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PL-13-191 (2)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JUN 202013 FBC 20 d0 Permit No. r -J 3 6 1 Master Permit No. VC A" 157 (i JOB ADDRESS: X011 M4 CMW% City: M;g1ni Shores County: Miami Dade Zip: 3 N 13 $ Folio/Parcel#: 32ti6 - -61-1 - M5'b Is the Building Historically Designated: YesT�O Flood Zone: - bivy sOWNER: Name (Fee Simp Titleholder): Cv 16 Phone#: 3 OSoS 14 1 Address: CM(WA( - City: m l4p'1 56Y*5 State: Tenant/Lessee Name: Phone#• ) dd Email: yeem -,lh c --e, rP • c,— ` CONTRACTOR: Company Name: h`1" �Vni .�� q '� T/rt eC_�'hone#: � & qdp % Address: e b '60)6 City: Qualifier Name•%' State: Zip: 3> 91.46K— Phone#: State Certification or Registration #:c F -co 44-1 CO - Contact -Contact Phone#: aO -S 1,0'1 3 1 q 4-4V Email Address: of Competency #: . �0 1 . Cc4v-) DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 9 ®® 0 Square/Linear Footage of Work: Type of Work: 17Address OAltteration ONew ®Repair/Replace CDescription of Work: s - Submittal Fee $ Permit Fee $ �� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE 11 ODemolition 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i4be hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wiloved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this on The for omg instrument was acknowledged before me this day of 25M , 20 _, by rho" day of by �+� , t who ' ersonally kne me or who has produced who is ersonally knowno me or who has pro uced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: s Sign:. a '' Sign: 14 Print: ' � G �� CD Print: My Commission Expires: FF,,�o�f,��r� My ComiCsio;Y�Exp�irCeHMIS ON ERYL oDD 577762 ,� ,c�'••.:,,...,,,.••` \� Q EXPIRES: August 9,201$ Bonded ThNBudget Notary SeMoes APPROVED BY �� Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09) ' CERTIFICATE OF LIABILITY INSURANCE 06/142013 "YY' 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 CONTACT Paychex insurance Agency Inc PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONE , 877_266-6850 FAX N9j: 585-389-7426 ROCHESTER, NY 14620 EMAIL Certs@paychex.com ADDRESS INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Associated Industries Insurance Company Ii icAlIC D P PLUMBING & FIRE PROTECTION INC P.O. BOX 170306 INSURER B: INSURER C: HIALEAH, FL 33017 INSURER D: INSURER E: INSURER F: 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. INSRTYPE OF INSURANCE NSR UBR POLICY NUMBER POLICY EFF (MWDDIYYYY) POLICY EXP (MMTID/YYY10 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY �CLAIMS•MADE�OCCUR DAMAGE TO RENTED $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: POLICY O PROJECT LOC PRODUCTS-COMPIOPAGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ er (PPeen) ALL OWNED SCHEDULED AUTOS AUTOS .pp HIRED AUTOS AI WNEO PODIILYY Id�)RY $ (Per PROPERTY DAMAGE (Per $ $ 7 UMBRELLALIM =OCCUR EACH OCCURRENCE $ EXCESS LIAR = CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND ENPLOYERS'LWBILrrY AWC1021440 04/08/2013 04/08/2014 X WC STATU-OTH- E.L. EACH ACCIDENT $ 100,000.00 ANY PROPRIETORIPARTNERiEXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 100,000.00 OFFICERIMEMBER EXCLUDED?.-YIN (Mandatory in NH) NN/A If yea, describe under E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10050 NE 2ND AVENUE DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY MIAMI SHORES, FL 33138 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ( 11C++.lr/itc.Y ilk I't�,y.. ACORD 25 (2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DPPLU-1 OP ID: RA ACOR© CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 0611212013 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 endomemen s . PRODUCER q� Phone: 954281-7070 6300 NW 6th ohn Gait Insurance Suite 100 Fax: Fax• 954-281-7090 Ft Lauderdale, FL 33309 U� Kenneth R. Fritz CONTACT NAME: �� Fid): FAX No: ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A: CENTURY SURETY COMPANY INSURED D. P. PLUMBING 8, FIRE PROT INC Dawn Rengifo P. 0. BOX 170306 HIALEAH, FL 33017 INSURER B: INSURER c INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE N11MRFR! RFVIiQInNI iu IMRFQ- .-.---------------- 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. 1CY LTR TYPE OF INSURANCE ADDL S POLICY NUMBER MMID LICY EFF EXP PMMIID LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR CCP799380 11/2412012 11/24/2013 EACH OCCURRENCE $ 2,000,00 PREMISES Me occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X1 POLICY I PRO LOC PRODUCTS - COMP/OP AGG $ 3,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -Or HIRED AUTOS AUTOS COMBINED eBIBINED SINGLE LIMIT E $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTYent)DAMAGE $ UMBRELLA UAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (MandatoryInNH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I WCSTATU- OTH- Y I-IM[1S ER E.L. EACH ACCIDENT $ E.LDISEASE- EAEMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATNE V 1BUB-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD Miami shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. v1 COPY OF QUALIFIER'S STATE LICENCES B. !✓ COPY OF LOCAL BUSINESS TAX RECEIPT C. V 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 LOCAL BUSINESS TAX RECEIPT 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 WORKERS 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 �L BUSINESS NAME: PP BUSINESS ADDRESS: M Im 3 Npj CITY al STATE t �- ZIP CODE I 1 BUSINESS PHONE: FAX NUMBER ( ) to 1W 5l6 CELL PHONE L )J .3 L QUALIFIER'S NAME: Gb/-,e-1 QUALIFIER'S LIC NUMBER: F7 ® 6 E-MAIL ADDRESS (IF APPLICABLE): _ p '7 2,0 , !j 6 ray-) Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS AC# 6 3 O Q 46 ® STATE OF FLORIDA DEPARTMENT OF.SUSINESS AND PROFESSIONAL REGULATION CONSTRUCTIOI�T INDUSTRY LICENSING BOARD SEW L12082401937 The PLUMING 08/,24---/2 61 2-, 1s18210838 &FIRE PROTECTION IN CONTRACTOR Named below IS CERTIFIED Expiration date: AUG .3 1, C 014 • � L, GORAf PAIL I D P PLYING & *IRE PROTECTION 19610 WEST LAKE DRIVE MIAMI FL 33015 RICK:SCOT REN LAWSON 'GOVERNOR SECRETARY �4 DISPLAY AS REQUIRED BY LAW FIRW-CLASS U.& POSTAGE I PAID MIAMI. FL PERMIT NO. 231 385189-7 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 402171-3 D P PLUMBING &FIRE PROTECTION INC STATE# CFC044144 1910 WEST LAKE DR 33015 UNIN DADE COUNTY OWNER D P PLUMBING &FIRE PROTECTION IN S iT PLUM NG WORKE3/S IB CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT i DOES NOT PERNOT THE HOLDER TO VIOLATE ANY ETOSTMG REGULATORY OR ZONING LAWS OF TME DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR IS .TILICEM REWIRED BY LAW. TIN � D P PLUMBING &FIRE PROTECTION INC NOT A CERTBACATION OF THE HOLDEIM GUALIRCA- PAUL GORAL PRESS P 0 BOX 170306 PAYMENT RECEIVED HIALEAH FL 33017 NIAMMADE COUNTY TAX COLLECTOR: 10/01/2012 601000000210 ITTiiTTTiiTll7Ti,TTil1T1111111TTIi)TIiTTT,iiTTIITTTTiiTiTTTil,7 SEE OTHER SIDE PO BOX 170306 • HIALEAH, FL 33017 PHONE 305-698-1444 FAX 305-698-5106 DP Plumbing& Fire Protectionbc. November 7, 2013 Miami Shores Village Building Dept 10050 NE 2"d Avenue Miami Shores, FI 33138 1 p, RE: Permit #P -- 13 Master #RC12-1570 Carlos & Barbara Miramontes 674 Grand Concourse To Whom It May Concern: DP Plumbing would like to put this plumbing permit on hold. We were contracted through Greenstein Construction and they were removed from the job. We tried to come to an agreement with the Owner but could not come to terms. We are not presently working on this project and want to make sure that no other contractor is working under our permit. We told the Owner that we would transfer the permit when they obtained another plumbing contractor. If you have any questions please do not hesitate to contact me at 305-698-1444. erely, Nc, Paul Goral