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PL-09-1950Miami Shores Village i�' � � � �� p g it NOV 2 4 2009 Building Department t0050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795.2204 Fax: (305) 756.8972 (� Permit Nog i� � "Ir _ q I � `J Master Permit No. BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) Mar 4-1 r, ' J u tt4441e_Phone # Owner's Address ZeS N.F F. 103 S+, 30S- 15y - S ) City it 0 yvt i $4 Ores State P.- L.. Zip 3313ei Tenant/Lessee Name Phone # E -MAIL: \ s\ owvc &1 -4s €- coo 1 • cow-, Job Address (where the work is being done) SoLvv,e Ct.S Gt \ac' 1e City Miami Shores Village County Miami -Dade Zip 13132, FOLIO /PARCEL# 11- 2.13( —0i3— 0440 Is Building Historically Designated YES NO x Contractor's Company Name M i arn14.W. i ?Iambi '�' Solar 14 - ,Phone # Contractor's Address 2.17D 'l 5 5+ . City V • 1 State Zip 35147 a, Phone # f '� Qualifier Name I Z % r/ p� d� 3 � �(�aff State Certificate or Regis tion No. P•t— ,® t90 ' E' Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # 305.835-8008 Value of Work For this Permit $ goo. ©Cj Square / Linear Footage Of Work: P pew _ 5 't''r. Type of Work: [Addition [ZIeKlteration QNew 1 Repair/Replace ® Demolition Describe Work: 'c l O G lea ti 0.. 5e c 's urP ty limp ,,J******,*** * ** ** * * * * * *,* * * * * *** * * * **** * *** ********,**,**** ** *,** * ** *** * * *** * * * **** * ** * * ** i4® 6bntaF ee Sr" Permit Fee $ // CCF $ O't(�! C C Notary $ .----- Training/Education Fee $L J Technology Fee $ • Scanning $ 6'00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 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 approved and a reinspection fee will be charged. Si Th 4- day of who 's Contractor The forego' in ent w kno , edged before me day of �`��/ 20by onally or who has produced ho is personally known to • e • NOT Sign: Print: My Commission Expires: UBLIC: * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED (Revised 02/08/06) NOTARY .' UBLIC: who has prod on and who did take an oath. <� �ti Q,tie Sign: !u....J L3'64 Print: My Commission Expires: �� ■ r / 6% fain Examiner Z Engineer Zoning . 4,CORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 05/05/2009 I PRODUCER McTaggari insurance Agency, Inc 9900 Stirling Road Cooper City, FL 30024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Miami Plumbing &Solar Heating 2170 NW 95th Street Miami, FI. 33147 I INSURER A National INSURER B: INSURER c: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD NAMED ABOVE!FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 1NSR LT�R I A NBC TYPE OF INSURANCE POLICY NUMBER GL 141147 -2 DATE CTIp (M EIFIV7) 05/08/09 �pLICY N DATE (MM/DD 1 05/08/10 LIMITS EACH OCCURRENCE $ 100,000 GENERAL UABILITY 71 COMMERCIAL GENERAL LIABILITY n CLAIMS MADE C OCCUR I DAMAGE TO RENTED PREMISES (Ea occurence) $ 50000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 100,000 GENERAL AGGREGATE $ 100000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT ■ LOC PRODUCTS - COMP /OP AGG $ 100,000 AUTOMOBILE LIABIUTY 1 ANY AUTO I ALL OWNED AUTOS SCHEDULED AUTOS —I HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ J GARAGE LIABILITY 7 ANY AUTO I AUTO ONLY - EA ACCIDENT $ EA OTHER THAN ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY J OCCUR I I CLAIMS MADE 7 DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below -1/VC STATU- OTH- TORY LIMITS i I ER E.L. EACH ACCIDENT $ E.L. DISEASE EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ i •E OTHER ON •F••3°. 'O? 7L• A- I• \iI ➢ _ 1V•R M fi •7 • CERTIFICATE HOLDER CANCELLATION : City of Miami Shor Shores 10050 NE Zed hor Miami Shores, FL 33138 ""MS, ,ore Ann ettess 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 CERII1FICATE HOLDER NAMED TO THE EFT, BUT FAILURE TO DO SO SHALL IMPOSE LIGATION OR LIABILITY OF ANY KIND U N THE INSURER, ITS AGENTS OR REPRESENTA S. /' I AUTHORIZED R RESENTA © ACORD CORPORATION 1988 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08/05/2009 EXPIRATION DATE: 08/05/2011 PERSON: GEORGE KITZMILLER FEIN: 352219643 BUSINESS NAME AND ADDRESS: MIAMI PLUMBING & SOLAR HEATING INC 2170 N W 95TH ST MIAMI, FL 33147 SCOPE OF BUSINESS OR TRADE: 1- SOLAR ENERGY SERVICE 2- CERTIFIED SPECIALTY CONTRACTOR 3- CERTIFIED PLUMBING CONTRACTOR F IMPORTANT OF to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. E Pursuant to Chapter 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 1 SEE OTHER SIDE DO NOT FORWARD MIAMI PLUMBING & SOLAR HEATING GEORGE KITZMILLER 2170 NW 95 ST MIAMI FL 33147 39 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 285 103 Street Miami Shores, FL Owner Information Expiration: 05/29/2010 Address MARTIN RANDLE 1121360130440 Block: Lot: 285 103 Street MIAMI SHORES FL 33138 -2430 MARTIN RANDLE Phone Cell WOO Contractor(s) Phone Cell Phone MIAMI PLUMBING & SOLAR HEATING (305)835 -8008 Valuation: Total Sq Feet: Type of Work: PLUMBING Type of Piping: SUPPLY LINE Additional Info: Bond Retum : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technolog' m ee Total: c" Amount $0.60 $0.20 $180.00 $3.00 $50.00 ($50.00) $0.80 $184.60 0 Ca A c Invoice # Total Amt Paid Amt Due PL -11 -09 -36495 $ 184.60 $ 134.60 r L PL -11 -09 -36495 $ 184.60 $ 184.60 $ 0.00 Check #: 1215 $ 1,000.00 0 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Underground Rough Heater Water Service Final Water Main Lavatory 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 tereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting ;;;;s permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required f6TILECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNER FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructs and zoning. Futhermore, I authorize the above -named contractor to do the work stated. November 30, 2009 A'thorized Signature: Owner / Applicant / Contractor / Agent Builcng Department Copy November 30, 2009 Date 1