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PL-19-354 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 I A - 9 J j � jcv Permit NO.: PL-02-19-354 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: Approved Issue Date:02/26/2019 Expiration: 08/26/2019 Location Address Parcel Number 1181 NE 92ND ST, Miami Shores, FL 33138 1132050270340 Contacts ANDREW & DANIELLE BEYDA Owner 1181 NE 92 ST, MIAMI SHORES, FL 33138 RT PLUMBING, INC Contractor ROBERTO CARLOS TOTH 20200 NW 2 AVE 402, MIAMI GARDENS, FL 33169 Business: 3053357812 ns ecti Description: NEW BATHROOM PLUMBING CONNECTIONS Valuation: $ 6,312.00 Ion Requests: 4949 TotalSq Feet: 700.00 Fees Amount Application Fee - Other $50.00 CCF $4.20 DBPR Fee $3.31 DCA Fee $2.21 Education Surcharge $1.40 Permit Fee $170.92 Scanning Fee $3.00 Technology Fee $5.52 Total: $240.56 Building Department Copy Payments Date Paid Amt Paid Total Fees $240.56 Cash 02/26/2019 $190.56 Credit Card 02/14/2019 $50.00 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 constyc!0, a— d zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Ownef / Applicant / Contractor / Agent Date February 26, 2019 Page 2 of 2 .r r Miami Shores Village RECEIVED Building Department �FEB 14 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 \ ' Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 L 01- l - 2(o BUILDING Master Permit No.� ; � �2 PERMIT APPLICATION Sub Permit No. F [ tQ' 4 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP C[ `'� C� q t CONTRACTOR DRAWINGS v 10B ADDRESS: I O p 1 L Lt City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: is the Building Historically Designated: Yes NO Occupancy Type: _ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V -C,'H Address: City: �� �� �►—�J State: 'Tenant/Lessee Name: Email: CONTRACTOR: Company Name: RT Plumbing, Inc Address: 20200 NW 2nd Ave #402 City: Miami Gardens state: FI Qualifier Name: Roberto Toth State Certification or Registration #: CFC1428899 DESIGNER: Architect/Engineer: hone#: ip: 651- 5 hone#: hone#: (305) 335-7812 Zip: 33169 Phone#: (305) 335-7812 Certificate of Competency #: ne#: Address: CB t �- ao City: State Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alte,ation ❑ New 10 Repair/Replace Description of Work: Wk�.1�a Specify color of color thru tile: Submittal Fee $_ Scanning Fee $ ._ Technology Fee $_ Structural Reviews $ Permit; Fee $ _ Radon Fee —Train ing/Ed ucation Fee $ CCF $_ DBPR $ Zip: ❑ Demolition CO/CC $ — Notary $ _ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I l� rJ (RevisedO2/24/2074) 41 Bonding Company's Name (if applicable) i 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 'DO OBTAIN FINANCING, CONSULT WirH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." fV .tire 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 f commencement and construction lien law brochure will be delivered to the person whose property is subject to otta ment. Also, certified copy of the recorded notice of commencement must be posted at the job site or the first inspection which/111',urs s ven J ays ar`ter the building permit is issued. In the absence of such posted notice, the inspection will not be opproved a, reins ct n fee will be chargers. Signature _ Signature-- rA.GENT CONTRACTOR The foregoing instrutr as acknowl-iAged before me this -rhe iorre�going instrument was acknowledged before me this ©+f1 _day of l�7CdC---- 20 1 —, by —_I --day of_-- ✓tom /J _ 2.0 /C� _ by �'i]G Cam—'nhpo is personally known to 4 �3."c_1'U _ .��� ' who is personally known to me ar who has produced �110DV_ l..t.�C�+�-a2 _ _ as me or who has produced as dentification and who did take an oath. 8 3"' o12Q4Qµ� O identification and who did take an oath. PdOTAR`P�•` NOTARY PUBLIC: Sign: —._ _--------- Sign:644 �. Print: Print: Seal: Sea!: a. MY COMMISSION # FF946473 BARBAIiAGARC� EXPIRES January 09, 2020 C"w4ulm it GG 187164 * * ExpiresFebruM18.2022 i-r0�)398-0�6J florWaNaaryS�rvks.com.. +ia+*:k-k :kWT>c ,tk`"�'k. aY�.�dti:k+k �11��f1 �'h:Fw:l+:k:<�:k�:�%.n:s:kR:+k>,:a•k:k:k:;::t1':l:i::4:k>,:44*�F#%�ry:%:rt**:ka:k�%ekk::k ek �k*#:k�s MM::�*+k W:l:k��**# PnROVEDBY Plan Examiner --- — _-- _Zoning -- -- Structural Review ----, -� — ---- Cler'r. v sedC.2/24/21014) RT Plumbing INC Date: 02/13/2019 State of Florida County of Miami Dade Before me this day appeared Roberto Carlos Toth who, being duly sworn, deposes and says: That he will be the only person working on the project located at:1181 NE 92 St Miami Shores Contractor signature: Sworn to and subscribed before me this 13 day of February 2019 By: Roberto Carlos Toth Personally know: Or Produce identification: C 456390561902 Type of Identification produced: Drivers license Print, type or stamp of notary URWAGARCIA *bom FebruM ia,ton 75 1' 8-m r- u4 ow-Y ! Mow 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: l . 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 County of Miami -Dade The f regooii1ng was acknowledge before me this day of , 20 . By 6ra-e who is personally known to me or has produced Nn"ooas Get'"Ce �3dD Dt 2 �as, identification. SEAL: EON e ,� a ,W +�