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PL-17-724Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. PL-3-17-724 ! Permit Type: Plumbing - Residential rl�' Work Classification: Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 4/17/2017 1 Expiration: 10/14/2017 Applicant 43 NW 110 Street 1121360030610 Miami Shores, FL 33168-4318 Block: Lot: INTER MALL INC Owner Information INTER MALL INC 8260 SW 2 Street MIAMI FL 33144- 8260 SW 2 Street MIAMI FL 33144- Contractors) Phone Cell Phone JC PLUMBING SERVICES INC (305)970-1612 (786)251-8027 Type of Work: REPLACE EXISTING FIXTURES AND NEW W Type of Piping: Additional Info: REPLACE EXISTING FIXTURES AND NEW W Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $2.40 DBPR Fee $3.38 DCA Fee $3.38 Education Surcharge $0.80 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $241.16 Phone (786)231-7789 Valuation: $ 4,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-3-17-63347 04/17/2017 Credit Card $ 241.16 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing ��J� Underground In consideration of th issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permitLksume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELEQn LUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIrtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and M. I authorize the above -named contractor to do the work stated. April 17. 2017 Authori3 1 ' re: Owner / Applicant / Contractor / Agent Building Depa ment Copy April 17, 2017 1 97�A 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 MAR-1-6 2017 4- L FBC 2014 Permit No. PL Master Permit No. RC JOB ADDRESS: /-/3 /V U/ 110st City: Miami Shores County: Miami Dade Zip: 3.3/6,8 Folio/Parcel#: 11 - 2,13 6 -OQ3 - 12616 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): -TY)4ey AL 11 Tyle . Phone#: 7A- Address: `260 IPW Z f6e.d City: AACA4 State: F L Zip: 3 3/y Y 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@JCPLUMBINGSERV.COM DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ONew ❑Repair/Replace ❑Demolition Submittal Fee $ Permit Fee $ eC .2J -'- CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ DBPR $ Bond $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Z T I - / G 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 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 absence Of uch posted notice, the inspection will not be apprpi*,qnd a reinspection fee will be charged. (� Signature LY l z Signature Owner or Agent The foregoing instrument was acknowledged before me thiscx`1 140 day okbwa4l 20 -a, by ' CX -n Cre-S�o who is Personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was ackno led&d before me §1 1-' day of ��Z 20/�, by+�' who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign. Sign: Print: Print: My Commission Expires: JIICOUEUNE ;:r U MY COMMISSION a Pf �i ISo36 LM*---,8W4edThrUNotwyPd*0WVft, 1„pY PU My Commission Expire ?; °� 1. MY COMMISSION #EE874505 EXPIRES: MAR 14, 2017 EXPIRES: Septembers, 2019 '°Ou" Bonded throur?h 1st State Insurance APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 3/8/2017 roundcube (700x847) " CERTIFICATE OF LIABILITY INSURANCE �"��"°°""� ac� 03,fti?lZD17 THE CERTIFICATE IS ISSUE} AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES MDT 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_ I the certificate holder is an ADDITIONAL INSURED, the pulecy(ies) must be endorsed- If SUBROGATION IS WAIVED, subject to the terms and c one itiDns of the policy. certain paticies may rewire an endorsement A statement on this eertific rle does not confer rights to the certificate holder in lieu of such endorselaLw4si- PRODUCER Great Florida of Kendal 10471 N Kendal Or Suite B101 Miami. FL 33170 9C PLUMBING SERVICES INC 1800SOCEAN DRIVE #1407 ANAKAPJNA CVILLEJAS J —... (3051515-N13 IB881237-7027 WWAMR A- AMhk I mLmnm R - AM Tnist THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW1THSTANDtNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE ENSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SLMJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS. URR TYPEGFoolulU m POLICYMIf�t AOLI[.7E;f P�YOrt LANTS A oH®IALL.IABB.TTY MIBE9aX-1LflEfJEfflLLM2anY CLAMIG-MM E❑ 00CU R N N AGLOO133MM 05/20P2Ci16 05rMD17 EACH Ooars cE i 1.000.0DD_00 PREMEM pearrerCel $ 100.4XIMOO MEDEXPWWw 5.W0.00 FeFmc m-aAOV OwRkRY i 1.000.000.00 Gr3EWLA TE i 2.000.0DO.01) GiNtAGGREGMELSKrAFFLIESPOL POLICY PrrO- L. FRODUCM-CCkVMPAda 3 1.000.ODD.Od A4n'O01711LE LKE iTY AMY AUTO ILL CRVNM SCHEDMEO AUTOS AUrOB "ONO LrRED I•LIT'Oi& AURM C7ommmm 804GLE LILBT am" OW(LY N AT O'er Palm) BGOILY NARTi IPe[ ta[dtlefk$ S i i I-- EM*Za LM OCC%ii OL,Vst9•MME EACH 06ACE. i AGGFM ATE Imn RETBYT40N B '1MDWFAr iXI1N90ATrBr AND BRAY6a" LNBLITV YdN NIA Y AVIC1 03d03d2117 031€ =G16 VYCSTJATLY OTFF 1TCRYtJMrM ER ELEAMACODOff ; 1.000.0DODD ANY Lr�Eerykine D ATeV. die ruder DE9CRIJ-n0N.0FLi6MiiKM beNv F-LORSEASE-EA t 1. 0.t Bfl EL mBEASE - Poucr uwr -1,i1OD.Ot10_t10 m DEELRIPiIOI GF OFERATIMBILGCATe.Mi I VOWLES OAImftACOM M,AddbwAPAMmft Sabodift.ff off *ftv*QL License mxnber- CFC 142MU7 =:4L'2. I J. L • SHOULD ANY OF THE ABOVE DESCR>$ED POLXX3 BE r"+LI11 LE I ED BEFORE Miami Shores viilage THE 'DIPIRATLON DATE THEREOF. NOTICE VAALL. BE DELIVERED IN BtddeTg OepaTtrTlent ACCORDANCE WITH THE POLICY PROVISIOFLS. 10050 NE 2nd Ave AUTH0RIZMF03WV3FrATrJE Miami Shores Village, FL 33138 https://gator3l79.hostgator.com:2096/cpsess275269121213rdpartylroundcubef? task=mail& framed=1& acbon=get&- mbox=INBOX& uid=7055&aart=2&_fra.. 1/1