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PL-17-2898Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 —�` Phone: (305)795 2204 Fio ion+ Penr»it NO. PL-12-17-2898 Permit Type: Plumbing - Residential Work Classification., Gas Permit Status: APPROVED issue mate: 12J13/2017 ] Expiration: 06/11/2018 Project Address Parcel Number Applicant 94 NE 93 Street 1132060130150 CHARLES WALTER MARIA PAU Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CHARLES WALTER MARIA PAULA 838 SALZEDO Street - - - CORAL GABLES FL 33134- 838 SALZEDO Street CORAL GABLES FL 33134- Contractor(s) Phone Cell Phone FOREVER GAS CORP (305)298-0193 Type of Work: RUN ABOUT 20 FEET INSTALL TANKLESS Type of Piping: Additional Info: RUN ABOUT 20 FEET INSTALL TANKLESS Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 Valuation: $ 1,500.00 Total Sq Feet: 20 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-12-17-65860 12/11/2017 Credit Card $ 50.00 $ 110.45 12/13/2017 Credit Card $ 110.45 $ 0.00 Available Inspections: Inspection Type: Final Press Test Review 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 AFFIDAVIT14-certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zora, g. Futhermork, lAthorize the above -named contractor to do the work stated. December 13, 2017 r / Applicant / Contractor / Agent Building Department Copy December 13, 2017 1 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 PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: Q � Sr DEC 2017 S4' ib FFBA/�C 201[- r Master Permit No. 31 Y� lY d'3 Sub Permit No. PL k1 - Zb 1 ❑ REVISION ❑ EXTENSION ❑RENEWAL, ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: 3 3 1300 Folio/Parcel#: I • 320(o - 013' C) 15 C7 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �,�l14!( �� V&I tics Phone#: ,3 q-1. 2 ( 0N0-7 Address: � 9q Ve 92 S'�n" A City: katrYII 5lao ✓ec State: �L Zip: 3,313-9 Tenant/Lessee Name: Phone#: Email: Of JV CONTRACTfO�R:: Company Name: EdWQ,1 � f C& li�` 9' Phone#: 30S � 9 TO' 7 Address: t� L l li ' %`� W U s M -5-10Jr City: &Ak, C�uv� State: FL Zip: �13 a�[dr l S 2 Qualifier Name: �rJC.1 }O l0011Z-a4t77 Phone#: 30sal S Qj9J State Certification or Registration #: LP (P 0Z$3Z �1 Certificate of Competency #: DESIGNER: Architect/Engineer: hone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/linear Footage of Work: F l Type of Work: ❑ Addition ❑ Alteration t� New ❑ Repair/Replace ElDemolition Description of Work: U h� cl4 'Ro C-4 1T CA."-^ .11, (0 Q ( gaA k b n �CG�n V 4f- \ &(A_k AkWe "IoVY-j 01-.nC� one NJ A gin n C'a-coY--N Specify color of color thru tile: Submittal Fee $ So Gj Permit Fee $ CCF $ CO/CC $ _ Scanning Fee $ Radon Fee $ 7 - Z DBPR $ 2 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ _ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revi5ed02/24/2014) 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 —ffe�:� OWNER or AGENT r The foregoing instrument was acknowledged before me this day of ee-r -"t.GI' 20 17 , by � C1%r e\AlJA�✓ who is personally known to. me or who has produced b �- 0 in 'Fi I,L as identification and who did take an oath. Signature ON ACTOR The foregoing instrument was acknowledged before me this q day of T- C, 20�� by �),�P a ho i errsJ ,Irl�IyknnoownQto me or who has produced *-Avyll 1 YesI i c' identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB C: t Sign: S1 Print:) Print: ��` �Y P �. Seal: ; ��::°:'�! % Suyapa T. Vasquez Seal: = MY COMMISSION # GO 044602 =*� ,, EXPIRES: November 2, 2020 �= Commission # FF942611 Expires: December 9, 2019 '•:So:?�?p'' Bonded Thru Notary Public Underwriters APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) w Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 notice to uwner — worKers, compensation Insurance txemiation 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. r 'Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of t>e,"ryl�ff , 20 l�. By 1kaV who is personally known to me or has produced di L O n '(VTR'_ X % as identification. Notary:.'_>Q�n .a�*�. Suyapa T. Vasquez SEAL: - Commission t FF942611 4" "= �` Expires: December 9, 2019 Bonded thru Aaron Notary Forever Gas Corp. DATE:12/04/2017 STATE OF FLORIDA COUNTY OF MIAMI SHORES BEFORE ME THIS DAY PERSONALLY APPEARED ROBERTO GONZALEZ WHO, BEING DULY SWORN, DEPOSES AND SAYS: THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 94 NE 93 ST MIAMI SHORES FL 33138 / 0' SWORN TO (ORAFFIRMED)AND SUBSCRIBED BEFORE ME THIS DAY OF 201�, BY (o PERSONALLY KNOW OR PRODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED �_/) Z,-- SIGNATURE �OF NOTARY PBLI ELIq �J✓i ��%� 21 >>F; m-g e s.o #FF131781 ; P ro�AGe.;G'Sli:Iindzc,�; �QQ+ DATE: 2 Loy 18111 NW 68 AVE UNIT 1-105 HIALEAH, FL 33015 • CELL: 305-298-0193 9 OFFICE: 305-331-2572