PL-19-2623Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/17/2019
Location Address Parcel Number
379 NE 100TH ST, Miami Shores, FL 33138 1132060135390
Contacts
Permit NO.: PL-11-19-2623
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/16/2020
AARON FEUER Owner EDWARD ROJAS PLUMBING CORP Contractor
EDWARDO ROJAS
Business: 3057219179 KRISTENLHOLT@HOTMAIL.COM 880 NE 111 ST, BISCAYNE PARK, FL 33161
Mobile: 3057219179 Business: 3059446788 EDDIE.ROJAS@HOTMAIL.COM
Home: 7864439846
Description: REPLACE EXISTING PIPE AND SEWER LINES Valuation: $ 10,000.00 Inspection Requests:
REPLACE FIXTURES 305-762-4949
Total Sq Feet: 200.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$6.00
DBPR Fee
$5.25
DCA Fee
$3.50
Education Surcharge
$2.00
Permit Fee
$300.00
Scanning Fee
$3.00
Technology Fee
$8.75
Total:
$378.50
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$378.50
Credit Card
12/17/2019 $378.50
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 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.
nature: Owner / Applicant / Contractor ! Agent
Date
December 19, 2019 Page 2 of 2
Miami Shores Village ENTnRErn
Building Department NOV ° 19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-0949
FBC 20 1"-1' '" . V)
�L BUILDING Master Permit No. I q — A i0 �L 3
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C� CONTRACTOR DRAWINGS
JOB ADDRESS: + i�d ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: R 320 ( d 13 5990 Is the Building Historically Designated: Yes NO
Occupancy Type: 1 FJtM'+Load: Construction Type: W S Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): AAA kyx Fww Phone#: 3dS 721 91 -9 7
Address: 3+ 1 K_ 10 o i l
City: Kip. .%Jye., State: � � Zip: :M3fr
Tenant/Lessee Name: r ,�_ Phone#:
Email: K'/1.Y)� t yD It �'`�
1p
CONTRACTOR: Company Name:
Address: ';� c1n IU.
one#7-h�.
City:' !4 ! / � Ri State: T �. • Zip: 3 SW
Qualifier Name: (-I,(., e4i f' Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ O (0,0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New SK Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
CCF S
CO/CC $
DBPR $ Notary $
Double Fee $
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
ZI
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, dPLUMBING, 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 IMPROVEMtNTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULTWITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCCEMENV', .
Notice to Applicant: As a condition to the issuance of a buildin j g permit with on estimated. value exc-
eeding $2500, the applicant must
promise in goad faith that a copy of the notice of commencement and construction h6n law brocirurel will be delivered to the person
whose property is subject to attachment. Also, a cerfled 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—liq Signature f0 ((
OWNER or AGENT C ANTRA OR
The foregoing instrument was acknowledged before me this
day of Sq,CG f/ 20 19 by
t7 �'"i 6i who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before
me this
—� day of 20 ! - J by
�dc �x't►�UP >> who i personally know to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:t/��'LC
// Sign:_
Print
Print:
Seal: rotit�%YPu�c ARLENEARMELY Seal:
+ . MY COMMISSION # GG 067100
�9l
A' EXPIRES: April 2021
#########��#a�##1kYtse+��kMriKlilglYWigt�oet(p�#t#####################*##
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ANA WISA PARRILLA
Florida
Notary Public - State of
•
Commission M GG 090452
. ry,J��jj
d s
My Comm. Expires Apr 21, 2021
9j�!,'!„�"• ••
Bonded through National Notary Assn.
as
***********************
APPROVED BY <=5 �— O��cL Plans Examiner Zoning
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:
l . 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.
Signat
Owner
A4aON �
State of Florida
County of Miami -Dade 9
The foregoing was acknowledge before me this / day of ��C C ►n i! C-1 20A.
By who is Eiy known o me or has produced
as identification. X`
�♦ �a y/t'� Vz
Notarysss�;v�,�
G aE� 1
� N
SEAL: ?,t
Z ��G 23ogg
EDWARD ROJAS PLUMBING
CC-CFC-049431
786 443 9846 / eddie.rojas@hotmail.com
4
Before me this day personally appeared ��Uwr cp who
Having duly sworn, deposed, and says:
That he will be the only person working at the project located at:
39 A-- t>b «►�; S�N� Ct
Contractor signature:
Sworn (or affirmed) and subscribed before me this n day of Dev—eMbW W(Cir
By: �'c�t✓��-o�(jlS
Personally know
.11;tiv n�� ANA LUISA PARRILLA
Notary Public - State of Florida
Commission#GG090452 Or pro i entification
^a.v, My Comm. Expires Apr 21, 2021
Bonded throughNationalNotaryAssn.
Type of identification produced
POW
Print, type or stamp name of Notary