PL-8-18-2327, 478 NE 92nd Str
Miami Shores Village
`SNunes
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FLOR1Dp
Permit NO. PL-8-18-2327
Permit Type: Plumbing - Residential
Permit Work Classification: Gas
Permit Status: APPROVED
Issue Date: 9/11/2018 1 Expiration: 03/10/2019
Project Address Parcel Number
478 NE 92 Street 1132060140020
Miami Shores, FL Block: Lot:
Owner Information Address
THOMAS ROGER & CHRISTINA WHITE 478 NE 92 Street
MIAMI SHORES FL 33138-
478 NE 92 Street
MIAMI SHORES FL 33138-
Contractors) Phone Cell Phone
5 STAR PLUMBING SERVICES CORP (305)796-3607
Type of Work: GAS LINE FROM EXISTING METER TO BBQ
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0 60
DBPR Fee
$2 63
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$175.00
Scanning Fee
$3 00
Technology Fee
$0.80
Total:
$184.23
Applicant
THOMAS ROGER & CHRISTINA'
Phone Cell
(305)546-1030 (305)439-2855
Valuation: $ 900.00
Total Scl Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-18-68737
09/11/2018 Credit Card S 184.23 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
Review Plumbing
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
September 11, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 11, 2018 1
BUILDING
PERMIT APPLICATION
❑BUILDING
16, PPL^^UMMBING
�'J
JOB ADDRESS:
M
Folio/Parcel#:_'
Occupancy Type:
❑ ELECTRIC
Miami Shores Village
Building Department AUG 3118
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 r
INSPECTION LINE PHONE NUMBER: (305) 762-4949 tl'
FBC 201"-1
Master Permit No. C-k ^ I S9�
Sub Permit No.q�U Z--
❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
7 0 C � -Z S I-
0 (' C) C)o L
Load:
-�-S13
s the Building Historically Designated: Yes NO e/
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Il�o-Nk-f W 11 1 1- t Phone#:
Address:
1 I' L0 C(Z S ✓
City: LA S(n�� � State: !_ l
Tenant/Lessee Name: \ Phone#:
Email: &-(. C>",L- cjCi1!
`3 "31.� 2
CONTRACTOR:
ICompany Name: � �'`�.J � `` ��, JPhone#: � l ('0 3(.01
Address:
''^n
City: YV \ (4kA^ State: I \ Zip:
Qualifier Name: r1rn } I Y � I Ll` Phone#:!',� �(�
State Certification or Registration #: C F(, �1Z �� l 3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Cj rV l f Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: /
i (AL
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $ / 1 5 . CCF $ CO/CC $
Radon Fee $ 2 - (V�' DBPR $ Z • '�'0 3 Notary $
Training/Education Fee $ Double Fee $
Bond $ TOTAL FEE NOW DUE $ L4 • 23
(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
Zip
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 an estimated value exceeding $2500, the applicant must
promise in good faith that a cofy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject tolattachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ighichloccurs 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.
i
Signature SignatureW"
/ OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before this The foregoing instru nt was ickno ledged before me this
I ,
Cl '' 'day of �'20-` by --ay by
C f u U h .is -personally known,;t>5 Coiseersonally
me or who h s produced as^' me or who -has produc �� as
identification and who did take an oath. identification and wh did take an oath.
I t
NOTARY PUBLIC: _ /NOTARY PUBLIC: /
Sign:
Print
Print:
Seal: o`"RY "'"� LORETTACOMES Seal: 40..�� -.. V pllk LORETTACOMES
* MY COMMISSION # FF 954664 * * MY COMMISSION # FF 954664
EXPIRES: March 21, 2020 EXPIRES: March 21, 2020
Bonded ThruBudget Notary Senae< �'q�oF�d�`OP BondedThruBudgetNotaryServ@a
############################################################################################################
APPROVED BY /3G 1 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5 Star Plumbing Services Inc
11710sw180st
Miami fl 33177
8/28/18
State of Florida
Miami Dade County
Before me This day appeared Manuel Pampin who, being duly sworn deposes and says
That he will be the person working on the project located at:
9 e 5th ave rd-.-Mi Shores
77
Contractor
Sworn to (or Affirmed) and subscribed to me this' ay o_ � f /L ' � 2,(1
ByA�QLaVJ-Lcl,YIP)-�1
Personally
Or produoed}de
e°SPaY Pue�'c LORETTA COMES
Notary * MY COMMISSION # FF 954664
EXPIRES: March 21, 2020
af��FOF KI 91 Bonded Thru Budget Notary Senka
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to uwner — worKers, compensation insurance txernwion
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:
Owner
State of Florida .
County of Miami -Dade
JJ`
The foregoing was acknowledge before me this L Y day of 20
By_ C r � w �s personally known to me or has produced
as identification.
Notigc:�i ! ,a
�( * M MISSION A FF 954664
SEAL: J� EXPIRES: March 21, 2020
'"rFOF �o��OP Bonded Dru Mpet Notary Senkes