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PL-18-1692`yHOR, L,! Miami Shores Village 10050 N.E. 2nd Avenue NW �- ... Miami Shores, FL 33138-0000 Phone: (305)795-2204 �OR1Dp` Permit NO. PL-6-18-1692 Permit Type: Plumbing - Residential ri Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 7/6/2018 1 Expiration: 01/02/2019 Project Address Parcel Number Applicant 175 NW 100 Street 1131010230320 Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER Owner Information Address Phone Cell CHRISTIAN LANSER 175 NW 100 Street (305)772-4313 MIAMI SHORES FL 33150- 175 NW 100 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone SMART PLUMBING LLC (954)772-3446 Type of Work: MAKE NEW SANITARY AND ATER SUPPLY F Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $6.00 DBPR Fee $5.25 DCA Fee $3.50 Education Surcharge $2.00 Penalty Fee $0.00 Permit Fee $350.00 Scanning Fee $3.00 Technology Fee $8.00 Work without Permit Fee $0.00 Total: $377.75 Valuation: $ 10,000.00 Total Sq Feet: p Pair Date Pay Type Amt Paid Amt Due Invoice # PL-6-18-67993 06/20/2018 Check #: 1269 $ 50.00 $ 327.75 07/06/2018 Credit Card $ 327.75 $ 0.00 AVallaDle I Inspection Type: I 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. O rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating structd zoning. Futh r -a�tbnLize the above -named contrac� r ,t,o d`o the work stated. -��`n-C. Sal � I�LT��y� July 06, 2018 uthorize ure: Owner / Applicant / Contractor / Agent Date Building Department Copy July 06, 2018 1 00 �2Miami Shores Village \ Building Department \! ' 100SO N.E.2nd Avenue, Miami Shores, Florida 33138 J Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 r� FBC 20 t BUILDING Master Permit No. tz-o-i 'Z�L2- PERMIT APPLICATION Sub Permit No.-?( , / 9- 1 ca ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP I CONTRACTOR DRAWINGS JOBADDRESS: 11� 00 'Do � ��— City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: j Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Cam- (c-C s-r'r►� �j�y`' Phone#: S 1% Z-- -1313 Address: ( :3]:� t'� Lk) L-D-D City: 1/y m ( State: r Zip: 37;�?l j D Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: P1 QN 1 t C_ Phone#: Address: I L:)U ) 4 �-7)\) ;'SIJ,�( Est- �y City: _�t('1"i�G �C[X 1 r State: _t-� Zip: Qualifier Narne: l;&D 665, MI'kbt`7— Phone#: b(�) `}- M State Certification or Registration M �� ? �� y Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ (() I OQ-'%Z> - Q-) Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ /Re lace Re air p p ❑Demolition ��t�(» dt��l 1-y�x�-)Inca rrr,�rhi►�P, 1-r��-�n�er�r 1- ln��r �rxler' Specify color of color thru tile: _1 v Submittal Fee $ Permit Fee $ 35� "/ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ 5 Notary $ Technology Fee $ TrainIng/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 3Z� (Revised02/24/2014) _ 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 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 $1500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days ofter the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee wip be charge Signature R or AGENT The foregonng instrument was acknowledged before me this 0 day of by (who is personally known to mm or who has produced as Identification and who did take an oath. NOTARY PUBLIC: Print: d. Signature C NTRA OR The foregcng instrument was acknowledged before me this 2 d day of�-20 18 by f_A"Jo A-�eL ht2v`d2Z . ho is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Z Seal: �•aiAYP�e,� BETSYO. PEREZ Seal: ,•��;yp. BETSY0. PEREZ Notary Public -State of Florida ;� III Notary Public - State of Florida • . ; • _ Commission fF 182380 ' Commlasfon #� FF 182380 ' My Comm. Expires Apr 3, 2019 "4l� dd:= My Comm. Expires Apr 3, 2019 : ss**ssessssss***** *Ry ZOO, -„ifi%i�iff�iM$Nd3t//jiA�'3h. �R*�d�'tdfbiM�lYs8Edt3IlAiafy'll�.n *»»»**»*»*» APPROVED BY Plans Examiner Zoning Structural Review - Clerk (Revised02/24/2014) ACORD® CERTIFICATE OF LIABILITY INSURANCE 7E�8 YYY) 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 endorsement(s). PRODUCER I CONTACT Customer Service Department NAME' Cennairus, LLC c e n n a i r u s 711 South Osprey, Suite 2 Sarasota, FL 34236 INSURED Smart Plumbing, LLC 17360 SW 302 nd St Homestead FL 33030-3310 (PAHO No, Ext): 941-927-9500 1 jA,X, No,. 941-927-9551 E-MAIL s: certificates@cennairus.comADDRE r INSURER(S) AFFORDING COVERAGE j NAIC O INSURER A. Associated Industries Insurance Company, Inc. INSURER B INSURER 0. INSURER D. INSURER E . I r- CCIVFRAnPA CFRTIFICATF NUMRFR: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEIJ ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOU!REMENT, 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� AUDLSUBR` POLICY EFF POLICY EXP LTR ! TYPE OF INSURANCE NUMBER MMIDDiY MMIDDrYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S DAMAGE rORENIED ERCIALGEN IABILITY I ,PREIU'ILEsteAgrcurrenre) " OCCUR ❑ ❑ I ❑ MED E)(P (" one person) $ _ FCLAI;,t3MADE 1 PFR^OF1AL & ADV INJURY S GENERALAGCREGATE S • 'L AGGR GATE LIMIT APPLIES PER PRODUCTS - COM.?IOP AGG S I Pot ICY PRO, LOC I $ AUTOMOBILE LIABILITY WN'.;,.'Iejtl_ CiLE LIMIT ANY AUTO BOC._Y INJURY (Pet person) 5 ALLOWNED SCHEDJLED EAG:Y INAIRY ("er sccider0 S - AJrOS 4 OS NON I -OWNED I PROPERTY DAMAGE S HRED AUTOS I 1 ALTOS I _L?et_820" 1 .� S UMBRELLA LIAB OCCUR _FACH OCCURRENCQ I S EXCESS LIAB CLAIMSWADE AGGREGATE S DED , RL-TEITTIONS S WORKERS COMPENSATION V4G5TA1J- OIH- x AND EMPLOYERS- LIAOLTY YIN ! TORY LiteJIS ER. . ANY PROP.^tETC'IPARTNERIEXECUTIVE AWC1102413 3/17/2018 3/17/2019 OFFICEPIM EUEER EXCLUDEDi �N NIA ❑ , E L EACH ACCIDENT $ t,000,000 -- — — - ----- — rE (Mandatory in NH) L DISEASE - EA EMPLOYE S 1,000,000 r yes, describe under DE.RCRIPT ION OF OPERATIONS below I P L DISXACI - POLICY LINT S 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space Is required) C'CDTICIrATC Unl nrD rANCFI I ATI1111d Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E. 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Forrest J Harris President V 195E-ZU1 D ACURU CURPUHA I IQN. AN rignts reserve0. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Proof of Coverage Page 1 of 1 WC Mobile App WC Home Search Our Data CFO Home Locations Detail Page This database was last updated Wednesday, June 20, 2018 12:10 AM. Return to Employer Detail Page SMART PLUMBING LLC Policy Number: AWC1102413 Effective Cancellation *Total Date Effective at Street Address City State Zip Number of 12:01 A.M. Employees Mar 17 2018 Current 17360 SW 302ND ST HOMESTEAD FL 33030- 0 3310 'Represents the total number of employees as reported by the Insurance carrier "Carriers were not required to report the total number of employees for policies issued prior to October 1, 2009 Return to Search Page https:Happs8.fldfs.com/proofofcoverage/LocationsDetail.aspx?PolicyID=AWC 1102413&... 6/20/2018