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PL-15-2367` SgOREs r I M 'CLOR1Op' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. PL-9-15-2367 Pe Permit Type: Plumbing - Residential rill'it W" Classification: Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 9 22/2015 1 Expiration: 03/20/2016 Applicant 9730 NE 5 Avenue Road 1132060171470 Miami Shores, FL Block: Lot: JOHN & MARIE PERIKLES Owner Information Address Phone JOHN & MARIE PERIKLES 9730 NE 5 Avenue Road (786)236-0254 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone 5STAR PLUMBING SERVICES CORP (305)796-3607 Type of Work: ADD 2 BATHROOMS, UPGRADE EXISTING P Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $12.00 DBPR Fee $10.50 DCA Fee $10.50 Education Surcharge $4.00 Permit Fee $700.00 Scanning Fee $3.00 Technology Fee $16.00 Total: $756.00 Cell Valuation: $ 20,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-9-15-57118 09/17/2015 Credit Card $ 50.00 $ 706.00 09/22/2015 Credit Card $ 706.00 $ 0.00 Avauame inspections: Inspection Type: lReview Plumbing 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?thregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construe n zo 'ng. Futhermoreize the above -named contractor to do the work stated. -/ I _ September 22, 2015 Authorig6d Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy September 22, 2015 1 Miami Shores Village E-1 \l 9 Building Department SEP 17 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:_ Tel: (305) 795-2204 Fax: (305) 756-8972 'k INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Master Permit No.>1.(-,I T l 3'13 �i Sub Permit No. ` S— 2-:�(O-�' ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: l 01 I `7 1 j `i o Is the Building Historically Designated: Yes NO Occupancy Type: �Q) J` Load: Construction Type: cis Flood Zone: BFE: FFE: OWNER: Name (Fee Sim Add City: Vt.A (A r Tenant/Lessee Name: Email: Titleholder): �jh'h M hone#: State: je(J Zip: Phone#: CONTRACTOR: Company Name: S�,'�- If ta"-6itit SrU`�� C&( Phone#: 71 b- �b�� Address: I_A tW -�OW �a Si City: M 1 V+.n : State: ` Zip Qualifier Name: 11 o,tn".k yc"L^'PC, V\ Phone#: r� State Certification or Registration #: G [�, kAj I � 1]2 Certificate of Competency #: - DESIGNER: Architect/Engineer: 3317-1 Address: . City: State: Zip: Value of Work for this Permit: $ Square/linear Footage of Work: q0*13 Type of Work: ❑ Additio Alteration �,{ ❑ New ElRepair/Replace, ❑ Demolition CDescriotion ofWonk: — � 7- kn' "t%C>�S , u 1/ �'-tj(- ce�t Sj-'1(I ., Specify color of color thru tile: ; . ip Submittal Fee $ �=��„„� l_i� J Permit Fee $ q CCF $ CO/CC $ It Scanning Fee $ �• V a % Radon Fee $ , o5O (D'BPR $ 10 • Notary $ Technology Fee $ ' �iV 6 Training/Education Fee $ v Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ • W 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 rei ection fee will be charged. Signat "�� Signature OWNER or AGENt CONTRACTOR The foregoing instrumiant was acknowledged before me this a day of 20 1 by n-A who i rsonally kno n t me or who has produced as The fo egoing instrum �rt was cknowledged before me this day of 20 1� by who i ersonally kn me or who has produced as identifi ation and who did take an oath. identifi tion nd who did take an oath. NOTAR PUBIC: NOT RY PU IC: _. �- Sign Print: Print. Seal: Seal: : �i, LORMA COMES `t`� .µr w LORETMA COMES MY COMMISSION #EE181658 r f.....,.titi� MY COMMISSION #EE181658 EXPIRES: MAR 21, 2016 EXPIRES: MAR 21, 2016 °"` Bonded through tot State Insurance Bonded through 1st Slate Iriurae APPROVED BY �'(� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD " ; 1940 NORTH MONROE STREET NE SP:. TALLAHASSEE FL 32399-0783 PAMPIN JIMENEZ, MANUEL 5STAR PLUMBING SERVICES CORP 11710SW180ST MIAMI FL 33177 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from arch:tects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For Information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT. GOVERNOR (850) 487-1395 ;:�`•_ STATE OF FLORIDA "F DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC 1428573 ISSUED: 05/14/2014 CERTIFIED PLUMBING CONTRACTOR PAMPIN JIMENEZ, MANUEL 5STAR PLUMBING SERVICES CORP IS CFRTIFIFD under the provisions of Ch 489 FS Expfatcndate ALIG21 20'6 U4Cbi c;p)OJ�^<0 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER FC14285773 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 PAMPIN JIMENEZ, MANUEL 5STAR PLUMBING SERVICES CORP 11710SW180ST MIAMI FL 33177 ISSUED: 05i14l2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405140000920 010257 Local Sus�pness Tax Receipt Miami —Dade County, State of Flor ida —THIS IS NOT A BILL — DO NOT PAY 6960836 RECEIPT r30. BUSINESS NAME/LOCATION ��I�T NO. 5 STAR PLUMBING SERVICES CORP RENEW 7 11710 SW 180 ST 72363 MIAMI FL 33177 EXPIRES SEPTEMBER 30, 3®15 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 SEC. YYPE OF BUSINESS PAYMENT RECEIVED OWNER 196 PLUMBING CON T RACTOR By TAX COLLECTOR 5 STAR PLUMBING SERVICES CORP CFC1428573 $75.00 07/17/2014 Worker(s) 1 CHECK21-14-023722 This Eocztftnsiness Tax Receipt only confirms payment of the Local Business Tax. The Receipt is nmi ase, permit: or a certification of the holder's sgnat'di requirements which apply o the bus ness do business. Holder must comply with any governmental or nongovernmental regulatory laws and The RECEIPT NO. above must be displayed on ail commercial vehicles — Miami —Dade Code Sec 8e-27G. For more information, visit sa v mij ___ amidade nnvRaxca!!ector JEFF fdTUl!ATEP Crt:EF FINIANCiAL vi=plc._ DIVISION' OF iiltQ wER61 COMPEMSAiIO I _ .=_'CTION TO aE EXEMPT 'NSAT+rOM 3_, A MNSTRUCT Obi; 0.1 This certifies that the ind;vidua! isle i below has elected to be Floods Workers'Compensation lay,. EFFECTIVE DATE. 2i2 ,i'2C-i -. FF-RSO,%j: PAMPIN-JlitiEtgE_' FEW: 45410222A tSUSMESS ItAPTE AND "WD37-:2,5: SSTAR PLUMBING SERViCEES 5 STAR LEAK DETECT ICN 11710 SlN 180 STREET MIAMiI SCOPES OF SUSPIESS ii.=: 33ii �X1E- R-1-1 _. 212612016 MANUEL LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(1• i, c, ,,.i; .�-r of a oor;)oration who elects exemp: cn i, s c `aoter by filing a certificate of election under V-s senon may not recover benefits or compens-tic { u u-7.; its c apter. Pu..uant to Chapter 440.3-- :2 -; iates a, election to be exempt... apply ontw :•yin the sccc- of the business or trade listed o ; t {c c:: t L un to be exempi Pu suent to C„ae. -`.•' n ^ '" .:.S., {4o,ices of etoc ion o be exa�pt and ^er:i8r_ates of election to be exempt Issuance of the certificate, the person nam_--` a.. ;ian ct:ca or certificate no longer meets the agjirernaras of t is section for issuance of a certinc,t . -'ne ups, :--,3ni shall ravoke a certificate at any time tc ' re c .- person named on the certificate to ^lee::ne recuirenents cf this section. OFS-F2-t7WC-252 CERTIFICATE OF EUECTION TO BE EXEMPT RE" SSE �,?-'-- '1i. c i 10XS? (,850)413-1609 5STAIt PLUAWIIPOSERMES CORP. 11710 SW 180 ST. MIAMI FL 33177 State of Florida County of Miami Dade Before me this day appeared m�0!0aho,,bein dul warn dgpos,�es nd ays that he will be the only person working on the project located at l ou �i' 1V`C_ - a(R-k shy ho or affi med and ubscr' ed before me this 16`h day of September 2015 by Personally known ORF produced Identification or Identification produced LORMA COMES MY COMMISSION #EE181658 EXPIRES: MAR 21, 2016 °"' Bonded through 181 We Insurance 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 ation Insurance Exemation Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. 3 440.05 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. Signatu : �-�— Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 1 , 20—G. By �I who is personally known to me or has produced as identification. Notary: 1__ykL1 &> _s SEAL: r► LORETTACOMES MY COMMISSION #EE181658 Insu me