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PL-19-2337Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 issue Date:10/23/2019 Location Address Parcel Number 74 NW 108TH ST, Miami Shores, FL 33168 11213601101SO Contacts Permit NO.: PL-10-19-2337 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 04/20/2020 Cory Mullinare Owner 74 108 R & I PLUMBING SERVICES Contractor RENE GUZMAN 7898 NW 174 TER, MIAMI, FL 33015 Business: 3058236911 Other:7864136365 on Re Description: REMOVE & REPLACE MASTER BATHROOM Valuation: $ 2,700.00 Requests: r-7102Inspection Re REMODEL Total Sq Feet: 80.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 10/03/2019 $50.00 Credit Card 10/23/2019 $61.90 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. OWNERS AFFIDAVIT: I certify that Althe foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fu*rknore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date October 23, 2019 Page 2 of 2 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 P'ECEIVED OCT 0 3 z03 FBC 20(-t Master Permit NoJ�C- 10 -1 cl - 01335 Sub Permit No.FL - I d ` I G 9 33� ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP T CONTRACTOR DRAWINGS JOB ADDRESS: q `t _ u u) t o ) _s�Y C Miami Dade Zip: 3b k 3 8 City. -Miami Shores County: 4 / Folio/Parcel#: /�-�,I3�--0��—��J�� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type:: Flood Zone: BFE:: FFE: OWNER: Name (Fee Simple Titleholder): (Oc!�_jWU AC{`Q Phone#: M- 0 y�b�� Address: Ju W 01z <w— City: c?�k ck_tj�l State: Zip: �I 7 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:��<U�� Phone#:S Address: City: State: Zip:3 O 5 Qualifier Name: ���/� ��'��� Phone#: State Certification or Registration #: Certificate of Competency #: © Z5 OcO no i 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 ❑ De lition � Description of Work: pcp V)�-t l � K_(h�Z •a a+_y C i ►pecy? color of tile: Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary S Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $� n (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) ` Mortgage Lender's Address City I State , Zip I 1 U 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. 1 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 Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 l by �+ ( % �t J��(e �], who is personally known to me or who has produced �L��F �N f l as identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR The foregoing instrument was acknowledged before me this day of Sp 1�ts Vv,bf r— 20 (G , by .yLa�lutye who i ersonally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print:AR Jules A. Print 3-9� cost • 'i Seal: Seal: : rMAR%PONCE �' •. s a4 • 1': Notary Public State of Florida u * ` Commission M GG 296294. orb., My Comm. ExpiresM4r'22,2023 londed through National Notary Assn. APPROVED BY IC � Plans Examiner Zoning 1. 1 Structural Review (Revised02/24/2014) Clerk Re: R & I Plumbing Services Corp. 7898 NW 174 Terrace Hialeah FI. 33015 CC #03P00004 Date: 9/27/2019 State of Florida County of Dade Before me this day personally appeared _ Rene Guzman who being duly sworn, deposes and says: That he or she will be the only person working on the project located at:_ 74 NW 108 St Contractor Signature:, Sworn to (or affirmed ) and subscribed before me this day of seoy nwe r20� '11_ byil 21ne (--,c a 2. -►- C. vA 6r�son�allyow Or produced Identification Type of Identification produced MARBIS PONCE :° • 14�. Notary Public - State of Florida a : Commission # GG 296294 '' ., rn My Comm. Expires Mar 22, 2023 Bonded through National Notary Assn. Print, Type or Stamp Name of Notary 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 sation 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 he 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 Z day of 0CT , 20—ka—. By l m ��`�' , c V��' who is personally known to me or has produced )>(= O R as identification. Notary: � Jules COMUGG35 67 SEAL: '* BO flute 3O, ZO�i �a A8ron Notary