PL-19-2123Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:10/24/2019
Location Address Parcel Number
325 NE 97TH ST, Miami Shores, FL 33138 1132060135740
Contacts
Permit No.. PL-09-19-2123
Permit Type: Plumbing - Residential
Work Classification: Sprinkler System
Permit Status: Approved
Expiration: 04/21/2020
LUIS BRENES ARRIETA Owner
127 NE 97 ST, MIAMI SHORES, FL 331382332
BANANAS GROUP, INC. Contractor
RAFAEL LEYVA
27501 S DIXIE HWY 403, NARANJA, FL 33032
Business: 3052571000 eallen.bananas@gmail.com
Description: REPAIR AND MODIFY CURRENT SPRINKLER Valuation: $ 2,500.00 Inspection Requests:
SYSTEM TO ENSURE FULL COVERAGE TO PROPERTY
Total Scl Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$3.75
Total:
$119.40
Payments
Date Paid Amt Paid
Total Fees
$119.40
Credit Card
10/24/2019 $119.40
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 and that all work will be done in compliance with all applicable laws
regfilating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
rized Signature: Owner / Applicant / Contractor / Agent Date
24, 2019 Page 2 of 2
SEP 13 2019
I
�I
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department 6101 9T d3S
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (13 n I 3 J 3 4
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 e
FBC 2017�
Master Permit No. L' 0 q - 1 9 - o"24j-3
Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION Ej EXTENSION RENEWAL
PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 325 N E
City: Miami Shores County: Miami Dade Zip: 3 8
Folio/Parcel#: ) 31a0 t.P - 013 - 5 -'qo Is the Building Historically Designated: Yes NOVIC
Occupancy Type: Lad: Construction Type: Flood Zone: NO BFE: _ FFE:
OWNER: Name (Fee Simple Titleholder): a- E (,O e 0" /VE Phone#: 3'Q 5 n 0 Leo 11O 5
Address: 3a6N l:-_ 9 2� S-Y
City: MIA 1-1 i 5 �G%aS State: � L Zip: 3 313V
Tenant/Lessee Name: Phone#:
Email: Di-E0. BQFN%S. A META n GM,41:L- GOM
CONTRACTOR: Company Name: IJ� 1G1Y10.S GAP P ' Phone#: — 2�l
Address: 2-1 Sy
City: !s State: Zip:
Qualifier Name: G Phone#: 2.^ 2-9 J
State Certification or Registration #:C PG I `. 3(:) I Sq Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: r� City: State: Zip:
Value of Work for this Permit: $ aSZ-) U Square/Linear Footage of Work:
Type of Work: ❑ Addition ire`' Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: a p,& o- + .M'.�ta r' y M
ACV
Specify color of color thru the:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 1 '
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State 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 x A%Q=t 1
7111— OW R or AGENT
The foregoing instrument was acknowledged before me this
t
day of 20 J / , by
bIEl.0 Q nl't 5 who is personally known to
me or who has produced �L*
identification and who did take an oath. —69 -0
NOTARY PUBLIC:
Sign:
Print: S
Seal:
a
to .1
2F2l2o�3m
Notary p,%ien
Elston ,onGG
MY comm,
�80 .
L 4
Signature
The foregoing instrument was acknowledged before me this
10 day of SG� P'f' , 20 1 c1 by
R14F REL I, JA who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
APPROVED
BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
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 Lacy 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, includingthe 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:
i . 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
i. The corporation is registered and listed as active with the Florida Department of
State. Division of Corporations,
No more than three corporate oficers 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 lie or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores tillage does not require verification of
workers' compensation insurance coverage fi-om the contractors company, for day labor. part-time employees or subcontractors.
BY SIGNING BEI.O%V YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS,
1!
Si+onature:
Owner
State of Florida
Countv oflkliami-Dade
The foreaoing was acknowledge before ore this 2— day of 1' .20 .
8N — _i L� _.----.._._ ' o is ersunall f Ei x f me or has produced
as identifica ' a
Not,
��stC�5 gtyg2
SEAL:j"'lt t i"��� ��4'�'0
Licenses #: CGC1527091 CFC1430157 CCC1331744
Roofing & Plumbing Division
27501 S. DIXIE HWY., SUITE 403, NARANJA, FL 33032
Office M 305-257-1000
Much 3, 2019
State of Florida
County of Miami Dade
Before me this day appeared who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
Qffntractor's Signature
Sworn to (affirm) and subscribe before me thi jK t'
By
,O\v
Persona y Kno 7
Print, Typeor Stamp Name of Notary
EA
*i�
of 2019