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PL-15-1736 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-246171 Permit Number: PL-7-15-1736 Scheduled Inspection Date: November 04, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: RUARK, JOHN Work Classification: Addition/Alteration Job Address:9909 NE 4 Avenue Road Miami Shores, FL Phone Number (410)610-2148 Parcel Number 1132060171310 Project: <NONE> Contractor: DALE PLUMBING Phone: (786)663-1804 Building Department Comments install kitchen appliances Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-238889. Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 03,2015 For Inspections please call: (305)762-4949 Page 18 of 39 Miami Shores Village -�' �� JUL 2015 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 201 � BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP A OIL) y� CONTRACTOR DRAWINGS JOB ADDRESS: R ` ` E E. City: Miami Shores County: Miami Dade Zip: 3331? p! Folio/Parcel#: Is the Building Historically Designated:Yes NO W'Occupancy Type: Load: Construction Type: " Flood Zone: BFE: FFE: OWNER: Name(Fee SimpleTi leholder): O V- 1ce4 V Phone#:LI ) !D (, 102-4g qM Address: /; C _ .Au4 1+ City: �,LOUM I `� cs-�7 State: 1 Zip: Tenant/Lessee Name: Phone#: Email: �- CONTRACTOR:Company Name: / (� t.V.rtr.,•Qy 00 r�i Phone#: " Address: l 4 0 W Q 7_ Il City:�moLCGt.w` . S L.%(3-4.0—!6 State: Zip: / �s 0 Qualifier Name: A.,�A� oM3 tl 1.wJ 1Gi CJS Phone#:7% (`.3 1S0 State Certification or Registration#: Certificate of Competency#: G(dc, (4,2 7ple DESIGNER:Architect/Engineer: _A4. Phone#: 3,13.5 —5 O,-,?a Address: City: State: Zip: Value of Work for this Permit:$L_7,0a Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru,tile: t r Submittal Fee$& Permit Fee$ !50 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address 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 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 apprw-d_and a reinspe a will be charged. JSignature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instru nt was acknowledged before me this _ 7 day of v 20 ,s by j +J d of 20 L ', by �Cle "l d who is personally known to ho is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PU 4Sign: Sign: ce- Print: ��''� Fu 7 If r Print: LcA-v ` C-, otpRY P�� 4P Z!%, LAURA FARLEY Seal: ;•••; LAURA ARLEY Seal: My Cc?I.�tISSiON#FF 1 * it * MY COMMISSION t FF 188027 * ;r1PES:March 16,2019 sr F EXPIRES:March 16,2019 a�oGetl's. ,N40 Nogry Servka OFF Bonded Thru Owo Noury SArvka a cr aw ************************************************************************************************************ APPROVED BY a 8'/y/s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SNORQ 1932 ES l,,, ,,,,,� Miami shores V + Building Department OR 1D 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Eli : i 01 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 The foregoing was acknowledge before me this `� day of A-dit 20 ISr By (^v who is personally kno o me or has produced as identification. Notary: _44 A URA FARLEY SEAL: * * MY COMMISSION N FF 18M EXPIRES:thmh 16.2019 '��C'Ude Bended Thru Budget Notary Servicer Dale Plumbing Inc. 154 NW 97 Street Miami Shores,Fl.33150 7/10/2015 State of Florida County of Dade Before me this day personally appeared Mr. Linton Dawkins who \being duly sworn,deposes and says , that he will be the only person Working on the project located at ggdg �A4'V\AV ir Sworn to and subscribed before me this---�-b day o --- L4- 2015 \ Personally known Print name-Laura Farley( UINFARLEY * * W=USM#FF INV a, EXPIRES,Much 16,2019 �� eaa�e iMu ami scary s�ryka 2-C. I<- 11-21 71 r Miami Shores Village ` f " � IF�t @1A 10050 N.E.2nd Avenue NE � � 'W; "A' � Miami Shores,FL 33138-0000PA Phone: (305)795-2204 \cl r f X315 Expiration: 04/27/2016 , Project Address Parcel Number Applicant 9909 NE 4 Avenue Road 1132060171310 Miami Shores, FL Block: Lot: JOHN RUARK Owner Information Address Phone Cell JOHN RUARK 9909 NE 4 Avenue Road (410)610-2148 MIAMI SHORES FL 33138- 9909 NE 4 Avenue Road MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation $ 1,200.00 DALE PLUMBING (786)663-1804 Total Sq Feet: 0 Type of Work:install kitchen appliances Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return Final Classification: Residential Scanning: 1 Final Final Underground Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-7-15-56309 DBPR Fee $2.25 DCA Fee $2.25 07/13/2015 Credit Card $50.00 $ 110.70 Education Surcharge $0.40 10/30/2015 Check#: 1481 $ 110.70 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 AFFIDAVI ertify he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction onin ut rmore, uthorize the above-named contractor to do the work stated. October 30, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 30,2015 1