PL-18-1248Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-5-18-'l248
Permit Type: Plumbing - Residential
Work Classification: Audition/Alteration
Permit Status: APPROVED
Issue Date: 8/8/2018
Expiration: 02/04/2019
Parcel Number
Applicant
42 NW 101 Street
Miami Shores, FL 33150-
1131010180250
Block: Lot:
DARYL AND MONICA BRANTON
Owner Information
Address
Phone
CeII
DARYL AND MONICA BRANTON
42 NW 101 Street
MIAMI SHORES FL 33150-1267
Contractor(s) Phone CeII Phone
CONWELL & ASSOCIATES CONSULT (305)962-5673 (305)926-5673
Valuation:
Total Sq Feet:
$ 4,000.00
0
Type of Work: REMODEL KITCHEN BATH AND LAUNDRY
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
$o.00
$o.00
$o.00
$0.00
$225.00
$0.00
$0.00
$225.00
Pay Date Pay Type
Invoice # PL-5-18-67495
05/10/2018 Credit Card
08/08/2018 Check #: 1848
Amt Paid Amt Due
$ 50.00 $ 175.00
$ 175.00 $ 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 anFuthermore, I authorize the above -named contractor to do th ork stated.
Aµtholized ature: Owner / Applicant / Contractor / Agent
August 08, 2018
Date
Building Department Copy
August 08, 2018 1
Ak(
5
FBC 20\
BUILDING Master Permit No. 12-C, 18 -" �2`t
PERMIT APPLICATION Sub Permit No. pl
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ERENEWAL
PLUMBING ❑ 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): M 0-IC7--- 1=2,474-r•rro._) Phone#:
2. M/JV•/ 10) s I--
City: ( 4 l ( State: 1-7
Tenant/Lessee Name: Phone#:
Email:
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
Zip:
CONTRACTOR: Company Name: hUJ N 74 5-Scet ier- Phone#:
Address: PI?, SW / 3 9 & Le_ City: 4i % Q NA r` ! / State: f� Zip: 33/0 p 6 /�
Qualifier Name: 14 +16At--''4 " l ,iitw/'er( Phone#: 307WS- `03
State Certification or Registration #: C Fe----60092 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip: :r
Value of Work for this Permit: $ /0O0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: -TO rCa‘a -expf i-Q cl rervv ► L TL\)o - 2063
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ Tc CCF $ CO/CC $
Scanning Fee $ Radon Fee $ ` 2- DBPR $ 3. 3a Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE 10- 03
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attac
for the first inspection which oc-i
inspection will not be approvd`dn
Signature
i
ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
a r&inspection fee will be charged.
OWNER or AGENT
The foregoing instrumentfwas acknowledged before me this
O day/of 'J jj , 20 / g , by
L3 V),1(J is personally known to
me or who has produced
,DL
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
iv Zettie Jones
COMMISSION 1 FF209081
EXPIRES: March 14 2019
***************y
APPROVED BY
uiiii10
X
Signatur
CONTRACTOR
The foregoing instrumentwasacknowledged before me this
At day of of ,
>Kew$ 6/Mwle
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
, 20 l0 , by
is personally known
C7
o ,,, Zettie Jones
''` �' . COMMISSION I FF209081
EXPIRES: March 14, 2019
*vviv rate rfitrmit. tr********************:* b , W►, ***wwNh NNIrpft :Cell****************
as
Sign: /
Print:
Seal:
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk
Notice to Owner — Workers' Com
p
Ir1 iami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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 Isted 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: '1' 0. i
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
By M.otv'C-
Zettie Jones
COMMISSIon # FF209081
EXPIRES: Meath 14
WWW.AARONNOTARY.COM
30
day of
who is personally known to me or has produced
DATE:
CACG GENERAL
CONTRACTORS
!Al I iw=aIyts7• FI61i rIWIaYrld
CONWELL & ASSOCIATES CONSULTING COMPANY
5/6/ZoIB
Before me this day personally appeared Kenneth F. Conwell who, being duly authorzied and says:
That he or she will be the only person working on the project located at:
12 �‘.J 1D / c�
Sworn to (or affirmed) and subscribed before me this
(Print name)
(Corporate seal)
6
psi,/ o� Ha-y y p/y
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Theforegoing instrument was acknowledged before me this (p day of , 20 /� ' by
7 II �Cy'/n (�0� � k�( on behalf of �,c�1 ��s7 f' [ +N 1 is
personally known to me or [ Jkar used as identification.
Notary Signature:
Type or Print Name: ' ' ` E j()
Zettie Jones
COMMISSION I FF219081
EXPIRES: Much 14, 2019
WWW.AARONNOTARy.COM
11771 SW 137 PLACE Miami, FL 33186 Tel: 305-926-5673 Fax: 305-385-7827 Email: info@caconsultingc.com
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N.
Owner's Name (Fee Simple Title Holder): (nO}.ij(A-- 13/Q.4A-131O/JPhone #:
Owner's Address: 2_ ) k 101 ��-
City:(kJti ( State : Zip Code:
Job Address (Of where work is being done):
City: Miami Shores ✓
Contractor's Company Name:
Address: it/0 So /%/• (,c) (c
City: No, 'Warn,-
//
Qualifier's Name : Amea P`E4 ey-
IZ ',AA' rot s7
State:
State: Florida Zip Code:
Phone #: 3 2S- 6 8S'
Zip Code: 3 / &
Lic. Number: Gf&�z11-
Architect/ Engineer of Record Name: Phone #:
Address:
City: State: Zip Code:
Describe Work:
I hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Miami Shores harmless of all legal involvement.
Signature 1A, `F-'1-. Signature
Owner or Agent
The foregoing instrument was aknowledged before me
this 3O day of fl 2 L ,2013,by l`-(o.SPC4:} JiDgi
Who is
personally known to me or who has produced
Notary Public:
Sign:
as indentification.
Seal:
Zettie Jones
COMMISSION I FF209081
EXPIRES: March 14, 2019
WWW.AARONNOTARY.COM
Contractor or Architect
The foregoing instrument was aknowledged before me
this ; to day of 4Q/'/ , 201$by /� //'/tPeil
who is e or who has produced
as indentification.
Notary Public:
SigniklS
S
,le ,'%
LUIS BARIAS
%State of Florida -Notary Public
,S, Commission # GG 157779
1-.4 415 M Commissi.-in Expires
'l,,,,,,,,," November 05, 2021