PL-17-119 Permit NO. PL-1-17-119
`SgoRes Miami Shores Village Permit Type: Plumbing-Residential
n�M 10050 N.E.2nd Avenue NEPerill ' Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 Permit Status:APPROVED
O
% ee �` Phone: (305)795-2204
Qy Ms
Issue Date: 1123/2017 Expiration: 07/22/2017
Project Address Parcel Number Applicant
68 NE 91 Street 1131010200020
Miami Shores, FL 33138- Block: Lot: ROBERT IRWIN FLOYD GONZAL
Owner Information Address Phone Cell
ROBERT IRWIN FLOYD GONZALES 68 NE 91 Street (305)492-9763
MIAMI SHORES FL 33138-2808
68 NE 91 Street
MIAMI SHORES FL 33138-2808
Contractor(s) Phone Cell Phone
Valuation: $ 4,625.00
QUINTERO GENERAL CONSTRUCTIO (786)487-5738 Total Sq Feet: 0
Type of Work:REMOVE AND REPLACE EXISTING BATHROO Available Inspections:
Type of Piping: Inspection Type:
Additional Info:REMOVE AND REPLACE EXISTING BATHROO Top Out
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
Invoice# PL-1-17-62631
DBPR Fee $3.38
DCA Fee $3.38 01/17!2017 Check#:404 $50.00 $203.76
Education Surcharge $1.00 01/23/2017 Check#:401 $203.76 $0.00
Notary Fee $5.00
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $253.76
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 assn r ponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL LU NG,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certi h t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni . F t re,I authorize the above-named contractor to do the work stated.
January 23, 2017
Authorized kigny11: ner / Applicant / Contractor / Agent Date
Building De rtment Copy
January 23, 2017 1
Miami Shores Village
Building Department �� �
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 `
V q� Tel:(305)795-2204 Fax:(305)756-8972
• INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20( t
BUILDING Master Permit No. " 9— 16— 2,940
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING Ej REVISION M EXTENSION MRENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKSA9 CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 6 B /V 6 9 / f7-4.9-, 7`
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: q
OWNER: Name(Fee Simple Titleholder):_ �� �2� �S PhoneA: ���� 2— 1_?( �
Address: 66 k) E_ 5t r?--ez—� T
City: kl/4-A,( ( ` State: 7'� Zip: _33 /-•3R
Tenant/Lessee Name: Phone#:
Email: / d � /�
CONTRACTOR:Company Name: & J2t / Phone#:
Address: g/90 A-) k)
City: 61r,, State: �G— Zip: 33DIO
Qualifier Name:l�in�,,�R lj L!n Phone#`. '
Z40
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 445 Square/Linear Footage of Work
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition ,
Description of Work: CE�C' b r� r✓��
AW,ji.•ti . ......
i�iUSi tU 9'L.Z i L '
Specify r0 f, for tbru tile. ''. K•_
Submittal Per�mAil e CCF CO/CC Of;"�.3►
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �
(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..... r-
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 Signature 622Z2���
OWNER or AGENT CONTRACTOR
The foregoing instrumentwas acknowledged befor/e1 me this The foregoing instrument was acknowledged before me this
-�--� 3 day of /fes 20 / by 3 day of 20 7 , by
b'+'1 Z-0. (C who is personally known to hwil�-044 �n e Z ,who is personally known to
me or who has produced t-- as me or who has produced `' as
identif=ication and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign.
Print: CJ �"I Print: D
Seal: ��''• MICHELLE MOLINA
'•s MICHELLE MOLINA Seal: w -
otary Public-State of Fib W i�uiary Public-State of FWW
r . `t � My Comm. Expires Sep 19,2011.
My Comm.Expires Sep 19,2011
Commission#F FF 055738 Commission#r FF 055738
APPROVED BY �'f D ! Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
FEB 0 g 2017
,StpOREs Gr BY:
Miami shores Village
Inge j our
Building Department
�ArOR10 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. P�-'• �' – 114
Owner's Name (Fee Simpip Title Holder): �a �flYJ2�(, S Phone#:
OwneRAW',
' Address: Ali 4+re,
City: State CL Zip Code: –33/39
Job Address (Of where work is being done): r/)g /
City: Miami Shores State:—Florida Zip Code:
Contractor's Company Name: u�6kk Q m
G" l ZO�-W - j!lQe Phone#:
,U
Address: N Z
City: Q gh S State: Zip Code: 3-
Qualifier's Name : 60MV00 OMWO Lic. Number: j'J�G IQ3t O 3
_Architect/ Engineer of Record Name: Phone#:
Address:
City: State: Zip Code:
Describe Work: �04100royi JS
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Miami Shores harmless of all legal involve nt.
Signature Signature
Owner or Agent Contractor or Architect
The foregoing instrument was aknowlledged before me The foregoing instrument was aknowledged before me
this 3 day of 1 !,b 2014',by F104d 6MZdLe4 this �3 _day of > 20(�y AArdo ��Im elD
Who is personally known to me or who has produced who i personall kno n to me or who has produced
�l as indentification. as indentification.
Nota li
Nota*i .``R�P�
°e��s MICHELLE MOLINA
ay P MICHELLE MOLINA _ + z Notary Public-State of Florida
Sign: Sign: 017
State of Florida ., o�c
Seal: N ePr My Comm.Expires Sep 19,2017 Seal: �''''.;FCF F�°"'� Commission#FF 055738
Commission#FF 055738
I
Miami Shores Village "P1C_F1.jVED
Building Department JAN 17 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 -, ,,
Tel:(305)795-2204 Fax:(305)756-8972 } " '-
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 1H
BUILDING Master Permit No. 'RC 1 (a "Zq4-0
PERMIT APPLICATION Sub Permit No. 191 l'=� -- 1 1C-1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
'PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
f/� _r ( �+1 CONTRACTOR DRAWINGS
JOB ADDRESS:__((/��1� � `Jf' 5+_
City: Miami Shores County: Miami Dade Zip: 3:313
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: C /
OWNER: Name(Fee Si le Titleholder):_ �CT6p t-A A(-e 5 Phone#:
Address: O I f q(Sf S"1l-
City: S140r es State: Zip: 3313?
Tenant/Lessee Name: 0/14 Phone#: 5r) q92--0j63
Email: CD-Y"
CONTRACTOR:Company Name: &Z; ci�'�✓Q �^j� /�' Phone#:
Address: sgd I Aj A) aa- 7eA,L,
City: 6ZAZ4 State: G( Zip:-�o to
Qualifier Name: �Q/Las��[�(� i J Phone#:
State Certification or Registration#: (ter LI�2 Y7-?3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: //-- City: State: Zip:
Value of Work for this Permit:$ 14 &2,5' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 146( e fS f(t retpyo -es
CiWA chaNt oo1- ColAdti b n(_
INI H ��.sf�ll
Specify color of color thru tile:
Submittal Fee;$ Permit Fee$ �Z,�i CCF$ 2A CO/CC$
•�'� Scanning Fee$ 4T Radon Fee$ DBPR$ 3V Notary$
Technology Fee$ L4 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
I ' TOTAL FEE NOW DUE$ �-
(Revised02/24/2014)
k
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.
VSignature Signature
OWNER or T CONTRACTOR
The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this
N_ day of 1 CV p c .20 ��lJ ,by Ah, day of Jriom 20 by
�Swho is personally known to /r1 o is personally known to
me or who has produced-elm� da `y C Iymo) as me or who has produced D.�' ' as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: �✓ Sign:
Print: -�ah�I (` 1 e� Print: �VK `� •� A. ary Public State of Florida
tiiy ;,qn:m =xri,,-s S,—9. ?t117
Seal: Seal:
K;r ,• MAHAM K GONZALEZ or ci���`` i3OITIM`.SIUI' c. '5"j5
� �'rrnnn
W VP
MY COMMISSION#GG 044602
EXPIRES:November 2,2020
P.
J W 0 0 X Mvh V,V Mt#3. *###*################**####################################
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
`5gOR Gi
.,,,,t" Miami shores Village
Building Department
ORIDP' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this�_day of JG\yl , 120
T 1
By 13�,I o' CJ�1 c pl y who is personally known to me or has produced
L • as identification.
Notary:
SEAL:
MICHELLE MOLINA
'�� •°= notary Public-State of Florida
Commission#FF 055738
Quintero General Contractors
CFC# 1428973
January 11,2017
State of Florida
County of Miami-Dade
Before me this day personally appeared Bernardo Quintero who,being duly sworn, deposes and says:
That he or she will be the only person working on the project located at: 68 NE 91 Street,Miami
Shores, FL 33138.
Sworn to(or affirmed)and subscribed before me this I Vh day of January,2017, by Bernardo Qintero.
Personally known
OR Produced Identification
Type of Identification Produced
vr_�
Print, Type, or Stamp Name of Notary
MICHELLE MOLINA
+ -
rotary Public-State of Florida
k My Comm.Expires Sep 19,2017'
.,,,occd;.• Commission N FF 055738
f,
Y u
t�
8801 NW 112 Terrace. Miami Shores_FL 33018
786-487-5738