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PL-18-1263 (2)hs L Miami Shores VillageSgOR 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 FLORiDA Permit NO. PL-5-18-1263 Pe01 ON Permit Type: Plumbing - Residential nni't Work Classification: Addition/Alteration Permit 5tatus: APPROVED Issue Date: 5/2912018 1 Expiration: 11/2512018 Project Address Parcel Number Applicant 240 NE 97 Street 1132060134020 PROPERTY ACES LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell PROPERTY ACES LLC 240 NE 97 Street MIAMI SHORES FL 33138- 240 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone NORTHWEST PLUMBING INC (786)586-5203 (305)986-1157 Type of Work: NEW SHOWER VALVE ON MASTER BATH AND Type of Piping: NEW SHOWER VALVE ON MASTER BATH AND Additional Info: NEW SHOWER VALVE ON MASTER BATH AND Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF 1.20 DBPR Fee 2.25 DCA Fee 2.00 Education Surcharge 0.40 Permit Fee 150.00 Scanning Fee 3.00 Technology Fee 1.60 Total: 160.45 Valuation: $ 2,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-5-18-67512 05/14/2018 Credit Card $ 50.00 $ 110.45 05/29/2018 Credit Card $ 110.45 $ 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 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fu erm 1 autho a the above -named contractor to do the work stated. May 29, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 29, 2018 1 n 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 BUILDING ELECTRIC ROOFING Ft RECEIVEC F B C 201 Master Permit No. 9C `A - IQ8 - t t 22 Sub Permit No. 1 18 — t Z(P 3 REVISION EXTENSION RENEWAL XPLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP 1 c77 CONTRACTOR DRAWINGS JOB ADDRESS: 2 1d o ! `r q ?yi City: Miami Shores County: Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholde Sw '?2 Construction Type: Flood Zone 17 r BFE: FFE: Rig -9616 City:- 1 1, Gr'C'JT r Tenant/Lessee Name: _Phi n`e# '- *'— Email- i 111 G 2S (D YIEn WC©n r'V!/fl . Cow , CONTRACTOR: Company Name: Nbt y/Jt `W(A(0 \—/l, Phone#: O , ' 6'rr) /+ _ . r n r Address: 0i vt City: 'J State: FL Zip: Qualifier Name: _L( 2 i hone#: State Certification or Registration #: C1 G 142 4_I % 4 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Zi &V - Square/Linear Footage of Work: Type of Work: Addition Alteration New Repair/Replace Demolition Description of VV6rk: V4rk/ 0945~ PA+s r Aq ))Cl AM Z -4 PI?f Nam+ Sz-,,C a r Z' — 'u- ,rs k. Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $ n CO/CC $ Radon Fee $ D B P R $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ r i4c3 Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) f ' Mortgage Lender's Address 1 City State Zip t 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 air work,wli.`be.•perfe-med'0p. meet the standards of -all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOL, -- 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 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 im pectior , which. orrurs seven_,(7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appro d and a reinspection fee will be charged Signature Signature or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of 120 113 by i!iflo g Vl. L7j st 11who is personally known to me or who has produced Mlt C_t-f+ as identification and who did take an oath. NOTARY P C. r+" No is State ot xt a Sign: r __ mABaaioR9(t839dfi'' F Print: The foregoing instrument was acknowledged before me this day of _ 20 18 by r v- Jam- who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUB Nota o kMa sHV Fe M 3768 Sign: - ,a P Print:`' Seal: Seal: APPROVED BY 5-41Plans Examiner Zoning Structural Review Clerk Revised02/ 24/2014) Accwa CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/11/2018 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 endorsement(s). PRODUCER CONTACT Sarai MedinaNAME: PHONE . (305) 693-0003 aC No): (305) 691-4381EmmanuelInsurance & Associates, Inc. E-MAIL Joel@emmanuelinsurance.comADDRESS: 2370 E 8TH AVE INSURERS AFFORDING COVERAGE NAIC # INSURER A: Wesco Insurance CompanyHIALEAHFL33013-4236 INSURED INSURER B : Associated Industries Insurance Company, Inc. INSURER C : NORTHWEST PLUMBING, INC. INSURER D : EDUARDO SABINA INSURER E : 9450 Caribbean Blvd INSURER F : Cutler Bay FL 33189-1514 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. INSRLTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADErx] OCCUR WPP148089101 07/22/2017 07/22/2018 EACH OCCURRENCE 1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence 50,000.00 MED EXP (Any one person) 5,000.00 PERSONAL & ADV INJURY 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X PRO LOCJECT OTHER: I GENERAL AGGREGATE 2,000,000.00 PRODUCTS-COMP/OPAGG 2,000,000.00POLICY AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCEHCLAIMS-MADE AGGREGATE DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A AWC1106140 05/10/2018 05/10/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000.00 E.L. DISEASE - EA EMPLOYEE 1,000,000.00 E.L. DISEASE - POLICY LIMIT 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COMMERCIAL & RESIDENTIAL PLUMBING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION Miami Shore Village Building Department 10050 NE 2 Ave Miami Shore Village FI 33184 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD