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PL-08-23-2098Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-08-23-2098 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date: 08/23/2023 1 Expiration:02/23/2024 Location Address Parcel Number 1240 NE 97TH ST, Miami Shores, FL 33138 1132050090590 Contacts RON KURTZ Owner MOTZ PLUMBING LLC Contractor LEE MICHAEL MOTZ RBKACQ@GMAIL.COM 820 NE 23 ST, NORTH MIAMI, FL 33161 Business: 3059924223 Description: RECONNECT SINK AFTER NEW CABINETS ARE INSTALLED Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $6.00 Technology Fee $10.00 Total: $120.90 Inspection Requests: Valuation: $ 200.00 305-762-4949 Total Sq Feet: 232.00 Payments Date Paid Amt Paid Total Fees $120.90 Credit Card 08/23/2023 $120.90 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. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and zoning. Futhermore, I authorize the above named contractor to do the work stated. Y z5> (zo z3 Owner / Applicant / Contractor / Agent August 23, 2023 Page 2 of 2 Miami Shores Village RECEIVED Building Department AUG 232023 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 C 2V/�� � = � _ BUILDING Master Permit No. C — v ? 131 PERMIT APPLICATION Sub Permit No. 0 -09-7- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1240 Ne 97th street Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder) 1240 Ne 97th street City: miami shores Tenant/Lessee Name: Email: Kaire -S V Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: _ State: florida Zip: XMIrWrJAIM ijftrlm CONTRACTOR: Company Name: Mott Plumbing Phone#:305-992-4223 Addrecc. 820 Ne 123rd Street ,North Miami FL 33161 Email: Motzplumbing@gmail.com Qualifier Name: Lee M Motz Phone#: 305-992-4223 State Certification or Registration #: CFC1429581 Certificate of Competency #: DESIGNER: Architect/Engineer: State: _Zip: Value of Work for this Permit: $ Ago Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of work: Reconnect sink after new cabinets are installed Specify color of color thru tile: Submittal Fee S Permit Fee $ Scanning Fee $ DCA Fee $ Technology Fee $ Training/Education Fee $ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary Double Fee $ Structural Reviews (Revised04/05/2022) P&Z Review $ Bond $ TOTAL FEE NOW DUE $ 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. 1?�� Signature SignatureE G ljVZ jj=�� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 2-3 day of 20 z-? , by (<arzn V, `0-4. , who is personally known to me or who has produced %2 -LW-1 Ve*-z Li L as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this + mot day of Nvu%,%A , 20 '2 N , by L-ee. 1-l�c�t^a Ho+-Z , who is personally known to me or who has produced Q- (110,c If Li(1-(*)(;(as identification and who did take an oath. NOTARY PUBLIC: Sign: l..J — �`-`-"' Sig Print: U I VL `e-V1V\.eJ rC.a Print: L "go11llg1i \ jryienne Yao S I' Sea : o�*Ar p�a�,- S� Comm.:HH 222410 ea . = � = Expires: Jan. 31.2026 Illf NotarYPublic • State of Florida APPROVED BY Plans Examiner 1 m-A -! Notary Public State of Florida Luis Javier Lavalle My Commission HH 188781 Exp. 1 /112026 *********************************** Zoning (Revised04/05/2022) Structural Review Clerk 8:51 as 5GC =', X license5865435.pdf �°+ U il:. Cx::. �s' IMWieSGNFn X,tM:A' dbpr STATE OF FLORIDA " DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONSOF CHAPTER 489. FLORIDA STATUTES .I MOTZ, LEE MICHAEL MOTZ PLUMBING LLC 820 NORTHEAST 123RD ST NORTH MIAMI FL 33161 LICENSE NUMBER: CFC1429561 EXPIRATION DATE: AUGUST 31, Y024 ,Nwm verily Ikemes oNlne at MYElmidalkarse.wm O '�O 4 Y K ;' � Do twl alter this document In arty loan. Eli This is voui I.cense. It is uNawN fa arryone oMu than the llcenfee to use ti document JIMMY PATRONS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/1/2022 PERSON: LEE M MOTZ FEIN: 812252115 BUSINESS NAME AND ADDRESS: MOTZ PLUMBING LLC 820 NE 123RD STREET, MIAMI, FL 33161 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers EXPIRATION DATE: 2/1/2024 EMAIL: MOTZPLUMBING@GMAIL.COM IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by fling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05 (13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01447617 QUESTIONS? (850)413-1609 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.qov 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 �Jbv the Division. (n Your contractor: I 1 U (�A{ i i�A is requesting a permit under this workers' compensation exemption and has acknowledge that 6e 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 ACKNOW DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:1C.1&4Address: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this -2J day of /4Uq U 20 . By ��c '\� V I ( who is personally known to me or has produced as identification. Notary: ( )I,, opuiu� Vivienne Yao \ Y P SEAL: .0:." ....'t ; _�: �_ Comm.:HH22241 _ y Jan. 31, 2026 Expires: Rev1212202 `,°,,� N°taryPublic•SlsteofFNotice to Owner Page 1 of 1 305-992-4223 license# CFC1429581 MOTZ PLUMBING LLC August 21 st 2023 State of Florida village of Miami Shores Before me this day personally appeared Lee Motz who, being duly sworn, deposes and says: That he will be the only person working o the project located at: 1240 ne 97th street contractor signature Sworn to (or affirmed) and subscribed before me this l I day of ,20Z by L�ti �� �� �.� HoVz- Personally know Produced id Type of id R Qy-fr Lic.t,► — Print type or stamp name of notary ANotary Public State of Florida Luis Javier Lavalle My Commission Illt HH 188781 Exp. 1iu2a2s