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PL-18-2240`yeo . cMiami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 aFN—d Phone: (305)795-2204 CORIDp` Permit NO. PL-8-18-2240 _01 No Permit Type: Plumbing - Residential Perin"It Work C►assfication: Add ition/Alteration Permit Status: APPROVED Issue Date: 812712018 1 Expiration: 02/23/2019 Project Address Parcel Number Applicant 366 NE 99 Street 1132060135560 ITAY BEN ZVI Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ITAY BEN ZVI 366 NE 99 Street (917)514-8517 FL 366 NE 99 Street FL Contractor(s) Phone Cell Phone EDWARD ROJAS PLUMBING CORP (305)944-6788 Type of Work: REPAIR 4 BATHROOMS. 12 FIXTURE UNIT Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $1.80 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $0.60 Permit Fee $250.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $264.05 Valuation: $ 3,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-8-18-68635 08/27/2018 Credit Card $ 214.05 $ 50.00 08/22/2018 Credit Card $ 50.00 $ 0.00 Avaname 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 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 t regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. yjhermauthorize the above -named contractor to do the work stated. August 27, 2018 AuSignature: Owner / Applicant / Contractor / Agent Date Building Department Copy August 27, 2018 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC 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: (30S) 762-4949 � -4 FBC 20 t�� Master Permit No. 1ZC( 9 — (ZOO Sub Permit No. ( Pi" 42-g6 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:y "1 5 City: Miami Shores County: Miami Dade Zip: 33m Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: C FIFE: X OWNER: Name (Fee Simple Titleholder): �U`� �� �ZV' Phone#: J " S j Address: & `ioy\, Sllwr e j � t City: - � 6 N ( Q q S4' � State: FL Zip: WIT Tenant/Lessee Name: Phone#: Email: b el N4 V ► a Vn CONTRACTOR: Company Name: Address: City: Ctual Stat( DESIGNER: Architect/Engineer: yv Phone#: _Zip: iJ #: I Phone#: Address: _ 019 City: State Value of Work for this Permit: $ 3 000 — Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Nf Repair/Replace Description of Work: R 1 i� /a %h 2 %/N � - Zip: ❑ Demolition r� . ' it n':r71, aP:� sP v,! f�1: �,�t„ • �W,•, P. Specify color of color+thra tile:' Submittal Fee $ Permit Fee $ J 5G � CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 �� DBPR $ 3. Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 'Zr I I ` , 0'; (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 I 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 ab�nte�of such posted notice, the inspection will not be approved and a reinspection fee will be charged. / 1 Signature Signature OWNER or AGENT -`CONTRAITC The foregoing instrument was acknowledged before a this The foregoing instrument was acknowledged before me this day of 20 ` by Z-7 day of 20 . by yswwh—,L personally known to tHiu wl QO\ who is personally known�o me or who A produced 1 1 ��� me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: identification and who did take an oath. NOTARY Sign:_ Print: MY COMMISSION # GG 044602 I Seal: EXPIRES: November 2, 2020 Bonded Thru Notary Public underwriters Commission N FF 235661 My Comm. Expires Sep 19, 2019 On indifroughNational Notary Assn. ************************************************************************************************************ APPROVED BY -+�—� e/J.; //,� Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 0812712018 12:34 (FA}) P.0011001 CERTIFICATE OF LIABILITY INSURANCE E DATE(MWDDNWY) 08/27/18 THIS CERTIFICATE 1S 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, tha pollo"es) must be endorsed. I! 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 certifkato holder In lieu of such endorsomont(s). PRODUCER Accurate NAME; l.ucla Estrella H NE ov (305)226-8727 8300 West Flegler Suite 114 M IL , FAx : (305)228-8787 accurate.oeNllcates®pmail.aom — Miami, FL 33144 INSURER(6) AFFORDING COVERAGE Phone (305) 2 "727 Fax (305) 226-8767 INSURED INSURER A : Arch Specialty insurance Company Edward Rojas Plumbing Corp 880 NE 111 St Biscayne Park, FL 33161- C COVERAGES w vwmm r c CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE Policy PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPFCT 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. LTR TYPE OF INSURANCE. ADDI, SUeR GENERAL LIABILITY POLI( ® COMMERCIAL GENERAL L41BILMY A C ❑ CWM84MDE © OCCUR GGL0003440 ❑ v N N ❑_.. GENLAGGREGATE LIMIT APPLIES PER: ® POLICY ❑ M ❑ LOC AUTOMOSILE LIABILITY ❑ ANY AUTO ❑ AUUTOLL SS � ANED CC SCHEDULED El HIRED HIRED AUTOS No gWNEO AUTOS UMBRELLA LIAR ❑ OCCUR -I ❑ EXCESS UAB ❑ CLAIMSAbE ❑ DE D R ION s WORKERS COMPENSATION AND IMPLOYERV LIABILITY YIN N ANY PROPMETOMPARTNER/EXECUTPA oFFICEWMEQ EXCLUDED? r� N / A 08/06/2016 108M&2019 MED EXP (Any one DIMWPJPTION OF OPERATfONS I LOCATIONS! VEHICLCS (Attsoh ACORD 101, Additional Rerrwke sehedule, If mwe apace I• r%Wred) CFC049431 CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 305-756.8972 CANCELLATION SHOULD ANY -OF THE EXPIRATION ACCQRDANCE W AUTHORED REPRBAI Lucia Estrella LINIIYS j82,000,000.C .000,00 0 0D,000.00 n,000.00 0$00,O01 ( s 2,000,000.0 a BODILY INJURY (Per parson) i 9013ILY INJURY (Par eoddenl S I -LERTY AMAO $ ddeMn S E.1.. EACH ACCIDENT • E.L DISEASE - EA EMPLOYE E.L. DISEASE - Prri I" i ruir e POLICIES BE CANCELLED BEFORE WILL BE DELIVERED IN ACORD 25 (2010105) QF 0198 - VO C RP RATION. All rights reserved, The AC a are registered marks of ACORD