PL-17-2693Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. P-11-12693
-
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Pennit Status: APPROVED
Expiration: 06/06/2018
Applicant
9145 N MIAMI Avenue
Miami Shores, FL 33150-
1132060130060
Block: Lot:
ALYKAY INVESTMENTS LLC
Owner Information
Address
Phone
Cell
ALYKAY INVESTMENTS LLC
FL
(305)219-8267
Contractor(s)
EF DESIGN & CONSTRUCTION
Phone CeII Phone
(305)409-4581
Valuation:
Total Sq Feet:
$ 1,500.00
0
Type of Work: PLUMBING WORK AS PER PLANS
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Penalty Fee
Permit Fee
Scanning Fee
Technology Fee
Work without Permit Fee
Total:
Amount
$1.20
$6.00
$4.00
$0.40
$100.00
$400.00
$3.00
$1.60
$400.00
$916.20
Pay Date Pay Type
Invoice # PL-11-17-65635
11/14/2017 Check #: 3395
12/08/2017 Check #: 3607
Amt Paid Amt Due
$ 50.00 $ 866.20
$ 866.20 $ 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 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. Futhelmpre, I�ze the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
December 08, 2017
Date
Building Department Copy
December 08, 2017 1
fir
State: Ft- Zip: 23/K-0
be42 ( /
•
Address: 49.9 7 At f 5 2 is.de_
A
Po-�� P c•-- State: 4/
Qualifier Name: C. tae_j
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
City:
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 0 MECHANICAL PUBLIC WORKS
JOB ADDRESS:
City:
Master Permit No.
FBC201g
3`1
Sub Permit No.?U — 2E_ l3
❑ REVISION
CHANGE OF
CONTRACTOR
'NC A • /7/e
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Shores
County: Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone:
BFE:
NO
FFE:
OWNER: Name (Fee Simple Titleholder): ti Ae4`1 e4 'I f Phone#:
Address: 90 (i QifCGl y n e igAr
City:/1(.4t17 f S/16�er
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: e
Value of Work for this Permit: $ f p.ov
Type of Work: ❑ Addition ❑ Alteration
• ti
Description of Work:
Ii " °"""1"( 97D
®V 1 3 2017
BY.
Phone#:
3sog 009 gre/
Zip: f`
Phone#: SOS �OS T,79 /
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
aftltnolition
Specify color of color thru tile:ct
r�
7 o0
Submittal Fee $ ,
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ 2, • Notary $
Double Fee $ CO, W
Bond $
TOTAL FEE NOW DUE $ v"KG • 213
(Revised02/24/2014)
4*
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.
Signa\nn
OWNER or AGENT
The foregoing instrument was acknowledged before me this
I ( day of l D , 20 17 , by
(Zon°te 'ELv^ I t , whotispersonally knovlino
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
arto,• Notary Public - StateRO ,ni't�i
,����,•c mission # FF 915108
''1,°;A My Comm. Expires Sep 7, 2019
The foregoing instrum
4CJ day o
nt was acknowledged before me this
me or who has produced
, 20 f/ , by
, who is rsonally nak w to
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign:gefre/ %//�(A.✓�l %U"� v`?
ke Print:
Seal:
****************************************************************
APPROVED BY
Plans Examiner
eNkb MARTHA RODRIGUEZ
'MY COMMISSION # GG42566
EXPIRES: October 26, 2020
Zoning
(Revised02/24/2014)
Structural Review Clerk
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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of , 20 1 .
By i-e 1.4e-J' ,,air e �
Notary•,
SEAL: ,
who •personally known to me or has produced
as identification.
SANDY ROMERO
Notary Public - State of Florida'
= Commission I FF 915708
Bonded through National Notary Assn. ► j
EF DESIGN & CONSTRUCTION, INC
297 NW 152 AVE
Pembroke Pines, FI 33028
Date: November 22, 2017
State of
1p7-7dot_
County of ,-2 Q( �c-C
Before me this day personally appeared
sworn, desposes and says:
efrio „e,
That he or she will be the only person working on the project located at
: 91Yrao h AM i AK •
who, being duly
Sworn t9,(gr affir
by ,10,-7
and subscribed before me this M' day of `
Personally known
Or Produced Identification
Type of Identification Produced
"% MARTHA RODRIGUEZ
MY COMMISSION # GG42566
‘a,," EXPIRES: October 26, 2020
Prin , Type or Stamp ame of Notary
EF DESIGN & CONSTRUCTION, INC
297 NW 152 AVE - Pembroke Pines, FI 33028
.20/Q