PL-16-1222 Permit NC). PL-5-16-1222
Miami Shores Village ot Permit Type:Plumbing-Residential
�T10050 N.E.2nd Avenue NE ri I
Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
FCORI'Op'
Issue Date:8/2/2016 Expiration: 01129/2017
Project Address Parcel Number Applicant
9915 NE 4 Avenue Road 1132060171300
Miami Shores, FL Block: Lot: ESTEBAN GIUGOVAZ TRS FRAP
Owner Information Address Phone Cell
ESTEBAN GIUGOVAZ TRS FRANCESCA 9915 NE 4 Avenue Road
- - -- --- MIAMI SHORES FL 33138-
9915 NE 4 Avenue Road
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,800.00
AA MASTERS MECHANICAL AIR MOV (305)244-0667
Total Sq Feet: 860
Type of Work:INSTALL NEW DRAIN PIPES FOR NEW BAT Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
DBPR Fee Invoice# PL-5-16-59662
$3.38 05/05/2016 Credit Card $50.00 $ 191.16
DCA Fee $3.38
Education Surcharge $0.80 08/02/2016 Credit Card $ 191.16 $0.00
Permit Fee
$225.00
Scanning'
IFee $3.00
Technology Fee $3.20
_a
Total:' $241.16
, y
In consideration of t e issuanc to a of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto an in strict c r ity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit assume p risibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required'for ELECTRIC L,PLUM IN ,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: ce 11 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z nin uthe I au rize the above-named contractor to do the work stated.
August 02, 2016
Authorized re`Ow er / Applicant / Contractor / Agent Date
Building Dep rtment Copy
August 02, 2016 1
Miami Shores Village
Building Department MAY 0 &2at�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: (12
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 A-11
FBC 20 Iq
BUILDING Master Permit No. G l( ) J 3-7s
PERMIT APPLICATION Sub Permit No. pL.� Iro --1222,
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-1 RENEWAL
(PLUMBING ❑ MECHANICAL F-]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
'r CONTRACTOR DRAWINGS
s
JOB ADDRESS: 139' !`�S �'� AtAl (U
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: ,.
,PPO (n C N v Cr 1 Rw SC
OWNER:Name(Fee Simple
'/�
Tiltleholder):ESTEgAU GU( E
royfl� if Figw-aCSLA Qi t-3 Phone#:
Address: 9� A 41► UP— U
City: 6&W State: Zip:
Tenant/Lessee Name: Phone#: e
Email: R Iq
CONTRACTOR:Company Name: •i1SAS �1�- -��l Phone#c
Address: II'S 9 SAXIIJ-or k' -
City: State: Zip:
Qualifier Name: �'eI X D S•ec-as 6 Lcy r-nA-- Phone#: '105--z4 j— 0(4 }
State Certification or Registration#:C t C I y2&( f0"l Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:'$ 312W Square/Linear Footage of Work:
Type of Work: ❑ Addition
� ❑ Alteration n❑nNew r ❑ Repair/Replace ,, /❑./Deem'olition
Description of Work: (AM�II AJr X i r� ;;YL u2VJ � BSM Noll 6AM LXfvr
F46) '*-C� eQla & b WnT- wnPA melI I All S-AmAle)� -1W n1a.,,1 ` ch P,004.,
Rg(.,wr. �1 w /Wa I L ifmr wrA p'x m cA Lo 0) Ran, (lam eo n'�---
Specify color of color�rtr�h�ru tile:
Submittal Fee$ v�1 Permit Fee$ CCF$ a- G CO/CC$
Scanning Fee$ 2> Radon Fee$ '3l� DBPR$ Notary$
Technology Fee$ 3 ' Training/Education Fee$ C) ' Double Fee$
Structural Reviews$ Bond$ f
TOTAL FEE NOW DUE$ Irl ! o
(Revisedo2/24/2014)
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.....
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-attach ment:-Also,-a-certified copy-of the-recordedwotice-of commencemerrt-mpst-bZrp-o3terd 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 nd a reinspection fee will be charged.
Signature Signatur
E o
OWNr AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The for ing i str ent was acknowledged before me this
day of 'G-L .20 by day OL .20 by
` Q--4Aa"X,-- xv &1C�0who iss y k,own to Tmazlc �elt'b who is personally nown
me or who has produced as me or who has produced as
identificati an;-u40 r_E(OBE NUNEZ identification n . " id
o � ifiir�hts°��
•��...� .-ftfNAaOf9CIBE NUNEZ
NOTARY P SIC' MY COMMISSION#FF166669 NOTARY PUB ka a. MY COMMISSION#FF1666fA,
S October 7,2018 i
'�oFN EX REe,,` EXPIRES October 7,2018
rid ice.com or ti,,..
(4 7'
398-0153 (407)398-0153 Floridallota ervicexorn
Sign: Sign: �2, -�n�..
Print: Y h Print: 1 (V 1 v V
Seal: Seal:
APPROVED BY /�jY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
AA Master Mechanical Air Moving & Engineering Sistems Corp
15591 SW 105 Terrace, Apt 525
Miami F133196
State of Florida
Countyof Miami Dade
Before me, this day, personally appeared Mr. Felix De Jesus Guerra who, being dully
sworn, deposes and says:
Tha he will be the only person working on the project located at 9915 NE 4th ave rd.
Affirmed and subscribed before me thi 3rd day of May, 2016
WASHINGTON 0 SCARANO Personally Known
MY•'OMMISSION*FF
E X
3FIES O 1
Noii�e.o�s3
♦5 It I S
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... .,.,� Miami shores Village
�- -�� Building Department
A�RNp' 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 2LA_ day of 120
By who is personally known to me or has produced
as identification.
Notary:
L
e Notary Public State 01 Fbrida
SEAL: Patricia Faggionato
My Commission FF 85880e
nd� E o es 0311512020