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PL-16-77Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -1-16-77 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: APPROVED Issue Date: 1113/2016 Expiration: 07/11/2016 Parcel Number Applicant 652 NE 105 Street Miami Shores, FL 1122310120140 Block: Lot: KILUAN, INC Owner Information Address Phone Cell KILUAN, INC 652 NE 105 Street MIAMI SHORES FL 33138- 150 SE 2 Avenue MIAMI FL 33131- Contractor(s) KUNES PLUMBING L.L.0 Phone (954)554-4415 Cell Phone Valuation: Total Sq Feet: $ 600.00 0 Type of Work: INSTALL 125 AMP ELECTRIC PANEL AND Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # PL -1-16-58301 01/12/2016 Credit Card 01/13/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 109.10 $ 109.10 $ 0.00 Available Inspections: Inspection Type: Final Press Test Review Plumbing 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 ac - - at all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -name • •ntractor to do the work stated. Authorized Signature: Ow plicant / Contractor / Agent Building Depart ent Copy January 13, 2016 ate January 13, 2016 1 jos -6714c Miami Shores Village OV 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC (l ROOFING {PLUMBING n MECHANICAL JOB ADDRESS: City: Folio/Parcel#: 652 N. E. 105 St. Miami Shores 11-2231-012-0140 11 RT — JAN 1 2 2016 t3Y: FBC 2_-f 0 ('- Master Permit No2)C'b 2398 Sub Permit No. ?(---) G ❑ REVISION fl EXTENSION (RENEWAL PUBLIC WORKS n CHANGE OF ❑ CANCELLATION n SHOP CONTRACTOR DRAWINGS County: Occupancy Type: Load: Construction Type: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO Hood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Kiluan, Inc. Phone#: Address: 652 N.E. 105 St. City: Miami Shores Tenant/Lessee Name: N/A Phone#: Email: State: Florida Zip: 33138 CONTRACTOR: Company Name: Kunes Plumbing, LLC. Address: 5030 SW 94 Terr. City: Cooper City Qualifier Name: Scott Kunes State Certification or Registration #: DESIGNER: Architect/Engineer: A Address: 370 N.E. 101 St. Phone#: (954) 554-4415 State: Florida , ,�� Zip: 33328 hone#: (954) 554-4415 r ��:""'g •te of Compete cy #: 111011/1 1 _ ! one#: ,iiy:AAiarrri" res State: FI. Zip: 33138 Value of Work for this Permit: $ 601 af Square/Linear Footage of Work: Type of Work: ri Addition n Alteration H t New Description of Work: Install gas line for Bar-B-Que Grill ❑ Repair/Replace ]T] Demolition Specify color of color thru tile: Submittal Fee $ g0 ' (C) Permit Fee $ Scanning Fee $ ' w G - 90 Technology Fee S /,of' CCFs O- n ^CO/CC $ Radon Fee $ a -'7 DBB-PRR$$ o(_ O5 Notary $ Training/Education Fee $ O . QO Double Fee $ Structural Reviews $ Y Bond $ (Revised02/7.4/2014) `f' 52) TOTAL FEE NOW DUE $ 10'. ` 0 Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) N/A 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 o 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. r Signature MaouC rector Kiluan, Inc) OWNER . r AGENT The foregoing instrumentiwas acknowledged before me this day of J Or1UD1 yta , 20 I CO . by 11 i" CAYC.O NULL 1 , who is personally known to me or who has produced (eerSonr)IItj gooviv\') as identification and who did take an oath. r: \ LUCIA G ISASI -' MY COMMISSION #FF182628 %..?o,,n;?�' EXPIRES December 10, 2018 Sign: (407) 398-0153 FloridallotaryService.com Print: 6uc,i a 0.15 o,5/i NOTARY PUBLIC: Seal: Kunes PI ing, LLC Signature CONTRACTOR The foregoing instrument was acknowledged before me this oq day of DC<.., , 20 15 , by ,''wnnho is personally known to me or who has produced j1 de(j2 _ identification and who did take an oath. NOTARY PURL1 Gek.. HOPE HAMPEL ';,9 MY COMMISSION 0 FF897718 EXPIRES July 09, 2019 , , tion 3110.01s3 fbAAeMwrySarviiscar Sign: Print: Seal: as **********************************s****************a*********a*rr***********************sr.************s**** APPROVED BY (Revised02/24/2014) Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 KUNES, SCOTT CALVIN KUNES PLUMBING L.L.G 5030 SW 94TH TERRACE COOPER CITY FL 33328 Congratulations! 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER CFC1428592 DETACH HERE (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1428592 ISSUED` 08/17/2014 CERTIFIED PLUMBING CONTRACTOR KUNES, SCOTT CALVIN KUNES PLUMBING L.L.0 IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31. 2016 L1406170002656 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 KUNES, SCOTT CALVIN KUNES PLUMBING LLC 5030 SW 94TH TERRACE. COOPER CITY FL,33328 ISSUED: 0811712014 DISPLAY AS REQUIRED BY LAW SEO # L1408170002656 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: Business Name: KUNES PLUMBING L.L.C. Owner Name: SCOTT CALVIN KUNES Business Location: 5030 SW 94 TERR COOPER CITY Business Phone: Rooms Seats Employees 1 Receipt #:182-2 NG500 N Business Type: Business Opened:03/30/2012 State/County/Cert/Reg: CFC14 28592 Exemption Code: Machines SPRNKL/CONTRACTOR Professionals THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: KUNES PLUMBING L.L.C. 5030 SW 94 TERR COOPER CITY, FL 33328 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 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. 2015 - 2016 Receipt #1CP-14-00014240 Paid 07/15/2015 27.00 07/14/2015 Effective Date BROWARD COUNTY, FLORIDA`' CERTIFICATE OF COMPETENCY,. JOURNEYMAN PLUMBER„ CC# 02 -CJ 2063-X KUNES. SC •TT CALVlti,, NOT FOR CONTRAC7ItVG For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee I Penalty l Prior Years Collection Cost Total Paid 27.00 0.00 0.001 0.00 If 0.00 0.00 27.001 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: KUNES PLUMBING L.L.C. 5030 SW 94 TERR COOPER CITY, FL 33328 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 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. 2015 - 2016 Receipt #1CP-14-00014240 Paid 07/15/2015 27.00 07/14/2015 Effective Date BROWARD COUNTY, FLORIDA`' CERTIFICATE OF COMPETENCY,. JOURNEYMAN PLUMBER„ CC# 02 -CJ 2063-X KUNES. SC •TT CALVlti,, NOT FOR CONTRAC7ItVG ��r.-O�� k........--- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/001YYYY) 12115/2015 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 :NSURANCE 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 Ace Underwriting Group Customer Service Center 5305 West Broward Blvd. Plantation FL 33317 CONTACT NAME: Ace Underwriting Group PHONE 954-581-0202 Fwx 954-581-2999 EMAIL E �_'�NO1 servi AopaESS:ceeunderwriting.com ADDRE. INSURERIS) AFFORDING COVERAGE NMC f INSURER A: city Insurance Company 32930 INSURED Kunes Plumbing, LLC 5030 SW 94 Terr Cooper City FL 33328 INSURER,: EACH OCCURRENCE INSURER C : INSURER 0: r If OCCUR 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 iI LTR TYPE OF INSURANCE ADDLI'Sl-T y•.un _ POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS tt � COMMERCIAL GENERAL UABIUTY (u( _j EACH OCCURRENCE 5 1,000,000 r If OCCUR PREMISES 4a% (ceEwi 100,000CLAMS•MADE $ A CLI -01002630B 03/0312015 03/03/2016 MED EXP (Any one person) $ 5,000 — PERSONAL a ALM INJURY $ 1,000,000 GENt AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATES 2,000,000 1 POLICY ❑ JECOr ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000 OTHER. S ( AUTOMOBILE LIABILITY j Lit (Ea loo en SINGLE LIMIT (Ea ice!) 5 ■ ANY AUTO 1 it eOOILY INJURY (Pr person) $ALL III AU OS OVVNED Al1TOSLED BODILY INJURY (Pr Pcddent ' 5 HIRED AUTOS NOAUT .O VNED OS oROPERTY DAMAGE Li Ac 5 IIII 'j _ S ill UAB AB ' OCCUR 1.--rll EACH OCCURRENCE $ Il EXCESS UAB .....a CLAIMS -MADE AGGREGATE. $ ■ DED ■ RET. NTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY _ ""'-""'• E R+ Y / N ANY PROPMETORIPARTNERIEXECUTWE N 1 A EL EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED? (Mandatory M NH) E DISEASE - EA EMPLOYEE 5 1/ yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space 1s required) Plumbing CERTIFICATE HOLDER CANCELLATION Miami Shores Villiage Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 Northeast 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Florida 33138 ACCORDANCE WITH THE POLICY PROVISIONS. FaX: 305-7564972 A THD' ,. D REPRESENTATIVE Ai %r _j ACORD 25 (2014101) The ACORD name and logo ar Produced using Forms Boss Web solhvare. www.Form ©1988-2014 ACORD CORPORATION. All rights reserved. marks of ACORD impressive Publishing 800-208.1977 Preview : Certificates of Insurance • https://adpia.adp.com/icertcf/#/run/preview/422306/900018367 CERTIFICATE OF LIABILITY INSURANCE DATE IMMI0OMVVY1 12/18/2015 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 docs not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER Automatic Data Processing Insurance Agency, Inc. Adp Boulevard Roseland, NJ 07068 CONTACT NAME: PHONE Na ext): I FAX No EJIAI1 ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC I oisutER A: NorGUARD Insurance Company 31470 INSURED KUNES PLUMBING LLC 5950 SW 44TH ST Davie, FL 33314 INSURER e: INSURER c" INSURER D: W SURER E : S INSURER F: ' CLAMS -MADE n OCCUR VERAGES CERTIFICATE NUMBER: 422306 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. N5R LTR TYPE OF INSURANCE Jo/W.-waft' NSD WVD POLICY NUMBER POLICY OF (MWOONTYY) POLICY OF (MDEVYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S ' CLAMS -MADE n OCCUR il PRE ESES (Ea omonamcr)SUAMA MED EXP (Any one parson) 5 PERSONAL a ADV INJURY S GENL - AGGREGATE LIE APPUES POLICY n , OTHER: II PER: WC GENERAL AGGREGATE S PRODUCTS- COMP/OP AGO S S AUTOMOBILEUA9UTYLt - ANY AUTO AILED AUTOS— HIRED AUTOS '-- — SUCHr ED ED AMNO 064NcLE LAWS BODILY INJURY (PH moon) S BODILY NJURY(Pee =idea) S (HPtR14119 At£ S S _ UMBRELLA LIMEOCCUR EXCESS LIAR CLAa1S.MADE EACH OCCURRENCES AGGREGATE S OED 1 1 RETENTIONS 5 A WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPNPo ETOPARTNEREXECURVE oFFICEReEMBER EXCU/DED7 (Mandatary In NH) DFJCRPTION OF OPERATORS Wow YNN Y N/ A N ,. KUWC636056 10/14/2015 10/14/2016 X I STATUTE 1 I IRR Hi EL EACH ACCIDENT S 100,000 EL DICEASE- EA EMPLOYEE S 100,000 EA.00EASE- POUCY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached a more now le rqutad) Contractor License: cfc1428592 cfc1428592 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2nd Ave Miami, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE "1I e.._,Jk, I _,.. k ACORD 25 (2014101) 01988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I of 1 12/18/2015 11:21 AM (is InspectionWorksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250718 Permit Number: PL -1-16-77 Scheduled Inspection Date: January 18, 2017 Inspector: Hernandez, Rafael Owner: Job Address: 652 NE 105 Street Miami Shores, FL Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1122310120140 Contractor: DELLA ROSSA PLUMBING & SOLAR LLC Phone: (954)479-4270 Building Department Comments INSTALL GAS LINE FOR BAR B QUE GRILL. Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Infractio Passed Comments INSPECTOR COMMENTS Inspector Comments False January 17, 2017 For Inspections please call: (305)762-4949 Page 3 of 62 DELLR ROSSR PLUMBING - AIR CONDITIONING - SOLAR WORK 6523 BILLING NAME JOB NAME JOB ADDRESS City/State/Zip E -Mail: RobbO 5140 SW 20th St. Plantation, FL 33317 Office: (954) 479-4270 Fax: (954) 636-8198 24 Hours Service & 7 Days Licensed/Insured CFC1427740 Backflow Lic. # 13366 Medical Gas - MedGas/Lic. # 3-0220-04 S2_/UE to `"51- l AvA i clA01/4c.k DATE ///x(/16 www.DellaRossaServices.com r • "eah font ?as". oft *sa Dm? Patiff SERVICE WORK - CONTRACT 0 AFTER HOURS 0 WARRANTY bk,/ ntirlf PHONE 9Sy-- t'Jf!� 67( /I -1P (-!. sA) LAvV\/ vett mev qqs, foir ✓I No G"s: i_Pne QTY. MATERIALS, EQUIPMENT, RENTALS UNIT COST TOTAL DATE LABOR PERFORMED BY HOURS RATE AMOUNT I >No() 'C'e-)- I km the authority to sans skill mull maul uthartra the work to M haw In kb Mao Rindang 1 Solar Sinless, property ifInt uMrwtNflwlpdyoat. !bedsit lsdos a dpaaMabadigsfrwtheohm that MIB Res Plumbing i Ulu Sondem, LLS Is oat nspwTMs for films or seen MM aid ug damp restage free Mann or for anydlots M winter nwtrlals alas Ike Marsha wits: aatlu toss sam Is on pld ly MI wItido by days from ohm dab, the Mt shall INuaboMagid fir t LW. It Is greed that the Mabe, aatttsd, rested, npll * soak Mu. ib CAMERA l save within to digs LABOR dab. 1 Montan! dstonlsratd or lad plass, sailor shall eat b Babb Is FEE kw the West kial PERMIT rwPROCESSING from Installation. rate lMinot uMkhan. eaMated sr Minced sok should scllsotesamhranaatMnlsrsanshasbb ape Muni l suet clMu. ha Mar hither wails spies s and b pay mumsonabmum by MM MATERIAL to sld rims) sed strap of the Mrs pnMaq, awl that the abm paresaslly nag be nms,d Russ Nanilap&SdxSonless, LLSMtoss salt oatbndes. Add Mdais shall dogma will M asteroid. Rhea Nom Plumbing rsunm the right to apply RMatithreat (15%I 11ha should It In Monad hr au Haan. *Bag Warty w M Maks, Sum Tur Numb Warrior/so bah CMuIs,11 MENIT WIXOM X and shred he2%.Utor3Sdays,aHsa dun asset as On, MATERIAL se Now 55Mtnetlss; M SALES TAX SUBTOTAL Authorize Signature X TOOL RENTAL Print Name 1 This work has been satisfactorily performed by Della Rossa Plumbing tt Solar Services, LLC. TOTAL AMOUNT x / THIS TICKET MATERIAL SUBTOTAL Authorize Signature LIC. CFC1427740 BUILDING PERMIT APPLICATION it Miami Shores Village 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 BUILDING I I ELECTRIC n ROOFING F 1PLUMBING n MECHANICAL JOB ADDRESS: 652 N.E. 105 St. PUBLIC WORKS IXI RECD -fl AU 5 ZOIO FBC 20 Master Permit No. RC -4-15-833 AC is- 23 q 9 Sub Permit No. PL -16-77 REVISION II EXTENSION (RENEWAL CHANGE OF ❑ CANCELLATION n SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#: 11-2231-012-0140 Occupancy Type: Load: County: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Kiluan, Inc Address: 652 N.E. 105 St. City: Miami Shores Tenant/Lessee Name: N/A Email: Phone#: State: Florida Zip: 33138 Phoneff: CONTRACTOR: Company Name: Address: 5140 SW 20 St. City: Plantation Della Rossa Plumbing Phone#: (954) 479-4270 Qualifier Name: Joseph Della Rossa State: Florida Zip: 33317 Phone#: (954) 479-4270 State Certification or Registration #: CFC 1427740 Certificate of Competency #: DESIGNER: Architect/Engineer: Victor Bruce Address: . 370 N.E. 101 St. Value of Work for this Permit: $ 1,000.00 Type of Work: I I Addition 1 1 Alteration Description of Work: Install LP gas line for BBQ Grill Phone#: (305) 310-5030 City:Miami Shores State: FL Zip: 33138 Square/Linear Footage of Work: n New Repair/Replace Chani o f con-l-rta c' I-o, Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ co/cc $ DBPR $ Notary $ Double Fee $ Bond $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) N/A 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 o 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. Kilu, Inc. Marco Bruzzi Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 1 5 day of A O5t 20 PCVCJO UY0Z2,1 , who is ersor ire Jos Della Ross The foregoing//��ins �c�da of v'to \JlL� -O me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: LUCIA G ISASI MY COMMISSION #FF182628 EXPIRES December 10, 2018 A APPROVED BY (Revised02/24/2014) TRACTOR ument was acknowledged before me this C/— , 20 1 W , by me or who has produced identification and who did NOTARY PUBLIC: Sign Print: Seal: as it a�'. tf . LAUREN BARGFSKY MY COMMISSION #FF171017 ^•,` ....; EXPIRES October 22, 2018 ((407 3 -0153 A F oridallotaryService.com **************k**************4*pit******:M********************* Plans Examiner Zoning Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. RC -9-15-2398 PL -16-77 Owner's Name (Fee Simple Title Holder): Kiluan, Inc Phone #: Owner's Address: 652 N.E. 105 St. City: Miami Shores State : Florida Job Address (Of where work is being done): 652 N.E. 105 St. Zip Code: 33138 City: Miami Shores State: Florida Zip Code: 33138 Contractor's Company Name: Kunes Plumbing, LLC Address: 5030 SW 94th. Terr. Phone #: City: Cooper City State: Florida Zip Code: 33328 Qualifier's Name : Scott Calvin Kunes Lic. Number: CFC1428592 Architect/ Engineer of Record Name: Victor Bruce Address: 370 NE 101 St. Phone #: City: Miami Shores Describe Work: Install gas line for grill State: Florida Zip Code: 33138 I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. 1 hold the Building Official and the Miami Shores harmless of all legal involvement. Scott unes Signature Signature Marco Bru Owner or Ag The foregoing instrument was aknowledged before me ,20 kk.by 1t -f rt ✓ CO &UaZ to me or who has produced as indentification. this 15 day of Who is p sonally k ow Nota Sign: Seal: Public: iq (407) 398-0153 LUCIA G ISASI MY COMMISSION #FF182628 EXPIRES December 10, 2018 FloridallotaryService. com Contractor or Architect The foregoing instrument rwas aknowledged before me this 1 / day o __ . , 2016 by who is_zersomaiiy`n to a or who has produced - as indentification. Notary Public: Sign: C,/f Seal: .07iiik HOPE HAMPEL e: MY COMMISSION k FF897718 • EXPIRES July 09, 2019 44C1 3U41$3 FlorgeHole 8ervico.con. ACORE) CERTIFICATE OF LIABILITY INSURANCE `....----- DATE(MM/DD/YYYY) 08/03/2016 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(ies) 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 Synergy Insurance Group 7771 W Oakland Park Blvd #122 Sunrise, FL 33351 CONTACT NAME: Nikki Sciacca FAX (H/CO No EMI: (954)792-3660 �e No): (954)791-8019 E-MAIL nsciacca s ner ins.net ADDRESS: @ Y gY INSURERS) AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Della Rossa Plumbing & Solar, LLC 5140 SW 20 Street Plantation FL 33317 INSURER B : National General Insurance Company CPS2476659 INSURER C : 07/12/2017 INSURER D : RetailFirst Insurance Company $ 1,000,000.00 INSURER E : $ 100,000.00 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. I LTR TYPE OF INSURANCE NSR S WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPS2476659 07/12/2016 07/12/2017 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY n PE0. 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDAUTSULED AUTOS2003484439 HIRED AUTOS X AUTOS NON -OWNED AUTOS 12/17/2015 12/17/2016 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ 100,000.00 BODILY INJURY (Per accident) $ 300,000.00 PROPERTY DAMAGE (Per accident) $ 50,000.00 $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER AD NPREXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE EX OFFICER/MEMBER (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / AECUTIVE 0520-022633 09/16/2015 09/16/2016 X WC STATU- TORY LIMITS T H- E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) Della Rossa Plumbing & Solar LLC License Number# CFC 1427740 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD