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PL-16-60Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number atk PROVE Expiration: 09/12/2016 Applicant 1208 NE 95 Street Miami Shores, FL 1132060144100 Block: Lot: PEDRO DE MELLO Owner Information Address 1208 NE 95 Street MIAMI SHORES FL 33138- 1208 NE 95 Street MIAMI SHORES FL 33138- Phone CeII Contractor(s) Phone CeII Phone AA MASTERS MECHANICAL AIR MOV (305)559-7004 Valuation: Total Sq Feet: $ 4,900.00 00 Type of Work: NEW MASTER BATHROOM GARAGE CONVERSI Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit ree Scanning lee Technology Fee Total: Amount $3.00 $3.38 $3.38 $1.00 $225.00 $3.00 $4.00 $242.76 Pay Date Pay Type Invoice # PL -1-16-58283 01/11/2016 Check* 570 03/16/2016 Cash Amt Paid Amt Due $ 50.00 $ 192.76 $ 192.76 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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 zoning. Fuh ii. . thorize the above-named contractor to do the work stated. orized Signature: Owner / Applicant / Contractor / Agent Building Department Copy March 16, 2016 Date March 16, 2016 1 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 RECEJ ED JAN 1 1.2016 FBC 201,-34 BUILDING Master Permit No7-C. / ' PERMIT APPLICATION Sub Permit NoP, /" El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q �1 �^ CONTRACTOR DRAWINGS JOB ADDRESS: /t 0 g /YE ✓s * iwa City: Miami Shores County: Miami Dade Zip:/ -3g Folio/Parcel#: //4204, -0//- 1//0 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: CyhfhiA ado) MA OWNER: Name (Fee Simple Titleholder):iidiO Henri 'e Co rtA de Mello Phone#: Address: i'a 0 g NE ' S.'' S' f rt e4, City: MA. `ii•W Dior -A) State: Zip: 33/3 $ Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: r1443Kec M ectaaii 1 L A i a ' D'oqPhon #: Address: I > ©I Std l0 CP TA - City: 14A2t, Cry-- % State:-FtZip: 33 j1 Qualifier Name: Se ti S. 6v'e " State Certification or Registration #: C /42-(0( 61 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: (� Value of Work for this Permit: $ / 0O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ANew ❑ Repair/Replace ❑ Demolition Description of Work: 'vC14.a ly 8 aTiiZI1 (6adra)k cohviah) Phone#: ,1i V 7(# C/330 Specify color of color thru tile: 0 vin•) Submittal Fee $ A70 "® 0 ` Permit Fee $ /I2 - S " CCF $ _ ' CO/CC $ Scanning Fee $ 5°° • I� Radon Fee $ =' 'R DBPR $ 3 ' MNotary $ '-t Technology Fee $ - CO Training/Education Fee $ 1 < Cla, Double Fee $ Structural Reviews $ (Revised02/24/2014) /0 Bond $ TOTAL FEE NOW DUE $ [ ?2 ° �� 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 --- ignature , OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1"►�%� , 20 , , by Ck day of g day of /`/ Aft -4 �"� ,20 t)• ,by `�C Ro I�' pai �0 , who is personally known to � � f-t'�0e'��a ' , who is personally known to me or who has produced "OSLO 4 SL • Q, 92.1 4 ° as me or who has produced as identification and who did take an NOTARY PUBLIC: c identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: Seal: E R 9SSEAU commissIGN tiYT1 i9itaa EXPh E : ************************************************************************************************************ APPROVED BY (Revised02/24/2014) //—/'of Plans Examiner Zoning Structural Review Clerk IVliami Shores Village Building Departmei 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Com ensation 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: • State of Florida County of Miami -Dade `` The foregoing was acknowledge before me this `\. 0 day of YVVATA' , 20 1'& . By Rai 0 OTAii `;Jk eo, ' e f` CietA4A who is personally known to me or has produced bc4ot0 V921'40 Notary: SEAL: as identification. E ROSSEAU 0.4v COMMISSION AFF119005 EXPIPES May 4 2018 ;ta-th rt. ufeivwarr mW win JORGE Floss tRVCOMM$t (N . r EXPIPE y rso•,. (407)2311-0153 FftrghiNimpro,U , Date: 63./D. State of FA) 21-r;" p� 4 Mmes /4ec/4it; Mo1[r Ltyget f� �, s c 122.P J Fn16, nlCcQln/ I 55�� 0S ' TRaA� /41,4 f25 Ma ami 1 33154 County of A P Before me this day personally appeared Se-Svs F &aee2404 says: ve,e_ 14/0-a< ,L;-5 Sworn to (or affirmed) and subscri 3ffsus F/ 1x, who, b ace Ng /s'gf- Mi.kwti ftp 33/3g g duly sworn, deposes and befikp nip this a ' day of MA CA . 20 f 5, by Personally know OR Produced Identification Type of Identificati.n Produced JORGE ROSSEAU MYCOMMISSION FF119045 EXPIRES Maya 2018 SoOJ) y9S U 3 Flarrtterk eySemce com t, Type or Stamp Name of Notary