Loading...
PL-19-1812Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 rrAiv--) Issue Date:10/30/2019 Location Address Parcel Number 5 NE 106TH ST, Miami Shores, FL 33138 1121360060250 Contacts Permit No.: PL-08-19-1812 Permit Type: Plumbing - Residential Work Classification: Repair Permit Status: Approved Expiration: 04/27/2020 BERNADEL & MARIE JOSEPH Owner 5 NE 106 ST, MIAMI SHORES, FL 331382034 MO-JO PLUMBING & SEPTIC SERVICES Contractor LLC JOSEPH MORISSEAU Business:7863465020 MOJOPLUMBINGLLC@GMAIL.COM Description: REPLACEMENT OF BROKEN KITCHEN SEWER PIPE Valuation: $ 2,000.00 Inspection Requests: TO PVC SEWER PIPE 305-762-4949 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.10 Payments Date Paid Amt Paid Total Fees $117.10 Check # 1135 08/06/2019 $50.00 Cash 10/30/2019 $67.10 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above namedIontractor to do th work stated. ra Authorized Signature: Owner / Applicant / Contractor / Date October 30, 2019 Page 2 of 2 0\ S \� 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�d INSPECTION LINE PHONE NUMBER: (305) 762_ 4949LOl FBC 2011 Master Permit No.�U� ' `v Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL �LUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �L City: Miami Shores County: Miami Dade Zip: 3 3/7 6 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):/ / �/ Q' �'/ e �l �f E.�'/ Phone#: Address: S /Ve I C% 6 �-4tl C—e V City: 'Z am J 4 c' p of State: l-/C' �' , ` c/9 Zip: 3 3 / ?,b Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company tlName: A? O PIC(M d it �'e,'c- Se/v�'cF Phone#: 7 g Address: / 2 /y/6, 4 f s Ll`'p e2� _` ? City: 1 I tt a its i• State: /m_r i P 4 9 Zip: Qualifier Name: .1 ©S e, tp /' ;'5f e c Phone#: 5r1�/4�? State Certification or Registration #: GFG It/2 7 ? / 3 Certificate of Competency #: DESIGNER: Architect/Engineer: Address City: hone#: State: Zip: Value of Work for this Permit: $ 2 / d G Square/Linear Foota a of Work: Type of Work: ❑ Addition ❑ Alteration New Repair/Replace ❑ Demolition Description of Work: k t e k P 1► a& to dive SeLve-r pai4C-. Specify color of color thru tile; Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 reinspfction fee will be charged. u f-�- Signature a,-- Q OWNER or AGENT The foregoing instrument was acknowledged before me this 19 day of #--t0L 1 20 t 9 by %'�0►� IG )Nf,,h who is personally known to me or who has produced PL ILL J ZI d Sq6 51 6y50 as identification and who did take an oath. NOTARY PUBLIC: Sign: ea!SA Print: GSe- L' Signature G�-L CONTRACTOR The foregoing instrument was acknowledged before me this 141 day of M-A 20 1'# by H6V 1 SStatJ , ,�h , who is personally known to me or who has produced 1- L. e-hL Ml(ZO has .Z identification and who did take an oath. NOTARY PUBLIC: Sign: ��- Print: ✓1 I cSC- O-A le - Seal: Seal: Deniese Gayle pentase Gayle NOTARY PUBLIC NOTARY PUBLIC STATE OF FLORIDA SN- Expires STATE OF FLORIDA 11/13/2022 CE Expires 11/13/2022 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) pF� RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY db,.,r 011 r 10 Ai 0 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 MORISSEAU, JOSEPH 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. Local Busi ness Tax Fbcei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6923255 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES MO-JO PLUMBING & SEPTIC RENEWAL SEPTEMBER 30, 2019 SERVICES LLC 6759097 Must be displayed at place of business 92 NE 49TH ST 92 NE FL ST Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYM ENT RECEIVED MO-JO PLUMBING & SEPTIC 196 PLUMBING BY TAX COLLECTOR SERVICES LLC CONTRACTOR 45.00 09/26/2018 rvn .Ir1RFPN MOPIGSFAI I Worker(s) 1 CFC1427913 0204-18-001960 This Local Busi nass Tax fbceipt only cot"r s payment of the Local Business Tax. The Fbom pt i s not a I icense, permit, or a certi "cation of the holders quail "cations, to do busi ness. Holder must conply with any governmental orrangovemnental regulatory laws and requirementswhichapply tothe business. The FEM Pf NQ above must be displayed on all corrrrercial vehicles - Miami -Dade Code Sac Ba-276. MILAMM Far more inWrre ion, visit www.rriamidade.amdWcdlector COU JNTT ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 08/05/2019 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 INSURERS , 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 endorsements . PRODUCER CONTACT NAME: Homesite Commercial Insu Ce Program Homesite Commercial Insurance Pr ram 09 PHONE ac No Ext : 844-288-7998 FAX ac No E-MAIL ADDRESS: commemialservice@homesite.com PO Box 5316 Binghamton, NY 13902 INSURER(S) AFFORDING COVERAGE NAIC fI INSURER A: Midvale Indemnity Company 27138 INSURED INSURER B INSURER C : MONO PLUMBING AND SEPTIC SERVICES LLC INSURER D : 92 NE 49TH ST INSURER E : MIAMI FL 33137 INSURER F : COVERAGES CERTIFICATE NUMBER: 303835123153355Z570BU5 REVISIUN NUMbLK: 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 CL MMS. rN_SR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MID POLICY EXP MMIDD LIMITS AN COMMERCIAL GENERAL LIABILITY JCLAIMS-MADE X OCCUR N GLP1015193 12119@018 12119/2019 EACH OCCURRENCE $1,000,000 DAM SO RENTED3100,000 PREMISES Ea occurrence MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- I I LOC JECT -IF --I� PRODUCTS - COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS Per accident PROPERTY DAMAGE HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR DCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MAD DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPMETORIPARTNERIEXECU -TIVE OFFICERIMEMBER EXCLUDED? 17 N/A E.L. EACH ACCIDENT (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT PROFESSIONAL LIABILITY OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing MIAMI SHORES VILLAGE BUILDING DEPARTMENT IS ADDED AS CERTIFICATE HOLDER CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 10050 NE 2ND AVE, MIAMI SHORES, FL 33138 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ' •��onwe• JIMMY PATRONS 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 * * He] Z&IIII :1111L0i III Is] zIIZI1111IRtIll d=:1:I A[J111[*]:I This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 1/16/2018 PERSON: MORISSEAU FEIN: 262624054 BUSINESS NAME AND ADDRESS: MO-JO PLUMBING & SEPTIC SERVICES LLC. F*YAZI:K PI&I 1110:141 M IAM I FL 33137 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers EXPIRATION DATE: 1/16/2020 IMPORTANT: 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 certificate at any time for 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 QUESTIONS? (850)413-1609 Mo-Jo Plumbing & Septic Services LLC. JOSEPH MORISSEAU Lic # dc1427913 Cell 786-346-5020 92 NE 49 ST MIAMI, FL 33137 07/20/2019 State of Florida County of Miami Dade Before me this day personally appeared Joseph Morisseau who, being duly sworn, deposes and says: That he will be the only person working on the project located at: S /V '�--/ a 6 5-tl F( f Contractor Signature Sworn to (or affirmed) and subscribed before me4his Z day of .2019 By ��CYSaYt al�N �y�p � y fio yf�-� 1 or stamp Name of Notary 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: l . 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: Owner State of Florida County of Miami -Dade /t The foregoing was acknowledge before me this Zay of VCyC P&eY` , 20 Q By i�� 1 who is personally known to me r has produced as identification. Notary: Notary erPublicElf Stab d Fior;da Chrianer Eliva SEAL: j My Commission GG 302113 ,,,�d Expires 02/14/2023 Q \l Eept;�T���r • • •••• ••••.• •. • .. • . • ...... ••.• ••.... •••••• ..•. • •. •. .. • • 00000 es 00 00 to 0 • •••••• • • • • • • • • • •••••• RECEIVED SE �1 PLUMBING PLANS ¢�f Approved Date r)isapproved Date