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PL-17-891 Permit NO. PL-3-17-891 d Miami Shores VillageM t Permit Type:Plumbing-Residential 10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration s� P ev Miami Shores,FL 33138-0000 Phone: (305)7952204 Permit Status. APPROVED FCORtOt'' Issue Date:9/2812017 Expiration: 08/12/2018 Project Address Parcel Number Applicant 1292 NE 95 Street 1132060144040 Miami Shores, FL 33138- Block: Lot: MARIA DEL LATORRES Owner Information Address Phone Cell MARIA DELLATORRES 1292 NE 95 Street (305)496-6599 MIAMI SHORES FL 33138- 1292 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 250.00 PAU PLUMBING CONTRACTOR INC (305)934-2894 , •. Total Sq Feet: 0 Type of Work:RUNNING WATER LINES AND SUPPLY LINE Available Inspections: Type of Piping: Inspection Type: Additional Info:RUNNING WATER LINES AND SUPPLY LINE Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground t { Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-2-18-66428 Change of Contractor Fee $110.00 02/15/2018 Credit Card $ 110.00 $0.00 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.20 Invoice# PL-3-17-63528 Permit Fee $150.00 03/31/2017 Credit Card $50.00 $115.10 Scanning Fee $9.00 09/28/2017 Credit Card $ 115.10 $0.00 Technology Fee $0.80 Total: $275.10 r In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING, ECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction n z Futher e,I authorize the above-named contractor to do the work stated. February 15, 2018 ize p icant / Contractor / Agent Date Building D artment Copy February 15,2018 1 _�- /' �-� �o�v «/ l�S�'2� �$ Mi_aml Shores Village Building Department EB 13 1118 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)7624949 FBC�B1(4 BUILDING Master Permit No. {.�c PERMIT APPLICATION Sub Permit NO.P F-IBUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL 'LU MBING ❑ MECHANICAL ❑PUBLIC WORKS ] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 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): _P'PoLA, ))6CZA -to92� Phone#: Address: /vC( ' l02 A)E 5! City: R IAX( 561o2c5 State: 'FL Zip: Tenant/Lessee Name: Phone#: Email: I CONTRACTOR:Company Name:_Ief U"44'61 Phone#:, �� !�� ✓�J� Address:_ P/I , 4 Puy (_a"-- / W 3 4 j. + City:4( a ce-A to State: ��— Zip: 3 3 01 Qualifier Name: RIOVA d L 00 �� Phone#: QT State Certification or Registration#: 0—Ft-I4 6010.I Certificate of Competency#:' 4 DESIGNER:Architect/Engineer: , i 4 e s._ + • .: � s;��!� r } • s.. , Phone#: Address: City: State: Zip: I Value of Work for this Permit:$ `'�i�� Square/Linear Footage of Work: Type of Work: ❑ AdditionAlteration ❑ New ❑ Repair/Replace � ❑ Demolition Description of Work: --�,t1 S7x�c� + '� Lo' �X a.4 S z Specify color of color thru tile:• Submittal Fee$ %�' Permit Fee$ CCF$ CO/CC$'= -- Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) M , I P Bonding Company's Name(if applicable) Bonding Company s Address City State Zip Mortgage Lender's Name(if-applicable) Mortgage Lender's Address City 1 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspect* n which urs seven (7) days after the building permit is issued. In the absence-of such posted notice, the inspection will hit-e ppro d and a reinspection fee will be charged. Signature Signaturq_44�p�� f OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of V U9-4- 20 )7 by day of 2012 by Y1Q rrt who is personally known to /J0LD0 /T6 who is personally known to me or who has produced 1 )Yt�/"e Y I �'el'T$'C as a or who has produced 14— Ale— "41CVC; as identification and who did take an oath. identification and who did take an oath. NOTARY P IC: NOTARY PUBLIC: \\e\,,,$1 �F?ANCIS��/�L'rz�ri. \� •• �•'rOry. .l Sign: 6 Sign:yC �+� NOTARY IC: Print: Y1 y1; Print: .D• ♦ ,x <•z Fo Seal: ,•ti�:'F ., YANADY 00 Seal: 2 0 � MY COMMISSION#FF 214031 EXPIRES:March 25,2019 c' Ude `i;R;;�d' Bonded Thru Notary Public UndeiwPnors ///��%/qTE OF FI�P�O�\�``\ s:*s******* r:* *******************rsss*sssssss*s******s*��ll!#61M1►��s*ss**�s**********ss*s**** APPROVED BY 3 tt Plans Examiner Zoning t j Structural Review Clerk (Revised02/24/2014) 4 ORE S �'� REEF E® Miami shores Village Building Department C� 0R1D� 10050 N.E.2nd Ave"nue Miami_Shores, Florida 33138 Tel:(305) 795.2204 Fax:,(305) 756.8972 CHANGE-OF CONTRACTOR / ARCHITECT Co Permit N. '�✓' Owner's Name (Fee Simple Title Holder): ' „� " — Phone#:— 0.5 6S Owner's Address: �n Ivfl6 _ II 1 City: State : Zip Code: �,((C u ,�p� I Job Address (Of where work is being done): �Z�� t°V `p,Y 4n Qb- 't { City: Miami Shores State:—Florida Zip Code- 514,() ode: F �14� SE�� idG Contractor's Company Name: 6XQPF-Gtc/4 MP Afl)l��h none Address: 5 �LDo A) U) 8(r" -S7-0e6,7– City: S QeETCity: -tAMA-�ZAC-- State: 'FL. Zip Code: „33.3.2 Qualifier's Name : J-1 OA) Y A �i0L OCJoa Lic. Number: M-N Y�0 Architect/ Engineer of Record Name: Phone#: I Address: s City: State: Zip Code: f Describe Work: � L � I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilli� to complete the contract. I hold the Building Official and the'- Miami Shores harmless of all legal involvement. Signature I E 1 Signature Owner or Agent Contractor or Architect The foregoing instrument was aknowlleA�dged before me j The foregoing instrument was aknowledged before me this ( day of NOV ,2011,by {�1l�ifiA gOtGt Q�IIa��Y" this day of 20 by ! Who is personally known to me or who has produced who is personally known to me or who has produced u y i V-2 r as indentification. as indentification: Notary ublic: Notary Public: Sign: a Sign: Seal: �� Seal: YANADY PRIETO } := MY COMMISSION#FF 214031 I ': a EXPIRES:March 25,2019 ff pF'�O Bonded Thv Notary Public undeiw6ters „f.`` ,SNaRFs Miami Shores Village Building Department 'ate r 4 10050 N.E. 2ND Avenue logo Miami Shores, Florida 33138 Tel: (305) 795.2204 1 Fax: (305) 756.8972 ��OR1Dp' Change of Contractor/Architect or Engineer; A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge -for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If'the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. t 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. ,� 2 4. Copy of original letter sent via certified mail along with the returned receipt.; m '; In addition to the requirements above the architect or engineer of record must authorized the new architect q or engineer to reproduce his documents. The authorization must be in'writing and must be signed and sealed. r r i p ' f r t 1 ! u 1 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON btLIVERY ■ Complete items 1,2,and 3. A ' nature 3- ■ Print your name and address on the reverse X . E3 Agent so that we can.return the card to you. ! ❑Addressee ■ Attac,this card to the back of the mailpiece,. B• ec b (Print Name) C. Date of Deliv or on the front if space permits. I0C�� 11-13—j6 1. Article Addressed to: 'D:Is delivery address different from item 1? ❑Yes C�O„�n(,15 k n� If YES,enter delivery address below: p No —WV CQ4 5408 /Uvi g1 sfnQel Tama rcr 3. Service Type ❑Priority redMaIlTm ❑Adult Signature (3 Registered MaIIT"� ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 3381 7227 9821 41 ❑Certified Mail® Delivery ❑Certifled Mail Restricted Delivery ❑Mer�chandeiceipt for 1:1 Collect on Delivery 2. Article Number(Transfer from service labeq ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmatlonTm ❑Insured Mail ❑Signature Confirmation ❑Insured Mail Reshlcied Delivery, I Restricted Delivery (over$500) PS Form 3811;July 2015 PSN 7530-02-000-9053 Domestic Return Receipt U G# First-Class Mail Postage&Fees Paid i USPS Permit No.G-10 9590 9402 3381 7227 9821 41 United States •Sender: Please print your name,address,and ZIP+4®in this box• Postal Service '? ']>—I`a� rra � 2Q2 AJE 4s-* 'b el vhOre� �nr�G < wt T rin 9-ef V I' CCA �jn 4z RECEIVED ?018FEB 2O UA I `$gOREs Miami shores Village Building Department ORIUp` 90050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 G 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 fall-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers t 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'compensate insur overage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BE JU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. i Signature: Owner 3 State of Florida County of �. 81e061J 3 The foregoing was acknowledge before methis� day of 20� By �qb Lk ��L car -Tne % who ' ersonally knownto a or has produced as identification. Notary: � �� SEAL: fi'�'" _, MARIE NDANDO M'COMM SION#GG 009235 :a EXPIRES:November 6,2020 cF F°'� B=W ihiu Notary Public UndervmlM