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MC-19-696Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 04/10/2019 Location Address Parcel Number 431 NE 100TH ST, Miami Shores, FL 33138 1132060170500 Contacts Permit NO.: NIC -04-19-696 Permit Type: Mechanical - Residential Work Classification: Alteration Permit status: Approved Expiration: 10/07/2019 ERIN HALLORAN Owner MIAMI MECHANICAL CONTRACTORS INC Contractor 451 NE 91 ST, MIAMI SHORES, FL 33138 JOSE F BATISTA Other: 3522623193 5005 COLLINS AVE #1018, MIAMI BEACH, FL 33140 Business: 7864024457 Description: INTERIOR RENOVATION OF KITCUEN AND Valuation: $ 1,500.00 Inspection Requests: INTERIOR WALLS, BATHROOM AND INTERIOR WALLS 3fJ5 76-4449MODIFICATION OF EXTERIOR OPENING AND MASTER Total 5q Feet: 500.00 BATHROOM ADDITION (WITHIN EXISTING FOOTPRINT OF HOUSE Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $166.10 Payments Date Paid Amt Paid Total Fees $166.10 Credit Card 04/10/2019 $116.10 Credit Card 04/01/2019 $50.00 Amount Due: $0.00 Building Department Copy 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 regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date April 10, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION 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 RECEIVED APR 01 101y FBC 2011 � Master Permit No. '_3 S Sub Permit No. Mcy _� q 18 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑PLUMBING aMECHANICAL E] PUBLIC WORKS ❑ CHANGE OF CONTRACTOR ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: q S I N Y I oPh Styr P Citv: Miami Shores County: Miami Dade Zip: 331,39 13 Q Folio/Parcel#: Is the Building Historically Designated: Yes NO X_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Er (Y1 VA ,�k I I pro r) Phone#: 3 S-42, 0 (0 -31 Address: 931 NE I DI DD!g S+. O City: Mi ckf& S harQS State: �L Zip: S 313 (� Tenant/Lessee Name: ,` i Phone#: Email: Ha I I Olr�: n_ )Ft- j nQ:Q jat 1• c OY•V� CONTRACTOR: Company Name: W c ,,". If `'l tc.66 ,,� cwl (CJw"k-T Phone#:1'7 1'4) 4 0Z -4 i s7 Address: ?(.eV N� SSr� Mi�4ri+i FL 33111 City: War -1 State: zip: 7317:1 Qualifier Name: CyrL 1� `a► ->I�rk r� Phone#: \-7 r&"1 �Z-` -A" State Certification or Registration #: Certificate of Competency #: ) 2P't o w 0-0-2-3 DESIGNER: Architect/Engineer: Phone#: Address: City:.s;t�#i?ka��,. Value of Work for this Permit: $1 5 00 00 Squarihin ar;Footage of Type of Work: ❑ Addition W --Alteration ❑ New tY %. ❑fR pair%F Description of Work: N 1 C 7 aa� r Specify color of color &u,;tiler s Submittal Fee $ :)— ="`, .=-Permit Fee $_. . -c+ • . r � ,.x�Cy.kbw.•3'��mad• .i Zip: ❑ Demolition L L4�)CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $, Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ T \�w TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City . State Zi 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 IMPROVEMENTSTO 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 L yll� OWNER or AGENT The foregoing instrument was acknowledged before me this 22—?'da'y% of I V O Ck 20 � by rtn who is personally known to me or who has produced %\JqY as �Nlllllilllll///// identific tion a who di ke an oath�a�!►�ppY P1t/Fr� ``. -k .��...... N TARY UBLIC• ; . �,H �S ?!, � : it Sign: S Print Signature CO TRACTOR The fgrj6going instru nt as ac owledged before me this AIA day of 20 L,�� by xo is personally known to �4 me or who has produced as identification and who did take an oath. NOTARY PU IC: Sign:�`� Print: Seal: v ,'''��y///�/ IIIf1N1�1 Seal: .'; PERLAM.GARCIA MY COMMISSION # 60142111 _•� pry EXPIRES: Janw y 7, 20222 �r�o►„ ..t 8wwW Thru Nfty PWM UN WON FWWWW APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) /A`C40RO® `...r.�--' CERTIFICATE OF LIABILITY INSURANCE DATE 9/20/19 3/29/2019 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 endomement(s). PRODUCER BATISTA INS INC. 4159 E. 4TH AVE HIALEAH, FL 33010 N ME: JOSt3 F. Batista , o, Ext): (305) 685-0524 (ac, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: UNDERWRITER OF LLOYDS OF LONDON INSURED MIAMI MECHANICAL CONTRACTORS INC. 5005 COLLINS AVE #1018 MIAMI BEACH, FL 33140 INSURER B: PROGRESSIVE INSURERC: INSURER D: INSURER E: Florida Citrus Business & Industries INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDNYYY) LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE = OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F-1PRO-LOC OTHER: JECT X X OONCO-5 09/19/2018 09/19/2019 EACH OCCURRENCE $ 1,000,000.00 PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL &ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS -COMPIOPAGG $1,000,000.00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 02885159-0 02/22/2019 02/22/2020 a acci ent) $ 1,000,000.00 BODILY INJURY (Per person) $ 10,000.00 BODILY INJURY (Per accident) $ (Per accident) $ UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDI RETENTION $ E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PROPRIETOREXCLUDED? ECUTIVE ❑ OFFICER/MEMBERANY (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 106-61359 03/20/2019 03/20/2020 X A LITE R E.L. EACH ACCIDENT $ 500,000.00 E.L. DISEASE - EA EMPLOYEE $ 500,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED CAC #12M000023 r`F:PTIF1rATF i4ni nFR CANCELLATION Miami Shores Building & Zoning g g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave, ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE �ese � �atrsta ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD