PL-14-2178Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-220990 Permit Number: PL -10-14-2178
Scheduled Inspection Date: December 18, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: BROWN, MORGAN Work Classification: Addition/Alteration
Job Address: 29 NE 102 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060131650
Project: <NONE>
Contractor: AMERICAN CONTRACTING, INC. Phone: 305-759-7000
Building Department Comments
REMOVE AND REPLACE ONE TOILET ONE BATH TUB
TWO LAVATORIES
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed (�
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
December 17, 2014 For Inspections please call: (305)762-4949 Page 9 of 29
FIUMe,'r Miami Shores Village CEIV;
Building Department OCT 06 20% I
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 20
BUILDING Master Permit No. PC -0I-' ` rZ,
PERMIT APPLICATION Sub Permit No. R11 "A
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
OLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: P ,' 1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: pts
OWNER: Name (Fee Simple Titleholder): ie.+R VI� CjMb(D Phone#: RIA 94696 4-1
Address: • C M7 YVA St p
City: M; q nn1 S" V—S State: FL Zip: 33134
Tenant/Lessee Name:
Email: l� 4q_%i
CONTRACTOR: Company Name:
Address: t? z- &'0
m
hone#:
City: State: — Zip: 33t
Qualifier Name: _- Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
City: State:
Val4p of Work for this' Permit: $ (= p ® Square/Linear Footage of Work:
E444gKIL 01"W'
ORISTypq., Wojk: n, A4&rbn ❑ Alteration ❑ New Repair/Replace
a
4i
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ �`"1 Permit Fee $ �' �`�` CCF $ CO/CC $ Y�
Scanning Fee $CID Fee $ DBPRR $^^ . ' Notary $
,
Technology Fee $ �-- r Training/Education Fee $ G - GO Double Fee $
Structural Reviews ,$ 0 Bond $
TOTAL FEE NOW DUE $ (�
(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. A — n OA. a Q
Signature � req —ft) YCLN.
r
OWNER or AGENT
Theforegoing instrument was acknowledged before Pme this The foregoing instrument Hllas acknowledged bef�e me this
`�yJ1l day of �� 20 f "I , by 4�6" day of��r,: fr—, 20 �, by
Owho is personally known to a1 if 0_, P— who is personally known to
me or who has produced -bf–`1 Fg'�O — 00--71(a me or who has produced An ( .)- as
identification and who did take an oath. (?X PI _ 1 16gl identification and who did tak
NOTARY PUBLIC:
NOTARY
MppgMIONIIEEMM Dedi:
EXPIRES: Mach 29.2017
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
RW
JANELL FONT
nary Public - State of FWW
Comm. Expires Jul 31, 2018
Commission #► FF 147125
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 jn 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, yqu may be
personally liable for the worker compensation injuries of M 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.
Owner
Print Name:Cry Q {�
Signature: V
State of Florida )
County of Miami -Dade) l tL
Sworn to and spbsc ' ed before me this t�
day of -�
•'••� a� JAN LL FONT
By Notary Public - State
M Y Comm. Expires Jul 31, 2016
(SEAL) ' . it; CommiSSlon * FF 147125
-000 -- 74-c?
Contractor
Print Name: �l i � �
Signature:
State of Florida )
County of Miami -Dade )
Sworntobs 'b
day of
of Identification
/v
JANELL FONT
Notary Publ� - State Of Florid
M"PIF08 Jul 1
'SSi0" # FF 147125