PL-19-1833Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue
Location Address Parcel Number
431 NE 100TH ST, Miami Shores, FL 33138 1132060170500
Contacts
Permit No.: PL-0849-4833
Permit Type: Plumbing - Red(k!0, 81
work classification: Sprinkler SysteM
Permit Status: Approved
Expiration: 02/ 12/2020
ERIN HALLORAN Owner BEACHSIDE PLUMBING INC Contractor
451 NE 91 ST, MIAMI SHORES, FL 33138 VINCENT JOHN KORTABANI
Other:3522623193
Business:9544449646 WATERBOYSPRINKLER@GMAIL.COM
Description: NEW UNDERGROUND SPRINKLER SYSTEM CITY Valuation: $ 2,200.00 Inspection Requests:
WATER
Total Sq Feet: 0.00 1305-762-4949
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
08/07/2019 $50.00
Credit Card
08/16/2019 $69.40
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
re _
Authorized Signature: Owner / Applicant / Contractor / Agent
-1i " 1
Date
August 16, 2019 Page 2 of 2
a
BUILDING
PERMIT PPLICATION
❑ BUIL G ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
Miami Shores Village DECEIVED
Building Department Au i 072019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.
Tel: (305) 795-2204 Fax: (305) 756-8972 Nw
INSPECTION LINE PHONE NUMBER: (305) 762-4949 49-C�4
FBC 20 l2t
Master Permit No. P L'
-o�) - M-i -a -3-
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION' O'$HOP
CONTRACTOR DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes -* NC)' -
Occupancy Type: Load: Construction Type: Flood Zone:` BFE: FFE:
OWNER: Name (Fee Simple Titleholder �iY1 : Phone#: # ,
CGn -` 3 0� �
1 1 21 A /t� ,,.,r1 11 C` I If
Add
Tenant/Lessee Name:
Email: W a-A-taYc
CONTRACTOR: Comoanv Name:
City: V { 1 IV \ -
Qualifier Name: C ' I
State Certification or Registration #C I `'1 f
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition El
� ❑` AAlteration
Description of Work: _ Mew V't
ne#:
Y1
C Phone#: qj<—t-/ qq111- S6
7-
Certificate of Competency #:
City: State: Zip:..
�juare/Linear Footage of Work:
New Repair/Replace ❑ Demolition
er
• .T a
Specify color of color thru dfe:;
Submittal Fee $ Permit Fee $ CCF $ CO/CC $ .
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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.
"WARNII, TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RE.. LT.] '.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 i� issue;. In the an nce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. , r
—Signature �=,��
OWNER or AGENT
The foregoing instrument was acknowledged before me this
-� day of , 20/�J by
ra, who is personally known to
me or who has produced
CONTRACTOR
The foregoing instrument was acknowledged before me this
T� day of 20� by
v1 A1CQ n %_ 1�0 f� ahl , who is personally known t
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign:. Sign:
Pri Pri ,
;� JAMI '
Seal: ;•: MY COMMISSION # GG088519 Seal: �; t•c MY COMMISSION # GG088519
'M? EXPIRES Apri101, 2021 .,'nor EXPIRES April 01, 2021
*******r**��*********�*s***************r*s*******r**r********s*�*****�**r***rs**r*******»**rs*•*******�s****
APPROVED BY ��—� CaP/,�1151 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
a ,M
Beachside Plumbing
2650 NE 91h Terrace
Pompano Beach, FL 33064
Date:
State of Florida
County of Broward
Before me this day personally appeared Vincent Kortabani who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
431 NE 100'At. Miami Shores, FL 33138
r
Sworn o (or affirmed) and subscribed before me this--7 day of 2019.
By
Personally Know v
4. JAMIE CAMUCCIO
MY COMMISSION # GGOM19
.a EXPIRES I April 01, 2021
OR Produced Identification
Type of Identification Produced
Print, Type, or Stamp name of notary
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
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this �_ day of 20�.
gym� 0` h f- 0s,2 who is personally known to me or has produced
as identification.
;; ►""'�"iir . JAMIE CAMUCCIO
Notary: 'c MY COMMISSION # GG088514
•.,,aEXPIRES April 01, 2021
SEAL
M r Proudly Serving
a
►.� _ Y�_ _ the Florida Real
ME LAN A t �, r Estate Community
K nE �P�h A -
ti `*
for 120 yw,
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;\,1;an-ji Shores Village
; •�� IOVED BY
DATE
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LOT 10 LOT 9
LOT 8
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Accepted By:
Property Address:
431 N.E. 100 Street
Miami Shores, FLORIDA 33138
PROFESSIONAL LAND SUR
ADMINISTRATIVE OODE PL
SIGNED
EFRAIN LOI
STATE OF F
NOT VALID WITHOUT AND
ELECTRONIC SEAL AND/OI
RAISED SEAL OF A UCENS
THIS BOUNDARY SURVEY ISATRUEAND
UNDER MY DIRECTION. THISCOMPLIES
ORTH BY THE STATE OF FLORIDA BOARD OF
PI THROUGH 5447--OSZ FLORIDA
FOR THE FIRM
P.S.M. No. 6792
SIGNATURE AND AUTHENTICATED
THOUT THE SIGNATUREAND THE ORIGINAL
MAL
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Notes: FENCES ENCROACH OVER EAST LOT LINE.
M.E. Land Surveying, Inc.\
10665 SW 190th Street
g�9
Suite 3110
..-...,..:, ,_.
Miami, FL 33157F+A
Phone: (305) 740-3319"'
Fax: (305) 669-3190
LB#: 7989
Survey #:B-46890 Client File #: FTG-18-0155 Page 1 of 2 Not valid without all pages