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PL-13-1750V 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 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 1208 NE 99TH STREET A..lGV L Uf I V FBC 20 Permit No Master Permit No 0 3 - 1-1 City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-3205-009-0200 Is the Building Historically Designated: Yes NO R Flood Zone: OWNER: Name (Fee Simple Titleholder): Daniel N Berger and Hara R. Berger Phone#: 305-542-6098 Address: 1208 NE 99TH STREET City. MIAMI SHORES State: FL Zip. 33138 Tenant/Lessee Name: N/A Phone#: N/A Email: dnberger@gmail.com CONTRACTOR: Company Name: �� elS b4Zi LA- Phone#: 7/ Address: / qW �.� U" Alk a r- k� l City: r� *r1l 5t L State: 9L Zip' 3 1 f Qualifier Name: ,J er ( sit/ i' ci Phone#: ? E -I! ",5 2 - State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: cd LY -;-' 51- (; k -k 9 V� Cid a °W DESIGNER: Architect/Engineer: Phone#: 00 Value of Work for this Permit: $ -3,4200.-- Square/Linear Footage of Work: Type of Work: ❑Address WAlteration ❑New Description of Work: li, 06 `We, )e- i TLH l.; Submittal Fee $ Permit Fee $ ZL . v CCF $ CO/CC $ G Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ ❑Demolition 10 A4 Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ • ' y . 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this l� The foregoing i strument was acknowledged efo me this day of N t , 20A$ -,by -Da�� " day of �� 20 0, by , who is personally known to me or who has produced who is personall known to �qne or w}to 4#s pr uc As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: r'y Notary Public - State of Florida My Comm. Expires Mar 14, 201, r,.m.iaalnn * 00 970723 did take an oath. NOTARY Sign: e 6&V AWL Uf) Print: JOSE RATOVICI l �0l My Co ' 's Mi ON EE167� • EYPIMM J1M Y 09•21)16 APPROVED BY '11� C1 -SFS') Plans Examiner Structural Review (RevisetlYIW012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk i 4 t 2012 / 2013 ST- LUCIE COUNTY LOCAL BUSINESS TAX RECEIPT RECEIPT # 1711-20030004 BOB DAVIS, CPA, CGFO, CFC, ST. LUCIE COUNTY TAX COLLECTOR FACILITIES OR EXPIRES SEPTEMBER 30, 2013 MACHINES / ROOMS SEATS EMPLOYEES 3 TYPE OF 1711 AIR COND/PLUMBING CONTRACTOR BUSINESS (PLUMBING) QL BUSINESS/ Abner Leyvay DBA NAME Leyva Plumbing Services Inc lee.xwk MAILING Abner Leyva coo ADDRESS 1502 SW Meridian Ave " 105 ,� RENEWAL Port St Lucie, FL 34953 ORIGINAL TAX $12.35 PENALTY BUSINESS 1502 SW Meridian Ave ' COLLECTION COST TOTAL{ LOCATION Port St Lucie, FL 34953 - $12.35 i City of Pt St Lucie CFC1425666 NONEXEMPT P00000094412 Paid 09/20/20.12 12.35 0218.20120920-002545 c7&j rns0ection Worksheet Miami Shores Village '1'0060 N.E.-2nd Avenue Miami Shores, rL Phone: ( )IW2204 Faun: 0)7564972 lnspect#dn furfier. tllP48 Prot Number:. $-- ?►n Scheduled InspeccUon Date: February 26, 2014 Permit Type:.PIlumbing - Residential Inspector- Diax, Osvaldo lnspeon 'type: Final Owner,a ERy DANIEL. Work Massif cation: Addition/Alteration. Job Atldaes� 1 NE 99 Street F:MODEL (CfTCHEN AND 1 BATHROOM Fato No Add tanat to c irsrr3 fan tie $cheduWd antff C�-frtspior� i&'�a�i.77' I February 24, '2044 For .ins ot .W please call*. 5)782-4949 8 Of 42 CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIWM 09/11/2013 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(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 Emmanuel Insurance & Associates, Inc. 2370E 8TH AVE CONTACT NAME: Sarai Medina PHONE (305) 693-0003 a No): (305) 691-4381 emmanuelinsurance.com ADDRESS: saral@emmanuelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC A HIALEAH FL 330134236 INSURER A: Ascendantlnsurance.CO. 13683 INSURED INSURER B: Preferred Contractors Insurance.Cop. 12497 LEYVA PLUMBING SERVICES, INC. INSURER C : ABNER / YAMILKA LEYVA INSURER D : 1502 SW MERIDAN AVE INSURER E : PORT ST LUCIE FL 34953 INSURER F: GOVERAGE5 CERTIFICATE NUMHFR! RFVICInN IAI IMRFIR- 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. ILTSRR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MIDD POLICY EXP M/DD LIMITS Miami Shores, FL 33138 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX -I OCCUR PREMISES Me occurrence $ 50,000.00 MED EXP (Any one person) $ 5,000.00 B X PCA83151-02 07/01/2013 07/01/2014 PERSONAL &ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000.00 N-1 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO AALOS ED �OESDULED BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Pare ddent $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X WC STATU- OTH- A AND EMPLOYERS' LIABILITY �ICERIMEM EPROPRIETOR PEXCLUDED? ECUTIVE YIN ❑ NIA WC -61870-03 03/30/2013 03/30/2014 E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000.00 - If DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Residential Plumbing Work. CERTIFICATE HOLDER (AmnFl I ATlnhl ^I,UKIJ ZU tLU1U/UO) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Phone: Fax: 305-756-8972 THE EXPIRATION DATE THEREOF, POInCE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVI 10 S. 10050 NE Second Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ^I,UKIJ ZU tLU1U/UO) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD