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PL-16-1568 y i Miami Shores Village, 04� � .fiji81� 10050 N.E.2nd Avenue NES s Miami Shores,FL 33138-0000 a �'• C17ftt� � Phone: (305)795-2204 r.. . Ex gyration: 12120/2016 Project Address Parcel Number Applicant 1557 NE 105 Street Number: 7-2 1122300530660 Miami Shores, FL Block: Lot: EVELYN GOLDENBERG Owner Information Address Phone Cell EVELYN GOLDENBERG 1557 NE 105 ST TOWNHOUSE 7-2 MIAMI SHORES FL 33138-2115 Contractor(s) Phone Cell Phone Valuation: $ 849.00 ALL FLORIDA PLUMBING CORPORAI (305)380-7777 (305)401-2492 Total Sq Feet: 00 Type of Work:REMOVE WATER HEATER INSTALL TANKLES Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# PL-6-16-60082 $2.00 06/06/2016 Check#:1066 $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 06/23/2016 Credit Card $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 inform tkon is accurate and at all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abo -na eo c tractor the work stated. c June 23, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 23,2016 1 Miami Shores Village � i Building Department artment r JUN ®6 2016 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 � 0-lqle�- Agn�{ Tel:(305)795-2204 Fax:(305)756-8972 -: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20l0-1 y BUILDING Master Permit No." /6 - PERMIT APPLICATION Sub Permit No. oeG /t!�- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL *PtUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: l 5'sl NE-- locs 5 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone:�jOFE: FFE: OWNER:Name(Fee Simple Titleholder): .-• n ,� 4z,r i Phone#:� Address: ZS 7 il/tL /© 4 3 7 T`5' S� �A _ City: /v/i.r,,•./ '��,���}y State: r�i Zip: 3/ Tenant/Lessee Name:_ �P� �7`i l T2_ Phone#:30 Email: CONTRACTOR:Company Name: Alt Fl0t-/DR ?/UPhone#: 3K-39-0-237-7 Address: City: /� GC�/ State: �� Zip: -3J/1? Qualifier Name: KlILIq/U0 rl��,re0A) S Phone#: 3- Y'0/'O T 22 State Certification or Registration#: 61 re l�*'7 3 3 / Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 4&. Or) Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ,/❑ New Repair/Replace ❑ Demolition Description of Work: r< 1rA2 ."'o7 ZT177 .. Jt— Specify color of colior"tru tile: Submittal Fee$ Permit Fee$ 6 �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ i '4- - Gc— (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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature ✓ �Qti SignatureZVI OWNER or AGENT CONTRACTOR The fore instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —day of /11�- P2016 by dayL��sonally 20/ ,by CSF l yrs W���NC1NQ� ,who is personally known to rr���./ c7 , known to me or who has produced as me or who has produced r(95Z Z01 09 ©sq as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: mo' "&*E .o..YA1Rs "�Yp"° MURRAYP.YANKS Seal: * * MYCOMMI ON#EE0150 Seal: ?®; •••`�� EXPIRES:SOPMmber 1/2011 * * MYCOMMISSION 1EE832''.'. oPR��oe BMWThmBud��sevea EXPIRES:September 14,20 ih Bided Ttn&40 Notary$ewe, APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r .f0• BMW Miami hOreS illage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33135 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA SPATE 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 form and Contractor 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 form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Halder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33135 Cerilliicate must specify the description of operations or contractor license number. o®■oo®ao®®ra®m®mm®®®®®®m®sa®aamcaa®me®aancameamamm®®®©®®®®©m®o0ovmm®®®mreamm®rmm®n®oomea0©eqa BUSINESS NAME: 19 GG I-2Law BUSINESS ADDRESS: / 7 u r CITY -3 1;d:-A STATE BUSINESS PHONE:U!�66 .?,;? FAX NUMBER CELL PHONE 6�L�— 4;-1®J- -V 9,� QtIALIF`IER'S E: QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONALREGULATION CFC1429337 ISSUED:. 07/26/2015 CERTIFIED PLAJWUW CONTRAOTOR FURONES,E11i31€ NE A Q�4ATION ALL FLORIDA Pl: l�!q . IS CERTIFIED under the provisions of Ch.47 EXpea6mti date:AUG 31,2018 002865 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT ABILL — DO NOT PAY LBT 5210018f-i 13USINESS NAMWWCATIOJN RECEIPT LNO_ EXPIRES ALL FLORIDA PLUMBING CORPORATION RENEWAL SEPTEMBER 3 ® Z®16 14227 SW 92 ST 54"732 must be displayed at place of business MIAMI FL 33186 Pursuant to County Code Chapter 8A—Art 9&10 OYMER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ALL FLORIDA PLUMBING CORP 196 PLUMBING CONTRACTOR gY TAX COLLECTOR Worker(s) 1 09P000548 $75.00 07/28/2015 CHECK21-15-107787 This Local Business Tax Receipt only confines payment of the Local Business Tax.The Receipt is rot a license, permit ora certification of the holder"sgaalificationsto do business.Holder mast comply vft any governmental or aongovemmental regulatory laws and requirements which apply to Lha business. The RECHPT NO.above must be displayed on all commercial vehicles—Miami-Dade Cate Sec 8a­-V& fvr more iofannotion,rift www.miamidad%gmd xracollecmr r ACC" DATE(lAWWNYYY) �.- CERTIFICATEOF LIABILITY INSURANCE 06/06116 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 INSUIRER(SL AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poTicy(Iles)must be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the poky,Certain policies may require an endorsentenL A statement on this cerWieate does not confer rights to the certficate holler in lieu of such endorsement(s). PRODUCER �CT ANAKARINA CALLEJAS Great Florida Of Miami PHONE , (305)515-5613 FAX No; (668)237-7027 10471 N Kendall Dr Suite BI01 -ADDRESS: anakarina@greatftorida cant Miami,FL 33176 INS AIPMROINGCOVERAQE kAlC# Phone (305)515-5613 Fax (888)237-7027 RERA: CAPITOL SPECIALTY INS CORP INSURED INSURER B All Florida Pluming Carp I Emiliano A Furores INSURER C: 14227 SW 92ND STREET INSURER D. MIAMI,FL 33186 VENDOR 193577 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. ILSR TYPE OF INSURANCE t POLICY NUMBER %VDOY EFF POLICY EXP Lam GENERAL LIABILITYEACH OCCURRENCE s 1,0D0,000.00 DA'A TO RENTED COMMERCIAL GENERAL UABIUW PREMISES Ea occulrenoe $ 100,000.00 [] ❑ A CLANS-MADE ® n OCCUR GS02610211-012!11/2015 12/11/2016 1 HIED EXP(Any we rte) $ 5,000.00 I_I PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE s 2,000,000.00 GEML AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG s 2,000,000.00 ❑ POLICY LJ jEcT PRO- ❑ LOC $ AUTOMOBILE W661LITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) S ALL OWNED (' 1 SCHEDULED i BODILY INJURY(Per accident) S L� AUTOS LJ AUTOS ❑ SWNED ; PROP�tte DAMAGE $ HIRED AUTOS ❑ AN ff $ U UMBRELLA UAB LJ OCCUR EACH OCCURRENCE S ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ Lj DEC) ❑ RETENTION S —— $ WORKERS COOAPENSATION ❑IC S LQTLI ❑ER AND EtP1 DYERS'LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A In NH) El ELDISEASE-EA EMPLOYE I $ 6 D RIPMON OF TIONS below E.L.DISEASE-POLICY L@AIT s I SCRIPIION OF OPERATIONS 1 LOCATIONS 1 VEHICLES cYi ACORD 161,AddMomf Remarka Schedule,B more stake is required) �^ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mimi shores Village Bldg Dept THE EXPIRATION DATE THEREOF,NOTICE WALL BE DELNERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. Mini Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/0 QF The ACORD name and logo are registered marks of ACORD ACCARV CERTIFICATE OF LIABILITY INSURANCE o-w(M. s 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 poNcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the teens and conditions of the pol[W,certain policies stay require an endorsernent. A statement on this certificate does not confer rights to the certificate holder to Neu of such endorsement(s). PRODUCER NAgg Sasha Aristy Horizon Insurance.Inc. PHonle 941 755-9500 7347 52nd Place E E�Atl iltf hor¢onir�.nee Bradenton,FL 34203 Nsu" AMgBDINGCOVERAGE - _-- _A: TUBA Workers'Comp AllFloridaFlorida Plumbing Corp. 94SUIERC: - 14227 SW 92nd Street INSURER 0: Miami,FL 33186 91RERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 17 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_. — IiiSR L,RI TYPE OF INSURANCE IN ASL��IN VAID POLICY NUS POLICY EFF POLICY EICP UktITS CaM�as ar GENERAL LlAtUUiY EACH OCCURRENCE s CLAIMS-MADE OCCUR I -- -- PREMISES(Ea ocmu Iw=) s— .__ MED EXP(Any one person) $ I i PERSQNAL&AOVINJURY $ SDI G_EML AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ I POLICY L___�PECT F I LOC A -- -- PRQDUCTS•COMP/OP AC,G $ OTHER AUTOMOBILE LIABI M NGLE LIMIT S ANY AUTO EDU BODILY INJURY(Per person)SCHLED S AUTOS OVVNOILY AUTOS BODILY INJURY(Per Se dent) S HIRED AUTOS ONLY I AUTOSNON-OWNED -OONED I PROPERTY DAMAGE $--- ( rrt — — $ _.aUMBRELLA LIAB OCCUR EACH OCCURRENCE IS IEXCESS LIAB CLAIMS-MADE AGGREGATE a Is .-. DED RETENTIONS ---- A WORKERS COMPENSATION AND EMPLOY8ffi'LIABIL" YIN 10646202 17J0212015 19!02/2016 X_ FE—Ft ANY PROPRiETOMPARTNEWEXECUT11E E.L.EACH ACCIDENT S 100, O IIS EXCLUDED'! E1I N 1 A I 0w ayes.desm-be under E.L.DISEASE-EA EMPLOYS 100,000 ------- --._ DESCRIPTION OF OPERATIONS below I i E.L.DISEASE-POLICY LIMIT s 500,000 I I scwPrroN OF oPERArows I LOCATIONS I VEHICLES(AC6F6,�01,Addbanat Rum,*s Soheduie.rosy be attached it more space is r"u§ed) Y CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELWERED IN 9�t ACCORDANCE WrtH THE POLICY PROVISIONS. 10050 NE 2 Ave Miami Shores,FL 33138 AUTHqkU=REPRESENTATIVE SSA ©1958-2015 ACORD CORPORATION. All right's reserved. ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD Printed by SSA on June 06,2016 at 09:46AM