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PL-07-21-1851, 162 NW 108th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 162 NW 108TH ST, Miami Shores, FL 33168 1121360100060 Contacts Jovens Degage Owner MG PLUMBING & SPRINKLER SERVICE Contractor 162 NW 108 ST, Miami Shores, 33168 JAMES WARREN NYCUM Mobile: 3058499102 JOVENS.DEGAGE@YAHOO.COM 1265 NW 203 ST, MIAMI , FL 33169 Business: 3055259236 Inspection Requests: Description: PLUMBING FOR ADDITION AS PER PLANS Valuation: $ 4,500.00 Total Sq Feet: 410.00,' ..j Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.36 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $107.50 Scanning Fee $3.00 Technology Fee $3.94 Total: $172.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $172.80 Check # 3269 07/16/2021 $172.80 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize pe Above named contractor to do the work stated. Authorized Signature: Owner 1 Applicant / Contractor / Agent Date July 16, 2021 Page 2 of 2 Miami Shores Village RECEIVED Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 JUL 16 2021 BY:� FBC 20 20 BUILDING Master Permit No. R C -0 9 -,-)LO PERMIT APPLICATION Sub Permit No. OL- n -;'I` I S ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL UD�LUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I G a NW i C5$ . S-T- City: Miami Shores County: Miami Dade zip: Folio/Parcel#: 11 aL t _� id O (O d O C. d Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): O�P1CnC�G Phone#: C3 oS J'VeO S b�t C'(r G i oa Address: i N iN LOS 5 City: /N oLVK s Sao ct)5 State: r zip: 33 W3 Tenant/Lessee Name: i Email: % E°V,\' CONTRACTOR: Company Na J— Z3S`. Address: /Z&5 Al Ind ?ZL4 � City: J Get r sic Cf' State: ��- ' Zip: ,33 /' Qualifier Name_7A, -1,E5r CI kin!`Z Phone#: 3 S —r123G State Certification or Registration #: CFd D,T4, c 44D Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ �0. G' Co Square/Linear Footage of Work: Type of Work: L2i Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $_ DBPR $ Zip: ❑ 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 Zip City State 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__ '1-O-Cf '"' OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this C 5�� day of 1uA / 20 cK k by Jov E v1 S c, c �c. ho is persona y J #o me or who has produced A// - as The foregoing instrument was acknowledged before me this day of 20 Z by :am'ao 6c/ who io ersonall to me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: i%f�L �Y�'l�/�' Sign: Print: R_L-"-lr` 1 -1G'yytCk Print:WILLIAMS GOROON Seal: Seal: =ot .•.*cam MY COMMISSION #GG105913 u+" Notary Public State of Flonda EXPIRES: AUG 08, 2021 ?4' Ruth Thomas a Bonded through 1st State Insurance My Commission GG 156700 an Sxpiras 11/12/2021 *********0 OPI 0******************s*************s********************************* APPROVED BY Plans Examiner Structural Review Zoning (Revised02/24/2014) Clerk Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary IMAMNLACLIV OF D"CIMICCC AND PROFESSIONAL REGULATION EXPIRATION DATE: AUGUST 31,2022 Always verify licenses online at MyFloridaljcensexom 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 M —r1 MGPLU-1 ACORNi7- �,,,,_,..- CERTIFICATE OF LIABILITY INSURANCE OP ID* LL DATE (MMIDONYYY) 10/13/2020 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 endorsements . PRODUCER 954-440-2800 The John Galt Insurance Agency 3303 W Commercial Blvd, 200 Ft. Lauderdale, FL 33309 Graham Troyer . cT Graham Troyer PHONE 954-440-2800 FAX 954-440-2833 J,wc, No. Este: _ _ _iArc, No) _ E-MAIL . Commerciaohalt.com %jn� ADDRESS _ INSURER(S) AFFORDING COVERAGE _ —__ NAIL #-- INSURER A: Kinsale Insurance Company 38920 INSURED f 1265PNW 203rd s3p�rit Sprinkler Service Inc. Miami, FL 33169 INSURER B : Mercury Insurance Company 03527 INSURER c : Technology Insurance Company 42376 -- INSURER D INSURER E : INSURER F : CnVFRAPFC CFRTIFI(_ATF NI11#RF17- RFVI31nN NIINIRFR- 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 TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXPLTR iMMIDOnnnm LIMITS A X COMMERCIAL GENERAL LWBLITY CLAIMS -MADE OCCUR 0100073642-2 09/25/2020 09125/2021 EACH OCCURRENCE 11000,000 DAMAGESORENTED 100,000 MED EXP (Any one on EXluded PERSONAL & ADV INJURY 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ JET D LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2'000'000 B AUTOMOBILE LIABILITY ANY AUTO _ OWNED SCHEDULED AUTOS ONLY X AUTOS AUTOS ONLY X AUTOS ONLY Blkt All Bikt WOS BAM000014572 09/23/2020 09/23/2021 COMBINED SINGLE LIMIT $ 500,000 BODILY INJURY (_Per person) BODILY INJURY Per accident BODILY X PerOeoEpdenI $ X __ PIP 10,000 UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ C ELRCOMPENSATION AND MPOYESI YJN I v l OFFICEOR/MEMBER�EXCCLUD EXCLUDED? (Mandatory In NH) � � I If yes, describe undeTIONS. elDESCRIPTION OF NIA TWC3907088 EXEMPT: E GORDON/M GORDON 10/12/2020 10/12/2021 X PERTUT, OTH- R E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 DISEASE Y LIMIT S 11000,000 f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks schedule, may be attached H more space is required) Residential and Commercial Plumbing Contractor, License Number CFC056920 Village of Miami Shores 10050 NE 2nd Avenue 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 REPRESE14TATFVE ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • 1 681-3152 IMPORT 0 mmyff L.M. HUMBERT 1561 N.W. 153rd. STREET OPA LOCKA, FLORIDA 33054 Local Business Tex Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL— 00 NOT PAY RECEIPT NO. 5871935 RENENAL BUSINESS N^Msvl 0Q^T10N 6124368 MG PLUMBING & SPRINKLER SERVICE INC 1266 NW 203RD ST .r MIAMI GARDENS, FL 33169 Tj EXPIRES SEPTEMBER 30, 2021 Must be displayed at Pleee Of bufinass Pursuant to CountV COda Chapter.8A — Art.9 & 10 OWNER SEC. TYPE OF SUBIN&SS PAYMENT RECEIVED MG PLUMBING & SPRINKLER SER 196 PLUMBING BY TAX COLIACTOR INC CONTRACTOR 45.00 09iO3/2020 Worker(s) 1 CFC055920 0220-20_005162 Th1e LOGOS s„ataeee T� 1104e4pa.slr o.n41s Pwvmnm e16a Least Rusisas! Tax. The Aaa v If no a km,POn1S , Or a cadlecsHw Of the Ilatrar s" MMWM to do 11WOO s. Holder must csmPw + 4" 1 Of nu19lnrnnu 1 replatm laws and requiresnob w" «Mw to ft buelaws. The RECEIPT NO. above me# be db#*ad oo all eonaaerelel wbkbs - Miwi-Dads Cods Sm Ir-M on For mo/s bdormat K r'srs