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PL-15-3172 Miami Shores Village h 10050 N.E.2nd Avenue NW . Miami Shores,FL 33138-0000 Phone: (305)795-2204 lw '9� l P n Expiration: 06/2712016 Project Address Parcel Number Applicant 21 NW 103 Street 1121360131130 Miami Shores, FL 33138- Block: Lot: JOAN CRAWFORD Owner Information Address Phone Cell JOAN CRAWFORD 21 NW 103 Street MIAMI SHORES FL 33150-1233 Contractor(s) Phone Cell Phone Valuation: $ 1,100.00 JAMES DENTICO CONTRACTING INC 305-756-6553 Total Sq Feet: 00 Type of Work:NEW KITCHEN SINK NEW FAUCET WATER L 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 $1.20 Invoice# PL-12-15-58149 DBPR Fee $2.25 12/30/2015 Credit Card $110.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 12/23/2015 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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, UMBING NICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. WNERS AFFIDAVI . I ify hat th for information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fut rm r ove-named contractor to do the work stated. December 30,2015 Autho ed Signature:Owner / Applicant / Con actor / Agent Date Building Department Copy December 30,2015 1 Miami Shores Village p,ECEIV' ��; Building Department DEC 2`3 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 L. INSPECTION UNE PHONE NUMBER:(305)7624949 F BC 20 , BUILDING Master Permit No. �� - PERMIT APPLICATION Sub Permit No. �l " VVz ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [--j RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: oa I I D-3 JtreiA City: Miami Shores County: Miami Dade ZiD: /-5-0 Folio/Parcel#: Is the Building Historically Designated:Yes NO t/ Occupancy Type: 5 P Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): rl 4l'?9 Phone#:309 212—12 0,� 6 Address. a/y Ixy°- City: i`�1,�X&g&_j State: 05L.- Zip: 3YISO Tenant/Lessee Name: Phone#: Email: 1 CONTRACTOR:Company Name: 66 / Phone# ®-s- �-�. � Address• Obi MLLO City: t State: Zip: 3 J� Qualifier Name: Nikr Phone#:� 62 State Certification or Registration M 0 F r9®s6 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ®� �_ Square/Unear Footage of Work: Type of Work: ❑ Addition Alteration F-1 F-1New [:] Repair/Replace El Demolition Description of Work: fQG_W T�. �1 SN tC,E0rW ELO 15W CC T, LJA)L � � Specify color of color thru tile: Submittal Fee$ Permit Fee$ /Jf�� CCF$ CO/CC$ Scanning Fee$ -3, Radon Fee$ 2 �5 DByyPR$ Notary$ 16 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 11c) °3 C) Bonding Company's Name(if applicable) Bonding Company's Address City State Tp 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. 1 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. re—.SignatSignature 4GENTOWNER 4��CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of&� &,& ,20 /5 ,by L_day of �in V ,20 � ,by �6 Qal n , itl)tW ,who is personally known to �ctw-s 1z-4.'c 0 ,who is personally known to me or who has producedPZ C 6/6,V7®SS.<6 zAl as me or who has produced J::�'l, D7 as identification and who did take an oath ��6 Zv Zv identification and who did take an oath. NOTARY PUBLIC: NOTARY PUHU C: &J,Sign: Sign: Print: N®ul ® Noy Print' Seal: Seal: �� Notary PO State M F�da Notary Public Stele Flotkia ! "My 06 m . NeulWe Noyes gg E>0 [!ar 31.20f7 % �@ MY Commission FF 202744 s'�: oF.��.` Corttroi@siRn.B fE-4Y03S7 rjd Expires 02/23/2018 "f"'$_ QOnd@Q'ThlOU�i Na13o 114ii y Assn. APPROVED BY / _ / �•Z��S Plans Examiner Zoning Structural Review Clerk _STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 VM1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DENTICO,JAMES L JAMES L. DENTICO CONTRACTING, INC. 10055 BISCAYNE BLVD MIAMI SHORES FL 33138-2645 CongratulationsI 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 architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMEKT QF BUSINESS AND and they keep Florida's economy strong. PROFES8110 GULATION c Every day we work to improve the way we do business in order to CFC019056 �x�08/17/2014 serve you better. For information about our services,please log onto r. www.myfforidallicerne.corn. There you can find more information 4 CERTIFIED P } about our divisions and the regulations that impact you,subscribe - DENTIGC;J *4 j � to department newsletters and learn more about the Department's 7 JAMES.L,.DENC. Initiatives. � � ,� OWN Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your ° s a°� customers. Thank you for doing business in Florida, j 16 CERTIFIED under ii e * liibll of ChA89 FS. and congratulations on your new license! r :AW31;2016- r140e1700=19 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION j CONSTRUCTION,INDUSTRY LICENSING BOARD The-PLUMBING C•COkT CT-OR Naiad below IS CERTIFIED. 'Un ler.the-prayisions ofthapter489 FS. :. j Ezpiratin daze.`P►UG.31,2016 DENTJAMES L �+ 4 o ICO, 'JAMES C Df*i�ITiCO EOE_ hIG, INC _ 0065 BISCAYNE`I31 1 MFAtifll"$MORES-- � ��i138 �y -7 } 44 6R ..4 Aim y, . A ISSUED: 08117/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408170002619 I — z • y.T7E ����� y� i��. ,.j `re .l'�s�'��I�� d 1 Y? f �4.•�ax +h � fi _ 5 maker c t ••� ` aF'•�. s. " f �7,.�{rep"e] �•-�� r V ..b avs ml ' s e ,#is4.11�e k7blAr,c � fl 5 i i ! A ri .�+r 1 v A a a - d € "r K 2 ¢ F 6 g PAYHH8H11 AE ownter�', lg6 PLSING �r rax Cou ec SgG, Oc DENTGCr YAMFS L UN INC x ' F5.00 69/23/-20 15-004276 '':mtrl ) -70 TrPPUt2 if ax TM ReceliH not lj . gg mom P'�-Ej _�'5 ei -� Pit "san all NO ebbYbe Policy Number. Date Entered: ACORO® E(MAVDD/YYYY) AT CERTIFICATE OF LIABILITY INSURANCE DATE MM 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 WW"ALLISON SALT INSURANCE 730 SW 4TH ST. #3 PHONE (866)587-7147 FAX ,. (888)542-3507 MMMa ALLISON@SALbzx NBURE.COD! CAPE CORAL, FL 33991 ADDRES INSURERS AFFORDING COVERAGE NAIC d INSURER A:PREB'ERRED CO1TTRACT0RS INS. CO. (RRG) 12497 INSURED JAMES L. DENTICO CONTRACTING INC INSURER 8: JAMES DENTICO INSURER C: 10055 BISCAYNE BLVD. INSURER D: MIAMI SHORES, SL 33138 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE 8D POLICY NUMBER MID EFF MSD EXP LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE OCCUR 8/25/2013 /25/2016 PREMISES R PCIC5026-PCA70585 occurrENTEY ence $ 50,000 -06 MED EXP(Any one person) $ 51000 PERSONAL&ADV INJURY $ 11000,000 GEV'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY❑JECT F-1 LOC PRODUCTS-COMPIOPAGO $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ e accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ %RED AUTOS AUTOS :ERM UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPWETORIPARITER/EXECUTNE NIA E.L.EACH ACCIDENT $ OFRCERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Byes,descnbe under DESCRIPTION OF OPERATIONS below E.t_DISEASE-POLICY LIMB $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addtdonai Remarim Schedule,may he attached B more space Is required) CFC019056-PLUMBING CERTIFICATE HOLDER CANCELLATION MLAbII SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. N AMI SHORES, FL 33138 305 756 8972 AUTHORED REPRESENTATIVE ©1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ProducedushM Farm Boss Plus softwo www.Fm mBoss. S00-20&1871 I 05-08-2014 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION e CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS, COMPENSATION LAW e � CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 05/03/2014 EXPIRATION DATE: 05/02/2016 PERSON: DENTICO JAMES L FEIN: 592246282 BUSINESS NAME AND ADDRESS: JAMES L DENTICO CONTRACTING INC 10055 BISCAYNE BOULEVARD MIAMI SHORES FL 33138 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR-COW 2- LICENSED ELECTRICAL CONTRACTOR 3- LICENSED PLUMBING CONTRACTOR 4- LICENSED GENERAL CONTRACTOR IMPORTANT: 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 ander this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.0502), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed an the notice of election to be exempt. Pursuant to Chapter 440.0503), 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. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW 9 D chapter. EFFECTIVE 05/03/2014 EXPIRATION DATE: 05/02/2016 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: JAMES L DENTICO H exempt- apply only within the scope of the business or trade listed on FEIN: 592246282 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440:05(13), F.S., Notices of election to be exempt JAMES L DENTICO CONTRACTING INC and certificates of election to be exempt shell be subject to revocation 10055 BISCAYNE BOULEVARD if, at any time after the filing of the notice or the issuance of the 1 MIAMI SHORES, FL 33136 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 SCOPE OF BUSINESS OR TRADE person named on the certificate to meet the requirements of this 1- HEATING, VENTILATION, AIR-CONO 2- LICENSED ELECTRICAL CONTRACTOR Section. 3- LICENSED PLUMBING CONTRACTOR 4- LICENSED GENERAL CONTRACTOR QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-251 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Miami shores Village ` 1 Building Department 100501d.E2nd Avenue Miami Shores, Florida 33138 Tet: (305)795.2204 Fax:(305)756.8972 Notice to Owner—Workers' Com ensation Insurance Exemption 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 parttime or fall-time employees,including the owner,roust obtain workers'compensation overage. 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 ownersbip; 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 excmpL 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'comtpensation exemption and has admowledge that he or she will not use day labor,parttime employees or subcontractors for your project.The contractor bas provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Sbores Village does not require verification of workers'compensation insurance coverage from the orrttactnr'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. Si Owner State of arida County ofMiami Dade The foregoing was acknowledge before me this j�day of.—LM_' — ,2Qd ByO*WM C r (Y(aJ F�p� who is personally known to me or has produced is identification. N REEf]State of Floridaelicianoon FF 082753/2018 GENERAL • ELECTRICAL • MECHANICAL • PLUMBING ROOFING JAMES DENTICO CONTRACTING, INC. ate:December 22,2015 State of Florida County of Miami-Dade Before me this day personally appeared James L. Dentico who,being duly sworn,deposes and says : That he will be the only person working on the plumbing project located at a K(W ( 0 3 d W;fimr. S (or ed)and subscribed before me this day of 2015 by N LAvJV- v� -DctgT1et) Personally known Produced Identification 14S-2-`u'S` 3_4 >1113 Type of Identi 'ons- Notary Public State Of FlOrida Sindia Alvarez My Commission FF 188700 iy Expires 09/03/2018 10055 Biscayne Boulevard • Miami Shores, Florida 33138 Telephone: 305-756-6553 State of Florida Lic. CGCO13750 Fax: 305-754-9605 CC, 1S7-3(-(7- 4,. f r -- 34 T 2 ./- PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE — — — -- -- — — IMPORTANT - - STATE OF FLORIDA I Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES who elects exemption from this chapter by filing a certificate of DIVISION OF WORKERS'COMPENSATION I F election under this section may not recover benefits or 'w � � compensation under this chapter. CONSTRUCTION INDUSTRY EXEMPTION 10 CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to WORKERS'COMPENSATION LAW D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: 5/4/2016 EXPIRATION DATE: 5/4/2018 listed on the notice of election to be exempt. PERSON: DENTICO JAMES L H Pursuant to Chapter 440.05(13),F.S..Notices of election to be FEW: 582248282 I E exempt and certificates of election to be exempt shall be BUSINESS NAME AND ADDRESS: R subject to revocation if,at any time after the filing of the notice JAMES L.DENTICO CONTRACTING,INC I E 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 10085 BISCAYNE BOULEVARD a certificate at any time for failure of the person named on the MIAMI SHORES FL 33138 certificate to meet the requirements of this section. SCOPES OF BUSINESS OR TRA LICENSED GENERAL LICENSED PLUMBING LICENSED ELECTRICAL HEATING,VENTILATION, CONTRACTOR CONTRACTOR CONTRACTOR AIR-COND DFS-F2-DVC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609