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PL-02-2390Miami Shores Village 10050 NE 2nd Avenue Phone: 305 -795 -2204 Printed: 9/9/2002 Applicant: GEORGE /KAREN Owner: GODFREY JOB ADDRESS: 1481 NE 102 Contractor LASSETER PLUMBING CO INC Local Phone: 305 - 893 -7180 Plumbin g Permit Permit Number: PL2002 -239 Page 1 of 1 GODFREY GEORGE /KAREN ST Contractor's Address: 865 NE 130 ST Parcel # 1132050240130 Legal Description: MIAMI SHORES BAY PK ESTS AMD CC / G 0 Permit Status: APPROVED Permit Expiration: 3/8/2003 Construction Value: $100.00 Work: GAS LINE FOR STOVE & BBQ PIT SINK 50 GAL HEATER PB 56 -86 LOT 17 & E1/2 OF LOT 18 (l o� 6 o Total Fees: $04W Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further ndition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulatio pertaining to the work covered hereby whether shown on the plans or drawings or in.the statements or specifications and that he assumes responsibility for work done by his agents, servants o mployees. (INSPECTOR) BY: t in consid atiieisivance 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 responisibility for all work done by either myself, my a e servants or em Signed: Contractor or Builder) BY: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ` 110050 N.E. 2nd Avenue • /Miami Shores, Florida 33138.305- 795 -2204 . Date�7ob A ess6 / ' v� < xif Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee/Tenet Master Permit # Owner's Address Phone 0 ^ cJ CJ 7 Z r `o �Contractin U Address � � � �/ Qualifie Phone f3" E 5 �J / �c✓ State # C / e O ( ,15 &unicipal # Competency # Ins. Co. IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,' THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTH ,,CTION. Permit Type (circle one): BUILDING ELECTRICAL P UMBING MECHANICAL ROOFING q&, Z WORK DESCRIPTION: Square Ft. Estimated Cost (value) �y WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. 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. Furthermore, I authorize the above named contractor to do the work stated. S42& 4 a7mm _ C-/--- Signature of owner and/or Condo President Date Signature of Contractor or-Owner Builder Date Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner Builder Date My Commission Expires My Commission Expires FEES: PERMIT % /D RADON C.C.F , NOTARY BOND APPROVED: TOTAL DUE Zoning Building Electrical Mechanical Plumbing Structural Engineer PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address / 7 / / " J` Tax Folio Legal Description Historically Designated: Yes No Ownerhmsee / Tenant = ;1, 'c >l Master Permit # Owner's Address Phone C1 % Contracting Co. l �G . ; � k' 4 Address = , 1 � 13 6, Qualifier r", SS# !� - Phone 3(J' j Municipal # Competency # State # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): I UIZDI1ti G ELECTRIC PLUM,BJP MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (value) IV- WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU" PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDS OR AN ATTORNEY BEFOR : RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all wot will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNERS AFFIDAVIT: construction and zoning Si a e of owner as to My I certify that all the foregoing information is accurate and that all work will be done in coin liance with all applicable laws, regulatir Furthermore, I authorize the above -named contractor to do ed. andI o i ate Signature of Contractor of-Owner-Builder Date vneFcasw(pr Op ident Notary as to Contractor or Owner - Builder Date e ANGELA n copanns; a , ct CNRlST1NAPORRAS , V P �'" q C ` e' ' MY COMMiSSiON I CC 997648 - -- I� MY Ci>fi4 AI t: or F,c NC' �Q= EXPIRES: May 30,2M5 _. .�. .. , ''',y�,aF ty,.• Bonded Thru Notary Public Underwriters FEES: PERMIT RADON C.C.F. NOTARY BOND APPROVED: Zoning Building Electrical Mechanical Plumbing Structural Engineer TOTAL DUE ADDENDUM TO BUILDING PERMIT APPLICATION (Ali APPLICATION FOR BUILDItZG PERMIT MUST ACCOMPANY 7:HIS ADDENDUM. IF A MASTER PERMIT IiAS BEF OBTAINED, THE OWNER -S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APYLICA`.CIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BATII TUB BIDET UNIT FEE ITEM SW11Cf1 OUTLETS LIGIT CUTLETS UNIT FEE ITEM SPACE BEATERS CEIHML HEATW3 UIIIT FEE DISHWASTIER 01SPOSAL URINKHIG FOUNTAIN _RECEPTACLES SERVICE 1Ehi'ORARY SERVICE SIZE IN MPS A/C (Wild)) A/C (CENTRAL) DUCT UK — FLOOR CMIII REPAIRACER UWIGE REFRIGERATION GREASE TRAP _SERVICE APPLIANCE CUUTLETS NdJ PRESS P1PIftG _ INTERCEPTOR RAIIGE TCf _PROCESS UItUERGROUIIU IANKS - LAVATORY T OVEN glUUtTU TNIKS LAUtURY TRAY WATER HEATER _ABOVE U.F. FRESSUIE VESSELS CLOTHES WASHER hUTORS 4- 1 IP STEAM BOILERS _ SIIOWER OVER 1- 3 I(' 1101 WATER BOILERS SINK, PUT /3 COhP. _MOTORS OVER 3- 5 IP MECIIANICAL VEIITILATIOII SIIIK, RESIDENCE � �_� —' _NUTORS hUTORS OVER 5-- 8It' TIIANSPORTIIIG ASSEHUES I S I 11K, SLOP � hOTURS OVER 8- TO IP -"- ELEVATUIIS/ESCALARAIS - - - - WATER CLOSET 6UTCRS OVER 10= 25 II' FIRE SPRINKLER_SYSTUNG UlIHARMY UIIFW_ �6UT(XIS OVER 25-100 IP -- ItTG TOYiERS WATER CLOSET hUI URS OVER 100 IP -COOL VIULATIUII _ III) I RECT WASTES A/C W I INW RE I IISPECT I ON -! WATER SU'PLY 10: AIR CUIdJ I T I ONERS A/C UIIIT HEATER FIRE SPRINKLER HEATER -NEW IttST. _STRIP GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS HEATER- REPLACE LAYRI SPRINKLER -WELL _ GENERATORS TRA%FO%icRS SPECIAL PURPOSE - SWIh1dING POOL OUTLETS C( mERCIAL WATER SERVICE SEWER CONNECT 10NS SIGN TUBES SIGN TMIISFOOGS -- — UTILITY -SEWER UTILITY -WATER SEPTIC TNIK SIGN TIME CLOCK FIXTL4IES - - - -" ' ---- ' RELAY _ANTEtU111 TELEVISION OUTLETS URAIIIFIELO, 4" TILE/RES. FLAP & At NWH SEP F IC TANK _VIOLATIUtI RE I NSPECT IOtl SOAKAGE PIT Cll, FT. CATCH BAS HI _ DISONGE WELL DOMESTIC WELL AREA. DRAIN ROOF HILET SOLAR WATER HEATER FIRE STAId.'P IPE — - POOL PIPIfu LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING _ Acoj CERTIFICATE OF LIABILITY INSURANCE, OP ID T DATE (MM /DD/0 SPLOl 09/03/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gateway Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2430 W. Oakland Park Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Lauderdale FL 33311 Phone:954- 735 -5500 Fax:954- 735 -2852 INSURED INSURERS AFFORDING COVERAGE INSURER A: FCCI Insurance Com INSURER B: Brid of ield Em to ers Ins. Co. Lasseter Plumbing Company, Inc Attn: Ms. Tina Porras INSURER C: 865 N.E. 13O Street INSURER D: North Miami FL 33161 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 LTR TYPE OF INSURANCE POLICY NUMBER DATE MM /DDS DATE MMIDDIYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR A252414 09/01/02 09/01/03 EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Any one fire) $ 30_0000 MED EXP (Any one person) s5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY X JECT PRODUCTS - COMPIOPAGG s2000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A252414 09/01/02 09/01/03 COMBINED SINGLE LIMIT {Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) i $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT { {{ $ I OTHER THAN IA ACC AUTO ONLY: AGG $ $ EXCESS LIABILITY OCCUR FI CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 083021471 05/25/02 05/25/03 X I TORY LIMITS ER E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER i I, DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS I CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION MIASH01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -I-Q_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL MIAMI SHORES VILLAGE BUILDING & ZONING DEPT. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 10050 N.E. 2 AVENUE REPRESENTATIVES. AUTHORIZ P N V MIAMI FL 33138 AUUKU Z* -s inai) OAGURU CORPURATION 19BB - - -- U srrq' +v enti nred A umr_nL See.. cp f r detnil .. .,. ... LASSETER PLUMBING Co INC 865N.E ,130 ST. 9132 NAfLWf FL 33,161 t PAY TO THE DATE ORDE / „ F ''V � 63 -4/830 FL �— 893 BankofAmeri D �k America. ACHq/r063700277 ® FOR ° ■009 13 2u' x00 6 30000 4 7f' • 00 38 7 13 3 cl 74 7n■ _ Il