PL-14-1654Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216915
Scheduled Inspection Date: October 30, 2014
Inspector: Diaz, Osvaldo
Owner: GONZALEZ, MARIO
Job Address: 9811 NW 1 Avenue
Miami Shores, FL 33150 -
Project: <NONE>
Permit Number: PL -7-14-1654
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number (786)236-0135
Parcel Number 1131010330080
Contractor: R&I PLUMBING SERVICES CORP Phone: 305-823-6911
Isulliai
comments
RELOCATE POOL EQUIPMENT APPROX 7 FT FROM
CURRENT LOCATION INSPECTOR COMMENTS False
Inspector Comments
Passed p
Failed
L
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 29, 2014 For Inspections please call: (305)762-4949 Page 12 of 36
M 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
FBC 20A C3
BUILDING Master Permit No. RPR Al " Z6=(. :3
PERMIT APPLICATION Sub Permit No. Z, Z
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL F-] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
G�CONTRACTOR DRAWINGS
JOB ADDRESS: (Alw i5�AVe
Ci Miami Sh Count • iamLDdde Zi •
Folio/Parcel#: is the Building Historically Designated: Yes NO
Occupancy Type: Load: �Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder/�[
r): ,, ,,� ���% ,moi/�� Phone#:��25 COO/ -5
Address:
, �4? bw f %7
City: I /L a_ 011e -4-D State: _ _ Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ^ a inn h i A CA Phone#: -10(-- fes- %
Address: -729' KU) 171 S k
City: 14 JA I4a State: 1: L Zip: _33 Q 157
Qualifier Name: R �P_ n e Coo 2. y^ Ain Phone#: `30(":
State Certification or Registration #: Certificate of Competency #: 6,3r-0000711
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 3Ub Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:.
OfnPr,3 k
❑ Alteration ❑y New ❑ Repair/Replace
1Oc'm� Ddu1-PG/ViDmall 4--
Fj -
.0 /1,-/—
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 5O
aZ Permit Fee $ � � CCF $ n , � CO/CC $
Scanning Fee $ Sd (3 Radon Fee $ A , 2�E-2 DBPR $ 2- < �b Notary $
Technology Fee $ n Training/Education Fee $ 6 , ,2,0 Double Fee $
Structural Reviews $ Bond $ p
TOTAL FEE NOW DUE $ Il
(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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
t
Signature i oil v° n Signature
OWNER or AGENT C NTRACTOR
The foregoing instrument was acknowledged before me this
—)-61 61 day of�--1-0 (L/ . 20 I by
aU Neem Ae 1 r , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLI
Sign:
The foregoing instrument was acknowledged before me this
�el day of Jy IV . 20 � � by
P-6%0 &uZdA 0 , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign
YHOSV
Print: Print: / 681
Seal: ,iQ`�� YHOSVANY MARTINEZ �.r ril 04, 2015
MY C
' Seal: +,��,. EXPIRES Ap
Y COMMIES, -.)N # EE080681 Floridallotaryservice.rom
EXPIRES April (14, 2015 (407) 398-0153
rk,mallotaryServ1ce.c0m
APPROVED BY /`! Plans Examiner
Structural Review
(Revised02/24/2014)
as
Zoning
Clerk
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. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, youmay be
personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Contractor
M�
Print Name:Print Name:,��,.
Signature: Signature:
State of Florida)
County of Miami -Dade )
Sworn to and subscribed
day of . 5.0—.y '1'
LIM
(SEAL)
State of Florida)
County of Miami -Dade )
before me this Sworn to and subscribed before me this ��
—,20 1� day of jCo �T. , 20JAL.
MY COMMISSION # EE08 5881
of
MY COMMISSION # EE08088