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PL-13-2825Miami Shores Village .__ .._ �1�� DEC 17 2013 �1JJ Building Department �� 90050 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 k' 22 Permit No. ?Li "J 2 2S Master Permit No. 1 13? 7 37 BUILDING PERMIT APPLICATION Permit Type: PLUMBING lJ JOB ADDRESS: (01 O N€ • City: Miami Shores County: Miami Dade Zip: �' 33138 Folio/Parcel #: Is the Building Historically Designated: Yes NO iC Flood Zone: OWNER: Name (Fee Simple Titleholder): CO K4 - t 2.1) SS Phone#: �S �? 7 34) 7 7 Address: lotto 1,3C 6115-1-1A- sf. City: V L 51,to y-e5 Tenant/Lessee Name: Finail: State: Y L Zip: 3 3 136 Phone#: CosuertQg V1 . Co IM CONTRACTOR: Company Name. '2>k(L) h1, iQl QA > Phone#: vi g^ 3 Y3 -a1751 Address: �°�� ` 402 Ate_ City: / i(dd.) State: Qualifier Name: Lhll � State Certification or Registration #: Cve `� 2 F� Contact Phone#: Zip: �v�v )0 Phone#: re�Ar 5 —�� rr Certificate of Competency #: l�('o- $12) Rmail Address: 71.111T-og, IXPW vwV Y.z.3.045Th DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 4'O6 " Square/Linear Footage of Work: Type of Work: OAddress -- ,^�DAlteration UNew °Repair/Replace (Demolition Description of Work: ll " dQrvtoGkV ?!V1 ****eeee*ee *ee*****e*e *era *ee*s******** *Fees*** *eee *e *** **+xeae see *** * ********* *******w*** Submittal Fee $ Permit Fee $ "/ JC, CCF $ co/CCs Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ �� -s0 Owl �:, DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 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 • be charged Signature L Owner or Agent Contractor The foregoing instrument was ackn%%�lledged before me this 2— The fore _ oing instrument was acknowledged before me this day of D2 C. , 20 13 , by l.1 �� , day of I/� 0 ab 20, , b)f _' r� an k$1, Si ✓� who is personall known • or who haL • Sign: VI $11440 Print: : � Pri n:�,' Print: tr My Commission Expires• My Commissio ires: / _cz---2 /7 - * * * *+b�k�Pl�**** * **** *** ****** *** ** e****** ***** * ***** *** ** * ** ********** ** *** * *** ** ***B*** ***** ********* ** ** APPROVED BY -/ 3" !* Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) S T A T E OF FLORIDA, AC#I` . 6 11.3 3 I '? S DEPARTMENT OF BUSINESS .AND, PROFESSIONAL REGULATION` CFC1428618 4�q CERTIFIED, MEDINA,- R FIX 'PLUMBS 4:111051461 RACTOR;:. IS :CERTIFIED wader the provieione of ch..489 vs EXptizatioa.datec AUG 31;x:.2014' L12051800427 `.. THIS DOCUMENT HAS A COLORED BACKGROUND MICROPRINTING • L INEMARK'' PATENTED PAPER STATE OF FLORIDA. P BUSINESS .AND PROFESSIONAL REGU TION RUCTION INDUSTRY LICENSING BOARD SEQ# L12051800427 BATCH NUMBER LICENSE N R DATE 0[5 18 13.7057361 .cFC142$61$51` The P U1 BING CONTRACTOR Named below IS • CERTIFIED Udder the provisions of 'Chapte Expiration date:' AUG 31 2014 MEDINA, REINIER L FIX PLUMBING CORP 8025 NW 8 ST APTO 1 MIAMI FL 3312 RICK SCOTT nntrratnervo ICEN_ :LA�nTSON JEFF ATWATER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. CHIEF FINANCIAL OFFICER 05 -23 -2012 EFFECTIVE DATE: 05/23/2012 EXPIRATION DATE: 05/23/2014 PERSON: MEDINA REINIER L FEIN: 455188991 BUSINESS NAME AND ADDRESS: FIX PLUMBING CORP PO BOX 22578 HIALEAH FL 33002 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S.; Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 05 /23/2012 EXPIRATION DATE: 05/23/2014 PERSON: REINIER L MEDINA FEIN 455188991 BUSINESS NAME AND ADDRESS: FIX PLUMBING CORP PO BOX 22579 HIALEAH, FL 33002 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED PLUMBING CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/26/2013 PERSON: TELLEZ FEIN: 462477582 BUSINESS NAME AND ADDRESS: ALL AROUND SOUTH FLORID 109 EAST 15 STREET HIALEAH EXPIRATION DATE: 8/26/2015 RAUDEL FL 33010 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609 From: 12/17/2013 15:27 #236 P.001/001 '4�, c �' CERTIFICATE OF LIABILITY INSURANCE °" . �,"17l;'3 '"' 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: lithe certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsemett(s). ..._. CONTACT PRODUCER Lucia Estrella Accurate PNONE gat): (305)226 - 8727 8300 West Flagler Suite 114 -NAIL .. luciaestreea®beilsouth.net Miami, FL 33144 _ Phone (305)226 -8727 INSURED Fix Plumbing Corp. 2531 SW 102nd Ave Miami, FL 33196- 786 - 343 -8127 Fax (305)226 -8767 INSURERS) AFPORDNNG COVERAGE INSURER A.:. Granada Insurance Company INSURER B : INSURER C : ..Nok (305)226 8767 NAIL a INSURER 0.; INSURER E 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 CONDmONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ON ... ......... -ADDLSUBR POLICY EFP POLICY EXP LM L .. ......13.F. . I- N-S•RANC-- -` _NNSR . WVD ......... POLICY NUM SER . _ tMulODIYYYY)_t?hf0pJYYYy.. ,S . . GENERAL LIAB1ITY EACH OCCURRENCE... .. $ 1,000,000.00 TO $ 100,000.00 ® COMMERCULLGENERAL uABUUTY PREMI5ES.(Eaocpwrrenae).. _. ❑ 0 CLAIMS -MADE ® OCCUR 0185FL00051011 MED EXP (Any one person) $ 5,000.00 A Y Y 07/10/2013 07/10/2014 ❑ _.._.._._._..-- -..._..._._ _PER$ONALBAOVINJURY .. $...1,000,00OAO _GENERAL AGGREGATE_ $ 2.000,060.00 GEN'L AGGREGATE LIMIT APPUES PER .PRODUCTS - COMP/OP AGO.. $ 1,000,000.00 © POLICY ❑ Jeer ❑ LOC - • AUTOMOBILE LIABILITY ❑ ANY AUTO BODILY INJURY (Per parson) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ❑ AUTTOS ❑AUTOS ❑ HIRED AUTOS ❑ OSWNED .i .. -- ... ... ©_ ........_. �.... _..._.... - _ . _ ........ __ _._... - $ - - -.. UMBRELLALJA6 -.EACH �CURRENCE .. --- $......--- -. . !�I OCCUR .. ❑ _EXCESS LIAO LJ CLAIMS•MADE. AGGREGATE _...._.- -- ...._:.$. _. --_. . ❑ DP Q RETENTION$--..... _ .._. _ . .... .:.. _ WORKERS COMPENSATION D. TIC) TMITS.. ❑ FR1,14. .__....___... AND EMPLOYERS' UABILITY Y/N -..._ ANY PROPRIETOR/PARTNER/EXECUTIVE EL FACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N!A (Mandatory In NII) - -- • E L. DISEASE - EA EMPLOYEE $ _ Idescribe under — ...... .._.._ _.__..._.._.._— ........._._.... t .. DESCRIPTIO.N OP OPERATIONS. below_ ._ __._. E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS N LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE . MIAMI SHORES, FL 33138 ACORD 25 (2010105) OF SHOULD ANY OF THE ABOVE THE EXPIRATION DATE THER ACCORDANCE WITH THE PO • AUTHORIZED REPRESENTATIVE Lucia Estrella ES BE CANCELLED BEFORE E DELIVERED IN © 1988 -2010 A r COR ' TION. All rights reserved. The ACORD name and logo are registered marks of ACORD