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PLC-02-19-326, 9050 NE 8th AveMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9050 NE 8TH AVE, Miami Shores, FL 33138 1132060110020 Contacts e Inspection Requests: Description: REPLACE FAUCET IN KITCHEN AND BATHROOM ; Valuation: $ 16,000.00 3ti�=72-49�9 Total Sq Feet: 50.00 Fees Amount Application Fee - Other $50.00 CCF $9.60 DBPR Fee $7.20 DCA Fee $4.80 Education Surcharge $3.20 Permit Fee $430.00 Scanning Fee $3.00 Technology Fee $12.00 Total: $519.80 Payments Date Paid Amt Paid Total Fees $519.80 Credit Card 02/12/2019 $50.00 Credit Card 02/26/2019 $469.80 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. I . AuthorizA Signature: Owner / bpplicar`tt / Contractor / Agent Date February 26, 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 MIPLUMBING ❑ MECHANICAL ❑PUBLICWORKS FBC 201 (,t n Master Permit No. Sub Permit No. �LU 2 - H - 3Zb ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: Cj°OLi N£ -e Ave, U,j6 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 3 Z Q C Q ) 0 Q "Z a Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): R 6 , S D $ --tea 1 L L-C Phone#: 3 7 Address: j2ji�C!! 1 ti F City: TFY1 M C Cke'^ State: F zip: -3 3 i 6 Tenant/Lessee Name: Phone#: Email: L CONTRACTOR: CompanyName:?(-fN I-e-r.-- %44i,n'Q C,-iAT 11a',C,n A- Phone#:(1S-t{)SSF! 7`t Address: -S-70S N VA 1 T�Pwr - City: Tamc.'ec(-- State: F L zip: .3 3 3 2 k Qualifier Name: ;�'h�� y d c 11 rM c Phone#:(/cj YY) SSS - 17 State Certification or DESIGNER: Architect/Engineer: Add on #: L PC I'(1-9 L4'7 0 Certificate of Competency #: Phone#: City: State: Zip: Value of Work for this Permit: $J 6Q� ' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: jZ�-►7��+cs- iy\ c�a . o� ®.c� �j c�~� Y� 1r� a n, Specify color of color thru tile: Submittal Fee $ j Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ CO/CC $ Notary Double Fee $ . Bond $ (Revised 02/24/2014) TOTAL FEE NOW DUE $ 'T 6 G . 80 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State E. 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. Signature _ OWNER NT The foregoing instrument was acknowledged before me this day of ()GIc us 'v 120 , by v � who is p sonally know to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Signat57 ur CONTRACTOR The foregoing instrument was acknowledged before me this day of AC9-b#-A?L 20 (0 by �Y d/t"� mr - who is personally known to me or who has produced Pl O i- as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: Jorge Nieto ° y .V _�Ordd SeaI: * N,8 .. ExOm ARYAry It, z � t� a�q ��e C s- �? ��563 rFp,�eP Ba�d�O'RMYNelsWSwrixt APPROVED BY — -�' t4l �l% Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk JHN REMODELING & MAINTENANCE February 12, 2019 State of Florida County of Broward Before me this day personally appeared ��� ✓1 y cyt who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 9050 NE 8t"Ave. Miami Shores, FL 33138 ontract ignature Sworn to (or affirmed) and subscribed before me this ji�day of r e [lyLhk . 201 � Personally know Or produced identification Type of identification produced Jorge Nieto cAlk No:arY Public • State of Florid: Commission #GG 95563 Ir Expires 4/18/2021 F o BondP.d through Cynanotary J6v 1V I °f0 Print, type or stamp name of Notary Notice to owner — worKers, uom Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation insurance txemation 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. 1 Signature: Owne State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 20 / 9 . By 3,11 Gy l �l I f Z c �c r who is personally known to me or has produced 1 as identification. LYNN MAY VELIT Notary: :�'�Pa� P,;F'. • utar, c ,p�ic - State of Florida s' • COmMissov! a GG 050I83 SEAL: :a ' •,,„_,V MY Comm. Expues Nov 28, 20200 Bonded through National Notary Arun.