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DEMO-05-19-984, 1041 NE 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1041 NE 94TH ST, Miami Shores, FL 33138 1132050120080 :ontacts MIAMI COUNTRY DAY SCHOOL INC Owner EAST SUNRISE PLUMBING INC Contractor MIAMI COUNTRY DAY SCHOOL INC VINCENT HERNANDEZ 601 NE 107 ST, MIAMI, FL 331617165 15075 SW 137 ST 7, MIAMI, FL 33196 Other: 3057592843 Business: 3053211672 ... ... . ........... .. .. __. _.w __..._ .......................... ........ .... Description: CAP PLUMBING LINES Valuation: $ 500.00 Inspection Requests: 305=762=4949 �= Total Sq Feet: 0.00 " Fees Amount Application Fee - Other $50.00 Building Demoloition Fee $50.00 CCF $0.60 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $0.20 Scanning Fee $3.00 Technology Fee $6.25 Total: $116.30 Payments Date Paid Amt Paid Total Fees $116.30 Credit Card 05/02/2019 $50.00 Check# 1060 05/09/2019 $66.30 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. 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 constructyb,n and pninguthermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner f " Applicant / Contractor / Agent Date May 09, 2019 Page 2 of 2 ` RTC\0'A Miami Shores Village MAY ' 2 Z019 Building Department BY: `\, t 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 111 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No.DEMO-12-18-3750 PERMIT APPLICATION Sub Permit No. Y110 — o(S- I -I -.184 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL MPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1041 NE 94th St City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: 11-3205-012-0080 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): MIAMI CTRY DAY SCHOOL INC Phone#: 305-613-6451 Address: 601 NE 107 St city: Miami state: FL zip:33238 Tenant/Lessee Name: Phone#: 305-613-6451 Email: buttsg(ED-miamicountryday.orq, martellc(d_)miamicountryday.orq CONTRACTOR: Company Name: Su n ('i Le 1 I pmV' `)!% TW, Phone#: 30,5_ 32 O Z Address: 2% S+ U�; l 7 City: Via � i State: y L Zip: 31961 Qualifier Name: \1, c e A Hervi.�n�':Z q Phone#: State Certification or Registration #: CePC Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ � V0i Square/Linear Footage of Work: te: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Cap plumbing lines Specify color of color thru tile: Submittal Fee $ 1 C1 Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ _ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE L--:3c) z�� Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State Zi 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 oppr ved and a reinspection fee will be charged. Signature Signature OWNER or AGENT TRACTOR The foregoing instrum nt was acknowledged before me this day of �� O �A 20 by t ) \k r R .� who is personally known to me or who has pf.Qduced `i Y 1C r)s-r as identific tion a d who did take an oat;`1�\��';nY..... fro•. �! `•: $ a Pii Sign: ,. Print:L4f�Y1CA V`\ Y�`F. °�.eone.��+�,s�`�'�R�' Seal The foregoing instrument was acknowledged before me this day of 20 � � , by (JA �i'r� n�(! Z who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: 1� Print: n6 �: y�;!BClC,S1►�_..���� Seal: APPROVED BY �.T _ `� ��`<,�� Plans Examiner bpft old it M as Zoning Structural Review (Revised02/24/2014) Clerk LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS THAT, I, �, l'; �t,� (Owner), do by these presents hereby make, constitute and appoint for the period of twelve (12) months from execution herein, Christopher Block, General Manager of Habify, a/k/a Florida Building Performance, LLC, Miami, Florida, my true and lawful attorney -in -fact for me and in my name, place and stead, to sign permit applications on my behalf with Miami -Dade County Building Department and with all municipalities located therein, regarding the property located at ,i i} i i.1c j{rl' ,;e i fhafid, Florida, r _ Folio No. � �2;��)A, 2- ' 0; ;9,; I give and grant unto said attorney -in -fact, limited power and authority to do and perform the specific acts necessary or incident to the performance and execution of permit applications with Miami - Dade County Building Department and with all municipalities located therein, with power to do and perform the limited acts authorized hereby, as fully to all intents and purposes as I might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that said attorney -in -fact or his substitute shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, I C7 3!:2, Z (Owner), have hereunto set my hand and seal this day of ke%blew. , 20. Sealed and delivered in the presence of of Witness S,'� tr ` ignature Owner) Print WitneLName: � y� C. f SiiG� 1 Baal1 f u A"iiess Signature Print Witness Name: (11 �, 61r16( 1) STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) The foregoing instrument was acknowledged bPe me this / V day of �e(,em r'' 20A by (Owner). (Check one) [ ] He/She is personally k wn to the or N He/She has produced ras �kentirition. i NOTARY—PUB-LIC-STATV OF FL k[DA DESSALINES FRANCOIS At Large My COMMISSION # GG027034 Print, type or starnntis i§ oned Name of Notary Public: EXPIRES September 06, 2020 001787 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7197982 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES EAST SUNRISE PLUMBING INC RENEWAL SEPTEMBER 30, 2019 15075 SW 13 ST 7UNIT 7 7480385 Must be displayed at place of business MIAMI FL 33196 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED EAST SUNRISE PLUMBING INC 196 PLUMBING CONTRACTOR BY TAX COLLECTOR C/O VINCENT HERNANDEZ PRIES CFC1429502 $75.00 07/02/2018 Worker(s) 1 CREDITCARD-18-046210 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector ACQRF' CERTIFICATE OF LIABILITY INSURANCE DAT D/YYYY) � - o21v1 19/ s/2o1 s 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). PRODUCER CONTACT MARIA ELENA HERNANDEZ NAME: PAH/CNE Ext): (305)559-7873 (FAX No): (305)559-2237 Sunshine Insurance Agency 10061 SW 72 St E-MAIL sunins@bellsouth.net INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33173 INSURER A: COLONY INSURANCE COMPANY Phone (305)559-7873 Fax (305)559-2237 INSURED INSURER B : PROGRESSIVE INSURANCE COMPANY INSURER C : AmTrust North America Insurance Co.- EAST SUNRISE PLUMBING, INC INSURER D : 15075 SW 137 St # 7 ISU N RER E MIAMI FL 33196- 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 N UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A © COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE OCCUR Y Y 103 GL 0020436-01 10/12/2018 10/12/2019 EACH OCCURRENCE $ 1,000,000.00 'DAMAGE REM SES (Eaoccurrence)$ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL &ADVINJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO ❑ LOC JECT ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS -COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY a ANY AUTO OWNED SCHEDULED ❑ AUTOS ONLY © AUTOS ❑HIRED ❑ NON -OWNED AUTOS ONLY AUTOS ONLY ❑ ❑ Y 04200766-1 10/12/2018 10/12/2019 CEa a .,denISINGLE LIMIT $ 100,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N OFFICER/MEMBANY ER ECUTIVF EXCLUDED? —] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A TWC3766399 02/12/2019 02/12/2020 e STATUTE TH- ❑ R E.L. EACHACC ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE -POLICY LIMIT g 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Plumbing -Residential and Commercial. Blanket Additional Insured is automatic included in the General Liability policy when required in a written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) QF The ACORD name and logo are registered marks of ACORD DRIAR LICENSE CLASS E E -92-029-1 V CE, A HERNAoN'DEZ 15498 SW 172NO TER MAN. FL 33197-1361 DOS 01.29-1992 SEX SSUM 1246-2013 t49F - -Es 04--2072" SY_ OORS£ -' -4KACIM. 97-26-M15 �I 0 ■1 IAM RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Florida dpr 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 HERNANDEZ, VICENT ALBERTO EAST SUNRISE PLUMBING INC. 15488 SW 172ND TERR M IAM I FL 33187 LICENSE NUMBER: CFC1429502 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.