PLC-19-3009Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
ID
U ul", L"U
issue Date: 01/10/207-
Location Address Parcel Number
723 NE 91ST ST 1C, Miami Shores, FL 33138 1132060440090
Contacts
Permimo.: PLC-' 2-l' 009
Permit Type: Plumbing - Commercial
Work Classification: Altemtilan
Permit Status: Approved
Expiration: 07/08/2020
Eduardo Caram Owner FIX PLUMBING CORP Contractor
850 NE 70 ST 1C REINIEER MEDINA
8025 NW 8 ST 1, MIAMI, FL 33126
Business: 7863438127 alejandro@rconstgroup.com
Description: REMOVE AND RESET KITCHEN SINK Valuation: $ 800.00 Inspection Requests:
TotalSq Feet: 16.00
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
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
12/27/2019 $50.00
Credit Card
01/10/2020 $60.30
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 the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. F h rmore, I authorize the above named contractor to do the work stated.
Authorized Signature: Oivneef#�O' /, ' Applicant / Contractor / Agent Date
January 10, 2020 Page 2 of 2
Miami Shores Village
IN
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: 1305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
QPLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: 723 ne 91 st unit 1 c
EC 217 2k19
BY: \ 1 /b
F��BC r/#
210 �J
Master Permit No. d i O r l �1
Sub Permit NoTI_l- 1 ':a_ 1 I —Sool
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: I FFE:
OWNER: Name (Fee Simple Titleholder): A i 'v Phone#: -�' 3C)5 q -ff O 33,?q
Address: X kso "ia go st
City:X A tee' M Stater' Fzip:' 3313�
Tenant/Lessee Name. -
Email
CONTRACTOR: Company Name: fix plumbing core
Address: 10398 nw 127 st
City: hialeah gardens
Qualifier Name: reinier medina
State: florida
State Certification or Registration #: cfc1428618
DESIGNER: Architect/Engineer:
Phone#:
Phone#: 7863438127
zip: 33018
Phone#: 7863438127
Certificate of Competency #: _
Phone#:
Address: City:
Value of Work for this Permit: $ 800.00 Square/Linear Footage of Work:
State:
Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace
Description of Work: remove and reset kitchen sink
Specify color of color thru tile:
❑ Demolition
Submittal Fee $ MOM M Permit Fee $ 1 IQ CCF $ 0 • 00 CO/CC $
Scanning Fee $ Radon Fee $ 2. (DU DBPR $ 2• QQ Notary $
Technology Fee $ 2 • '"QC) Training/Education Fee $ 0 • 2-0 Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ LaD An
(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
ELI
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
?P day of n"Pe;gZrt0CYL , 20 19 by
6WAr(U_op who is personally known to
me or who has produced as
Signature l
CONTRACTOR
The foregoing instrument was acknowledged before me this
/10 day of Gr p 20 If , by
who is personally known to
me or who has produced �_0g350%3Z` 91.S 00 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Z",
Sign: .ens Sign:
Print: F IZAR Print:
Seal: _.� P`,.•EXPIRES: August28,2023 Seal: f�
ti0f1d9d iiW Ptutary PUtINC UI1d81VVltbla _
r' - s9w'vMiSVtit'FRAGA NAp Jdpida i '•
Rabdc�vbtaiaiba
APPROVED BY c� 1 ems- Plans Examiner J Zoning
Structural Review Clerk
(Revised02/24/2014)
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:
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 %vith 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 gill
be the only person allowed to work on your project. In these circumstances, klianti 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 I'l
CONTENTS.
Signature:
Owner
State of Florida
Countv of Miami -Dade
The foregoin_ was acknowledge before me this /GI 20
day of 3✓
By �/��„� Cry may, who is personally known to me or has produced
Ivv 402 u as identification.
R
SEAL �. = QA nnT" ..
=': �� S October 25, 2020
FIX PLUMBING CORP.
Date
01/06/2020
State of G e,,
County of
Before me this day personally appeared who, being duly sworn,
depose and say:
That he will be the only person working on the project located at:
as 3 N4c sC 1 c ,.�i �..,► ��,a,�., �'�, 33�
Contractor Signature
Sworn to (or affirmed) and subscribed before me this i!� day of La . 20 20
By
Personally know
Or Produced Identification_ I,CCL>Sr—
Type of Identification Produced s A 33h O -+S- 2 49 5aC) ,
JEWIFFERANDREINAVILLAMM
MY COMMISSION 0 GG 908737
I S: Augud 28, 2023
n
Print, Type or Stamp Name of Notary