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DEMO-15-1441 gj `euaaFs Lit Miami Shores Village 10050 N.E.2nd Avenue NW tfib Miami Shores,FL 33138-0000 t -" 1 r ,1 F"may Phone: (305)795 2204 .. :; GORiDA ` `� f ` til Expiration: 12/26/2015 Project Address Parcel Number Applicant 11004 NW 2 Avenue 1121360020240 i LSP HOMES LLC Miami Shores, FL 33168- Block: Lot: Owner Information Address Phone Cell LSP HOMES LLC 455 NE 210 Circle Terrace (305)527-3643 I MIAMI FL 33179- 455 NE 210 Circle Terrace MIAMI FL 33179- Contractor(s) Phone Cell Phone Valuation: $ 600.00 ALL AROUND PLUMBING ENTERPRI: Total Sq Feet: 1376 Type of Demo:Plumbing Available Inspections: Additional Info:SEPTIC TANK ABANDOMENT Inspection Type: Classification: Residential Final Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# DEMO-6-15-55949 $2.00 06/12/2015 Check#:3153 $50.00 $58.60 DCA Fee $2.00 Education Surcharge $0.20 06/29/2015 Credit Card $58.60 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is cur a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named t csor,jo do the work stated. �f June 29, 2015 Authorized Signature:Owner / Applicant / _AWrSetor / Agent Date Building Department Copy June 29,2015 1 Miami Shores Village �����: Building Department JUN 12 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 -<— BY: ---- � INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No. m�6-1 `I I PERMIT APPLICATION Sub Permit NoDi(�7m4 15 " `% ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL �MBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: //00(7/ CGU c;l Civ "jr,,A 4h0l-- S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /1,�2/3(p 000 Da V6 Is the Building Historically Designated:Yes NO Occupancy Type +J d: : `ChaConstruction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): (_S/�- / C [ C. Phone#: Address: �-3 !D C i YCfQ /P/J� , yes—/y— Z City: �% State: Zip:�,t�Z 29 Tenant/Lessee Name: Phone#: Email: Q CONTRACTOR:Company Name:AlAwn'c_j_ -/ 0�37��� Phone#:�N Address: ���� 5 �l a S1. City: / State: Zip: /7 Qualifier Name: A.�.2 C , W' Phone#: State Certification or Registration#: e 0 V(//, `7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: 4City: State: Zip: Value of Work for this Permit:$ &66, 10 0 Square/Linear Footage of Work. Zo Type of Work: ❑ Addition '' ❑ Alteration ❑ New ❑ Repair/Replaces". °❑ Demolition Descriptian.of-.W16r r Specify color of color thru tile: Submittal Fee$ CjO• (70 Permit Fee$ 160, ri7' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (> (Revised02/24/2014) ' 4 Bonding Company's Name(if applicable) Bonding Company's Address City State f-41Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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. �'LSignature API, Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this tN day of -:1-6 i c 20 1 , by day of /f/j 20 I� , by who is personally known to � U-A), w s personally known t me or whd<ZEas7procluced ) D ������ as me or who has produced as identification and who identification and who d' t�k e1,oa ii 8��, �"i%s''•,, MARALYS CASTILLO MARALYS CASTILLO Notary State of Florida NOTARY PUBLIC: `�= Notary Public- NOTARY PUBLIC: - y PuDltc State of Flonn, :. •'' Commisslon Ar COmn11ssI0n#FF 188402 �' FF 188402 '�,;°`���c °•' MY Complres Jan �",',F�►�d�d; My Comm.Expires Jan 11 Bonded 11 ?019 Sign: thONatlanal J Sign: No1a►yAssn. Print: &J Print: G �7 Seal: Seal: APPROVED BY /;/s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) _ 503 „4l f PERMIT #: �. APPLICAT #:AP 1192150 STATE OF FLORIDA f' DEPARTMENT OF HEALTH :; DA PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: WE DOCUMENT #: PR977480 CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Kenny J. Paris(LSP Homes LLC) PROPERTY ADDRESS: 11004 NW 2 Ave Miami, FL 33168 LOT: 20,21 BLOCK: SUBDIVISION: Shoreland Height PROPERTY ID #: 11-2136-002-0240 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S. , AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS+ -PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIQNS MAY. RESULT ; IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT'OF; THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ J GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ ] SQUARE FEET SYSTEM. R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ) STANDARD [ ],'FILLET} [ J MOUND` ( ] I CONFIGURATION: [ ] TRENCH [ ] '.BED N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ ABOVE/BELOW ]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [ / ] [ ABOVE/BELOW IBENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ j INCHES Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom O of the tank shall be opened or ruptured, or the entire tank=collapsed so as:to prevent the tank from retaining water, and(c) T The tank shall be filled with clean sand or other suitable materia(, and completely covered with soil.Have the system H inspected by the health department after it has beep pumped and ruptured but be*"ore it is filled with sand and covered. t. E R SPECIFICATIONS BY': \ TITLE: APPROVED BY: TITVTVy LE: Engineering Specialist II Dade CHD i 1 s DATE ISSUED: 06/10/2015 EXPIRATION DATE: 09/08/2015 DH 4016, 08/09 (Obsoletes all previous editions which nay not be lased) Incorporated: 64E-6.003, FAC Page 1 of 3 SNORES �, 119f..7932 L�ll owes �_ .�.�.�' Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. �COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. .-NORK-ONENN.-EN7 BUSINESS NAME- 0 �10�?�in E�/1 efis,, BUSINESS ADDRESS: /OW_ S4t' /�3- S� CITY STATE 7 ZIP BUSINESS PHONE: FAX NUMBER�) CELL PHONE( ) x(02 6?NS_ QUALIFIER'S NAME:ay-P f 4e)" 441 QUALIFIER'S LIC NUMBER: o r-e CE ISS" Jun 12 15 06:44a p.1 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA _ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION E s � CONSTRUCTION INDUSTRY LICENSING BOARD CFC044154 The PLUMBING CONTRACTOR �. Named below IS CERTIFIED W Under the provisions of Chapter 489 FS_ Expiration date: AUG 31, 2016 rl HERNANDEZ, RENE ELOY ;' ALLAROUND PLUMBING ENTER INC k 10345 SW 112TH STREET MIAMI FL 33176-3423 ISSUED: 07/09/2014 DISPLAY AS REQUIRED BY LAW SEQ# L140709000103C 005854 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 2145308 BUSINESS NAME7LOCATION RECEIPT NO. EXPIRES ALL AROUND PLUMBING ENTERPRISES INC RENEWAL SEPTEMBER 30, 2015 10345 SW 112 ST 22568811 Must be displayed at place of business MIAMI FL 33176 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC_TYPE OF BUSINESS PAYMENT RECEIVED ALL AROUND PLUMBING EN7ERP INC 196 PLUMBING CONTRACTOR BY TAX COLLECTOR Worker(s) 2 CFC044154 $75.00 07/15/2014 CREDITCARD-14-027334 This Local Busi ness TaK Receipt only confirms payment of the Local Business Tax.The Receipt is nota license, permit,or a certification of the holder's qualifications,to do busi ness. Holder mulcomply with any govemmantal or nongovernmental regulatory laws and requirements whish apply to the business. The RECEIPT N0.above must be displayed on all Com:.tercial-=.-COes-Miami-Dade Code Sac 8a-Z76. For more information,visit www.miamidade.00vltaxcoll&cter CERTIFICATE OF LIABILITY INSURANCE DATE 06/11/15 6/111/15 Y) 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 NACONTACT ME: MARIA L DIAZ MS Discovery Entr.Insurance Agency PHONE Ext): (305)718-8919 FA c No): (305)718-3584 10733 N.W.58th Street E-MAILADDRESSd marilu@discodoralins.com Miami,FL 33178 INSURERS AFFORDING COVERAGE NAIC# Phone (305)718-8919 Fax (305)718-3584 INSURERA: CAPITOL SPECIALTY INS CORP INSURED INSURERS All Around Plumbing Enterprises INC INSURER C: 10345 SW 112 Street INSURER D: Miami,FL 33176 (305)279-3127 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. INSR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 300,000.00 TO © COMMERCIAL GENERAL LIABILITY PREMISESE;Mrrence $ 100,000.00 A ❑ ❑ CLAIMS-MADE Q OCCUR CS02348268 03/13/2015 03/13/2016 MED EXP(Any one person) $ 5,000.00 d❑ P.D.$500.00 DEDUCTIBLE PERSONAL d ADV INJURY $ 300,000.00 ❑ GENERAL AGGREGATE $ 600,000.00 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 600,000.00 ❑ POLICY ❑ PRT ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ E] ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ❑ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ ❑ AUTOS Per accident _ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WRY LAM T 0TH W AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yyes describe under DPS` OF OPERATIONS below E.L.DISEASE-POLICY LMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) PLUMBING LICENSE No CFC044154 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd AVE AUTHORIZED R BE - VE MIAMI SHORES,FL 33138 @k1988-201 0 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD DATE(MMIDDIYY) �►c""o CERTIFICATE OF LIABILITY INSURANCE 06/11/15 _ - PRODUCER Ramall0 Assurance Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 12955 S.W.42nd Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)207-1332 Fax (305)207-1343 INSURERS AFFORDING COVERAGE NAIC#_ INSURER A!_ CastlePoint Florida Ins Co INSURED ALL.AROUND PLUMBING Enterprises Inc. INSURER& 10345 SW 112 ST INSURER C: Miami, FL 33176- INSURER D: INSURER E: COVERAGES INSURER F: E ISSUED OR THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAPVIED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVIT H RESPECT TO WHICH THIS CERTIFICATE MAY B MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC r TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS — INSR ADD'LPOLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE,(MM/ODM') DATE(MM/DDIYY)_ EACH OCCURRENCE GENERAL LIABILITY DAMAGE TO RENTED ^'COMMERCIAL GENERAL LIABILITY PF2EMISES(Ea occurence)_ _ MED EXP(Any one person) ,- CLAIMS MADE _ OCCUR PERSONAL&ADV INJURY _ GENERAL AGGREGATE _ PRODUCTS-COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: POLICY _PROJECT i LOC ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY ' SCHEDULED AUTOS (Per person) -- HIRED AUTOS BODILY INJURY -- (Per accident) NON OWNED AUTOS PROPERTY DAMAGE - (Per accident) _ __ _ _ _ _.. AUTO ONLY-EA ACCIDENT GARAGE LIABILITY ^' ANY AUTO OTHER THAN EA ACC , AUTO ONLY: AGG EACH OCCURRENCE EXCESS/UMBRELLA LIABILITY AGGREGATE OCCUR r-' CLAIMS MADE _ DEDUCTIBLE RETENTION 5 __.. — WORKERS COMPENSATION AND rte.TORY LIMITS ER){- EMPLOYERS'LIABILITY WCC 0048954-00 07/24/14 07/24/15 A E.L. 100000 ANY PROPRIETOR;/PARTNER 1 EXECUTIVE : _EACH ACCIDENT OFFICER'MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 500,000, If yes,describe under E.L.DISEASE-POLICY LIMIT 100,000' SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PLUMBING LICENSE NO CFC044154 CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE C TIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL I PO MIAMI SHORES VILLAGE SE NO OBLIGATION OR LIABILITY BUILDING DEPT OF ANY KIND UPON THE INSURER,ITSAG T OR VES REPRESENTATI . 10050 NE 2 AVE _ _ AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 ' ....._.... ACORD 25(2001108)QF CORPORATION 1988 �F' t' ......................