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PL-11-732Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple (Titleholder): Address: c2 1 -(;V ( &�� - City: (C ltit ( 51 ceJ State: F( / 'w ET:tltle•eaetlaeseee••e•e" 'e Permit No.9 l (I--- Master Permit No. Phone #:23? Zip: i'J i )g-7 Tenant/Lessee Name: Phone #: Email: S t JOB ADDRESS: l) k C �� City: Miami Shores County: Miami Dade Zip: ,...) Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ati",,lek:,,,-,3„, Phone #:,3e,K7>(07 Z —7-c--(4S Address: 91- �C I VI- n City: (M —e tAAAA_. ` State: V-- \ o Zip: 3 3 i3r Qualifier Name: 14 L I 'V�_.,..171-`c. Phone #: State Certification or Registration #: C PC_ 1 4-2,io O2...3 Certificate of Competency #: Contact Phone #: 3 0 S- (mid- 12.2---' Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ (00 f ) '— Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration UNew ORepair/Replace ODemolition Description of Work: gj..s1q,�,.L�,,, *** *. x************. x***** *x:****. x********* Fees**. x******** x:+ xm *******.x.x.x******>1«:*** *x:******* Submittal Fee $ Permit Fee $—/y5?" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $f16.i Bonding Company's Name (if applicable) Bonding Company's Address City • , State Zip Mortgage Lender's Name (if applicable) Mortgage.Lender's Address City -_ rr 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, BOTT FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVI':,,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 fir , pection which occurs .even (7) days after the building permit is issued. In the absence of such posted notice, the inspec, 'In will `' of be ap. - an tion fee will be charged. Signature Own•i"Agent Contractor pThe foreg •ng instrument was acknowledged before me this 45 The foregoi g instrument was acknowledged before me thise--16 day of "'t (,20 , by day of ✓1 ( ,20L , by who is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. NOTARY?' LIC: As identification and who did take an oath. NOTAR Sign: Print: My Commission Ex BLIC: 1. 8004NOTARY 1 Notary Discount- Assoc. Co. Sign: Print: My Commission - rt�4 li�'sft V .�•1 ******************** *********** ******Nags, k**H= B+ *skds*# **ek******+ k*ekek***8s**ds*****ek*He***** *+ k**ek* *sk**d:**Na**** **+k**** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 1 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 1291 NE 102 Street Miami Shores, FL 33138- 1132050200050 Block: Lot: EMMANUEL PAZ Owner Information Address Phone Cell EMMANUEL PAZ 1651 NE 115 Street MIAMI FL 33181- (239)565 -3103 Contractor(s) SEROTA PLUMBING CO Phone (305)672 -7252 Cell Phone Valuation: Total Sq Feet: $ 1,500.00 0 1 Type of Work: PLUMBING Type of Piping: IRRIGATION SYSTEM Additional Info: Bond Retum : Classification: Residential Scanning: 6 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $18.00 $1.80 $175.70 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -4-11 -40725 05/17/2011 Check #: 8875 $ 175.70 $ 0.00 1 Available Inspections: Inspection Type: Final Underground Sprinkler In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 17,2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date May 17, 2011 1 °R CERTIFICATE OF LIABILITY INSURANCE OP ID JG DATE (MM/DDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. r . T 08 d11 ills CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 4)R 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 cerdRlca }e holder is an ADDITIONAL INSURED, the poiicy(ies) must 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 BROWN 6 BROWN OF FLORIDA INC 14900 NW 79th Court Suite *200 Miami Lakes is 33016 -5869 Phone:305 -364 -7800 Fax:305- 822 -5687 INSURED MsaI�N1338greeeuay Inc. NAME: [.f.VB ' Eat): ADDRESS: curt PRODUCER ID IF SEROT -1 hAX (AIC, No }: INSURERS) AFFORDING COVERAGE iNSUFFR A : *USF Insurance Company INSUF:ER B : •Bridgafield L'mployere In Co INSUF:ER C: INSUF:ER D: INSUF:ER E : INSUF:ER F : NAM* 17159 10701 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LISTED BELOW HAVE BEEN ISSUED TO THE NSUREO TERM OR CONDITION OF ANY CONTRACT OR C THER INSURANCE AFFORDED BY THE POLICIES DESC 11BED LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID INOR cruel; INBR, YWi.7j POLICY NUMBER NAMED DOCUMENT HEREIN IS CLAIMS. �Fp {MIYYYY) ABOVE FOR THE WITH RESPECT SUBJECT TO ALL {M OEM POLICY PERIOD TO WHICH THIS THE TERMS, UNITS LTR TYPE OF INSURANCE A GENERAL LlA6ILlrY COMMERCIAL GENERAL LIABILfri CIP101O13 11/18/10 11/18/11 EACH OCCURRENCE 31,000,000 8100,000 X DAMAlit IVHGNItU PREMISES (Ea =currence) 1 1 CLAIMS -MADE I X I OCCUR MED EXP (My one person) $ 5, 0 0 0 C f PERSONAL &ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2,000,000 $2 0 0 0 OOO' GEN%AGGREGATEUMIT APPLIES PER: PRODUCTS- COMP/OP AOG j POLICY I .iECT LOC _t S AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Es accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ rJ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LAB i OCCUR EACH OCCURRENCE $ EXCESS LIAR ' [ CLAIMS -MADE AGGREGATE $ DEDUCTIBLE lRETENTION $ WORKERS $ $ B COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOFUPARTNEWEXECUTIVEn OFFICER•MEMBER EXCLUDED? (Mandatory lnNH) + H yes, describe under DESCRIPTION OF OPERATIONS below L� N!A 83004907 0$/01/11 04/01/12 I TORY LIMITS ER E.L. EACH ACCIDENT $ 100000 E.LDISEASE - EAEMPLOYE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace Is squired) CFPT1FIt",dT F Nr11 nao - _ -- - -- - - -- - Village Of Miami Shores Building Dept 10050 Ne 2Nd Ave Miami Shores 91 33138 SHOtILO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE l7(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACC(IRDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ©1988-2009 ACORDD4ORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ; • v v 2a.';" i 'JP ;.i • _ -I...44, ... -a0 b 'P';'•tr- AN t'il:', 4 ' e...r., .vi:Nat:•S.4.* ' ... Lf A T C 11 iq U MEE • .uto ••,-, •:,1 ,!..1.-7, •- , ro ,,......z% , .,.. ,,, . — — v v • • • --------- ........-, ...• y.,•• •.,.........■ . ,:,'.."''';■;:■:,',....;.,;'J';''',.'...'U.:',•••%14i'':f.4,')re,,le....q.;.'. ;',' ' ... • ,''''' ' '''';' :' . '''il:' ' '''I. '''' ': • , • 'A •?" ?"'''r;..4.:4 orS''. ' ''. ' ''. :: 4.- ... (. .. 02643,N4 11*. oix m EROTAi.P8UMBINE6CO. f 1"'"h": •IN;Fe:' 144":•1:.• P•It',11::, EROTIOPLUMBI NG 1:11.14.00,114YPAtte 4473, 11.14491 wow. THE GuAifeti • ',NOR 10:41114Pr • NE ' • *M. *4:4•;,•;14 ":0XVIIM .07%30/2018 460000000437 ,t 101 SEE OTHER SIDE DO NOT FORWARD SEROTA PLUMBING CO 893 NE 79 ST MIAM/ PL 33138 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 158796 Permit Number: EL -4 -11 -734 Scheduled Inspection Date: September 06, 2011 Permit Type: Electrical - Residential Inspection Type: Final Owner: PAZ, EMMANUEL Work Classification: Addition /Alteration Job Address: 1291 NE 102 Street Miami Shores, FL 33138- Inspector: Devaney, Michael Project: <NONE> Contractor: AJL ELECTRIC INC Phone Number (239)565 -3103 Parcel Number 1132050200050 Phone: 305 - 895 -4971 Building Department Comments SPRINKLER PUMP AND LANDSCAPE LIGHTING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments SYL_ // September 02, 2011 For Inspections please call: (305)762 -4949 Page 5 of 36 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1291 NE 102 Street Miami Shores, FL 33138- 1132050200050 Block: Lot: EMMANUEL PAZ 1 Owner Information Address Phone Ceti EMMANUEL PAZ 1651 NE 115 Street MIAMI FL 33181- (239)565 -3103 Contractor(s) AJL ELECTRIC INC Phone 305 - 895 -4971 Cell Phone Valuation: Total Sq Feet: $ 1,500.00 0 1 Type of Work: ELECTRICAL Additional Info: SPRNKLER PUMP AND LIGHTING Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $3.00 $1.60 $160.70 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-11 -40727 06/16/2011 Credit Card $ 160.70 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy June 16, 2011 Date June 16, 2011 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Permit No. Master Permit No. App 'g 201i. BY: s OWNER: Name (Fee Sim le Titleholder � A� 2#3 _- 56-5- 3/ a3 P-'t Address: City: N. ((ISM. ( 10`16.20--i State: ( Zip: 3 Tenant/Lessee Name: Phone #: Email: Vrs JOB ADDRESS: 12- Q t V 142-7— City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: Zip: 3 318' CONTRACTOR: Company Name: /4 J? (` L 07a., Phone #: A q — V`' -7/ Address: City: State: Zip: Qualifier Name: 4W 1 S I Go % 0 Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: ee Value of Work for this Permit: $ /.5r010 Square/Linear Footage of Work: Type of Work: DAddress DAlteration UNew URepair/Replace Description of Work: c...‘ at L6-4_,v, • DDemolition Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ ���P� P Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ CCF$'.' CO /CC$ TOTAL FEE NOW DUE $ 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 w r r e approved a d <re i ection fee will be charged - Signature Own i Agent Th- oregoiii'g instrument was acknowledged before me this 7 The foreg ,20((,by , day of ...✓i! ,2011 ,by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. day of g instrument was acknowledged before me this Zd Sign: Print: My Commission Exp. APPROVED BY NOTARY Sign: Print: 1-"4 v ✓ IC: My Commission Ex MY CO i ' 1 ION # EE53276 2 /72- / / Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder A J L Electric, Inc. Address of policyholder 12408 N. Bayshore Dx . N. Miami Beach, FL 33181 -2431 Location of operations same as above Description of operations Electrical Contractor - Anthony J Lupo Jr. The policies listed below have been issued to the pofcyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY NUMBER TYPE OF INSURANCE 98BHH9347 This insurance includes: Comprehensive Business Liability POLICY PERIOD Effective Date Expiration Date 05/15/11 05/15/12 Products - Completed Operations ►5 Contractual Liability ❑ Underground Hazard Coverage ® Personal Injury ❑ Advertising Injury ❑ Explosion Hazard Coverage ❑ Collapse Hazard Coverage ❑ General Aggregate Limit applies to each project LIMITS OF LIABILITY (at beginning of policy period) BODILY INJURY AND PROPERTY DAMAGE Each Occurrence General Aggregate Products Completed Operations Aggregate $1,000,000 $2,000,000 $2,000,000 EXCESS LIABILITY ❑ Umbrella ❑ Other POLICY PERIOD Effective Date Expiration Date 98BHJ6801 Workers' Compensation and Employers Liability 05/15/11 05/15/12 POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Date Expiration Date BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) Each Occurrence $ Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Each Accident $100,000 Disease Each Employee $ 100,000 Disease - Policy Limit $500,000 LIMITS OF LIABILITY (at beginning of policy period) Name and Address of Certificate Holder Miami Shores Village Bldg Dept 10050 NE 2nd Avenue Miami Shores, FL 33138 558 -994 a 2 -90 Printed in U.S.A. If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives.