PL-17-1877 (2)Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
yF—moo` Phone: (305)795-2204
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Permit NO. PL-7-17-1 77
Permit Type: Plumbing - ResidentialPen' 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•
gymgym6jPrint: 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` yz; 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
7CONTENTS.
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:
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4„ • MAHARAI K. GONZALEZ / ' n SelMYCOMMISSION # GG 044602 , ,/, ' l t 1
EXPIRES: November 2, 2020
Bonded TTwNotary Public Underwriters t`
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