The URL can be used to link to this page

PL-19-49Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 [D� Issue Date: 01/09/2019 Location Address Parcel Number 9730 NE 5 AVE, Miami Shores, FL 1132060171470 Contacts Permit No.: PL-01-19-49 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 07/08/2019 JOHN & MARIE PERIKLES Owner JOHN & MARIE PERIKLES Applicant Other:7862360254 Other:7862360254 5 STAR PLUMBING SERVICES CORP Contractor MANUEL PAMPIN JIMENEZ 11710 SW 180 ST, MIAMI, FL 33177 Business: 3057963607 Requests: Description: ADD 2 BATHROOMS, UPGRADE EXISTING Valuation: $ 20,000.00 Inspection 05_4949 PLUMBING. TO REPLACE PERMIT#PL15-2367 Total Sq Feet: 4,073.00 mj Fees Amount Payments Date Paid Amt Paid Application Fee - Other $50.00 Total Fees $700.00 Permit Fee $650.00 Credit Card 01/09/2019 $700.00 Total: $700.00 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 fore ing inf, rmation is accurate d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,A authoriz the above named co tractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date January 09, 2019 Page 2 of 2 Miami Shores Village REcE1vED I1� NN 0 9 2019 � BuildingDepartment BY: 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 20 BUILDING Master Permit No. (-C t 4 Cl PERMIT APPLICATION Sub Permit No. �l ` BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION PAfNEWAL MPLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �U_30 At(_s2d= City: Miami County: Miami Dade Zip: �� S a 1Shore�s" Folio/Parcel#: 11 3 L-0 l d 111 q-7 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Uh A40 1i ay Phone#1 rto' 23LO 10 2- —T Address: "l I )U' City: Tenant/Lessee Name: Email: CONTRACTOR: Company Company Name:.! r' Address:, to ! L City: Ai 6 N A State: Qualifier Name: fb T1 ttt 0A_ t d-Vy"% Phone#: _.aQ, • 1 % - 34 in Zip:�� ZZ Phone#: '36 ` ?q (P ) 601 State Certification or Registration #: 0, PC I�42 61-5 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: one#: Value of Work for this Permit: $ 2Q, GIYJ • CO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: _ Submittal Fee $ � Permit Fee $ _ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF DBPR $ te: Zip: ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ - i (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 rein 7/o will be charged.Sign — Signature OWNER or AGENT CONTRACTOR The f�egping instrurrt nt was acknowledged before me this day of fl" 20 J by wh ersonally known me or who has oduce as identification Ind who did take an oath. ARY Sign:_ Print: The foMdayof_-J�;"M instrus acknowledged before�mse this , 20 " 1 , by personally known me or who has p6duced ' as identification ind who did take an oath. Sign: Print: PU Seal: +°`:U LORETTACOMES Seal: �LORMACOMES * * MY COMMISSION 0 FF 954664 * * MY COMMISSION t FF 954664 EXPIRES: March 21, 2020 EXPIRES: March 21, 2020 BQW7hru84etNMrySenkn ��'o►adt BondedThNBudANoterySerft APPROVED BY '/g / % Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Q�) I5= 13 q-3 � 23 6-7 _ Y *�I� JEFF ATWATER CHIEF FINANCIAL 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: 2/26/2016 EXPIRATION DATE: 2/25/2018 PERSON: PAMPIN-JIMENEZ MANUEL FEIN: 454102224 BUSINESS NAME AND ADDRESS: 5STAR PLUMBING SERVICES CORP 5 STAR LEAK DETECTION 11710SW180ST MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14), F.S., an officer of a corporation 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 election to be exempt... apply only within the scope of the business or trade listed on the notice 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 meets the requirements of this section for issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 AC4011f,1r ,r CERTIFICATE OF LIABILITY INSURANCE16��C,3/11/16 MM/DD/YYYY) ,,.. 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 CONTNAME:ACT GRETELL GONZALEZ USA General Insurance Corp/USA Insu PHONE N : (305) 386-3305 FAX No): (305) 386-6778 13631 SW 26St -MAILADDRESSo GRETELL@USAGENERALINSURANCE.COM Miami, FL 33175 INSURERS AFFORDING COVERAGE NAIC # Phone (305) 386-3305 Fax (888) 330-1123 INSURER A : United States Liability Insurance Company INSURED INSURER B INSURER C : 5 STAR PLUMBING SERVICES CORP INSURER D : 11710 SW 180TH STREET INSURER E : MIAMI, FL 33177 (305) 796-3607 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 LTR TYpE OF INSURANCE ADD IN UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE C' OCCUR ❑ N N CL1709153 07/02/2015 07/02/2016 EACH OCCURRENCE $ 1,000,000.00 AMAGE PREM SESOEaENTED 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 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS ❑HIRED AUTOS NON -OWNED ❑ AUTOS ❑ ❑ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Fn] If yes, describe under DESCRIPTION OF OPERATIONS below NIA n ❑ WC STATU- OTH- T MI ❑ ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) State Licensed Plumbing Contractor CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES FL 33138 ACORD 25 (2010/05) QF 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 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD