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PL-06-22-1398Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 55 NE 94TH ST, Miami Shores, FL 33138 Contacts FREDERIC SNITZER Owner 55 NE 94 ST, MIAMI SHORES, FL 33138 Permit NO.: PL-06-22-1398 Permit Type: Plumbing - Residential Work Classification: New Permit Stotus: Approved Issue Date:06/08/2022 Expiration: 12/08/2022 Parcel Number 1132060130560 OVIDIO J PEREZ 135 37 5T, HIALEAH, FL 33013 Mobile: 7863577232 Other: 3055580596 Description: NATURAL GAS LINE Valuation: $ 4,400.00 Total 5q Feet. 0.00 Fees Amount Application Fee -Other $50.00 CCF $3.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.00 Notary Fee $5.00 Permit Fee (Manual) $154.00 Scanning Fee $6.00 Technology Fee (Manual) $3.86 Total: $226.86 TRIPLEJPLUMBING@GMAIL.COM Inspection Requests: 305-762-4949 Payments Date Paid Amt Paid Total Fees $226.86 Credit Card 06/02/2022 $50.00 Credit Card 06/08/2022 $176.86 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 re7ulati s n and the foregoing information is accurate and that all work will be done in compliance with all applicable laws more, I authorize the above named contractor to do the work stated. / Applicant / Contractor I Agent Date June 08, 2022 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING [2'LUMBING ❑ ELECTRIC ❑ MECHANICAL JOB ADDRESS: S'S &) 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 ❑ ROOFING ❑PUBLIC WORKS O/ L4 A RECEIVED JUN 0 2 20 BY: FBC 20 Master Permit No. ; --�i-ZL -/j ✓J� Sub Permit No. Y L 0L0_9'^� '_1�� D �i ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Mip/4i ,. Miami Shores-__`-) County: Miami Dade Zip: 33 is 6 Folio/Parcel#: Is the Building Historically Designated: Yes NO - Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: 30�_ 5/ — City: 114, 7ndr` .ShOras State: Tenant/Lessee Name: %3F, Email: //Dj� T J�y�h/✓6� G/t/ft/L CO� CONTRACTOR: Company Name: l /✓" p/r f ('��/r, G,.�y �l�tt�c t1C Phone#: ! .357• 733�. Address: 3 City: L&d/fvh State: /'w Zip: fl?O/'� Qualifier Name: ��/il:n :- ��fZ Phone#:'_ � 357-703.�_ State Certification or Registration #: Certificate of Competency #: C:0C l qg `?O t� DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration IJ New ❑ Repair/Replace ❑ Demolition Description of Work: 04 k,ro L Gx)s L,nc- 1-iyJu R IF-7- '6, Specify color of color thru tile: Submittal Fee $ ,fib, R Permit Fee $ 611—IL" CCF $ 3 . V�(t/ CO/Cc $ Scanning Fee $%%�� {� Radon Fee $DBPR $ '�' V Notary $ Technology Fee $ l// Training/Education Fee $ I • Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $Q 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 low 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. The foregoing ihst C''( day of r A . C� me or who has produced identification and who NOTARY PUBLIC: Print: Seal: ++s+ssssss or AGENT acknowledged before me this 'te— 20 22_ by who is personally known to Vi�c�VO f�CQfISE as Signatu The foregoing instrument was acknowledged before me this /,_�rrday 000f i (i� 20 % Z , by U U! of who is personally known known to me or who has produced Dri V-eyI Oe I as did take an oath. identification and who did take an oath. (Revised02/24/2014) Structural Review Clerk RECEIVED t'ce�,tP.rIC 5,>��2e� 55 u E 9y� 5T f-L*,Z,, CW-Y-es, (71 33132 3bs' Vi- $9'710 JUN 0 2 ZOZZ BY: Miami Shores Village Building Department Zoning Dept. Date Building Dept• Date Subject to compliance with all Federal, State and County rules and regulations. Permit# (� _O,_ — ZJ a �E,41 _..: 204 O.RI�P -7$1,-357- -7.>3 a C.:cencr- C'FC 14;ROBO CITY COPY �trG�v s. � " / l3Tt) aBI�ODO GenCre•rp� eJ a �E� ro;cb I..SM 90 Tr 4� o Q,Q ymQ� 1'!y "VALlwc Okol bmv✓d 4" t>las-),G uneecG a��d ¢oa•4 r� ��d� coa , Ran Desantis. Go C.., Halsey Bcshwm. Secretary f-lrlida .. i 1W STATE OF FLORIDA 4" DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES PEM, OVID10 J TRIPLE J PLUMBING SERVICES, LLC 135 EAST 37TH STREET HIALEAH FL33013 LICENSE NUMBER_CFC1429080 D(PIRATION DATE: AUGUST 31, 202.2 Always verify licenses online at MyRoridaLicense 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 005821 Local Business Tax Miami-DadeReceipt County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 7173932 Bt1MSSNAMWrAMON TRIPLE J PLUMBING SERVICES LLC 135 E 37TH ST HIALEAH FL 33013 owmm TOLE PIDWING SEIMCIS LLC C/O PEE O010 J Worker(s) RECEIPT No. RENEWAL 7453116 R ■ SEC. TYPE OF BOS@I[ = 196 PLUMBING CONTRACTOR CFC1429080 LlBlr EXPIRES SEPTEMBER 30, 2022 Must be displayed at place of business. Pursuant to County Code Chapter BA - Art 9 & 10 PAYAM MUMD BYTAX COLL=8 $45.00 07/30/2021 CHECK21 21-067257 This Local Business Tax Receipt only confirms paymnent of the Local Business Tax. The Receipt Is not a license, permit, or a certification of the holders qualifications, to do business. Holdermust comply with any governmental or aaugavertnental regulatory laws and reguirementswhich apply to the business The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec go-=. For more iaferr orlon, visit www mfanmidade garltmcc IbMr ,to CERTIFICATE OF LIABILITY INSURANCE I .-1- gorrrrl 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 PISURERISI. AUTHORIZED MPORTANT: N thew cerUbcate ITolder It an ADDITIONAL INSURED, Ulew pollcyfasl must haea ADDITIONAL INSURED pravNions oI bee andaned. H SUBROGATION IS WAIVED, wbocl to Mo to.. and candifions of the policy. certain policies may rament an andorsamani A statamant on reomcm Custom ConmcWan)uralcD. LLC PO Boo 2389 GiICM INSURED Trill! J Plumbng SarVYAS LLC 135 L.m 17M St AZ e5___ P..W. Ra1c11JI Gb:cn rWnGoxWe s�L_L8flB11;;2_d5') .wcllo 1806j274 7438 �! �3. Inlo�'cusvncueraclusimumlrc.con IFSLRMIYI Llra107NC [DYIRI\F< MNCS NsumKA: PREFERRED CONTRACTORS INSJRANCE CC 1249' NSYRR e: wSURR C: NsulmRD NSURRa 7H15 5 TO CERTIFY THAT tB POLICIES OF INSURANCE LISIEC BELUA -W'eE BEEN ISS.F_D TO THE INSLREL NA C MOVE FCR THE P0.•=l' PERIOD INCCAIED. NOTl%'THST-IXNG kNY REOb RSIWNT TEfCd OR CONDI-ON-OF ,ANY CONTRA-1 OR OTHER DOCUMENT W TH �v SPECI 10 WHICH THIS CEPTIFlCATE LIAY BE SSUED OR IAAv c RTAN THE IN%RAV_E ArzC LO B" THE P]UCIES DESCRIlED HEN£IN IS SLBJECI 10 ALL THE TEWAS. EXLLUSICNSA^D CCN011-0115 C<SUCH POLICIES LM1115 SHC?rA NW%'NAtiEB£ENR_PG.lOEOPAICCLJYHAS 'GR Aett HOa POLCY Ere 3'KICYIJP .IB.�• fTR arIbUUR[ .Mp.A]IO. POLICY XSMpI .INNND'YYYYI..IY00'TVITJ. LY313 X wAWexaL eeRRAL LunuIY GLcr u_Luxr•nrI s '000,000 50.Due Nut%, Nry,•N•.m s 5000 A X X PCA5041 PC42923L Cm10'2022 C4^0r2021 rLNw\u • a_�: ru.ro s • 000,000 :Am auueLLArL .Ivr AY._n..r _r. :crvLxu m:u<r�%:L s 2OW.000 X ,coc. I'llr u 'xD_o.l _.::uw•.cY.:.- 3 2060.000 cL �UVbrl[� :II'1L LIA 1 f AVYOIIDNIa LY1aLIT' SI.uYru, NIV NJr[i a'.LLY'.WJNY Yrr.rrv. 1 '\'11LU U q;,ULY tWxY'Yu uurul S Nl'.�•_�N.Y L_��U_LL N2.: WAVAtr Lx1Y U4L42 f . NJ'�S JI.Y _�J. V\L• uruWUl. 3 `_UIRCLLALMa_—' �.__F G4CX VCLV NSSW:L 3 tam 1. f NpRL1N CDYRNSa noe .: YLn 1_. 4IO L1/LnY[IN'WNIIArTY V,N 'WI[ [ll }r,Y IV<'_'1'IbL W'll'NnKRL%Li J"':L x A FYI SYNLFCL'DLO' GL G.LLN.V;CI."GNI 1 IYMrtlYury ,"e MranNll [L 4:LJy[ [AtVYLi:YIL S _11,�4•'lu'Vl'S :TLCLI V\t:•I:x _ ,.L L•:LaJL I`A1.-L. F'I'.I SLSCNPTgM p W 1M11CN3. LOCAtgN31 VINCttS IACOM lal, AWpovl lunnla %MUY nu/ b. tlYeFp /ewe rp✓.+n ny/.CI N OLDER NAMED ADDITIONAL INSURED COVERAGE APP'J6S IN FLORIDA FOR 'WORK ON PRIVATE UNITS ONLY CERTIFICATE HOLDER than, Shcrls Vllago Hall 3.0dIm aecarmam I C050 NE 2 AYc \ban, Shcr!) Flarim 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CNICELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 f2016M31 Thew ACORD name and logo are registered marks of ACORD Kim Haley COI-MIAMI SHORES May 31, 2022 at 11:12:21 AM TRIPLEJPLUMBING@gmail.com See attached. Thank you. Kimberley Haley Custom Contractors lnsurance LLC Monday thru Friday 7AM to 3PM AZ time 0 JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW " CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 1002020 PERSON: OVIDIO J PERF7 FEIN: 464734704 BUSINESS NAME AND ADDRESS: TRIPLE J PLUMBING SERVICES, LLC 135 EAST 37 ST HIALEAH, FL33013 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers EXPIRATION DATE: 10/6/2022 EMAIL: TRIPLEJPLUMBINGC@GMAILCOM IMPORTANT: Pursuant to subsection 440.0.5(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13). F.S., notices of election to be exempt and certificates of election to be exempt shall be Subject to revocation if, at any time after the filing Of the notice or the Issuance of the certificate, the person named on the notice or certilicate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01202576 QUESTIONS? (850) 413-1609