PL-17-103Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
mit
Permit NO. P'L-1-17-103
Permit Type: Plumbing - Residential -
Work Classification: Addition/Alteration
Perrnit Status: APPROVED
Issue Date: 113012017
Expiration: 07/29/2017
Parcel Number
Applicant
444 NE 93 Street
Miami Shores, FL 33138-
1132060140200
Block: Lot:
SETH & LYNETTE LONG
Owner Information
Address
Phone
Cell
SETH & LYNETTE LONG
650 W Avenue
MIAMI BEACH FL 33139-
(305)325-6976
650 W Avenue
MIAMI BEACH FL 33139-
Contractor(s)
AVR CONTRACTORS, CORP
Phone
(786)818-0337
Cell Phone
Valuation:
Total Sq Feet:
$ 12,000.00
0
Type of Work: INSTALL NEW DRAIN PIPE AND WATER LI
Type of Piping:
Additional Info: INSTALL NEW DRAIN PIPE AND WATER LI
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$7.20
$5.40
$5.40
$2.40
$360.00
$9.00
$9.60
$399.00
Pay Date Pay Type
Invoice # PL-1-17-62615
01/30/2017 Credit Card
01/13/2017 Credit Card
Amt Paid Amt Due
$ 349.00 $ 50.00
$ 50.00 $ 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:
construction and z
Author
th.t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ore, I authorize the above -named contractor to do the work stated.
gnature: Owner / Applicant / Contractor / Agent
January 30, 2017
Date
Building Department Copy
January 30, 2017 1
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
ECE.i \/
JAN 1 3 2017
BY:
FBC 201`�
BUILDING Master Permit No. % C 1 -
PERMIT APPLICATION Sub Permit No.Q1 -1 0,3
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9 / NE q 3 5 /
City: Miami Shores County: Miami Dade Zip: 33/ 3 8
folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 542714 toi y ? Lye -le Con 1 Phone#: 30/- 72. - 33 2
Address: 53 7 /t/96 9/
City: /`--i la/-i--1 - 7IW c' State: --/ Zip:. 3/ 3 8
Tenant/Lessee Name: Phone#:
Email:
CONTRACTO Company Na e: l�f!'
Address:y7 t aS/ �6
City: <1 �/ �.
le t
State:
Qualifier Name: r /C_q)2 f p cried
2,5 a'afi
P2iiJz/Y4
-Phone#`35 7 9 57 V
Zip: -330
/[� -�" Phone#: 7�J 3 % 419g
State Certification or Registration #: GfC / 1 Z'✓ �2 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ I I I�I
Type of Work: ,�,pd , d tionr ZiII Alteration ❑ New -Repair Replace Demolition
Description of Work: /'rs/q l /i/eLl,, opl ✓/� 20 uh„ P Apt 1 lyl�
Square/Linear Footage of Work:
Specify color of color thru tile:
Submittal Fee $ /]r' Permit Fee $ 36 CCF $ CO/CC $
Scanning Fee $ VRadon Fee $ 5• y1 DBPR $ _5• u 0 Notary $
Technology Fee $ (D 0 Training/Education Fee $ Z . Cr (d Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 3 "1 01
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochur will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commegcem t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. II /t%e ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signat
OW ' ER or AGENT
The foregoing instrumentomwas acknowledged before me this
/ 3day of //y /V1/%�/p/,y , 20 / -7, by
SSA G0 7 , who is personally known to
\
me or who has produced FL biz 1 /(Psgas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
�j/ 3 day of 7A4vvn.9ny , 20 / , by
!C/ Caan l / /aft& , who is personally known to
me or who has produced FL (!/ ,f 4 (CQ$.' es
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
************************************************************************************************************
APPROVED BY
Plans Examiner . Zoning
Structural Review Clerk
(Revised02/24/2014)
AVR Contractors Corp.
Date: O ///
Stare of F/DR/�
County of Hri" �/-4 6E-
Before me this day personally appeared /\ t CCe 2S0 2CL who, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at: vvy///t °!3 -iiil.6011 S Zon-e s
33139
Sworn to (or affirmed) and subscribed before me this / ? day of ,3 A iv ()k1 r9/
20 1 . by 2 l Gcfkh `V 12I &
.
Personally known
OR Produced Identification
Type of Identification Produced rL INRUJ-2 L 1 C -QS PS
Miami Shores Viiiage
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.
Signature:
State of Florida
County of Miami -Dade
The foregoin was acknowledgeTi before me this / 3 day of vL//A9/ , 20
By s--e� 261 1-1
Notary:
SEAL:
se
o ary uc • tate of Florida
My Com. Expires Oct 30, 2018
Commission # FF 173169
who is personally known to me or has produced
entification.