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PL-15-1466j'Z Miami Shores Village ,sNones g' 10050 N.E. 2nd Avenue NE r $2.25 Miami Shores, FL 33138-0000 $2.25 Phone: (305)795-2204 �LOR�DP' Permit Fee Permit NO. PL -6-15-1466 Permit Type: Plumbing - Residential Perm'It Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 7/7/2015 1 Expiration: 01/03/2016 Project Address Parcel Number Applicant 10634 NE 11 Avenue 1122320280650 TUYEN TIED Miami Shores, FL Block: Lot: Owner Information Address Phone Gell TUYEN TIEU 10634 NE 11 Avenue MIAMI SHORES FL 33138- 10634 NE 11 Avenue MIAMI SHORES FL 33138 - Contractors) Phone Cell Phone PINO'S PROFESSIONAL PLUMBING It (305)323-2455 of Work: INSTALLING FAUCET of Piping: onal Info: Return : ,ification: Residential Scanning: 3 Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 Valuation: $ 300.00 Total Sq Feet: 00 Pav Date Pav TVDe Amt Paid Amt Due I Invoice # PL -6-15-55978 07/07/2015 Credit Card 06/15/2015 Credit Card $ 115.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: 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 AFFI VIT: I Artify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and kning. Fu ermore, I authorize the above-named contractor to do the work stated. July 07, 2015 Auth`�Sig :Owner / Applicant / Contractor / Agent uare Building Department Copy July 07, 2015 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 rvED JUN: 17-15 2015 BY: FBC 2016 Master Permit Nq�C Z�__ - /U G Sub Permit Nop ❑ REVISION ❑ EXTENSION ❑RENEWAL 51 PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 73 9 Folio/Parcel#: Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): iN *1 the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: one#: 7% Til S� -13 i q Address: City: JSA A'y�. t S State: FL Zip: 331 3 Tenant/Lessee Name: Phone#: S�� Email: CONTRACTOR: Company Name: t?1NU tS, P20ACSSIONAL ( [_L'm6 1 5 Phone#: 30C 323 2_4(T3_ Address: OS -9 I. SIAJ Z!K- �-R-2 City: ��� State: Zip: 331'1S� Qualifier Name: 'PING Phone#: -36-5- 323 LAST Sta a Certification or,,Registration #: 7? 35 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ Type of Work: © Addition Description of Wor02.��� �JO��y ❑ Alteration k/ City: State: Zip: Square/Linear Footage of Work: ❑ New Repair/Replace ❑ Demolition a- •n..,reg:.xs°km.•:,d�rrw.a'Ita.tTt;.„ea�:..a�! #Y:n±� w. Specij, color of color thru tile. •3 _ i -y Submittal Fee $ Permit Fee $ U . CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Co'mpany'slName (if `applicable) Bonding Company's Address City State 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. ! p t I "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 occurseven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b apiJN nd a . spection fee will be charged. t Signature Sign atur o CONTRACTOR The foregoing instrument was acknowledged before me this �— day of VIQp , 20 k(�;;_, by n✓IG f �..1iS 1�2C� who is personally known to me or who has produced identification and who did take an oath. NOTARY PIJPAIC: ® v Print: �•oi v Pie MIGDALIA MARTIN Seal: cr • ° z Notary Public - State of Florida My Comm. Expires Jan 5, 2018 Commission #E FF 080964 ********** The foregoing instrument was acknowledged before me this day of V? Q_,,/ 20 rb by o is personally know me or who has produced as identification and who did take an oath. NOTARY Sign: Print: Seal: Notary Public - State of Florida N o;? My Comm. Expires Jan 5, 2018 OFF ,d,Commission # FF 080964 *************************************************************** APPROVED BY �G -2-f- /3 Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk a, T= -1&L ---1W- -'F-J 13841 SW 25 Terrace MIAMI, FL 33175 PH # 305-323-2455 CFC 1427235 June 12, 2015 State of Florida County of Miami Dade Before me this day personally appeared ALEX PINO who, being duly sworn deposes and says: That he will be the only person working on the project located at: 10634 NE 11 Avenue. Sworn to and subscribed before me on this 12th day of June, 2015 by Alex Pino, who is personally known to me. A- PVe(°, MIGOALIA MARTIN ,. Notary Public -State of Florida My Comm. Expires Jan 5, 2018 I Commission N FF 080984 Page 1 1 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. r. Signature: State of Fli County of Miami -Dade Theforegoingwas acknowledge before me this �2- day of V V V1 (2-,)20' By 1 OVIn �U jeYj t< < n who is personally known to me or has produced Notary: SEAL: 0,1111108" _V MIGDALIA MARTA Notary Public - State of Flori My Comm. Exolres Jan 5. 2018 lel Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236853 PermitNumber: PL -6-15-1466 Scheduled Inspection Date: December 08, 2015 Inspector: Diaz, Osvaldo Owner: TIED, TUYEN Job Address: 10634 NE 11 Avenue Miami Shores, FL Project <NONE> Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)218-2387 Parcel Number 1122320280650 Contractor. PINO'S PROFESSIONAL PLUMBING INC Phone: (305)323-2455 Building Department Comments INSTALLING FAUCET INSPECTOR COMMENTS False Inspector Comments Passed L Failed Correction 1 Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 07, 2015 For Inspections please call: (305)7624949 Page 9 of 44