DEMO-16-38 T) 6F
Inspection Worksheet
Miami Shores Village
10060 N.E.2nd Avenue Miami Shores,FL
Phone: (306)796-2204 Fax:(306)766-8972
Inspection Number. iNSP-253967 Permit Number. DEMO-1-16-38
Scheduled Inspection Date:March 07,2016 Permit Type: Demolition
Inspector. Hernandez,Rafael Inspection Type: Final
Owner SOUZA,HENRIQUE Work Classification: Plumbing
Job Address:479 NE 102 Street
Miami Shores,FL
Phone Number (846)3204171
Parcel Number 1132060170840
Project <NONE>
Contractor. M&C CONTRACTORS Phone:(306)76348166
Bullding De rt meat Comments
PLUMBING DEMO OF THREE BATHROOMS AND Intracitto Passed menta
KITCHEN INSPECTOR COMMENTS False
Inspector Comments
Passed
FailedEl
✓����`
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspedton fee Is paid
� r
Miami Shores VillageE
10050 N.E.2nd Avenue NE i
Miami Shores,FL 33138-0000
Phone: (305)795-2204
� Expiration: 07117/2416
E �
Project Address Parcel Number Applicant
479 NE 102 Street 1132060170840
HENRIQUE SOUZA
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
HENRIQUE SOUZA 479 NE 102 Street (646)320-4171
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 400.00
M&C CONTRACTORS (305)763-8166 Total Sq Feet: 265
Type of Demo:Plumbing Available Inspections:
Additional Info:PLUMBING DEMO OF THREE BATHROOMS A Inspection Type:
Classification:Residential Final
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# DEMO-1-16-58260
DBPR Fee $2.00 01/19/2016 Check#:2882 $64.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 01/08/2016 Check*2868 $50.00 $0.00
Permit Fee $100.00
Scanning Fee $8.00
Technology Fee $0.80
Total: $114.60
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 th oing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermor authorize he abo amed contractor to do the work stated.
January 19, 2016
Authorized Signature:Owner / A licant / Contractor / Agent Date
Building Department Copy
January 19,2016 1
Miami Shores Village RECEI 7RD-
Building Department JAN 0820%
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 JBY: W710-
Y-144
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 A/
BUILDING Master Permit No.azaa 1 3-3
PERMIT APPLICATION Sub Permit No.Z'—/! /zS— 34?
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
%PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: *-9 1-115 /00- S5 f '
City: Miami Shores County: Miami Dade Zip: 'L
Folio/Pard#: IS the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): T►Q.V1Y�V L 01 1 0 U2-fir- Phone#:
Address: 4 _1 �V1 e 1 0 Z h n S
City: t O1.4y1►6. �, D� State Zip:
Tenant/Lessee Name: Phone#:
Email: Cjak+ramr�
CONTRACTOR:Company Name: c Phone#:?fE- . a1t
(9L
Address:
City: w wai S e: �1 rp: %a C)
Qualifier.Name: 6ermcal I } Phone#: •93Z I 3
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: t p� City: State: Zip:
Value of Work for this Permit:$ "[d V Square/Unear Footage of Work: 2.i0J_
Type of Work: ❑ e {Adddition ❑ Alteration F-1 New Repair/Replace 1 'Demolition
Description of Work: �C i%A Yy% cy►j2 C�.Q Vh D 04 3 )"- rowy %S I�1+Cl�V 1
Specify color of color fhira tile.
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Re41sed02/24/2014)
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. 1 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$250, 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 forst 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 Signa
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�O day of 20 ,by6, day of A�VeM1.� ,20 t S •by
w rL
o�rsonally ersonaliy known to
_-
me or who has produced as me or who has produced as
Identification and who di n oath. identification and who did take an oath.
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NOTARY P QUIDA JACOBS NOTARY PUBO
My COMM1SS10N 4 F11430.1
SXPIRBS;Au"14.2017
Sig Sign:
Print: 1 Print: �� V (ra Q C.�
Seal: Seal:
EXP-MA1WUMS
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReviseWZt24/2014)
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M & CContractors
960 Arthur Godfrey Road, #304 Miami Beach,FL-, 33140
Phone: (305) 763-8166
License:CFC-1426609
January 8,2016
State of FL
County of Miami-Dade
Before me this day personally appeared German Previsdommi who,being duly sworn,deposes and says:
That he will be the only person working on the project located at 479 NE 102w St.,Miami Shores,FL 33138.
Sworn to and subscribed before me this 8&day of January,2016 by German Previsdomini.
Produced FL Drivers License
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QUIDA JACOBS
(n► MY COMMISSION#FF43955
L EXPIRES:August 14,2017
Quida Jacobs
.n. Miami shores VkArillage
Building Department
R>� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tet: (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 fill-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 it
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: QUIMA JACOBS
Owner n4Y COMMISSION a FF43g55
(47V r'Xulitt� August 14,2017
State of Florida
County of Miami:Dade
The foregoing was acknowledge before me this�day. of ,20p
ByWQ is to me or has produced
as identification.
Notary.
SEAL: