PLC-17-2639Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permits p. PLC-11-1r.7-2639
,'Permit Type: Plumbing,. Commercial
WorkClassification: Addition/Alteration
Permit*Status: APPROVED
Expiration: 05/16/2018
Applicant
9220 BISCAYNE Boulevard
Miami Shores, FL
1132060141460
Block: Lot:
Owner Information
9220 BISCAYNE LLC
Address
1110 BRICKELL Avenue
MIAMI FL 33131-3132
1110 BRICKELL Avenue
MIAMI FL 33131-3132
Contractor(s) Phone
JYP SERVICE & REPAIR CORP (305)216-7283
Cell Phone
9220 BISCAYNE LLC
Phone
(786)703-7002
Type of Work: NEW DRAINS AND VENTS AND WATER PIPI
Type of Piping:
Additional Info: NEW DRAINS AND VENTS AND WATER PIPI
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$13.80
$11.81
$7.88
$4.60
$787.50
$3.00
$18.40
$846.99
Pay Date Pay Type
Invoice # PLC-11-17-65571
11/17/2017 Credit Card
11/06/2017 Credit Card
Amt Paid Amt Due
$ 796.99 $ 50.00
$ 50.00 $ 0.00
CeII
Available Inspections:
Inspection Type:
Top Out
Re Pipe
Main Drain
Heater
Water Service
Final
Water Main
Lavatory
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 prorer 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 certi
construction and zoning. Fut
the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
authorize the above -named contractor to do the work stated.
/ Applicant /
Contractor / Agent
November 17, 2017
Date
Building `Depafrtment Copy
November 17, 2017
1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Faic (305) 756.8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
RE
2017
FBC 201'
Master Permit No. C C (> I - S 5-‘
Sub Permit No. P I C (•R --Z(o3 i
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION (RENEWAL
PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: C122-0 3 (sc_ere `11ki c-Cc
Gtv: Miami Shores County: Miami Dade Zio: 3 % 138
Folio/Parcel*: (( - 2 Z J - O (Lf . 14 Go Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
92 m +�isca7 lac
OWNER: Name (Fee Simple Titleholder): ► •Z�c-cs-�T--- `" Phone#: S6 (- 64q - 3 S - 3
Address: 42-c) . S. S h 0I-es l`A-
City:
Re
State: f ( Zip: 3`3 (L/ c7
Tenant/lessee Name: Phone#:
Email: vl �J I'�-� gf vry OEM Z, ( C,cOM
CONTRACTOR: Company Name: Tl%ta•�G✓�d CGS /1/ !I S S r Orgne#: 3o.S- Z16-X Zc5' 3
Address: q1 `T W . 1 cb ken i!6o L1'e l2J. 6 A? , — /o i'
City: l h L t // G r� State: lic\re:d6 Zip:Qualifier Name: '5OS :� ftf/J Phone#: 3 ° 5-1/6 Z6
State Certification or Registration #: ep G I Z qe9 .3Certificate of Competency if:
DESIGNER: Architect/Engineer: Phone#:
Address:. City: State: Zip:
Square/Linear Footage of Work
Value of Work for this Permit $
L2Sd
Type of Work: ❑ Addition En Alteration ❑ New ❑ Repair/Reply
Description of Work: A r 4 I L C4) • 7 5 ,4foijal-n • lc A I-74 eviie E/34.7/LAr z*"
h6 //ate
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ :kit7-1 CCF $ CD/CC $
Scanning Fee $ Radon Fee $' • 8 8 011PR $ 11 •9 I Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ .9 6
(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. 1 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. 1 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 FINANcNG, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As o 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,l a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven ) 4 after the building permit is issued. in the absence of such posted notice, the
inspection will not be approved and a rei • fee will be charged.
Signature
OWNER or AGE
The foregoing instrument was acknowledged before me this
day of 4C)---19`
CONTRACTOR
The foregoing instrument was acknowledged before me this
, 20 . by \ day of 004-&'11- , 20 (-- , by
afti'i2 , who is personally known to nc-e Qe Z , who is personally known to
me or who has produced as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
Seal:
•
el
'': MY COMMISSION # FF964004
EXPIRES Februay 23. 2020
Hon Noss soMco.mon
as
rrstssssaa•tr*ss*ss•a*srs*s*rwstss+ssasssssss*****ssssssasisrsasssssssrssss*****ssssssasssssssases***** ***
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review aerk
jyp service & repairs corp
date: 10/23/2017
estado of: florida
county of: miami dade.
Before mi this day personally appeared jose y pena who, being
dudy sworn,deposeds and say:
That he will be only the person working on the projet located at:
9220 biscayne blvd.
contractor signature.
sworn (or affirmed) and subscribed before me this 23 of oct 2017.
by SaCC
,''' MARTIN G TORRISS
c:_ MY COMMISSION 0 FF964004
EXPIRES February 23.2020
•x,i) 3,46 4)• 3 fierdioNotorySemice.awn
personally know
or produced identification
Print Ti
1
amp N.m-. Notary.
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 coverom the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of c 7'?"%/, . , 20 (T.
By 3C •v� li — who is personally known to me or has produced
AC
�� •
�j
Owne
Nota
SEAL:
as identification.
MARTIN 0 TORRISI
004
.,,.. EXPIRES February 23.2020
3
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