Loading...
PL-15-1230 RK JL( - 211� Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(305)756-8972 inspection Number: INSP-251980 Permit Number: PL-5-15-1230 Scheduled Inspection Date: February 02,2016 Permit Type: Plumbing-Residential Inspeclor. Diaz,Osvaldo Inspection T Final P� � YPe� Owner. , Work Classification: Addition/Alteration Job Address:435 NW 111 Street Miami Shores,FL 33168-3305 Phone Number (305)790-5467 Parcel Number 1121360010790 Project <NONE> Contractor: FIX PLUMBING CORP Phone.(786)343$127 Building iDeparbnent Comments REMOVE AND REPLACE ALL FIXTURE IN KITCHEN AND merits INSPECTOR COMMENTS False BATH MOVE LAUNDRY PLUMBING AND NEW W.H nspector Comments Passed CREATED AS REINSPECTION FOR INSP 251761.caulk fixtures vacuum breakers Eprovide d/w connection Failed Correction Needed �lz Re-Inspection Fee No AWItional Inspections can be scheduled until re-inspectlon fee Is paid February 01,2016 For Inspections please calf(305)762-4949 Page Y4 of 32 40. Miami Shores Village 10050 N.E.2nd Avenue NW sn ••� Miami Shores,FL 33138-0000 , Phone: (305)795-2204 h £d Expiration: 0612712016 Project Address Parcel Number Applicant 435 NW 111 Street 1121360010790 SPIN FLIP 1001 LLC Miami Shores, FL 33168-3305 Block: Lot: Owner Information Address Phone Cell SPIN FLIP 1001 LLC 435 NW 111 Street (305)790-5467 MIAMI SHORES FL 33168- 5910 SW 74 Street MIAMI 33143- Contractor(s) Phone Cell Phone Valuation: $4,200.00 FIX PLUMBING CORP (786)343-8127 Total Sq Feet: p Type of Work:REMOVE AND REPLACE ALL FIXTURE IN K Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# PL-12-15-58199 Change of Contractor Fee $75.00 12/31/2015 Check#:423 $78.00 $0.00 DBPR Fee $3.38 DCA Fee $3.38 Education Surcharge $1.00 Invoice# PL-5-15-55685 Permit Fee $225.00 05/22/2015 Check#:3222 $50.00 $192.76 Scanning Fee $3.00 05/28/2015 Check#:3233 $ 192.76 $0.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $320.76 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 accurate a t at II rk will be o e in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor d o stated. December 31, 2015 Authorized Signature:Owner / Applicant / Contracto ent Date Building Department Copy December 31,2015 1 Miami Shores Village (� IJR R(­"r.;-- Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 DEC 3 o 2015 i Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No. rte-, PERMIT APPLICATION Sub Permit No. `tel S - IZ•`30 r-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING ❑ MECHANICAL [:]PUBLICWORKS to CHANGE OF ❑ CANCELLATION ❑ SHOP ��J CONTRACTOR DRAWINGS JOB ADDRESS: .3 s - K/ /// City Miami Shores Coun)y;: Miami Dade Zip: 1 eS2 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: � ) LOS Phone# � + OWNER:Name(Fee Simple Titleholder): 1 �� Address: SW Sw 441S Vt �*N ITO!fi O 2 City: k1&NI% State: L Zip:33��7 Tenant/Lessee Name: Phone#: Email: ,o CONTRACTOR:Company Name: T I_Y ?0&A4/31W 6 6 ne Phone#: �3 Address: %f_3 9A) 4&- 4 1,/C City: MJd),V? State: Zip: �Lual)fler Name: fes. ` / �/ 1� Phone#: ?fe, 3404f/.d 7 "State Certification or Re istration#: Certificate of Competency#: g ` � DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of work: Type of Work: ❑ Addition ❑ Alteration ❑ New 54_Rep_� ❑ Demolition Description ef k• P"4r- .421- .. I ,.•!i 0 Specify c 1 � 5 .CXR co cc Permit Fee CCF Submittal Fee $ $ / $ Scanning Fee$ 3 • O o Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revisedo2/24/2014) 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 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 6 if h V Signature O *was �NT CONTRACTOR The foregoing instr ent acknowledged before me this The foregoing instrument was acknowledged before me this 7 day of A&Ue' .3 kA_ 20 ,by Zv't—day of 20 1Z ,by 4^43 Atov personal) n teplta& A✓1�jymq ,who' ona y now me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ARC L Sign: ." Print: ." N •S o Floridaphis Print: �,,?o. ; t >IJa Commission#EE 145618 Comm- es Fab 15, Seal' %:,°;;; '� god Through Nat111OteryAssn. Seal: %;;os:t;::a' Commission N EE 14581 , " Bonded Through NaUonel No" APPROVED BY ��•' 7s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Dep ai tment 10050 N.E.2nd Avenue �IORQJ� Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT :Permit N. comer's Name.(Fee simple Title Holder):W19 RAJP5 tib1,UL PhonetDS�b�- Owner's Address:_ .�"�D1 C44/ 7ff 4:111- city: A41 A.-19 f State: r-z, Zip Code:33Io'3 Job Address.(of where work is being done): 54TW6J /// City: Miami Shores State:_FloridaZip Code: 3341 Contractors Company Name: k P141JW '3 if✓S a2if Phone#: 7d'G l-7 Address: z d"3 ! Sal /®a 4 dl city: 14114/41 State:_ #t Zip Code: Qualifier's Name _ Fn /L-0-6.1 IV Lic. Number. Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: �K do%. A&A".. 4ZA „v ICirc�is / I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvemen •a Signatu Signature ' � �titdrac�ororArrfi The foregoing in ru an w s aknowledged before me The foregoing instrument was aknowledged before me this�Z day ofd 00-',by 4/zKl P 1Z" this :ZZ day ctkfe 0/96y IP71oll ii persortailynown to o has produced �afro-trsonally a or who has produced as indentiflcation. as indentiflc ation. Notary _ c;,.,,,, ., YALCAR94KIL Notary.Pu_ CEL r Fronda `= Sign: Sign. r e or Ronda A °:� Commission#EE 145618 Commission 8 EE 145618 Seal. "9I , Seal: ,���'��' �� Bonded Through National Not Assn. ���''..i„�`'�, Bonded Through N910nat Notary Assn. r y • E If ■ Complete Items 1,2,and 3. A s Print your name and address on the reverse �,�, � 0 Agent Sweew so that we can return the card to you. ■ Attach this card to the back of the mailptece, a ed by Printed Nana*) C: or on the-front If space permits. 1. Ardcle Addressed to: D. Is dd m address awent from(tern 1? tAV t �w�'►�� G- t� �,rEs,errterdeuvery address brow: ao . &F P(W In, "t o r o o o 9590 94021239 5246 2107 82 13 cwnti•aMOM coffed2. Article Number fifer from service label o Coffed o o t�atr4otsct ueitDaum vey 4. cww n'"° ramile �t� 22251D oaob 4516 57U a �a orm 3811.July 2015P3N 7530-02400-9053 '� ftgtien Resp U5PSTRACKNOO First-Class 9W. Postage&Fees Pani 111111,111111111111111111111111 11111111 USPS Permft No.G-10 9590 9402 1239 5246 2107 82 United State» •Sender.Please Print your natrya,address,and ZIP+40 In this bpi- Postai Servlte MkKi Spin Flip 1001, LLC 5901 SW 74St, Suit® 410 Miami FL 33143 (305) 7905476 November 3rd 2015 MARINI PLUMBING INC 8319 NW. 43rd St., Coral Springs, Fl-33065 Telephone: (954) 557-3040 Hereby we want to notify you that from this moment we are changing Plumbing Contractor for the property located at 435 NW 111 St, Miami Shores FL, 33168. Please, don't hesitate in calling if further information is needed, *inFlip 1 �' (305) 7905476 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32398-0783 MEDINA,REINTER L FIX PLUMBING CORP PO BOX 22578 HIALEAH FL 33002 Congratulationsi With this license you become one of the nearly __. .•_ one million Floridians licensed by the Department of Business and Professional Reguletion. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to berbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strorhg. PROFESSIONAL REGULATION Every day we worts to improve the way we do business in order to CFC1428618 SUED 06!2912014 serve you utter. For information about our services,please log onto www myttaridagcenee.cam. There you can find more Information CERTIFIED PLUMING CONTRACTOR about our divisions andIt . t khhpad you,subscribe MEDINA.RI:tNIER L to department newsletters==more about the Department's FIX PLUMBING CORP Initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. We strive to starve better so that you can serve your cxustonters. nk you for=business in Florida, Is CERTIFIED under the provisions of Ch082 2 and congratulations on your new license! ' an,ions t� aas DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTIIIENT OF BUSINESS AND PROFTESS101NAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD MR CFci42ss1s The PLUMBING CONTRACTOR �� WE Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 MEDINA,REINTER L a • FIX PLUMBING CORP' ° 8025 NW 8 ST APTO 1 MIAMI FL 33126 ° [E ISSUED: 06rM14 DISPLAY AS REQUIRED BY LAW SEO s Lt4062l 1205 R At— � -3 et SEC ow 9� S tlIt ORp ymoti v ar CORP 2 T,ax cgs:; CfC16 8 f PM �; tF, 5.00 106!2 EDITCNW-15-033618 o = CERTIFICATE OF LIABILITY INSURANCE 12128l�}15 THIS Ci �ATE AS A�ITTIt O>s T R .Y AND001:111 )RISMUPON1111E TE FSR.THIS CERTIFICATE DOES NCIT T .Y i>�t1 ATNEt.Y Ate.EXTEND OR ALTER THE COVERAGE AFFORDED BY TO MX=S t LC1N. Tt s CI 1`tI ATE tx� RAI t t t87ITUTE A CONTRACT BETWEEN THE NWJ=MWJRErO)-AUT ED i RIs�TATIVE,�a UCI��T�CERTATE IMPfMT7aNT: a ��pcnu�ont. � tea} � tl TSI� txs � I� � fRB�rage an A aa� � rl�s to tie { 774.8210 AhWbra „ I i 4757 61N$ti Sued Nam p MWW,FL 33134 PhO 774 210 Fax VISURER A: GRANADA INSURANCE COMPANY nfsuaEc FIX PLUMBING CORP C' 1091 WEST 55 PL MALEAH FL X112 I COVERAGE$ CERTIFICATiQ I ftEVt8�1 NUMBER: 1`141116 TO CERTIFY THAT THE S Cw CE •BELOW HAVE SM ISSUED TO THE IN3t1RED NAND ABOVE F THE PO1lCY PERM? INDICTED. NOTWITHSTANWG ANY REOUIREMENT,TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH REACT TO WHICH THIS CERTIFIATE NAY BE ISSUED OR MAY PERTAIN,THE BY THE S HEREIN IS SUB CT TO ALL THE TERMS. EXCLUSIOW AND t AWAY HAVE BEEN REDUCED BY Ply'! T OF PCS u j mqo COWERCtAL UASL rY EACH 1,000 5.66 i D DE 0 OCCUR a 100,065.66000 MEDEViAryomPOMA 1 A ® N N 01 BSFLOOQ72387 07t1 13 07110P2016 &AM NAJRY a 1,000,OW W GENL A ATE LUT APPt IREW C A301 GATE ffi 1000,000.00 D PCS ICY ❑ ❑ LCC STs-Coes aao a a D OTHER umrr 0 ANY AUTO Aas—049LITY 6..I ALLOWNED U ❑ SCHEDULED Y INJURY(Rer so¢!de $ KM AUTOS ❑ AUTOS g ® LAD ❑00" EmCµOCCVulRWRJEWNm a LOMELLA ERC m LAN CLAMAS44ADE AGGREGATE $ a I OTHe wommampamaiT —I I AND EMPLOYEW UABIUTY YIN E.LEACH $ ANY PROPRtETO-f-W R7Ai@Ri Cr-�cEwa �Hca. MIA EL DWEASE,EA gvpm $ E -Pf user a 9 yes, j 4OESCRPTION of OPERATONS below oEscMpn=CFOPERATWSILOCATWWIVSNCM Oftab ACORD f0f,AdMWM ROMM 1114110dulo,If PLUMBING, s CERTIFICATE HOLDER SHOULD,CAI' EI.LATtOI 7=777::�� RNY+F THE ABOVE DESCRIBED POLICIES SO CAKILLED BEFORE THE W~I=DATE THEREOF,NOTIOB WILL 95 OgLP#VM IN MIAMI SHORES VILLAGE ACOORDANCEVM THE POLICY PFtW*189M BUILDING DEPARTMENT 10060 N.E.2ND AVENUE AUT»Oi ATS IVIU+tMt SHORES, FL 33139 I .� ® ACORD Tit. A6 tuts r�etved. ACS 26{3698 9)QF The n ke of ACORD c •�°oo we JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/23/2014 EXPIRATION DATE: 5/22/2016 PERSON: MEDINA REINTER L FEIN: 455188991 BUSINESS NAME AND ADDRESS: FIX PLUMBING CORP 2531 SW102 AVE MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not never benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(1350)113-1609 FIX PLUMBING CORP. 2531 SW 102 Ave Miami, FL 33165 CFC#1428618 Phone (786) 343-8127 Date: December 29, 2015 State of: Florida County of: Dade Before me this day personally appeared Reinier Medina who, being duly sworn, deposes and says: Noslen Ruiz That he will be the only person working on the project located at:435 NW 111th ST. Miami Shores, FL 33168. Sworn to (or affirmed)and subscribed before me this day o a S gow 20 by 2,01109rt I-A&AIR 44t�'� Personally know t� OR Produced Identification Type of Identification Produced /////jj���►`""""' Y ARCEL �4PaY 01011C Astate of RWW8 2016 :9r P�oc Commission#E EE 145618 Pr' t,T �"r. assn. Miami shores Village �.� Building Department artment tORU� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption - -x��.�r� .'�..' a r�',�f� r, ^?`.,��.�t'' ;�" F-' .� -` -�' �;a.� �"ar,xt j8'`�', ''�"Y .f r ,�;��2 ,u,z-_'- - �..._,. , Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if- 1. f1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: a*04 _ Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of—DFeJ0,A473t& ,20 14--. Byr, -r wh s personally known tom r has produced �pnuupqI en cation. 8 Notary: 15.2018 ,,ofr��;ViGOMMMSIN=#F EE 145 118 SEAL: „��"" Bonded Through N Assn Miami Shores Village 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000SO { , Phone: (305)795-2204 ` ; I R '� Expirat!on: 1112412015 k Project Address Parcel Number Applicant 435 NW 111 Street 1121360010790 CAPITAL INVESTMENTS LLC Miami Shores, FL 33168-3305 Block: Lot: Owner Information Address Phone Cell CAPITAL INVESTMENTS LLC P.O. BOX 2382 FAIRFAX VA 22031- P.O.BOX 2382 FAIRFAX VA 22031- Contractor(s) Phone Cell Phone Valuation: $4,200.00 MARINI PLUMBING INC (954)557-3040 (954)340-9661 Total Sq Feet: 0 Type of Work:REMOVE AND REPLACE ALL FIXTURE IN K Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# PL-5-15-55685 DBPR Fee $3.38 05/22/2015 Check#:3222 $50.00 $192.76 DCA Fee $3.38 Education Surcharge $1.00 05/28/2015 Check#:3233 $192.76 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $242.76 In consideration of the issuance to me his permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and ins ict confof with the plans, rigs,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I sume res risibility for all yr6 one by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRI L,,PLUMB MECHANICAL OWS,DOORS,ROOFING and SWIMMING POOL work. i OWNERS DA I cert' all he fo is accurate and that all work will be done in compliance with all applicable laws regulating constructio an g. Fut e o e ve-nam contractor to do the work stated. _ May 28,2015 g e / nt ctor / Agent Date Building De a me t Copy May 28,2015 1 c � Miami Shores Village w Building Department MAY 222015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 'BY' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(303)762.4949 FBC 20 BUILDING Master Permit No. I{� '1 H"d yt4 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION 0 EXTENSION MRENEWAL O PLUMBING ❑MECHANICAL OPUBUC WORKS [] CHANGE OF ❑CANCELLATION ®SHOP CONTRACTOR DRAWINGS JOSADDREss: L(35- City: f3S' 3 � 14 Folio/Parcel#: &Z� ,.Z—te —C7?40 the Budding HistOrically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood®Zone: SFE: FFE: OWNER:Name(Fee Simple Titleholder): P P2/A17 L �1' � Tarr �C Pnone#:�.�7/Y . —/.�/ ® o Address: z3 City: ��� State: Zip: 42e�03/ Of Tenant/LLe-s^see Name: 171,& Phone#: Et,� Email: 1 do- CONTRACTOR:Company Name: k 6, Cr ( ti , Address: ,`rA?)\ City: CA ( <1Q C tY1Qr— —State: Zip:, Qualifier Name: ( ` Phone#. State Certification or Registration#: G - Sb k Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: 715� 47?/— Address: City: State: Zip: Value of Work for this Peanut$ °lk © ®o Square/Ur ear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: y 7 e o,11 Akk* Spec*color of color thru We: Submittal Fee!& Permit Fee$ 2 Z5. CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Tem Fee$ TraiMrgj/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (ReWsedOZ/24/2014) 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 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 certijted 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 The foregoing instrument was acknowledged before me this day of A Q:!% .20�L by day of�� ,20 15- ,by / iOA //Z�l who Is personally known to o f" o�.�� who is personally known to me or who has produced Lf&=TO as me or who has produced r7777f-' � as identifkation and who did take an oath. identification and who did."ke an oath.. � NOTARY PUBLIC: NOTARY P UBLIC STATE OF L NOTARY PUA C Comte AYE OF FLORIDA 20M17 Comr*EE853894 Sign: Sign: e� 2li M17 Print- ARY pUSJCr- Prirrt: � STATE OF Cartrrr#EE853894 Seal: Seal: STATE OF FLORIDA Eacpires 2[912017 Commit EE853894 Expires 219,120.1 i 444iii44ii###4ti#tii4i4444ii44444#it##4ii4#441##ti##ii#iii#44#44#iiii4ii##i##•#i#iiii444#4###4#4###14444444# APPROVED BY S LT 9S Plans Examiner Zoning Structural Review Clerk (ReWsedOW4J2014) SROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 Dme:MARINI PLUMBING INC Re�:eipt#'PLUMBING/LWN SPRNKL/CONTRACTOR Business iVam@; Business Type:(MASTER PLUMBER CONTRACTOR) Owner Name:RosERT MARINI Business Opened:o5/12/1997 Business Location:8319 NW 43 ST Stete1CoU*jCerUReg:CFC1425818 CORAL SPRINGS Exemption Code.- Business ode:Business Phone:954-557-3040 Room Seats Employees Machines Professionals 1 Fos Vending Business Only Number of Machtries: Vending Type; Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.04 0.001 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax Is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipardy planning WHEN VALIDATED and zoning requirements.This Business:Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does riot Indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MARINI PLUMBING INC Receipt #03A-13-00011094 8319 NW 43 ST Paid 09/30/2014 27.00 CORAL SPRINGS, FL 33065 2014 - 2015 RICK SCOTT.GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD g. CFC14=18 The PLUMBING CONTRACTOR ` `Y Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2816 MARINI, ROBERT a MARINI PLUMBING INC •` 8319 NW 43RD STREET CORAL SPRINGS FL 33065 a MMIQ CERTIFICATE OF LIABILITY INSURANCE. I?AT5(/201)/YYYY) 5/22/2015 THI i CERTIFICATE IS t1SUE0 AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CEI:TEFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFOORDED RY THE POLICIES BEI OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($). AUTHORIZED REI•RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMP DRTANT., If the cerllflcate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBR0GA*n0N IS WAVED,subject to the terms and corrditEom,of the policy,certain policies may require an endorsement. A statement on this ceftEnCBfe doss not Confer rights to the con Iflcate holder In lieu of such andorsement(s). PROOI CERIC AM:RICAN QUALITY INSURANCE p e 3700 W.HILLS»ORO BLVD o Extl: (954)420-00l�:�(nrc,N.):t95�t}920-0083 371)0 I.HI LSPOR 1±'B 33942 ADDRESS.americax�C3uality@bellsouth.net DZ: INrtIAMP)APFOMM COVERME NAF ml. r;R A;GOTHAM INSL1 OLNCE INsuR:D MARMI PLUMBING, INC. .� �r. INSURr:RB:AkMR1CM EMP SIE INSUFMCE CCM INSURER C• ^' 8319 Nig 43RD STREET INSURER D: PAWa,A W r FL 33076 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMSIM R EMSION NUMBER: THI i IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE?FOR THE POLICY PERIOD IND CATER, 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 AF'FOKDED BY THE POLICIES DESCRIBED HIeR@IN IS SUBJECT TO ALL THE TERMS, EX(LUSIONS AND GONE ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TNW AWL !SUM Ow TYPe OF INIIURANCe wit wM POLICY NUMBERCY EX LIMITS ,IENERAL LIABILITY (MMVDDfPACH OCCURRENCE $ 1'-0 0000 COMMERCIAL G@N►iRAL LIABILITY F REMISS$ So p wrgIMl S 50,000 CLAIMS-MADE ®OCCUR h15D ow(My am ) L S 1,000P000 A OUS009038233 09/14/14 09/14/15 PERSONA &ADV INJURY $ 2,040,000 ---— OENERAL AGGREGATE; S 1,000,000 ';ENL AGGAtC-^A'TE LIMIT APPLIES PER: -PRODUCTS-COMPIOP AGO $ 7 7 POLICY I 1 PR LOC E ,UTONOBILE LIABILITY ANYAUTO EIODILY INJURY(Par pnrr�) MAMS LL OOISMV@O AUTNO.�SCKEDWULED EIODILY INJURY(Per axWem) $ .�..• _ HIRED AUTOS AU r03 NED Ter—Neff S UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADS AGGREGATE S E ReTEN'ION$ $ 'VOR—KERS COMPENSAT ON 1 • ,ND EMPLOYERS'LIASIL ITY YIN — T RY LIMU• OTA NY PROPRt�ORIAARTNCFdOR+GlnVB H i ft"dERJAISNM Ne)nxrrorsr IN N/a RWC003592-12 07l05/14 o7/os/ss L.MHACCIDENT $ 1,000,000 �a �^ +► dear�beunder ELL DISEASE;•FAEMPLOYI=I $ 1,000,000 I�Bt�RtPT10N OF OPew TIONS betovv LS.L.DIOP ASR-POLICY LIMIT $ 1,000,001 DESCr IPTION OF OPERATION!I LOCATIONS I VENICLES (Attadt ACORD 159,Addhional Remarks ftixlule,Ir more space Is r"ulyw) LIC NSE # CFC1.425818 CER-7FICATE HOLDEF CANCELLATION — MIAMI I3HORSO _ 3050 NIS tad !AVENUE SHOULD ANY OF THE.ABOVE;OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TH5AF-OF, NOTICE WILL BE DELIVERED IN MIAMI ;3HORE8, FT. 33139 ACCORDANCE WITH THE POLtC'f PROVISIONS. FAX # :305 756 9972 AUTHORIZED REPRESENTATIVE ACOI 025(2010/05) 1988,2010AC 15 CO ORATION, All rights reserved. The ACORD name and IDgo ars reglStereo nl8rk3 of ACORD