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DEMO-14-106Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2244 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING FBC 20 Permit No.,1,ema 141 106 Master Permit No.Q?flz l y %� JOB ADDRESS: _1 36 JOE q(p 57�I City: Miami Shores County: Miami Dade Zip: 3 313 Folio/Parcel#:. 1I -3-0 % • 0 14 - 37 9 0 Is the Building Historically Designated: Yes NO k' Flood Zone: OWNER: Name (Fee Simple Titleholder): .illlam 0 A04 PA(wiswo Phone#: 305. 7CI0 ---L413 Address: /035 &1E_ % 6T�-7 City: A41444) amek5s State: Ft- Zip: 3313 g Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ("I Address: U-1 U' I a City: State: 1. Zip: Qualifier Name: Phone#: State Certification or Registration ##- n Certificate of Competency k Contact Phone#: -7 % \,q ` �jga�SEmail Address: L On, DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ .300. 0 y $quarelLmear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace demolition Description of Work: 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 $ 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 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 _ Signature Signature Owner or Agent Contractor The fore omg instrument was acknowledged before me this a 2- The foregoing instrument was acknowledged before me this° �- day of J 20 A, by :T, -,J6 �A(- NISA Sb day of 20 by who is personally known to me or who has produced-.;-vhois onall me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: SMELLIE identification and who did take an oath. NOTARY PUBLIC: Sign: Print: lir S - ed My Comm. Expires Feb 28, 2017 MY Commission Commission # EE 849356 Bonded Through National Notary Assn APPROVED BY Plans Examiner MARY S. HARTMAN W COMMISSION # EES35W .EXPIRES S,aDamberl8. 2016 Zoning Structural Review Clerk (ReviwO/124012)(Revised 07/10/07)(Reviud 06/10PM)(Revised 3/15/09) STATE OF FLORIDA jDEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION !CONSFRgqTIP'N INDUSTRY LICENSING BOARD `85 Q) 487-1395 TAZI "T STREET L AHADWONROE FL 32399-0783 MORRISON' P �,Us ELL THOMAS H6E S P Tju'rb COMPANY 07P7 W E MIAMI FL 33143 C Congratulationsl With this license you become one of the nearly one million if's .8 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. ' C ig28 027485 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 wwwimrorldallcense.corn. oik t, There you can find more InformatioH about our divisions an the regulations that Department's Initiatives. Impact you, subscribe to department newsletters and learn more about the Our mission at the Department Is: License Efficiently, Regulate Fairly. We constantly strive to serve you better !so 4 -P that you can serve your customers. ta. sI. . P.Fovi i 9 JSL Thank you for doing business in: Flotida,'and congratulations on your new license!:1`X*4:_:'-­q'w Tn g 91 DETACH HERE ou `4 P Ig ot -'.S -Q#L12DUUZU1791 lif"T." _2 At ;-43 R X, & W40N Ro r 24 94I/ Must bo mgplki ibd st place of business x.: Purausnt`tb,County Cbtle Chapter 8A —Art. 9,& 10 O SEC fVPE OFSi`USINESS' 1 PLUMBING COMB 196 P.�kr�UJMp8y�jNd 6NTRAC'�dp PAYMENT 99CEIVED CFC�4IL Ai.7 c. BY TAxtML%ECTOii s) 20 $125.00 b8/22/201'3 h" TXH51--T —0483U Race* OURl Suslum Tax. The Re'i*ipt is not a.license, d r a ca of the qualHlc b ess. Holdeamust com0lj'�iiWth any gutiemmemal or { g at tTairaia`.s wito o the b m RECp oy above displayetlFon alI co Tel vehicSieYfiiUShc Code Sec E76; x. FFfe iijfomotion ffisit mmmou miemidede"iileatbe '4� �� CERTIFICATE OF LIABILITY INSURANCE �/8i 014 ' 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(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 endorsement(s). PRODUCER Brown & Brown of Florida, Inc. dba T.R. Jones & Co. 1780 N Krome Ave Homestead FL 33030 SME' CT Patti Spires, CIC PHONE(3O5) 247-5121 FAX (305)248-8543 UM6,pspires@bbhomestead.com INSURER(S) AFFORDING COVERAGE NAIC9 INSURERA:Wesco Insurance Company 5011 INSURED Horne Plumbing Company, Inc. 6767 S.W. 81st Street Miami FL 33143 INSURER B:Philadel hia Indemnity Ins Cc 18058 INSURERC:St Paul Fire & Marine Insurance 24767 INSURER D: INSURER E: 1 INSURER F: 1%nVF1?APFC f_FRTICIf_ATF NIHIMRF12•13 Liabillty 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. INSRTYPE LTR OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIO POLICY EXP M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurrence) $ 300,000 MED EXP (Arty one person) $ 5,000 A CLAIMS -MADE RX OCCUR P1067831 02 0/1/2013 0/1/2014 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ X I POLICY JER PRO- LOC AUTOMOBILE LIABILITY EaMBacddentINED SlN LEU 11000,000 BODILY INJURY (Per person) $ B AN AUTO ALLOOWNED OS SSCCTHEEDDULED HIRED AUTOS NON-OWNED(PRer I MM1081557 0/1/2013 0/1/2014 BODILY INJURY (Per accident) $ sc d TY DAMAGE $ PIP -Basic $ 10,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 C EXCESSLWB CLAIMS -MADE ZUP14597940 0/1/2013 10/1/2014 FIDED RETENTIONS $ COMPENSATION WC STATU O R AND EMPLOYERS' LIABILITY YIN ANY PROPRIEfORMARTNER/EXECUTIVE _LIMITSWORKERS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - POLICY LIMIT $ It yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) roo'neu+A'M unr nco ftA WCFI I ATInNi ACORD 25 (2010/05) W 115 s-ZU1U AL.Vrcu L.VMrUrw "WIN. iau nBmx, rasorvuu. INS025 poloos).o1 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10500 NE 2nd Ave Miami Shores, FL 33143 AUTHORIZED REPRESENTATIVE Hamilton Jones/VERINC ACORD 25 (2010/05) W 115 s-ZU1U AL.Vrcu L.VMrUrw "WIN. iau nBmx, rasorvuu. INS025 poloos).o1 The ACORD name and logo are registered marks of ACORD -%. g I HORNPLU-01 CLAUDIA .4CC?R©Q �- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/8/2014 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(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 endorsement(s). PRODUCER InSource, Inc. 9600 South Dadeland Boulevard 4th Floor Miami, FL 33156-2867 CONTACT NAME: PHONE El: (305) 670-61115363 ac No): (305) 670-9699 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: FCCI Insurance Company 10178 INSURED INSURER B : INSURER C : Horne Plumbing Company INSURER D : 6767 S.W. 81 Street INSURER E: South Miami, FL 33143 INSURER F : rnUMPAraFc t11:17TICRIATF Nl IMRFR• 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. INSRR TYPEOFINSURANCE ADDLSUBR 10060 NE 2nd Ave. POLICYNUMBER MM/LIEFF DD MM/DD EXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS40DE EIOCCUR EACH OCCURRENCE $ DAMAGE PREMISES Ea oxurrence$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: POLICY I I PRO LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N HIRED AUTOS AUUTOSTOS ED C a ardd..tSINGLE LIMIT $ BODILY INJURY (Per penton) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) UMBRELLA UAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ FEXCESSLUIB DED RETENTION $ $ A WORI(ERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 001 WC14AS6821 1/1/2014 1/1/2016 X TOR SU TU OE H E.L.EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remaft Schedule, U more space Is required) rcorrCu+Ar= unI neo C -ANC -Fr r ATION W luutl-Lulu AtouKU toumrvRAI lvn. All nuns rgoal vou. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department g g p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NE 2nd Ave. Miami Shores, FL 33138 AUTHORED REPRESENTATIVE W luutl-Lulu AtouKU toumrvRAI lvn. All nuns rgoal vou. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i