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PL-16-2101 ^ Perm it . ' Miami Shores Village t Pennit Type:Plumbing-Residential 10050m.e.2nd Avenue NW Wairk Classification:Addition/Alteration Miami Shores,FLuo1o8-000u Per i Phone: (305)79ee204 Pep�iit Status:APPROVED issue r)ate.8/1,012016 F Expiration: 02106/2017 ProjectMiami Shores, FL 33150- Block: Lot: ` 190 NW I bO Terrace 1131010230250 ` Owner Information Address Phone Cell LUZ ELENA LERA 638 NE 0 Street MIAMI SHORES FIL 33138-2471 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 cbNWELL&ASSOCIATES CONSULT (305)962-5673 (305)926-5673 Total Sq Feet: 0 Type of Work:PLUMBING FOR KITCHEN RENOVATION. Available Inspections: Type of Piping: LInspection Type: Additional Info: 0 t Top Out Bond Return Final Classification:Residential Scanning: 1 Review Plumb�ing UndergrounLd Fees Due Amount Pay bate Pay Type Arnt Paid Arnt Due CCF $1.20 Invoice# PL-7-16-60752 DBPR Fee $2.25 i 08/10/2016 Credit Card $ 160.70 $0.00, DCA Fee $2.25 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 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 ' " ' ` . | ` ' / � ^ | =u ' . ` p*u=ing August 10, 2016 , acceptingrthis permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are requ'ired fci-r'ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWN ERAFFI DAVIT: I gairtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable.laws regulating [on and construc6' �oningh rmore, I authorize the above-named contractor to do the work stated. 4 August 10, 2016, A:Othorized Signature:Owner / Applicant / (Contractor,) Agent Date Building Department Copy ' 1 t ` SNORes s� Miami shores Village Building Department `�tieNr� 81—E 10050 N.E.2nd Avenue �l0R1Dp' 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 l 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 statingthat 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 tAELOW YOU ACKN WLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: caner , 1 State of Florida County of Miami-Dade / The foregoing was acknowledge before me this L�� day of AQ GU - ,20 I� . By 1JJ:Z ZLFNO jOeA who is personally known to me or has produced as identification. Notary: SEAL: ��(up�Q (�\ /�( Foi��%LOP otary r�:;biic State of Florida f�1\✓`/1'" india Alvarez y Commission,FF 156750 xpires 03/03;2018 f t t Miami Shores VillageBY a 26 2o's 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 c Tt FBC 20 14 BUILDING Master Permit No � -(�//��� PERMIT APPLICATION Sub Permit Non_j 6-2 li\J I BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL K UMBING ❑ MECHANICAL [:]PUBLICWORKS F—] CHANGEOF ❑ CANCELLATION ❑ SHOP CONTRACTOR I DRAWINGS JOB ADDRESS: 190 NW 100th Terrace City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3101-023-0250 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Luz Elena Lera Phone#:305-528-5552 Address: 190 NW 100th Terrace City: Miami Shores State: Florida Zip: 33150 Tenant/Lessee Name: Phone#: Email: i CONTRACTOR::Company Name6c 1,(+A 15 Oe-f Phone#: S�— /�v 3 Address: 071 5_(_j t 3 p, City: 114;-6 State: 4�1 Zip: Qualifier Name:7APhone#: State Certification or Registration#: foG ffi 0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address; City: State: Zip: alue`of Work-for this Permit Square/Linear Footage of Work: ype of Work: ❑ Addition [K11 Alteration ❑ New F-1Repair/Replace ❑ Demolition D�scrip ion of Wor : UD C1�1 a.tjt' &n v ` U Specify color of color thru tile: Submittal Fee$ Permit Fee$ � �� CCF$ 20 CO/CC$ Scanning Fee$ 'fes . �1 Radon Fee$ �' DBPR$ ,99; Notary$ Technology Fee$ 4 CQ Training/Education Fee$ Q Double Fee$ Structural Reviews$ Bond$ /0 TOTAL FEE NOW DUE$ 166 (Revised02/24/2014) i 1 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 ' In the absence of such posted notice, the inspection will n be approved and einspection fee will be charged. Signature &X Signatu OWNER or AGENT CONTRACTOR The f re ing instrume t was acknowledged before me this The foregoing instrument was acknowledged before m this day of 20�, by / day of 20 _ by rJ�� l!c 2t who is personally known to �� Ww �tho i pe onally knowh t me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: •`' �"'' GIADYS C.PAZ Sign: =pro• ¢s Notary Public-State of Flori a � S r' ti My Comm. Print: Commission#EE 863742 Bonded Through National Notary Assn Seal: ?o�"FLY Poe, ,� VERONICA PHILLIPS * * MY COMMISSION t FF 068609 "+re�r�oe� Bonded TAruBudget Notary Services � APPROVED BY ,� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CONWELL, KENNETH FITZGERALD CONWELL&ASSOCIATES CONSULTING COMPANY 11771 SW 137 PLACE MIAMI FL 33186 h -'. 'y l- +•'7�J r Q•::h-• a.k;..•i:.f £ ,r.„�:�tJ Tv'1" i, ''S Congratuiations? With this license you become one of the nearly ,xY one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses rangeFL1RiDA. from architects to yacht hrokers,from boxers to barbeque restaurants, Ii DEPART ; � t ISiNESSAND I and they keep Florida's economy strong. ULATION Every day we work to improve the way we do business in order to ` CFC"I48.tI#7 1$�12/2Q1I serve you better. For information about.our services,please log onto www,rn flaridalicense.com. There you can find more information +: about our diii vsons and the regulations that impact you,subscribe COJL> i t CIR`f•lFt }P 1 to department newsletters and learn more about the Department's 's 1; initiatives. p �+ �2JhlVVElw��, .� C{stC CO Our mission at the Department is:License Efficiently,Regulate Fairly. r ! x We constantly strive to serve you better so that you can serve your q "'E ;,ate n ` customers. Thank you for doing lousiness in Florida, 4 �s�Elxrt�;iE[i under tlSe p'r�ivisions and congratulations on your new license! !jasr<ouaate�Qu© i'.2ra�s ttnus�2o4oxsss �'+t`c'EtxhA�•.^•`�'.r qi i'.v.�.�i`�w.44�Fn'ti.il Yob\_.f...2f�},r ��.',E'PF..f.'S'.�' � ..... •., DETACH HERE. RICK SCOTT, GOVERNOR KEN LAWSON SECRETARY STATE OE'fLOkIUA t DE1f'ARTMEN7 OIC;I3USI IESS ANt3 FRO ESSIaNA k 01,iILATIC�N.' Cd iS C US I+b i,.tM!'1X:1Y LI NSILA B16A145" . i..P5,90C144147 ar rhs . j 'TIS+��LUTutB1NG CONTRACTOR ;.Irnec!below iS C:ERTiFIED sem + tlrltlrthe provision "qf Chspter 489 FS ;4 R ,� 1 s�rt Explraflorl di�'te AUO 3'C Za't6 Cei��•�J ,� �,�� - � n •�• �k'�I< �+�Arbr�jMi t t 11y� a # Ql4 WlELL f fRuff WK .f �>vrlAl � ' l: �" � f 'Y ��.-.v N`�'��`t �iM 1 f .�•� 'i y yPi h t Y x �. : 4�'v<<e�. "°c�,�'4 � �`�,' off+ "4 { t�4,h'� � �.`'"a,� ���'•y a ;, .e ,� ,aha+ ..�.,., •.'!jsi.,'�'r �'.>t.��e� ,avk%Mh�ce..•,�Y_. ,.x.;mo � e.1S ro� - a..x. .,, ..,.. .,......., _.._ ._....,,. .... .. ISSUED: 08/1212014 DISPLAY AS REQUIRED BY LAVH 5EQ# L1408120001969 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 6242952 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES V�I Cl C C� CONWELL&ASSOCIATES RENEWAL SEPTEMBER S 2016 CONSULTING COMPANY 6766001 11771 SW 137 PL Must be displayed at place of business MIAMI, FL 33186 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS CONWELL&ASSOC CONSULTING 196 PLUMBING PAYMENT RECEIVED CO BY TAX COLLECTOR CONTRACTOR 75.00 09/13/2015 Worker(s) 1 CFC1428047 CREDITCARD-15-045695 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 N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276. MNN DE For more information,visit,. VK !w WJ/Y.r�lAll'UJ�fl11�99�.dX641.I��101 r a JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION t **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 6/8/2016 EXPIRATION DATE: 6/8/2018 PERSON: CONWELL KENNETH F FEIN: 383763521 BUSINESS NAME AND ADDRESS: CONWELL&ASSOCIATES CONSUTLING COMPANY 11771 SW 137 PL MIAMI FL 33186 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING LICENSED ROOFING HEATING,VENTILATION, CONTRACTOR CONTRACTOR CONTRACTOR AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 r { G 1 1 h �ACC GENERAL CONTRACTORS CONWELL & ASSOCIATES CONSULTING COMPANY DATE:July 21,2016 Before me this day personally appeared Kenneth F.Conwell who,being duly authorized and says: That he or she will be the only person working on the project located at: orn to(or affirmed)and subscribed before me this 23 day of February 2016. ICjture`l�� , (Date) 9 K"'I?Atc ( �hwP (Print name) (Corporate seal) STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me this day of 20/ by LJ G / � ( on behalf of [ ]who is erso all 'k o me or[ ]has produ as identification. Notary Signature: a Type or Print Name:��i i�(�Q, �G __s �o�►;:��� VEMNICAPHIWPS MY COMMISSION t FF 069609 * * EXPIRES:February 22,208 �grFOF�oe�OP Bonded Thru Budget Notary services 11771 SW 137 PLACE Miami, FL 33186 Tel:305-926-5673 Fax:305-385-7827 Email:info@caconsultingc.com