PL-16-810 Miami Shores Village
10050 N.E.2nd Avenue NW
s M a k
Miami Shores,FL 33138-ONO
Phone: (305)795.2204
"
Expiration:09/26/2016
Project Address Parcel Number Applicant
55 NW 94 Street 1131010340120
Miami Shores, FL 33150- Block: Lot: SAGE HOFFMAN
Owner Information Address Phone Cell
SAGE HOFFMAN 55 NW 94 Street
MIAMI SHORES FL 33138-
55 NW 94 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 10.00
BEST-WAY PLUMBING INC (954)966-6234
-- -- --- -�----�-_- Total Sq Feet: 0
Type of Work:GAS VENT INSPECTION.CHANGED TOP CO Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Final
Bond Retum: Press Test
Classification:Residential Scanning:1 Review Plumbing
Fees Due Amount "Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-3-16-59166
DBPR Fee $2.00 03/25/2016 Check*13311 $50.00 $58.60
DCA Fee $2.00
Education Surcharge $0.20 03/30/2016 Check#:13337 $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 accurate and thatalpqork will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor toFlo w stated.
Ql March 30,2016
Authorized Signature:Owner / Applicant / Contractor / nt Date
Building Department Copy
March 30,2016 1
Miami Shores Village cE D
Building Department M R 25 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20(4 —
BUILDING Master Permit No.RF-3-16-576
PERMIT APPLICATION Sub Permit NoV-1 C -a(6
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
ME PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 55 NW 94 STREET
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#:If •314`O l y`t)/;t b Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type.✓ x Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):SAGE HOFFMAN Phone#: ?-o S-40y 7?
Address:55 NW 94 STREET
City: MIAMI SHORES State: FL Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: BEST-WAY PLUMBING, INC. Phone#: 954 966-6234
Address: 5840 DEWEY STREET
City: HOLLYWOOD State: FL Zlp: 33023
Qualifier Name: GWYN KIZIAH Phone#: 954 966-6234
State Certification or Registration#: CFCO21447 Certificate of competency M
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 Ey Repair/Replace ❑ Demolition
Description of Work: GAS VENT INSPECTION Cjj&) j
Specify color of color
thru tile:
Submittal Fee$ ® ` W Permit Fee$ J CCF$ 0'60 CO/CC$
Scanning Fee$ 3 Radon Fee$ DBPR$ c Notary$
Technology Fee$ O Training/Education Fee$ n G Double Fee$.
Structural Reviews$ Bond$--r /►
TOTAL FEE NOW DUE$ t5e a 6
(Revised02/24/2M)
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 Signature
OWNER or AGENT COATRACTOif
The foregoing instrument was ac nowledged before me this The foregoing instrument was acknowledged before me this
I day of (Ma:1 ,20 (19 ,by 24 day of MARCH 20 16 by
. 444Z who is personally known to GWYN KIZIAH who is personally known to
me or who has produced b as me or who has produced PERSONALLY KNOWN as
identification and who �kgi°�iW'�i �+�4r identification and who did take an oath.
a "�e� Notary Public state of Florida NOTARY PUBUt:
NOTARY UBLIt: ? ^ Meg A Romeo
Q My Commission EE 202823
E s 08/22/2018
Sign: Sign:
Print: Print: P N A
Seal: Seal: ,'•• PENELOPEADKM
3'sr .r_ MY COMMISSION#EE 151685
Z'Z
EXPIRES:April 7,2016
;, Bonded Thru NoWy Pubs UmWwritm
4##########4444444444#4444444444#444/44444444444#44#4444444444##4#4444####444444#4#########4##4444###4#444444
APPROVED BY ® � Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850}487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
KIZIAH,GWYN WESLEY
BEST-WAY PLUMBING INC
5840 DEWEY STREET
HOLLYWOOD FL 33023
Congratulat1=1 With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation Our professionals and businesses range STATE OF FLORIDA
from architISLIs to yadt brokers,from boxers to barbeque restaurants, DEPAR BUSINESS AND
and they keep FkxMa s economy stror>g.
PROFE�'��'��1
U
LATION
,::,,:
4
Every day we work to improve the way we do business in order to CFCO21
447 a . U 07!31/201
serve you better. For information about our services,please log onto MRA "f8R
www myflorkMlicense com. There you can fkrd more information CERTIFIED P CO,,
about our divisions and the regulation that impact you,subscribe KOAH,GWYN
m department newsletters an learn more about the Department's BEST WAY PL ;
Our mission at the Department is:License Efficiently,Regulate Fairlyy.
We constantly strive to serve you better so that you can serve yourISCERTIFIED under the provisions of Ch.489 FS.
customers. Thank you for doing business in Florida, d0e:nuo31.2018 04o73 WM781
and ins on your new license! .
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT
INDUSTRY LICESS AND NSING REGULATION
SING BOARDU
CFCO21447
The PLUMBING CONTRACTOR n "
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
KIZIAH,GYY f N WESLEY LL r r
BEST-WAY PLUMBING
5840 DEWEY STREET,
HOLLYWOOD -FL33023 w
z
rssrlFn: 07/3112014 DISPLAY AS REQUIRED BY LAW SEO# L1407310001761
M 's..., ° ."." q .'c°"'=srs4'z�,,`
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-8314=
VAUD OCTOBER 1,2015 THROUGH SEP I EMBER 30,2016
Reoelpt :pLx2xo/LVN SPRNKL/CONTRAt; OR
Biel Now:BEST WAY PLUMBING 8U810 Type:(PLUr19M CMR)
owner Name:vssLEY JcIyIAH Gm B :08/24/1995
EWnq=Limon:5840 DEWEY ST 8tatsCpUMy/C9rNR9q:CFCO21447
HOLLYWOOD Exemption Code:
Business Phone:966-6234
Rooms soma Employees medwi res Profassionde
12
F;;Yew&AIMM My
Number of MachlIM Taw.
Tax Amount Thusfer Fee Fes` ► `' Yearn i Cost Total Pahl
54.00 0.dd m' $.00` ' -0.00 - 0.01 0. 54.00
may.
THIS RECEIPT MUST BE POSTED CONSPICUOUMY IN YOUR PLACE OF BUSINESS
IM BECCAM A TAX RECEIPT TINS tax Is levied for the privies of dohs bushes within Broward County and Is a
non-regulatory In nature.You must cry all County andfo r Municipality planning
and zoning rqufwrtamts.This BushTax Roos"must be trornbrred when
WHENVALIDATED the business Is sold, buskxm name has chard or you have moved the
busirmss location.This recelpt does not Indio that the business is legal or that
it is in compliance with StMe or local taws and regulations.
Wiling Address:
WESLEY KIZIAH GWYN Receipt 01CP-14-00019019
5840 DEWEY ST Paid 07/24/2015 54.00
HOLLYWOOD, IPL 33023
2015 - 2016
'.:- , :. ;.. ..;," 4.ap �, -x �' -&j, �-,;^qua,s73 ^cv r f P�nl' .�tsar- s :,a:.ask' r ..fs? re f. •"
OP ID:HP
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A BATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'SUPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFl"T9 OF SCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING MISURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the cofflade how Is an ADDITIONAL INSURED,the poky(Im)n uft endamt N SUBROGATION IS WANED,subject to
the terms wM conditions of Me pxfay,cerisin poRdes nay require an endorsen e A*Ubamt an this cwfflcde does not confer rights to the
cerdllcate her In lir of Such s.
P CONTACT
INNOVATIVE INSURANCE PHOW
Nei CONSULTANTS INC 03
CORAL SPRINGS,It 330P
DAVID LEE`SCHWARTZ BESTW-1
"sautes► BM-WAY P LUTABING,INC. aa:Ab{1ERICAN BUILDERS INS.CO 11240
U4if s
68OEWEY STREET 40DHOLLYWOOD,FL.33023 visuRmt S:FCCI COMMERCIAL INSURANCE CO. 33472
"saec:BRIERFIELD INSURANCE CO 10883
"ISURER D:
"r81OM E:
COVERAGES CERTIFICATE REVOMMMM
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABtWE FOR THE POLICY PERIOD
INDICATED. NOTdMMANDING ANY REQS,TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTP'ICATE MAY BE ISD OR MAY PERTAIK THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH PSS.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWRmlLim .
TYPEOFNW00MCELam.LWeEItY EACtiI�E S 1r�,
A X cOM? IAt GEIRALLUIBILITY 43891-02 04>01tSttS O4101i�1S $
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X BLKT WAIVER GENERA.AGGREMTE
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GEN'L AGGREGATE LIW APPLIES PER PRODUCTS-COMPW MG S 2.000,01
POLICY X LOC $
AUTO$LIAIRRY COED S94GLE L"M"T $
B X MYAWO 33217 04U011MG O4i01iMS (Oaao ) +
S}DLLY M."IR7(Per peon) S
ALLOWNEDAUTOS 8OMY" Y(Pw w, ) S
SCFEOULEO AUros PROPERTY DAMAGE
X HMED AUTO (PERW.009M S
X DAUTOS $
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UNBRELIALIM R OCCUR EACH OCCUR $
EXCESS L" CLA MsaAm AGGREGATE E
DEDUCTWE _
ti C A"M X WC STA X OTN
B No IMPLOYEW ANY PtrDPR �� 1674 0"11 18 O&VM16 E.L.EAM�r $ Ste,
EXCLUDED4 L J NIA E.L.DISEASE-EA EMPLOYEE S SQO•
E.L.DISEASE-POLICY LIMM7' S
C 7 04MIMS O4Wt2mill
B GUIPBENT FLOATOR 7 04ro1IMS OW/206
CON�TRAICTQR3 STEI«I�I?N� FC9Z744 ��,aa�o,Md rare a e >s
CERTIFICATE HgM
C
MIAAAI-S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTA WILL BE DELIVERED MI
MUM SHORES VILLAGE ACCORDANCE NmH THE POLICY PROVISIONS.
BUILDING DEPAftIMUT a R rraTlvE
MUS 2 AVENUE �J�'Glioir�'�•t;3CI�W4
SHORES.FL 33132
ACORD (20 ) The ACORD Warne andare 01�-2�ACORD CtR;PORATRMI. A8 rights reserved.
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