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PL-19-1308Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date: 06/28/2019 Parcel Number 335 NE 93RD ST, Miami Shores, FL 33138 1132060136260 Contacts Permit NO.: PL-06-19-1308 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: Approved Expiration: 12/25/2019 PAUL MADSEN Owner 335 NE 93 ST, MIAMI SHORES, FL 331382854 RADIANT PLUMBING & BOILER CO. Contractor ROY VALDES 1276 93 ST, MIAMI SHORES, FL 33138 Business: 3057856649 Description: GAS LINE TO WATER HEATER, FUTURE DRYER, Valuation: $ 2,400.00 Inspection Requests: GENERATOR, COOK TOP AND RELOCATE WATER HEATER Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 06/28/2019 $111.90 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 authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date June 28, 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 [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS:✓ RECEIVED JUN 0 6 2019 FBC 201 Master Permit No. f1'O4° ` 19 A3 Sub Permit No.PL-C16-1 I - 130S ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 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): /"7/ y- (O/'S A U( l °�gAr-11 Phone#: —5� s D05 �7C� Address: 33S— %L R13 5t City: li A I , ._� Tenant/Lessee Name: Email: State: i1 Zip: Phone#: CONTRACTOR: Company Name: &0L/,,e,:Y f7U4/u 4 AnPhone#: 0-5- /79S ay/F Address: Y(} City: / Qualifier Name: S e#: p: 33a's State Certification or Registration #: 121&C. 0__; - Kg (7) Certificate of Competency #: DESIGNER: Architect/Engineer: () Phone#: 1ti/4 Address: A_, /�' City: AlState: State: A-/9-Zip: Value of Work for this Permit: $ �� rSr'S Square/Linear Footage of Work: Type of Work: ❑ Addition ki Alteration ❑ New ❑ Repair/Replace Description of Work: ❑ Demolition 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 $ q_.Lk�/ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address 141 City State �y J Zip Mortgage Lender's Name (if applicable) `v Mortgage Lender's Address City State 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 on estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low 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 proved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 , by A who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: ? 141� Seal: SILVANA L. AGOGLIA MY COMMISSION # GG 148382 :•.40= EXPIRES: October4,2021 as The foregoing instrument was acknowledged before me this 10 day of 20 1 L by Q who is personally known to me or who has produced 7r�2pi'SCz>E?lkIZ4- identification and who did take an oath. NOTARY Print: Seal: :rY: Herena Szczepanski y My Comrmssion GG 315621 ejdn Expires03125/2023 *******��i�,R:A**Ptl�ntlad►1�W#'WW��i!'k'YlISRSf?�...,=r=a***********************************************************s******* APPROVED BY E 6/7- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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: �26)",� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of , 20—ft who is me or has produced as identification. Notary: .Gp�1MIS5%py`F�� SEAL: , .,arch 6, �c *• N Roy Valdes Contracting Services Inc. PO Box 56-5273 Miami, Florida 33256 (305) 785-6649 email: roVvaldes@vahoo.com Date: 6-21-2019 State of Florida County of Dade Before me this day personally appeared Roy Valdes who being duly sworn and deposed and says that he will be the only person working at the project located at:335 NW 93 Street. Votke.-6. Contractor signature Sworn to or affirmed and subscribed before me this 211t day of June 2019 Personal) known CLAUDIAM.NAVAS I Y MY COMMISSION # GG 315006 EXPIRES: May 17. 2023 I' Bonded i1ru Notary Public Undeiwrlte�s