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is
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
Permit Type: PLUMBING
FBC 20
Permit No. !'
Master Permit No.
JOB ADDRESS: �L, Hi
City: Miami Shores County: Miami Dade Zip:
I t
Folio/Parcel #: I " 3� -' cGo \�,®�
Is the Building Historically Designated: Yes
OWNER: N� Simple tle
Addreec e N`—
NO Flood Zone:
/'
City: State: Zip: -S�>
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name. I(nL �/Qu% �11AMM�
Address: -! Q 0 VW _ l 7 0
cos -�s� 3�1�b
City: state:
FL Zip: 33110 $
Qualifier Name: ! N A4 e-1 g&14w 14 Phone#:
State Certification or Registration #: e Fe 01q ;4j Certificate of Competency #:
Contact Phone #: Email Address: MS P 01 V m �Gng op a-$/. awn
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
0 i5 Work Address OAlteration ONew ORepair/Replace
Description of Work:
F � � /liPlf•�
ODemolition
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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
Zip
s
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. 1
Signature--4!L �� y `--� Signature i
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this
day of NO-4 , 20 13, by
wh sonally known to me who has produced
\1111produ�
As identificat� and v�d3$,�ake an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: ��-7/Vn nu +��`���\\`•
APPROVED BY
The foregoing instrument was ackno ledged before me this
day of Alw¢m 6dl , 20 L, by 44ii
who isgerson_X_n_ooW to me or who has produced
as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
NOTARY
Sign:
Print sow o �,` NATNALIE ANNE FERNANDEZ
My Commissi MY Commission Expires
•.,,,,p���.•� August 04, 2017
Zoning
Clerk
05/11/2012 09:05 FAX 1 800 985 7530 DATA SCAN FIELD SERVICES Q001 /001
e �.
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR ! ARCHITECT
Permit N.
Owner's Name (Fee 5anple Tits Holder) o �O-Y/ �� Phone #: 3 0S-_ 199 - 5X'3
Owner's
City: d
State : E1_ Zip Code:
Job Address {or where work is being doney 302 'Ve- 93rd g¢
City: Miami Shores State _Florida Zip Code: ?� 3 9 3 4
Contractor's Company Name:
City:
Qualifier's Nam:
Phone* -)®S - qS/
State: ft. Zip Code: X53100
i Lic. Number: 6Fe D/ 19-0 5-
Architect! Engineer of Record Name: I Phone M
Address:
City: State:
Zip Code:
Describe Work: s ic/ 1904A aw9 Vla.a� Tptu9
I hereby certify that this work has been abandoned andlor the contractor /architect is
unable or unvAlling to complete the contract. I hold the Building Official and the
Miami Shores harmless for all dal involy t.
SignaturEL —B Signature
osnerorAgent rorArafiba
The foregoing instrument was aknowie3ged before me The foregoing instrument was aknowledged before me
thisk day o f 15by� this day of �evE�r,b 2or3 by n'
Who is personalty known to me or who has produced
as inwntification.
Notary t , .
Sign:
Said:
NATHALIE ANNE FERNANDEZ
Commission # FF 42370
My Commission Expires
August 04, 2017
who is per2n_ aim to me a who has produc ad
Notary
seat
as indeffmation.
057", N-,,, NATHALIE ANNE FERNANDEZ
Commission # FF 42370
d., My Commission Expires
Augusf 04, 2017
a
Permit N.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 758.8972
CHANGE OF CONTRACTOR / ARCHITECT
Owner's Name (Fee simple Title
Owner's Address: CMG -
City:
C Phone #:
state: Zip Code:
.lob Address (Of where work is being done): 3 G b A 6 5 3
City: Miami Shores State :_Florida Zip Code:
Contractor's Company Name: mAR f 1v►�diNei Phone #: 9 o f- 26 L3 5'V2-
Address: 0 9SY sw 7S-r4&
City: ? State:_ Zip Code: .32!
Qualifier's Name: `5 Ro Lic. Number. 490000 SS"K/-
Architect/ Engineer of Record Name:
Address:
City: State:
Describe Work:
D e L►• of
( Cot LO Aloe" ASACF OP PR.ice
I hereby certify at the work has been abandoned and/or
vublemer awdliffig to complete the contract. I hold the
Miami Shores harmless for all legal invo
Signature Signature
Phone #
Zip Code:
contractorlarchitect is
ding Official and the
sent_
ooarerorAgetn Cot*Kwor
The foregoing Instrument was aknowledged before me The foregoing instrument was akn edged' before me
this tday of N1 V /),by this –I— day of V I • . 2U113 by 144 %
o is personally known to me or who has produced
infA. ► � �- as indents ication,
Notary li
Sign;
Seal:
NATHALIE ANNE FERNANDEZ
* Commission # FF 42370
My Commission Expires
''� p,,,M1ro•�' August o4, 2017
who is personally known to me or who has produced
as indentiflcaticn.
Notary Publ�-' P �®
Seal: cggC RENETINA
= rr Aviv MY COMMISSION # EE 051463 EXPIRES: AQItI 25, 2015
. •a Bonded ihru Notary Public Underwt tem
Miami Shores Village
f Building Department
10M N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3W 762.4949
.BUILDING
PERMIT APPLICATION
P., EcE IT V —E] j
OCT 012013
BY:
FBC 20
Permit No. p L 3 - d,
Master Permit No. 10).
Permit Type: PLUMBING
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
h the Buliding ffiotorleatly Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
city: Y " a `? State:
TenanAmsee Name:
Email:
CONTRACTOR: Company Nam: JV El. � ✓: � � % N� Phone#: 3 frr' � G � 3 c%ti L
Address: q Roy 5W 71'
Mr. IM t dyK i - Stare: EL Tap: 3 d / Kr
Qualifier Nam: 1,-U65 ff ILUUlco-DW
State Certification or Registration #: k F p0 3%2w.
Contact Phone# 3 Order- '1 l C= 6 X13 0 Enwil Address:
of Competency #: 0190
DESIGNER: Architect/Engineea: Phoned:
Value of Work for thla Permit: $ 4�, % seD C�) Squarell hua r Footage of Work:
Type of Work: DAddmu OAlteration ONew1 URepair/Replace D>'l ambtion
Description of Work: _ ��t��^ �� n� �� Xl , �c
�e��+aeea ax+ ease��e�ea�aw�eea�re�aeasoaexwas�
SubnWW Fee $ Pernmtt Fee $ emu° e — CCF $ MCC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ TrabdoWEducation Fee $ Teciut kqW Fee $
Double Fee $ Stracioral Review $ E
TOTAL FEE NOW DUE S. a A
n
Bonding Company's Name (if applicable)
Y
goudiq Company's Address
City State
Mortpge Lender's .Name (if applicable)
Mortgage Lender's Address
Zip
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 m this jurisdiction. I understand that a separate permit must be secured for ELMTRICAL WORK, PLUMBING, SIGNS,
WELLS, FOOLS, 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 a with all
applicable laws regulating construction and taming.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
DRROVEMENTS 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 tae issuance of a building permit with an estimated value exceeding $2500, dre applicant must
promise In good faith that a copy of the notice of commencement and emm* action lien law brochure will be delivered to the person
whose property Is subject to attachment. Also, a cerg0ed copy of the recorded notice of commencement must be posted at the job site
for-the fast Inspection which occurs severe (7) days Oer the building permit is issued I absence %4kch posted notice, the
Inspection will not be approved and a rehWection fee will be charged
Signature �' Signatcue
Owner or Agent I
The foregoing instrument was acknowledged before me this The foregoing instrument was aoknow before me this —0
day of L 13 by �G�t ���� day of 20,13 by V t� %� �. 8 drRiL,
ruuu� ;r�,�
who is orally known o��t � whoa personally known to me or who has produced
As idegdceti�oar0ci'�ke an oath. as identification and who did take an oath.
NOTARY PUBLIC: ®J' 'vd,� �_ NOTARY PUBLIC: /
Sign: ,�' �� Sign:
Print ''� F ' ��� Print:
My Commission Expires• ° °°r,n n i n c►ho""I My Co = .My CMMUM i E 051463
e+ewa�s�aeaaeees�w�a�a�ware��e +sasses ee��weus�aas+a�e�seaseaeseee x�+e
APPROVED BY Plans Examiner Zoning
Structu ml Review Clerk
(Re beW12Mt2)QtwbW 07 /IO/Dt7pi M=d 06tLQ>M){Revind 3/13!09)
Oct 01 13 07:10p
p.l
.4coRVP CERTIFICATE OF LIABILITY INSURANCE
OATE(MM/DD1YYYn
TYPE OF INSURANCE
10/01/2013
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
NAME: Sarai Medina
Emmanuel Insurance & Associates, Inc.
2370 E 8TH AVE
PHONE
ADeRe
( 308 ) 693 -0003 ( 305 ) 6914381
ss, eara(@emmanuelinsurance.com
_ INSURER(S) AFFORDING COVERAGE
NAIC #
$ 1,000,000.00
HIALEAH FL 33013 -4236
INSURER A: Preferred Contractors Ins. Co.
12497
INSURED
INSURER a: RetalIFlrst Ins.Co.
10700
INSURER C .
$ 50,000.000
MED EXP (Any oneperaW,
NELMAR PLUMBING, INC.
INSURER D:
$ 1,000,000.00
4954 SW 75 AVE
INSURER E:
_
MIAMI FL 33155
1 INSURER P:
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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iLTA
TYPE OF INSURANCE
INSR
WV13I
POLICY NUMBER
MMID MME
LIMITS
GENERALLIABAJTY
OCCURRENCE
$ 1,000,000.00
A
COMMERCIAL GENERAL LIABILITYSES
CLAIMS-MADE vim; OCCUR
I
Y
PCASS713 -02
04/27/2013 104t27/2014
_EACH
Ea
$ 50,000.000
MED EXP (Any oneperaW,
5 5,000.00
PERSONAL a ADV INJURY
$ 1,000,000.00
GENERALAGGREGATE
$ 2,000,000.00
OEN1 AGGREGATE LIMIT APPLIES PER:
POUCY Lac
i
PRODUCTS - COMPIOP AGG
$ 2,000,000.00
$
AUTOMOBILE LIABILITY
Ee aeddmrt
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIREOAUTOS NON pYVNED
AUTOS
i
BODILY INJURY (Per person)
$
BODILY INJURY (Per aedderd)
$
ry AMAGE
u arm
_
$
UMBRELLA LIAB
EXCESS I."
OCCUR
CLAIMS MADE
N 1 A
52043054
i
;
10/29/2012 ; 10/29/2013
EACH OCCURRENCE
$
AGGREGATE
DED I RETENTION$
�WORKERS COMPENSATION
ANO EMPLOYERS' UABUTY
IANYPROPRIETORIPARTNERIEXECUnVE YIN
B ! OFFICERIMVS EXCLUDED? F
(N�andazory to NH}
Nyes, deeCtibe under
OESCRIPTION OF OPERATIONS bekmv
N5/C A7 - TH-
7 R�LIM E
$
EL EACH ACCIDENT
$ 1.000,000.00
F.L. DISEASE - EA EMPLOYEE;
$ 1,000.00OAO
E.L DISEASE - POLICY LIMIT ' $ 1,000,000.00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, K mara $page Is reWlred)
Commercial & Residential Plumbing
CERTIFICATE 1410I_171ER ,....�_... _.__.
Miami Shores Village
Building Department
10050 NE 2 Avenue
Miami Shores,FL 33138
ACORD 2S 12ni nm-41
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROYRIONS.
AUTHORIZED REPRESENTATIVE
54M,� M&1-?&141
_ �._ --.... ••�•••v a....'"dw 0.m'wV'*wFU0 marKS OT ACURD
Oct 01 13 05:16P
000133
Local Business Tax Receipt
Miami —Dade County, State of Florida
THIS IS NOTA BILL - DO NOT PAY
265140
BUSINESS NAMEMOCATION
NELMAR PLUMBING INC
4954 SW 75 AVE
MIAMI FL 33155
LBT
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2074
265140 Must be displayed at place of business
Pursuant to County Code
Chapter SA - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
NELMAR PLUMBING INC 196 PLUMBING CONTRACTOR BY TAX COLLECTOR
Worker(s) 20 000008586 $325.00 09/06/2013
TXHS1- 13-056351
This Local Business Tax Receipt only coniirms.paymeat of the Local Business Tax. The Receipt is not a license,
permit, are certification of the holders qualifications, to do business. Voider must comply with any governmental or
nongovernmental regulatory taws and requirements which apply to the business.
The RECEIPT NB. above mud he displayed on all commercial vehicles - Miami -Dade Code Sec go -M
For more information, visit www miamidade aov/texcollector
Municipal Contractor's Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A HILL -DO NOT PAY
CC NO: 000008566
BUSINESS NAME/LOCATION
NELMAR PLUMBING INC
4954 SW 75 AVE
MIAMI, FL 33'55
OWNER
NELMAR
MC
RECEIPT NO. EXPIRES
NEW BUSINESS SEPTEMBER 30, 2014
7437688 Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art, 9 & 10
TYPE OF BUSINESS
PLUMBING CONTRACOR
MIAMFOADEj,' Far more information, visit y 3tjAst miaAtdjb gayA"Soilectar
PAYMENT RECEIVED
BY TAX COLLECTOR
200.00 09/23/2013
3225-',3-r-01216
P.2
Oct 01 13 05:18p p,l
CTQB
Construction Trades Qualifying Board
» BUSINESS CERTIFICATE OF COMPETENCY
000008586
NEL MAR PLUMBING INC
O.S.A.:
RODRIGUE;ZZ C.UIS F
Is certified under the provisions of Chapter 10 of Miamf -Dade County
VALH) FOR *0ftTMCTING tf%nXOW3012015
QUALIFYING TRADE(S)
0001 PLUMBING
0022 MEDICAL GAS INSTALLATION
Chadee Danger P,E((4;,,r,
"��!!
Secretary of the Board
winvrt�e�dade.pwfdnvabCe»id
Oct 01 13 05:1Bp
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
'CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
RODRIGUEZ, LUIS F
NELMAR PLUMBING INC
4954 SW 75TH AVE
MIAMI FL 33155 -4439
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myfioridalicense.com. There you can find more information
about our divisions and the regulations that Impact you, subscribe
to department newsletters and learn more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulations on your new licensel
p.3
(850) 487 -1395
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
H PROFESSIONAL REGULATION
RF0038206 ISSUED: 08/21/2013
REGISTERED PLUMBING CONTRACTOR
RODRIGUEZ, LUIS F
NELMAR PLUMBING INC
(INDIVIDUAL MUST MEET ALL LOCAL
LICENSING REQUIREMENTS PRIOR
TO CONTRACTING IN ANY AREA)
HAS REGISTERED under the provisions of Ch.489 FS.
Explraffon date : AUG 31.2015 L1308210001436
The Department of State is leading the commemoration of Florida's 500th anniversary in 2013.
For more information, please go to www.VivaFlorida.org.
Vi'dA fiUllOd ":
DETACH HERE
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING anARn
RF0038206
The PLUMBING CONTRACTOR
Named below HAS REGISTERED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2015
(INDIVIDUAL MUST MEET ALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANYAREA)
RODRIGUEZ, LUIS F
NELMAR PLUMBING INC
4954 SW 75TH AVE
MIAMI FL 33155 -4439
{ }l� r
.: r , ..�RRRR����511111 LLLLL����"'''111111111f �
nua eauoa
RICK SCOTT ISSUED: 08/21/2013 SEQ# L1308210001435 KEN LAWSON
GOVERNOR DISPLAYAS REQUIRED BY LAW SECRETARY