PL-08-19-2007, 685 NE 93rd StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
685 NE 93RD ST, Miami Shores, FL 33138 1132060141750
:ontacts
MARIBEL VALMOCINA Owner ACCURATE GAS SERVICE CORP Contractor
685 NE 93 ST, MIAMI, FL 331382906 ALEJANDRO MOREJON
Other:3057587829
Mobile: 7864998261 alex_morejon@yahoo.com
Inspection Requests:
Description: RUN NEW GAS LINE FROM LP TANK TO Valuation: $ 1,200.00 gw
APPLIANCES f u
Total Sq Feet: 0.00 fr J
Fees
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$50.00
$1.20
$2.00
$2.00
$0.40
$50.00
$9.00
$2.50
$117.10
Payments
Date Paid Amt Paid
Total Fees
$117.10
Credit Card
08/29/2019 $50.00
Credit Card
09/16/2019 $67.10
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 AFF V certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating cons d zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signat4rrowner / Applicant / Contractor / Agent
Date
September 16, 2019 Page 2 of 2
Miami Shores Village RECEIVEDau �� z �s
Building Department BY;
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 -� I
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�-
BUILDING Master Permit No. ?j-.-d
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
/PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami S(h'ores County: Miami Dade Zip:
Folio/Parcel#: 20' A ` T7 Is the Building Historically Designated: Yes NO
Occupancy Type: itA Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple itleholder : W �lx ��1� Phone#:
Address:. W'US- Simple
\ > �a—t
City: )6A\' P0\1K� cl= t—mC
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
State:
Certificate of Competency #:
Phone#:
Zip: 79:?-> �:Z's
Address: City: State: Zip:
`�f� CO•
Value of Work for this Permit: $ \ w (D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ AAlteration ❑ New ❑ Repair/Replace [� ❑ Demolition
Descriptiorf Work: \ )t,,
F_
.. . _. . a .
Specify color of color thru t11,0
Submittal Fee $"� Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $.
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ - 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 obsenca of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. 1-1-L
Signature%�a "W4� Sign
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
d y f Co 20 , by day of 't `� ��� 20 �- . by
who is personally known to who is personally known to
me or who has produced p`i V 452-55-51 512130s me or o has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
Sea]:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
COMMISSION # G130063661 Seal:
EXPIRES June 27, 2020
***********************************************************
APPROVED BY
Plans Examiner
Structural Review
53
MY COMMISSION # GGWO366
EXPIRES June 27, 2020
**********************
Zoning
Clerk
(Revised02/24/2014)
Notice to Owner — Workers' Corn
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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.
r Signature:
Owner
State of Florida
County of Miami -Dade
The fo egoing was ackn wledge before me this 1�) day of r 20--6:
O
By ( who is wn to me or has produced
as identification.
Notary:
SEAL:;: DAYAMY PENA
MY COMMISSION * 0431005366
EXPIRES June 27, 2020
K
7ZE CF, I jE11--) Property Owner: Maribel Valmocina
Property Address: 685 NE 93 St.
AU 2 9 2019 Miami Shore FL. 33138
BY:
I
3/411
Galv. pipe
' �r
Gas Cook -top
-0 j
90 000 BTU's
�" r
—
LP Tank
Q
r
18'
Outdoor
f
1
Tankless water heater
I
Galv. pipe
180 000 BTU's
Gas Dryer
22 000 BTU's
8'
nn.�
ly
1/2"
8,
Galv. pipe
Contractor: Accurate Gas Service
Address:16480 SW 139 Ct.
Miami FL. 33177
Phone: 786-499-8261
Email: alex_morejon@yahoo.com
Contractor: Accurate Gas Service
Address: 16480 SW 139 Ct.
Miami FL. 33177
Phone: 786-499-8261
Email: aIex_morejon@yahoo.com
Gas Dryer
22 000 BTU's
Outdoor Tankless
water heater
180 000 BTU's
1"
Galy. Pipe
Cooktop 18'
90 000 BTU's
LP Tank
#420
32/4" First and Second
Galy. pipe [stage regulator
Longest Run: 36'
Total Load: 292 000 BTU's
Type of Gas: Propane
Material: Galvanized pipe
New Outlet: 3
New Connection: 3
8'
Florida Building Code: Fuel Gas 2017
Chart # 402.4(28)
Schedule 40 Metallic pipe
Inlet Pressure: 11.0 in. W.0
1/2„
Galy. pipe
ACCURATE
September 9, 2019
State of Florida
County of Miami Dade
Before me this day personally appeared Alejandro J. Moreion who, being duly sworn
Deposes and says:
That he will be the only person working on the project located at:
NE 93 St. Miami Shore
Contractor Signature
Swo to(or affirmed) an ubscribed before me this day ofP2-20�
B
Personally know
Or produce identification
Type of identification
DAYAMY PENA
MY COMMISSION 8 GG006356
EXPIRES June 27, 2020
Print, type or stamp
Cut Here
State of Florida
Department of Agriculture and Consumer Services
Division of Consumer Services Certificate No: 31216
Bureau of Compliance Exam Date: February 24, 2015
,(850) 921-1600 Issue Date: April 22, 2018
52 Expiration Eam: 080321, 2021
Tallahassee, Florida xx
MASTER QUALIFIER CERTIFICATE
This Certificate is issued under authority of Section 527.02, Florida Statutes, to:
ALEJANDRO MOREJON
Valid For
License Number. 35908
ACCURATE GAS SERVICE CORP. a"
16480 SW 139TH CT ADAM H. PUTN M
MIAMI. FL 33177-2023 COMMISSIONER OF AGRICULTURE