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PL-17-1372 > 3 72 k - 3 �t PtetkJl ..•� � '-'� `yrt°gym y,� Miami Shores Village M Pelrrtlt Type, pesei1t )° P' 10050 N.E.2nd Avenue NE Ci# ' SICe #CfTilt�f� [lAt ��►M' Miami Shores,FL 33138-0000 yv y �+}� by o tJl's�., C f tiPVE R Phone: (305)795-2204 z p� Ex Iration:.11i1017 Issue tate:SCI1 . .:' Project Address Parcel Number Applicant 12 NE 101 Street 1132060131380 Miami Shores, FL Block: Lot: DAVID AND JANICE SNOW Owner Information Address Phone Cell DAVID AND JANICE SNOW 12 NE 101 Street MIAMI SHORES FL 33138- 12 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 BROWN PLUMBING LLC (305)764-1731 M... Total Sq Feet: 0 Type of Work:RE-ROUTE SANITARY LINE TO NEW SEPTI Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-5-17-64070 DBPR Fee $2'25 05/19/2017 Check#: 1117 $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 05/30/2017 Check#: 1118 $ 116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 ELECTRI L,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS c ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con ctio nd zo $. u erm uthorize the above-named contractor to do the work stated. May 30,2017 A d Signature: wner / Applicant / Contractor / Agent Date Building Department Copy May 30,2017 1 inn ��1� �1 OR Miami Ohores Village �o�� Building Department �'-pp�> 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice t0 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. Pursuarrt to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or fa11-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. f1. 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 ce coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BEL YOU ACKNOWLEDGE THAT YOU READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Si ner State of Florida County of Miami-Dade The egoing was acknowledge before me this day of ,20_JJ. BySW who is personall own to me or has produced s �_©� ✓�(�. t�o? [�/3 as identification. n�e,4�c ..... �i ITALOIMPRIME SEAL: ''1 MY COMMISSION#FF123264 y '':� ',�o� �P.• EXPIRES May 14,2018 (407)398-0153 F10ddaNgtaryS,,I,,.,M Brown Plumbing LLC Office@BrownPlumbingMiami.com Date: State of � County of Before me this day personally appeared 'U � Aflw, who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: FL- Contractor signature Sworn (or affirmed and subscribed before me this day of,r 2017 by Personally know Or produced Identification �Sp 7k , 7 9 q� Type of Identification Produced Z> C2175(f,. , . ,��e:••• •�, iTALO IMPRIME ' Notary signature and stamp � MY COMMISSION#FF123284 EXPIRES May 14,2018 mow.,... 47)398-0153 FlaidnNoteryService.com Miami Shores VillageCEMP rD Building Department � 19, 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 13Y. Tel:(305)795-2204 Fax:(305)756-8972 ? o INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 4 _ BUILDING Master Permit No. ? L PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E:]RENEWAL rN_jPLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12 NE 101 ST City: Miami Shores County: Miami Dade zip: �ollo/Parcel#i I�- _3'20(o' ()13 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):David Snow Phone#: Z12 y� Address:12 NE 101 ST City. Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#:6233305438 A � Email• I L t '' 0&, 1 orn I g CONTRACTOR:Company Name: Brown Plumbing Phone#: 3057641731 Address: 2007 Opa Locka Blvd City. Opa Locka State: FL Zip: 33054 Qualifier Name: Robert Brown Phone#• 3057641731 State Certification or Registration#: CFC 1427691 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$1500 Square/Linear Footage of Work: Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Re route sanitary line to new septic tank Specify color of color thru tile: Submittal Fee$ , OD Permit Fee$ 1570 CCF$ e CO/CC$ Scanning Fee$ 6 (5-3 Radon Fee$ a. �)-G DBPR$ Notary$ Technology Fee$ t • Ci O Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) I 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 Zp 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 Signature V�& 51,CW OWNER or AGENT 4 ( &a,,,/q7CONTRACT0R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 149C .by 17 day of 20 ZZ by <�,,®a J ,who is pe�ally known to T IO�r 13j!2 ,who is persona ly known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:-19 Print: Print: `...PY PU .... Seal: A VAI RAYM®FiE Seal: o ` MY COMMISSION#FF020273 e` '- MALTY RAYMORE EXPIRES June 19.2017 PJY COi�MHSSION =FF020273 -�� EXPIRES June 19,2017 o i ota Service.com ***��**��***� �(Adiv>R89fi+i(Dh9tD►>k�k4�t�I4tR �L�!$$i47�"�"�"� '�`+R+R>R>Rtl��k�►>k>B�k>w!r* APPROVED BY J Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) MWIM lot, 712 �Vv4t 4V1()1 P 0:9:9 PIC6- ...... �p A L • ' i...is •i•.•• Auk f cn yot, %�O/k 7.M � G.. t W t Lj- z o I < c Y 2017 PLITA�BING g3Y• Approved �- Disapproved date