PL-18-3436Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/17/2018
Location Address Parcel Number
361 NE 102ND ST, Miami Shores, FL 33138 1132060135090
'ontacts
Permit NO.: PL-11-18-3436
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 05/13/2019
ERIC BENSON Owner BATH FITTER Contractor
361 NE 102 ST, MIAMI SHROES, FL 331382428 ROBERT ANTHONY SHINSKY
Business: 7865178699
Description: TUB TO SHOWER CONVERSION WITH ACRYLIC Valuation: $ 6,090.56 Ins ection Requests:
LINING REPLACE VALVE WITH DELTA 1400 SERIES 3ii5 762 4949
Total Sq Feet: 15.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.20
DCA Fee
$2.13
Education Surcharge
$1.40
Permit Fee
$163.17
Scanning Fee
$9.00
Technology Fee
$5.33
Total:
$238.43
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$238.43
Credit Card
12/17/2018 $188.43
Credit Card
11/13/2018 $50.00
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 that all work will be done in compliance with all applicable laws
regulatinglconNruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
r
AutoAutoppifd Srgghature: Owner / Applicant / Contractor / Agent Date
December 17, 2018 Page 2 of 2
Miami Shores Village
201
Building Department °d _
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. �� -�4z
S
PERMIT APPLICATION Sub Permit No. tPLI� -643 6
❑ BUILDING ❑ ELECTRIC 7-ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: :5 (0 l Nt- d 0'z ST-V_C-C-1-
City: Miarni Shores County' Miami Dade Zip
Folio/Parcel#:"— 5 7-0�g>" D ('� " �j U 90 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 15'_1 (. p6w e3L NS0r%11 Phone#:
Address: ?J l0 NE to-L
City: State: Zip: 5!) 13E5
Tenant/Lessee Name:
Email
Phone#:
4fi r A � {
CONTRACTOR: Company Name: _ ►� \�' '� � -` i� { —, NOVA4AOW Phone#:
Address: _Ljslp 1`lW Z1.1 m T�(ZQ
City: nO'Q-CA State: mil. Zip:
Qualifier Name: i_oR,E2T 5ft� r,-C. " Phone#: 113(b 7,5 1-- 2GI 23
State Certification or Registration #: (:,fr_'j25U-9Rk>fh Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address
City:
Phone#:
State: Zip:
Value of Work for this Permit: $ (Dori 0 . SCO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ^ ❑ Demolition
Description of Work: TU 13 Oro
-1+'1 C V C4 I J V C W 'Vtt l rw- N no s E rL'1 C
Specify color of color thru tile:
Submittal Fee $ So ) Permit Fee $ 2(� �� CCF $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $ / f
TOTAL FEE NOW DUE $ 169 . 1 3
(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 wort: 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 .ki!l be done in cDmrliance 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 cr�
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
✓ 0 _ day of 0 _t 0'�., 20 by
9CGv1 'SUN , who i personally known to
me or who has produced as
The foregoing instrument was acknowledged before me this
30 day of 20 18 by
W who i to
me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: Co'�
R��lQ,►IdOSA NOTARY PUBLIC: ;:��°�i3®C9®®SA
§IQRP,GG013348 _� MY COMMISSION # GG013348 �Sd { 1 ; 2020
K?. W Y 9 !2020 /A� EXPIRES July 19,
Sign: �- -- Sign: —
Print: /hUGJ Print:
Seal
Seal:
APPROVED BY ��/L/ Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
V
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
Ti H E C N - P AC- T 0 P HERE;'' 15 C E R T 1 E'D L,%i'E-:E -7- F
,
PR 0 1 /1 '5: C N S C-) F C H A P R 48 9 0-4 E-TATI -S
Ll-
E
SHINSKY, ROBERT ANTHONY
8 'A 77H F IT 7 E
388 53 'v%" '-, 7 8 S I FEET
EL-v F i- 331.
5'7
LICENSE NUMBER: CFC054868
EXPIRATION DATE: AUGUST 31,2020
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - 00 NOT PAY
6312953
BUSINESS NAME/LOCATION RE PT NO. EXPIRE
MARTIN MARTIN RENOS
VATIO ENEWAL EXPIRES
2019
INC 6579321
8956 NW 24TH TER Must be displayed at place of business
DORAL, FL 33172 Pursuant to County Code
Chapter 8A - An. 9 & 10
OWNER SEC. TYPE OF BUSINESS
MARTIN MA RENOVATIONS INC 196 PLUMBING PAYMENT RECEIVED
BY TAX COLLECTOR
CONTRACTOR 4 • 07/05/2018
Wo (S) 1 CFC054868 CRED RD-18-049766
This Local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt is not a e,
Permit or a certification of the holders qualifications, to do business. Holder must comply with any goverome
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dada Code Sec Be-276.
MI � For more information, visit www.miamidade,gov/h■collector
2018 2O19 2019001797
LOCAL BUSINESS TAX RECEIPT
CITY OF DORAL, ,FLORIDA
8401 Northwest 53`d Terrace MACHINES:
Doral, Florida 33166 SEATS:
(305) 593-6631 STATE LIC.#:
2131NS INSTALLATION SERVICE (NON. CONTRACTOR) EMPLOYEES: 16
FOR THE PERIOD COMMENCING OCTOBER 1, 2018 LICENSE FEE: $78,00
AND ENDING SEPTEMBER 30,2019 LICENSE070
ENGAGE IN THE FOLLOWING 910SINESSi,
Business Name: MARTIN MAtTIN RENOVATIONS INC
De : BATH FITTER
8956 NW 24 TER
Address: DORAL, FL 33172
DBABATH FITTER, OFFICE AND STORAGE, NO RETAIL Chief Icensing _ ffici I
Conditions: SALES, NO OUTSIDE STORAGE OR DISPLAYS, DRY USE
ONLY.
8401 NW 53rd Terrace, Doral, Florida•33166-'W".CitVofdoral.com • 305-593-6631 Fax 305-593-6616
MARTIMAR17
® DATE (MMIDOIYYYY)
CERTIFICATE OF LIABILITY INSURANCE I
11/13/2018
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 endorsemen s).
PRODUCER FACT Gwenn Burrell
Commercial Lines - 800-868-8834 PHONE _.—:--- . -- -- -.
USI Insurance Services National, Inc. E-MM IL E"d 704-901-8630 Not 610-537 1902
ADDRESS: gwenn.burrell@usi.com
6100 Fairview Road --- ------ ---- - _
INSURERISI AFFORDING COVERAGE NAIC M
Charlotte, INC 28210-
INSURERA: Amerisure Insurance Company - 19488
INSURED ---------------- — ---
Martin Martin Renovations, Inc. d a Bath Fitter (ID472408)
8200 Unit G, Arrowridge Blvd.
INSUREREI: Amerisure Mutual Insurance Co. 23396
INSURERC: Bridgefield Casualty Insurance Co 10335
INSURER E :
Charlotte, NC 28273
INSURER F :
COVERAGES CFRTIFICOTF NI IRARFR• 13665050 RFVICInM Nl IMRFR- Apia halnw
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.
ILTR i TYPE Of INSURANCE DL B
POLICY NUMBER
POLICY EFF
MMIOOIYYYY
POLICY EXP
MMIDWYYY
_
LIMITS
X COMMERCIAL GENERAL LIABILITYEACH
A X CPP20563891001
I CLAIMS -MADE OCCUR
XI $3,000 PD Deductible
..-------ible ----
9/01/2018
9/01/2019
OCCURRENCE
DAMAGE TO RENTED
PREMISES(Ea occurrence) _
S 1,000,000
$ 300,000
MED EXP (Anyone person)
S 10,000
PERSONAL. & AOV INJURY
S 1,000,000
GEML AGGREGATE LIMIT APPLIES PER:
POLICY ! X I JJERT LOC
GENERAL AGGREGATE
S 2,000,000
_
PRODUCTS - COMPIO_ P AGG
S_ 2,000,000
_
S
OTHER:
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
Ea accident
S
_
BODILY INJURY (Per person)
S
OWNED S
AUTOS ONLY AUCHEDULEDTOS
BODILY INJURY (Per acr. denq
S
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
S
S
B X
UMBRELLAUAB X OCCUR CU20563881002
9/01/2018
9/01/2019
EACH OCCURRENCE
S 2,000,000
EXCESS LIAB CLAIMS -MADE,
AGGREGATE
S 2,000,000
S
OED RETENTIONS 01
C WORKERS COMPENSATION 0196 46111
. AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNERIEXECUTIVE
'OFFICERIMEMBER EXCLUDED? NIA
(Mandatory in NH)
`tl Yos, describe under
DESCRIPTION OF OPERATIONS below
5/18/2018
5/18/2019
X STRTUTE ERH
E.L. EACH ACCIDENT
_
S 1,000,000
E.L. DISEASE - EA EMPLOYEE
-
S 1,000.000
E L. DISEASE - POLICY LIMIT
S 1,000,000
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required)
Certificate Holder is an Additional Insured regarding their interest in the operations of the Named Insured, as it relates to the General Liability coverage in
accordance with the terms and conditions of the policy.
Plumbing Contractor
Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g p ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Ave
Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE
The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103)
(ra. wMft ampx o�nwat 133003641,..,,.e a tvnaore)