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PL-17-1877Miami Shores Village " 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 yF—moo` Phone: (305)795-2204 LORtDp` Permit NO. PL-7-17-1 77 Permit Type: Plumbing - Residential Pen' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 8/18/2017 ( Expiration: 02/14/2018 Project Address Parcel Number Applicant 290 NE 101 Street 1132060134590 Miami Shores, FL 33138-2423 Block: Lot: STEVEN T DOBIE Owner Information Address Phone Cell STEVEN T DOBIE 290 NE 101 Street (512)569-3370 MIAMI SHORES FL 33138- 290 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone DALE PLUMBING (786)663-1804 Type of Work: REPLUMB KTICHEN ADN BATHROOM, RELOC Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DCA Fee DCA Fee Education Surcharge Notary Fee ]An Permit Fee Scanning Fee Technology Fee Total: Valuation: $ 6,000.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due I Invoice # PL-7-17-64655 08/18/2017 Credit Card $ 233.90 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground �J� 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 pla drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assum responsibility for a rk done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRIC66-P)4JMBING, MECHAN , WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: T- pttify that all the forg goifig information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonigg. F rmore, I authori pI`jq above -named contractor to do the work stated. August 18, 2017 Authorized Signature: / Applicant / Contractor / Agent Building Department Copy August 18, 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING OPLUMBING ❑ MECHANICAL PUBLIC WORKS JOB ADDRESS: 290 N E 101 st Street RECEIVED JUL 21 ZV j_�-C 4-L- FBC 204 Master Permit No. RC 17-1793 Sub Permit No. qu I 1 '�_ I ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 -3206-013-4590 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: X BB`F'E: FFE: OWNER: Name (Fee Simple Titleholder): Steven T. Dobie Phone!! 512-569-3370—A-- Address: 290 NE 101 st Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Owner Phone#: 512-569-3370 Email: sdObiel@gmaii.com CONTRACTOR: Company Name: Dale Plumbing, Inc. Phon (786) 663-1804 Address: 154 NW 97th St. City. Miami Shores State: FL Zip: 33150 Qualifier Name: Linton Dawkins Phone#: 7 b' 6 d3 / 4po State Certification or Registration #: CFC1427087 Certificate of Competency #: DESIGNER: Architect/Engineer: redesign studio/Kimberley Flower (FL#94059) Phone#: 305-778-1019 Address: 720 NE 62nd Street City: Miami State: FL Zip: 33138 Value of Work for this Permit: $ 6000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition Description of Work:. Replumb kitchen and bathroom, relocate toilet and shower in bathroom per remodel plans. Connect bath/kitchen/laundry to new on -demand water heater. Specify color of color thru tile: Submittal Fee Permit Fee $21 6' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ z_ 16 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. so, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs s e (7, days after the building permit is issued. In the absence of such posted notice, the inspection will not b proved and a r in pection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of J U — 1 20 C4 by R ( day of �y 20 17 by SN (UD —Pdt3c E who is personally known to C.�rTtC�r�! ?}'jG�,�cwS , who is pl�ona y kna to me or who has produced as me or who has produced as identification d who did take an oath. identification and who did take an oath. NOTARY PU IC NOTARY PUBLIC: \\\\\1d 11'0I1BndZ Sign: Sign. `�p.•�o�a c,ProN• ^gym gym6j Print: Print: =a a o9�aS Seal. > O09PppP&W, Notary Public State of Florida Seal: } ? Sindia Alvarez *ism 0 ,��o } 11 MyOommissior. FF 156750 p •.6iy �OZ'9`� y�z;� a } pfo Expires 09103=1 8 '�i '•:�NOISS�� ,�a\��� APPROVED BY "Plans Examiner Zoning Structural Review (Revised02/24/20I4) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to uwner — worKers' C;omoensatlon insurance hxemotion 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 coveraAftom the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU AC 7 CONTENTS. LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS � f Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this i's day of known to me or has produced SEAL: fie AQ � o L) ri a M« tq I a 49 CAJ ©rj G c C2/� � ? 0 N 4� /0 r C5� lee? G r,We Is 7a ( 4�„ • MAHARAI K. GONZALEZ / �' n Sel ' MY COMMISSION # GG 044602 , ,►/,� ' l��t 1 EXPIRES: November 2, 2020 Bonded TTwNotary Public Underwriters t`�tGho►►' a � E,d'l�a � � 2