RC-14-1624 (5) Miami Shores Village NOV 201
Building Department
10050 N.E.2nd Avenue,MiamiShores,Florida 33138
72
ON P E U R:(30S)76FNE2
FBC 201 C�
BUILDING ft [jer ermithlo.f- H - I GQ
PERMIT APPLICATION Sub Permit No.PL-1 y — 16 ZS
❑PUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
[: ' UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
a /� CONTRACTOR DRAWINGS
J
JOB ADDRESS: ® 2 I J t' � A ST.
City: Miami Shores County: Miami Dade Zip: 3 3 .�
Folb/Parcot#: b=Iv 3.2 L-) Is the Building Historically Designated:Yes NO. A(
Occupancy Type: Load: Construction type: �2 13 Flood Zone: BFE: FFE.
OWNER:Name(Fee Simple Titleholder): / ® � Phone#: ' �7)Z{/lo `-'>7�5
Address: / ® 2 ^ [r) e j T AC.A %
City/'L i AM,` ���.c !.� State: FL Zip: 3'
a
Tenant/LesseeName• Phone�y0 ,) 4/6 -39-1&
Email: I-6 42P
CONTRACTOR:Company Name: /'e',Gl P—la i22 161n Phone#: Z Jr�f p0se,
Address:
City:_j&,*A/DA-e- &h&.-�—State• PL zip: 13 o ca
Qualifier Name: 64/1 i GI," Phone#: 95i r 6Y8!-f?DZ-
State Certification or Registration#: EO j 1) %F3 Certificate of Competency#: . 71 CM
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �:!0 t� SqudW ldear"F"ftge of Work:
Type of Work: ❑ Addition. ❑ Alteration 13New F-1 Repair/Replace ❑ Demolition
!�� &
Description of work: ,R!g S w c�f i d r(� �aq✓i%
^z�°LF�-f s F A14tjh)�/fir'.
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$
StruFturai Reviews$ Bond$
TOTAL FEE NOW DUE$--W?
(Re*ed02n4n01e)
a -
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 �P
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$250,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.
0 Signature Signature .� n!
� it
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me t Wb—
re—
—
day of N0~404-( .20 �� ,by L�day of N0.1•Q+� r 20 1
who is personally k� - ,who is personally known to
me or who has produced as me or who has produced ` 3 �''b•
r '
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC '��n
Sign: Sign:
Print Print: lleamamrw
Seal: of Homer Mulro Seal:
" COMKIM 9 FF1207
EXPIRES: 21, 2018
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APPROVEDBY lr f Z S Plans Examiner Zoning
Structural Review Clerk
(ROVMMz/24/2014)
115 S. Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—VA-831-4000 `F
VALID OCTOBER.1,2015 THROUGH SEPTEMBER 30,2016
N
DBA: 128C@ipt#:PLUMIXG/L89
WN SPMGM/CONTF CTC
Business Name:FI3RA PLUMBING INC Business Type:(MASTER PLLnHh3h�t)
OWnw Name:WILLIAM A TRL*MRT Business Opened:03/07/2013
Business Location:1860 NW 83 TER StMCpuNtyl(;OMRe9:79CMP512X/CFC1429148
PEMBROKE PINES Exemption Code:
Business Phone:954-658-8086
Rooms seats Employees tti�chirres Professionals
1
M
For Vending awhress 0
Number of Machines: Vending Type:
Tax Anvur t Transfer Fee NSF Fee Penally PrW Years Coftftn Cost Total Pals
A^
27.00 0.001 0.00 2.70 0.00 1 0.00 29.70
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THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This twc Is levied for the privilege of doing business within Broward County and is
non-regulatory in nature.You must most 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 net indicate that the business is legal or that i
it is in compliance with State or local laws and regulations.
Mailing Address:
FERA PLUMBING INC Receipt #WWW-15-00000452
1860 NW 83 TER Paid 10/06/2015 29.70 -
LL PEMBROKE PINES, FL 33024
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2015 - 2016
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Miami Shores Village Imo= -Y T T -
• Building Department Nov 1 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
T 795.2204 Fax:(305)756.8972 --
INSPE ' P NUMBER:(305)762.4949
WELDING rmit No.
PERMIT APPLICATIO '-4 S
FBC 20 L-0
Permit Type: Electrical
OWNER:Name(Fee Simple Titleholder): / ® 3 2- AJ ` ®� LZ Phone#1y�DA– Vd'R�
Address: 1032 ria, `1 Q :S7-A-4–,-r
City: AA -A 04/- 6 'YoxiL S State: /Zip:
TenandUssee Name: Phone#f �/6`� 1 /6`-' .3f®-e
Email: X941 /J 2 d JL /Psl o`,/04
JOB ADDRESS:�z b 3 2. f R-= q ;8 Sri:
..
City: Miami Shores County: Miami Dade Zip: 3 f 3
Folio/Parcel#: / / 3 2-1)S Q l 6 6) '3 2C�
Is the Building Historically Designated:Yes NO lC Flood Zone: X
CONTRACTOR:Company Name: y e)(+ 1 Phone#:
Addressp 0 -7r-7v
City: 1-6-4 L-1=w& State Zip: 3 l�
Qualifier Name: O bnja& /Z i) co aI , V c 2Z Phone#:
State Certification or Registration#: ER 1,3 cp 14 13& Certificate of Competency#: t 3 E O
Contact Phone#: Email Address: 4 Ab A U® � -e •.
DESIGNER:Architectl&gineer: To /1 S'146(Lyq &ej /LZ Phone#: Nb
Value of Work for this Permit:$ 3quare/Linear Footage of Work:
Type of Work: OAddress Alteration flew ORepair/Replace ODemolition
Description of Work: a
6
oA1 • viang L--+ /v+,A d 2.
— &a da
�ee���ea�s��$sseesseeesaee�e+�a�ee*����eg�*a*e���a�ee��a�aeae�aae*�e�e��ee�e�e�osea�e��
Submittal Fee$ Permit Fee$ CCF$ COICC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE
I
Is
Bonft 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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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
Owner or Agent Contractor
The forego g instrument was acknowledged before me this. The foregoin insLt was acknowl before
day of Ahw 20day of v ,20 by
who is personall known to me qr who has produced--L- who is personally known to me or who has p
As identification and who did take an oath. b 41e " as identification and who did;t oath.
NOTARY PUBLIC: NOTARY PUBLIC:
WV
Sign: Sign:
Print: Print 1R-c�
My Commission Expires: My Commission Expires:
Heather Moil
x CONN f RUM
APPROVED BY ZOAWW'15'Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10=WXRevised 3/15!09)
P
%.vmm 1 Ir moA t C VP LIADILI I T INOUKAIVtsC
12/8/2015
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 WANED,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 Var Maximo Dopazo CPIA
Dopazo & Associates Inc PHONE . (305)470-8500 FAX Not
(866)647-9673
(AIC Mg.8725 NW 18th Terr Ste 300 ADL .max@dopazo.com
INSURERS)AFFORDING COVERAGE NAIC#
Miami FL 33172 INSURER A MOSCO Insurance Company 25011
INSURED INSURER B RetailFirst Ins CO 10700
Volt Electric Corp INSURERC:
831 W 53 Terrace INSURER D:
INSURER E
H:i.aleah FL 33012 INSURER F:
COVERAGES CERTIFICATE NUMMR-CL1511911704 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.
ILSR TR TYPE OF INSURANCE POLICY NUMBER L SUERPOLICFBF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE Fx1 OCCUR D SES $ 100,000
WPP1420280-00 11/26/2015 11/26/2016 MED EXP("One person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000
NPOLICY JEC LOC PRODUCTS-COMP/OP AGG $ 1,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED U $
(Ea accidon!)
ANY AUTO BODILY INJURY(Per per800) $
ALL OWNED SCHEDULED BODILY INJURY(Per aoddent) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (per accident)
UMBRELLA LJAB OCCUR EACH OCCURRENCE $
EXCESS LUU3 CLAIMS-MADE AGGREGATE $
DED I RETENTION $
WORKERS COMPENSATION xT TH-
E
AND EMPLOYERS'LIABILITY
ANY PROPRIETORPARTNERIEXECUTIVE YIN NIA
E.L.EACH ACCIDENT $ 1,000,000
B OFFICER ry In H)OCCLUDED? a 0520-51999 10/7/2015 10/7/2016 E.L.DISEASE-EA EMPL $ 1,000,000
(�Myaensdatory in NH)
MMMON OF OPERATIONS below E.L.DISEASE-under POLICY LIMIT $ 1,000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD N".Add(dorrei Remarks Sohedule,may be attached If more space to required)
E?.ectrical contractor
CERTIFICATE HOLDER CANCELLATION
(305)756-8972
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Miami. Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10052 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami. Shores, FL 33138
AUTHORIZED REPRESENTATIVE
M Dopazo CPIA/MAD
01988-2014 ACORD CORPORATION. All rights reserved.