PL15-1485 i 1 1111 JI IV1 CJ V 111dt;e
n- y
Ing Department JUL za,
50 d Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949 T'i
FBC 20
ILL I N G Master Permit No. gc_ - /0,3
PERMIT APPLICATION Sub Permit No.-PL .171- \�ffD)`J
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): D(I" s C_V, Phone#:
Address: -15' T
City: State: -.a,�. c+�G� '"� Zip: _23 436
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 6vVe �( Utll'f // Celrt* -Tett-s Phone#:
Address: 7✓t/ ( s L s � L
City: k4 W-CtA t State: « Zip: .3 3 l J-J—
Qualifier Name: P_4-F'te Phone#:
State Certification or Registration#: C �'C c' ��STI Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
O � ®
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑,, New Repair/Replace ❑ Demolition
Description of Work: 4 C _117 pcj
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE 9 S (�
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 o a building permit with an estimated value exceeding 2500 the applicant must
PP f g Pe 9�
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 instrume was acknowledged before me this The foregoing instrument was acknowledged before me this
day of/� J 20 by � da''yy�of �v Cy 20 l , by
who is ersonall known o -� 1aY6/r �� who is ersonall known to
P Y
me or who has produced as nee or who has produced - as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: — Sign:
Print: - `� Print:
Seal: MY COMM1S5t 21 2018
_•�, EXPIRES January Seal: MY COMWit; ,ION#FF084828
•" fbridallotarySe 4..?a;nd:,• FXP1RcS January 21,2018
(aWl 39g 0193 t4a71:. ot: FbridallotaryService.com
ss*s*ssss*ss******s*****s*s*****s***sss**s*s*ssssss**s*ssss***ss*************************s********s*****sss*
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Aug 24 15 02:54p Above All Plumbing Contra 7868011059 p.1
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DONYYY)
07/23/2015
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(ies)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 CONTACTPABLO M CONDE
A&A Underwriters, Inc- PHONE
305-220-7447 N
FAX o 305-220-4821
8778 5W 8th St E-MAIL "
Miami, FI 33174
ADDRESS: pmC@aaunderwriters.COm
INSURER($)AFFORDING COVERAGE MAIC R
INSURED
INSURERA:Granada Insurance Company 116870
Above All Plumbing Contractors, INC. INSURER B:BusinessFirst Insurance Company 11697
3481 SW 152nd Pl. INSURER C:
INSURER D:
Miami FL 33185 INSURER E:
COVERAGESINSURER F
CERTIFlCATE NUMBER: EEt� I
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.
LIR TYPE OF INSURANCE D POLICY NUMB ER Us POLICYEFF POLICYEXP
X COMMERCIALGENERALLIABILTTY 1!19i22Ly=LM p LIMITS
CLAIMS-ASADE � OCCUR EACH OCCURRENCE $ 1,000,000
A t S Ea
EoccuEirDenee $ 100,000
0185FL00038388 08/14/15 06/14/16
MED EXP(Anyone ) $ 5,000
GEPERSONAL BADV INJURY $ 1,000,000
IY'LAGGREGATELAtITAPPLIESPER: GENERALAGGREGATE S 2,000,000
X POLICY❑PRC- C
JECT LCC
OTHER:
PRODUCTS-COMPiOP AGG i 5 2,000,000
AUTOMOBILE LIABILITY S
COMBINED SINGLE LIMfI'
ANYAUTO (En acdden1 S
ALL OWNED ^I �SCHEDULED 'BODILY INJURY(Per person) $
AUTOS I I AS BODILY INJURY(Per aoddent) $
HIREDAUTOS N %WNED
AUTOS PROPERTY DAMAGE S
Per a 'dent
UMBRELLA LIA$ L
OCCUR
EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE s
CED RETENTIONS 1 AGGREGATE g
WORKERS COMPENSATION 5
AND EMPLOYERS,LIABILITY _
.ANYPROPRIETORIPARTNER/EXECUTIVE Y!N .521-08937 0]/16/15 O7I16/16 X S'ATUTE I EAH
B (Mandatory in H)EXCLUDED? N I:NIA E.L.EACH ACCIDENT 5 1,000,000
(Mandatory In NH) •- �
IIyes'�esQl"a W>der E.L.D SEASE-F1i EMPLOYE 5 1,000,000
DESCRIPTION OFOPERATIONS below
E.L.pISEASE-POLtCYLIMIT'S 1,000,000
i
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES
PLUMBING CONTRACTORS (ACORD 101,Additional Remarks Schedule,may hte e attached It more spaIs required)
CERTIFlCATE HOLDER
Miami Shores Village Building Dept. CANCELLATION
10050 NE 2nd Ave- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS.
305-795-2204
305-756-8972 Fax AUTHORIZED REPRESENTATIVE
ACORD 25(20134) The ACORD name and logo are registered marks o ACORD
O�CORPORATION. All rights reserved_