PL-15-1275 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235535 Permit Number: PL-5-15-1275
Scheduled inspection Date: February 29,2016 Permit Type: Plumbing- Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: TAVARES,TIERES Work Classification: Addition/Alteration
Job Address:10050 NE 12 Avenue
Miami Shores, FL Phone Number (305)244-2356
Parcel Number 1132050190370
Project <NONE>
Contractor: MILLENNIUM PLUMBING LLC Phone: (561)674-7727
Building Department Comments
BATH AND KITCHEN PLUMBING WORK Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
l
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
February 26,2016 For Inspections please call:(305)762-4949 Page 4 of 60
Permit NO. PL-5-15-1275
Miami Shores Village Permit Type: Plumbing-Residential
10050 N.E.2nd Avenue NE e r m Work Classification:Addition/Alteration
'• ""' Miami Shores,FL 33138-0000 PPermit Status:APPROVED
Phone: (305)795-2204
Issue Date:7/10/2015 Expiration: 01/06/2016
Project Address Parcel Number Applicant
10050 NE 12 Avenue 1132050190370
Miami Shores, FL Block: Lot: BEYOND ALL REVOCABLE TRU
Owner Information Address Phone Cell
BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue (305)244-2356 (786)709-3909
- --- - --- MIAMI SHORES FL 33138-
10050 NE 12 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 4,500.00
MILLENNIUM PLUMBING LLC (561)674-7727
Total Sq Feet: 0
Type of Work:BATH AND KITCHEN PLUMBING WORK Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# PL-5-15-55737
DBPR Fee $3.38 05/27/2015 Credit Card $50.00 $192.76
DCA Fee $3.38
Education Surcharge $1.00 07/10/2015 Credit Card $ 192.76 $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 . I ass re ponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required fo this
, LUMB G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNER AFFI AVI I ce ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a zoning. F hermore,I authorize the above-named contractor to do the work stated.
July 10,2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 10,2015 1
Miami Shores Village , . �
Building Department 7 �®15
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �.,.
Tel: (305)795-2204 Fax:(305)756-8972 "c-
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC MO 1
BUILDING Master Permit No.- Q - ( LI 3
PERMIT APPLICATION Sub Permit No. L� -����
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I iO 0 '5 AV L
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-32-05 -019 -03+0 Is the Building Historically Designated:Yes NO Y
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):?C'y,oNO /, LL /,_'c0o cr 6 L E "Tw'r Phone#:-910 S Z y y L3 56
Address: 113 S P14-2-
City:Nae_zd� 4:�J State: 'I'L Zip: 33 l4
Tenant/Lessee Name: Phone#:
Email: AI'viI(•L)t;L N1 cow
CONTRACTOR:Company Name: /Vk C-k Phone#:
Address�:, 3 'J mcpck
City: State: �L Zip: %7
Qualifier Name: sEL FE-0 E-`(2- -5 1 /V L Phone#:
State Certification or Registration#: C. `7 �� / 7certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ `7'50'0 - Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ''q-Tk x-1 1 G RG-/j A&N o
Specify color o(flcolor thru tile: t .
Submittal FeO$sv ' Cz Permit Fee$ 25'�y 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)
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w o curs sev 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be proved and reinspection fee will be charged.
6 1A Ll
Signature Signatu e
OWNER or AGENT TR V
The foregoing instrument was acknowledged before me this The foregoing inst ent was acknowledged before me this
day of M " 20 V S by 2- 0 day of Ae`n-Y ,20 1 by
i z42,a 5 74-VAiZ.i -oho is personally known to cT— VO-1-4n-
me
is personally nown to
me or who has produced �� '�CL1V as e or o has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
g � Sign: ���� C—
�
Sin: �'
251-
Print: by o�'�cA _ Print: (OAF r n- `P to�
• �� .e! O vii'C ^o
Seal: =o o � rn Seal:
SILVAI
.•�$ �s R DACUNHA
L� �' �.` ,Q Commission g FF 170061
*�*****�*�*****�******��**�*******���A.....•' MY Commission Expires
APPROVED BY ®S Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Millennium Plumbing
11133 Model Circle E
Boca Ratan,(133428
5613057323
May 26,2015
State of Florida
Before me this day personally appeared Fabio Ribeiro Silva who,being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at: 10050 NE 12 AVE
Sworn to (or affirmed)and subscribed before me this day of '20 tS ,by
1 ILZ"'W
4''JHA
.`eP4�O FF 110061
S Personall A. lvlE res
Ge'4.0 Produced I enh 1 °'�"'i"
400 ..._...
Type of Identification 6
.n,N
i
INbt o 6`21 L&
Print, Type or S
t
gt1�,�S
some p,., 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'compensatio surance,pever-age from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING AVLOW YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
1,
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this Z-3 day of 20 IS
BAv who is personally known to me or has produced
as identification.
Notary: 40 31k,
SEAL: `�N6�5o
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