PL-19-2202Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
a
I�C�I�1�P:1 h5
Issue Date:12/16/2019
Location Address Parcel Number
969 NE 92ND ST, Miami Shores, FL 33138 1132060060031
Contacts
Permit NO.: PL-09-19-2202
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/15/2020
Dwight Bourne Owner MAAFA ENGINEERING CORP. Contractor
969 NE 92 ST, Miami Shores, FL 331382910 AURELIO FERNANDEZ
12260 SW 8 ST SUITE 155, HIALEAH, FL 33016
Business: 7864260936 ajfatwin@hotmail.com
Other:7864260936
Description: BATHROOM RENOVATION luation: $ 500.00 Inspection Requests:
49
TotalSq Feet: 65.00 i I
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
Work Without Permit 1st Offense
$100.00
Total:
$210.30
Payments
Date Paid Amt Paid
Total Fees
$210.30
Credit Card
12/16/2019 $210.30
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
regulatigg-cpnstructicgn-aN zoning. Futhermore, I authorize the above named contractor to do the work stated.
Si4aatwe-6wner / Applicant / Contractor / Agent Date
December 16, 2019 Page 2 of 2
DIVED
BUILDING
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
SE2 0 2019
BV
'a T14
FBC 2019
Master Permit No. Tu`U6—
PERMIT APPLICATION Sub Permit No. F (.,;-UC'1- I C)- 'zzoz
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
s4PPLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
� ( (�(� r CONTRACTOR DRAWINGS
JOB ADDRESS: k ( KJ"I �- �^ "( 2-�� -r,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Bd�Iding Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Ve? 1 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address: t
G ba- i q 2.f jr-> $ 7
City: th ri= i s=44e2_E=�s State: zip:3�1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A JA m �Fi 1 ^✓LL-C f �✓1 f p Phone#:
Address:_.
City: kc- At- c State: L Zip: ?101 6
Qualifier Name: I d-M c✓ &_.0 /- / Phone#:
State Certification or Registration #: IC C I �.� Z %Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ r»� O CD Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: T l AI•lCrfc U,-a"- i tom-` % X 1 u � _44+: j C. E
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 110 • 30
(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 inspection which occurs seven (7) days after the building permit is issuV
the absencefiu
ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatu
The foregoing instrr(ment was acknowledged before me this
0 CQ day of � 120 � by
'bW 16t+ri u IL1 Fes-, who is personally known to
me or who has produce as
identification and �, id takcftpflW. Duignan
NOTARY PUBL Isk
UnInmwo'lo 40
.*= Expins: March 11, 2023
%,��� • ``\`°,; Bonded Thru Aaron Notary
Sign: �►InN
Print:
Signature,
CONTRACTOR
The foregoing instrument was acknowledged before me this
d G day of 20 ( 5 by
V l6 (f -D 0 personally to
me or who has produced
identification h�hdidxake _
`�pY PJ,�•,'•, TI SUSANAVOIZ-GONZALEZ
NOTARY PUB C
f,iY 4 �Ai�ISSiON # GG 007879
*:
^� EXPIRES: July 4, 2020
a ru otay I Underwriters
Sign:
Print:
Seal: Seal:
as
s*ss**s*****ss*ss*a*s*•sss*****s**sss*ss*s*s******ss*s**s**s*sssss*****ss****s**s*a*s*sss*s*ssssssss*ss*a*:*
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
f>�
MAA A ENGINgERING
2129 W 53 St
CFC142MM
Date Q: --01- U[T
State of 9't ny' Z A
County of P"6'
Before me this day personally appeared eing duly sworn.
deposes and
That he or she will be the only person working on the project located at
Sworn to (affirmed) and subscribed before me this a' day of J17LL4 2019
,by
Personally known ! "°"" TS `°'t �
Eµrte isi�e GG 193011
'�*W EYP,� 0y0An032
try
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.
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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.
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of C 20
ByIwi; t
L
Nota
SEAL:
OUrn4
who is personally known to me or has
as identification.
PNp,DY PR....I O'/--
i
y #GG 287268 _
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