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PL-12-20-3012 \ l� � ��� � 1.. . i � �1� � � � ��,�\ ��. a ��� ��� <�l ���\\ti���1 � �l ���i� l �� ������ �t \\ \� � � � � - � � ��� l� z ��v ��� � > > ���.��s � ���vl � }�� l� �����rS�,� z � � �, � r � � � ���� � s�� � �°�\�`��`����'�'. '� .sb � �" �t \.� >>>>tt 1 i�,1� �v�.,��� ���A ��Zcir,����` � � 1�PT�i�E'SQC�S'�I��c��E' � t � t , �� � � � �� ��\� �� \ \ �� � ti� \ � �� � ""' � � � S{}O50 NE 2 AV� > > � �� � °��� z tii<� ��t� �� t \ � � r� � �� � � ��� � � k 1 �1 �� 3 �� � � � �� � ���` � z �� Miami Shores FL 3313$ � � � `���t���������������������� � � z i � V � � �x ���El��tizlV� �� �Z�ti Z � l.� �Z� � s\i V � A A � Z a ���� � ��A� V����. '`-,y" .�',�4� 3(�5-795-22f14 �� ��� ����`���t� ��� 1 � ti tV�i ���`����� ��t� rt k �fi+t�....,a✓' � �A� ti � �� � �� �� �i � ������ } ..;:.�.;.,, ... . . .i � �e�. � .�.1..>z� '������..: . �` �,;;'E;, ;;��`�4,��;����``���,,����� <ExpErat�on;�o8/24/2i?22 tocatia�n Addr�ss @arcel tUtsmber � 438�R��ICt��t��,l4�i��rti Sh�r�s, FL�31.�€� 1132Q60S�04��3 � '� � Contaets ���PATftICK TQOPYI�Y �_ ��������������������� � �� O�rn�r RhQTZ PE�UM�ING[.LC . � . . _Contraetor � 438 GR�ND CQNC,Miami Shores,F�3313$ lEE MfCHAEL MOTZ ; �20 NE 23 SF,NORTH MIAMI,�G 33161 € �u���,�ss.�a���z�za� i � .. � m_ u_� �� .��.�.���������_� � e lns erhonRe u�sts } Descriptie�n:PEUMRIN�-REPIACE 5(NKJFAtJ�ET C3fSNWASHEft, � Vatuation: $ 1,6Q0.00 ��������� `� �� ��� � REPLACE SHUT OFF V�LVES.ALl S,4ME�OCATiQNS ; � �� � � ��� � �� ; ; `�ota(Sq F�et: 1$t?,00 `` � � � ` � � �. ,��. �. �.. `� Fe�s Amaurtt Payrrtents R�te Paid Arnt Paid Applicatian Fee-Other $SQ.QQ TOtai Fc�s $111.3� CCF $1.20 CreditCard 12J3�/2Q20 $SQ.pp D�PR Fe� 52.00 Credit Card a2j24J2Q22 $61.1Q DCA Fee $2.44 Educatican Surcharge SQ.44 Amount�tte: $0.00 Permit Fee $54.00 Scanning Fee $3.QQ TechnologyFee $2.50 Tata€: �211.10 ul� tCl L' � In cansideratian of the issuanee Fo m� of this permit, I agree to perform the work covered hereunder in compliance with ail �edinances and regulatians pert�ining thereto and in strict conformi4y with the plans, drawings, statement� or specificatians submitted tc� the prop�r authQrities of IVliami Shores Village. In aecepting thi� permit l assum� responsibili4y€or aIl work done by eithar myseif, my agent, seevani�, ar employes. I und�estand that separate permits are requir�d for EL�CTRICAL, P�.UMBING, Nf�GNANICAL,WINDQWS, DOC?F�S, ���FING and SWIMMING POOL wark. OWNERS AFFlD�VET; I certify that a(1 � for�going inform�tion is accurate and that aIl wrork will be d�ne in compliance with ali applicabl� Iaws r�gulating eonstruct[on and zaning. �u� r�e�r�, I o�riz�Ehe abo e named eontractor to d�th�wark stated. Flutharizsd Sigr��tur�: Qwner 1 A pEi ar�t i Cc�nt 4or ! Agent Date Eebruary 2�,2421 Pa�e 2 0#2 . ��.����������r�����.� � � � '`.' � t.,.lF g > I� � ���: a.. t f w,� .,,� .,.N�n 10�5�N.E.2r�d P.��nu�,�Viiarv�f Sh�resF F(�arida 33138 ��E.{�o�}a�s-zz�����.��os}a�s-���z €�sR���r¢c��«��R������r��E�;{s��p��a-� � � � ��� � ��st�r P�rrt��t l�+�. � � �� � � �,� �`?,� ���� � P'E���� ���L������ Stab��rr�nit tVca��...°"��. ri. *�'� ,.� ���� ��- �a������� ���.���r��c � �oc����� � �E�Esfca� � �x�rr��ss�� ��E��w�� PLl1t1��1€�C� NiECFiA�11C�C �PU��I�VI�CJRKS CFI,��t�E C?F ����d�E�L�Ti�M1I SFiC?F C��l�"R�ICTt�R ���i�ti�lCiS JQ6,4��RESS. �" � � �. Ci� ; (�iami Shores �oun : �i�mi D d� Zi : F�a{i�jP��rr�l#: � � '°""��'��"^- �`t'� ,�°- (.�f��t� is th��uild€re��#��ter�cally 6��s3�n�t�d:Yes (VCJ� � �ceupaney Typ�: �' o�d: �eansteuc2i�an Typ�: �ie��d�one: �FE: FFE: C}r�rYdEi2:N�rrr�(Fe�s�mpl�'fi�f��ald�r}:� ��C� Phon�#: �',� ��.�... `" �� ,4ddr�ss: ,� i1 f City: � 5t�te: Zip: T�nantJLessee(�ame: P��rre#: Em�il: � �� �R:�ornparry N�r�t�: Phc�n�#: ,�.� `�� � ' �� � �ddr�ss: '`� �icy: S��t�: � ZEp: � � � �,.� C�u�li�er�t�rn�: � ` � Rhon�#�; St�t�C�rCifieatic�n or R�gtstratio�#. ���. (��`���� C�rtifi�ate�f C�mp�terscy##. �ESI��EE�e Ar�hft�ct/En�in�*er: Ph�n�#: Addr�ss: City: State: Zip; V�{c���f V�c�rk for this P�rrn�;� �� _ Sc�uar�J!€n��r f t����#t9��rk: T'yp��f�Al�rk: i,e,_# Fiddifilo� 41�eratior� ❑ IVew Repair R�pf� e ❑ C�ernol�tis� �cr� tictn of Wcar[c: f � �' C�' � ��. ,7'�,�� �. � � � � S'p��f�jr���t�r c�f�c�de�r t�r�c� til�: ` s��►���e������ ��rr����� �c�6 �c�/�c� s����t�����$ ������ � ����� �v �u� T�chnatc*�y F�er� Br��r�in�Ecic�e��i�n Fe�$ ubE�Fe�$ Strcacte�r�l R��i� $ ��� T'�T�.!FEE N�Vlt�E�E$ ��`� � . (Reviseci��/2�(2Q14) �c�ndin�Corrsp�n�'s E�ar�e(if applicafale) ��nd�rsg��ar°np�ny's,4ddr�s� �ity Stat� Zip Mart�a��l.end�r's M1l�m�(i#�ppl�cable} ��rt������ttder's Addr�ss City St�te Zip ARpl�c�tic�n is trereby rt��d�ta c�bt�ir� a p�rtni��c�d�the v�c�rk and inst�IlaYicsns�s ir�dic��ed. ( ��etify that nc��,tc�rk c�r 1nst�I1�L[�n h�s eammen��d pri�r to �h� issu�nc� caf a p�rmit �nd th�t �I! wrc�rk will b� perFormed tca �neet the stand�rds �f �II I�ws re�ul�ting cons�rucfiie�n in this jurisdiciic�r�. i und�rst�nd that � separ�t� p�r�it must b� secur�d fc�r ECECTRfC, P(�tJM�1Nta, 51CaNS, PC?C�LS, FtJRRU,A��S,�QILERS, hiEATERS,T��t�S,�tIR CC�Nt�IT(C)�tERS,ET�..,.. t)if4fNER'S��FIDAVIT: I cert�fy th�� all th� fc�ee��ing in��rmat��n is acc�r�k� and tl��t�11 wrc�rk wiil be dcrr�e in camplianc� with aEl �pplicala(�laws re��latin���ns�rucfiior�and z�niv�g. rr������� TQ �����: �{��� ����.��� �� ����}�� �, ������ �}� ��}���������� ��� �� �� � � � �� ��� � � � � � �� � � � ��� . �� � � � �� � T�� F� �� � � ���.� �� � �.� � �� � � �� � � � ���� � � � �� � �.tr Pdc�gi������r�a#ice�r+t: .4�e��e�ra�iti�ar� tc� tfr�issu�rtc�af�tacrrl�ing�e it wrlth an�stdmcated vatu��xe���ir�g$2.5t7Ct, th�c�p�lr`c�c�t r�ausT �rr�rrti�e rn �caoe�fczrth fha�cr eespy o�'the e�o�iee o,�c�rrrrra�nc�m�nt��ad cc�nstructaon li�ra faur br�eMure tr�i11 b€� d�l£uer��tc the��sc�n wr�r�s�p �aer-�y 1s subj�et tca at�t�achrr�ent. �lso, a c�rtr'��d��py of th�r�cord�d rao�ic�e�f�crrx�rrten��m�rtt rrrust be pc�sted af Ptr���b.�it� f�r tks�,�"rrs� irt��asc�i�aa �vlaFeh e�ceurs s�uera �T) dcrys aft�r th� buildrn� p� r't is issu�d, in t�� abserace of such ;��a.sf�d nc�tice t�h� irr�p�ctic�r€�c+r11 rto£be cag�prov��ca�td�a r�insp��tf�n f��w�i#1 be cPa�r��d. �.,� �� � �� ��p � � S�gn�tur� � ,F� �:?�� � � �°��`� g Si$n�t � {��il(�ER�r�kC�EiVT ���lTR��T�R Th�f�r�g�ing instr�am�nt�as�ckn�m�eied$ed fa�f��e rr#e�F�is TF��far��c�ing ins�r�arr��nt���ackr�ca�el�d�ed b�foe�rrae this ��� m . � � , �� � �� � P ��..� y ofi ������- ���,���� _�' a � � �v ��. �`°��y o� ����°�����c� °��,.���� �y �, � � t �� �� � � N_ . � , i�,�r �,� , : , ,a� , � � �,' � ` �' ; �hc�is p�esc�nally kne��t�r to , , �� .. wrho is p serr��ll}��r�c�v�n''�o �� � � �..�..�.�._..� � � ,��__..P-�- me�r whv has pr�due� ���. � as rt���r��i�a h�s pr�`duc�d � � `�� as id�nti�icat6on and uvk�o did t�k��n oa�h. id�nti�c��iean and v�nc��did t�k��€�c�atf�� IVt}3"AE�Y PtJ�1�EC� IU{)T,4RY FU�IlC: �r�� � ,. �--�--~, E � ,: .�-e, �, � � rt , �- .,..,. h �i�rt: ° `� �•�.� ���, � �...�,_..��,.�..� ��,� �. � �. ,_ � �� ��,< � �.., � �" .,; ��,� �.�.�""- r�,. 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"t.s.� 1.�:t.titi ��-...1.. ��.:`2�.,i��3 Z ��\`�.�.. . � t -� <�, s�� '£.' �� � .. t.. �:��., ..', �i�.�u, :. .�.,3. i tt -.'�� �\.�..i� . �2. z 3�s.`��< :�\ \ i' `s �Ss r�i^�,�.ti a�Sl, l. , `l`,E,'•. .a.+�. �1 �'.i', .�,.b.\l .�,.�.�4.?��':�1;,., ��k, `�tn��,����{zt��yaya��� �����?s��t��a,.z;,'<��;t .�\ t�t �iy�`'e1�,.������.., �,x��?.z,�� �,�3��\��,�� ,C;1S,s^,����,�`*,.c,`�,��,. �`� � ��o- ���l',O,4,.�,7, ,.,A�,t<� � �. ���a. ��a . s`�\�'�� t, t � �.., �, . . A.}.�,�, ,a,:be,ti. . . . . . . . _. . . . . . .. . . ( FEorida La��� requires 1G�orkers' �'anlp�nsatiQn insurance cavera�e under Ch�pt�r 440 af�he Florzda Statutes� Fta. SCat= � 440.OS � j allo+��s corp�rate affc�rs in the consEruction tndustr��to exer��pt�herr�seiv�s fror�l this reqtizirem�nt�'or any constructiar�project pric�r to � abt�it�it��;a buildin��ermi�, Pursuant�t�the Fit�rida Division of\A'arkees'Gompensatian Emplay°er Facts�rochure: } i � �n emplo}%er in th� construction ir�dustr�� «ho emplc�ys one or more part-time ar full-tirr2e i � ern�loy�es,includin�the aw�er,must obtain wark�rs' cc��np�nsation c-a��era�e. Carpora�e officers � ar members of a limited liabilit}� �ompan�� (LLC) in the coz�struc�ion industry may eIeet to �e ; � f',XefTlpx FF: ' � I i 1, The officer�wns at least l Q p�rc�nt af the stack af the c�rparatian, Qr in the case of an LI,�,a statem�n��ttes�in�to the minimurn 10 percez�t o��=��ership, 2. The officer is listed �s an offic�r of tl�e corpor�tian ira the records of the Florida � Depar�f�ent of Seate, Diuiszon of Cor�aaratic�ns;�nd � i �. The 4c�rpor�tion is reg�st�r�d ar�d tisted as acti��� ��tith the Flarida Departrraen� af j I ( � St�te, Division Qf�orporations. i i ' �o m€ar� t}�an t}�r�� eorporat� ofi�i�er� per corporation c�r lirnited iiabiliry company Fnembers are � ailo��ed ta be exez��pt. �onstruc�ion ex�r�ptic�ns are valid for a period of two �=ears or until a i � ��alant�r�•revocatian is�l�d or the ehemptian is eevo[:ed�y�the L?ivisic�r�. � � � i Yaur contractor is requestin�a permit under�his worl:ers' conlpensation exemptian and has acknoujled�e that he ar she will not use ' � day Iabor,part�time�mplc�y�es or subcar��raetor�far your prc�ject.The cantra�;tQr]�as�ro��ided an a�da��it s�atin�tt��t ir�ar sh�v��i1i i ' be the only��rsc�n allc�w�d to urork or��our project. tr�th�se cir�uznstane�s,1Ffiami �h�res Vi11a�e does not requir�verific�tiorz of � ���arker�" con�pensation in�uraa7ce cc�vera�e fira�n tk�e contractor's con�pan}r far day labar,part-tizne emplati�ees ar subcazleractors. E3Y SI�'\I?vC'i BELQt�' YC?L" ACK'�C�EA'LEDCiE TI-I.4T YC}I; HAV'E P.E�L) THIS :tit�TIC� :�tiD L>'ti�I��RSTA'vD ITS CC)'�TE'tiTS. i � � � �r'�f� �� � �F `, � � � �I�TIt��UC�: ,•�/f4, ,9 d�` ±t lr` . �'��� i I C��Y'IF£`[° � i 1 � ; State af Fiorida ; � �'ounty of��iami-Dacle � i �, � The foregc�sn�w=as ackr7awl�dge befare me this �� day of_ .���"' � �0 � � � "� � � E3Y �`��-�... � '� � ��uho is personall��knoti��n to me ar has praduced � � �C.— � as idenTi�carion. i �� . �_ � ���� I '.�Qtar}: �—� .��� .,.w SE[.ENft ARAND� ' _ e� �',. �IY C lSSD # 971705 � ( SEAL: _�;� � �� �a� EkPEl�ES� �h 2'1,2fl24 � i '"•��?"'�':°r`� �iad tt twriY�es � i I