE NOW DUE $ 5 ' • —r V Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 0. 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 abse of such posted notice, the inspection wil t be approved and a reinspection fee will be charged. Signature Signature d I Owner or Ag nt Contracto pp The foregoing "in _sttrument was acknowledged before me this � The foregoing instrument was ackno ledg d before me this d day of 4201(2, by �. S a /1 H� / Kt day of oveiti, r!ier 20 /4 , byastca who is personally known to me r who has produced whonally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: Print: My Commission Expire = • *):i SAND' PENA MY COMMISSION °' r �'°6 SSION #EE874505 My C si8l f% `' #FF163783 a PIKES: MAR 14, 2017 ` September 18 Bonded through 1st State Insurance 99"153 ryrvEXPIRES e2.8co, m20 S(407) FloridaNta ********************************* ***************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)