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PL-18-1165Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 100 NE 92 Street Miami Shores, FL 33138 - SCOTT ALEXANDER Permit NO. PL -5-18-1165 Permit Type: Plumbing - Residential erill'It Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date. 612812018 1 Expiration: 12/25/2018 Parcel Number 1132060133290 Block: Lot: Address 100 NE 92 Street MIAMI SHORES FL 33138- 100 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone UNLIMITED PLUMBING TECHNOLOG` (954)624-5827 Type of Work: REDO SHOWER CONNECT FAUCETS AND SIN Type of Piping: REDO SHOWER CONNECT FAUCETS AND SIN Additional Info: REDO SHOWER CONNECT FAUCETS AND SIN Bond Return Classification: Residential Scanning: 1 Fees Due Amount CCF $2.40 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $163.65 !cant SCOTT ALEXANDER Phone Cell (786)282-2104 (305)414-9998 Valuation: $ 4,000.00 Total Sq Feet: 200 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -5-18-67382 06/28/2018 Check #: 1188 $ 113.65 $ 50.00 05/02/2018 Credit Card $ 50.00 $ 0.00 Avauame Inspection Type: Top Out Final 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 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 construction and zoning. Futhermore, I authorize the a Authorized Signature: Owner / Applicant / Building Department Copy June 28, 2018 and that all work will be done in compliance with all applicable laws regulating to do the work stated. / Agent June 28, 2018 1 Miami Shores Village RECEIVED - Building Department MAY 0 2 2016 �� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 R BUILDING Master Permit No.y �1 1u PERMIT APPLICATION Sub Permit No. �- l (0S ❑BUILDING ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL OPLUMBING ❑ MECHANICAL F-] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10V n t c) -)- (J City: Miami Shoresyy�� County: Miami Dade Zia• �fi3313 Folio/Parcel#: �� ,�o-0�� `2710-p i Is the Building Historically Designated: Yes NO Occupancy Type: 7QS Load: Construe qon Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: t( i) D /UF Qa S, City: V4 b A+ -t Tenant/Lessee Na1ne Email: G State: •W"b L Phone#: %k h - ,-� ka_ p: �/tra CONTRACTOR: Company Name: n (1 Address: v y / W �-) City: I qv 1 &4 L"� Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: 0 zip: _-3 Phone#• `S / ' l Certificate of Competency #: Address: %�� I)� City: State: Zip Value of Work for this Permit. $ Square/Linear Footage of Work: Oy Type of Work: ❑ Addition )I ( Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: i; e d ppp S n e A- S'r;v S koye Specify color of color three tile:, Submittal Fee $ Permit Fee $ �� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 ' Q DBPR $ Z ' 2 S Notary $ Technology Fee $ Training/ Education Fee $ Double Fee $ Structural Reviews $ _ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 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. 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 e ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur Sign OWNER or AGENT The foregoing instrument was acknowledged before me this Qom_da of Y21` 20 1% by JGoT[' f� \ , who is personally known to me or who has produced D. L- . as identification and who did take an oath. NOTARY PUBLIC: Sign:�.. � Print:1 , N;?s Q) --t CONTRACTOR The foregoing instrument was acknowledged before me this day of kPau%— , 20 14; by �7— who is personally known to me or who has produced 4l- , as identification and who did take an oath. NOTARY PUBLIC: ign: Print: - () - -�� eal: Awl -It JERYL C. BOYCE MYCOMAIIsslO PE930543 CJERYL C. BO E o,, EXPIRES: October 25, 2019 ss,YC*****sc4i 2019 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 02/24/2014) Unlimited Plumbing Tech. Corp. Hollywood, Fl. 954-624-5827 CFC 1429020 May 18, 2018 State of Florida Miami -Dade County Before me this day, Reniel Santoyo Being duly sworn, deposes and says: That he will be the only person from his company working on the project located at 100 NE 92 St. Miami Shores, Fl. Reniel S toyo Sworn to and subscribed before me this 1851 day of May, 2018 by Reniel Santoyo. Drivers License 11 ern°Bow 05;3 °�25, 2019 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 otice to Owner —Workers' Compensation Insurance Exem Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows icorporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaini 1 g 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. f1. 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 Amployees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: a„ Owner State of County The foregoing was acknowledge before me this 14 day of &A�j , 20—i . By Notary: I SEAL: who is personally known to me or has produced as identification. WCo�ss oBOYCE F, 2019 3 ��' �� 25, 2019