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PL-16-2615Miami 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 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 2- 4_1 VVW 131 IV 0 5Tr2 a -ET RECEIVED FEB 10 FBC 2019r911‘ Master Permit No. '�( (_ p Sub Permit No. ` S 'e " 2.,1E 1 S ❑ REVISION ❑ EXTENSION ❑ RENEWAL CANCELLATION ❑ SHOP DRAWINGS 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: OWNER: Name (Fee Simple Titleholder): Address: 244 iv i?(/ 32 NPP City: ti n ,f� M I Tenant/Lessee Name: ?E"grEci 11E1T LL(. ST(IET Phone#: 0 -G 08— 4 672, State: ovt p Email: iiv1-O @ Pc(t` EGTpL,'tY. HV Phone#: Zip: 3315-0 CONTRACTOR: Company Name: Address: 4 /Wt) ? A k %� f/i q 6/416 Phone#: 72C -26-6-2z/0 City: /(/ ! Ai/�' /� Qualifier Name: �1 '/.I /1 /LAA t\/ PEA__ State: i - State Certification or Registration #: � v 0 (:),(1) DESIGNER: Architect/Engineer: L AW(k. MVCE 5j1N101V Address: 1 x-3-1 NE 162 6T2 ECT Value of Work for this Permit: $ Type of Work: ❑ Addition Description of Work: zip: ,33/ Z Phone#: 7 (r(e• ! r . 22/0 Certificate of Competency #: Phone#: 3O5 —@45— 35- 6.3 City: NnRT}( M inti BP4 tate: Zip: 33 (.62... Square/Linear Footage of Work: ❑ Alteration ❑ New Arco i'z (5' 'Repair/Replace n Demolition Specify 'color of co Submittal Fee $ Scanning Fee $ Technology Fee $ r thru tile: Permit Fee $ Radon Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ go. 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 /9th e42-- tr OWNER or AGENT The foregoing'U'instrument was acknowledged beforelme this a'1 (: ,d� ay of i� , 20 1l , by Pte(J r (2 ZO who is personally /known n to me or who has produced T ,�"DCJ�u identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: SIO/y'•••ol :* #FF 954760 . �' ••. Qom. aae , : O , ***************************************w*►*. 1********* APPROVED BY (Revised02/24/2014) The foregoing instrument was acknowledged before me this 2:7 day of 1 -'D , 20 , by GUS S 1-1Q,1'r1 ti..Q , who is personally known to me or who has produced 4#605,c -17C/ 34" kaP identification and who did take an oath. C9Y ce'42, NOTARY PUBLIC: scif,; T% MAHARAI K. GONZALEZ *c MY COMMISSION # GG 04412 EXPIRES: ;,� •� Pa: EXPIRES: November 2, 2020 ;; ig1' Bonded Thru Notary Public Underwriters ******************************************************* Plans Examiner Structural Review Zoning Clerk LUIS QUALITY PLUMBING CO. 245 N. W. 59 CT. MIAMI. FLA. 33126 PHONE: 261-1953 DAtE: a-9>/7 _STA- 7E O F CouAJ 1, /12414 I. ,23,4,-)4. 136 FQ /ZE .MI- T/Jr d a? P 4SOAJA //V A 1),L-Anr1) LU1 S Dtitynora wDuca, Esaht/G vvly swo vrsPas dui _Lays: TL/Ar/IE ©A _S1/e W,// ©NI(Y P& so,v L+JO,L K/,VC U/V TIE aad G7- Z.6.0471=4> An a4/ .� y 2 cdt Sibo2 Ai %O (Oa AFF/R A4 ni1.3 LISC2.1•6C1-. ME 77114 2 L 4 V D a f -e -h 2 a At r3 Lu i S ay) r o tier nq nd.ca P €2.SoAv4 //y ICrvc, w Olt P2OvuCe-v TvE.v7i �i4.47,,, 1 -1(a -1.5- -goo- -77 -fie e2,Iv��v/r �i��7 �.,� P40,cD4.1cCv for C dG 11'Ce ns2 P/1rE Urr sTMp An LJ ox A.1972 -Ay MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 P,ondeo Ihru Notary Public Underwriters MY COMMiI SIOk fi:GG u44602 EXPIRE :N v m¢er2,:200 3or..ir Thr in U ��rvriters Notice to Owner — Workers' Com p Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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: Owner CT HE Z_c_ State of Florida County of Miami -Dade t.j The foregoing was acknowledge before me this 1 day of , 20 1 ill Bim By who is personally known to me or has produced Da/W --, u — Las 0\-eld Me/ / �r 5 .� ........ •' ••�N Notary: SEAL: • -0: r m 0•a- Z0• J ya• �ZT —v3• % * ••• Idx3 N9 •• c Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): Owner's Address: MI Nota, L2 City: }AAA r )3 Phone #: 305- C,06 -4072_ State : - Zip Code:3311 Job Address (Of where work is being done): City: Miami Shores Contractor's Company Name: Address: J? 0 �1 . 111 Si— City: !? i S C )Q j A -/e. �%4 2 State: Qualifier's Name : 0 / 4 r State: Florida Zip Code: Architect/ Engineer of Record Name: Address: 1773 N 1,6721 city: Nar I- -- Nl Ali i 4f - lh * Phone #: 7j6 y93.7 d 4 6° Zip Code: -3316 / Lic. Number: C/C- 1%L;'/ c65 lit.. Phone #: ( 505 -")+45-3'9 State: Zip Code: 62 Describe Work: ea:WE U 1•31 N P TWMewq reow 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. 1 hold t . - Building Official and the 4 ft) -IA- Signature Owner or Agent The foregoing instrument was aknowledged before me this 1(P day of Ftbwar y,20IC) ,by A'kala ?Al -c) Who is personally known to me or who has produced CnQ`( C)4(‘‘ \►e.K S UC€ SCas indentification. Notary PyJplic: Sign: Seal: Miami Shores harmless of all legal Signature ontractor .r Architect The foregoing instrument was aknowledged before me this IV -11 day of FebarAt4 , 20 f by Etc-oP 3c who is personally known to me or who has produced as indentification. Nota ublic: ELYStRUSS Notary Public - State of Florida • % + • Commission f FF 255270 :7). Al My Comm. Expireu Jun 29, 2019 "'"n'� os Bonded through Wood Noisy Ain. • — Notary Public - State of Florida My Comm. Expires Apr 21, 2017 Commission # EE 867787 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -9-15-2615 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 913012016 Expiration: 03/29/2017 Parcel Number Applicant 241 NW 92 Street Miami Shores, FL 1131010331180 Block: Lot: PERFECT HEAT LLC Owner Information Address Phone Cell PERFECT HEAT LLC 241 NW 92 Street MIAMI SHORES FL (305)608-4672 241 NW 92 Street MIAMI SHORES FL Contractor(s) Phone EDWARD ROJAS PLUMBING CORP (305)944-6788 Cell Phone Valuation: Total Sq Feet: $ 1,800.00 0 Type of Work: REPLACE BATHROOM 1 FIXTURES EXISTEN Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 , Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $3.38 $3.38 $0.40 $225.00 $3.00 $1.60 $237.96 Pay Date Pay Type Invoice # PL -9-16-61433 09/22/2016 Credit Card 09/30/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 187.96 $ 187.96 $ 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. Futhermore, I authorize the above-named contractor to do the work stated. tvyr Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy September 30, 2016 Date September 30, 2016 1 • BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC PLUMBING JOB ADDRESS: City: 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 FBC 201y5114:- Master Permit NolGv..( D 2•13 Sub Permit No A6 -2G IS ❑ ROOFING C REVISION ❑ EXTENSION Li RENEWAL ❑ MECHANICAL pi PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS AY/ AlutJ Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: NO FFE: OWNER: Name (Fee Simple Titleholder): y_1 S 9 (D l� 12.6 _ hone#: 1( /Uw Address: City: /11 -rills ] k_S Zip: 3(3 F Tenant/Lessee Name: d e#: Email: CONTRACTOR: Company Name: Address: City: 1 4 / 1 ! tate: 1- I o Qualifier Name: ) �J0,((Gl cJ )'1 O ij r State Certification or Registration #: e PC; 0 4-9 ¢ 3 / Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Phone#: 3o ) q/ . Co 7 J Zip: 3 3/7 Phone#: Value of Work for this Permit: �a $ � � [i �� -� Square/Linear Footage of Work: Type of Work: ❑ Addition n/ Alteration n New Repair/Replace Description of Work: r --2P (� ( Q CY / m %? co/l/) p4) P rp c{ »()l2 /2 ea j p6c,0-e Fl Demolition Specify color of color thru tile: Submittal Fee$ Scanning Fee $ 01Z) Technology Fee $ �0 Permit Fee $ lir CCF $ 1 • 20 Radon Fee $ 3 - .a& DBPRt/$ CO/CC $ Notary $ Structural Reviews $ (Ravisad n? /24/711141 Training/Education Fee $ Double Fee $ Bond $ ALJ TOTAL FEE NOW DUE $ � 9 R • 9 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 /4,0 OWNER or AGENT The foregoing instrument was (acknowledged before me this ! � day of -Pte 10 V 20 � � , by Las it 6 \Y O , who is ersonally know to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ' POn�( v r� �c�rrL11�i_ Signature The foregoing instrument was acknowledged before me this 9 day of pk-C M'O-e V 20 I `f' , by Stlux7&' , who is ersonally know) to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Wl�,/)6t in, Q`�"• Print: ANS JCA p(i\I\4. — ;,`C��`µY :;',,„ ANA PARRILLA 0 1 ��µ"'' ANA PARRILLA Seal: Seal: Notary Public - State of Florida 1 '�: ','.� Notary Public - State of Florida ', , ;N : un. � My Comm. Expires Apr 21, 2017 � � z iii « ; My Comm. Expires Apr 21, 2017 J O 1 �;'�, ;s' Commission # EE 867787 '%e���0`0oCommission # EE 867787 ********** €**OF*T**f*?*********s************** * *e#*,-**‘* *-Y* *1r*OlF*T** *i'**fix****** Print: as APPROVED BY Plans Examiner Zoning Structural Review Clerk