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ELC-14-941 (2)Miami Shores Village Building Department�urv� 20,E 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 9401 Biscayne -Blvd. FBC 20 l-0 Permit No. ELC-5-14-941 Master Permit No. Pl--" —11 6-S City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcelt 11-3206-049-0010 Is the Budding Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Archdiocese of Miami phone#: 305-762-1032 Address: 9401 Biscayne Blvd. City. Miami Shores Ste. FI. Zip. 33138 TenandUssee Name: N/A Email: CONTRACTOR: Company Name: Metropolitan Plumbing, Inc Phone#: 305-888-2720 Address: 1020 E 14th St City: Hialeah State: FI. Zip: 33010 Qualifier Name: Miguel Guiardinu Phone#: 305-888-2720 State Certification or Registration #: GFC 057152 Certificate of Competency #: Contact Phone#: 305-888-2720 Email Address: miguel@305metroplumbing.com DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 2800.00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of work. Relocate existing Generator Submittal Fee $ Permit Fee $ 1564 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) N/A Bonding Company's Address City State 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 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. "WARMING 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 Signatureems. Owner or Agent ctor The foregoing instrument was acknowledged before me this day of, 20, ba who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: The foregoing ins ment was acknowledged before e�me fuse day of ,20LL(,by M)QJel�su ord,11 who i personallyknown me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Si rn ,o Si l� v V esson-Pu�ueuo t: �S!1_0,ri 0- 4v My ommission Expires: Zg� / IOTAa( Rd LSC STATE Of FLORIDA My Commie}on ExPOS p�reg: Oo�n�rasEitO -095939 A�oFpPYPp�.COMMrSSiON�#EE117934 Expires 5/26/2015 °�aQpi? EXPIRES: AUG. 01, 2015 oil %A APPROVED BY G s� Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, has made, constituted and appointed, and by these presents does hereby make, constitute and appoint Sister Elizabeth A. Worley, C.O.O., his hue and -lawful attorney for him and in his name, place; and stead. Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all intents and purposes, as he might or could do if personally present; with full power of substitution and revocation, hereby ratifying and confirming all that Sister Elizabeth A. Worley, C.O.O., his said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. In Witness Whereof, I have hereunto set my hand and seal this 15 day of August, A.D., 2013. Signed, sealed and delivered in the presence of - s: s: W ess Signature a -+ lkzn C anv Printed Name —/- "�4' �Z" Witness Signature Printid Name STATE OF FLORIDA SS: COUNTY OF DADE The Most Reverend Thomas Wenski As Archbishop of the Archdiocese of Miami his successors in office, a corporation sole I hereby certify that on this day, before me, an officer duly authorized to administer oaths and take acknowledgements, personally appeared The Most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, known to me to be the person described in and who executed the forgoing instrument, who acknowledged before me that he executed the forgoing instrument, who acknowledged before me that he executed the same, and an oath was not taken. Said person is personally known to me Said person provided the following type of identification: Witness my hand and official seal in the County and Staa last aforesaid this A.D., 2013. y My Commission Expires: 41 MAYRR NEUUNA SS WoWy Pubk SWO of ROWS commission #FEEO= ,u o� alv Cnmailasion txates dart. � Z015 15 day of August, AC#6454072 STATE .OF FLORIDA �$ c� City of :Hialeah .M low 4 Business Tax Recei t 2011311IP Mayor Carlos Hernandez No: 238220-121 (OLD -1711-981) Amount: $ 150.00 The person. firm or corp. listed here has paid the business tax required to eng4e in or operate the business specified subject to the regulations and restrictions of the City of Hialeah, Florida Owner: MlCs1TEL:LIIATtD1NA - METROPOLITAN PLUMBING INC. Type egf'lit siness: Plumbing, Heating, and Aar -Conditioning Contractors METR04 OP ID: KH '4li% R* CERTIFICATE OF LIABILITY INSURANCE DA 06/07/201 I� 05/07/2014 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 [Sure Insurance Brokers 8700 W. Fla9ler St, Suite 270 Miami, FL Fernandez Javier A. Ferandez CONTACT NAME: Javier A. Fernandez acco"N EI: 305-223-2533 No : 305-220-0765 E-MAIL ESS: Javier@iSureBrokers.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Ins. 41297 INSURED Metropolitan Plumbing,lnc. Miguel Guiardinu 1020 E 14 St Hialeah, FL 33010 INSURER B : Wesco Insurance Comp INSURER C: INSURERD: 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. INSR LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMMD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 10050 NE 2 Ave. Miami Shores, FL 33185 CPS1929180 03/31/2014 03/31/2015 EACH OCCURRENCE $ 2,000,000 PREMISESEaoocurrence $ 5000 MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Ee eBBIINEDdSINGLE LIMIT $ BODILYINJURY(Per person) $ BODILY INJURY(Peraccident) $ PROPERTY DAMAGE $ PER ACCIDE A X UMBRELLA LIARX EXCESS LIAR OCCUR CLAIMS -MADE XBS0038269 03/31/2014 03/31/2015 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I I RETENTION$ $ B WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECU71VEYI" OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WWC3066956 08/02/2013 08/02/2014 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) plumbing residential & commercial. CERTIFICATE HOLDER CANCELLATION MIAMI S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2 Ave. Miami Shores, FL 33185 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD July 7, 2014 Miami Shore Village Building Department 10050 NE 2nd Ave Miami Shores, Fl. 33138 To Whom It May Concern: This is to certify that Metropolitan Plumbing, Inc. has performed a drop test at the following site and tested the appliance connection. The gas line has been checked to the standards of the 2010 Florida Building Code and properly tested to meet the standards of NFPA 54. The work was performed at 9401 Biscayne Blvd. Miami Shores, FL. 33138 Test Pressure: 4.0 Lock up pressure: 7.2 Operating Pressure: 7.0 Test Time: 10 minutes State License #: CFC 057152 If you should have any questions regarding this matter please do not hesitate to call us. Sincerely f Mig I GuRrd u President 1020 Cast 14d` Street, Hialeah, Florida 33010 Telephone: (305) 888-2720, Fax: (305) 8882758