PL-19-308Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/21/2019
Parcel Number
671 NE 105TH ST, Miami Shores, FL 33138 1122310120100
Contacts
Permit NO.: PL-02-19-308
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 11/04/2019
UNAM 671, INC Owner
MARCO BRUZZI
671
H. BETO'S PLUMBING INC Contractor
SAYDA WALESKA HERNANDEZ
8454 NW 24 PL, MIAMI, FL 33147
Business: 7863681902
Description: INSTALL PLUMBING FOR NEW POWDER ROOM Valuation: $ 3,700.00 Inspection Requests:
305-762-4949
TOILET AND SINK AND OUTSIDE KITCHEN SINK
Total Sq Feet: 2,400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
Change of Contractor
$110.00
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$79.50
Scanning Fee
$3.00
Technology Fee
$3.24
Tota I :
$252.94
Payments
Date Paid
Amt Paid
Total Fees
$252.94
Credit Card
02/11/2019
$50.00
Credit Card
07/03/2019
$110.00
Credit Card
03/21/2019
$92.94
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
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Si a re: Owner / Applicant / Contractor / Agent
July 03, 2019
Date
Page 2 of 2
Miami Shores Village
—TI
BUILDING
PERMIT APPLICATION
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
FBC 201-1�°�
Master Permit No. Tz` --02 —� 0�
Sub Permit No.p-- o-z4q-
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
®PLUMBING ❑ MECHANICAL [--]PUBLICWORKS ® CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 671 NE 105 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): UNAM 671, Inc. Phone#:
Address: 671 NE 105 St.
City: Miami Shores State: FI. Zip: 33138
Tenant/Lessee Name: Phone#:
Email: / / f C
CONTRACTOR: Company Name: f� �('��Q�S �%1 (ili% f �i 9 1"r Phone#: �a �7� 21
Address: g qS T /
City: ii� / State: 10 ✓ 1 Zip: a3 l Y .
Qualifier Name: S aYD12 (A). Phone#: 3CKR 2
State Certification or Registration #: ��' �iZ 72 Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phone#: (305) 310-5030
Address: 370 NE 101 St. City: Miami Shores State: FI. Zip: 33138
Value of Work for this Permit: 3- (30 Square/Linear Footage of Work: 40 Sq. Ft.
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of work: Install plumbing for outside bathroom, I toilet, I sink and future water lines and waste line for outside
kitchen
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
,CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 110 • GO
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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 issued. In the absence of such posted notice, the
inspection will not be app oved and a reinspection fee will be charged.
Mar Bru (VP- UNAM-671, Inc.)
Signature w Signature
OWNER or AGENT <--� CONTRACTOR
The foregoing instrument was acknowledged before me this
day of Jy>'tk _ - 20 1G by
Marco Bruzzi who is rsonally know to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
Seal: , :{ t,N-, LUCIAG.ISASI
w cC1MM18 m all GG 24747s
' EXPIRES: December 10, 2022
gP A4• Bonded Ttru Notary Public U XIWfibm
APPROVED BY
as
The foregoing instrument was acknowledged before me this
nd
1 .1 day of �1 O I� 20 Q by
c�[ kcrn riPZ , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 1 t'
Seal: �mw VILMA SMCM
MY cOMM1 001:M
EXPIRES laanat07.2m
********************** **************
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Corner's Name (Fee Simple side rloider): NUAM, 671 Inc.
Owner's Address: 671 NE 105 St.
City: Miami Shores S=e
Fl.
ch Address (Of where work is being done):_671 NE 105 St_ _
City: —.—Miami Shores State Ftot da
Miami ZOholes lVillage
Building Department
Phone
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
tax: (305) 756.8972
Zip Code: 33138
Zip Code: 33138
Contractor's Company Nsnie: Marino Construction Engineering Phone—: (786) 443-1685
Address: 17082 SW 91 Ave.
City: Palmetto Bay State: Fl. -ip Code: 33157 _
Qualifiers Nar:e : Fausto E. Guerrero f _.ic_ Number. CFC 14291691
nr.ni.eal Engineer of Record Name:
Address: 370 NE 101 St.
C,ty: Miami Shores
Victor Bruce
Satz: Fl.
?hone -':_ 305 310-5030
Zip Code: 33138
Describe Work: Install 112 bath. Toilet, sink, septic connection. water line and waste for future outside kitchen
h-aF'ebV certli� Chat the work has been abandoned andlor the contractor/architect
:s unable or unwilling to complete the contract. 9 hold the Building Official and the
Miami Shores harmless of all legal involvement.
�1�r,�1� Br i Fausto-E.uerraro
Signature 1 sY�/iiY,�r i �.
Ovm ar .�� et Contracter
The fore.zomz inscru}}went was aknowledgcd before me The for ego:ng in strume nt was aknowledged be`cre nne
[his day ofW201q,baV� Uthis Z 7 day of
Whc is rsonz iy kr.o tc me or who has produced Nyho is personally known to me or who has prod" reed
as indeniifirµ_jen. ; inderniectticr:.
Notary F ' ilC:
Sea': ,•�.
y :o UICIAG.ISASI
COMMISSION # GG 247475
EXPIRES: December 10, 2022
8arnfn! ]luu Notary PuNk uw Ww tens
tai4t:3,ry I'bFk?liC?
Sim:
�r_
Seal:
=40.vp . PATRICIA ACOSTA
MY COMMISSION # GG005073
°CSt� EXPIRES July 24.2020
(407)3Yt-01S3 fbldr+Nda service can
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 YO EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
'��"�'v' �.�•
,k%?vr,jveJA MAA.4ri I
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of h'i (1y C 1L , 20_JC1 .
By E Yyion V d U �" � cAyn ZZ ; who is tonally kno to me or has produced
A /� as identification.
Notary:
-LWAO. US
W COMMISSION i GO 247475
EXPIRES: December 10, 2022
Marino Construction Engineering, Inc.
DBA Marino Plumbing Solutions
License # CFC7429769
17082 5W 97 Avenue, Palmetto Bay FL. 33757 * PHONES.' (786) 4431685 * FAX.- (305) 9710240
GENERAL CONSTRUCTION
Date. -
State of Florida
County of Miami Dade
To whom it may concern:
Before me this day personally appeared ---- who being
PP ---------------------- -
duly sworn, disposes and says:
That he will be the only person working on the project located ar
_ 7 i_o%_ is s--�� *,e - --- ----------------
Sworn to to ,Rvaff/ m subscribed before me this ! __- day of--WAee# _, 20-0 ,
by- -------------------
Personally Known to me ---- "_W_`___
OR Produced Identification ----
Type of Identification Produced
Type, Print or Stamp Name of Notary
PATRICIA ACOSTA
1 MY COMMISSION # GG005073
EXPIRES July 24, 2020
(407) 3oB-0163 FbtiOallotaryService.ccm
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
NIM
Issue Date: 03/21/2019
Parcel Number
671 NE 105TH ST, Miami Shores, FL 33138 1122310120100
Contacts
Permit NO.: PL-02-19-308
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 09/17/2019
UNAM 671, INC Owner MARINO CONSTRUCTION ENGINEERING Contractor
MARCO BRUZZI INC
671 FAUSTO E GUERRERO
17082 SW 91 AVE, PALMETTO BAY, FL 33157
Business: 7864431685
Description: INSTALL PLUMBING FOR NEW POWDER ROOM Valuation: $ 3,700.00 Inspection Requests:
TOILET AND SINK AND OUTSIDE KITCHEN SINK 305-762-4949
Total Scl Feet: 2,400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$79.50
Scanning Fee
$3.00
Technology Fee
$3.24
Total:
$142.94
Payments
Date Paid Amt Paid
Total Fees
$142.94
Credit Card
02/11/2019 $50.00
Credit Card
03/21/2019 $92.94
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
regulating construction jaAd2o"g. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent
Date
March 21, 2019 Page 2 of 2
pECEIVED
Miami Shores Village 4.FB 112019
Building Department B
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 2W 4
Master Permit No. (Lt—\ - OZ-Iq -30�)
Sub Permit No.?L-0Z- 1
❑ REVISION ❑ EXTENSION ❑RENEWAL
®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 671 NE 105 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): UNAM 671, Inc. Phone#:
Address: 671 NE 105 St.
City: Miami Shores
Tenant/Lessee Name:
Email
State: FI. Zip: 33138
hone#:
vc,v IU N ,ter i,�j I noc'-j 11 n .
CONTRACTOR: Company Name: 1ti 0p Phone#: 3
Address: 177 o g i;L 9. L%)- -1 I POL
City: I Stater Zip:Lm /S -1
Qualifier Name: cp > Phone#: aN<- S 82- O 1?03
State Certification or Registration #: _E�Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phone#: (305) 310-5030
Address: 370 NE 101 St. City: Miami Shores State: FI. Zip: 33138
Value of Work for this Permit: $ �, G C a'O Square/Linear Footage of Work: 70 OF
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Descriotion of work: Install plumbing for new powder room toilet and sink and outside kitchen sink
Specify color of color thru tile:
Submittal Fee $ 50' (30 Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Marco Bru i VP- UNAM-671, Inc.)
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_ day of I Y 20 �G by �� day of � u�� 20 / / by
Marco Bruzzi voo is per nally know o O oe010112 who is personally known to
me or who has produced as me or who has produced �/� as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLI
Sign: Sign:
r • '' ,.0 fPA TI
Print: Print: 9$
Seal: i �!�P,''•. LUCIAG.ISASI Seal: 9 EXPIRES July 24. 2020
MY COMMISSION 8 GG 247475 (407)'� FO"dsNots $°""" CO11
-9 EXPIRES: December 10, 2022
B"4W Thor Notary Pubk Und w hers
APPROVED BY �/ �. Plans Examiner a.'�. Zoning
Structural Review
Clerk
(Revised02/24/2014)