PL-18-3121Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
905 NE 92ND ST, Miami Shores, FL 33138
Contacts
Issue Date: 11/05/2018
Permit NO.: Pi.-10-184121
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved::,
Expiration: 04/08/2019
Parcel Number
1132060050010
GARRETT SCHAEFER
905 NE 92 ST, MIAMI SHORES, FL 33138
Mobile: 9178421768
Owner
FOREVER GAS CORP
ROBERTO GONZALEZ
18111 NW 68 AVE 1105, HIALEAH, FL 330153989
Business: 3052980193
Contractor
Description: GAS LINE (NATURAL GAS) FOR NEW 27 KW
GENERATOR
Fees
Amount
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
$50.00
$1.20
$2.00
$2.00
$0.40
$50.00
$3.00
$2.50
Valuation: $ 1,800.00
Total Sq Feet: 0.00
Inspection Requests:
305-762-4949'
Payments
Total Fees
Credit Card
Credit Card
Amount Due:
Date Paid
10/10/2018
11/05/2018
Amt Paid
$111.10
$50.00
$61.10
$0.00
Building Department Copy
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.
AFFIDAVff: I certify that all th
oning. Futhe
ing information is) acc
ate and that all work will be done in compliance with all applicable laws
i rhorize the a ove a d co actor to do the work stated. � ✓r" icerg / /Y
uthorized Signature: Owner
/ Applicant /
Contractor / Agent Date
November 05, 2018
Page 2 of 2
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 MECHANI ❑ CAL ❑PUBLIC WORKS
%s /25 9y
JOB ADDRESS:
City: Miami Shores County: Miami Dade
RECE
0 T 10 2018
BY•
FBC 20
Master Permit No. tti E3 3\r-
Sub Permit No. L 0 _3 [2_.- I
❑ REVISION ❑ EXTENSION El RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel
/1-34)-64-O 3-eoio
Zip:
Is the Building Historically Designated: Yes
Occupancy Type: 5 F Construction Type: C33 J Flood Zone:
BFE:
OWNER: Name (Fee Simple Titleholder):
City:
Load:
Address:,, /5 2 A )I '/ �'L J
!miltat_1>r4/ LZfL
3 vs
NO
FFE:,
YY� fr,/%1,� 4e. l� Phone#: ?l 7 IY) /7C
47/
State: /7 1.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ,76 r e vuQ4.- 44, j
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer: Phone#:
Address:
Zip: 33 ! Si
Phone#:
3®r t/73
2 ` State: [ ' L Zip: 3 '3 (.� i 3
, on �i /,Q — Phone#: 30)—g(f 0/ 9 !
6 tN Certificate of Competency #: / zv
Value of Work for this Permit:
Type of Work: ❑
Description of Work:
FeA
Addition ❑ Alteratio
rct/New Repair/Replace n Demolition
$ /G f City: State: Zip:
a (� . Square/Linear Footage of Work: S 0 1
9 �.,s/imi
(,r�nr�.a2 90_4) %r�L- fLe.ct) k cJ
Specify color of color thru tile:
Submittal Fee $ c� • CO
Scanning Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
•
Permit Fee $ (AD' CCF $
CO/CC $
Radon Fee $
(Revised02/24/2014)
DBPR $ . Notary $
1:.
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 6 I 10
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 1 ( •
' 4
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 buildingg $
permit Frith' an estimated value exceeding 2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose properly 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 theibuilding permit is issued. In the absence of such posted notice the
inspection will not be approved and a reinspection fee will be charged.
Signature
The foregoing instru
day of
OW or AGENT
nt was acknowledged before me this
20 /0 . by
✓Qh ceho is personally known to
me or who has produced
iaennn ion an w o i a e an oa
NOTARY PUBLIC
Sign:
Print
Seal:
;fp,
APPROVED BY
as
Signature
The foregoing instrument was acknowledged before me this
day of 1-X. , 20 by
12-,UAY2i0 C—,tc-nactleZ, who is personally known to
me or who has produced L - as
iaentitication an w o i to a an oat
NOTARY PUBLIC
Sign:
Print: )I Lk) F— -
Seal.
****************
Plans Examiner
Y" MONICA L SANTANA
•'i MY COMMISSION # GG065755
-'3r; • EXPIRES February 28, 2021
* t.****************************
**************
Zoning
(Revised02/24/2014)
Structural Review
Clerk
Forever Gas Corp
,18111 NW 68th Ave.
Miami, Fl. 33015
7 5 ,2018
State of Florida
Miami Dade County
Before me this day personally appeared Robert Gonzalez who, being duly sworn, deposes
and says:
That he will be the only person working on this project located at:
905 NE 92 St., Miami Shores, FL. 33138
Sworn to (or affirmed) and subscribed before me this I S day of, 41 u
20 l
Personally know
OR Produced Identification
Type of Identification Produced:
)1\-0.\/k)„,e_QA. 5°)
Print, Type or Stamp Name of Notary
MONICA L SANTANA
'``` '? MY COMMISSION # GG065755
.+,, �� -S EXPIRES February 28, 2021
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.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
Bygarr
SEAL:
day of
,20/0
who is personally known to me or has produced
as identification.
YP
MY COMMISSION # GG 215153
EXPIRES: October 24, 2020
•Os i�. Bonded Ttuu Notary Public Underwriters
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