PL-16-1606 permit N6 6 4 ;1:606
75
O11f��s Miami Shores Village P fmlr�y ���#1-Aesili nt('si�
10050 N.E.2nd Avenue NE
a ff;foitW", Y14
Miami Shores,FL 33138-0000
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POW, tStt! "`A�'P� ED
yF Phone: (305)795-2204
_ Expiration: 17/26/2016
Project Address Parcel Number Applicant
1208 NE 95 Street 1132060144100
PEDRO DE MELLO
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
PEDRO DE MELLO 1208 NE 95 Street (305)753-5504
MIAMI SHORES FL 33138-
1208 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,300.00
AA MASTERS MECHANICAL AIR MOV (305)244-0667 Total Sq Feet: 0
Type of Work:POOL PIPING AND SYSTEMS Available Inspections:
Type of Piping:
Inspection Type:
Additional Info:
Main Drain
Bond Return: Final
Classification:Residential Scanning:1 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# PL-6-16-60133
DBPR Fee $3.38 06/29/2016 Credit Card $ 194.56 $50.00
DCA Fee $3.38
Education Surcharge $0.60 06/09/2016 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $244.56
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and _ ermore,I aut on a above-named contractor to do the work stated.
June 29,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 29,2016 1
Miami Shores VillageTf
J N 00 2016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY'
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 ST4
FBC 2019
BUILDING Master Permit No. AC- IG09;
PERMIT APPLICATION Sub Permit NOB.bC- I.GO ro
❑BUILDING ❑ ELECTRIC ❑ ROOFING F-1 REVISION E] EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /20$ AtE 9S4* X r
City: Miami Shores County: Miami Dade Zip: 33 /3 o
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Q
`eclry Ve "d4, Phone#: Sot` V3 .S'.ro
Address: 0"99 Ale` 9 S"y' r7'
City: t16topu ��tO�e s State: P-L zp: 3 3/3 9
Tenant/Lessee Name: Phone#:
Email: AA , p [r� '
CONTRACTOR:Company Name: A-A-�".1..1d tErs ec,V aAV i CA-�.. k2 oV I wP Phone#: S - c)-4 tA®(2-0 --
Address: 156 , l O <®� rerraCQ 4fure�.�
,,pp
City: i't ►Lkd-{,t State: EL Zip• 33 l
Qualifier Name: i 2Sv [e- Phone#:
#•�
State Certification or Registration l� - ,ertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Vale-of Work far*Qfier 2:3 4 Sq�Wf �..
mil -
y L Ad �Itb Alteration New ( p '_`�3� {a /( ❑ Demolition
T e of Work: L-1`'Rd F
Description of Work a `pe,01-4,1, i vt.
Ns� iia i�,�-�,► poo r S PA.
Specify color of color thru tile:
Submittal Fee$ 90 Permit Fee$ �'zF_� CCF$ D® CO/CC$
Scanning Fee$ 3 ' 00 Radon Fee$ & DBPR$ �" Notary$ -ck1
Technology Fee$ 0L Training/Education Fee$ Q '(�;C) Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I S
vised02/24/2014)
A
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 of 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.
Signat i Signature. '
OWNER or AGENT TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
nn®Ce day of 1,,, 020 1(f ,by 06 'day of J;1_-e' ,20 /4 ,by
��A., 4t qelto .who is personally known to T, 6doer-11 ,who is personally known to
_e or who has produced as me or who has produced as
identification and who did take an oath. identification and who did takgoath. U
ROW-
NOTARY PUBL j=jSOM6RO8800NOTARY PUBLIC: All
lir #"1'ygs
Sign: Sign:
Print: Print:
Seal: Seal:
APPROVED BY de u try e' �' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5 °REs Gi
s� Irl iami shores Village
logo p ""'f" Building Department
10050 N.E.2nd Avenue
�LORNUp' 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.
Signatur
Owner
State of Florida
County of Miami-Dade
The foregoing wa acknowledge before me this 09 day of U� ,20 (k) .
By RO � � wo is personally known to me or has produced
�[
as identification.
Notary: L ooaY P119 Notary Public State of Florida
r Sindia Alvarez
SEAL: My Commission FF 155750
`-OFW Expires 03/03x2018
AA Masters Mechanical Air Moving and Engineering Systems
Date: June 27, 2016
State of Tlo'4d'C'
County of Dade.
Before me this day personally
appeared hell de TfJu4 (v✓tYw� who, being duly sworn,
deposes and says: .e Will co -the Pool F„'j A,,d
fo a of nett) POV 1.
!SLAm b 11'15 Syd fie.--7
That he will be the onlyerson working on the project located at:
1,10 B
At 9.V*; Si
A-OArn; Shore$ K
Sworn to and subscribed before me this;.Iday of< u.nf- .2016,
by Fe.4v 4,e Tcj Lq G of vrrr�
He is personally knowing tome o has rodu D�G 600-2yN�6Z'I�D-�s
identification.
(Notary Seal)
:os.....
CUe►RA E RODRIGUEZ otary Public State f Florida
M commis 'on expires:
Y P
MY COMMISSION#FF138588
EXPIRES July 5.2018
(407)39"153 F1or1k aNatarY3ervlce.com