PL-18-113L, Miami Shores VillageeO1S
10050 N.E. 2nd Avenue NE
DBPR Fee 5.25
Miami Shores, FL 33138-0000
CO R'l0A
Phone: (305)795-2204
Permit NO. PL -1-18-113
Permit Type: Plumbing - Residential
Work Classification: AdditioniAiteratioin
Permit Status: APPROVED
Issue Date: 1/25/2018 I Expiration: 07/24/2018
Project Address Parcel Number Applicant
10007 NE 4 Avenue 1132060170490
Miami Shores, FL Block: Lot:
JOHN & CRISTINA BUTLER
Owner Information Address Phone Cell
JOHN & CRISTINA BUTLER 10007 NE 4 Avenue
MIAMI SHORES FL 33138-
500 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
EF DESIGN & CONSTRUCTION (305)409-4581
Type of Work: RUN NEW PVC DRAIN PIPE AND WATER PI
Type of Piping:
Additional Info: RUN NEW PVC DRAIN PIPE AND WATER PI
Bond Return
Classification: Residential Scanning: 1
Fees Due Amount
CCF 6.00
DBPR Fee 5.25
DCA Fee 3.50
Education Surcharge 2.00
Permit Fee 350.00
Scanning Fee 3.00
Technology Fee 8.00
Total: 377.75
Valuation:=
7:__0TotalSqFeet
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -1-18-66132
01/25/2018 Credit Card
01/16/2018 Check #: 118
327.75 $ 50.00
50.00 $ 0.00
Avaname
Inspection Type:
Too Out
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contractor to do the work stated.
0Z!S 9j,( January 25, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 25, 2018
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
RECEIVED
JA_
yN
146 /018
INSPECTION LINE PHONE NUMBER: (305) 762-4949 S
FBC 201
BUILDING Master Permit No. ?(f-6 — l % lZ/,PZ
PERMIT APPLICATION Sub Permit No. PI IR- 113
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
ZPLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
L
CONTRACTOR DRAWINGS
10B ADDRESS: 1 0 d 0 rl NE l V F—
2
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1/3Z eG 0 '20S! !27 Is the Building Historically Designated: Yes NO_
Occupancy Type: 9-I Load: Construction Type: Flood Zone:
L
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): cr vS
Address: l 000)l IVP LA A_\
City:M\ V y 6l( V , "9_'S State: Zip: 3 J
Tenant/Lessee Name: Phone#:
Email:
7 CONTRACTOR: Company Name: i (x Phone#:
Address: 15 6 p j (/t S >LC
City: / /. 0? / r -de M S State: Or7-0,/Zip: 336
Qualifier Name:
y
Q'rcyc Phone#:
State Certification or Registration #: C. , 22 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $_ i 00 D Square/Linear Footage of Work:
Type of Work: Addition Alteration Newlaceair Re Rep / p Demolition
Description of Work: ".j'J V VC crvo/ *2{
7<c
GiI C aj /' / e
Coo n el \` /, / he k/ -Fk' L/ N h
IP /`
Specify color of color thru the:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ .3 •V ) DBPR $ • 2 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
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. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first i ection which oc s seven (7) days after the building permit is issued. In the abse of such posted notice, the
inspection w 1 no be approved a reinspection fee will be charged.
ER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 by
who isSona y o n to
me or who has produced as
MOM
The foregoing instrument was acknowledged before me this
day of 20 by
who i e ovally known td
me 6r who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign: Sign: ,
02
Print: s .°' F : c - Print:
Seal: X50 :
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FF 55 0
Seal: ,
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4 19 •• N.1; MARTHA RODINUEZ
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MY COMMISSION k 0042566
I)IIIIIIN .
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
Notice to Owner — Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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' co ensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGN NC BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTEN S. , A 1 A
Signature. -\-W
er
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this T day of 201S.
BY 811 0,L -l[,.lL issonallwho n to me or has produced
A as identification.
Notary:\\\\\ 111111SI I IS1/
Z
SEAL:
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FF 954760O: e..
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V 11 1 1111\to`
x e
January 16, 2018
State of Florida
County of Dade County
Before me this day Personally appeared Ernesto Monguia who, being duly sworn, deposes and says:
That he will be the only person working on the project located at:
10007 NIE 4.Avenue
Miami Shores, F133138
Sworn to (or affirmed) and subscribed before me this I () day of -AQ-rx--, 2018
By c3 ae%
Personally Know x
Or Produced identification
Tipe of identification produced
k RODRIGUEZ
MSION I G042566
000ba 26, 2020
MGJ=FA,
15600 NW 15 AVE Suite E Miami Gardens, Fl 33169 - Cell 305 409 4581 - Off, 954 249 2145
E-mail: efcontTattor@),h01A1ail.com / Lie #s CGC 1512772 and CFC 1428221
WEB PAGE: WWW.EFCONTIZACTOPCOM