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PLC-17-2955• Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permi' Issue D Permit NO. PLC -12-17-2955 Permit Type: Plumbing - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED : 12/28/2017 Expiration: 06/26/2018 Parcel Number Applicant 9190 BISCAYNE Boulevard Miami Shores, FL 1132060100030 Block: Lot: BRITE STONE INVESTMENT LL( Owner Information Address Phone Cell BRITE STONE INVESTMENT LLC 1160 KANE Concourse BAY HARBOR ISLANDS FL 33154- (786)340-7513 1160 KANE Concourse BAY HARBOR ISLANDS FL 33154- Contractor(s) FISHBOX PLUMBING LLC Phone (561)324-2887 Cell Phone Valuation: Total Sq Feet: $ 15,000.00 0 Type of Work: PLUMBING WORK FOR INTERIOR ALTERATI Type of Piping: Additional Info: Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $9.00 $6.75 $4.50 $3.00 $450.00 $3.00 $12.00 $488.25 Pay Date Pay Type Amt Paid Amt Due Invoice # PLC -12-17-65922 12/15/2017 Credit Card $ 50.00 $ 438.25 12/28/2017 Credit Card $ 438.25 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground 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 and zoning.Eukhermore, I authorize the above-named contractor to do the work stated. 'A ki 2j/T uthorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy December 28, 2017 Date December 28, 2017 1 4 -v-ciba: Miami Shores Village .0‘0 Building 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 ❑ ROOFING •PLUMBING ❑MECHANICAL ❑ PUBLIC WORKS FBC 204 Master Permit No. CC -8-17-2109 Sub Permit No. ?-tsar " 2� ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9190 BISCAYNE BLVD Miami Shores, FL 33138-3224 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-010-0030 Occupancy Type: M Load: Is the Building Historically Designated: Yes NO X Construction Type: 2B Flood Zone: X BFE: 8 FFE: 9 OWNER: Name (Fee Simple Titleholder): BRITE STONE INVESTMENT LLC Address: 1160 KANE CONCOURSE #202 Phone#: City: BAY HARBOR ISLANDS, State: FL Tenant/Lessee Name: Bank of America Corporation N.A. Email: Furat.Alazzawi@am.jll.com CONTRACTOR: Company Name: FISHBOX PLUMBING Address: 331 SE 5TH AVE Zip: 33154 Phone#: (954) 540-7664 4�U 3C Phone#: 561-324-2887 City: POMPANO BEACH State: FL Qualifier Name: SCOTT CHODAK Phone#: Zip: 33060 561-324-2887 State Certification or Registration #: CFC 1429694 Certificate of Competency #: DESIGNER: Architect/Engineer: Infinity Engineering Group, LLC Address: 1208 E. Kennedy Blvd, Ste 230 City: Tampa State: FL Zip: 33602 Value of Work for this Permit: •$ 200700e' 15, coo, co Square/Linear Footage of Work: Phone#: 813-380-6930 Type of Work: Er Addition n Alteration ❑ New ❑ Repair/Replace E Demolition Description of work: Interior alterations for ADA compliance: Handicap accessibility in customer service areas and bathrooms. Specify color of color thru tile: Submittal Fee $ .5) • W Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 44. S DBPR $ ' —IS Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 14.32i • 2-5 Structural Reviews $ (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A city N/A State N/A zip N/A Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A city N/A State N/A Zip N/A 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 s h posted notice, the inspection will not be approveddgnd a reinspection fee will be c• • rged. Signature OWNER or AGENT The f. :oing instrj ent was acknowledged befor- me this day of U/CC , 20 / 7 , by "-AYP" who is personally known to tme or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Prin Seal: a�+gY P'o` C Boris miDB oru ; 392 .r. .�khov vi =�p,� Expires: SEP 30, 2018 -':Faf tc0,7, BONDED THRU 1ST FLORIDA NOTARY LLC *********************************************** APPROVED BY (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this C day of DG , 20 n by Sc.o 4-+- `I c..Lt C►.ocA1 k,.who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLI : Sign: Print: Seal: as Notary Public, State of Florida Commisslon# FF 2243919 My comm. excites April ************************************************************* Plans Examiner Structural Review Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CHODAK, SCOTT YALE FISHBOX PLUMBING LLC 331 SE 5TH AVENUE POMPANO BEACH FL 33060 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.myfloridaIicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn 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 RICK a SCQTf,•GOVERNOR STATE,OF FLORIDA": DEPARTMENT'OF BUSINESS AND .: PROFESSIONAL REGULATION . t 4 CFC1429694i ISSUED° 12/06/2016 .- ,, CERTIFIED PLUIVIBINe'CONTRACTOR [, CHODAK SCOTT YALE FISHEOX PLUMBING LLC. ."` IS CEAT1 FLIED;undei-the° provisions-or'Ch.489 FS. �r E,kF+irall�rt d9M,:•'AUG 3� 016 - v 11612060000402 DETACH HERE y* i KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUIHEER ThekPLUMBING CONTRACTOR. Named below IS°CERTIFIED' Under the provisions•af Chapter 489 FS.L Expiration-date:—AUG 31, 2018_ i so* CHODAK, SCOTT YALE .K ,r f/FISHBOX PLUMBING LLC` .33ISE 5TH AVENUE- .�,'rPOM_P.ANO BEACH FL 33060 � ISSUED: 12/06/2016 t • "`''.�� •• � ,�'fiy\Lim_ • �y''`. i s L 1 ti 0 • DISPLAY AS REQUIRED BY LAW SEQ# L 612060000402 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018 DBA: Business Name: FISHBOX PLUMBING LLC Owner Name: SCOTT CHODAK Business Location: 331 SE 5 AVE POMPANO BEACH Business Phone: 561-324-2887 Rooms Seats Employees 1 Receipt #:P 8 ING/LWN SPRNKL/CON Business Type:(PLUMBING CONTRACTOR) Business Opened:12/09/2016 State/County/Cert/Reg:CFC142 96 94 Exemption Code: Machines Professionals Number of achii• For Vending Business Only Tax Amount Tr , r h ee 1. N F Fee J Peel Ity P: ears - Collection Cost Total Paid 27.00 0.00 0.00 0.00 �.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: SCOTT CHODAK 331 SE 5 AVE POMPANO BEACH, FL 33060 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. 2017 - 2018 ,"OUNTYi " Receipt #52A-16-00006935 Paid 07/18/2017 27.00 CTOR ACORLf CERTIFICATE OF LIABILITY INSURANCE ‘ii....'"---'‘. DATE(MM/DD/YYYY) 10/31/2017 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 have ADDITIONAL INSURED provisions or 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 Insurance Medics 5450 S. State Rd 7Suite 35 Davie FL 33314 CONTACT NAME: Husam Mohammed PHONE 954 34 FAX (A/C. No. Extl• ( ) 3-5151 (A/c, No): (954) 343-5152 E-MAIL @• in ADDRESS: lou@insurancemedics.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: United States Liability Insurance Co COMMERCIAL GENERAL LIABILITY INSURED Fishbox Plumbing LLC 331 SE 5th Avenue Pompano Beach rIoridl 33060 INSURER B : Progressive 10193 INSURER C : 01/20/2018 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE 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. INSR LTR TYPE OF INSURANCE ADDL NSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y N CL 1735303A 01/20/2017 01/20/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE _ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY AUTOSULED NON -OWNED AUTOS ONLY 03970705-0 10/31/2016 10/31/2017 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 100,000 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ 50,000 $ A UMBRELLA LIAB EXCESS LIAB ^ OCCUR CLAIMS -MADE Y N XL 1580338 07/26/2017 07/26/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is listed as additional insured. CFC 1429694 CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department 10050 Ne 2nd Ave 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACGRa CERTIFICATE OF LIABILITY INSURANCE DAT.= rairArnnivv) 10/31/2017 "°°LicEil T.B.H. Enterprises, Inc. P.O. Box 30411 Palm Beach Gardens, FL 33420 561-626-0952 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. INSURERS AFTORDING COVERAGE INSURED Fishbox Plumbing, LLC 331 SE 5th Avenue Pompano Beach, FL 33060 INSURER A: Normandy Insurance Company j INSURER a: j INSURER C: INSURER D: THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRENIENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. is r POLICY 'EFT !E I POLICY EXPIRATION i L . I TYPE OF INSURANCE ! POUCY 141.1 . OATE eii Limas . GENERAL upaiLrry 1 j. 1 EACH OCCURRENCE I COMMERCIAL GENERAL LIABILITY 1 ; i FIRE DAMAGE (Any one fire) j S 1 I CLAIMS MADE 1 ] OCCUR 1 MED EXP (Any one peraon) 1 S PERSONAL a ADV INJURY , S , 1 , GENERAL AGGREGM ! GEN'LAGGREGATEUMTAPPL1ESPERI • PRODUCTS -COMP/OP AGO 45 j PLICY 1 j O AUTOMOBILE LIABILITY . COMBINED ENGLE LIMIT 1 s (Ea aeckleno . / I ANY AUTO !i . ; . 1 ALL OWNED AUTOS : ' i , ---= 1 j SCHEDULED AUTOS I ,..—...— 1 BODILY INJURY i (Per peraon) i BODILY INJURY I I (Per eccidant) , 5 1 ' • I i -BRED AUTOS r—i NON -OWNED AUTOS r-1 PROPERTY DAMAGE I , (Per accident) I ! ; GARAGE LIABILITY I , ----1 : I ANY AUTO !-----; 1 I ; AUTO ONLY - EA ACCIDENT ; S ' I EA ACC $ OTHER THAN . AuTo ONLY: ; • ti Excess uAssirr 7-1 r --,I OCCUR 1 : CLAIMS MADE ; EACH OCCURRENCE i $ ". AGGREGATE I 5 ; i S -.; OEOUCTIRLE i s r i1 EN1I, iWORKERS COMPENSATION AND 1 EMPLOYERS! UABILITY ; NHFL0071612017 6/22/17 A , I 6/22/18 WC STATU- 1 10714; : TORY LIMITS: ; ER ' — 1 E.L EACH ACCIDENT i $ 1,000,000. I • 5..1. DISEASE - EA EMPLOYEE $ 1,000,000. , E.L. DISEASE - POLICY Lima s 1,000,000. , ! OTHER ! I 1 ; 1 ! . . , ; DESCRIPTION OF OPERATIONSILOCKRONSIVEHICLES/P.XCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS Contractor license number CFC1429694. _ ..._—. . .—........ CERTIFICATE HOLDER AODMONAL INSURED; INSURER LETTER: Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED eF,Porta THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THP. CERTIRCATE HOLOER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE t40 OBLIGATION OR LIASiLiTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENT Thomas Hirsch, CIC A 2 6) ACOD CORPORA9