PL-19-2941Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Fr- @)G'C�i�i�I�i�
Ism Date: 03/05/2020
Location Address Parcel Number
149 NE 99TH ST, Miami Shores, FL 33138 1132060132200
Contacts
Permit No.: PL-12-19-2941
Permit Type: Plumbing - Residential
Work Classification: AReration
Permit Status: Approved
Expiration: 06/ 10/2020
SAMUEL SORIERO Owner R&E PLUMBING SERVICES CORP Contractor
14999 MIGUEL CABRERA
Home: 3054799857 sam@1011c.com 4258 SW 96 AVE, MIAMI, FL 33165
Business: 7865873269
Description: REMOVE & REPLACE ALL PLUMBING AS PER NEW Valuation: $ 11,600.00 Inspection Requests:
CODE r-762-4949
Total Sq Feet: 1,800.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.20
DBPR Fee
$6.09
DCA Fee
$4.06
Education Surcharge
$2.40
Permit Fee
$356.00
Scanning Fee
$3.00
Technology Fee
$10.15
Work Without Permit 1st Offense
$406.00
Total:
$844.90
Payments
Date Paid Amt Paid
Total Fees
$844.90
Credit Card
03/05/2020 $794.90
Credit Card
12/13/2019 $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 a d/that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named con actor to do th9j0Astated.
Authorized Signature: Owner / Applicant / Contractor / 'Ag4nt— Date
March 05, 2020 Page 2 of 2
I r=M Plumbing_Service, Co I
331 NW 132nd CT. Miami, FL. 33182
0 Email: info@replumbingservice.com
Web: www.replumbingservice.com
786-587-3269
—�--
Lice-CFX, 1429569
ll:1'l`E: 03Al2/2020
Miguel Cabrera Del Sol
Miami Shores 6'illage
1554.1 SW 163 ST
Building Department
Miami fl 33157
10050 NE 2" d A VE
Miami Shores, Florida 33138
I
Tel. (305)795-2204 Fax: (305) 756-89 72
—
State of _ ui
County of l
Before me, this day personally appeared V l W"L,6"—i"ho, being duly sworn
deposes and says: U�
That he or she will be the only person working on the project located at
ContractjorH,o!}ld�er Name Sign ure of Contractor
State of
County of vv�y�,1cG
Sworn to (or arined a d subscribed before me this day of
2020 by =� $jt4
�A/►A.�►A#.AAA �. A. �. �►.� J � a. Y
WiAry PubW $t*W d fWgW
MyPOM
COW-M46 mG0137M
e.. ..,L0r" 0211O=4
Signature of notary public -state of
personally Known _ or produced Identification ` Type of Identification. Produced
BUILDING
PERMIT APPLICATION
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
FBC 20
Master Permit No. �rj 4 1 - ---3V&
Sub Permit No. `1"j�l: Iz— 19 —Z r4
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: r3 3 139
Folio/Parcel#: / / - 3W --0/3- 2-SOd Is the Building Historically Designated: Yes NO
Occupancy Type: k� — Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder):
Address: l'
City: (2 S� �k
Tenant/Lessee Name: J Email: 00--w\ (c
CONTRACTOR: Company Name
Address:
City:
Qualifier Name:
State: ��( Zip: �1022
ff Phone#: �—
C C n we
Phone#:
71v
Zi
Phone#: I
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: lie State: Zip:
i
Value of Work for this Permit: $ uare/linear Footage of Work:
Type of Work: ❑ Addition Alteration D New ❑ Repair/Replace ❑ Demolition %
Description of Work: .)E?- N--0 -\-e e JS 124 /i0'Ge 4-GZ
Specify color of color t u tile:
Submittal Fee $ �0� 1 Permit Fee $ '4-0 (-• 0Z) CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CO/CC $
Notary $/�9/
Double Fee $ —tEJ{e+ O
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ Y I V
--)14.9()
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.
Signature T� J'' I-r�rignature I 1
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
Z day of CC -CAA e%, 20 • , by
_ — ho is perso Enown to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
Z of 20 , by
r4da ' who is personally known to
me or who has produced
identification and who did t � ''•, EYBELL PEREZ
= Notary Public -State of Florida
NOTARY PUBLIC: Commission M FF 962591
My Comm. Expires Feb 18, 2020
Sign: -- �--� Sign:
Print: /Z, Gy Print:
� c
Seal: F Seal:
Notary Public State of Fonda
Juan P Rodriguez
My Commission GG 254582
61 Expires 09114/2t)22
APPROVED BY 11�elxe� Plans Examiner Zoning
as
(Revised02/24/2014)
Structural Review
Clerk
JIMMY PATRONIS
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 1/15/2020
PERSON: MIGUEL CABRERA
FEIN: 473283070
BUSINESS NAME AND ADDRESS:
R&E PLUMBING SERVICE, CORP
4258 SW 96 AVE
MIAMI, FL 33165
SCOPE OF BUSINESS OR TRADE:
Plumbing NOC and Drivers
EXPIRATION DATE: 1/14/2022
EMAIL: INFO@REPLUMBINGSERVICE.COM
IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S.. Certificates of election to be exempt issued
under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or
trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be
exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate
no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01101607 QUESTIONS? (850) 413-1609