PL-18-3368Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: PL-11-18-3368
Permit Type: Plumbing - Residential
Work Classification: Sprinkler System
Permit Status: Approved
Issue -Date: 11/09/2018''
Expiration: 05/06/2019
Parcel Number
102 NE 102ND ST, Miami Shores, FL 33138
1132060131900
I
Contacts
Nicolas Duke
102 NE 102 ST, MIAMI SHORES, FL 33138
Owner
BERNIES SPRINKLER & LANDSCAPING INC
GRADY B LANIER
810 NW 186 DR, MIAMI, FL 33169
Business: 3056201111
Contractor
Description: INSTALL SPRINKLER SYSTEM, SYSTEM HAS
EXISTING WELL.
Fees
Amount
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
$50.00
$1.80
$2.25
$2.00
$0.60
$50.00
$9.00
$3.75
Total: $119.40
Valuation:
$ 2,400.00
TotalSq Feet: 0.00
Inspection Requests:
762-4949
Payments
Total Fees
Check # 6761
Credit Card
Amount Due:
Date Paid
11/09/2018
11/06/2018
Amt Paid
$119.40
$69.40
$50.00
$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.
OWNE F 'AVIT: I certify
•nin• ery� •re, I au'horize the abo amed contra or to do t work stated.
regulati . o•n- ==+n and
uthorized Signature: V r er
oregoing information is accurate and that all work will be done in compliance with all applicable laws
Applicant /
y 1�,1�er
Contractor / Agent Date
November 09, 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 ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: 1 V f. NG. `OND ! r
City:
Folio/Parcel#:
Occupancy Type: Load:
Miami Shores
County:
FBC 2017 '
Master Permit No. pLIB - 33 8
Sub Permit No.
❑ REVISION EXTENSION
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION
❑ RENEWAL
❑ SHOP
DRAWINGS
Miami Dade Zip: �;
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): 7 3 _ 5 U4
Address: 102 145 1MND Sf-
City: NI.s..kr tT S hi:n:2gs
State: FL.-
BFE:
FFE:
Phone#: (Qr )44 5j-4 2 2.
Zip: `3O
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Com s . n N e: 11+ lr-S rk
Address:"'
City: ''A�. /�'"1 /' State:( Zip:
( C�Y
Qualifier Name: l� �c ✓� & €%' Phone#:
State Certification or Registration #: '"7 Poo 24/ o Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $ 2 , nd. Gv Square/Linear Footage of Work:
Phone#: 34�'_420 (t l t
City: State:
Zip:
Type of Work: ❑ Addition ■ \Alteration ' LM ew Repair/Replace El Demolition
Description of Work• L S �1 S`P� r n ``ter S y t y /vL
kc S CIS ti S�l—.\iJ
Specify color of color thru tile:
Submittal Fee $ "SO"Pal'Cli Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $6`3. T 0
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. I the absence of such posted notice, the
inspection willnot be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
3) day of (� , 20 l$ , by
j� 1.Q—'aA 1Jt•JC-4Q--, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
Seal:
LISAARIVERA
Notary Public - State of Florida
Ir <I Commission # GG 262308
,,zn, My Comity, Wires, Sep 25, 2022
Bonded through National Notary Astn.
Signature
The foregoing instrument wasacknowledgedbefore this
\V day of No , 20 1 , by
G tY0 Carl\ v! who is personally known to
me or who has produced4,1 `I as
identification and who did take an oath.
NOTARY PUBLIC:
‘.1
Prin
Seal:
.. vP� ••••�• .GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
>-oP Bonded Thru Notary Public Underwriters
************************************************************************************************************
APPROVED BY '�—� 1 t - C 4 Plans Examiner
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
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIERS STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
COPY OF CERTIFICATE -OF COMPETENCY OF QUALIFIER)
COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE..000NTY_MUNICIPAL1
1CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have'NOTICETO_OWNER form and Contractor Affida7/193
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: �''/) 1 e`V S ` ri o f `S (sq,c(s-rces
BUSINESS ADDRESS: f? to L`% 6 g•Or CITY 1":11G4TATE c.- ZIP 3 / 65
BUSINESS PHONE: (3 3 t 2a ( )_ I l FAX NUMBER ( )
CELL PHONE ( ) QUALIFIER'S NAME(`) rG cL .4/1 r `Q r
QUALIFIER'S LIC NUMBER: 1 Poo 2,g6
MIAM DE
CTSB
Construction Trades ualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
1 4P000240
BERNIES SPRINKLER & LANDSCAPING INC
D.B.A.:
LANIER GRADY B
Is certified under the provisions of Chapter 10 of Miami -Dade County
Municipal Contractor's Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOTA BILL - DO NOT PAY
CC NO: 14P000240
BUSINESS NA M E/LOCATION
BERNIES SPPoNK ER & LANDSCAPING
INC
810 NW 1861H DR
MIAMI GARDENS, FL 33169
OWNER
BERNIES SPRINKLER & LANDSCAPING
INC
GO GRADY LANIER
MAMI.DAM
el
RECEIPT NO.
7553605
MC
EXPIRES
SEPTEMBER 30, 2019
TYPE OF BUSINESS
SPECIALTY PLUMBING CONTRACTOR
Pursuant to County Code
Sec 10-24
PAYM ENT RECEIVED
BY TAX COLLECTOR
175.00 11/05/2018
0237-19-000415
This receipt is not valid in the following Municipalities: Aventura, Doral , Hialeah, Key Biscayne,
Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay.
For more information, visit www.miarridade.gov/taxcollector
Local Bust ness Tax Recei pt
Miami-DadeCounty, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
7195201
BUSINESS NAM E/LOCATION
BERNIES SPRINKLER &
LANDSCAPING INC
810 NW 186TH DR
MIAMI GARDENS, FL 33169
RECEIPT NO.
RENEWAL
7477387
SEC. TYPE OF BUSINESS
EXPIRES
SEPTEMBER 30, 2019
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
OWNER
BERMES SPRINKLER & 196 CONTRACTOR
PLUMBING
LANDSCAPING INC
t In rlRAIIY 1 ANIFR 1
Worker(s)
This Local Business Tax Receipt only con"rms payment of the I rral Business Tax. The Receipt is not a license,
permit, or a cert "catior r of the holders qual i "cations, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RBOEI PT NO. above nest be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276.
For more information, vi sit www.miamidade.gov/taxcol lector
14P000240
PAYM ENT RECEIVED
BY TAX COLLECTOR
51.75 11/05/2018
0210-19-000347
QUALIFYING TRADE(S)
0003 LAWN SPRINKLER
Jaime D. Gascon, P.E.��
Secretary of the Board
Mann -Dade County retains all property rights herein.
www.miamidade.gov/economy
JIMMY PATRONIS
CHIEF FINANICAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 3/21/2017
PERSON: GRADY B LANIER
FEIN: 461461775
BUSINESS NAME AND ADDRESS:
BERNIES SPRINKLER & LANDSCAPING, INC.
810 NW 186TH DR
MIAMI, FL 33169
SCOPE OF BUSINESS OR TRADE:
Plumbing NOC and Drivers Irrigation or Drainage System
Construction & Drivers
EXPIRATION DATE: 3/21/2019
EMAIL: SPRINKLERSBERNIE@GMAIL.COM
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
BERNIE'S SPRINKLER, INC.
THE FULL SERVICE COMPANY THAT CARES!
LICENSED & INSURED CC# 96P000355
3531 NW 170TH STREET
OPA LOCKA, FLORIDA 33056
(305) 620-1111 CELL (305) 345-7058
Date: l
State of f(ori.ka
County of MjgM;-1)GUIN4
Before me this day personally appeared C,rgdi.6. Lanky
deposes and says:
That he or she will be the only per n worki
(t 2 NE (07 S+ MIN am;'
Contract • gnature
Swor to (or affirmgd) and subs u
by br&c • 6 Ufi'iv
this
who,yng duly sworn,
tted at:
3.13
day of NOVVQmb4.' .20
Personally know
OR Produced Identification
Type of Identification ProducedTb dV4v I i c t.(
Print, Type or Stamp Name of Notary
YANADY PRIETO
MY COMMISSION ## F' 214(',' ti.
EXPIRES: March 25, 2 ,
''',''' Bonded Thru Nota: / Pubic Underxria;r;
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 YOLd--ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owne
State of Florida
County of Miami -Dade p
The foregoing was acknowledge before me this day of 1 V N 24A , 20 . •
By I V J lift 1 Oati „E_ who is personally known to me or has produced
SEAL:
as identification.
( •10act LISAARIVERA I
ai \ `f'\ Notary Public - State of Florida
A: * is Commission # GG 262308
'tei! My Comm. Expires Sep 25, 2022
4 ''' Bonded through National Notary Assn. 4