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PL-19-1443Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address a Issue Date:10/15/2019 Parcel Number 304 NE 105TH ST, Miami Shores, FL 33138 1121360130070 Contacts Permit NO.: PL-09-19-1443 Permit Type: Plumbing - Residential Work Classification: Pool - Private Permit Status: Approved Expiration:04/13/2020 ROCCO MARANDO Owner 304 NE 105 ST, MIAMI SHORES, FL 331382022 roccoml3@aol.com J & J DAVIS PLUMBING SERVICE INC Contractor JOHN WALLACE DAVIS 5101 SW 111 TER, DAVIE, FL 33328 Business: 9546806543 Mobile: 9544446795 Description: POOL PLUMBING Valuation: $ 3,500.00 Inspection Requests: Total Sq Feet: 450.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Plumbing - Pool - Residential $100.00 Scanning Fee $3.00 Technology Fee $3.75 Total: $163.95 Building Department Copy Payments Date Paid Amt Paid Total Fees $163.95 Credit Card 10/15/2019 $163.95 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. certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws zoning. Futh ore, uthorize the above named contractor to do the work stated. Authorized Signature: Owner Applicant / Contractor / Agent Date October 15, 2019 Page 2 of 2 Miami Shores Village r �tLl BUILDING Building Department JUN 24 201 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 2on Master Permit No.PC,-ao _� I �yy� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL j PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP TT``�� CONTRACTOR DRAWINGS JOB ADDRESS: 3 C)L I N E os'" S+ City: Miami Shores County: Miami Dade Zip: 33 )3FS Folio/Parcel#: — 00%0 Is the Building Historically Designated: Yes NO Occupancy Type:.Y_eS Load: Construction Type: Flood Zone: BFE: FFE: 2Q G OWNER: Name /(Fee Simple Titleholder): Phone#: 3C.L5'� J `� 1 Address:3oy City: m 1 a VA.I ill _ Stater— Zip: 331 i Tenant/Lessee Name: Phone#: Email: L)f m ) U 60 nU } 1. Coyn CONTRACTOR: Company Name: cT)ai1 S �I��mh�nG Phone#: 016C14M— 695(4J Address: 610 1p SW I I Ity) 11t�Y City: �.J-"y C_ State: R_ Zip: 3339-0 Qualifier Name: yV1 1 LL) L)MI) S Phone#: State Certification or Registration M Certificate of Competency #: DESIGNER: Architect/Engineer: I )QV ICI ! F(i'i?If' i1� i Phone#:5Q I" Lags— I Address: 2041 LQ 1 � o ldL -------City: &rll aState: L Zip: ab Cn Value of Work for this Permit: $�S �� Square/Linear Footage of Work: �1 t Type of Work: ❑ Addition ❑4,Alteratio i P(NJew _ ElRepair/Replace` ❑ Demolition Description of Work: Specify color of co or thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ k (0 3' G1 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 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 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 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 OWNER or AGENT The foregoing instrument was acknowledged before me this `1 day of n-'�L 20 (' by � CC) who is personally known to me or who has produced CL- \721 V EZ as Signature /5 /,�,; "V"A CONTRACTOR The /oregoing instrument was acknowledged before me this `,� day of Yl by 75�)r 1 \ ho is personally known me or who has produced as identification and who did take an oath. identification and who did take an oath. NOT7::2 NOTARY PUBLIC: \\\ 11111111////�� Si n: �J,��yFIRES ,�'0 g Sign: - Print: °- r �� 2 g' ae Print: _' h -i II �� Seal: �� :�� " Seal: ;p""" AMY ANOUS �i, °�;T No��:•°�V�� At MY COMMISSION #t FF937559 NOTARY \\\ W, ,, ' EXPIRES November 18. 2019 //IJi�IiI \ N07)398-0.53 FbrW&NowyS*rwA.00m APPROVED BY — %G Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY dblar 4 ows STATE OF FLORIDA DEPARTMENT OF BUSINE SJO-4W .ROFESSIONAL REGULATION CONST THE PLUMB[ PROV[S{ EXPIRA -1t71 A=0_00'T 31, 2020 Always verify licenses online at MyFloridaLicense.com BOARD UNDER THE I Do -not alter this document in any form. � I This is your license. It is unlawful -for anyone other than the licensee to use this document. I BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301-1895 — 954-831-4000 i VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA; ReCsipt#:PLUMBING/LWN SPRNKL/CONTRACTOR Business Name: J & J DAMS PLUMBING SERVICE INC Business Type: (PLUMBING CONTR) b Owner Name; JaxN w DAvxs Business Opened:05/03/2000 Business Location: 5101 SW 111 TERR State/County/Cert/Reg:CFC057602 DAVIE Exemption Code: Business Phone: 954-981-3666 I Rooms seats Employees Machines Professionals i - 10 For Vending Business Only Number of Machines: Vendina Tvice: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business Is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with 'State or local laws and regulations. Mailing Address. JOHN W DAVIS Receipt $SCP-17-00020405 5101 SW 111 TERR Paid 08/21/2018 27.00 DAVIE, FL 33328 2018 - 2019 J&JDAVI-01 ONAPOLE DATE(MMIDDIYYYY) 04/01/2019 .4C4:31IRO' CERTIFICATE OF LIABILITY INSURANCE `� 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 NAME: ac°°, No, Ext : (305) 822-7800 FAX Ne : 305) 362-2443 Collinsworth, Attar, Fowler &French, LLC 8000 Governors Square Blvd Suite 301 RMASS: Miami Lakes, FL 33016 INSURERS AFFORDING COVERAGE NAIL # INSURER A: Allied World Surplus Lines Ins Co INSURED INSURER B : National Union Fire Ins Co of Pittsburgh, PA INSURER C : Brid efield Employers Ins Co 10701 J & J Davis Plumbing Service, Inc. INSURER D : 5101 SW 111th Terrace Davie, FL 33328 INSURER E 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—X] OCCUR 50572988 09/14/2018 09/14/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREM DAMAGE Ea occurrence 50,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F—xl jp& LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 CONTRACTORS POL 1,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS O pyy p AUTOS ONLY AUTOS ONLY EOMBIcNEeDtSINGLELIMIT $ BODILY INJURY Per n $ BODILY INJURY Per accident $ PROPERTY AMAGE Per accident $ B UMBRELLA LWB EXCESS LIAB X OCCUR CLAIMS -MADE EBU067936636 09/14/2018 09/14/2019 EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIIET6OERRIPARTNER/EXECUTIVE Y� (Mandatory In NH) EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N / A 8306"30 04/0512019 04/05/2020 PTAT TE I I EOT RH E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMB 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Plumbing and Gas; CFC057602 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 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 ACORD 25 (2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD