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
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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)
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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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature—C *""4_ Signature �-
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
� —J�day of / 20 by 0 day of ____120 by
t / �' o is personally known to j�hie sr onally�known
me or who has produced T'l�60�7T,Z ct"T-.ZY�-Q as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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APPROVED BY - 15 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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Original Plumbing Inc
18001 NW 2nd Place Miami FL 33169
Date: 03/22/16
County of Miami
Before me this day personally appeared Haughton Harris Jeslin
says:
That he will be the only person working on the project located
at 138 NW 107 street Miami shore FL 33168
Sworn to (or affirmed) and subscribed before me this .�
day of os . 201,6 bya� FrA�
If
Personally known
oR produce Identification
Type of Identification producedFF
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Fr-r 191
yes Fnb 17.2019
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$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: .�
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