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PL-01-21-96BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC 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 6AN 1 3 2022 Fik 20c� � Master Permit No. RC iy zo 2 3 2 T Sub Permit No. ? L — o 1 2 i - I`L, ❑ ROOFING �EVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: \ O G '-:� M E (') . S J, c'd:� City: Miami Shores County: Miami Dade Zip: 3 3 � 3 (-y Folio/Parcel#: \ r — `3 `2c '� -- 0 Q 2.3 o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): a L)— C- Phone#: 3uS S 2-5- Address: C7 cs 0 71 V-% CAS A t-- -4- r q�' 715 S City: )OLk G-ice, State: 1' 1_ Zip: -3--3 ) 38 Tenant/Lessee Name: Email CONTRACTOR: Company Name: C--CJ k.lO/J-)a O S6i'S C-11peone#: Address: f i U E 4, i S� City: N SLA'.)f L,e Qcy t— State: Zip: —T- Qualifier Name: ZE�j L-P &r Phone#: State Certification or Registration #: C rrC- c kt'V'i 4 3( Certificate of Competency #: DESIGNER: Architect/Engineer: Address City: Phone#: State: Zip: Value of Work for this Permit: $ �IJ C) c? Square/Linear Footage of Work: Type of Work: ❑ Addition 21 Alteration ❑ New ❑ Repair/Replace ❑ emoliti Description of Work: Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ / f r- CCF $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this i ? -- day of 20 Z2L by E' � Csr � J :'s F'� � � w,�who i personally know to me or who has produced Signature U G CON RACTOR The foregoing instrument was acknowledged before me this day of J-)J' 20 �, by G(0 f20 t 6, 5 who i personally known tom as me or who has produced identification and'tho did take an oath. identification and who did take an oath. PoR NOTARY PUBL : _ NOTARY PUBLIC: ``t�`tliilNlllly/� ;Sign. cS aN�T0s +A Sign: o oER =a* • �y� �wF�'• Print: ' Print: C",� Seal: i y Can+missIm O GG 2731" Seal: � •.g � � z Expires February 12, 2029 ��Oii��'� BakrtlTMuB�OpoldoWySNvwN -•• ' . • 4� R� �y ' .� yi;''Pi••J',o'nded'.``��,y���0.0��0�\ STATEONX 1, APPROVED BY Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Permit Number: a l 96 Owner's Name (Fee Simple Title Holder): °m �_�-Y,r, ,.g f- LL L Phone: 3:15 ,.$ YY J 72S Owner's Address: a �-Aj r.y s z -VIC City: M .6--iM� i' �- State • L- Zip Code: 1 . Job Address (where work is being done): l c=t K �► c� City: Miami Shores State: Florida Zip Code: 3 3 13 c Contractor's Company Name: 4C o ,xnIn c,;� 12 er-�'r h� Phone : '-jc, �;? ( Address: 2.2. � L( (� � ���� Ply C.. City: t� 4- �-o �1-��._ State: � L — Zip Code: '33 o 5 L/ Qualifier's Name: i . `M , c�zli C 0 Y ru Lic. Number: C-F C ) y 2_ Gi,,,3 �. Architect/ Engineer of Record Name: Address: City: Describe Work: �M Phone:_ State: Zip Code: rv, io ca t n u 1 hereby certify that the work has been abandoned anti; or the contractnr/ architect !s unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature � ice---- � Signature Owner j Agent Contractor j Architect / Engineer The foregoing instrument was aka rowledged before me this day of � 2u 22, by � zr Yr) Who Is personally known to me or who has produced Notary Public,: Sign and Seal: as indentification. (III UY �1�R 14� 1'OHENQRY DEL RI Corn 6sIW # GG 2731" i�;fcar eoraw nw a�.cwwy s«� The foregoing instrument was aknowledeed before me this ' day ofJ� (p) .►Ar-20ZZ by M Who is personally known to me or who has produced as indentification. Notary Public: Sign and Seal ` "NQIA aVaREz MY COMMISSION # GG 238273 EXPIRES: September 3.2022 ?•:� ,• ' Bonded TAru Notary Pubk Under*Tbrs S.- RiDj Change of Contractor/Architect or Engineer Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795-2204 www.msvfl.gov A change of contractor, architect or engineer must be done under a permit revision .There is a 5110.00 charge for a change of c^ntractor. The owner x..�iill submit a Charge of Contractor Form completed with notarized signatures of both, owner and current contractor. If the signature of the current contractor cannot be obtained the owner must send a certified letter return receipt notifying the current contractor, architect or engineer the reason for the change .The owner must allow 10 business days for the contractor, architect or engineer notification before action is taken as required under section 8-13(4) of the Miami Dade County Code. A permit application must accompany the change of contractor form, with the information and signature of the new contractor and owner or owner agent as required under FS 713.135 (6)(a) .The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the current architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed, and shall comply with Florida administrative code 61G1-18.002 a�, 11062020-:iha.ngtibfCoatractor Form, Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC049431 ISSUED:06/06/2020 CERTIFIED PLUMBING CONTRACTOR ROJAS, EDWARDO/,- EDWARD RqAS KUMB�NCCORP RM LICENSED UNDER CHAPTER 489, PLORIDA STATUTES EXPIRATION DATE: AUGUST 31, 2022 ACORO® CERTIFICATE OF LIABILITY INSURANCE �.. DATE (MM/DD/YYYY) 01 /11 /2022 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 NAME: Lucia Estrella a/cNN Ext): (305) 226-8727 (aC, No): (305) 226-8767 ACCURATE GROUP E-MAIL accurate.certificates@gmai1.com ADDRESS: @gmai1.com 8300 West Fla ler, Suite 114 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA; EVA_NSTON INSURANCE COMPANY —� 35378 Miami FL 33144 _ INSURED INSURER B : INSURERC: _ Edward Rojas Plumbing Corp. INSURERD: 880 NE 111th St INSURER E : INSURER F : Biscayne Park FL 33161- 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. ILT R LTR TYPE OF INSURANCE IADDL SUBRr POLICY EFF POLICY EXP LIMITS � POLICY NUMBER � MM/DD MM/DD � X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �_ �� _ J CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) ._ $ 5,000 _ 'L AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1,000,000 $ 2,000,000POLICY A 3AA497005 08/06/2021 08/06/2022 PRO-�i- F71LJECT LOC PRODUCTSCOMP/OPAGG $ 2,000,000 —uOTHER: $ AUTOMOBILE LIABILITY r�'.. ANY AUTO OWNED SCHEDULED AUTOS ONLY HIRED I NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE I (Per accident) $ $ UMBRELLA LIAB OCCUR, EXCESS LIA� CLAIMS MADE' EACH OCCURRENCE $ AGGREGATE $ _ DEDD� RETENTION $ _ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE E.L. EACH ACCIDENT $ — —-- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ led i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 Additional Remarks Schedule may be attached if more ace is required) ( � Y P Q ) Plumbing contractor License # CFC049431 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores building Department 10050 Northeast 2nd Ave Miami Shores 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 FL 33138 &azp ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD jlWy pATRONIS STATE OF FLORIDA CHIEF FINANCIAL OFFICER ANCIAL, SERtACIES DEPARTMENT OF FIN DIVISION OF F WORKERS' COMPENSATION LAW S COMPENSATION FICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKER CERTI CONSTRUCTION INDUSTRY EXEMPTION Etas elected tolbe exempt from Florida Workers' C This certifies that the individual risted below EFFECTIVE DATE: 7/10/2021 PERSON: EDWARDO ROJAS FEIN: 453073611 a USINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 880 NE 11 ITH ST MAMI FL 33161 rlw�� ExPIRATION DATE: 7110/2023 EMAIL: LICENSES114 IMPORTANT Pursuant to subsection 440.05(14). F.S., an officer of a 00r1=Mttun who 01003 09WTVW iti,s s�!tori, may not recover benefits or wmpensftm under this chapter. Purwant to subseCl1w 4401 ijrvder subserlk7r (31 "t apply only to the oorporaW ofxvr named on the V10408 Of el=6611 is trade listed ors the rroize of ejectton to be exempt Pursuant to subsection 440,,M(13), F S., nnikAw Of I 1<j,pr' V shall be stto revocation If, at any lfriqe after the fAing of the r4tca W the *Suarul-a dlwa 0 -,n conqcr meets the rawirements of "a section for tasuanceof a certificlitite, The da 6hM RCfiO -,el on the cs,rljfi(-Ale 10 most the requirarrimft of "S S n, U -2 rS-' -DIINC-252 CERTIFICATE OF ELECTION TO BE EXEWPT RED SMJW-13-