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PL-19-1352 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Ij- S SLIJ Ilq Issue Date: 06/20/2019 Location Address Parcel Number 79 NE 91ST ST, Miami Shores, FL 33138 1132060130130 Contacts Permit NO.: PL-06-19-1352 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 12/17/2019 ROBBIE & KARLA SINGER Owner 79 NE 91 ST, MIAMI SHORES, FL 33138 R&I PLUMBING SERVICES CORP Contractor RENE GUZMAN 7898 NW 174 TER, MIAMI, FL 33015 Business: 3058236911 Re Description: INTERIOR RENOVATION OF KITCHEN AND LAUNDY Valuation: $ 8,500.00 Requests: Inspection tition Re ROOM DISPOSAL AT EXISTING LOCATION. INSTALL REFRIGERATOR WATER LINE. INSTALL RECESSED GAS SHUT Total Sci Feet: 370.00 OFF VALVE FOR GAS RANGE TOP. INSTALL LAUNDRY SINK, RELOCATE WASHING MACHINE. Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $4.46 DCA Fee $2.98 Education Surcharge $1.80 Permit Fee $247.50 Scanning Fee $3.00 Technology Fee $7.44 Total: $322.58 Building Department Copy Payments Date Paid Amt Paid Total Fees $322.58 Check # 1065 06/20/2019 $322.58 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 autglze t�above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor 05 / Agent Date June 20, 2019 Page 2 of 2 Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING X❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 79 N E 91 st 3►y' 61- FBC 201 �2Y Master Permit No. Sub Permit No. Ti - (�o ` M - 13b ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-3206-013-0130 Is the Building Historically Designated: Yes NO Occupancy Type: RES Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ROBBIE S SINGER, KARLA E SINGERPhone#:786-564-5925 Address: 79 NE 91st city: Miami Shores state: FL Tenant/Lessee Name: zip: 33138 hone#:786-564-5925 Email: Robbie rsinger(_nearlynatural.com, Karla singer. karla(d_)yahoo.com CONTRACTOR: Company Name- �L;7" (��/� G ��J Phone#Q"''`�Y Address: 7821 .41 ev &0-0, 1 City: ZA� 19XJPL State: '' Zip: '3 3Z-) / t5r Qualifier Name: ��tic �p02--4/,L —1 Phone#: 0,0 -z; "5 z17 State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: :�00 Certificate of Competency #: E)8 f "0©C)C) 7 4/ Phone#: City: State: Zip: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition Specify color of„color thru tiler Submittal Fee $ r Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 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 reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this &±1^ day of J Q NL , 20 1 9 by V AIZL- A !� /,QC .rt , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ', Print: C- n � I S 7D P iuz Seal: .• CH Vision#GG109M * * Expires may 30.2021 w� .o� ThN gydpelNolar/ Servke� 0,f' 0onded Signature _d's,� CONTRACTOR The foregoing instrument was acknowledged before me this 125 day of \i t..) iii0-- 20 ) ? by rrg&e �-, .- who is personally known to me or who has produced 1� �'� = 7--,-'b $7 3616As identification and who did take an oath. NOTARY PUBLIC: 61�� Sign: /7 Print: C., ifi'2!S -TOPI` �-a C.dc ►v CWISTOPHER B" BL Seal: �,' ;:•• , ConrUSIon # GG 109098 * * Expires May 30, 2021 p'7j�.a�°e`oc �pddThygaAye�N�SN� APPROVED BY - ��� Z12 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) June 11, 2019 State of I- A7iz / O 4 County of J) .dam Before me this day personally appeared Qe/VE: 60ZPAA) who, being duly sworn, deposes and says: That he will be the only person working on the project located at: W�K/141 NO = Contractor Signature Sworn to (or affirmed) and subscribed before me this day of J U NQ- . 20 l Q By CVeA-,Ie— 6 t1Z/�dy Personally know ✓ OR Produced Identification Type of Identification Produced Jam 0 at Sew 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: 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. Signature: Owner State of Florida County of Miami -Dade h The foregoing was acknowledge before me this day of 20)1. By r V (z, --A 't�t \)(y ,6_ who is personally known to me or has produced � Oication. w.Notary: SEAL: s ? 01