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PL-19-2973Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:12/20/2019 Location Address Parcel Number 895 NE 95TH ST, Miami Shores, FL 33138 1132060142950 Contacts Permit NO.: PL-12-19-2973 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: Approved Expiration: 06/ 17/2020 MAURICE HERNANDEZ Owner MARK E STIRRUP PLUMBING, INC Contractor 895 NE 95 ST, MIAMI SHORES, FL 33138 MARK ERIC STIRRUP Business: 9547931097 kmsswie@gmail.com Business: 9549656200 Description: gas vent for the natural gas water heater Valuation: $ 300.00 1305-762-4949 Inspection Requests: TotalSq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $116.30 Payments Date Paid Amt Paid Total Fees $116.30 Credit Card 12/20/2019 $116.30 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. ERS FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws sting construction 6n . Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date 20, 2019 Page 2 of 2 Miami Shores Village Building Department ENTERED \C\C)' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 DEC I a-M9 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 py, FBC 201"t BUILDING Master Permit No. PERMIT APPLICATION Sub Permit NoTL-12-1 q— ?—?+z ❑BUILD NG ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [:]RENEWALPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP Q LJ C ^� �—^ LJ CONTRACTOR DRAWINGS JOB ADDRESS:y / J / " G City: Miami Shores County: Miami Dade Zia: c 01Jn Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee SSiimple,Titlehol Address: City: &4/' , ' Meal 4 Tenant/Lessee Name: Email: / „07MA814 Construction Type: Flood Zone: BFE: FFE: 9414,f'6 / / e,'W10L1eZ.- Phone#- r7O � Q046 O6" State: " Zip: 33 !Jy P CONTRACTOR: Company Name: T//�4�1 ill��' r Phone#aq5j Address: 13,991 IS W15! .4ye City: 1/I�4S 4/�''%1 �cJ+ State �L- zip.33dl2 3 Qualifier Name: / I4 7/✓�� Phone#: O�)'1-,99 ~ 777 State Certification or Registration #: CSC I Lj;zl (0 �DI Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Type of Work: ❑ Addition Description of Work: City: State: Zip: JAVV,& LA-1 Square/Linear Foota a of Work: ❑ Alteration ❑ New Repair/Replace ❑ Demolition S' 1/e4 ) fb/' 7' ie Jfd f41.44 149.5 LJ4 X° - Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ W0.120 (Revised02/24/2014) 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. N Signature Signature �� Zlgi�� O rAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrum was acknowledged beforemethis day off 20 �� by S day of C 20 / by Al ! l�P F�who is personally known to aY ?' !L9Z. who is personally known to (�j� u me or who has produced �Q "�' 5� as me or who has produced L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign• Print. Ia1PlU �C.� Print: �' �/' �✓ 4 \�� pDYPP/1- i� I//, - Seal: �� • ossioo SINDIA ALVAREZ Se I: r :�o�GH2s,'•- '��rnr • MY COMMISSION S GG 238273 EXPIRES: September 3, 2022 y aGG ''r •�: Pubiit Underv+rNers 2a2 - APPROVED BY %� (r °rA/4 _ Plans Examiner ��e[ nly^'U�7,drg,�"'\o�� 1�ATt' ��piI11111111\t��\ Structural Review Clerk (Revised02/24/2014) ❑� a Ron DeSantis, Governor Halsey Beshears, Secretary bFlodda pr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES STIRRUP, MARK ERIC MARK E STIRRUP PLUMBING INC 3981 SW 59TH AVE HOLLYWOOD FL 33023 LICENSE NUMBER: CFC1426501 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. BROWARD COUNTY LOCAL -BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020 DBA: Business Name: MARK E STIRRUP PLUMBING INC Owner Name: MARK ERIC STIRRUP Business Location: 3140 W PEMBROKE RD 614 HALLANDALE Business Phone: 954-965-6200 Receipt #:PLUMBG4 IN/LWN SPRNKL/ Business Type: (CERTIFIED PLUMBING Business Opened: 01/26/2005 State/County/Cert/Reg:CFC142 6 5 01 Exemption Code: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vendinq Type: 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 WHEN VALIDATED Mailing Address: ':,MARK ERIC STIRRUP P '0 BOX 61114 6 ^`f t MIAMI, FL 33261-1146 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 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. Receipt #05A-18-00008924 Paid 09/30/2019 27.00 t I A oDATE (MMIDDN � CERTIFICATE OF LIABILITY INSURANCE F1211612019YYY) 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). CON 'RODUCERAce Underwriting Group NAME: T JANE COOK Customer Service Center PHONE 954-922-18990 i A XtC. N01,954-921-1964 5305 West Broward Blvd. EMAILfAMservice underwritin com Plantation FL 33317 AD,QRF,SS: g INSURER(S) AFFORDING COVERAGE NAIC INSURERA:Capacity Specialty Insuranc 32930 vauaeD MARK E STIRRUP PLUMBING INC INSURER B. Mercury Insurance I 11201 PO BOX 611146 MIAMI FL 33261 INSURER C : INSURER D : I INSURER E: INSURER F : ) :OVERAGES 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. LIMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ISRT - :A06L7131)6h, i POL16Y EFF POLICY EXP i TR , TYPE OF INSURANCE ! POLICY NUMBER MM Y M0.L' YYY LIMITS RCIALGENERALLIABILITY I I EACHOCLURRENCF. S 1,000,0000 Q I DAMAGE TO RENTED 10 0,000 FCLAIMS-MADEOCCUR I PREMISES (Esoccurrence) S 1 I I !CS02487225-05 03/21/2019 LIED EUP (Any ono Pcram) 03121/2020 1 PERSONAL aADvI"Amy S 5,000 1,000,000 _ ` , S G£N'L I AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE 2,000,000 ✓ j, POLICY Q jE 4 LOC { PRODUCTS - COMPIOP AGG 15 I S 1,000,000 OTHER. ) S AUTOMOBILE LIABILMY I COMBINLINT (Es scmdsM) I I NGLE S 1,000,000 ANY AUTO 1 I WANLY INJURY (Per fowler») 1!! S OWNED SCHEDULED BODILY INJURY (Per oocident)I $ AUTOS ONLY AUTOS HIRED NON -OWNED 1 {ii{{I PROPERTY DAMAGE I S AUTOS ONLY AUTOS ONLY I I (Por Ikn;Nklnl) I $ UMBRELLA Lu8 OCCUR HCLAIMS-06CADE ( ) EACH OCCURRENCE 15 EXCESS LIAO I 1 AGGREGATE } $ DED RETENTIONS + 5 WORKERS COMPENSATIONLj STAFIT ERH AND EMPLOYERS' LIABILITY YIN .t I tANYFROPMETORFARTD:ERT£XFCUTiV£ I I E.L EACH ACCIDENT $ OFFICFRIMEMCEREXCLUDED? a�N/A` ) ; (Myyarl�rd.. etory in NM) 1 1 ! E L DISEASE EA EMPLOYEE 5 N DE ;GRunder IddnsTION OI OPERATIONS below I E.L, DISEASE - POLICY LUAT Sµ I �F-1 ESCRIPTION OF OPERATIONS / LOCATIONS / VEMICLES (ACORD 101. Additional Remefts Schedule, may be attached N more apace 19 requ)red) umbing :ERTIFICATE HOLDER CANCELLATION IIAMI SHORES VILLAGE 3050 N.E. 2ND AVENUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IAMI SHORES, FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AX: 305-756-8972 1 ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ®1988-2015 ACORD CORPORATION. All rights reserved. ,CORD 25 (2016103) The ACORD name and logo re eyed marks of ACORD JIKMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION •' CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW' • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/20/2019 PERSON: MARK E STIRRUP FEIN: 562480712 BUSINESS NAME AND ADDRESS: MARK E STIRRUP PLUMBING,INC. 3981 SW 59 AVE HOLLYWOOD, FL 33023 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers EXPIRATION DATE: 8/19/2021 EMAIL: STIRRUPPLUMBING@GMAIL.COM IMPORTANT: Pursuant to Chapter 440,05(14). F.S., an officer of a oorporaWn who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12). F.S., Certificates of olection to be exempt... apply only within the scope of the business or trade listed on the notion of election to be exempt. Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer moots the requirements of this section for issuance of a certificate. The department shalt revoke a certificate at any time far failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08.13 E-01018332 QUESTIONS? (850) 413-1609 MARK E. STIRRUP F�—ez —/ 0/ —Zcl —7,� Date: l� l 2J l zj I / State Of: Florida County: Dade County Before me this day personally appeared _ who, being duly sworn, deposes and says: /�/,, le e- 4 V That he or she will be the only person working the project located at: R 17S "JIz- ' S J Contractor Signature Sworn to (or affirmed) and subscribed before me this day of-Ji 20-(�. Personally know OR Produced Identification Type of Identification Produced Prepared For Maurice Hernandez 895 NE 95 st Miami Shores, Florida 33138 United States Mark E Stirrup Plumbing,inc. Stirrup. CFC1426501 9549656200 Proposal Date Proposal Number 12/14/2019 00000013 3981 SW 59 Ave West Park, Florida 33023 United States ...... . .. ...... .... . ..... ...... .. . ..... .. .. ... ...... . . . . ...... Pricing • • • Description Rate Qty Line Total Plumbing permit for gas vent Plumbing permit for the gas vent for the natural gas water heater Notes $300.00 1 $300.00 Subtotal 300.00 Tax 0.00 Proposal Total (USD) $300.00 This is only for obtaining the permit for the gas vent any modifications or changes to the gas vent or the natural gas water heater will be an extra charge To the homeowner The homeowner will be responsible for paying the permit fees. k (1 Terms If you have any questions do hesitate to contact me at 305-495-4777 thank you for your business Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of-C QA_--M t� 201� ByMtp M P-U'P1 CE >t {� r°N � who is personally known tome or has produced t=L�Q,�LU C'i` NEE as identification. Notary: �0MP SINDIA ALVAREZ SEAL.'' MY COMMISSION # GG 238273 ' ;�o EXPIRES: September 3, 2022