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DEMO-15-2459 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)785-2204 Fax:p"7664W2 Inspection Number INSP-2444279 Permit Number DEMO-9-15-2459 Scheduled inspection Date:April 04,2016 Permit Type: Demolition Inspector:Hernandez,Rafael Inspection Type: Final Owner. ARMSTRONG,MARVIN Work Classification: Plumbing Job Address:138 NW 107 Street Miami Shores,FL 33168- Phone Number Parcel Number 1121360080200 Project <NONE> Contractor. ORIGINAL PLUMBING,INC Building Department Comments DEMOLITION OF ILLEGAL.ADDITION i `�' Comments INSPECTOR COMMENTS Fay ENCLOSUREIUNAUTHORIZED STRUCTURE Inspector Comments Passed Failed a Correction ❑ Needed Re-inspection D Fee No Additional Inspections can be scheduled unto re-inspecdon fee Is paid Cnr mane-mnnc r"sea oun. t4fl4.17R9-&OLQ Miami Shores Village x 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 ' rF Phone: (305)795-2204 �� �� � ��� � ��� � � ��.. � � Explration: 09/19/2016 Project Address Parcel Number Applicant 138 NW 107 Street 1121360080200 Miami Shores, FL 33168- Block: Lot: MARVIN ARMSTRONG Owner Intormation Address Phone Cell MARVIN ARMSTRONG 138 NW 107 Street MIAMI SHORES FL 33168- Contractors) Phone Cell Phone Valuation: $ 800.00 ORIGINAL PLUMBING,INC Total Sq Feet: 0 Type of Demo:Plumbing Available Inspections: Additional Info:DEMOLITION OF ILLEGAL ADDITION ENCL Inspection Type: Classification:Residential Final Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-9-16.57224 DBPR Fee $2'25 03/23/2016 Credit Card $109.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 09/25/2015 Check#:2162 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 1 c Linc. Futhermore,I authorize the above-named contractor to do the work stated. March 23,2016 Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 23,2016 1 e Miami Shores Village Department sEP2 5 2015 Buildinge 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 IB Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No. U In_ 24,5c PERMIT APPLICATION Sub Permit No. �.� a�Li S� ❑BUI ING F-1 ELECTRIC E] ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL LUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 138 NW 107th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1121360080200 Is the Building Historically Designated:Yes NO X Occupancy Type: single Fernaiy Load: Construction Type: CBS Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Marvin E. Armstrong Phone#:305-308-4250 Address: 138 NW 107th Street City. Miami Shores State: Florida Zip: 33168 Tenant/Lessee Name: same as owner Phone#: Email: marmst1312@aol.com CONTRACTOR::Company Name: F r N J1 a-t /9�/�/'"'J l C-- Phone#: C8Address: D s/p � / City: —State: - /L Zip: Qualifier Name: ,S Phone#: State Certification or Registration M G® q7 06 Certificate of Competency#: DESIGNER:Architect/Engineer: Arbab Engineering Phone#: 305-940-3088 Address:3363 NE 163rd street Suite 701 City: North Miami Beach State: FL Zip: 33160 Value of Work for this Permit:$ 700 Square/Linear Footage of Work: 264 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Q Demolition Description of Work: Demolition of illegal addition enclosure/unauthorized structure 4�2/® "'e•",tw// W *_0e®/ 4&wr'. Specify color ��oo–f--��color thru tile: 45 _&01 Submittal Fee$ J CO Permit Fee$ .150, A17 CCF$A-roG CO/CC$ Scanning Fee$ ° _Radon Fee$ 0 '0'5 DBPR$ Notary$ m� Technology Fee POD Training/Education Fee$ G - PO Double Fee$ Y' Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r li 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 approved and a reinspection fee will be charged. Signature—C *""4_ Signature �- NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this � —J�day of / 20 by 0 day of ____120 by t / �' o is personally known to j�hie sr onally�known me or who has produced T'l�60�7T,Z ct"T-.ZY�-Q as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 4. Sign: *A a/T I r Print: Print: �E9�11 Seal: •sd Seal: 11RoddliPn-S�ofFI� C #�FF 200191 0 F.20 200191 my Cmn.�Feb 17,MID •F.Xres Fab 11,2019 . , ******* * ** ***************** ************ APPROVED BY - 15 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) e or 8TI►MOPR WAM DOWAT"11 OPoY I1fiM. OIVIN MiUP1NOt1 'COIAPIMI M •• IMOPl61AC1W11089 1'HM YI 'COWEMAIMLAMN• t, IMe IkvUILw BION 'ft 01`*KIM k*40 t"dbdMhiseb"bbReo MMM t oftftftdo#CMVWAsMtau. FM ?JI'Itgm suommmmp"'. ma OVOOMPU*AMMC UM WA2M MAW it" R saw I OP {RM"a CCIAiTNPU PlIon1t PJ16 s 1 11 16 T� • Y�MI��•M� o0oam><+otte�rat�criori1o86�uPr �a'� �r�ot�tt(t�tsteoo Scanned by CarnScanner OM03 Local Business U* He dei Miami-Dade Count * of Florida -THS I Nora VU-:.,* 7- Alf 448270 LB NAKNULOaaT E CPIRES O11AI.MUMM INC. I8m01 Fit 2 g=468877 PT4M'BCR 34. 2416 MUS GABS F1 Uis Must6e dbpkqW eta of budnew Purmimto CeuOy Bade ChsPter#A-Att9&j0 OWN19R •TYM OF susnum PAYM IC ORK RUAGM IK 196 BWG CONTRACMR RsespM CROSM 9YTAXGOUACTGt X51 1 $45.00 07j28J2t015 CHECK21-15-107677 TliLpe�l Tdxlam Tac ra bmtaQee , �� asst TIreNMI Kabmwwhq =d - 4odeBeoSa-iJ8 Scanned by CarnScanner Original Plumbing Inc 18001 NW 2nd Place Miami FL 33169 Date: 03/22/16 County of Miami Before me this day personally appeared Haughton Harris Jeslin says: That he will be the only person working on the project located at 138 NW 107 street Miami shore FL 33168 Sworn to (or affirmed) and subscribed before me this .� day of os . 201,6 bya� FrA� If Personally known oR produce Identification Type of Identification producedFF _ 1 Fr-r 191 yes Fnb 17.2019 0, PL $a.. 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 ii 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. Si Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this �`L—day of 2016 By. !/ ()1 4J?-eft0,1f who is personally known to me or has produced r;t "!/L- as identification. ;E:Z,4Notary: SEAL: .� Sit .