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PL-14-919Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. I NSP- 211886 Permit Number. PL -5 -14 -919 Scheduled Inspection Date: May 20, 2014 Inspector. Diaz, Osvaldo Owner. ACOSTA, CECILIO Job Address: 736 NE 92 Street 2 -K Miami Shores, FL Project <NONE> Contractor. SERVICE AMERICA ENTERPRISE INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Repair Phone Number (305)264 -8560 Parcel Number 1132060440380 Phone: (954)979 -1100 Building Department Comments REPLACE 30 GALLON WATER HEATER Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No AddMonal Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 36 4! . .24 P� rc is�� J .� 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 FBC2010 Permit No. Master Permit No. 1 Cl 14 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: City: Miami Shores . County: Miami Dade Zip: x'51 3 Folio/Parcel #: 1\ � Q (D L ( c ') Is the Building Historically Designated: Yes NO Flood Zone: 9, ay_ !FRF,c iVVED MAY 052.014 OWNER: Name (Fee Simple Titleholder): CI, 1 C...1 \ 0 A. re--) Th 9 -- Phone #: — Gf �3 Address: 15L.0 �--- City: � !:.0 f•j • _ tate: Zip: -3-5 ca Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 'Pf \j 1 C f •'r> Phone#: O.51 1Q— \ \ Cf3 "—�J' J� Phone#: ��-T P—t — f co Address: 9-)s- ■3� d C ott City: fort L V`C`'erci&° State: 42( Qualifier Name: E r, G State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: ■ Lik4r0A.. e Value of Work for this Permit: $ 50 L ) Square/Linear Footage of Work: Type of Work: °Address Description of Work: °Alteration °New °ftepair/Replace °Demolition at" 4..__LJ * ** *********************************** p************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ ' Permit Fee $ 1/0t) i -- CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I I (✓' [D Ica c . 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 RT.RCTRICAL 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 s. h posted notice, the inspection will not be approved and a reinspection fee will be charged. (lil Signature �-�-e- 0l1 • (ms's -�►�.� az�/ Owner or Agent Signature J � /Contr_ The forego , : instrument was acknowledged before 9e this') was The foregoing instrument was day of , 21:1.i__, by G 110 114-6-(114--- , day of �1, � _ 201\1 , by who is personally known to me or who has produced 0. Z-I 6 who _ .. - own to me or who has produced As identification and who did take an oath. as iden 'fie = 'o and w s 'd fore me this. NOTARY PUBLIC: Sign: Print: My Commission Expires: NOTARY PUB BRIDC±r MY COMMISSION # FF 067455 EXPIRES: November 9, 2017 ded Thou Notary Public Uncle/writers Sign: _ 1 1 Print: BRIDGET I IODATIT MY COMMISSION # FF 0 ' 1H -.o; b' "i( •< EXPIRES: Novemb' z,0i lit 4P °• � Bonded Tim Notary Pt& row,:. My Commission E + s, t,*+ s******, xa, w, xa,**** a x+ t,* x, ***** *****+ i•, i,********* *,x**+><***a,*,r****** ** *w **, x***+ x*,>,* ********* ***+ x ,x*a,*x,**** ** ***+x,x*** APPROVED BY C c� $� Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Miami Shores Viiiage 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 (CERTIFICATE 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: Service America BUSINESS ADDRESS: 2755 NW 63 Ct CITy Fort Lauderdale STATE FL ZIP CODE 33309 BUSINESS PHONE: (954 ) 979-1100x5673 FAX NUMBER (954 ) 977 -3591 CELL PHONE ( ) QUALIFIER'S NAME: Eric Todd Nerenberg QUALIFIER'S LIC NUMBER: CFC056891 E -MAIL ADDRESS (IF APPLICABLE): epermitsgroup@serviceamerica.com Created on 3119109 BY MLDV 1 RV 3126109 MLDV ' - c wrt �Awi 'io .�(; ■,.. .r ANMOW-��..= ,r_r, w. �r..�oi�� V AIM �ti • 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 D: Business Nameme: SERVICE AMERICA ENTERPRISE INC R@Ceipt#:PLUI ING /LWN SPRNKL /CONTRACTOR Business Type: (PLUMBING CONTRACTOR) Owner Name: ERIC T NERENBERG / QUAL Business Opened:06 /20/2o07 Business Location: 2755 NW 63 CT State&CountylCertiReg:CFC056891 FT LAUDERDALE Exemption Code: Business Phone: Rooms Seats Employees 265 Machines Professionals For Vending Business Only • Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 150.00 0.00 Q.00 0.00 0.00 0.00 150.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ERIC T NERENBERG /EQUAL 2755 NW 63 CT FORT LAUDERDALE, FL 33309 1 . Receipt #10A- 12- 00001718 Paid 07/12/2013 150.00 • 2013 - 2014 Fax Server 5/2/2014 8:48:21 AM PAGE 2/002 Fax Server ACC?RU" CERTIFICATE OF LIABILITY INSURANCE 10/25/2014 DATE (MM/DDIYYYY) 10/23/2013 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 poiicy(les) must be endorsed. If SUBROGATION IS WANED, 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 LOCKTON COMPANIES 444 W. 47TH STREET, SUITE 900 KANSAS CITY MO 64112 -1906 (818) 960 -9000 CONTACT N E: PHONE (A/C, No. E#): E-MAIL ADDRESS. I FAX C. No): INSURED SERVICE AMERICA ENTERPRISE, INC. 1343427 2755 NW 83RD COURT FORT LAUDERDALE FL 33309 I INSURER(S) AFFORDING COVFRAGE INSURER A : Zurich American Insurance Company INSURER B : American Guarantee and Liab. Ins. Co. INSURER C : Pennsylvania Manufacturers' Assoc Ins Co INSURER D : NAIC 1C 16535 26247 12262 INSURER E • JNSURERF: COVERAGES FIRC015 CERTIFICATE NUMBER. 11498961 REVISION NUMBER. XXXXXXX 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, �.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTSR SUBR TYPE OF INSURANCE POLICY NUMBER A A B C X COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE n OCCUR GENL AGGREGATE LIMIT APPLIES PER: POLICY❑ JECT LOC OTHER AUTOMOBILE UABIUTY X ANY AUTO AS ^� ,� D gCFIED N N 0106555467-04 UCY EFF 10/25/2013 10/25/2014 OMITS pEAACCHHOC CURRENC T PI(FMIRFS�A neq) MED EXP (Anv one Person) s 1,000,000 s 1,000 000 s 10,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG ULED X HIRED AUTOS X pO�N.aWNED X UMBRELLA LIAB EXCESS LIAB N N BAP6555466 -04 10/25/2013 10/25/2014 OBA �ED 71 SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident OPERTY DAMAGE X OCCUR CLAIMS -MADE DED 1 X 1 RETENTION $0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If seyaa daeaibe under DESGtRIPTION OF OPERATIONS below N N AUC 6555463 -04 10/25/2013 10/25/2014 EACH OCCURRENCE AGGREGATE $ 1,000,000 $ 5,000,000 $ 2,000,000 $ 1,000,000 $ XXXXXXX XXXXXXX $ XXXXXXX $ XXXXXXX $ 5,000,000 $ 5,000,000 Y/N N/A N 201375 7650856 12/31/2013 10/25/2014 X1PER H- STATUTE Ir R $ XXXXXXX EL EACH ACCIDENT EL DISEASE - EA EMPLOYEE ..i DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached H more apace is required) Evidence of Coverage. Eric Nerenberg— CFC056891 CERTIFICATE HOLDER $ 1,000,000 s 1,000,000 $ 1,000 000 11498961 Miami Shores Village 10050 NE Second Ave. Miami Shores FL 33138 ACORD 25 (2014/01) CANCELLATION 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 The ACORD name and logo are registered marks of ACO p ID ORPORATION. All rights reserved