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PL-17-217Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 90 NE 96 Street Miami Shores, FL 33138- Owner Information Permit Permit NO. PL -1-17-217 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 2/27/2017 Expiration: 08/26/2017 Address Parcel Number 1132060130600 Block: Lot: Applicant VERO HOMES LLC Phone CeII VERO HOMES LLC 701 BRIECKELL AVE MIAMI FL 33131- (305)902-4660 701 BRIECKELL AVE MIAMI FL33131- Contractor(s) SLAZAR CONSTRUCTION INC Phone CeII Phone (365)412-6355 Valuation: Total Sq Feet: $ 7,500.00 3000 Type of Work: KITCHEN REMODELING REPLACE DRAINLIN Type of Piping: Additional Info: KITCHEN REMODELING REPLACE DRAINLIN Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $4.80 $3.38 $3.38 $1.60 $5.00 $225.00 $3.00 $6.40 $252.56 Pay Date Pay Type Invoice # PL -1-17-62744 02/27/2017 Credit Card 01/26/2017 Check #: 2221 Amt Paid Amt Due $ 202.56 $ 50.00 $ 50.00 $ 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 AFFIDAVI . ce. that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo . . ;+amore, I authorize the above-named contractor to do the work stated. zed Signat Owner / Applicant / Contractor / Agent Building Department Copy February 27, 2017 Date February 27, 2017 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 PLUMBING ❑MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: • •o t" 01 s ori Z(v,�'� C12 $Q—eci-7 g -t -N FBC 20ig Master Permit No. \C1C0 - 2(05 Sub Permit No. el i - Z. 1 `-i- ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR ❑ SHOP DRAWINGS City: Miami Shores County: Folio/Parcel#: Occupancy Type: Load: Construction Type: Miami Dade Zip: 3 51 3 ? Is the Building Historically Designated: Yes NO Ver Flood Zone:/BFE: FFE: c� OWNER: Name (Fee Simple Titlj older): v e (� v 1' Y7 C S 1 C ` C Phone#: O5 / d z ‘G Address: 70 l `3r,'Ze(f ace 5 a,r , / S5 c-) City: //cl;/s1 1 State: L_ Tenant/Lessee Name: Email: Phone#: M -v VY -a ° b omPJ C CONTRACTOR: Company Name: Phone#: 1 Address: 6 6% C)("3 V?) �^ City: I ,t State: Qualifier Name: Phone#: Zip: `331x3( Zip:G State Certification or Registration #:C'` ' 4-2:1 \ 1 b Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ S 00 Square/Linear Footage of Work: 3 0®0 Type of Work: ❑ Addition ❑ AlterationK❑—New Repair/Replace El Demolition Description of Work: ('t G -C yJ M. � v �, �,��i I ,p--QCL -& ?ct l't ii.A• CS f' u S < Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 21)2.TOTAL FEE NOW DUE $ t -J--^ 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 of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was ackno -dged before me this Z 3 day of .) , 20 / 3 , by 44 day of ba ±�'�iarz. Vt GAR40, 0 is personally known to 'Sqj,c Sb\iZ'., , who i personally known o me or who has produced r( --- V tQI--_' as me or who has produced as Signature CONTR TOR , 20 \,\ , by identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) identification and who did take an oath. NOTARY PUBLIC: ..;\ VC• f. • ��. I /tom • G�.1> X20 9 ;. Print: QQ�X�_ C DNezll - •m - • _ .��"'��., CHARLES GONZALEZ * kg 951i1� h; e; Seal: 4 ; °1 e` 's Notary Public - State of Florida 1-:,i gym; •:,--)i.-.Commission # FF 239788 q ' '-nary `.-0. 0 � =:,,,. �� J My Comm. Expires Aug 1, 2019 #4,1111i100\ Sign: '1'1 "******************* ***Skslr)&,..* NO ********* Plans Examiner Structural Review Zoning Clerk Slazar Construction Inc. 10381 Sw 138 Ct Miami FI. 33186 305-9024660 1/26/2016 State of Florida County of Dade Before me he will b 3313 personally appeared Antonio Acosta who,being duly , deposes and says: that erson working on the project located at 90 NE 96 ST, Miami Shores FI. Contractor signature Sworn to (or affirmed) and subscribed before me this 2 4 day of dart • , 2017, by Personally Known K Or produced Identification Type of ID Print,Type or Stamp Name of Notary garbs Gonzalo Notary Public. hats of Holds My Comm. Expires AM 1, 2019 Commission No. R: 238786 • 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 BELOW YOU ACKN• LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade �-_ The foregoing was acknowledge before me this Z3 day of,,`�'` , 20 17 B} -t' ,V z. L A who is personally known to me or has produced Notary: SEAL: