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PL-18-510 f Permit'wo. PL-2-18-510 Miami Shores Village Permit Type:Plumbing-Residential 10050 N.E.2nd Avenue NE I I work Ciass ration:Addition/Alteration Miami Shores,FL 33138-0000P Permit Status:APPROVED' ENs Phone: (305)795-2204 -- F�ORLD� i Issue oate:.3/121201Expiration: 09/08/2018 Project p� Project Address Parcel Number Applicant 1250 NE 95 Street 1132060144070 DIANNE FISCHER Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DIANNE FISCHER 1250 NE 95 Street MIAMI FL 33138-2550 Coritractor(s) Phone Cell Phone Valuation: $ 1,000.00 A PLUS PLUMBING AND GAS LLC (954)604-5025 Total Sq Feet: 0 Type of Work:REPLACE SHOWER FAUCET,VANITY TOILE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final ' Classification:Residential Scanning: 1 Review Plumbing Underground c i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-2-18-66602 DBPR Fee $2.25 DCA Fee $2.00 03/12/2018 Check#: 1606 $ 108.85 $50.00 Education Surcharge $0.20 02/27/2018 Cash $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 4 Technology Fee $0.80 Total• $158.85 i 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 to4o the work stated. March 12, 2018 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 12, 2018 1 .a v .f Miami Shores Village RE Building Department artment F 27 2018 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY; Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 f (OT � FBC 20; BUILDING Master Permit No. 1 PERMIT APPLICATION sub Permit No.-E" ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ,PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION E] SHOP CONTRACTOR DRAWINGS JOB'ADDRESS: I.2�d N C a'S 3 ,f3� r City: Miami Shores County: Miami Dade , ZID: , Folio/Parcel#: H� I�3 2:UCT-PW-U-1/0 0 Is the Building Historically Designated:Yes NO x g Occupancy Type: Load: Construction Type: Flood Zone:`BFE: FFE: ���I a h�nn�---- i� ' _ _ l OWNER:Name(Fee Simple Titleholder):_l/�C!e .ilk T C SC� e✓ Phone#:3C75— 6 (2 Address: 12-90 O C 1`J ��1 5�-• i City:l" I(CLVVN I J�O 1'-e-5State: f L zip: 'S 3 3 Tenant/Lessee Name: Phone#: ` Email: �e� �e . SCke✓g gkeYvvlav\ - con CONTRACTOR:Company Name: !v S Plw;0hll�l 4Wd UlPhone#: ( Vy-C!br .L d Zr Address:_ //1 C !A)- City: State: , Zip: zir Qualifier Name: /k/92 /'G� LleZ �-7 n Phone#: �kJ State Certification or Registration M Z 77 / Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: � .�----gip Value of Work for this Permit:$C'4490©�.-—--= Square/Unear Footage of Work:. Type of Work: ❑ A,(d�dition ❑ Alteration ❑ New Repair/Replace.— ❑ Demolition Description -of Work: Qe.L '.c7��c't!v@✓�Z�(,�Ge. ��ttiCT�1 / lQ1 Specify color of color thru tile: Submittal Fee$ Permit Fee$ ` CCF$ CO/CC$ ' Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ r Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ i TOTAL FEE NOW DUE$'. j ~ d pRevisedo2/24/2014► l 'Bonding Company's Name(if applicable) i Bonding Company's Address City State Zip Mortgage lender's Name(if applicable) Mortgage Lender's Address 4 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..... i OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance wifh 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. t Signature 1 Signature 'd OWNER or AGENT CONTRACTOR 1 .The foregoing instrument was acknowledged before me this" The foregoing instru7-bf- was acknowledged before me this A w ZV day of ��b�r✓q 20 $ by /!3 day of r` 20 �0 by C.h h-t ��>~C1�o✓ ,who i personally known VI h Z�(,�P 2 _ ,who is/personally known to me or who has produced as me or who has producedP--0-Kf ��,,I d Of- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1 , � 1 Sig V Sign: k Print: Print: 1 raN Seal: Seal: aa _ � JEANETTE MARTINEZ ��d�a MAUREEN'YVIL6dW- :- Nota Public-State o'Florida �� i^Nit"PVIIc-St N ill Florida I 44 Co rmissior=GG'0579•�,� My Comm.Expires Dec 9.2C2tCommission N FF 195326 s'ss'i► 1s � {tAssns sssssasssssssss««sss ;o s1AysFli4�Fil9�s2ial� «sssss«««sss %° Bonded through National Notary Assn. APPROVED BY Pians Examiner Zoning s , Structural Review Clerk (Revised02/24/2014) . i i ....................._... _._........_- i ..........W_ BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT r _ + 115 S.Andrews Ave..Rm.A-100,Ft.Lauderdale,FL 33301-1895—954-831.4000 7 VALID OCTOBER 1,2017 THROUGH SEPTEMBER 30,2018 I I !f7 DBA: 'Receipt#:182-b6076 AILi, FLUMBING AND CAS LLC rxt„•iwaNau ; Business Name: Business Type:I��jtMalh,,, , Owner Name:ADRIAN VAZUttaz Business Opened:o4;oT/2o':-E �. Business Location:11-876 Sw 12 PL State1County/Cert1RegCCFC1427772 + DAVIE. Exemption Code: i Business Phone:554-604-5025" I I' Rooms scats Employees -Machines Professionals ? For Vending evsireess Qnly -� ...... ' Number of Machines: Vending Type:. r - Tax Fvrrount Transfer Fee NSF Fee Penalty Prior Years Collection Cast - Total Pea I 27,00 c.cc; :C.00 6.75 0..00' 2° On.I h .5 e' d .............. — �f i THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS t- THIS BECOMES A TAX RECEIPT This tax is levied for the'plivilege of doing business within Broward County and is ' non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when .......... °...�"�' '„ the business is sold, business name has changed or you have moved the -"•`�`�' business location.This receipt does no,indicate that the business is legal or that it is in compliance with State or local laws and regulations. t t s Mailing Address: A PLUS PLUMBING AND GAS LLC Receipt p02C-17-00001807 t` 876 SW 12 PL Paid01/16/2018 56.75 DAVIE, FL 33325 ^ � I _... 2017 - 201$_ i a I e G E , f + E * �A PLUS PLUMBING 6 OAS Date: a` 3 State of VL of— Ock, County of hcowandI VBefore me this day personally appeared L , who being sworn, ,deposes and says: That he dr she will be the only person working on the project located at: 2 so ti.E, q-5-11 5-fme.f- A'aml " e)z � y Contractor's Signature f Sworn to (or affi med) and su cribed before me this ",)J day of k6, , 20j, by 0 a r 164 2C Personally know OR Produced Identification Type of Identification Produced E P in , Type of Stamp Name of-Notary MAUREEN WILSON Notary;P01c-,State of Wide , • :Coamdiitlon�►FF 195526 4 -M`ton�n Ei Feb 2.2019 E fbiidl4tl�OiidiNtBoiWMO� yAm E ' gt1OR1FS�j ttiC•i9j2 -I` s� � Miami Shores Village logop Building Department ly',*_1"d 10050 N.E.2nd Avenue ORIDp' 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 i 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: s 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 i 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: caner State of Florida County of Miami-Dade The foregoing was acknowledge before me this Z 1 day of talo . ,20A_7. Byrn i scw�/ who is<EEly known t me or has produced as nen Not SEAL: r�;;ii�A JEANETTE5NEZ ?: Notary Public—Commissior A4 Comm.rmyniFes Doe 9.90 dsd(toughN8