BPP-16-2400 (3)Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
-?�P ib- ZLCIM
Inspection Number: INSP-271609 Permit Number: PL -11-16-3196
Scheduled Inspection Date: June 12, 2017
Inspector. Hernandez, Rafael
Owner.
Job Address: 1060 NE 105 Street
Miami Shores, FL 33138-2106
Project <NONE>
Contractor: La Casa de las Piscinas Inc
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number 1122320280070
Phone: (305)633-9699
Building Department Comments
POOL PIPING
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee Is paid.
June 09, 2017
For Inspections please call: (305)762.4949
Page 3 of 31
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
3196
Residential
ion: Pool.. private
Status: APPROVED
Expiration: 06/20/2017
Applicant
1060 NE 105 Street
Miami Shores, FL 33138-2106
1122320280070
Block: Lot:
DUPLEX 900 LLC
Owner Information
Address
Phone
CeII
DUPLEX 900 LLC
44 W FLAGLER Street
MIAMI FL 33130-
44 W FLAGLER Street
MIAMI FL 33130-
Contractor(s)
La Casa de las Piscinas Inc
Phone CeII Phone
(305)633-9699 (305)216-3107
Valuation:
Total Sq Feet:
$ 2,500.00
0
Type of Work: POOL PIPING
Type of Piping:
Additional Info: POOL PIPING
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$3.38
$3.38
$0.60
$225.00
$3.00
$2.40
$239.56
Pay Date Pay Type
Invoice # PL -11-16-62153
12/22/2016 Check #: 371
11/22/2016 Check #: 303
Amt Paid Amt Due
$ 189.56 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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 A
construction
IDAVIT: certify t
uth
Autho
t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
re, I authorize the above-named contractor to do the work stated.
December 22, 2016
er / Applicant / Contractor / Agent
Buildin' 'partment Copy
Date
December 22, 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
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
NI 222616
BY. r'
FBC 2014
Master Permit No. tiPQ \b -2,i00
Sub Permit No. t-' L 1(-\V '3\ 96
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRA OR
/C0
JOB ADDRESS:
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County:
Miami Dade
Zip:
Folio/Parcel#: %/ 22-
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titlehol er): o
14 Lk V t k� r
City: `'/�% c.5" State:
Address:
BFE: FFE:
Phone#:
Zip: 3 /� D
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: i
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ i424Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
eci. •
r SCiy s Phone#:�
f,
Zip:
Phone#: 3
...2 -/k ---,31P 7
%f C Certificate of Competency #:
Description of Work: - j1.7� f � / ��
/ l
Specify color of color�thru tile:
Submittal Fee $ »LJftl1.(1 Permit Fee $ 13-r. CCF $ 1 " d co/ccs
Scanning Fee $2 Radon Fee $ S. s3 DBPR $ 3
Technology Fee $ 2 ' "L 0 Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
mimmassO
Notary $ P
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 143 q
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.
i�
Signature `fir
OWNER or AG
The foregoing instrument w. s ac
day of
T
owledged before me this
20 l \o ,by
who is personally known to
me or who h' , 'roducecf as
identification and who did take an oath.
NOTARY PU
Sign:
Print:
Seal:
N CHEZ
MY COMMISS O ' #FF158432
er 9, 2018
:m -
APPROVED BY
(Revised02/24/2014)
Signature /
CONTRACTOR
The foregoin instrum
7 day of
'/f-;�> c
ledged before me this
20 '} 4. by
'43-1-7`3 O is personally known to
me'or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
— ✓z Piysic 4
Plans Examiner
-Alec-431
*
Zoning
Structural Review Clerk
Casa De Las Piscinas
2601 N.W. 18 Terrace
Miami, FL. 33125
Date: December 20, 2016
State of Florida
County of Miami -Dade
Before me this day personally appeared Maria Rodriguez who being duly
sworn, deposes and says:
That he or she will be the only person working on the project located at:
1060 N.E. 105 St.
Sworn to (or affirmed) and subscribed before me this 20 day of
December 2016 by Nbv ice( °`_0 (14 ,10a- •
Personally know
OR Produced Identification
Type of Identification Produced
4111-
,,,,,c,..„.41.4777rN
HEz
�u►PimmISSION #FF158432
XPII�F^�. .te� . • 2018
„t.
ry e ifn
Print, Type, or Stamp Name of Notary
Notice to Owner
M iamb Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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, parttime 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 ta0 day of
Byu1/q,1\' avl-
dJ 20 ((Q.
who is Ry known a or has produced
No
SEAL:
asi
is SANCHEZ
'r MY COMMISSION #FF158432
EXPIRES September 9, 2018
338-0153 FloridallotaryService.com