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PL-14-1625 (2) r Miami Shores Village 10050 N.E.2nd Avenue NE 3 Miami Shores,FL 33138-0000 Phone: (305)795-2204 , Expiration: 1 1312015 Project Address Parcel Number Applicant 1032 NE 98 Street 1132050180320 1032 NE 88TH HOLDINGS LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell 1032 NE 88TH HOLDINGS LLC 800 CORPORATE Drive FT.LAUDERDALE FL 33334- 800 CORPORATE Drive FT.LAUDERDALE FL 33334- Contractor(s) Phone Cell Phone $ 12,450.00 Valuation: BUTLER PLUMBING INC (561)613-7738 .:.��....,�,.��::.�... ��...- ,,�...�._..�_..�... ., Total Sq Feet: 180 Type of Work:ADD SECOND FLOOR BATHROOM,REMODEL Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.80 Invoice# PL-7-14-52411 DBPR Fee $6.54 04/16/2015 Check#:2625 $428.63 $50.00 DCA Fee $6.54 Education Surcharge $2.60 07/28/2014 Credit Card $50.00 $0.00 Permit Fee $435.75 Scanning Fee $9.00 Technology Fee $10.40 Total: $478.63 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 that all work will be done in compliance with all applicable laws regulating construction ZZOE�5 ' horize the above-named contractor to do the work stated. April 16,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 16,2015 1 e s Miami Shores Village g APR 0 7 2 15 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20lc� BUILDING Master Permit No. / ,L/-4 2/ PERMIT APPLICATION Sub Permit No. P L.I 14— j (d ❑BUILDING ❑ELECTRIC , ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ME PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: d I1✓� `�� �S%��/ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: it–Pos'-q 0– ®32O Is the Building Historically Designated:Yes NO V'oe Occupancy Type: -3 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Id 3 A Al ?8 A�0106;2 4_/'Ce Phone#: Address:_ e00 C0 o✓'m- "ea C0/_.'V4_ ��!!a� City:_6 e:�t L aAd-ou•b(ale State: 14� Zip: 4'33-y Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Butler Plumbing Inc Phone#: 561-613-7738 Address: 2440 Deercreek C.C. Blvd city; Deerfield Beach State: FI Zip: 33442 Qualifier Name: Jon Sabaroff Phone#: 561-613-7338 ` State Certification or Registration#: CFC1427470 Certificate of Competency M. CFC 1427470 DESIGNER:Architect/Engineer: (��•'t Phone#: . / --36 2 "7a d 3 Address:b o J w !t�'l • rVrt9-f– City: 610 C-0 G1 State: Ft- Zip:3 3 9if4 Value of Work for this Permit:$ /02g !(s 10 ,�'Square/Linear Footage of Work: Type of Work: F-1Addition Altera�rtiioon2�' New ❑ Repair/Replace � ❑ Demolition Description of Work: A4!?? � / � pX}3/5/�7 ��7`.f /i `��✓c ���`��`°°� Specify color of color thru tile: Submittal Fee$ Permit Fee$ S CCF$ CO/CC$ ri Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ • TOTAL FEE NOW DUE$ 44 • (Revised02/24/2014) 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 herdby 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 ail 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 AGENTC TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged beforemethis . day of fM� .20 I S by --� day of (�T 20 I J by N4CL.� ,who is personally known to Te)h tm LX a f(n,, ,who is personally known to ale or who has produced as me or who has produced �1 S/ �U1 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Res M.A--Uen.o5 Print: �aun�p. Seal: !f Seal: :+ot rp`e�� JOHN RANDAllO Off Z. a Notary Public-State of Florida apt f 'ss� My Comm.Expires Jun 26 2017 ewe k* 21. 2mo 'OFF,, Commission ***** ********* **sem APPROVED BY !,( �z`�fs Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) `yNORES yl sell •.... Miami Shores Village Building Department �IORiDp' 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 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 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. ......................................................................................... BUSINESS NAME: Butler Plumbing Inc. BUSINESS ADDRESS: 2440 Deer creek country club Bird suite los CITY Deerfield Beach STATE FL Zip 33442 BUSINESS PHONE: 5( 61 ) 613-7338 FAX NUMBER( ) CELL PHONE(561 ) 613-7338 QUALIFIER'S NAME: Jonathan Sabaroff QUALIFIER'S LIC NUMBER: CFC1427.470 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ��►� 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SABAROFF, JONATHAN LEE BUTLER PLUMBING INC 2440 DEER CREEK COUNTRY CLUB BLVD UNIT 209 DEERFIELD BEACH FL 33442 Congratulationsl With this license you become one of tFie nearly - `Y one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE-OF FLORIDA. from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTAhE BUSINESS AND and they keep Florida's economy strong. PROF ULATION Every day we work to improve the way we do business in order to CFC1427470-0� •08/03/2014 serve you better. For information about our services,please log onto ' I� www.myfloridalicense.com. There you can find more information CERTIFIED P ' about our divisions and the regulations that impact you,subscribe SABAROFF, to department newsletters and learn more about the Departments BUTLER PLU initiatives. i ' Our mission at the Department is:license Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your Th -j IS CERTIFIED under the-provisions of Ch.488 FS. customers. Thank you for doing business in Florida, and congratulations on your new lic:ensel °" =accaf.zoos L1408030003205 j DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUST LESS AND.PROFESSIONAL REGULATION CONSTRUCTIW INDUSTRY LICENSING.-BOARD CFC1427470 TfTe--PLUMBING CONTRACTOR. Named below tS:CERTaFIED ' Udder the ptovisions of Chapter489 FS. Expiration date: AUG,31;-201.6 . SABAROFF;JONATF#M r BUTLER UNIT 2D9 DEERF1J=Lt B A H-- } y �• „. 9 Z� •M41,m ap, � �5..,. icci mn• nsamann1n nisp1 AY AS REQUIRED BY LAW SEQ# L1408030003285 *<&±a a�,.. .:, _ *. �"5m1d � .._.a, .sv_-,., ,.;x"�+....�a?"a; >..i:r..,.+ .. ,a.. .... ...;+; .�.�,qui.:�^as.3�.'�::i %= f:,a�€`%<�I '.�P+ `+"s�`t_YS"+rr.�•.-.,�•'r t . BROWARD 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 DBA:BUTLER PLUMBING INC Receipt#:PLL MBING/LWN SPRNKL/CONTRACTOR Business Name: Business Type:(CERT PLUMBING CONTRACTOR) Owner Name:JONATHAN LEE SABAROFF Business Opened:04/15/2008 Busin's"Location:2440 DEER CREEK CC BLVD 209 State/County/Cert/Reg:CFC1427470 DEERFIELD BEACH Exemption Code: Business Phone:561-613-7338 Room Seats Employees. Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 1. 0.00 27.00 4<T ' 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 Municipality 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 not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: JONATHAN LEE SABAROFF Receipt #ICP-13-00012914 2440 DEER CREEK C.C. BLVD Paid 08/20/2014 27.00 #209 DEERFIELD BEACH, FL 33442 2014 . 2015 - Aco CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 2/19/2015 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(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 NAME: Andrea Lopez Ext.314 BB Insurance Marketing Inc PHONE FAX 954-452-0450 10167 W Sunrise Blvd,3rd FloorE-MAIL Plantation FL 33322 ADDRES INSURERS AFFORDING COVERAGE NAIC# INSURER A.-0h*O Casualty Insurance Co 24074 INSURED BUTLE-2 INSURER B.-GMAC Insurance 2 Butler Plumbing Inc INSURERC: 2440 Deercreek Country Club INSURERD: Blvd,#209 Deerfield Beach FL 33442 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1582115967 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. ILTR TYPE OF INSURANCE N DL UBR POLICY NUMBER MM/LDIDY� MM/DD/YYYY LIMITS A GENERAL LIABILITY BRO55124072 /14/2014 /14/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENT D PREMI ES Ea occurrence $100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO-JECT LOC $ B AUTOMOBILE LIABILITY 2001358983 /14/2014 /14/2015IN E LIMIT Ea acpdent ANY AUTO BODILY INJURY(Per person) $100,000 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $300,000 HIRED AUTOS NON-OWNED PROPERTY DAMAGE $100,000 AUTOS Per accident Is UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB - CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I TORY LIMITS I ANY PROPRIETOR/PARTNER/ECECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Plumbing Service Contractor. PIP$10,000 limit w/$0 deductible,Comp/Coll$1000 deductible. Lic#:CFC1427470 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. Miami Shores Village FL 33138 AUTHORIZED 1REP REPRESENTATIVE 6 y= ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Report Viewer Page 1 of 2 r7_11 i+ JEFF ATWATER :CHEF FINANCIAL OFFICER STATE OF FLORIDA 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: 8/9/2014 EXPIRATION DATE: 8/812016 PERSON: SABAROFF JONATHAN L • FEIN: 261311621 BUSINESS NAME AND ADDRESS: 0 BUTLER PLUMBING INC 2440 DEERCREEK C.C.BLVD DEERFIELD BEACH FL 33442 SCOPES-OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR PwKwd to Chapter 440.05(14),F.S.,an offlcer of a corporation who elects exemption from this chapter by fittrflcate of election wader this section may nal recover bareilts�comperreatian urxiaUus chapter.Ptusteatt to Chapter 440.05(12),F.S..Certdwates of election to be ex�npt..apply only within the scope of the business or tri listed on the notice of election to be exempt P�asuant to Chapter 440.0131,F.S..Notices of election to be exanpt arni oertficates of election to be exempt mall be subject to revocation if,at arty lane after the firing of ttre nonce or tf�issuance�the certiftt�e.the p Waned on the mice or certficate rto kx�meets the oegrriremerus of this section for issuance of a cefiru;ate.Tire department shall revoke a oert�cate�any time far fakse of the person named on the certificate to meet the requnemerrts of this sectiorn. DFS-F2-DWC-25Z CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(860)413-1609 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data.=kdvpginc9D7Q3gH6TER6e... 6/5/2014 Butler Plumbing Inc. 2440 Deer Creek Country Club Blvd Suite 209 Deerfield Beach, FL 33442 (561) 613-7338 Butler-Plumbing.com February 201h, 2015 State of Florida County of Broward Before me this day personally appeared Jonathan Sabaroff who, being duly sworn deposes and says that he is the qualifier and will be the only person to work on the project @ 1032 NE 981h Street Miami Shores Village, FL 33138 Sworn to (or affirmed) and subscribed before me this 20y day of February 2015, by p A- ©/--/--Personally know OR Produced Identification Type of Identification Produced /c;-/- Print or Stamp Name of Notary LESYA KEEN NOTARY PUBLIC STATE OF FLORIDA Comm#EE878300 Expires SJ MI7 SNtic.1932 oRs G,! M Miami shores Village Building Department IV Jt4 ,PLpp�ipA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption ME.f�,r` - 4if �k 1P "� r. ' ''n�� '.d"' is "t�..- ,rte '�. '�'° c 'L '`.a`3 'rk '� iF �"3,:.;;"sE a�a wr v>.;, 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. 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.. Therefore,you may be personally liable for the worker compensation iniuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner ontractor Signature- Signature: State of Florida State of Florida County of Miami-Dade County of Miami-Dade The foregoing was acknowledge before me this Ir The foregoing was acknowledge before me this ; day of Z'OA=L)f, .20 LS day of eZ20 /J By_ &UCllfta AdLUILs.n By who is personally known to me or has produced who is personally kno n to me or has produced �- LESYA KEE as identification. identification. NOTARYOMER IC Notary: STATE OF DA �, Y Comrn#EE8 SEAL: . L: $Expires 17