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PL-01-21-20, 9333 N Miami AveMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9333 N MIAMI AVE, Miami Shores, FL 33150 1132060130350 Contacts PATRICIA N PENICHEIRO Owner Lemon City Applicant 9333 N MIAMI AVE, Miami Shores, FL 33150 Kamau Powell Other: 9167965773 tpenicheiro@yahoo.com 3634 Grand AVE, Miami, FL 33133 kpowell@lemoncity.com ELITE INNOVATION CONSTRUCTION INC Contractor ELROD PHILLIPS Business: 3055278303 ERROLPOLANCO@GMAIL.COM Description: 5 PLUMBING FIXTURES FOR ROOM ADDITION Valuation: $ 3,500.00 Ins ection Re c uests: Total Sq Feet: 1,110.00 Q Fees Amount Application Fee - Other $50.00 CCF $2.40 Change of Contractor $110.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $72.50 Scanning Fee $3.00 Technology Fee $3.06 Total: $245.76 Payments Date Paid Amt Paid Total Fees $245.76 Credit Card 01/06/2021 $135.76 Credit Card 03/25/2022 $110.00 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws r ulating co fr eEiQWnd zing. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date March 25, 2022 Page 2 of 2 Miami Shores Village R.ECEIV F-r-) 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 QPLUMBING [:]MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: w ► r FBC 20 Master Permit No. `P� 0 - Z 0 —I ca Sub Permit No. l_ 0 V% i - M ❑ REVISION ❑ EXTENSION ❑RENEWAL ,IV CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �r r"� �t" :�E �� ' t> Phone#:I (P 5�71 Address: iV'l iA ►wl J4-V e. City: M' 6tyyo State: �L� Zip: Tenant/Lessee Name: Phone#: Email: � 'l F v o , C`fi ►„� CONTRACTOR: Company Name: ELITE INNOVATION CONSTRUCTION INC Phone#: 3055289436 Address: 2400 NW 98 ST City: MIAMI State: FL Zip: 33147 Qualifier Name: ELROD PHILLIPS JR Phone#: 3055289436 State Certification or Registration #: CFC1431114 Certificate of Competency #: DESIGNER: Architect/Engineer: +ke;t-c) Phone#: Address City: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: V -I ww'.10 Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ Zip: S' ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ (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 reinspection fee will be charged. Signature _ Signature _z j7 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 2-2— day of YCI-,— 20 2 7- by Gn 1 C iGi who is personally known to me or who has produced �r ►�l Cx- L-JCR-*-� as The foregoing instrument was acknowledged before me this 22 day of MAR 20 22 by ELROD PHILLIPS who is personally known to me or who has produced FLDL identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: Sign: f�--- i Print: 1 o AMIL AH PHILLIPS T W C.�� Pri Seal: ��Nuwq'' j� N�tlt NathkiPafrNN Seal:"' JAMILAH PHILLIPS ?: �,' Notary Public • State of Florida r�.o1��r 'cr; Comm.:HH 159435 V �� Commission a GG 295734 9 �• i — 7 2i)25 of? My Comm. Expires Jan 28. 2023 National Notary Assn. � •.'� �� ***********X411 1'h�* Bonded through ****************** APPROVED BY Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Permit Number: T L" 0 1-2-1-2-0 Owner's Name (Fee Simple Title Holder): �,a� r��+4 ��.�tt Phone: Owner's Address: 0 ttAt "e City: RTi4ryyV St-coQc 5 State : F-t- Zip Code: Job Address (where work is being done): q 3 3 3 t,) t a✓N,,, Ave - City: Miami Shores State: —Florida Zip Code: Contractor's Company Name: MA Cm Phone : Address: l 63 5 3 S w Soosa-wooer W s►j City: State: tom'- Zip Code: 34'I' S'la Qualifier's Name : J .,.ZTS N v r- Lic. Number: Lt=G 05G 9 2-0 Architect/ Engineer of Record Name: �A ArSob ►N i A,-s Arur Phone: 3b9-91g-g49S Address: 2yoa N0 gar'= �L City: t>0 ��t- State: !' L Zip Code: Describe Work: �j� o-� 3-s ..� G. W o a,.V-- we- Imo , I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores -. armless of all legal involvement. i Signature __� ____ Signature _ er % Agent Contra or / Archi ct / Engineer The foregoing instrument was aknowledged before me thisO -> day of 2Q2�, by N Imo( !%>7PJ5;y ►G.S Who Is personally known to me or who has produced -r-Z- tU-, ux-0ew-jsrs as indentification. Notary Public: Sign and Seal:_ •'i�rn $INDIA ALVAREZ Q MY COMMISSION # GG 238273 ;P EXPIRES: September 3, 2022 ,OF F�q •• Bonded TtYu Noy Polk Underwr teB The foregoing instrument was aknowledged before me this V d y of 20 , by Who is personally known to me or who has produced as indentification. Notary Public: Sign and Seal: thWep MW PWM M_ ' CommAH M435 • Expires: Sept.27,2025 ► �� Notary Public • Ste* of FWW8 Ron DeSantis, Governor Julie I. Brown, Secretary MA bp STATE OF FLORIDA dr DEPARTMENT OF`BUSINESS AND PROFESSIONAL`REGULATION 00 Do not alter this document in any form. 0 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 7326703 BUSINESS NAMEILOCATION ELITE INNOVATION CONSTRUCTION INC 2400 NW 98TH ST MIAMI, FL 33147-2136 OWNER ELITE INNOVATION CONSTRUGI]ON INC nin Ft Rnn Pi,.m I lPq JR 01 IAI IFIPR Worker(s) I RECEIPT NO. RENEWAL 7618265 SEC, TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1431114 EXPIRES SEPTEMBER 30, 2022 Must be displayed at mace of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 0911512021 INT.,21-384417 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 See 80-276, iMIAM for more information, visit w", oliont[do'k. a lox,0114ow '4� bF CERTIFICATE OF LIABIUITY INSURANCE DATE`""°°"""' 01/2412022 THIS CERTIFICATE 1S 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: ,R the certificate holder is an ADDITIONAL INSURED, the policypes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 ALL CITY INSURANCE INC. 1400 NW 107th AVE SUITE 210 DORAL FL 33172- caNrAcr INGRID HERRERA .l+A FAX PHONE 3 9431 m 30$ 36.6797 ADM= GMAt LCITYINS.COM INSURER(SIAFFOMDINGCOVERAGE N=# INSURER A :State National insurance Company. Inc. 12831 INSURED ELITE INNOVATION CONSTRUCTION INC 24M NW 98TH ST. Miami FL 33147- INSURER a :WESTERN WORLD INSURANCE C 13196 INSURER c : INSURER o : USURER E : 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 CLANKS. TYPE OF INSURANCEADDUSUBR N RMEMULG PO IC11 EFF POLICY EV LI MTS X OCCUR � X PPS8164N SM12021 5/21/2022 occuRRENCE s 1,�.�CLAIMS4IADE 10 PRELIMS CIA QQMffw=L—DAMAGE TO RENTEDS 100,000MEDEXP are 5000 ZGEMML PERSONAL E ADV INJURY S 1,000,000 GREGATE LIMIT APPLIES PER: ICY Q JECTPRO- LOC GENERALAGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG S 2r�0A00 s AUTOMOBILE LIABILITY ANY AUTO �f OWNED SCHEDULED H� ONLY NOON O RIVED AUTOSONLY AUTOS ONLY j i COMBINED SINGLE LIMIT S Booty NAM (Per person) S SOOILY RAJURY (Pw aorldwq s PROPERTY DAMAGE s T UMBRELLA LAB EIIGESS LBAB f OCCUR { CLAIMS -MADE EACH OCCURRENCE A .GREGATE �L� YIN CUTIVE f--1 OFF10ER01AEMBER EXCLUDED? (Mandatary In NHi I eNaaribeunder NIA 4HHWK4P-00-WC 11=022 1124I2023 X �RorH. E.LEACH ACCIDENT 3 1,000.000 E.L DISEASE - EA 9ft2M S 1,000,000 E.L LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES- (ACORD 101. AddidonN Rwnwb SabWub, may be supdod If own spew In rwAd" Certificate holder is included as an additional Insured with respects to general liability when required by written cost wL License: CFC1431114 MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES AI N1W 17 O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FL 33136- AUTHORQEDREPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9333 N MIAMI AVE, Miami Shores, FL 33150 1132060130350 Contacts PATRICIA N PENICHEIRO Owner Lemon City Applicant 9333 N MIAMI AVE, Miami Shores, FL 33150 Kamau Powell Other: 9167965773 tpenicheiro@yahoo.com 3634 Grand AVE, Miami, FL 33133 kpowell@lemoncity.com MG PLUMBING & SPRINKLER SERVICE Contractor JAMES WARREN NYCUM 1265 NW 203 ST, MIAMI, FL 33169 Business: 3055259236 Inspection Requests: Description: 5 PLUMBING FIXTURES FOR ROOM ADDITION Valuation: $ 3,500.00 Total Sq Feet: 1,110.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $72.50 Scanning Fee $3.00 Technology Fee $3.06 Total: $135.76 Payments Date Paid Amt Paid Total Fees $135.76 Credit Card 01/06/2021 $135.76 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore I arise the above named contractor to do the work stated. Authorized Signature: Owner / Agent Date January 06, 2021 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RIECEIVED FBC 201 �i tilk, BUILDING Master Permit No. i'C. 0:?-- 20 "16bl PERMIT APPLICATION Sub Permit No. PL.- DI -2t-20 ❑BUILDING [ ELECTRIC ❑ ROOFING ❑ REVISION [ EXTENSION ❑RENEWAL [�UMBING ❑ MECHANICAL [PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP �V CONTRACTOR DRAWINGS JOB ADDRESS: 9 331 0 M t Gt1N� �� Ay L City: Miami Shores �^ County:3 Miami Dade zip: 51 , Folio/Parcel#: j 3—LO(D 01 30'8 SO Is the Building Historically Designated: Yes NO Occupancy Type: S706 Load: Construction Type: Lg5 Flood Zone: BFE: FFE: It OWNER: Name (Fee Simple Titleholder): � � � 4L • a 9C0% t Gee Ory Phone#: V ` 3 Address: 3 33 �`'� �� Q+r••: • 1�•✓t City: t 0.s%A-j S�df State: ` Zip: 3 3 5y Tenant/Lessee Name: Phone#: Email: City•. —AC;W_r- Qdlow State: State Certification or Registration #: of Competency #: DESIGNER: Architect/Engineer: _a S�eltbw.OS Phone#: ?$CO " ZIS— 636' 3'313� Address: 331S 1,19 ,.� �1 �Jc. City: PA� � � State: Zip•. Value of Work for this Permit: $y�i *-D Square/Linear Footage of Work: Type of Work: A Addition ❑ Alteration ❑ New ❑Repair/Replace ElDemolition Description of Work: 5 A u a�'6 t 0%& Ara.. h4eeS '6r mom... ^4j slsv Specify color of color thru tile: Submittal Fee $, Scanning Fee $ Technology Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ 1 CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) 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 c ified copy of the recorded notice of commencement must be posted at the job site for the first ' ch o en (7j s after the building permit is issued. In the absence of such posted notice, the inspectio ill notnea ved nd a rein ecti ee will be charged. Signature( OWNER AGENT The foregoing instrument was acknowledged before me this � day of �cxn� 20 -X) , by C^ `",I cr &;-CA.-A n}, wh'o is rsonally know me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature fV CONTRACTOR The foregoing instrument was acknowledged before me this s day of 20 .;� l J by Jarc.r Nt �t�tvw who is onally know me or who has produced as identification and who did take an oath. NOTARY PUBLIC: G Sign: Sign: Print: Print: .otv.PUB c NATELEGE N NATELEGE NATA,K1 P^V,-. Seal: _. ' MY COMMISSION # GG 146583 2nd 2021 Seal: ��< MY C;G1�N EXPIRES: September i Xuli ,umber o c Undc^e�r'ter F c Bonded Th u NcGP public �w = V - C ru hct, "PUblic Lrc_ APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review Zoning Clerk