PLC-19-1776Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
725 NE 91ST ST 3D, Miami Shores, FL 33138
Contacts
•
1st Date: 08/09/2019
Permit NO.: PLC-08-19-1776
Permit Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status. Approved
Expiration: 02/05/2020
RENE MEDINA Owner
Home: 3057599069
QUINTERO GENERAL CONSTRUCTION Contractor
BERNARDO QUINTERO
8801 NW 112 TER, HIALEAH, FL 33018
Business: 7864875738
Description: REPLACE SECTION AND ELBOW OF 1 1/2 " DRAIN Valuation: $ 375.00 Inspection Requests:
PIPE LEADING TO 3" STALK, PVC PIPE USED AS PER CODE r762-4649
Total 5q Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$116.30
Payments
Date Paid Amt Paid
Total Fees
$116.30
Credit Card
08/09/2019 $66.30
Credit Card
08/01/2019 $50.00
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---Futhemaor� authorize the above named contractor to do the work stated.
4"k.-4_ 2'0 t y
Authorized Signature: Owner / Applicant / Contractor / Agent Date
August 09, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
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
p,ECEIVED
AUG 012019
BY:
FBC 20 f -�
Master Permit No. C 09
Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�( a 1 CONTRACTOR DRAWINGS
JOB ADDRESS: —7Z5- N, l I 1' '`J� 3 D _
City: Miami Shores County: Miami Dade Zip: 3 ✓ 6
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):S'�i"�
"
\ L-A-LA vkST CS1Oi 6
Phone#: /�'-�o0
Address:l�_
City: M\� Sv�L!-.�
State: �L
zip:3313�
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
N \ CJ tarj COr>-j t
16tju k8,11) v
Qone#:
Address: 886
City: kk+ State: -C'l_ zip: 3 3 G \ 8
Qualifier Name: � � G Q>—k\ Phone#:
State Certification or Registration #: /YZ 8 % _)3 Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: _ City:
Value of Work for this Permit: $ 3 Square/linear Footage of Work:
03
Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition
Description of Work: l �-� S£X' _j\ u`j A }��3ow 0 'P \ P l_ F� >> 1 cam► (�
Specify color of color, thru .tile: ^"
Submittal Fee $ Permit Fee $ CCF $ "CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary$.
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 6(0. �3 O
(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.
"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.
Signatu%
OWNER or AGENT
The foregoing instrument was acknowledged beforemethis
7-2—clay Ia
VZ -20 1 by
CA IR L(2 S L V 22 ho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: E?e-�qvr.N
**********
Notary PubBAtate of Florida
Oscar M Zaragoza
My Commission FF 939267
Expires 12/=2019
as
***********
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
2-2-2-2— day of `Vy � 20 /1 , by
if�? #P-PiiV I�rjQAho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Can
Print: cCiG 6
Seal: F;6PTV
APPROVED BY �� Plans Examiner
Structural Review
Notary Public State of Florida
Oscar M Zaragoza
My Commission FF 939267
fixp►res 12/00/2019
**********
Zoning
Clerk
(Revised02/24/2014)
Quintero
Geeerai Centmetor
QUINTERO GENERAL CONTRACTOR CORP
Bernardo Quintero 8801 nw 112 terrace
Hialeah Gardens fi 33018
Date:
State of florida
County of dade
Before me this day personally appeared Bernardo Quintero who, being duly sworn, deposes and says:
That he or she will be the only person working on the project locate at
as P►t 611 I ', 31S
Swam to (or affirmed ) and subscribed before me this of�-�-- �- -, by -�: � 1 xq ' 0
Bernardo Quintero
<—;01
Personally know Air
Or produced identification
Type of identification produced
Print, type or stamp nam f nota
��+ Put Notary Public State of Florida
Oscar M Zaragoza
a� My Commission FF 939267
a Zo E.0 12/08/2019
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972 E
Notice to Owner - Workers' Compensation Insurance
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:
I . 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 V U L" _ , 20/.
By eq 2 -
t s A&,A Vr IF A ho is ersonally known to me r has produced
as identification.
Notary:.
SEAL: Notary Public to of Fbrld
Oscar M Z goza
av My CommLsAon FF 939267
w�0' Expires IZW2019
AFFIDAVIT OF UNIT OWNER
Before the undersigned authority personally appeared Rene Medina
who being first duly, sworn, deposes and says:
1. My name is Rene Medina , I am over the age of 18 and have
personal knowledge of the matters set forth therein.
2. My residential address is
400 Kings Point Drive Apt 1123 Sunny Isles Beach Florida 33160
3. I am the registered owner of the property located at 725 N E 91 st Street Apt 3
Miami Shores, Florida 33138 By virtue of this ownership, I am a member of
Shores Plaza East Condominium Association, Inc.
4. It has come to my attention that the unit within Shores Plaza East Condominium
Association requires repairs and/or modifications.
5. I fully authorize Shores Plaza. East Condominium Association to handle all
aspects of ese r irs and/or modifications. •„• •
Y •
• • •••• ••••••
• • •
•••••• •• *a,- ••••••
•
A iant's ignature • • • • •
•�
Sworn to and subscribed before me on this day of v Z. �- �,y at:***
on F N T who produced Fla Drivers License as fotm af; • • • • • ; •
•••••*
identification and also known personally to me. 0 00•
Votary Public
Notary Public state o► Florida
Oscar M Zaragoza
MY Commisslon FF 93OX7
at Expires 1?1U8/2019
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pLUMBING PLANS
R- i, Approved -�� T) tees 4
Disapproved