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PL-19-740Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 UU1PJ 1� Issue Date: 04/26/2019 Location Address Parcel Number 1245 NE 93RD ST, Miami Shores, FL 33138 1132050270070 Contacts Permit NO.: i'L-04-19-740 Permit Type: Plumbing - Residential Work Classification: Alteration Permit status: Approved Expiration: 10/01/2019 MARK HUNTER Owner Other: 9176048328 R&I PLUMBING SERVICES CORP Contractor RENE GUZMAN 7898 NW 174 TER, MIAM1, FL 33015 Business: 3058236911 Inspection Requests: Description: REMOVE SINK AND PUT IT BACK (REINSTALL) SINK Valuation: $ 300.00 Inspec ion Re WILL BE ORIGINAL Total Sq Feet: 50.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 04/04/2019 $50.00 Check# 1004 04/26/2019 $60.30 Amount Due: $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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructioy-apd zoning. Futhermore, I authorize the above named contractor to do the work stated. 91 SignatSe: Owner / Applicant / Contractor / Agent April 26, 2019 Page 2 of 2 h It BUILDING PERMIT APPLICATION Miami Shores Village RErEIVED Building Department APR 0 4 1019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 /�� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 tFBC 2(0� F_+ Master Permit No. ILA 1 "�'r U0 2 Sub Permit No. — t _4 q0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / ` S 10! City: Miami5hores County: Miami Dade Zip: �J �3"S Folio/Parcel#: l / .3.2 0Y 0.1, 7 - 0 D `% 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 4 Q . Phone#: Ow Address: /.) q6 NE 93 s City: State: Zip: 33132 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: r ! Az p/t/14f �/ Phone#: Address: �9 U LO (7y 749"" �CZ� City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Add L9 �_17/ Zip ,�©15 Phone#::p y Certificate of Competency #:10 hone#: City: State Zip: Value of Work for this Permit: $ 300 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New UotRepair/Replace Description of Work: nfnM0C S1 OK__ tnIr, U)1ll hP_ bn;ar Specify color of color thru tile: Submittal Fee S Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF S DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 6? 00 { Bondingtompany's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT The forgoing instrument was acknowledged before me this day of —`��l L 20 ( 1 by wh erson ' nown to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_0 Print Commission # GG 067097 Seal: " r ` MY Comm. Expires Jan 29, 2021 a ca bonded thro ugh National Notary Assn. CONTRACTOR The foregoing instrument was acknowledged before me this 3 - day of {c 20 19 by 4?eA.; e— � v 7-"-d , who i rsonal y nown to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: PrintA"4'42rt� Seal: as s*ssssssssssssssssssss*ss**s**********s********s***s*s**ss*ss*sssss*s*sss*sss**s*ss*ss*sssss*sssss*s*s*sssss APPROVED BY C�f��/m Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to VWner — WorKers, Vompensation Insurance txernwion 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: l . 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 rAvocation 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: -Y� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of Ir 120 9 . By b . who rsonally kt o me or has produced as identification. fl CIA lrnr P VENANCIO GARCIA Notary: ; r NotaryPublic-State of Florida Co067097 • Commission # GG 067097 SEAL:,��f4 MY Cn 29, 2021 :;�Y My Comm. Expires Jan 29, 2021 BondedNotary Assn. Bonded through National NolaryAsan. Re: R & I Plumbing Services Corp. 7898 NW 174 Terrace Hialeah Fl. 33015 CC #03P00004 Date: y /IC7 State of - � tp ri d a, County of !]] i am 1 •- bQ de - Before personally appeared Z�� Before me this day ��� � who being duly sworn, deposes and says: That he or she will be the only person working on the project located at: . I 4 S 1�C �3 �'am, vres a. :3 3130 Contractor Signature: Sworn to (or affirmed ) and subscribed before me this I 4! day of i 20 19 by ''1e'06 Per y k _ Or produced Identification Type of Identification produced ,•••'ir.' VENANCIO GARCIA Not Public -State of Florida CGn ion # GG 7097 0.,rE MY Comm, ires Jap(29, 2 1 Print, Type or Stamp Name of Notary