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PL-11-788 (2)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 No. ?LI( --13-Y Master Permit No. t S 9,(' p Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): M P / SA �A �� Phone#: '30 ' % s°� ' �c3 6 6 6 Address: q 3 %' /y 7 f City: /i o ��" State: �� zip: `3 3 / 3 d Tenant/Lessee Name: Phone#: ''3 © -' ?TT --sc,CC Email: JOB ADDRESS: 13 Vo /4/6 6 City: Miami Shores County: Folio/Parcel #: // `° 32 o(:, ® `3 Miami Dade Zip: 1. /3e7 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: JJ 5i y 1"4"1--7-2, 6/-1 • Phone #:30) `%' /y/ Address: "3 ,c) 9 (.._,,i, y City: State: Zip: / Qualifier Name: 4� 74 5 Phone #3') 5----5/6, - g/I State Certification or Registration #: C.7 6,D5 ),_co 7 Certificate of Competency #: gfelidanoebaypl urrbingeo o m Contact Phone#: ( 1 ---S- c2 $ ---S-6, 4 "mail Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: UAddress OAlteration Description of Work: `ACA --,- V V •_AIM". UNew ORepair/Replace ODemolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees** *+ x+ x******** **** ****** ** *** * ***x:***** ** ** 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 $ Sign: Print: My Co * * * * ** Zoning Clerk 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 promise in good faith that a copy of the notice of commencement and construction lien whose property is subject to attachment. Also, a certified copy of the recorded notice of for the first inspection which occurs seven (7) days after the building permit is issue inspection will not be approved and a reinspection fee will be charged. Signature ue exceeding $2500, the applicant must rochure will be delivered to the person encement must be posted at the job site the absence of such posted notice, the Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoin instrument was acknowlc lged before me this day of , 20 ` \ , by , day of kg .v. . , 20/7, by who is personally known to me or who has produced i L 'L who is person ly kno ` to me or who has produced .( 54..-\U,SqQj O identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commissior Ex .1� T `' �,�,. GEORGE � . FE ..3 K>r:`NO JR. `y,; " 4t'' MY COMMISSION #1: EE084486 +�'%'• EXPIRES May 31, 2015 APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) x5RGE FELICIANO JR. MY COMMISSION # EE084486 EXPIRES May 31, 2015 Client#: 129708 BAYPLUMB ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM011 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 USI Insurance Services, LLC /CL Box 141916 Coral Gables, FL 33114 -1916 305 669 -6000 —CONTACT PHONE (E )` 305 669 -6000 (A/C, No): 305 - 669 -6030 MAIL , ADDRESS: PRODUCER CUSTOMER ID # INSURER(S) AFFORDING COVERAGE , NAIC # INSURED Bay Plumbing Company 3029 SW 28 St Miami, FL 33133 INSURER A: Hartford Ins Co of SE 38261 INSURER B : Bridgefield Employers Insurance 10701 INSURER C 01/01/2012 INSURER D : $1,000,000 INSURER E : GE TO PREMISES (Ea RENTED 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 DESCR BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR R LT TYPE OF INSURANCE INSR INSR SUBR IM/p POLICY NUMBER (MM/DD EFF (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 21UUNUV7897 01/01/2011 01/01/2012 EACH OCCURRENCE $1,000,000 X GE TO PREMISES (Ea RENTED $300,000 CLAIMS -MADE X MED EXP (Any one person) $1 0,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 7 POLICY X 78f LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 21UUNUV7897 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Peo DAMAGE accident) $ X X $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IA ANY OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, DESCRIPTION OF OPERATIONS N ECUTNEY N NIA 83028220 01/01/2011 01/01/2012 X TORYLII OTH- TgRY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment Miami Shore Village Building and Zoning Department 10050 N.E. Second Avenue Miami, FL 33138 -2382 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 (2009/09) 1 of 1 #S6000909/M5131685 /-iefre 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VRMZP MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 471852 -5 STATE# CFC057007 451970 -9 BUSINESS NAME / LOCATION BAY PLUMBING COMPANY 3029 SW 28 ST 33133 MIAMI OWNER BAY PLUMBING COMPANY Sec. Type of Business THIS Is 416A f?ole,IMBING CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI.DADE COUNTY TAX COLLECTOR: 08/12/2010 60010000123 000045.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD BAY PLUMBING COMPANY ROBERT L BEANS 3029 SW 28 ST MIAMI FL 33133 I'. 174 '.!, }l..1111l111.111„111,W..1,h:,W,l i'I•! -LICENSE' -NB 08/16/2010 - 100076294 CFC057007. The PLUMBING CON CTG L Named below IS CERTIFIED Under the provisions of .RChapte Expiration date: AUG 31, 2012 BEANS, ROBERT LYNN BAY .:PLUMBING - COMPANY 3029. S Td .28TE STREET MIAMI FL 331333