PL-17-1556 (2)yF�P
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PL-6-17-1656
Pennit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Pe►mit Status: APPROVED
Issue Dow- W16/2017 ' Expiration: 12/13/2017
Project Address Parcel Number Applicant
10125 BISCAYNE Boulevard 1132050190190
BISCAYNE 10125 LLC
Miami Shores, FL 33138-2647 Block: Lot:
Owner Information Address Phone c;en
BISCAYNE 10125 LLC 10125 BISCAYNE Boulevard (786)390-3177
MIAMI SHORES FL 33138-
10125 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
DIAL PLUMBING CORP (305)221-8569 (786)412-6720
Type of Work: ONE MASTER BATHROOM AND ONE HALF BA
Type of Piping:
Additional Info: ONE MASTER BATHROOM AND ONE HALF BA
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.80
DBPR Fee
$3.38
DCA Fee
$3.38
Education Surcharge
$0.60
Permit Fee
$225.00
Scanning Fee
$3.00
Technology Fee
$2.40
Total:
$239.56
ValLSq
$ 2,550.00
Toteet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-6-17-64290
06/12/2017 Credit Card $ 50.00 $ 189.56
06/16/2017 Credit Card $ 189.56 $ 0.00
Avauame ins
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 the fore ping information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authArize above -named contractor to do the work stated.
Authorized Signature: Own / '76—prl6ant
Building Department Copy
June 16. 2017
June 16, 2017
/ Contractor / Agent
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 10 `2-5 (�t5(A`; �E I lLVi)
UN 12.2017
FBC 20 kt,-�
Permit No. P t ( a - Lrj.s�p
Master Permit No. 1 c - 3 -1
City: Miami Shores County: Miami Dade Zip: 33 13 $
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 3 SC AY Yl e 1 O 125 U-C. Phone#:
Address: l% i;Q Jl,(iC6i oAkl ave <Ilu IA e G 1 U
City: hAi i /_�ea Cal State: FL Zip: :5 3 , 3�
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
Address:
City:
Quali
v
State Certification or Registration #: (SQL4 2g 12:0 9 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer:
Phone#:
3a5 - --1�1 S - 03clo
Value of Work for this Permit: $ Z 5'50 ' 00 Square/Linear Footage of Work:
Type of Work: ❑Address 81Alteration ❑New ❑Repair/.Replace ❑Demolition
Descrip'tion•of Work: - �(Q �[try dvvl Gtl,(C4._... Y Yam' �"A
�.. _ h..l.
Submittal Fee $ Permit Fee CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ ( ` f--G
Bonding Company's Name (if applicable)
Bonding Company's Address
City
rff
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 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comment nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit i sued. x1n the abs n e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. I
h�
Signature Signature
Own or Age Contractor
The foregoing instrument was acknowledged before me this IF The foregoing instrument was acknowledged before this �5
day of 5,)•n e , 20 (4_, by C(_A,)D' o day of 1�9 �'1 , 20 f7, byf-ra ncc SC-*P,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Si .
Print: 6 6e�17 t ,� k! --i Lisbetll LW Rmeitel Print:��'%�� / � L C L=f � P-6
M Commission Ex fires: _ a►. COMMISSION IFf9?2657' M Commis n PATRICIA ELENA CEPERO
Y P = EXPIRES: Septsmbar 30.2ots YP.
�; Notary Public -State of Florida
`�� www.AARONNOTARY.COM .: Commission *FF942477
My Commission Expires
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
DAT! (MMIDDrMY)
�co 04' CERTIFICATE OF LIABILITY ONFEsNSURA INSURANCE N THE CERTIFICATE 6/HOL15120 His
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN
CERTIFICATE I$ OERTNO A AFFIRMATIVELY
FIRMATIIE OF URANCE DOES NOTIVELCONSTITUTE A CONTRACT BETWEEN THAMEND, EXTEND OR ALTER THE E ISSUING NSURER(S), AUTHORIZED
BELOW.
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. if SUBROGATUR IS
IMPORTANT: H the Csrgficslte holder la an ADDi kON�AmaIyNS�RE�.athe nd ilorsemellt AA statement own this certificate does not coonfeWAIVED,
rights to the
#warrtiHrato holder in Ie terms and hiou of such ns of the policy,
donsemelrt(s r
..r..rG �ler1A1
PItODUCeR
MUTUAL INTEREST ASSURANCE
1295 CORAL WAY
SUITE 3
MIAMI, FL 33145
w1suf0 DIAL PLUMBING CORP
9940 SW 22ND STREET
ADDRESS
MIAMI, FL 33165
DVERAGES CERTIFICATE NUMBER:
THIS
IS TO
D.CNOTVNTH TS ANDING ANYIREQUIR REOF QUIREMENT, TERM OR CONDITION OFANCE LIE"; tED BELOW HAVEBANY CONTEN RACT OR OTHER DOCD TFIHE INSURED NUMENT WITH RESPECT TOLWHICHTIHIS
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 SHOVMI MAY HAVE BEEN REDUCED Y PAID CLAIMS. LIMITS
assatAL LIAe1LrrY
MERCIAL GENERAL LIABILITY
CLAIMS -MADE E OCCUR
LIMIT APPLIES PER:
AUTOMOMILG LIAYILRY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
UINRELLALIAa ]��
w"MaLIAs ADE
DED RETENTION S
A Y1pRKlRSCp1MiNSATN7N
AND MNWYSW LIANUTY
ANY PROPRIETORIPARTNERIEXECUTWE Y l N �NIA
OFFICERIMEM13ER EXCLUDED? a
fMandat0fr In NN)
TWC3609013 11 /27/2017 11 /27/2018
OMMPTM OF
OM
AIMS / LOCA11ONS J VENICLiS Wheh ACORD 101, Addoonel Remnke Sehedule, if more ""0 to nquireM
PLUMBING CONTRACTOR LIC# CFC 1429207
pgEMIaES tEp ocWrrenml
MED EXP(Ar1Y one PersoJAGG
PERSONAL6ADVINJUGENERAL AGGREGATEPRODUCTS-COMPIOP
yt-a al'aeerm__
BODILY INJURY (Per Panora) f
BODILY INJURY (Per OCCOKM f
�R07SER DA GE f
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE VVILL BE DELIVERED IN
VILLAGE OF MIAMI SHORES
ACCORDANCE MATH THE POLICY PROVISIONS.
10050 NE 2ND AVE
MIAMI SHORES, FL. 33138 AUTNORIziDRiPRESiNTAIM
0188E-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010M5) The ACORD name and logo are registered marks of ACORD