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PL-16-485 x, j,:,! V�' 4j 72 Kl� 1A C 77, 25 I i e"—Kt Inspection Worksheet Miami Shores Village C, 3 s 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(305)755-8972 inspection Number: INSP-253400 Permit Number. PL-2-16-485 Scheduled Inspection Date: May 05,2016 Permit Type: Plumbing-Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner TREVISA,SUSAN Work Classification: Addition/Alteration Job Address:100 NE 105 Street Miami Shores,FL 33138-2033 Phone Number (305)992-3134 Parcel Number 1121360130690 Project <NONE> Contractor. CASTELLON PLUMBING CORP Phone:305-553-1490 Building Department Comments 1 NEW BATHROOM 3 LAVATORIES,3 TOILETS,2 1519W Passet! ments SHOWERS INSPECTOR COMMENTS Fake Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be sctreduled until re-Inspection The Is paid Mow nA *n4* For Inspections please call:(305)762-4949 b..ww 49 wi AA IKI Miami Shores Village ' ' 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 29/2016 MEN Project Address Parcel Number Applicant 100 NE 105 Street 1121360130690 SUSAN TREVISA Miami Shores, FL 33138-2033 Block: Lot: Owner Information Address Phone Cell SUSAN TREVISA 100 NE 105 Street (305)992-3134 MIAMI SHORES FL 33138- 100 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $4,800.00 Valuation: CASTELLON PLUMBING CORP 305-553-1490 __n_. .. Total Sq Feet: 0 Type of Work:1 NEW BATHROOM 3 LAVATORIES,3 TOIL Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# PL-2-16-58772 DBPR Fee $3.38 DCA Fee $3.38 03/02/2016 Check*1221 $192.76 $50.00 Education Surcharge $1.00 02/22/2016 Check#:1012 $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $242.76 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 a ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECT I L, LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS FID I : I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating construction n g. uthermo , uthorize the above-named contractor to do the work stated. March 02,2016 A riz ignat� / Applicant / Contractor / Agent Date Building D partment Copy March 02,2016 1 -- t Miami Shores Village =BY:-- Tel: Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 941 k FBC 20N BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ` i YS ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ZTPPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /DD �D 5 15—/ City: Miami Shores County: Miami Dade Zio: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Address: �®® Q E:7 W SE�- City: V-Qck", State: Zip: Tenant/Lessee Name: Phone#: Email: 786, - /!9s cell CONTRACTOR:Company Name: <:t S_Q 1�1 �17 Phone#: c3 � _ S&-F- 10�� Address: tJVJ i 3 City: iR 6.*r en-S State: �_ _ �Q. Zip: O 1� Qualifier Name: - Cuts j? Phone#: 76 6-2-56- 5117� State Certification or Registration#: K'�90-" Q 1[ d 5 1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �d y Square/Linear Footage of Work: Type of Work: ❑ Addition 0 /Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1,66rA r-oo m = .3 i l�fs — c5hzwa r- Specify color of color thru tile: Submittal Fee$ `rrw Permit Fee$ :2'�L s. ® CCF$ - CO/CC$ Scanning Fee$ .CQ Radon Fee$ 3E�) DBPR$ '3•.30 Notary$ Technology Fee$ L4 • 00 Training/Education Fee$ 1 . 00 Double Fee$ Structural Reviews$ Bond$ pp TOTAL FEE NOW DUE$ 19 2- YQ - (Revised02/24/2014) A --- 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 flrst 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument as acknowledged before me this The foregoing instrument wasacknowledgedbefore me this �t day of .20 .by oZ day of ,P,P1• ,20 .by �� eyZS( ,w to hO 0A;372%4y4b 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 C: NOTARY PUBLIC: Sign: Sign: Print• ' Print: / i4/�/�i l4 • �Cti e S Ale a f••i. WATRIZA.BUA�,Os Seal: $ •'` °�CMgISSION#FF025143 Seal: MY(�A�IISSIONIEFF194734 3RAIc EXPIRES:JUN.06,2017 ' EXPIRES:A,ptil7,2019 %•yF ago• y�1h w AwoxNt� V _ � aOJAntBa�etidoTerySera�es APPROVED BY / 2- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) gone am 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 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: 167 Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 20 . By , IS—SA-2 I.Ste- who is personally known to me or has produced as identification. Notary: Alelda I Guevara s;g . {�MWl0N#FF025143 SEAL: ry EXAIRFS:JUN.t)6,217 °n„ai+°°V YMWWA4R0NN=RU= CASTIELLON PLUM$INC CORP CFC019059 9841 NW 130 st Hialeah Garden FL Date 3/2/2016 State of Florida County of Dade Before me I this date I personally appeared Giraldo Castellon who, being duty sworn,deposes and says: That I will be the only person working on this project located at 100 NE 105 ST,Miami Sho Sworn to(and affirmed)and subscribe before me this march 3,2016 P II r • fltllrll 1�ARCE soe�►I' S state a F1orlde �' CeaMU �/FF$09903 y MY Cantu.EAPIM Aup 10,2419 '" afi Notary Assn. T�T:aBed 2LG89SZS0£:01 S968 f?S S0£ WSW jeuoFssaJOJd:woad 22:£T 9TO2-20-NUW