PL-12-1304Miami 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
FBC 2001
]hermit Type: pL�TNG
E
JUL I" 261jr
Permit No.
)L -Y)4
Master Permit No. Z '14q, r,
OWNER: Name (Fee Simple Titleholder): fAVJCjeW MPi�6i,(2� 6 q%ft
Address: ( � iql kow UoS _ 2�
City.- 4 t �iA %S state: Zip: "W 6
Tenand,esseeName hs/A l?bvne#: {'� T..
Email: -Atzi,ei,a AAA'I(�C L1�i19•r.�iC.? A�.A-conu �-u� Din rin cAse __
JOB ADDRESS: q1 Me 13 &J
City: Miami Shores County: Miami Dade Zip:
F0li0/Parce1#:
Is the Building Historically Designated: Yes NO Flood Zone: .
CONTRACTOR: Company Name: ^ Phone#:
Address: 0
C.
State: PC Zip: _ Qi
Quali '_- Phone#:io5, 3 h 13
State Certification or'Registmtion #:' AS ,w 3 At 3 S Certificate of Competency'#:` b-0 601 C Y:GC)
Contact Phone#: LZ= Email Address: Y"ov-•e uL CB
DESIGNER: Architect/Engineer: llwkm Q5 Gt u ra-n&A+tTR z '-4hn.41 05 &-1Z O'i tl'Is
Value of Work for this Permitt- $- �& r0o .00 Square/Linear Footage of Work:
o .v.
t>Wof -Work. _pAddresi OAlteration ONew ORepair/Replace ODemolition
Bewipb of Work: t -i Mgt ne)N�tit i-te + ftOO 1 IPS ,(2m .t. Aw C .ftanA agum }
c uru001 Fr�twu
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 $V2-54 Ca
Bonding Company's Name (if applicable)
Bonding Company's Address
City State zip
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address '0
City State �P
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, P&UMBING,,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
COIVIIVIENCEMENT MAY RESULT IN YOUR PAYING TWICE I FOR
IMPROVEMENTS TO YOUR PROPERTY. IF ' YOU - INTEND TO OB'T'AIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF CO1VIl1/IENCEMENT:'
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the appiicanrmust
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 proved anndd%a reinspection fee charged
Signature Signature-
r3L1LT T1 -Q tTVJ3 TVE
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this��(f . The foregoing instru ent was ackno led_ before me this_-
day of t � by day of � �- - by`
wh is personally known me or who has produced wh is rsonally kno ' o me or who produced
As identification and who did take an oathi ratification and who did take an oath.
NOTARY PUBLIC:
&- ` -
Sign: MP
Print:—�Tv+A 1?'ti, 1 1 G�3
Print: 064M jam
o•' r n''., J am
DITH DEMILfO
'' y C mmission
My Commission Ex : n-. Notary Public -State of Florida
•s My Comm. Expires Jun 13, 2013
Commission # DD 891548
or " Bonded Thro h
ea�seee+��esee<ee<��ee��e=ea„
APPROVED BY �TC I Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10=09)(Revised 3/15/09)
i
MIAMI-DADE COUNTY 2011 MUNICIPAL CONTRACTOR'S 2012 FIRST-CLASS
TAX COLLECTOR TAX RECEIPT U.S. POSTAGE
140 W. FLAGLER ST. MIAMI-DADE COUNTY - STATE OF FLORIDA PAID
1st FLOOR PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI, FL
MIAMI, FL 33130 EXPIRES SEPT. 30, 2012 PERMIT NO. 231
THIS IS NOT A BILL — DO NOT PAY
RECEIPT NO. 30-0709577 CC NO: 000011450 RECEIPT HOLDER MAY DO
BUSINESS NAME / LOCATION BUSINESS AS A CONTRACTOR
RONEAN PLUMBING INC AS SPECIFIED HEREON.
480 W 84 ST
OWNER :RONEAN PLUMBING INC
SEE BACK OF RECEIPT FOR PLUMBING CONTRACTOR
A LIST OF NON—PARTICIPATING
MUNICIPALITIES
DO NOT FORWARD
Receipt holder must
register in the city RONEAN PLUMBING INC
where work is to be ROMAINE MUNOZ PRES
done. 6710 N AUGUSTA DR
HIALEAH FL 33015
PAYMENT RECEIVED
M"-DADE COUNTY TAX
°O1 W23/2011
60040000158
000200.00
i„li,,,ii,Il,,,,,,il,l,l,,,l,l,,,ll,,,ii, li,,,,,lifi,,,i►Z,�t
;.CTQB
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
000011450
X17 ,
PLUMBING SERVICE CORP
r D.B.A.:
MUNOZ RODOLFO
Is certified under the provisions of Chapter 10 of Miami -Dade County
OP ID: LG
144104GORL>1 CERTIFICATE OF LIABILITY INSURANCE
DA 05 011D 2
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 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 endorsemen s .
PRODUCER 305-362-0052
Insurance Network Center
Luis De Gongora 305-362-0080
7735 NW 146 ST., SUITE 204
Miami Lakes, FL 33016
Luis De Gongora
NcAOMEACT
ac° NNE, Est : aC No):
E-MAIL
ADDRESS:
CUSTOMER ID t1: RONEA4
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURED RONEAN PLUMBING INC
INSURER A:SCOTTSDALE INSURANCE COMPANY
6710 N AUGUSTA DR
HIALEAH, FL 33015
INSURER 13: CASTLEPOINT FLORIDA INS CO
INSURERC:
INSURER D:
INSURER E:
CLS1562288
INSURER P:
06/71/7$
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.
INSR
TYPE OF INSURANCE
ADDL
POLICY NUMBER
POLICY EFF
MID
POLICY EXP
D
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,00q
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F OCCUR
CLS1562288
06/11/12
06/71/7$
DAMAGE TO RENTSPREMISES Ea occurrence $ 100,00
MED EXP (Any one person) $ EXCLUDE
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 1,000,00
POLICY X PRO LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED AUTOS
BODILY INJURY (Per accident) $
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Peraccident) $
$
NON -OWNED AUTOS
$
UMBRELLA LIAR
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
DEDUCTIBLE
$
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? El
(Mandatory In NH)
N / A
CP760565100
09/01/11
09/01/12
WC ST AT f OTH-
I ER
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
PLUMBING SERVICES
CITYOFM
CITY OF MIAMI SHORES
FAX # 756-8972
BUILDING & ZONING DEPT.
10050 NE 2ND STREET
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICELL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISWNS1
Luis a ongoENTATNE
Luis De Gongora
n 1999-2009 ACORD CO ORATION. All riahth reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD