PL-20-537Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/30/2020
Parcel Number
1311 NE 105TH ST, Miami Shores, FL 33138 1122320270050
Contacts
Permit NO.: PL-03-20-537
Permit Type: Plumbing - Residential
Work Classification: Repair
Permit Status: Approved
Expiration: 09/28/2020
DAVID CARLISLE Owner EDWARD ROJAS PLUMBING CORP Contractor
700 NE 90 ST, Miami Shores, FL 331382138 EDWARDO ROJAS
Business: 3052182999 david@davidinmiami.com 880 NE 111 ST, BISCAYNE PARK, FL 33161
Business: 3059446788 EDDIE.ROJAS@HOTMAIL.COM
Home: 7864439846
Description: INSTALL NEW 1 1/4 COOPER WATER MAIN LINE Valuation: $ 1,200.00 Inspection Requests:
305-762-4949
Total Sq Feet: 1,900.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments
Date Paid Amt Paid
Total Fees
$111.10
Cash
03/11/2020 $50.00
Check # 788
03/30/2020 $61.10
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 mf la ' n is ccurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I auth ' thrre �e med contractor to do the work stated.
Authorized Signature: Owner / Applicant / ( Contractor ' // 'Agent Date
March 30, 2020 Page 2 of 2
Edward Rojas CC-CFC-049431
Plumbing Complete Plumbing Services
Hi Speed Water Jetting
24 Hour Service
Licensed, Bonded & Insured
One Call Does It All
(786) 443-9846
Email: eddie.rojas@hotmail.com
We are now accepting Insurance Claims
Miami Shores Village ENTERED
MaR 11
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
to _iq. 2aa,3y FBC 201 q
BUILDING '-Z,��� Master Permit No.k- _- 03-2D-539
PERMIT APPLICATIONSub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
f p ' CONTRACTOR DRAWINGS
JOB ADDRESS:
City: M. 5h Miami Shores County: D PaP Miami Dade Zip:
Folio/Parcel#: 10 2232Q21 00,S0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
1 I , i 3 ' `%
OWNER: Name (Fee Simple Titleholder): U U f�� Q l l $ / Q Phone#: f � �i • L
Address: I 'i 1 I N
City: I ' " (k S State: f''I • Zip:
Tenant/Lessee Name: Phone#:
Emaii: /
CONTRACTOR: Company Name: �p �( � I/QS / �l m �l / P �re J#:_ �/ L1 3
Address: ! -!� W / 1 ,�//57—
City: I^ ive PCState: Zip: 3 3 )b f
Qualifier Name: Phone#:
State Certification or Registration #: [�--C- L _L���T_Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 0 0 O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
-r Ns e'w I' oop�e
w W T-e 12— hn V9 I' ICI 41" PVC,
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ V� (c)
(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
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 issue¢��p the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. � �
Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of ko Kc I , 20 20 by
UId 69 t[(-S`(e , wh is personally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Signatu
R
The foregoing instrument was acknowledged.beforree me this
dayof ^_ _kairCh 20 L 0 by
►-%1 US who i personally kno to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Print:
Seal: 'a�N.`"` "
' '
ANA LUISA PARRILL
NotaryPublic-State of Florida Seal:
Commission4GG090452
; • ", ';:'
,`s,�"
_ »
r »'3
ANA LUISA PARRILLA
NotaryPublic- Siateof Florida
Commission # GG 090452
.1''••.,,,,,,,
My Comm. Expires Apr 21, 2021
• '.
My Comm. Expires Apr 21, 2021 '
Bondrd through National Notary Assn.
lionded through National NotaryAsv r
APPROVED BY
C�—� 75 Plans Examiner
Zoning
Structural Review
Clerk
(Revised02/24/2014)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to uWner — 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.
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
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. h
State of
County of Miami -Dade 1
The foregoing was acknowledge before me thisZha day of
BY v1 �C� 4aC `� S1L who is pers ewe to me or has produced
�5 as identification. Martinez
`'i�r o NOTARY.PUBLIC
Notary: STATE OF FLORIDA
SEAL: Comm# FF950260
s�Noilso Expires 1/13/2020
EDWARD ROJAS
PLUMBING SERVICE
880NE111THST
BISCAYNE PARK, MIAMI FL 33161
SEWER AND DRAIN SPECIALISTS
My phone 786-443-9846
305-944-6788 my office
LICENSED -BONDED -INSURED
CC-CFC 049431
Date: -3A '3o— 2 o
State of
Country of ►A d Q.
1?
4
Before me this day personally appeared A who, being
duly sworn,
That he or she will be the only person working on the project located at:
13 i / ry gr rvyl►' a • s In as
a
Contractor Signature
+ :
ANA LUISA PARRILLA
Notary public - 5tdtp of Florida
€ • ; �' •
Commissloh M GG 090452
My Comm. Expires Apr 21, 2021
Bonded through National Notary Assn,
Sworn to ( or affirmed ) and subscribed before me this .34y of I o'' CL— 2-00184�
By A-,v- Pc"'—v L,
Personally Know
40 - .
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PROPERTY
Not valid unless embossed
with Surveyor's Seal.
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ca a:3uucliucu�i SURVEY
1 hereby certify t t �rvey repre-
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lnical s�tarSd rds set forth by the
—B<tord of land Surveyors. pursuant to
oncuorf�72.027, Fla. Sta{�rtes. There are
noenyr a'chments,ov�f aps,easements
apP9 rt'tR on the,Pfyt, other than as
shin n, hqr to.
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RECEIVED=
MAR 18 20
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Carlisle, David L.J
MIL AlNSN�rS� an� ��1R I A, 1 N C.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
Office address: 359 Alcazar Avenue, Coral Gables, Florida 33
Mailing address: P.O. Box 561131, Miami, Florida 3315E
fla. Re t nd carve or No. ��'
` R �. j y DATE SCALE DRAWN BY DRWC;. N
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WIIhXurveyor'S ealet ertify that the survey repre-
.)Jossed
hereon meets the minimum ENGINEERS - LAND SURVEYORS - LAND PLANNERS
inical standards set forth by the
and of Land Surveyors.pursuant to office address: 359 Alcazar Avenue, Coral Gables, Florida 33
ction 472.627, Fla.Staprtes. There are
enfrppachments,ovgf aps,easean asMailin address: P.O. Box 561131, Miami, Florida 3315(
py hrrg on thei, otherthan as Kp n.hgr to.. Reg. tfnd jurveyor No. DATE SCALE DRAWN BY,, DRWG. N
191
9-28-99 "Recertified", Name, Certified To and flood �nformat' n 10868'
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