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RC-01-22-184Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: RC-01-22-184 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved Issue Date: 06/27/2022 1 Expiration:07/25/2022 Location Address Parcel Number 117 NE 95TH ST, Miami Shores, FL 33138 1132060132730 Contacts 117 NE FAMILY VENTURES LLC Owner GB4 ASSOCIATES LLC Contractor Michael Pena GONZALO GOMEZ 117 95th ST, Miami Shores, FL 33138 Mobile: 7863142353 MIKESAILY@COMCAST.NET Mobile: 7864513862 GB4COMPANY@GMAIL.COM Description: REPLACE KITCHWEN FIXTURES AND CABINETS Valuation: $ 40,000.00 Inspection Requests REPLACE BATHROOM FIXTURES (, STUCCO EXTERIOR OF 305-762-4949 HOUSE; INTERIOR EXTERIOR PAINT, REFINISH ALL WOOD Total Sq Feet: 0.00 FLOORS Fees Amount Application Fee - Other $50.00 CCF $24.00 Certificte of Completion for Single Fam $50.00 and Duplex DBPR Fee $18.00 DCA Fee $12.00 Education Surcharge $8.00 Permit Fee $1,150.00 Scanning Fee $9.00 Technology Fee $30.00 Total: $1,351.00 Payments Date Paid Amt Paid Total Fees $1,351.00 Credit Card 06/27/2022 $1,301.00 Credit Card 01/25/2022 $50.00 Amount Due: $0.00 B inIcep rtment Copy In n iderasuance to me of this permit,I agree to perform the work covered hereunder in compliance wRh all ordinances and regulations pe ingthstrctonformitywith the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Vill ge. In apermit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate pe its re rLECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent June 27, Date Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION FE-IBUILDING ❑ ELECTRIC ❑ ROOFING PHMOTM� OAN 25 2022 Iluull FBC 20 2O ' Master Permit No.�i(` -- Q� � V 2 z - Sub Permit ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [-]MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 117 NE 95th St City MiamlShores County: Miami Dade Zip: Folio/Parcel#: 11-3206-013-2730 Is the Building Historically Designated: Yes NO X ` Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):117 NE FAMILY VENTURES LLC Phone#:786.314.2353 ,,, Aa. 6115 MIRAMAR PKVVY. A City: MIRAMAR State: FL Zip: 33023 Tenant/Lessee Name: Phone#:786.314.2353 Email: MIKESAILY@COMCAST.NET CONTRACTOR: Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration M Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State:Zip: Value of Work for this Permit:$ C.l�i- Square/Linear Footage of Work: TypeofWork: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Replace Kitchen Fixures and Cabinets (NG.9WGk4QaIwer*, ) Replace Bathroom fixtures( Stucco Exterior of the house Interior/Exterior Pai t ;Refinish all wood floors. Spe f y color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 13 01 • 00 (Rmised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City Si 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:GWMENCEMENT." Notice to Applica t: a condi 'on to he issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good ith at a co of th notice of commencement and construction lien law brochure will be delivered to the person whose property is ubje to att hment. Iso, o certified copy of the recorded notice of commencement must be posted at the job site for the first inspe ion hich ccurs sev n (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not oved and a rei spection fee will be charged. The foregoinginst day of me or who has produced ER or AGENT acknowledged before me this 20 **) i . by who is personally known to identification and who did take an oath. NOTARY PUB Sign: Print: Seal: ****+++++++**** APPROVED BY (Reviwd02/24/2014) S�Z0,f ended V 9,�^ ?eblic U�da �Fi' Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of as me or who has produced 20 by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 611 SI (l Plans Examiner Structural Review as Zoning Clerk Detail by Entity Name Page 1 of 2 Florida DeE; Irtment of Slate Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company 117 NE FAMILY VENTURES LLC Filing Information Document Number L21000385701 FEI/EIN Number NONE Date Filed 08/30/2021 Effective Date 08/27/2021 State FL Status ACTIVE Principal Address 6115 MIRAMAR PKWY UNIT A MIRAMAR, FL 33023 Mailing Address 6115 MIRAMAR PKWY STE A MIRAMAR, FL 33023 Registered Agent Name & Address PENA, MICHAEL 6115 MIRAMAR PKWY UNITA MIRAMAR, FL 33023 Authorized Person(s) Detail Name & Address Title MGR PENA, MICHAEL 6115 MIRAMAR PKWY, , UNIT A MIRAMAR, FL 33023 Annual Reports No Annual Reports Filed Document Images 0!j 0tZ021 -- Florida rff eL Liability, View image in PDF format DIVISION OF CORPGRFTIONS https:Hsearch.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 1 /25/2022 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) 7624949 BUILDING PERMIT APPLICATION ABUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS FBC 20 c{I Master Permit No. \',C— Sub Permit PQ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: wl N e V S S- City: Miami Shores County Miami Dade Zip: Folio/Parcel#: N� 3?—D o — 0 �3-27317 Is the Building Historically Designated: Yes NO x Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): \N7 Oe City: VA%P LMA/ State: 1' L Zip: 33 0 % 3 Tenant/Lessee Name: Phone#: "79b —3114 __'13 53 Email: % % 20 CONTRACTOR: Company Name: t/ /7 1�5�C� /4 C Phone#: Address: /VW A-7 di City: POA'ZC.. State: Zip: Qualifier Name: State Certification or Registrattiion #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ aSiyr/C[IE� Tvoe of Work: ❑ Addition ❑ Alteration Alteration Specify color of color thru tile: Submittal Fee Scanning Fee $ Technology Fee $ Structural Reviews $ of Competency #: City: State: Zip: _ Square/Linear Footage of Work: ❑ New ® Repair/Replace ❑ Demolition Permit Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Notary Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE$ Z—WA oft" J �em Miami Shores Village Building Department ��ORiDp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE' (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE' E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. .........................................z....../............................................ BUSINESS NAME: (3;b4 73�1]CI0/ S`1L c BUSINESS ADDRESS: ID93)- (,t/ W' 5 CITY STATE FL ZIP 331 �'g BUSINESS PHONE: ( ) FAX NUMBER ( ) CELL PHONE QUALIFIER'S NAME: (;Ow" QUALIFIER'S LIC NUMBER: _ CGCIS Zzl 92 Bonding Company's Name (if applicable) Bonding Company's Address Zip City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address State Zip City obtain a permit to do the work and installations as indicated. I certify that no work of orl installation regulahas Application is hereby made to commenced prior to the issuance of a permit and that all work will be performed todmeet for E the standards of all SIGNS, POOLS, ing construction in this jurisdiction. I understand that a separate permit must be secure FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... 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 toning. "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, CONS ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As o promise in good faith tho a whose property is subject o for the first inspection is inspection will not be oep ov Signatu oAlso, e of a building permit with an estimated value exceeding $2500, the applicant must off commencement and construction lien law brochure will be delivered to the person imecertified copy of the recorded notice of commencement must be posted d the job site irsays after the building permit is issued. In the absence of such posted notice, the J a fee will be charged. , NER o� AGENT The foregoing instrument was ac owledged before me this z2. day of r'� 20 2 . by who is personally known to La' C-u u who has_produced as me or identification and who did take an oath. NOTARY PUBUC: CONTRAfflrOR The forego instrument was acknowledged before me this 20 ZZ by ZZ day of A .�n�, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ' • Sign: Sign: ��'�� `---V�-�-�-� lVl �ht'1� CR..� Print•, Print: um�s enne ao Seal: p~� •.. Seal: _ ''�`'c+ Comm,0222410 ..•�,;�w MARIACAROUNADARREtO •ZVO - lre8: Jan. 31, 2026 46F Notary Public -State of Fio5 C'Notary Public • State of Florida Commission A GO 2209�5 NWAAWA �y2y,2, 2022 on le APPROVED BY Plans Examiner Zoning Structural Review Clerk i ACOCERTIFICATE OF LIABILITY INSURANCE �,i DATE(Mh12DMrYlr)o22 o4/2sRV 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(los) 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 certificato does not confer rights to the cortificato holder In lieu of such ondorsement s . PRODUCER Excellence Insurance 3801 SW 107 Ave Miami FL 33165 CONTACT Adriana L Clavi o Maud PHONE 305 226-3900 ac , ; 305) 226-3997 Nip Ext), E"MAIL Ess aciavi o srisk.com ADDRINSURER 8 AFFORDING COVERAGE NAIC 0 INSURER A : STATE NATIONAL INSURANCE COMPANY, INC I 12831 INSURED GB4 ASSOCIATES, LLC 10832 NW 84Th St Oral FL 33178 INSURER B I INSURER C. INSURER 0 INSURER E,. 1 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 ILT R , TYPE OF INSURANCE I DDLlugn WVnSUBRI POLICY NUMBER �m LICY EFF POLICY EXP LIWTS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 f CLAIMS -MADE I^ I OCCUR DAMAGE TO RENTED PREMI $ 100.000 MED EXP one S 5,000 ` PERSONAL & ADV INJURY $ 1,000.000 A NXT03R97Z0-00-GL 08/18/2021 08/18/2022 AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000.000 �GEEN'L POLICY71JECT 1 7 LOC S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ten 00046N) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per ocodmd) S PPROP DAMAGE $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE S HCLA[MSWIADE AGGREGATE S EXCESS LIAR DED RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA PEA ERN E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEq S E L DISEASE - POLICY LIMIT $ If yes, desalt under DESCRIPTION OF OPERATIONS below I I A Contractors Errors and Omissions NXT03R97Z0-00-GL 08/18/2021 08/18/2022 Each Occurrence: Aggregate $ 25,000 $ 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is inquired) LICENSE NUMBER: CGC1524897 Miami Shores Village Building Department 10050 N.E.2nd Avenue 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 FI 33138 V 7955-207ti ACVKu L;uttrurv�LIVIni. Aji.r;gns reserves. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department iL]�C_EIVED 10050 N.E.2nd Avenue, Miami Shores, Florida 33135 NOV 1 E q?—z Tel: (305) 795-2204 Fax: (305)756-5972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY: BUILDING PERMIT APP�LICATION 7.BUILDING y,;7�;ELECTRIC ❑ ROOFING FBC 20SO'� Master Permit No.- _&_ ZZ— 151 i Sub Permit No. V,iiII ^2Z. — Z`I I S REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: L 17 J t q s 5T Folio/Parcel#: J 13 0(eO13 Z75� I Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: (U 1 1-7 U�Ra!Ajd JLU( City: j,A(Al2AAdoor j Tenant/Les`nseeeName: \ rl Email: • ,0� 1ti'Sal 4 64,cb" CONTRACTOR: Company Name: Address: Email the Building Historically Designated: Yes NO Zone: BFE: FFE: 11i., PhnnFtt. -7&b ,51L� one#: /D 7?Z - , , Qualifier Name: 7 Phone#:-W�474 State Certification or Registration #L�4 le2w�Z ��Certificate of Competency.: DESIGNER: Architect/Engineer. ne#: Value of Work for this Permit: $ 12 DD,a Square/Linear Footage of Work: Type of Work: ❑ Additloril"" qe ..Alteration ElNew (Repair/Replace Description of Work: �1) 1� FFGT rAyr/ 'f& Specify color of color thru tile: Submittal Fee $ ?errnit Fee $ Scanning Fee $ DCA Fee $ Technology Fee $ Training/Education Fee $ CCF DBPR $ Structural Reviews $ P&Z Review $ _Zip: ❑ Demolition CO/CC $ Notary Double Fee $ Bond $ Bevised04,'052022, 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 COM ENCEMENT." )Notice to Applicant: s a co dition o t issuance of a building permit with on estimated value exceeding $2500, the applicant must promise in good fait that a copy o the n tice of commencement and construction lien law brochure will be delivered to the person whose property is su "ect to ttachm nt. Al s , a certified copy of the recorded notice of commencement must o d at the job site for the first inspe i whic occurs seven ( days after the building permit is issued. In the absence su p sted notice, the inspection will not he pprov d and einspec ion fee will be chorged. Signatu WNEK dFAGtNT The foregoing instrument was cknowledged before me this 2- day of r V , 20_ by rAwA... ?&N A who is p< r.a i y kno , to me or who has produced 014W as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: AgLENJ SILVERA '•• '.,� MY COMMISSION # GG 950477 Seal: =*� - 2024 f _��• ;o�: EXPIRES: March 6, •�rFOFF4�.��- Bonded ThtU Not Public Underw�itets Signature CONTRACTOR The foregoing instrumen was acknowledged before me this day of -er 20 3—Y , by JP51C L • nc e,� who is personalIv known to me or who has produced identification and who did take an oath. N UC: `��1�1t1111111���� • Si ..•�MMISSION . �+ S• Print: r• ,,. Seal: =z -Sr, #HW017463 ; *� Z .�qq•?A nded VO �6, r '���i.:'BiGbrc llndg ` `•�p`�� ************************************************************************* APPROVED BY l �l��Z Plans Examiner as ******************* Zoning Structural Review (Revised04/05 '2022, Clerk ., ."-V,ld H00,1A 9-MISM w I 3nodddvi I L I F I IILI ola � 1 If - -T ` •- ��ECEIVE� MAY 2� 2�72 EnTuxD s,Daw „Mx, E NG nxs Flow Y c�c" hjgL REVIEW "E5CISTIN& FLOOR PLAN NCNx! [ ,Ex• • a fJ Miami shores Vill ? PPROV fJL' DATE - 7` 2en1ng Dept. u(Iding Depart Buildin Date sub e g Dept Date -- and Couno compliant ede - _ rules an all F I Permit# d regulations. -22 SCOPE OF WORK LEGEND NOTES APPLICABLE CODES xlPl /.Q gippl {tY1V125 yq C.rBIXER (NO ELEGIXYJL FwR. EOSINC - YC xCR.. I. . 60 N,R ¢' ... 1Ig h LAVA,ON C� [NSDXc YN15 AT, -ONE AN CnTMIG 10 P[YM'. r (xo c¢awcu xvxx. Enslxc vo - ALL siwE DcrtcrznT Axv w A<nRYs AXE ALL WORK 10 BE DONE IN ACCORDANCE wnns m Acxux� vs- rNDoxs a Dews FKft l prove ru,we ,o xwux AN m.Enwxx[a[o. WIIH FBC 202.0, MC -PLUMBING 2020 h sw= EM1CWw a TU Xw1' M'o .1.1E0 GFATA 3yARAlE x�-gErt - 9xw[ DEICcrws IAE d, o1TIxCOY I)wl NEC 2017 x61wNTRON ALL NW]iNLOORS - x0 6YxQ TO MC EISCM2H NAND - PLUMBING PLANS Approved _Date 21 Z L Disapproved Date i •••• a•••• • • • • aAD f 22,11J •U•••• f Io 000 <iu 12.nJ ••• •O A. •' s.U, m.vop •q••' • r•Y ISIC U AL LWO) •••••• a•• I.U. . 2,+Ro= IJslo / Tao VCLT- J3 AMPS ' • 9•• Y (NEW MCl) • • • • • mono �f}1GG L' ' • •' M"• Gzpr�k�� 4p�C11 EXISTING ELEC IRICAL RISER DIAGRAM ( NO NEW LOADS) N NHN CU q L CIRCUITS N1 R+ ARE EXISTING O o' AT CU PPHEL 'C' PANEL 'P' 2/0 11111N C. 20o ARMS PANEL 'R' t1> YI TU GR 125 AMPS WRAGC loo 4S PUT SPACE 12 SPACE PO SPAP.0 PETER ELECTRICAL Ip1 YI I.N L° REVIEW Z Lr 4 iLY 2 Z / q�I (U Ylo N W L NDID APPROVED m s/e Ip• L. . DATE N 12 t21 5/0 1p• LING FGDS - MAIN PANEL "A" u41 PULE pE1CRIPLICN VRR/[ N0. POLE pE2[RIPII[N VIE2/[ 1 2/p5 pMl P Y6 2 2/190 PPHEL B q3 3 2A5 q1U q Y6 + 2/Im PpICL B B3 5 2/Tv ICU q YB 6 2/60 TipRp4C XL J 2/35 N P q8 R 2/60 GgFNOE q6 9 2/30 V/N qlp 10 1/2p BgiN G(CI u 2/3o v/N p10 Tz 13 PANEL "B" H6 PULE pE$CRIPIIOH VqC/C NO FRE DESCRIPTION VITS/C 2/EO XANC{ p6 2 MILY NUOI p12 3 2/W RnxLC p6 LIG11p121/IS faNILY RWMp12 5 RLLMPp12]1/lipR-3 pl2B CRILCNAlI1R q129p12l0LIGHTplpt2 jllIb.TC.EN III/20 SHALLqPP.plt 12 iNLIGNI p12nz/+o cwafu a e 1+ 1B MIING RHkI p12 PANEL "C" GARAGE NO POLE YESLRIPINN VIRC/[ NO, PoLE DESCRIPTION 41P.E/[ 1 V2p LAUNDRY p6 2 2/39 oNYER p12 3 V20 G9 [FLIER X6 < 2/3p DRYER p12 5 V20 fi[i Y2 6 V. SPRIKKLFR pl2 J R 2/2p SPRINI(LER qli LOAD ANALYSIS AT 120/240 PANEL •A' TYPE lOgp PXU A 32W VP1CR EATEN iCR +,pW PAILL •A• q,5+o Pg1EL •C GMP(d 1J,510 3pA5o /21p VR1 125 AMPS Pn"a •e' 2259 $E X 3 6J J] SMALL APP 3p90 RPrzE 12poo REERIGER>1Wt Ippp IRA ¢u LUgB LWO x +px : 2Mao Is.up a . 2.+po w = 1].slwzgo WELT .J3 pwz PANEL 'C' LgU1pRT ISpO ➢NY[12 S.opp LANPLE UPCNER 1,5pp SPRINKLER TNC Constuction & Egineering LLC Field Observation Report — 117 NE 95 St Miami Shores FL FIELD OBSERVATION REPORT p: 006 g // f e' dldl OBSERVATION DATE/TIME: December 4, 2022 9:30 AM 1`"j r REPORT DATE: December 16, 2022 PROJECT: 117 NE 95 St Miami Shores FL FOLIO NUMBER 1132060132730 aL2,2221!1122Z WEATHER: Sunny -82F mxi PRESENTATSITE: Tarcisio Noguera PE TNC DISTRIBUTION LIST: Michael Pena 117 NE Family Ventures LLC Miguel Cabrera City of Miami Shores Building Department On the date indicated representatives of TNC Construction & Engineering LLC visited the referenced site to observe the bathrooms, with the purpose to determine the general installation condition, under permit No RC-01-22-184issued 1/25/2022. Observations/Comments 1 001-1. Parcel Overview 19244 NW 42 Ct Pembroke Pines FL 33029- C (954( 8504288; email tnoguera.pe@gmail.com TNC Construction & Engineering LLC has completed a bathroom installation assessment of the referenced building. A visual inspection for each of the bathrooms, during the remodeling process and the work performed. TNC CONSTRUMON & ENGINEERING LLC Project: 117 NE 95 St Miami Shores FL Observation Date: Report By: Tarcisio Noguera PE Report Date: December 4, 2022 December 16, 2022 PAGE 2 OF 4 Report ti: 006 Thermography inspection A thermographic scanning of the kitchen and both bathrooms, with the plumbing system under pressure and the water heater working to determine, if there are any leaks or water issues. Report attached, showing no issues at the time of the inspection. TNC CONSTRUMON & ENGINEERING LLC Project: 117 NE 95 St Miami Shores FL Observation Date: Report By: Tarcisio Noguera PE Report Date: December 4, 2022 December 16, 2022 PAGE 3 OF 4 Report #: 006 Comments This 1984 building is being remodeled and the bathrooms are being upgraded. The inspection was performed on site on December 2022 to observe the condition of the bathrooms and perform a Thermographic survey to determine if there are any active leaks or misplacement of insulation. Additionally, the photographic record of the installation provided by the building owner indicated the replacement of the wooded trusses that were found in bad condition, maintaining the original installation pattern. I, Tarcisio Noguera P.E. having performed a visual inspection and evaluation of the submitted documents, hereby attest and certify that to the best of my knowledge and professional judgment, the bathrooms wall paneling have been installed correctly. Limitations This report has been prepared on behalf and for the exclusive use of 117 NE Family Ventures LLC. This report and the findings contained herein shall not, in whole or in part, be disseminated to any other party or used or relied upon by any ither party, in whole or in part, without prior written consent. 0 No ��''► TarclSlo _= Digitally signed by c, •••.....•,*�{� fry n.Tarcisio Noguera P -P r'GENS�`'�. 9 Noguera PE Date:.2022.12.22.•. g 19:52:37-05'00' w No. 64615 :• STATE OF •,' TA IO N OGU ERA. PE %�F•'�• 0 Rlt} A.•'`• �''� � G Professional Engineer FL #64615 fO N A L�.,�'� This item has been digitally signed by T Noguera PE on the date adjacent to the seal. Printed copies of this document are not considered signed and sealed and the signature must be verified on any electronic copies. TNC CONSTRUCTION & ENGINEERING LLC Project: 117 NE 95 St Miami Shores FL Observation Date: Report By: Tarcisio Noguera PE Report Date: December 4, 2022 December 16, 2022 PAGE 4OF4 Report #: 006 TNC Cc,ns[�,ct or, Cq'reeiha L.I C Thermographic Report Measurements Sp1 74.9 °F Sp2 74 2 T Parameters Emissivity 0.95 Refl. temp. 68 °F FUR E6 1/30/2010 7:17:52 PM T 78.3 70.9 63991552 110 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNC Coosnct'on & Eglneernq I. LC Measurements Sp1 73,4 T Parameters Emissivity 0.95 Refl. temp. 68 T Thermographic Report 1/30/2010 7:18:03 PM T 78.1 3 2 2/10 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNC Constuction & Egineenng, LLC Thermographic Report Measurements Sp1 73.9 T Parameters Emissivity 0.95 Refl. temp. 68 T 1/30/2010 7:18:14 PM T 76.6 69.3 1552 3/10 19244 NW 24 Ct Pembroke Pines FL /+1 (954) 850 42 88 Certified Thermographer Level 11 TNC Constuction & Egineering LLC Thermographic Report Measurements sp1 73.4'F Parameters Emissivity 0.95 Refl. temp. 68 T .II FLIR0004.jpg 1/30/2010 7:18:33 PM FLIR E6 "F 76.2 68.9 63991552 4110 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNC Const,,-hon & Eginceiinq'_LC Thermographic Report Measurements Spt 72.8 T Parameters Emissivity 0.95 Refl. temp. 68 T 1/30/2010 7:18:44 PM T 75.9 68.5 1552 5110 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level II TNC Thermographic Report Cons-tuction & Egineering LLC Measurements Spt 75.6 T Parameters Emissivity 0.95 Refl. temp. 68 T = 69.0 63991552 1/30/2010 7:19:03 PM 6110 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNC Thermographic Report Constuction & Egineering LLC Measurements SP1 74.2 T Parameters Emissivity 0.95 Refl. temp. 68 T 1/30/2010 7:19:30 PM 7110 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNc Thermographic Report Constuction & Egineering LLC Measurements Spt 78.3 T Parameters Emissivity 0.95 Refl. temp, 68 T 1/30/2010 7:20:30 PM 8/10 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNc Thermographic Report Constuction & Egineeing LLC Measurements Sp1 76.3 T Parameters Emissivity 0.95 Refl. temp. 68 T � --•72.0 63991552 1/30/2010 7:20:40 PM 9/10 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 TNc Thermographic Report Ccnstuction & Egneerng LLC Measurements 3p1 75.7 T Parameters Emissivity 0.95 Refl. temp. 68 °F 1 /30/2010 7:22:28 PM 19244 NW 24 Ct Pembroke Pines FL / +1 (954) 850 42 88 Certified Thermographer Level 11 T 78.7 71.4 15A9 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. .......................................................................................... BUSINESS NAME: G %SSvC/ �T 5 1L C BUSINESS ADDRESS: IDK3z W A 9�A,S/. CITY STATE r ZIP 3.3/ $ BUSINESS PHONE: I—) FAX NUMBER ( ) / CELL PHONE ( ) 38 G 2TQUALIFIER'S NAME: t19 I,n , Jo r j0"11P2 QUALIFIER'S LIC NUMBER: CGCI7 I $9 e ba dor STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Ron DcSanns, Govemor Halsey Beshears. Secretary CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHA�PTE,�489, FLORIDA STATUTES d GOMEZ, GONZALO GB4ASSOCIATES LLCd 10832 NORTHWEST 84TH STREET+ ') DORAL FL 33178 41 LICENSE NUMBER: tdd1 214897 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at My Florida License.com Qi 7.zyi•L"4' [E rr,5 Do not alter this document in any form. Jt' kAL This is your license. It is unlawful for anyone other than the licensee to use this document. O i7 TGB4 ASSOCIATES LLC General Contractor Date: State of Florida County of Miami Dade Licensed & Insured CGC1524897 Before me this day personally appeared Choy% v 6we who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 'Contractor Signature �f �j Strokes AZ Sworn to (or affirmed) and subscribed before me this 2Z day of by ?e� Personally know /OR Produced Identificat Identification Produced - s••-„ ACHAEL PENA 1: -tary Public - State of F.onaa 'nt;F CcmmissicnfMH 250625 Comm, Ex, Tres Jul U 2026 3prcec MatWnal Notary Assn. Print, Type or Stamp Name of Notary iM n,L Type of 20-22, 10832 NW 8411 St. Doral FL 33178 (786) 451 3862 / 451 43.14 gb4company(o)gmail.com Local Business Miami -Dade County -THIS IS NOT A BILL 7227320 BUSINESS NAME/LOCATION GB4 ASSOCIATES LLC 10832 NW 84TH ST DORAL, FL 33178 OWNER GB4 ASSOCIATES LLC C/O GONZALO GOMEZ AMBR Worker(s) Tax Receipt State of Florida DO NOT PAY RECEIPT NO. RENEWAL 7512178 LBT EXPIRES SEPTEMBER 30, 2022 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 07/09/2021 CGC1524897 INT-21-332312 This Local Business Tax Becoipt only confirms payment of the Local Business Tax. The Receipt is not a license. permit. or a certification of the holders qualifications. to do business. Holder must comply with any governmental or nongovernmental regulatory taws and requirements which apply to No businoss. The RECEIPT NO above must be displayed on all commercial vehicles - Miami-Oado Code Soc Ba-276. MIAM � For mom information. visit gYIY/.mlAIDldgdg.94yi1a344QYfLOL JIMMY PATRONIS 0 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: 6/27/2021 PERSON: GONZALO GOMEZ FEIN: 814994645 BUSINESS NAME AND ADDRESS: GB4 ASSOCIATES LLC 10832 NW 84TH ST. MIAMI. FL 33178 SCOPE OF BUSINESS OR TRADE Contractor -Project Manager, Construction ExecuWe. construction Manager or construction Superintendent EXPIRATION DATE: 6/27/2023 EMAIL: GB4COMPANY@GMAIL.COM IMPORTANT: Pursuant to subsection 440.05(14). F.S., an officer of a corporation who elects exemption from his 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 bade 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 certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a cortrflcets at any bme for failure of the person named on the certificate to most the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01365896 QUESTIONS? (850) 413-1609 MiamiVillage �hores BuildingDepartment 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner— Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat_ § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions arc valid for a period of two years or until a vo ary rev cation is filed or the exemption is revoked by the Division. Your contractor i rcqueroyeges a p 't u er this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-ti a em or subcont tors for your project. The contractor has provided an affidavit stating that he or she will be the only pers allo ed to wo on your oject. In these circumstances, Miami Shores Village does not require verification of workers' compe ation insuran coverage fr m the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING ELO Y ACKNO EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County ofMiami-Dade 1 hd The foregoing was acknowledge before me this day ofAI , 2. By M r) who is personally known to me or has produced Fbirf& 1 ��'� 5 I C as identification. Notary: /i�` �,'!z NATHALEE RAUOALES SEAL: ��_. Notary Public - State of Florida Commission I HH 182421 My Comm. Exeires Oct 6. 2025 iarrli bhores Village Building Department 10050 hi.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 75&8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the I ; ida Statutes. Fla Stat. i 440A5 allasys corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to :-htaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure! An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. I. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State„ Division of Corporations, No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Constriction exemptions are valid for a period of two years or until a vo ary rev cation is Filed or the exemption is revoked by the Division. Your contractor i requrvdto ap it ur cr this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-tm erns or subcont . tars for your project. The contractor has provided an affidavit stating that he or she will he the only pegs altowo on your gject. In these circumstances, Miami Shores Village does not require verification of workers' compe ateonn coverage fir m the contractor's company for day labor, part-time employees or subcontractors. Ell` SIGNING hFLO ACKNOSX EDGE. THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS ('oN,rF.N7S. 'N Signature: 5 �' Owner State of Florida County of Miami -Dade `\ The � nil - `I he foregoing was acknowledge before me this < day of _ l __ 2( iiy—)�ik ✓� �� who is personally known to me or has produced It3tida ,� rI /�rJ I(C'iU �V _ e,as3drnliticatiaii Notary:-,_._. ,. k'ATHALEE RAU0+11ES ,*ta SEA L c «= .. ryRwirc-StaEttrrPbrida Ccmmlrtiap a Ne 182421 " ..: MyC—m. Ex -,,re, ^ct 6, 2025 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795.2204 Location Address 117 NE 95TH ST, Miami Shores, FL 33138 Contacts Permit NO.: EL-06-22-1514 Permit Type: Electrical - Residential Work Classification: Addition Permit Status: Approved Issue Date:06/27/2022 Expiration:12/12/2022 Parcel Number 1132060132730 117 NE FAMILY VENTURES LLC Owner Michael Pena 117 95th ST, Miami Shores, FL 33138 Mobile: 7863142353 MIKESAILY@COMCAST.NET 1LP ELECTRICAL SERVICES INC Contractor JOSE L PINERO 19477 NW 56 PL, MIAMI GARDENS, FL 33055 Business: 3057258388 Description: ADD ELECTRICAL LIGHT IN THE KITCHEN AREA Valuation: $ 800.00 Ins ection Requests: { 5-762-4949 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee 52.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 06/14/2022 $50.00 Credit Card 06/27/2022 $60.30 Amount Due: $0.00 Building Department Copy In censiderat' n of ' suance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining t ret and i strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In cce ling thi ermit 1 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are equi ed for CTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 1 IT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating s citi zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized SignaIre: Owner / Applicant / Contractor / Agent Date June 27, 2022 Page 2 of 2 Miami Shores Village p Building Department �uN 142o2z D 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. RL-oii PERMIT APPLICATION Sub Permit NO. U V.Q-22-' 15 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): \\/ N£ Address: (D( 12> i'Al"Wa✓ r )'- ( V1 %I&te City: Al1GlQIMGr State: Zip: .330a� Tenant/Lessee Name: Phone#: Email: N\ % KF$(L\`tf to, C.yrncnsr •air T CONTRACTOR: Company Name: Address: Email: At Qualifier Name: State Certification or Registration #: [SG Z,3�1�Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Add Zip: Value of Work for this Permit: $ - M �i Square/Linear Footage of Work: Type of Work: D Addition ❑ Alteration y El New ❑ Repair/Replace ❑ Demolition Description of Work: �(�plr7,�-nJ� l m +Q 9� hre v Specify color of color thru tile:, Submittal Fee S Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $_ DCA Fee $ DBPR $ Training/Education Fee $ P&Z Review $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 2r 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 con ' r the issuance of a building permit with on estimated value exceeding $2500, the applicant must promise in good faith h t a cop of ih otice of commencement and construction lien law brochure will be delivered to the person whose property is sub ec to attac ment. so, a certified copy of the recorded notice of commencement m posted at the job site for the first inspecti w ich occ rs seven (7) days after the building permit is issued. In the abse a of su h posted notice, the inspection will not b ppr ved d a reinsp ction fee will be charged. or AGENT The foregoing instrument waI acknowledged before me this 1 day of 20 9,)- by ri 1 cue a 1, ie� 0 who is personally known to me or who has produced if500 -540 - 76-33q-oas identification and who did take an oath. The foregoing instrument vitas acknowledged before me this —A—_dayof Ju6g 20 -Z2.by who is personally known to me or who has produced 75L ' as identification NOTARY PUBLIC: NOTARY a Sign: Sign:_ Print: (-yelk,v Print: Seal: ?:"••., GSiESISFERNANDEZ Seal: MY CDWISSION N GG 301202 d• EXPIRES: June 4, 2023 OY PtgC, 9on6ed Thru Notary Public UnderViters APPROVED BY Plans Examiner an oath. MICHAEL PENA " Notary Public - State of : ;onaa Commission 4 HH 250525 My Comm. Expires Jul 23. 2025 Bonded throuth National Notar, .155r. ############# Zoning (Revised04/05/2022) Structural Review Clerk ',., Ron DeSantis, Governor Halsey Beshears, Secretary r STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES PINERO, JOSE L JLP ELECTRICAL SERVICES, INC. 8925 SW 21 TERRACE M IAM I FL 33165 LICENSE NUMBER: EC13009774 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com Pr ff] Do not alter this document in any form. 3C Thic is wni it liranca It is i inln%A1fi it fnr anvnnP nthPr than the lirPngP.P to iisp this document. F/ lorida DRIVER LICENSE �(a use CISG E, o "OL�. � JOE L #8925 SW 2TER , MIA MIAM[;331. FL 3316!-8246 S coo 0912211962 �,sE% M Y _%v 09122/2028 rsnos 5'-06"' 12rs'e NONE a+Ew NONE •co» ?. rc!`l�R �.. 071e1,2o20 5 a %eROp;gme65. Opeq n of a , vMpde mnaimm. COnwnl W any;50Y,Wry:RSt rtlgwmJ oy few 003052 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL -00 NOT PAY 7022908 BUSINESSNIWEAACAMON JLP ELECTRICAL SERVICES INC 8925 SW 21 TERR MIAMI FL 33165 OWNER JLP ELECTRICAL SERVICES INC JOSE L PINERO, QUAURER Worker(s) �1 EXPIRES SEPTEMBER 30, 2022 Must be displayed at place of business Pursuant to County Code 0��'�, ,O OChapter BA - Art 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13009774 RECEIPTNO. RENEWAL 7298987 PAYMENT RECEIVED SYTAXCOUECTOR $75.00 08/17/2021 FPPUI1-21-010165 This Local Business Tax Receipt only confirms paymerdof the Local Business Tax. The Receipt is not a license, permit are certification afthe holder'squalificeuons,to do business. Holdermust 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 Cods Sec ga-276. For more information, visitvvwwmiamj;j.de.qovttgKcoIlgctor JLPELEC-01 SMENDEZ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/31 /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 C & C Insurance, Inc. PHONE IFAX arc, No, Ext : (954) 431-2008 1 (A/C. No):(954) 704-0507 1921 NW 150 Ave, Suite 101 Pembroke Pines, FL 33028 EDMAIL info@candcinsurance.com INSURERS AFFORDING COVERAGE I NAIC # INSURER A: USLI 25895 INSURED INSURER B : FLORIDA Citrus, BUSINESS & iNDUSTIES FUND JLP ELECTRICAL SERVICES, INC. INSURER C: _ 8925 SW 21 Terr INSURER D : Miami, FL 33165 — — INSURER E : INSURER F CnVFRAnFS 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 CONTRACTOR 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X CL1799139E 4/8/2022 4/8/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED -PREMISES occurre 100,000 $ MED EXP (Any one person) $ 50,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 7� jE a FI LOC OTHER: GENERAL AGGREGATE $ 2,000,000 _ PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLYY COMBINED aBI�SINGLE LIMIT $ BODILY INJURY Per person)_ $ BODILY INJURY Per accident_Z $ PROPERTY AMAGE Per ac id $ $ A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE XL1571924F 4/8/2022 4/8/2023 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPER/FA IETOR EXCLUDED? ECUTIVE Y 1 N (Mandatory n NH) Ll If yes, describe under DESCRIPTION OF OPERATIONS below NIA 10657654-2022 4/8/2022 4/8/2023 X PTA ZE OTH- E.L. EACH ACCIDENT 1,000,000 $ _ E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES `ACORD 101. Additional Remarks Schedule, may be attached If more space Is required) Blanket Additional Insured included if required by contract. MIAMI SHORES VILLAGE HALL 10050 NE 2ND AVE 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 REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-06-22-1513 Permit Type Plumbing -Residential Work Classification: Repair Permit Status: Applied Issue Date:I Expiration: 12/11/2022 Location Address Parcel Number 117 NE 95TH ST, Miami Shores, FL 33138 1132060132730 Contacts 117 NE FAMILY VENTURES LLC Owner HOMESTEAD REPAIRS AND SERVICES INC Contractor Michael Pena ELICEL GONZALEZ 117 95th ST, Miami Shores, FL 33138 8430 SW 28 ST, MIAMI, FL 33155 Mobile: 7863142353 MIKESAILY@COMCAST.NET Business: 7863322549 Ins ection Requests: Description: REPLACE KITCHEN AND BATHROOM FIXTURE - Valuation: $ 1,000.00 305-762 4949 MASTER RC-01-22-184 Total Sol Feet: 0.00 �I Fees Amount Application Fee - Other $50.0o CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.D0 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 BuildjRg,pippartment Copy Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 06/27/2022 $60.30 Credit Card 06/14/2022 $50.00 Amount Due: $0.00 In con deraf n "he)nuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertai ng t reto a din strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village! In 4cceptingithis 4rmit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permit are ecluired r EL TRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNE : I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulati ru nd zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Silature: Owner / Applicant / Contractor / Agent Date June 27, 2022 Page 2 of 2 1[R@R0Tf JUN 14 2022 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 I ECEI 'F� J�u FBC 20 BUILDING Master Permit No. FR.c-0 �4 PERMIT APPLICATION Sub Permit No. t O(P'�—�S I� BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: U % NG City: Miami Shores County: Miami Dade Zip: �� 2 Folio/Parcel#: ,1 —3AO(v— 043-2?30 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: �� Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): k1/ Nt +j KUyu a LL Phone#:'7Z-.36-.2353 r City: ala%ln'lR/L State: Zip: 19300 Tenant/Lessee Name: Phone#: 7rft7-1Q #-a?3 0 Email: CONTRACTOR: Company Name: 4?—PXOsS orr-0 nit Phone#: 30S-(41;6-7273 Address: SU{?✓-0 .SW �Lo (CAS Ktct K\ FL. Sloss Email: C %Vo1\1a1C b6 1CL ,00-Corn Qualifier Name: d k\ C—I07M 1- Phone#: State Certification or Registration #: Cu. — I y2a 2q Q)Certificate of Competency #: DESIGNER: Architect/Engineer: Zip: Value of Work for this Permit: $ -l( /yUU r-A' Square/Linear Footage of Work: Type of Work: ❑ Addition �` ❑ Alteration El New Repair/Replace ❑ Demolition 17. u Description of Work: tC Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ CCF DBPR $ CO/Cc $ Notary Double Fee $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $` �➢ ' (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State NE 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 promise in good faith t whose property is subj ct for the first inspectio w inspection will not be ppj The foregoing to the issuance of a building permit with an estimated value exceeding $2500, the applicant must the notice of commencement and construction lien law brochure will be delivered to the person ndqt. Also, a certified copy of the recorded notice of commencement must be posted at the job site -s ven (7) days after the building permit is issued. In the absence of such posted notice, the a r inspection fee will be charged. or AGENT acknowledged before me this --N—day of "iuhG 20 2y by ?5m—940--%*-33`I -O . who is personally known to me or who has produced Mwe .1 LIC, 1FL_ as identification and who did take an oath. NOTARY PUBLIC: Print: LUIS ALBERTO GUTIERREZSeal: My COMMISSION#GG 910152 EXPIRES: Se teniber 4. 2023 APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of lX'1-e 20 9�L by f f,lr ^ 11 y (CvkCwJ`• . who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: V Print: U S Seal: p" GENESIS FERNAND,EZ MY COMMISSION # GG 301202 EXPIRES: June 4. 2023 'Fo.i R`'- Borred Tlvu Notary Public Underfile, Plans Examiner as Zoning (Revised04/05/2022) Structural Review Clerk Ron DeSantis, Governor Halsey Beshears, Secretary Florida STATE OF FLORIDA dopr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489. FLORIDA STATUTES GONZALEZ ELICIEL HOMESTEAD REPAIRS AND SERVICES INC 8430 SW 28 STREET MIAMI FL 33155 LICENSE NUMBERF'(1429298 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridal-icense.com kDo not alter this document in any form This is your license. It is unlawful for anyone other than the licensee to use this document. '. s ;s t f LG�Ft�iis � ris y,�+ s.Local ut if s a e s Y.i � Ss} n'•t t. � �.e.- "+�Sj F t �e } 17 6 Pa l �i7��iQL t ��•`�t;i'fi�ga - _y- r tl ii'' �" .r s tv bit A i+�ioNc 753Ia "F HQ I Cl PA�i jj I , '' $-."2 N[I MI, FL;:31:5 f(juuri tli sd�* �M r OWNER. SVC. TYPE of BUSINEss H01i E1STEAD REPAIR$AND 166 PLUMBING „ NrAC RAYME SERVICES' INC 1i TAX �nNTRACTbEt { O n Fr IclFl Q0N7Ar F2 A.IAI IKIFR 82�60 T2 1 rr�r(s� c�c1a2� oars-21 off..... This taasF 0us6ss.T4tcRRaaiptaRiy aa�trmstgitcaftlte Cacti i3usitte9sThx.Th0 eita#s;[Caenae, r=nit, ar a "dificstica al the hnlde�'a , � iaA to do ltuusigess,f llatdor Est tieecans phf+��i�mrnealal ar gagave l regulatory laws slut ret r asastte wch a { ji 0 6ttaiaasi The RECM!NO. above must'ho dta�iayod`w eft comraerai`x�hbs— Misati-ifado'Cade Sec B$-2f6. For stars iniarrpatiaq.oi3itww�am�antid�de.aev/kaxatteatar_ ACORO CERTIFICATE OF LIABILITY INSURANCE �'� DATE(MavooffYYY) 06'14/2022 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 pollcy(les) 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 ACCURATE GROUP 8300 West Fla ler, Suite 114 9 Miami FL 33144 CONTACT NAME: Lucia Estrella PHONE 305) 226-8727 FAC 305 226-8767 E-MAIL accurate.certificates l,com ADDRESS: @9ma INSURERS AFFORDING COVERAGE NAIC0 INSURERA: Century Surety Company 36951 INSURED Homestead Repairs and Services Inc 8430 SW 28th Street Miami FL 33155- INSURER B: Insurance Company of the West 27847 INSURERC: INSURER D: INSURER E: WSURERF: 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 ADDL SUBR POLICY NUMBER POLWYEFF D POUCYEXP DDI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 3367579A 06/19/2022 06/19/2023 EACH OCCURRENCE $ 1,000,000 DAMAGETO PRE SES eEmurterKo E 100,000 MED EXP (My oneperson) It 5,000 PERSONAL S AOV INJURY $ 1,000,000 GEN-LAGGREGATE LIMIT APPLIES PER: X POLICY PEcT LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG S 2,000,000 $ AUTOMOBILE LIABILITYCOMBINED ANYAUTO OWNED F-1 AAUTOS ONLY AUTOSULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY SINGLE LIMIT Ea sdnidrun $ BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per euident) $ $ UMBRELLA LIAB EXCESS UAB CLAIMSADE CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYX YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMSER EXCLUDED? ❑Y (Mandatory in NH) If yes, deacdba under DESCRIPTION OF OPERATIONS below NIA WFL505516502 05/09/2022 05/09/2023 �/ STATUTE ER EL EACH ACCIDENT $ 100.000 EL DISEASE - EA EMPLOYEE $ 100,000 EL DISEASE - POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be anached If more space Is req.lmd) Plumbing. License #CFC-1429298 Village of Miami Shores 10050 NE 2 Ave Miami Shores FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE c W411 ©1988-201S ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD