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DEMO-18-2107Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address --� Permit NO.: DEMO-8-18-2107 Permit IVR Number. 607852 Permit Type: Demolition Work Classification: Plumbing Issue Date:10/05/2018 Parcel Number Permit Status: Approved Expiration: 02/05/2019 Project 9801-9845 NE 2 AVE, Miami Shores, FL 33138 1132060134380 <NONE> LD Contacts PARK LLC Owner PARK LLC Applicant 4141 NE 2 AVE, MIAMI, FL 33137 4141 NE 2 AVE, MIAMI, FL 33137 A SUNNY PLUMBING COMPANY Contractor OSIRIS CHAVIANO 6800 SW 17 ST, MIAMI, FL 33155 Business:3052817317 ASUNNYPLUMBING@YAHOO.COM Description: DEMO FOR PLUMBING Valuation: $ Inspection Requests: nests: 305-762-4949 Total Sq Feet:0.00 Fees Amount CCF $1.20 DBPR Fee $3.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $200.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $211.20 Building Department Copy Payments Amt Paid Total Fees $211.20 Credit Card $211.20 Amount Due: $0.00 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. OWNER FFI VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulat' g nstr�ction and zoning. Futhermore, I(�au�t/h�orrrii/z7e the above named contractor to do the work stated. i ♦ / / Y Owner / Applicant / Contractor / Agent October 05, 2018 Page 2 of 4 c 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 UG O. j BY V� FFB-CA20 I -ems Master Permit No. Sub Permit No.-V"�--Mo - 2 ( D ❑ REVISION ❑ EXTENSION [—]RENEWAL [VLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q 1 CONTRACTOR DRAWINGS JOB ADDRESS: —1 �© I N� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name ((Fee Simple Titleholder) a'� �LLC ^ Phone#: �o� Address: `1 � 2-1� E` - City: \ ' 1 � cx--L- State: Zip: + Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 0 Phone#: Address:: d _ City:— /p State: Qualifier Name: � t} la ptn Phone#: :�M C�Lv �'1r% State Certification or Registration #: G kAZ � Z � C7 Certificate of Competency #: (=�L 4-2 `(Z 11epw DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:i1ry Specify color of color thru tile: Submittal Fee $ Permit Fee $ also �v CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ 1 TOTAL FEE NOW DUE $ (1 (Revised02/24/2014) t f Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State r" 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. J � Signature OWNER or AGENT The foregoin instrument was ack owI dged before me this 1� I� day of v 20 Lam) � by M who is personally known to me or who has produced identification and o did tak an ath. NOTARY PUBLIC: Sign: Print: CAROLI Seal: r v�"% MY COMMISSION # FF 928131 ac FJCPiREg: October 15, 2019 16� �';; d�?°,• Bonded Thru Notary Public Underwcf Signature CONTRACTOR The foregoing instrument was ackn wledged before me this day of 20 �Q_, by S ` who is personally known to as me or who has produced identification andimho did take an oath. NOTARY PUBLIC: as Sign: Print: I `, = CAROLINA R. HE c Seal: - . MY COMMISSION # FF 928131 EXPIRES: October 15, 2019 ; Bonded Thru Notary Public Underwriters .r APPROVED BY rq/a/fi Plans Examiner Structural Review Zoning Clerk 0 (Revised02/24/2014) i4 SUftftY PLUMBING COMPANY LIC# CFC1427249 September 13, 2018 State of Florida, Miami Dade Miami Shores Village 10050 NE 2"d Avenue Miami Shores, FL 33138 RE: Contractor's Affidavit Property: 9801-9845 NE 2nd Ave, Miami Shores FL. 33138 Folio# 11-3206-013-4380 Permit # Demo 6-18-1704 Owner: 9801 Park LLC 4141 NE 2nd Ave, #204A, Miami, FL 33137 Regarding the Plumbing demolition Scope under the above permit, before me this day personally appeared Osiris Chaviano who, been duly sworn, deposes and says: That he will be the only person working on the project located at: 1-9 5 E 2nd Avenue Mia ' hores FL. 33137 Osiris Chaviano, Plumbing Contractor A Sunny Plumbing Company. License # CFC1427249 Sworn to (or affirmed) and subscribed before me this 131h day of September, 2018 Personally knTn CAROLINA R. HERNANDEZ Publi Nota � 4 {: fJIyCOW-MISSION #FF928131 EXPIRES: October 15, 2019 Pol^nd Thru Notary Pubic Underwriters CC. Maria Fuentes 6800 SW 17 STREET, MIAMII, JFL 33155 305-261-7317 asunnyplumbing@yahoo. com 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: l . 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. Signature: 2�,a, ✓L Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ` day of V , 20J� By who is personally known to me or has produced \IV as identification. Nota CAROLINA R. HERNANDEZ �� ^* + MY CO MMISSIO;b , t'E 928131 SEAL. =;p�= EXP'RE S: Occoser 15; 2Q 9 Bonded Thru Notary Public Underwrko s t i j �,� t -,-,3 1 MT tio) �,� i LIC# CFC1427849 September 13, 2018 State of Florida. Miami Gaat- Miami Shores Village 10050 NE2"d Avenue Miami Shores, FL 33138 RE: Contractor's Affidavit Property: 9801-9845 NE 2nd Ave, Miami Shores FL 33138 Folio# 11-3206-013-4380 Permit# Demob-MI704 Owner: 9801 Park LLC 4141 NE 2nd Ave, #204A, Miami, FL 33137 Regardingthe PI umbing demol ition Scope underthe above permit, before me this day personaliy appeared Osiris Chaviano who, been dulysworn, deposes and says: That he wiI I be the only person working on the project located at: 9801-9845 NE 2nd Avenue Miami Shores FL 33137 Osiris Chaviano, Plumbing Contractor A Sunny Plumbing Company. License#CFC1427249 Sworn to (or affirmed) and subscribed before methis 13' day of September, 2018 Personally known j 0e ,��,, Pilar Masci Moral P Commission # FF995206 - Expires: May 23, 2020 Pu otary ��� „� ..�' Bonded thru Aaron Notary CC. Maria Fuentes 6600 SW 17 STREET. MIAMI, FL 33155 305-281-7317 asunnypiumbing@yahoo.com