PLC-09-10640
BUILDING
PERMIT APPLICATION
FBC 2004
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition ❑Alteration
Describe Work: •
Jac. o�oa *� * * * * * * * * * * * * * * * * * * * * * * * * **
Vtmi�ttal Fee $ 1 j ,J • 00 Permit Fee $
Miami Shores Village
Building Department
>0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
[New
Notary $ Training/Education Fee $
Scanning $ 1' OD Radon $
Bond $ Code Enforcement $
DPBR $
Double Fee $
Permit No.
Master Permit No.
Zip 3'6 ‘$ Cp
Phone #
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder1 ; &'Q.CI \\I). Lf1e.6 I p 1N Phone #
Owner's Address EA dress \ \ � � � 1c
VA `
City �'1 \ Q Cl1 \ State C �. Zip '- 1 I
Phone #
LL5Ce loo SWeA
City Miami Shores Village County Miami -Dade Zip S� 1 2) C 6
FOLIO /PARCEL# 11 -32tr o — 0 35O
Is Building Historically Designated YES NO
Phone# (t9() ZS 1
Contractor's Company Name wt r umb 1 n
Contractor's Address I?) fl 0 5 \' \ �- cc Z-ee -0-
Cit M\ Q State Vioe k C LC
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
E -MAIL:
Square / Linear Footage Of Work:
Repair/Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
***
e ?MEWY
JUN 2 4 2009 IN
BY:
CCF $ 1 - CO /CC
Technology Fee $ 413
Zoning $
Structural Review. $ Total Fee Now Due $ 9a, t
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 a v- l a reins r ec fee will be charged.
Signature
APPLICATION APPROVE
(Revised 02/08/06)
Signature
‘,2
Owner or Agent Contractor /
� 1
The foregoing instrument was acknowledged before e this' The foregoing instrument was acknowledged before me this /
day of Q. , 20 0 % by ,4/A,,,,/, u a-b , , day of <J ld /7 9 , 20 Q by �/ .0 i O OZ.
who is personally known to me or who has produced
As identification and who did take an oath.
who is personally known to me or who has produced
as identification and who did ta,, an oath.
NOTARY
� ∎11
;�. tmtt te11naveeeec
FY, ^ ? <
My Commission Expires:
* * ** ** * *** * ** * * *tar**,t,x*** * ** * * * ** ** ** *,r* *, * *, err *** **t * ** * ****,r***ter*** * * *t * **,t*,t *********
A64 Plans Examiner
Engineer
Zoning
'
• v •ft,a,
1 /5 N),
rinanialWaroiretway.?
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Project Address
456 100 Street
Miami Shores, FL 33138-
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$162.86
$3.00
$50.00
($50.00)
$4.75
$172.21
Building Department Copy
Address
THE CHURCH OF THE RESURRECTION 11173 GRIFFING Boulevard
MIAMI FL 33161 -7249
Contractor(s)
Y&T PLUMBING CORP
Phone Cell Phone
(305)255 -8919
Authorized Signature: Owner / Applicant / Contractor / Agent
July 27, 2009
Parcel Number
1132060170350
Block: Lot:
Phone
Valuation:
Total Sq Feet:
Type of Work: PLUMBING
Type of Piping: REPAIRS IN BATHROOMS
Additional Info:
Classification: Commercial
Invoice #
PLC -6-09 -35188
PLC -6-09 -35188
Check #: 021063
Total Amt Paid Amt Due
$ 172.21 $ 50.00 $ , 122.21,'
$ 172.21 $ 172.21 $ 0.00
Expiration: 01/23/2010
Applicant
THE CHURCH OF THE RESURRE
July 27, 2009
Date
CeII
$ 2,000.00
0
For Inspections please call:
(305)762 -4949
Available Inspections:
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 1 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 the above -named contractor to do the work stated.
1
Inspection Type:
Re Pipe
Main Drain
Underground Rough
Heater
Water Service
Final
Water Main
Lavatory
Top Out
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
CRUZ, EGIDIO F
Y & T PLUMBING CORP
13170 SW 134TH STREET
MIAMI FL 33186
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and leam more about the
Departments initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
Acs _393 -_
DETACH HERE
t�r':w1 '"Si:r -
08/22/2008 088040693 -- = CFCO5?66 r ''`- - -ge ,, : - = ""\•'
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter.
•
i dat • AUG 3 2010 --
Expiration
e , - � , z . •
x4 � ��n." p :H�`k"'
CRUZ, . z:, —;:; i
Y & PLUMB y -•44. . ° _^ '' :
: :'414 . i.- A
13170 S.W. - 134TH STREET ;� � = ;;' *3D . -_
MIAMI .. FL 3 318 6: e''`.. = -_ - -
EGIDIO F
ING CORP
CHARLIE CRIST
GOVERNOR
rIIRP1 AV AC RPC)11IRFf1 RV 1 AW
(850) 487 -1395
- ,: ac# 3937 6
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
311.01 REGULATION
7 `CFCO57666 08/22/08 088040693
CERTIFIED PL13I4BI CONTRACTOR
CRUZ, EGIDIO
Y & T PLUMBING CORP '.' 77.' 7
•
IS CERTIFIED under the provisions of ch.489 as
_ -s ptration sate. AUG 31;. ?010 .08082200963 _
LICENSE . NBR :;;;:: F _- -
: uvSTATEOF FLORIDA
r
PARTMENT 07 BUSINESS= AND PROFESSIONAL REGULATION .... :., :;, - •
= w t�£ONSTRUCT30N NDUSTRY: LICENSING BOARD
r%at — =�� SEQ#L080822
CHARLES W. DRAGO
SECRETARY
• MIAMI DADE COUNTflrt tit t
TAX COLLECTOR f g
140 W. FLAGLER ST
14th FLOOR :;
. MIAMI, FL 33130
MYMBIT amiss
MIIA@IMADE COUNTYWM
COLLECmR
07/14/2008
60010000459
000075.00
SEE OTHER SIDE
_ - — _ ,.THIS IS NOT A BILL -DO NOT PAY
RENEWAL
RECEIPT NO. 052512
STATE$ CFCO57666
052512-2
BUSINESS NAME / LOCATION •
Y & PLUMBING CORPORATION
13170 SW 134 ST ..
33186 UNIN DADE COUNTY.,
OWNER
Y & T PLUMBING CORPORATION
Sec. Type of Business
196 PLUMBING CONTRACTOR
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING OR REGULATORY
OR ZONING LAWS OF THE
COUNTY OR CITIES. NOR
DOES IT EXEMPTTHE
HOLDER FROM ANY OTHER
PERMIT OR RECEIPT
REQUIRED BY LAW.THIS IS
NOT A CERTIFICATION OF
THE HOLDERS QUALIFICA-
TION.
WORKER /S
10
DO NOT FORWARD
Y & T PLUMBING CORPORATION
13170 SW 134 ST
MIAMI FL 33186
209
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
• ^v ORD ra c•tt 1 I N(ATE OF LIABILITY INSURANCE 1 5/2
PRODUCER (305) 714 -4400 FAX: (305) 714 -4401 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN INSURANCE -HBA DIVISION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2500 NW 79th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite# 101
Miami FL 33122
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: Hartford Fire Ins. Co. 19 682
Y &t Plumbing Corporation INSURER B: Hartford Casualty Ins. 29424
13170 Sw 134 Street INSURER c: Hartford Ins. Co. of SE 38261
INSURER D:
Miami FL 33186 INSURER E:
COVERAGES
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ADD'L
LTR 1NSRD TYPE OF INSURANCE POLICY NUMBER PDATE (MM DDC/YY) DATE (M IM/DDIYY))N LIMITS
GENERAL LIABILITY
C OC U. E $ 1 ,000,000
AG
X COMMERCIAL GENERAL LIABILITY IL AME TO RENTED
p, ,IS u i. e $ 300,000
CLAIMS MADE I X I OCCUR 21UU ■ � NUV6195 8 /10/200! 8/10/2008 BSI D EXp An one .arson $ 10,000
. • .. DV I U $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PR DUCT - • •pgGt^, $ 2,000,000
`J POLICY JECT LOC
AUTOMOBILE LIABILITY
X ANY AUTO COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
A ALL OWNED AUTOS 21UUNUV6195 8/10/2007 8/10/2008
BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS
X NON -OWNED AUTOS BODILY INJURY $
(Per accident)
PRO (Per ac dent) TY DAMAGE $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA CC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
.• _ $ 1,000,000
OCCUR CLAIMS MADE
AGGREGATE $
B DEDUCTIBLE 21XHUUV6163 8/10/2007 8/10/2008 $
X RETENTION 810,000 $
C WORKERS COMPENSATION AND $
EMPLOYERS' LIABILITY x WC STATU- OTH-
ANY PROPRIETOR/PARTNER/EXECUTIVE
To E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 2]HTgAB0116
If yes. describe under 6/1/09 ' 6/1/2 E.L. DISEASE - EA EMPLOYEE$ 1,000,000
SPECIAL PROVISIONS below '"
OTHER E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATI ONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
*Except 10 day notice for non - payment
CERTIFICATE HOLDER
CORD 25 (2001/08)
VS025 (0108).088
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
H INSURANCE GROUP /MLC (7_
Miami Shores Village
Building Dept
10050 NE 2 Ave
Miami Shores, FL 33138
@ ACORD CORPORATION 1988
Page 1 of 2
CERTIFICATE HOLDER
CORD 25 (2001/08)
VS025 (0108).088
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
H INSURANCE GROUP /MLC (7_
Miami Shores Village
Building Dept
10050 NE 2 Ave
Miami Shores, FL 33138
@ ACORD CORPORATION 1988
Page 1 of 2
CORD 25 (2001108)
NS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL_ INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2