PL-17-2881Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Pe
Permit NO. PL -12-17-2881
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: APPROVED
Issue Date: 1211912017
Expiration: 06/17/2018
Parcel Number
Applicant
1201 NE 102 Street
Miami Shores, FL 33138-
1132050250160
Block: Lot:
MacDAM & DENISE GLINN
Owner Information
Address
Phone
Cell
MacDAM & DENISE GLINN
1201 NE 102 Street
MIAMI SHORES FL 33138-2600
Contractor(s)
ACTION PLUMBING OF MIAMI INC
Phone
(305)278-6900
CeII Phone
Valuation:
Total Sq Feet:
$ 900.00
0
Type of Work: TEAR OFF AN EXISTING GAS LINE TO SU
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$9.00
$0.80
$114.60
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -12-17-65837
12/19/2017 Credit Card $ 114.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
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 AFFIDAVIT: I certify that all the foregoing ;formation is accurate and that all work will be done in compliance with all applicable laws regulating
construction findzoning. Futhermore, au ori the above-named contractor to do the work stated.
044
Aut r¢ed Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
December 19, 2017
Date
December 19, 2017 1
\''\
BUILDING
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
D C 0 7 2817
BY:n�
FBC 20 IL -P
Master Permit No. P L Z
Sub Permit No.
❑ EXTENSION ID RENEWAL
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
[PLUMBING El MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS:
City:
c� k IU Ick S\
Miami Shores County:
❑ CANCELLATION D SHOP
DRAWINGS
Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: 0 1, t\ -1C -7 -
City:
' -1l_
City: IA i ete•—.
L) nt
Construction Type:: Flood Zone:
rt
M
i lQrAla, te
a a ,S -\
State:
NO
BFE: FFE:
Phone#:
Zip: 3 3 1 3g
Tenant/Lessee Name: Phone#:
Email:
CONTRACTO : Company Name: A C,
(9. 8177 9 17 d.
Address:
City:
Qualifier Name:
V %
State Certification or Registration #: G rt, )1-1-- 3t/.„1.I Certificate of Competency #:
CNA ?LL,1
State: fl
(:/lis
Phone#:
Zip: 3.3d470
0
7S,' - s $- - 73c'6
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
°1 cD
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work: ize_
0_ A eltv-
Zip:
Square/Linear Footage of Work:
A t ation D New
eels '�
❑ Repair/Replace
a5 I(L't
❑ Demolition
S /y
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ /o) CCF $
Scanning Fee $ Radon Fee $ 2 'OJ DBPR $ 2
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
CO/CC $
Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ ' (1 '
Bonding Company's Name (if applicable) k l 1 ! I
Bonding Company's Address
City State 1 Zip
/�
Mortgage Lender's Name (if applicable) C L a se (k. 4
Mortgage Lender's Address
City State Zip
•
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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
OWNER or AGENT
The foregoing initrume�nt/was acknowledged before me this
'1A' day of A/(✓ I L 20 / 7 , by
''7rn &U^; who is personally known to
•
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
IIIN//,�
gip `\ ..:...� :O
ez,
-�•�.° Sys
.o
..•
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
ij day of Itt ✓e/AA/IMi� , 20 1 7 , by
1-1 4./ 0...011(145 , wh ' personally known
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Prin :
Seal:
as
Plans Examiner
Structural Review
ev-k,c,GLORIA J. CHIAPETTA
MY COMMISSION # GG76997
EXPIRES: February 26, 2021
******************
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
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 BELO 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
By %�i/1r4e4624)^1 toA �J
Owner
20
Notary:
SEAL:
so
=v
day of
who is
z °AFF �e a:
t' • ,writes .J. , '
i� lrE F1� !llllo‘\O\a\\
to me or has produced
PO Box 900067
Homestead FL 33090
Phone: 305-278-6900
Email: actionplbg@aol.com
State of Florida
County of Miami Dade
Before me on this day personally appeared Harlin Collins who, being duly sworn, deposes and says he will
be the only person working on the project located at /.0 / 11Oati
s,/
Sworn to (or affirmed) subscribed before me this 1 day of DedewerQ,r- 2017,
by i4ar'Liu (�D111.11S
Personally known tr
Produced Identification
Type of Identification
1ZOZ `9Z kmuqad :SHJIjx3 , "'"ON,
L669L00 # NOISSIWP OE ANI
VII3dd1HD1 VRIO'IJ ���",,„it
i '`.4"fre'
000008
Local Business Tax Receipt
Miami -Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
3735884
BUSINESS NAME/LOCATION
ACTION PLUMBING
18545 SW 104 AVE ****
MIAMI FL 33157
OWNER
ACTION PLUMBING OF MIAMI INC
HARLIN COLLINS QUALIFIER
Worker(s) 10
RECEIPT NO.
RENEWAL
459263
SEC. TYPE OF BUSINESS
196 PLUMBING CONTRACTOR
CFC1428021
LBT
EXPIRES
SEPTEMBER 30, 2018
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
PAYMENT RECEIVED
BY TAX COLLECTOR
$75.00 09/18/2017
ECHECK-17-192767
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles — Miami—Dade Code Sec 8a-276.
For more information, visit www.miamidade.gov/taxcoliector
c, -d55 c rJCs \off Si
S) k X313
Po. 32)-sc (,) t --6A-9 33 y
-.23? `(a qC
k &re, CIO L vi -1-1) aM -ext. vi
Lev-- Syriv 94 s
dm_ CL/Se- g its qt,- 1/ • 4-1Xq
1,41U IWO L I ( h -e- Lv -L1 . /la
sverev 4 4L L tve,
Miami Shores Village
APPROVED
BY
DATE
7''Ill\IG D'PT
fl° rr nrPT
P /
l . IANC[ WITH ALL
N- Y P' ,I I S AND ul
12'tiv' %-
FEDERAL
f ULATInNS
(. TO ! :c ,
' -
0 KITCHEN DOMESTIC WATER FLOOR PLAN
GAS PIPING ISOMETRIC DIAGRAM