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PL-19-2026
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WHITSON PLUMBING IA♦ A —• f T�7•R. -VA. 1 J & I L'C V L":1I'Ur HOLLYWOOD, FL 33020 (954) 929 -- 3599 STATE LICENSE #CFC1425789 DROP TEST CERTIFICATION Aif A iltf� f� f� fT�I1f�f • � I!1►A� vTr1��.:1W 11�1'V.L�LY1t111V1Y NAME: �.� e9 rl U ADDRESS: -7 CITY: z2L,4azu S'—hadeedfZATE: f TYPE OF INSTALLATION: NEW 1/ UPGRADE DESCRIPTION OF WORK:A-Y�- SYSTEM PRESSURE FROM METER: Q-0 C -C> �s IF YBRU) SYSTEM, BRANCH PRESSURE: -7 G� WATER COLUMN: TEST DURATION: DATF OF TFCT• l C ON CT OR (QUAL ) SIGNATURE DATE Sri �►*O*o AF � y•i �n County ofyL4iX%Cl sworn to and subscribed before me this day of 20� (personally known () produced identification — type of identification Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:10/01/2019 Location Address I Parcel Number 746 NE 95TH ST, Miami Shores, FL 33138 1132060141900 Contacts Permit No.: PL-08-19-2026 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: Approved Expiration: 03/30/2020 JAMES O'CONNOR Owner EH WHITSON PLUMBING Contractor 746 NE 95 ST, MIAMI SHORES, FL 331382515 JOHN LIPKA 421 S 21 AVE, HOLLYWOOD, FL 33020 Business: 9549293599 Description: INSTALL NATURAL GAS LINE FROM EXISTING GALSJ aluation: $ 2,281.00 Inspection Requests: 449 METER TO CUSTOMER PROVIDED GENERATOR TotalSq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 10/01/2019 $111.90 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regutattrtg construction and zoning Futhermore, I authorize the above named contractor to do the work stated. - L Authorized Signature: Applicant / Contractor / Agent Date October 01, 2019 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING RECrjV2D AUG 2 a -,nq 4 FBC 201-4 Master Permit NO._E -- 015 1 c�." oZ Sub Permit No.?L C6 _ i G - 610Zo ❑ REVISION ❑ EXTENSION ❑RENEWAL ®PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -ILA LD HE q; S79115JE T City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 111- 3ablo—ai4-19 O O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Nome (Fee Simple Titleholder): Tft MES C O I C O N N O K k W-10y 14 Phone#: OS - 6 19 -21 1 O 4 Address: '14 U NE CIS S'T City: M 1 A M I S ND IR ES State: Ir L Zip: 3 313 $ •— a 5 lS Tenant/Lessee Name: Phone#: Email: JOCO9-aLe5@ Y1 rRti, tom CONTRACTOR: Company Name: E" W( k %-r S ON P L U mB I N G Phone#: G 5 Li - C)11q _1SQ101 Address: 441 Sou-rH Qi ArV 6 City: {-Lb L.L Y Lz o Q j� State: Zip: 3 0 oZ0 QualifierName: Tb" t4 L I iP K A- Phone#: a5tt-q1°►- 3549 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City• State: Zip: Value of Work for this Permit: $ Q.Z W k , O D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: 7T- IJ &-T A-LL. R N-C U-ILA-L 6- Nk S L I M E i-R.o M E k 1 S T I N G 6. iprS th >` Tip 2 To C, I,L t To " it K. R a � , a � G it n� i✓ Ti, I2 Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ hh TOTAL FEE NOW DUE $ I 1 V 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 posteo at the job site for the first inspection which occurs seven (7) days after the building permit is i In the sc7o�, uch ste notice, the inspection will not be approved and a reinspection fee will be charged. Signature cl -1 n�z� OWNER or AGENT The foregoing instru ent was acknowledged before me this day 0, uatls f 0 2 by I� DY1rXI� w �ispersonally nOa ----------------- me or who has produced as Identification and who did take an oath. NOTARY PUBLIC: Sign: r " ' \< Print: _.AEI 44 The foregoing instrument was acknowledged before me this a 4+� day of 314 �—� , 2 QJ by —SOW NL IPKII ,wh• me or who has produced N 14 a :R'o\- v: . 2Y-4 a \�-�V.• MWaivry vsv� identification and who did take an oa> - :mac°GoaeRs oA��'F `P� _ w o ", ° NOTARY P C: Z : y tics 146500 09 Sign i� QUA ublic Uno, Print: r con Sa f frcan Rossi �iiii i i T ii� W Seal: � ry� MYCOMMISS101 FF9MI98 Seal: 4c ' EXPIRES: February 3. 2020 !\ Bonded Thru Notary Public Underwriters APPROVED BY 9 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Florida pr STATE OF FLORIDA DEPARTMENT OF BUSINESS -AND -PROFESSIONAL REGULATION CONSTRUCTcION`�INDlJSTRY=LICENSING BOARD 37 THE PLUMBIN/JG`CONTRACTOR .OEREIN=IS C RTIEIED UNDER THE /J NSF , •,� ,,.. ,_ r � PROVIS10� x:'OFCHAPTER 4891 FL-ORIDAfSTATUTES t?r r + —1— JPKAJ E H WHITSON PLUMBING — �'' .�21kSQUTH 21ST AVER' f `lio-)-), XWOQD, ,, .V `PL 3�020i`, . r -t r LICEN E NN BER `CFC1425789 EXPIRATIOND TE:'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. i BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA: :: a,: -TSON PReceipt #:PBS E P.N 1BING/LWN SPKL/CONTPACTOR Business Name: 1�' PLUMBING Business Type:( PLUMB ING CONTRACTOR) Owner Name: JoxN S LIPF.A Business Opened:ol/07/2005 Business Location: 421 S 21 AVE State/County/Cert/Reg:CFC1425799 HOLLYWOOD Exemption Code: Business Phone: 954-929-3599 Rooms Seats Employees Machines Professionals 11 For Vending Business Only Number of Machines: Vending Tvne, Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 54.00 0.00 0.00 0.00 0.00 0.00 54.00 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 ton,ng 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 S LIPKA 421 S 21 AVENUE HOLLYWOOD, FL 33020 2018 - 2019 Receipt #1CP-17-00017501 Paid 07/31/2018 54.00 07/27/2018 Effective Date A�C�RO® v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)7/24/2019 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 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 Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 NAME: Pam Hardin PHONE FAX /C No): A/ No xt : 954-724-7000 VC. AbMDResS: pharding@keyescoverage.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company 39993 INSURED 12193 INSURERB: AmGuard Insurance CO E. H. Whitson Plumbing Al & John Enterprises Inc d/b/a 423 S. 21 st Avenue INSURERC: Nat'l Union Fire of Pittsburgh 19445 INSURER D : Zenith Insurance Co. 13269 INSURER E : Hollywood FL 33020 INSURER F : COVERAGES CERTIFICATE NUMBER: 692272809 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 OF INSURANCE ADDILTYPE IN= UBR POLICY NUMBER MM/ DPOLICY/YYYY MM / D1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx] OCCUR Y Y GL 0022592-01 3/7/2019 3n12020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE PREMISES Ea occu ante $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JE LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO SCHEDULED ALL OWNED Ix X HRTEDSAUTOS AUTOS NON OWNED AUTOS Y Y JSAU020542 3/7/2019 377/2020 COMBINED SINGLE LIMIT Ea accident $ 1.000,000 BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE Y Y EBU011921947 3/7/2019 3n12020 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION $ c $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, desa be under DESCRIPTION OF OPERATIONS below N / A Y Z127057805 4/12/2019 4/12/2020 X STATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) State of FLorida License #CFC1425789 John S. Lipka, E. H. Whitson Plumbing L:tK I IFIL:A I t NULULK L:ANL:tLLA I IUN 3U UaVS Notice /1 U UavS Tor Non-I'av MIAMI SHORES VILLAGE 10050 N.E. 2nd Ave. 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 * xe- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD