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PL-17-1295
Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address P la •mit Permit NO. PL-5-17-1 95 Permit Type: Plumbing - Residential Work Classification: AdditioniAlteration PermitStatus: APPROVED Issue Date: 7/12/2017 Expiration: 01/08/2018 Parcel Number Applicant 101 NE 104 Street Miami Shores, FL 33138- 1121360130700 Block: Lot: RMGM PROPERTIES LLC Owner Information Address Phone Cell RMGM PROPERTIES LLC 4764 NW 120 Drive CORAL SPRINGS FL 33076- 4764 NW 120 Drive CORAL SPRINGS FL 33076- Contractor(s) Phone BLUE DOLPHINECONSTRUCTION LL( (954)605-1418 Cell Phone Valuation: Total Sq Feet: $ 500.00 0 Type of Work: CHANGING EXISTING SINK AND BATHROOM Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 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 $3.00 $0.80 $108.60 Pay Date Invoice # 05/10/2017 07/12/2017 Pay Type PL-5-17-63986 Check #: 103 $ 50.00 $ 58.60 Credit Card $ 58.60 $ 0.00 Amt Paid Amt Due 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 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 a . z.l in•. Futhermore, I authorize the above -named contractor to do the work stated. d ignature: Owner / Applicant / Contractor / Agent July 12, 2017 Date Building Department Copy July 12, 2017 1 i escripfio►i' of Work ie .","; f_ f+aN,' s; vs. ,,=r1 _ .,,..le . BUILDING PERMIT APPLICATION ❑ BUILDING JOB ADDRESS: 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 MAY 0 2017 BY: _ !.� • FBC201y Master Permit No. 14 — Zc 3 Sub Permit NoPL-14 — 2915 ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 0 ► l 04 ee City: Miami Shores County: Folio/Parcel#: �' C� l ' (o v12 l' 6 3-67, Occupancy Type: Miami Dade Zip: Is the Building Historically Designated: Yes • NO Load: Construction Type: Flood Zone: BFE: FFE: LLC OWNER: Name (Fee Simple Titleholder): R , ' ` 6-vh pro pe Phone#: ' n 9 2 '! Address: T\.} 1 ZU °A O r- City: GU (2a S Io z 1 n c State: Zip: 3 0 Tenant/Lessee Name: Email: ) r e cn �\I (r i 0 0 r CSC ), U 0/1/N CONTRACTOR: Company Name: i2L '-e. DoL pii vt Address: Eq 3.. S t,J yr-4x C City: c cDPe-Y y Qualifier Name: 4-4- Sal- QL wa i s h e State Certification or Registration #: CI- G I / 2 8 i-% f 8 DESIGNER: Architect/Engineer: Address: �� Value of Work for this Permit: $ J "J LA/Square/Linear Footage of Work: State: , 1. Phone#: Phone#:.St;,129 721-1z' Zip: .3 3 ? 20 Phone#: 95 L( 6 0 5 41:/ Certificate of Competency #: cifla Phone#: Tyke of Work ❑ Addition ❑ Alteration Hy--yXSI;^ tc-14144. t}n*r yntyl r <+ r t f 1¢e T G I _ 1:; Specify color`of color thru tile:• • • `�" . $_r/ov— Submittal Fea;$ ` Permit Fees • �' CCF $ Scanning Feeup,vARadon,ER. $ . DBPR $ Technology Fee $ Structural Reviews $ City: State: Zip: ❑ New JAL Repair/Replace ❑ De molition sr wt �..,. \r�._.P/ S k: tg Training/Education Fee $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I 60 (Revised02/24/2014) 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature v OWNER or AGENT Signature • ONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this — day of ��a(4 , 20 (-, by 6 re cp rL-f c-155 who is personally known to rets QQt wt personally me or who has produced M2©0 Z�^(Dcr identification and who did take an oath. 'PACr t d ' i (Car NOTARY PUBLIC: Print: Seal: Bonded Tin Notary Public UndewHiters known to day of r'c , 20 1 7 , by r , who is ersonall identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************************************************************** APPROVED BY VV ,j i Imo( • • • HAMZAFIABU 1QAB %FIRES: t MI, 2020 f* .~ . 4 00025818 • ********** Plans Examiner Zoning Structural Review 9 � Clerk (Revised02/24/2014) TE,:qPIFLORIDA MENT Of SUSLNESS AND PROFESSIONA ON' INDUSTRY LteEffSfRE3 —CARD I SLAR 6TONE ROAD TALLAHASSEE FL 32399-0783 TitititCHE. CESAIWARTitsi BLUE DOLPHN.CONSTRUCTION, LLC 8932 SW 49TH ST -c-esTncTry TPL33328 Conoratulationsf Nth Ms WOMB you becmni one Of the nearly -ctle'tcar±tici*RtrittraEtters.uvd3VVeilepartmenttflitii—ness ard Pret74.-;s1r.Tr4alnegaatiort -0131-ptoT-Ilanals.end bu Isnot rern!-etttlietts*to-yabht kom boxers to barbezps restaurants-, and they-keep:Florida's contrray strong, -Eversi'davve 4Ate-,*to _ ..urovell-tewe Tet order te salve you better.. For ram- labor' about our services. please onto www.thyrioildeficense.cant: There you can find more affair bouor dhrisiOns and the refittiations titat impact you. subscribe to tinpannlent neylbletters and learn more about the DeNtrument's ftiaive Our ui.•=ionat tie" Depertrneritisa tioense UizQ' enUti. Regut-E,ta Fah* cortflistritele tzeVe, von: better 11~,M,I'MIP: Serve yortUstOrnere Thank Volt for doing busatess Florida. and ttultsoitulatiorts rle‘t rcertstl RISKCt-1Yr, ilt-tPiftRMO-R • (850) 487- V 5- , ttrsiriEss AND eft0FeSICtNAt.:-RE-GuLATION CFC1428468 _ ,08/24420tti ' - • - CERTIFIED RiligiriMPONTTOR • .•• MIMICRY-2, GMRICARTitr - aWEDOLPI-Idif LAM -12& CtaTiglEt; k".(`'" •-•-t-D • - Lifgaze- . • . • . - - . • • 1<SN, 4 AWSON. SE AR' - - .• _STATE_W :FLORIDA . - _ * DEPAUTMENTbFlaUSINESS AND PROFESSIONAL REGULATION - : - - CONSTRUCTION INDUSTRY LICENSING BOARD CF114.7tA4 UMBER. :.t-ILeA,sie4ss • - „. • al • Tv11:14=t- :001_1114=1"M.r.„, • ,- 8 SYV•ticiritit T -tn0 ER, • - • t1C- . • •- - - - - - • •-• •- • • - . . . . _ . . . .. - - ' : .. - • .. . _ . , . . . . . .. . ...... _ .. . - . . _ . . . ' -- ---• - Ef:1--*. -uso-0240misb --:- . BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017 DBA: Business Name: BLUE DOLPHIN CONSTRUCTION LLC Owner Name: CESAR MARTIN RUMICHE Business Location: 8932 SW 49 ST FT LAUDERDALE Business Phone: 954-605-1418 Rooms Seats Employees 1 Receipt #: PLBi MBI44447 NG/LWN Business Type: Business Opened:o5/o1/2006 State/Cou my/Cert/Reg: CFC14 2 8 4 8 8 Exemption Code: Machines SPRNKL/CONTRA Professionals For Vending Business Only Number of Machines: • Tax Amount Transfer Fee NSF Fee Penalty Prior Years + r Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: CESAR MARTIN RUMICHE 8932 SW 49 ST COOPER CITY, FL 33328 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning 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 not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2016 - 2017 Receipt *04B-15-00008303 Paid 09/20/2016 27.00 tt�G1/1\A/A nn n�1 j 1\1-r i 1 /\/+A 1 mot IAIwIr"r► TA •i r+r•pr-,rik.s. 1 etc, A JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 6/15/2016 EXPIRATION DATE: 6/15/2018 PERSON: RUMICHE CESAR M FEIN: 200583431 BUSINESS NAME AND ADDRESS: BLUE DOLPHIN CONSTRUCTION LLC 8932 SW 49 STREET COOPER CITY FL 33328 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING CONTRACTOR CONTRACTOR 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 Miami Shores Vijiage 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner State of Florida County of Miami -Dade rt The foregoing was acknowledge before me this `p® 6_ lday of A`"r , 20 (a-. By �ip5 who is personally known to me or has produced -"CI- _ALL as identification. Notary: w ..x-r, ,ram.,:. , �v�r Aye. Notary Public State ,+cionda tt SSindia Alvarez- oK YCor„rniss;o,-, c ,;B7 0 '?oF Tke Expires 09/03/20' "i SEAL: