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EL-12-2116Miami 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 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No. ,1 �'� �✓ X22 -2A(o Permit Type: Electrical �n,,,,0 JOB ADDRESS: ij �Q pie- 1» (0, City: Miami Shores County: Folio/Parcel#: 1)— 32 —062'0 i 12:30 Is the Building Historically Designated: Yes Miami Dade Zip: 3 Y NO Flood Zone: OWNER: Name (Fee Simple Titleholder):�— /1-7/ j Address: I J Q 1E 4 i° 4P° ✓✓ City: /Pi7'?I fit State: 40 Phone#:1-7 -35) L75 zip: 33/3$ Phone#: Tenant/Lessee Name: Email: 1 CONTRACTOR: Company Name: Y / /°i F /c Address: 5P-6 City: pAR,4 State: �a o vbtc Qualifier Name: 41 A 6424 rK ` i P h o n e # : q 2. 6 /7 Zip: ' �`3 6 Phone#:' 4.,-C ( " 8.40/ `"? State Certification or Registration #: L G d46 Certificate of Competency #: Contact Phone#: "%4.161-- 6 t;1 Pj Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ O 2 Square/Linear Footage of Work: Type of Work: °Address °Alteration °New Description of Work: 9 ORepair/Replace °Demolition Submittal Fee $ Permit Fee $ / ✓ ' e' 4 CF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL I'EE NOW DUE $h 0 1 O 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 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 ti hment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection - hich i curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ' I r1 roved a reinspection fee will be charged Signature Own • gent ° Contractor The foregoing instrument w knowledged before me this : 7 The foregoing instrument was acknowledged before me this .- day of _it Akt,E, 20 'Z by ti) Na , day of i��=s� 0 L by i who is personally known to me or who 0,05t has produced who As identification and who did take an oath. NOTARY PUBLIC: Sign: Print me or who has produced as identification and who did take an oath. JULIETA PAULA SAAL MY COMMISSION 8 EE152683 ,2016 mosdatiatelyseviesmffi My Commission Exp * * * * * *** * * * * * ** APPROVED BY 2-11'1 NOTARY P HELENA PRESSLEY COMMISSION # EE 072597 PIRES: March 20, 2015 Thru Notary Pablo 11r a@r:ss Sign: Print: My Co ***** * ** ** * * *e ** * * * * * * * * *** *** *** *** mss** *** ***** * ***** ** * ***,w****** s * * * **** Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk 11/19/2012 10:50 FAX 9545306781 4 STATE OF FLORIDA DEPARTMENT OF HUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS ICENSZNG HOR 1940 NORTH E O TALLAHASSEE FL 32399 -0783 • GRANT, GLEN EDWARD VICON ELECTRIC INC. 520 SOUTHWEST 63RD TERRACE 0/:8 CongratuIatlonsl With this license you become one of the nearly one million Floridians licensed by the Depadrnent of Sushiess and Professional Regulation. Our professionals and businesses range from architects 10 yacht brokers, from boxers to due restaurants. and they keep FIodda's economy strong. Every day we work to Improve the way we do business In .order to serve you better.; For inhumation about our services, please log onto www.myUeridaIicense com. There you can find more FM:Irritation about our divisions and the regulations that >,; II004 /005 (050) 487 -1395 .'oas .H :;''.. .� ` �ve'.i • ' •O ° ^e iSi •n "•:a�'T.'yY il:• .. 4. •.. ',.^' .;!L ca;0 0207x • :.; ", "f h •. 'lie,- impact you, subscribe to'departMent newsletters and learn mere about the Department's initiatives. Our mission at the Dew is: license Efficiently, Regulate Fairly. We constantly strive to serve Y c , Thank you for doing business Florida, and you congratulations on your new license! <c. pr:;G rIa .: , ;• . • 'a3 ofy, e^;�es "al; L)C)CU(.11: N r yivs A CULURE!) 7r4C:' CR _liihl!) • P,7frRC :p ir.4T iLY • LINFR9ARK ' F'A { ENTF) PA.F•EF- BATCH NUNI FF 11/18/2012 10:51 FAX 8545308781 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-8314000 VALID OCTOBER 1.2012 THROUGH SEPTEMBER 30,2013 BusinessName:VICON ELECTRIC INC Owner Name: GLEN B oRANT alleirlelge Location: B20 SW 63 TBRR MARGATE Business Phone: 954-486-7010. Rooms I TacA.,mmord 27.00 Soils Employees •1 IMO 0 5 / 005 R/"Pt *181C421ML/ALARNE/03NTRA Business Type: ()ELECTRICAL CONTRACTOR) : EkmanottOpened:01/01/1994 Stidel/COUllty/Cert/ROWEC0002072 Exemption Code: . ..MoOldine Pmftsolcmdlo Nianbor of Maoldnos: Truster Fee NSF Fee 0.00 0.00 For Vending Elusion** Only Vending Type: Collection Coot Total Pala 0.00 0.00 27.00 THIS RECEIPT MUSTI3E POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This ta* is levied for the privilege of doing business within Broimni County and is WHEN VALIDATED non-regulatory In nature. You mud Met alt Courdy and/or Municipality planning and zoning muukernents. This Business Tax Receipt must be transferred when the business is sold. heatless name has changed or you have moved the business location. This receipt does not indicate that the business is regal or that a in compliance with State or local laws and regulations. Malting Address: OLEN E GRANT PO BOX 9601 FT LAUDERDALE, FL 33310-9601 Receipt *30a-11-00006283 Paid 09/26/2012 27.00 2012 - 2013 Nov 20 12 02:20p VICON ELECTRIC 9549728107 p.1 :ACCRDa .. CERTIFICATEOF- LIABILITY ITY INSURANCE ...: . t riaAm"" • PRODUCER ' McKinley North Fin M ewe inc.COMPANIES Port Lie, FL 33301 554.11311.2655 • INS CANIEWICATE la MUM AS A WIER OR INFORMATION way ANDCOI4FERS no mom UMW ME c�/ua',OLDER. MIS CONicAi3E DOM or MIEN / MEND OR AL1ER 1IE COVERAGE l A EDHYTMPOIXIES COMPANIES A RD11�G COVERAGE COMP marrow .... Ascendant Commercial Insurance r -r: -1 Vim Electric Inc lin SW Se Terrace Margate, R. 33069 =PAW r1 1 Dag nip r•,' r •/ + :1 :`I V . a VINEWIRS COMRCIannerDE • •3.1ii_. . ....._ 1 a MID hf.. R!_: / �1 1: ' __ e 1 [ 1_ I• comma OFANYCONTRACTOR DEWED CROW PERIPULTHE INEURANCEAFFORDEDWITHE / i ' ■ OF -L2t / -:•1:1 : o • ^❑/ mucus - _ '.7i F7r 'DI .f, `/- POLED, DINER Y • f - O DESCEDBED HEREIN a smear io."u. BY 1 CO CSR MIMS if • '° _ _: r:__i1J ! 'J1 ¢ -. UDDERY GEMENIULAGGRECIATE OWNERSICCIOTIACTORSPROT INCIAXESJUREOC 1- ISACHOCCUMBICE lirsakautsmor -' AMY- ADM — ALLOWNED AUTOS - �A�1W MHOS - AUTOS a UG. 11 III= ' MI AtffOotaxautedeon ANY' AUTO INIONIMIN - 11411319EILKFORIPA - talksiEugr "mum triennia= # i- / -1 h- ...I.:. ✓ _ ■1,.A._:_t_ai PON EUSICHACCIDENT E.22110` .,2•�,2 1 F i tT i OFFICOSOME OM rn st. wow -IaloneuREE t i;. .. 1:1)1°111.11 I an: IMO II Conbards Deductible O'rlOwl� ItEirg Miami Shores ViIage Building Department i0Q50 i 2'�' Ave Miami Shores. FI. 33138 - ORD2s,'S•('tlik4) . - :.. :.....:.. .1 .: .. •.. ..: . 811dA D ANT OP 7IE ABOVE POLE 8E CAN ae sllrt: E A1ION OuCiE 11 OFi r�1�ANY W*L ENDEAVOR 1V' MAB. SAYS vCFdsra NOTE: 1O ENE CiBt,DICA�P i. r i t r rrsi►trerrsao REPRESENDMVES. - _ -. .. .. - . :.. • eA�RDCOri ORK11(Mt 19� Nov 2U 12 U9:4Ua VICON ELECTRIC 9549728107 P.1 " .ACORI CERTIFICATE OVUM =LIAI ILA T ' .1 1SURAN+C warm" PRODUCER McKinley Ficanctai Services, Inc. • $45 Nom AndreweAvenue Pert Lauderdale, R 33391 , !354.898.3886 111113 CERUUACKIE PS AS A OF IA71QN 01&YAHDCAMS HOME= UPON THE L'S'EHOLUM 1168 CEN1W1CATE DOES NW MEND. EXPEND OR ALTER THE COVERAGEAFFORDEDBYTHE POMS COMPANIES AFFORDSIG COVERAGE Ascendant cor meanie! insurance VIco6 EIecb c Etc 820 SW 63i1 Imam Ate. R. 33068 s COMPANY C COMPANY 0 Ties ETOt rararr vaiicies F iarrEns+ moo sEnCATED.PlotWITHSTAWDROANY'REMENEMENTAERUOROMMOP4OFANYCONnuCTOROTHEra WHICH USCEREROORMAYSE OR SAY FERTAINLTHEINEUraticeAF memos OwurarantessouCONO r MOFEli x, POWER erneeE SHOW MAY • TolHE N anairiceeTHE kW, =NMI a1HINRESPECTTO RYTHE RIMS DESGMEEDnEREIN ESSIEUEOTTO All seems SarruCifrier n atu.A e0 r.rin rallat arrMSORAIME POUCT EFIRMINE , , EMPIHMION prootnn LAMS - UASa.rrir cerasetaacraerea . 5 $ C010113112004.0sium Lowly fetAiniitaft [Doc= ChifteRS sCatinueCTORSP PFMIDUCHIVOMIMP Aga PERSONAL&NXIKJURY $ SMISOCCURPERCE FIREWAIRMAIWgisfild 5 ra,tat ANY AUTO A omenAUTOS SCHEDULOE > NOMONNED • $ -- $ GARAGE UASILI11- • AUr0WS7f•FAA $ ANY AUTO A ANIMATE $ *MEW Maury "WC 44 12 04/01E2013 EIICIl14CCtl r $ =UMBRELLA —10n4ERTHat MORELIA rmor e $ Y i T $ A 1110Mi 118001pa:1180 ELEAd1 BiC VIEPROPRINOV rimumesesincusive rainceremas c. � •i�OLlClrtYi ,ODftaO ,! c - &LPIFtOfIEi Contents Deductible ' OTHER • 1l OP oPatranalistLoousOrraraMonEsewracaLmrass TE-ldOt reR.. ..: - • •. . ... Miami Shores Village • Building Department - - 10050 hE 2nd Ave Miami Shores, EI. 33138 A.ORD t4�9j - c$ JAT N.:- ' :.: ." :.:. : • :.. ' •' - MIRO 44 OF THE D Wens= larPineniou DitTE 1 E3EoF,THE Reale COMPANY WEE. ENDRAVORIO L Q pM Vaunt* HOME TO IRE GERTIPMATE SAL HOLDER *MED 10 HIE LEPT. BUT MUNE TO HAIL sum a NO O81l0A� UMW ANY � – :•' . neausenSertneraeSalltAlwee. `} :, 188 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1?. Inspection Number: INSP- 181391 Permit Number: PL -11 -12 -2120 Scheduled Inspection Date: January 07, 2013 Inspector: Hernandez, Rafael Owner: MINSKI, JOEL & ANDREA Job Address: 9969 NE 4 Avenue Road Miami Shores, FL 33138- Project: <NONE> Contractor: G&L PLUMBING SERVICE Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)510 -0916 Parcel Number 1132060171230 Phone: 305 -551 -5090 Building Department Comments PLUMBING WORK FOR BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 04, 2013 For Inspections please call: (305)762 -4949 Page 10 of 25 3 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 alb N6V 0 8 2142 I B Y: FBC 2V j L--2A20 Permit No. 'C Master Permit No. � Z-21,15 Permit Type: PLUMBING JOB ADDRESS: 196(1 V .+(*'" i' 40 City: Miami Shores County: , Miami Dade Zip: 3138 Folio/Parcel #: i 122--Q J "0 % 3° Is the Building Historically Designated: Yes Flood Zone: NTO OWNER:` Name (Fee Simple Titleholder): 7.'E L OA. ! �-i Phone#: (r!� (1 3 31 ° LI "I Address:. 1 6 9 v i 79-k/- it City: 4,94-f Lc/400,05 State: FL. Zip: 3;13S Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: P 4 L PIJt i !' Phone #: 2z) c � 3 /6 ° .-,41(' Address: //o 2 t (40.- Atv,—._ City: di r State: r(-- Zip; 3 %� l Qualifier Name: E Lo i ✓ Phone #: State Certification or Registration #: l fe. () - ? 3 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 5 Q Type of Work: ❑Address Description of Work: Square/Linear Footage of Work: ❑Alteration ❑New ORepair/Replace ❑Demolition ***********************+ **:x *****+x******Fes*x s******************************************** Submittal Fee $ Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ r 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 whi - ~: occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app and a reinspection fee will be charged. Signature Signature Own. Agent The foregoing instrument was . cknowledged before me this ,' The foregoi instrument was acknowledged before me this day of X4-220 1.27 Ei- ? re-41 4-i , day of NJ() \I , , 20 11.-; by et0V 6 ,24s , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUI who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: tt;. JUUETA PAULA SAAL or: MY COMMISSION # EE152683 ,2016 APPROVED BY Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Sign: Print: My Commission E • • es: Z_ 11 N Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE jCERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: & I__ PL-4h v(.)(,- BUSINESS ADDRESS: 71-1 I ( Si.9 6-7 &V CITY STATE FL ZIP CODE °a 3 L 7 BUSINESS PHONE: ( 31 (P- 5-60/6/. FAX NUMBER ( ) CELL PHONE ( 3103^) 31(a -$7a qy QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: CFC..O 507 C5 4 E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD /YYW) 07/23/2012 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 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 ROYAL CARIBBEAN INS. AGENCY 1772 W FLAGLER STREET MIAMI. FL 33135 INSURED G & L PLUMBING SERVICE. INC. 13957 SW 140TH STREET MIAMI, FL 33186 CONTACT NAM LAYDA TUNON PHONE.. - ...._..._..._..__._..._ ____ .................. _4, `,,�,up 305 642 -4541 1 (ac, Not 305 -642 -1087 ADDRESS. LTUNONROYALIIOBELLSOUTH.NET • INSURER(S)AFFORDING COVERAGE NAIL N INSURER A :ASCENDANT INS. CO. INSURER 8: CATLEPOINT FLORIDA INS. CO. INSURER C • COVERAGES INSURER 0 : INSURER E : INSURER F THIS INDICATED CERTIFICATE EXCLUSIONS RceionalY iv VROCt It: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. — ._..__ —_ ..... ..... ... ....... INSR- LTR :AOOL SU8R .....___._._.__._. .. ._......_. __. .._ TYPE OF INSURANCE , MISR • W V11 POLICY NUMBER PSVODIr ry1 oimrootyv P i (MM /OO/YYYY� (,MMIDD/YYYY), LIMITS A • GENERAL LIABILITY GL -1 19688 05/04 /2012 05/04/2013; EACH OCCURRENCE $ 1000,000.00 X COMMERCIAL GENERAL i DAMMADETORENTED ' ' PREMISES fEaoccurrence} S 100,000.00 CLAIMS•MADE X , OCCUR ; • MEO EXP tAey one person) S 5,000.00 _ -. _ . __._ __.___._..._.. _.. P£ RSONAL. A AOV INJURY 5 1 .000.000.00 __ • ..._._�..._.__ GENERAL AGGREGATE 2.000,000.00._ _•, s GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS • CCMP/OP ACG S INCLUDED POLICY PRO. -- - JE CT LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ROPILY INJURY (Per person) 5 ALL OWNED - --' SCHEDULED AUTOS , AUTOS BODILY INJURY (Per esculent) S WNEO _..._. .,._.,N PROPERTY DAMAGE S HIRED AUTOS .• ; AUTOS t!er acdde) S UMBRELLA LIAB I _....:OCCUR - EACH OCCURRENCE S EXCESS LIAO ; CLAIMS•MADE AGGREGATE $ DEO , RETENTIONS S B WORKERS COMPENSATION WCP761100400 05/10/2012 05/10/2013 we sTAru• ? OTII• ANO EMPLOYERS' LIA8IUTY _. __: TORY LIMITS.._.. ER.. • .. ... ... ..... ..._. ANY PROPRIETOR:PARTNER/EXECUTIVE Y IN . l E L EACH ACCIDENT S 100.00000 OFFICER /MEMBER EXCLUDEOEXCLUDED', N / A (Mandatory in NH) E L DISEASE _EA EMPLOYEE S 100,000.00 II os. desnroo under .. ........_...... DESCRIPTION OF OPERATIONS beLcw E L DISEASE • POLICY LIMIT S 100,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101. Additional Remarks Schedule, it more space is required) PLUMBING CONTRACTOR. CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AV MIAMI SHORES, FL. 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION • THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE THE P ILICY PROVISIONS. © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (20'0;051 The ACORD name and Ioao are reaistered rks of ACORD AC# . DETACH HERE_ 7t %iS OCCUMEN7 K45,4 CO �� tiJ c�j:SC G UNr Rr� ?: EN'`E PAPER STATE! OF FLORIDA DEPARTMEgi fl BUSINESS AND_PROFIMS/ONAL ON INDUSTRY . LY SING REGULATION SECtf X1220805001! BATCH NUeOSER LI SE 08 05.2012 128030036 The -PLUMBING 0056755.. . Named below IS CERTIFIED Under the provisions of Chapter -489 Rviration date: AUG 31, 2014 GG L PLUMBING SERVICE INC 13957 SW 140 STREET FL 33186 RICE . SCOTT GOiERNOR. rlersr u A t/ a rs nrr►t I II fl amt MIA/ sitar KEN LAWS0N SEXY s ,1 t=4: r5 Th - 460190--3 & #a � U lirSERVItE -1 12335 SW 31 ST 33175 UNIN DADE COUNTY L PLUMBING. SERVICE INC S1 NG CONTRACTOR-.. • Ins GALT A LOCAL MOM= *a*�ap T a DOES nor v .J F BILL —'3tii '40T ?A?• muarr ot�• PEWS' co ANCICEIME or *or *touswouonom ME MOMS COALIRCIL. MAL • FA TAX INIAMEDADE CiflASMAU 10!04/2012 09010061001 000082.50 - amyl SLOE PAL- RENEWAL '0 7 3 $TATi%6755 4844- POSTAGE MIPAO PSAT 110.231 WORKER/3 00167rFORWASO LUISL0 ARR SERVICE INC ERA PRES 7411 SW 67 AVE MIAMI FL 33143 53 p.2 PERMIT # CONTRACTOR:1)I S P-L. CONS 5-1 c1L� SUBMITTAL DATE: / -I i I'1 ADDRESS: 01 91P k _- `z NAME: RESUBMITAL DATES: PROJECT TYPE: 11Y4-1)-jk (LOY) ClaitaXI-L-1 ZONING FIRE STRUCTI�RAL, IMPACT FEES ELECTRICAL HRSIDERM . ,N✓ /(-144 PLUMBING NOC MECHANICAL