PL-19-72 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 02/26/2019
Location Address Parcel Number
1055 NE 96TH ST, Miami Shores, FL 33138 1132060143710
Contacts
Permit No.: PL-01-19-72
Permit Type: Plumbing- Residential
Work classification. Alteration
Permit Status: Approved
Expiration: 07/10/2019
PATRICE ROBINET Owner PLUMBEST CORP Contractor
1055 NE 96 ST, MIAMI SHORES, FL 331382551 ROBERTO GONZALEZ
718 NW 33 RD AVENUE, MIAMI, FL 33125
Business: 3052138025 plumbestservice@gmail.com
Description: NEW PLUMBING SYSTEM FOR TWO BATHROOMS Valuation: $ 5,200.00 Inspection Requests:
& RESET PLUMBING FIXTURES AT KITCHEN AREA. 3Cf5- 62-4949
Total Sq Feet: 300.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.60
DBPR Fee
$2.73
DCA Fee
$2.00
Education Surcharge
$1.20
Permit Fee
$132.00
Scanning Fee
$33.00
Technology Fee
$4.55
Total :
$229.08
Payments
Date Paid Amt Paid
Total Fees
$229.08
Credit Card
02/26/2019 $179.08
Check # 2308
01/11/2019 $50.00
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
r ating nstructi and zoning. Futh more, I authorize the above named contractor to do the work stated.
Si*ature: Owner / Applicant P Contractor / Agent Date
February 26, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
�BUI ING
PLUMBING
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
❑ ELECTRIC ❑ ROOFING
RECE I
AN 1 201
BY:
FBC 20`
Master Permit No.'� G V J (� � —�5570
Sub Permit No. � L H 9 — _� 2
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ MECHANICAL [—]PUBLIC WORKS [-]CHANGE OF [:]CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 4'_3 77 /"1,— —! 1U / 1• -
City: Miami Shores (� County- Miami Dade Zip: 7 l 1
Folio/Parcel#:1 — � � I "t �� � Is the Builder Historically Deskpated: Yes NO ,z
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �,�LS� �Ld h f't Phone#:_ -�UZ
City: _ lLl ( State: Zip:? -
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Qualifier Name: Ro Le6 g l Phone#: qv5?_ ;'-:?Q2j
State Certification or Registration #: CfiC 1(-42501 f2 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: Crty: State: Zip:
Value of Work for this Permit $c Square/Linear Footage of Work
Type of Work: ❑ Addition Alteration ❑ New ElRepair/Replace ❑ Demolition
Description of Work-9` O
C 4(A4 r n 11� i ,Z 006�i %
Specify color of color thru tile:
Submittal Fee $ 56 Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $,
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I - I • V Qj
(ReWsed02/24/2014)
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
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.
Signature )��:: Zgj-�7_
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20by
y _, who is personally known to
me or wh as produ eo V- . ( D i _ as
identification and who did take an oath.
NOTARY PUBLIC:
Print: 1 [X
Seal: °"°-- LUZ P, MLICH
MYCOMMISSIONi gjCilgW
oFnoPA EXPIRES: May 30, 2W
Signatw
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20.19 by
who is rsonal o to
me or who has produced
as
identification and who did take an oath.
N0
NOTARY PUBLIC:
Oq o
x2nr
Sign:
— C
Print
m
Seal: LUG i
o
Go 199267
MY COMMISSION GG
C
EXPIRES: May 30, 2022
c�
WVVVW
N
v
APPROVED BY `� IzaPlans Examiner Zoning
Structural Review Clerk
(R& sed02/24/2014)
Notice to Owner — Workers' Gom
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exem
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
I . 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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this ao
SEAL:
_ day of (r�`� , 20.
who is personally known to me or as pro
5cation.
"'�� LUZ P. ERLICW
MY COMMISSION # GG 199267
�� EXPIRES'. May 30, 2022
Plumbest Corp.
718 NW 33 Road Ave.
Miami, FL 33125
305-213-8025
Date: O 0
State of BONAI& County of -UJ,,e
Before me this day personally appeared.
R`)"g1_ who, being duly sworn, deposes and says: That he or she will be the only
person working on the project located at:
Contractor Signature Sworn to (or affirmed) and subscribed before me this day of
•
.�. v
by C- ly knol
V4'(?-7Ver7 Personally
Produced Identification.
Type o Identification Produced
�ZVJ,f
Print, Type or Stamp Name of Notary
?0 "�� LUZ P. ERLICH
MY COMMISSION # GG 199267
EXPIRES. May 30, 2022
OR