PW-08-22-2176Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PW-08-22-2176
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Issue Date: 09/09/2022 Expiration: O3/09/2023
Location Address Parcel Number
161 NE 108TH ST, Miami Shores, FL 33161 1121360090220
Contacts
MICHAEL BELL Owner PIMENTEL CONSTRUCTION Contractor
161 JONATHAN PIMENTEL
Mobile: 7865311565 JONATHAN@THEPIMENTELGROUP.CO
M
Description: base mill and resurface Valuation: $ 6,300.00 Inspection Requests:
305-762-4949
Total Sq Feet: 750.00
Fees
Amount
Education Surcharge
$2.10
Public Works Permit Fee
$100.00
Scanning Fee (Manual)
$9.00
Technology Fee
$10.00
Total:
$121.10
Payments Date Paid Amt Paid
Total Fees $121.10
Credit Card 09/09/2022 $121.10
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. 1 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
pgulating constructioMand zoning. Futhermore, I authorize the above named contractor to do the work stated. t
k W A.W Vivuo,AA 16A. kl(,h111. G-YMIV? 6g1o4121-
/ Applicant / Contractor / Agent Date
2022 Page 2 of 2
Miami -Shores Village
Public Works Department
(305)795-2210
Public works forms are available from the building department,10050 NE 2" d Ave., Miami Shores, Fl. 33138
PUBLIC WORKS PERMIT APPLICATION
Permit 7jype: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: `0 r" 7,1-7(c
Name of Applicant (if utility see below): Michael J Bell
Owner off the following described property:
Legal Description: Lot 14 Block 216 Subdivision Dunning Miami Shores EXT NO 5
Folio #; 11-2136.009-0220
Address: 161 NE 108 ST, MIAMI SHORES, FL 33161
UTILITY NAME-
Qualifier/Authorized Agent:
Address:
aty: State: ZIP:
Telephone: Email:
State Certification or Registration #:
Certificate of Competency #
CONTRACTOR NAME:-PIMENTEL CONSTRUCTION GROUP, LLC
Qualifier/Authorized Agent JONATHAN J PIMENTEL
Address: 4490 SW 154th Avenue
City: Miami State: Florida ZIP: 33185
Telephone: 768-531-1585 Email: lOn8than@#WMenWgmp.com
State Certification or Registration #: CGC1528279 Certificate of Competency#:.
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: Rec:onsbucdGn of base =10' x 2' and 3' x 3'
MIN and Resuftce.Area of 75' x 9.5'
Type of Work: ® Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape [] Antenna
DESIGNER: Architect/Engineer:
Address:
City
H Other: Base Reconsb'uedon
State: ZIP:
Telephone: Email:
Registration #: _
Value of Work for this Permit: $ !!�oaaa Square/Lineal Footage of Work: 750
***** Fees *****
Permit Fee $1A0.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning
Bond $ (if required] Total Fee Now Due $
Bonding Company's Name (if applicable): NIA
Bonding Company's Address:
City: State: ZIP:
Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in
this jurisdiction. I understand that separate permits must be secured for
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with applicable laws regulating construction and specifically construction in the
right-of-way.
"WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value
exceeding $2,500, 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 the
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 public works permit is issued. In the
absence of such posted notice, the inspection will not be approved and a reinspection will be charged.
n
Signature Y�I I ►"� Z-t
Applicant or Authorized Agent
The forego ng instrumeAAt was acknowledged before
me this I � day of 1� USi 20�, by
11 ;clv.et 1�e� who
is personally known to me or who has produced
' CW,QU5 _L_cer5f_ as
identification. &4o055,0S"7 38d,(j
NOTARY PUBLIC:
Sign:
Print:
SEAL: J
ASHLEY SOISVERT
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION * HH123873
MY COMMISSION EXPIRES:
Signature
,J Company/Utility Agent
The foregoing instrument was acknowledged before
me this II ( day of 20-2.1:-, by
�t.11(,.-li Abtl �k ti\it iftl who
is personally known to me or who has produced
ILDL as
identification. 'PS f'3-U30ONI-3YZ-L)
NOTARY PUBLIC:
Sign:
Print:
SEAL: Notary Public Slate Florida
3' Veronica Sagaslume
40VMy Commission HH 007316
Expires 0610712024
0 18/202�
APPROVED BY: 'L Z ublic Works Director, or Designee
2017-04-15
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Property Address:
161 N.E. 108 Street
Miami Shores, FLORIDA 33161
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13.50' 11.0' PARKWAY 11.0' _
75' RIGHT OF -WAY (BY PL4 r)
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N.E. 108th STREET
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SIGNED
• FOR THE FIRM
Miami, FL33157
ME LAND
EFRAIN LOP
STATE OF FL
, P.S.M. No. 6792
Phone: 305 740-3319
( )
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Fax: (305) 669-3190
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LB#:7989
Survey to-79741 Client FlIe#: 20070 Page t of Noty Id without all Pages
Ron DeSantis, Governor Melanie S. Griffin, Secretary
Fiolida
dopr
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE
PROVISIONS OF CHAPTER 489, FLORIDA STATUTES
PIMENTEL, JONATHAN JOSE
PIMENTEL CONSTRUCTION GROUP, LLC
4490 SW 154 AVE
MIAMI FL 33185
LICENSE NUMBER: CGC1528272
EXPIRATION DATE: AUGUST 31, 2024
Always verify licenses online at MyFloridal-icense.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 Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL -DO NOT PAY
7291277
SEP 0 9 2022
LBT
BUSINESS NNNIWCATION
IIECEIPf NO.
EXPIRES
PIMENTEL CONSTRUCTION GROUP LLC RENEWAL
SEPTEMBER 30, 2023
4490 SW 154TH AVE
7580521
MIAMI FL 33185-4548
Must be displayed at place of business
Pursuant to County Code
Chapter 8A-Art 9 & 10
OWNER
SFC.T"E OF BUSINESS
PIMENTELCONSTRUCTION GROUP LLC
196 GENERAL BUILDING CONTRACTOR
PAYMENTRECENED
C/O JONATHAN I PIMENTEL
CGC1528272
BYTAxCOLLECTOR
$75.00 08/26/2022
Worker(s) 1
INT-22-398478
This Local Business Tax Receipt only confirms payment of the Lou] Business Tax. The Receipt is not a license,
permitora certification of the holdersqualificatiuns,lodobusiness. Holdermust comply with any governmental
or nongovernmental regulatory laws and mquirements which apply to the business.
The RECEIPT NO. above must he displayed on all commercial vehicles- Miami -Dada Code Sac 8a-276.
For mom Information, visit mmmgnamidada aov/texcollecmr
CERTIFICATE OF LIABILITY INSURAN
o7120/zo'°"""'
z2
O e[AT LDER. THIS
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHPBy
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THERAGE AFFORDED B ,1 E POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEE ISSUING ER(S), UTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED prov, sons 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
CONTACT
NAME:
PHC0NNo exu, (855) 222-5919 ac No
Next First Insurance Agency, Inc.
PO Box 60787
Palo Alto, CA 94306
E-MAIL
ADDRESS: support@nextinsurance.com
INSURERS AFFORDING COVERAGE
NAIC#
INSURERA: State National Insurance Company, Inc
12831
INSURED
INSURERS:
Pimentel Construction
4490 SW 154th Ave
INSURER C:
INSURER D:
Miami, FL 33185
E
INSURERRE
NSUF:
R
COVERAGES CERTIFICATE NUMBER: 434364497 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
TYPEOFINSURANCE
ADOL
BRAIN
POLICY NUMBER
� YEFF
P� IYYY
LIMITS
X
COAIMERCIALGENERALIJIIBILITY
EACH OCCURRENCE
$1.000,000.00
CLAIMS -MADE � OCCUR
DAMAGE TO RENTELI
PREMISES Ea naummae
$10D,000.00
MED EXP (Any one person)
$10,000.00
PERSONAL SADV INJURY
$110001000.00
A
X
NX17023220-01-GL
11/04/2021
11/04/2022
GENL
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$2,000,000.00
POLICY❑ j C7 7 LOG
X
PRODUCTS-COMP/OP AGG
$2,000,000.00
$
OTHER
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
We acdclenl
$
BODILY INJURY (Per person)
$
ANYAUTO
OWNED SCHEDULED
AUTOSONLY AUTOS
BODILY INJURY (Par aadderd)
$
PROPERTY DAMAGE
Per aoddent
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
UMBRELLALUIB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DELI
I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETORIPARTNER/EXECUTNE
OTH-
STATUTE ER
E.1- EACH ACCIDENT
$
OFFICEWMEMBEREXCLUDED? ❑
NIA
E.L. DISEASE -EA EMPLOYEE
$
(Mandatory In NH)
R es, descdbs under
DE SCRIPTION OF OPERATIONS bebw
E.L. DISEASE -POLICY LIMIT
$
Each Occurrence:
$25,000.00
A
Contractors Errors and Omissions
X
NX77023220-01-GL
11/04/2021
11/042022
Aggregate:
$50,000.00
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Addkbnal Remarks Schedule, may be sdeched B more apace is required)
The Certificate Holder is Miami Shores Village BLDG DEPT. This Certificate Holder is an Additional Insured on the General Liability policy er the Additional Insured Automatic
Status Endorsement General Liability coverage applies for General Contractor operations in Florida. All Certificate Holder privileges app� only if required by written
agreement between the Certificate older and the insured, and are subject to policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village BLDG DEPT LIVE CERTIFICATE
10050 NE 2nd Ave
O
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami, FL 33138
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
/
AUTHORIZED REPRESENTATIVE
o
Click or scan to view
C
ACORD 25 (2016/03)
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
11flI15INRn n
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A� ®
CERTIFICATE OF LIABILITY INSURA°E SEP 0 9 202Z
TE (Mn D° rYv'7
/07nozz
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG TS UPON TMW
OLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TH RAGEHE
POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEE
AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
H 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
CONTACT
NAME:
Next First Insurance Agency, Inc.
PO Box 60787
Palo Alto, CA 94306
FAX
. (855) 222-5919 AIC No):
EMAIL
Mrsupport@nextinsurance.com
ADDRESsupport®nextinsurance.com
INSURERS AFFORDING COVERAGE
NAIL0
INSURERA: State National Insurance Company, Inc
12831
INSURED
INSURERS:
Pimentel Construction Group
4490 SW 154th Ave
INSURER C:
INSURERD-
Miami, FL 33185
INSURERE:
NSURERF-
COVERAGES CERTIFICATE NUMBER:943724449 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
DLSUBR
Po
PLVD��
MID EXP
LIMITS
COMMERCIALGENERALLWiILITY
EACH OCCURRENCE
$
CLAIMS-NIADE OCCUR
PREMISES (Eaoccu m
$
MED EXP one Person)
$
PERSONAL S ADV INJURY
$
GENL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S
POLICY ❑ JECT 7 LOC
PRODUCTS -COMPIOP AGO
S
$
OTHER:
AUTOMOBILE LIABILITY
e SINGLEUMIT
COMB1IINNEIS
$
BODILY INJURY (Per Person?
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
P %%
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS444DE
DED
I I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICEOPRIETRARTNEEDTECUTIVE YIN
(Mandatory In NH)
NIA
NXTUW4D869-01-WC
03/17/2022
03/17/2023
X PTRA OR
E.L.EACH ACCIDENT
$1,000,000.00
E.L. DISEASE -EA EMPLOYEE
$1,000,000.00
E.L DISEASE -POLICY LIMIT
$7000 G00.00
If yes, dascdbe under
DESCRIPTION OF OPERATIONS below
DEBCRIPnoN OF OPERA7IONSI LOCATONS I VEMCLES (ACORD 101, AddlUonal Rerneft Schedule, may be attached IT more apace Is required)
Proof of Insurance.
Regarding: Pimentel Construction Group, License #CGC1528272, subject to policy terms and conditions.
Miami Shores Village BLDG DEPT LIVE CERTIFICATE
ID050 NE 2nd Ave ?' — O
Click SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami, FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE L
❑c r scan to view
W TUn6-2U10 At:UKU LJUKYUKA I Ion. All rlgnts reSerVeO.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD