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PLC-16-3008BUILDING PERMIT APPLICATION 0BUILDING PLUMBING mECHANICAL 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 ❑ ELECTRIC ❑ ROOFING JOB ADDRESS: City: Folio/Parcel#: RECPTTTED NOV 0 3 2016 BY: Master Permit No. Sub Permit No. CI (c scoy ❑ REVISION EXTENSION ❑RENEWAL 0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS c-tttr i J ca_a/ — `t>O U rPAk Miami Shores County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ►�`�,t A4"1 l SQ-S IIt4_ r&C_Phone#: Address: 1cs1/4 i`. C Z Avg. City: nl (Aim 544 t -Yr -a.) State: 1"-k..-- Zip: 3?1' Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: gto 5- i% City: AA li 1/4 v44 i L SS�TFt2 "p\001\1ot)1/4 .5 /30 • Phone#: - 9 -'7/eV State: Qualifier Name: el 44 ` ' G a SS ETE State Certification or Registration #: e F -C 0 .96 DESIGNER: Architect/Engineer: Address: Value of Work for thislrermit: $ Zip: 33/6 Phone#: 3os— 5-25--5b 7 Certificate of Competency #: Phone#: State: Zip: City: Square/Linear Footage of Work: Type of Work: Q Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descriptign of Wor�C:P�G2� Dodo Specify color of color thru tile: Submittal Fee $ Permit Fee $ dlook Scanning Fee $ ' Radon Fee $ Technology Fee $ ' • (4, O Structural Reviews $ C (Revised02/24/2014) 45-6 • a S DBPR $ • ` -S Notary $ 6° Training/Education Fee $ c �'i� Double Fee $ CCF $ i '2-C) . co/cc $ - CO - Bond $ TOTAL FEE NOW DUE $ 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 OWNER or AGENT Thelforegoing instrumentwas acknowledged before me this Ccefh day of UGAU (/� , 20 To elNb me or who has produced identification and who did take an oath. NOTARY PUBLIC: , who i ersonally know Sign: Print: Seal: (Zak by Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 , by o , who is personally known to as ************* BARBARA A. ESTEP MY COMMISSION # FF 073975 EXPIRES: March 29, 2018 Bonded Thru Notary Public Underwriters APPROVED BY (Revised02/24/2014) me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: **************************************************************** Plans Examiner Zoning Structural Review Clerk ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEr OBTAINED, THE OWNER'S NOTARJZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BAT11 TW UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL IIEATIHG DISHWASTER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY SERVICE SIZE IN AMPS SERVICE REPAIR/METER CHAE A/C (CENTRAL) DUCT WORK REFRIGERATION DRINKING FOUNTAIN 1 FLOOR CAIN GREASE TRAP APPLIANCE OUTLETS FRCCESS APD PRESS PIPING INTERCEPTOR RANGE TCN UIUERGROUtD TANKS LAVATORY OVEN ABOVE MOUND TNIKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER _ MOTORS 0•- 1 IP STEAM BOILERS SHOWER MOTORS OVER 1— 3 FP HOT WATER BOILERS SINK, POT/3 COM'. MOTORS OVER 3— 5 FP MECHANICAL VEM ILATION SINK, RESIDENCE MOTORS OVER 5— 8 IP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 IP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET hUTORS OVER 10•- 25 FP FIRE SPRINKLER SYSTEMS URINAL hUTORS OVER 25-100 FP COOLING TOWERS _ WATER CLOSET MORS OVER 100 IP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER—NEW (NIST. GENERATORS TRANSFORMERS HEATER—REPLACE GENERATORS TRANSFORMERS _ LAWN SPRINKLER—WELL SPECIAL PURPOSE — SWITNING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY—SEWER SIGN TIME CLOCK UTILITY—WATER FORCES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAIUFIELD, 4" TILE/RES. VIOLATION ' 1 FUM' & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISUfARGE WELL 'JCMESTIC WELL ATEA. DRAIN 100E INLET I ;OLN1 WATER HEATER IRE STANDPIPE POOL PIPING . AWN SPRINKLER SYSTEM AS RNdvE ETER SET (GAS) AS PIPING RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 LASSETER, JOHN MARK LASSETER PLUMBING COMPANY 13925 NE 1ST AVE . MIAMI FL 33161 ISSUED: 07/04/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607040001563 0954 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 922097 BUSINESS NAME/LOCATION LASSETER PLUMBING CO INC 865NE130ST NORTH MIAMI FL 33161 OWNER LASSETER PLUMBING CO INC Worker(s) 7 RECEIPT NO. RENEWAL 922097 LBT J EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC041696 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/26/2016 CHECK21-16-100929 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commerciai «chicles — Miami—Dade Code Sec 8a-276. For more information, visit www.miamidade.govltaxcollector 6� • '`�` RD® CERTIFICATE OF LIABILITY INSURANCE DATE TEQAioD 016 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 CERTIRCATE 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 Mack, Mack & Waltz Insurance Group, Inc. 1211 S Military Trail - Suite 100 Deerfield Beach FL 33442 CONTACT Gina Saivat NAME PHO(AicNE Ext): (954) 640-6225 FAX Nos: (954) 640-6226 ADDRESS: gsalvat@ma-ki-surance . COm INSURERIS) AFFORDING COVERAGE NAIC # INSURER A :Ohio Security Ins. Co. 24082 INSURED Lasseter Plumbing Company, Inc 865 N.E. 130 Street North Miami FL 33161 INSURER B Bridgefield Employers Ins . Co. 10701 INSURER c Berkley National Ins. Co 38911 INSURER D: 1 INSURERE: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER F: COVERAGES CERTIFICATE NUMBER:CL1682935156 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. ILTRR TYPE OF INSURANCE INSD SWIM POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP IMMlDDIYYYY) UMITS A X 1 COMMERCIAL GENERAL UABILITY �� BLS 56272467 9/1/2016 9/1/2017 EACH OCCURRENCE S 1,000 , 000 1 j(X OCCUR CLAIMS -MADE I � DAMAGE TO RENTED PREMISES (Ea occurrence) S 100,000 MED EXP (Any one person) 5 EZt2LUDED PERSONAL &ADV INJURY S 1,000,000 GEN_ X AGGREGATE�--SLIMIT APPLIES PoucY ( 1 PRC)- JECT i OTHER: PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 5 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS (,, SCHEDULED AUTOS NON -OWNED AUTOS BAS 56272467 9/1/2016 9/1/2017 (CEO BINE�DtSINGLE UMIT accid $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident ) S PROPERTY DAMAGE (Per accident) 5 Uninsured motorist combined S 1,000,000 UMBRELLA UAB EXCESS LJAB OCCUR CLAIMS -MADE EACH OCCURRENCE 5 AGGREGATE 5 DED I I RETENTION 5 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory In OFFICER/MEMBER EXCLUDED? NH) If yes. describe udder DESCRIPTION OF OPERATIONS below Y!N NIA 83021471 ' q / 5/25/2016 ; 5/25/2017 ER I PERR OTTUTE I S EL EACH ACCIDENT 5 500,000 E.LDISEASE -EAEMPLOYE ES 500,000 EL DISEASE - POLICY UMIT 5 500 , 000 C Equipment Floater MI121002286 . 9/1/2016 9/1/2017 Scheduled Equip. Limit 5,430 Unscheduled Equip Limit 25,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) v v CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Greg Waltz/GSALVA ACORD 25 (2014101) 1NS02519n14n11 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11/1/2016- 410 SM & SM SS W/ Optional Pet Fountain - Most Dependable Fountains • • • • •• • • • • • • • • • • ••• • • • •••• • • • • • • • • • •• • •• •• •• • • • • • • ••• •••• ••• • • • •••• ••• • •••• • • •••• • • • • • • Related Photos: 410 SM & SMSS w/ optional pet fountain Outdoor pet drinking fountains/ Pet Fountains associations or anywhere there is a thirsty pet. are designed for parks, pet parks, pet clinics, homeowners and Made in the U.S.A. <s. Downloads: PDF Drawing, AutoCad DWG, AutoCad DWF Specifications Operation Manual/ Submittal Description: • Push button requires less than 5lbs ofpressure to operate. • Vacuum breaker included for pet fountain. • Available in one piece welded construction with standard 3/16" wall or standard 304 schedule 10 stainless steel • Solid engineering and intuitive design. • Maintenance friendly and built "tank tough". • Optional.l0" stainless steel surface carrier is recommended for easier installation. • Simple winterization if applicable. • Supply connection stops above grade behind the access door. • All products including 'SS' are powder coated for extra protection. • Weight: 145 lbs. http://wwni.mostdependable.com/products/pet-fountains/410-sm--smss-w-optional-pet fountain/ 6/16 MOST DEPENDABLE FOUNTAINS, INC. •. • • • • • ..•• • . 1 • .• . • • •• 3354-1.32 • • •. •• • • • • • •••• • • • • • • • tn • N • •• p • +_ • •• •••. •• • 0 • •••• • • •••• • CONTROL VALVE FOR PET FOUNTAIN 18" • •• • • • • • 8 1/2" o o ACCESS DOOR O 0 •• 4 -STAINLESS STEEL 1/4-20 SS TORX BOLT W/ PIN OPTIONAL INTERNAL SURFACE CARRIER MOST DEPENDABLE FOUNTAINS, INC. 5705 COMMANDER DR. P.O. BOX 587 ARLINGTON, TN 38002-0587 TOLL FREE: 1-800-552-6331 PHONE: (901) 867-0039 FAX: (901) 867-0159 www.mostdependable.com 3/8" NYLON REINFORCED NYLONBRAID TUBING W/ 1/2" MIP (WATER SUPPLY) 1 1/2" PVC PET FOUNTAIN 1/2" X 12" ZINC PLATED ROD TOP VIEW 2", 3", 4" OPEN HUB DRAIN, IF POSSIBLE, OR RIGID CONNECTION WATER 2", 3" OR 4" OPEN HUB DRAIN PET FOUNTAIN NOTES: 1. MEETS ADA REGULATIONS. 2. OPTIONAL STAINLESS STEEL SURFACE CARRIER RECOMMENDED. 3. SHOWN WITH OPTIONAL 10 SS SURFACE CARRIER, ATTACHED PET FOUNTAIN. 4. INSTALLATION TO BE COMPLETED IN ACCORDANCE WITH MANUFACTURER'S SPECIFICATIONS. 5. DO NOT SCALE DRAWING. 6. THIS DRAWING IS INTENDED FOR USE BY ARCHITECTS, ENGINEERS, CONTRACTORS, CONSULTANTS AND DESIGN PROFESSIONALS FOR PLANNING PURPOSES ONLY. THIS DRAWING MAY NOT BE USED FOR CONSTRUCTION. 7. ALL INFORMATION CONTAINED HEREIN WAS CURRENT AT THE TIME OF DEVELOPMENT BUT MUST BE REVIEWED AND APPROVED BY THE PRODUCT MANUFACTURER TO BE CONSIDERED ACCURATE. 8. CONTRACTOR'S NOTE: FOR PRODUCT AND COMPANY INFORMATION VISIT www.CADdetails.comfinfoAND ENTER REFERENCE NUMBER 3354-1.32. 0 SHOWN W/ OPTIONAL SS SURFACE CARRIER,PF MODEL 410 SM REVISION DATE 07/20/2016 PROTECTED BY COPYRIGHT ©2016 CADDETAILS.COM LTD. CADdetails.com Dol pA(R yvt_s a . i I • • • • •• •• • • • > •• p p mw-O4,rLef ©- ... •••• { .••••. ,BAG e'Lc W •_ • • .• vz w/e.„ • •• •• . • • • . • / .930. `Z pe � i PC Vlb %P- 31 'teUe 11/1/2016 410 SM & SM SS W/ Optional Pet Fountain - Most Dependable Fountains • •• • • • • • •••• • • • •• • • • • • • •• • • • • • • •• • • • •••• •• •• •• • • • • • • • •••• •••• •••• • • • •••• ••• • •••• • •••• • • • • • • • • • • 9 C s‘ci.- J ` r Related Photos: 410 SM & SMSS w/ optional pet fountain 1kj‘,CCIv Outdoor pet drinking fountains/ Pet Fountains are designed for parks, pet parks,, pet61mic5, ho" e owners and associations or anywhere there is a thirsty pet. Made in the U.S.A. Downloads: PDF Drawing, AutoCad DWG. AutoCad DWF Specifications Operation Manual/ Submittal Description: • Push button requires less than 5113s ofpressure to operate. • Vacuum breaker included for pet fountain. • Available in one piece welded construction with standard 3/16" wall or standard 304 schedule 10 stainless steeL • Solid engineering and intuitive design. • Maintenance friendly and built "tank tough". • Optional 10" stainless steel surface carrier is recommended for easier installation. • Simple winterization if applicable. • Supply connection stops above grade behind the access door. • All products including 'SS' are powder coated for extra protection. • Weight: 145 lbs. http://www.mostdependable.cordproducts/pet-fountains/410-snr-smss-w-optional-pet-fountain/ 6/16 1 MOST DEPENDABLE FOUNTAINS, INC. • .• •• • • •.•• • • • •• • • .• 3354-1.32 • • •• •. • • • • .•.• • •••• • �, • • • • • .••. ••.. • •• • . • • • 81 /2" CONTROL VALVE FOR PET FOUNTAIN 18" O 0 ACCESS DOOR O 0 4 -STAINLESS STEEL 1/4-20 SS TORX BOLT W/ PIN OPTIONAL INTERNAL SURFACE CARRIER ti 4. r MOST DEPENDABLE FOUNTAINS, INC. 5705 COMMANDER DR. P.O. BOX 587 ARLINGTON, TN 38002-0587 TOLL FREE: 1-800-552-6331 PHONE: (901) 867-0039 FAX: (901) 867-0159 www.mostdependable.com 3/8" NYLON REINFORCED NYLONBRAID TUBING W/ 1/2" MIP (WATER SUPPLY) 1 1/2" PVC PET FOUNTAIN 1/2"X12"ZINC PLATED ROD TOP VIEW NOTES: 1. MEETS ADA REGULATIONS. 2. OPTIONAL STAINLESS STEEL SURFACE CARRIER RECOMMENDED. 3. SHOWN WITH OPTIONAL 10 SS SURFACE CARRIER, ATTACHED PET FOUNTAIN. 4. INSTALLATION TO BE COMPLETED IN ACCORDANCE WITH MANUFACTURERS SPECIFICATIONS. 5. DO NOT SCALE DRAWING. 6. THIS DRAWING IS INTENDED FOR USE BY ARCHITECTS, ENGINEERS, CONTRACTORS, CONSULTANTS AND DESIGN PROFESSIONALS FOR PLANNING PURPOSES ONLY. THIS DRAWING MAY NOT BE USED FOR CONSTRUCTION. 7. ALL INFORMATION CONTAINED HEREIN WAS CURRENT AT THE TIME OF DEVELOPMENT BUT MUST BE REVIEWED AND APPROVED BY THE PRODUCT MANUFACTURER TO BE CONSIDERED ACCURATE. 8. CONTRACTORS NOTE: FOR PRODUCT AND COMPANY INFORMATION VISITwww.CADdetails.com/infoAND ENTER REFERENCE NUMBER 3354-1.32. 2", 3', 4" OPEN HUB DRAIN, IF POSSIBLE, OR RIGID CONNECTION WATER 2", 3° OR 4" OPEN HUB DRAIN PET FOUNTAIN MODEL 410 SM SHOWN WI OPTIONAL SS SURFACE CARRIER,PF6111 REVISION DATE 07/20/2016 PROTECTED BY COPYRIGHT ©2016 CADDETAILS.COM LTD. CADdetails.com taGO • it 1 1 ft IA 01° •• ••• .�• �• `�`� oil • • • ••• • 1 •• • •• •• • • • • •• • • • • • • •• • • • • • • •::+ti • • • • • • • • •• • • •• • • • • •• • ••• • • i • •• f• • • • • ••• • ••• • • • •• • • • • •• • , . . ,.D1 pAtg Mspo \ _.4„....t,t • • • • • • • •• • • l I '•' • k4 :....: I 1 • •ilic� j• .. • cLD � •••••• 1kp t 10 z C.4Ve I • • • o p mxu -oare o� ' 11. I •11.... •....• ,BOGY 'Lo w •••••. • ••• •••• i • '2l/iV • ii• .•• •• • • . 4,5- 14 Peg i 1 0- a4 7 bi 61 wec .-o-0 5 ecFle