PL-16-917 (2) Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL 1
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-259734 Permit N6mber: PL-6-16-1451
Scheduled Inspection Date:August 22,2016 Permit Type•. Plumbing - Residential
Inspector: Hernandez,Rafael Inspection Type: Final
Owner CLARK,JOHN Work Classification: Addition/Alteration
Job Address:803 NE 99 Street
Miami Shores,FL Phone Number
Parcel Number 1132060340090
Project: <NONE>
Contractor: GMP CONTRACTORS Phone: (786)443-3548
Building Department Comments
REMOVE AND REPLACE EXISTING PLUMBING FIXTURE Infractio Pa Comments
INCLUDING NEW SHOWER PAN. INSPECTOR COMMENTS False
Inspector Comments
Passed EZ
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
41,
'errr it NO
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 "
s� 1 IMM'St APPR
Phone: (305)795-2204 r,
3 , :8131 i�16 Expiration: 01/3012017
Project Address Parcel Number Applicant
803 NE 99 Street 1132060340090 JOHN CLARK
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
JOHN CLARK 803 NE 99 Street
FL 33138-
803 NE 99 Street
FL 33138-
Contractor(s) Phone Cell Phone $ 800.00
GMP CONTRACTORS (786)443-3548 Valuation:
Total Sq Feet: 0
Type of Work:REMOVE AND REPLACE EXISTING PLUMBIN 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 $0.60
DBPR Fee Invoice# PL-5-16-59933
$2.25 05/25/2016 Credit Card $50.00 $109.10
DCA Fee $2.25
Education Surcharge $0.20 08/03/2016 Check#:2445 $ 109.10 $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 complince with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the prop r 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 comdliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-nam ntractor to do the work stated.
August 03, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
August 03,2016 1
Miami Shores Village 4 V" 1-74-D
Building Department M
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. o(6 —19
PERMIT APPLICATION Sub Permit Noy(— (10 — I k451
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
JZPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 903 )-7 9 9 ee
City: Miami Shores County Miami Dade Zip .3 8
Folio/Parcel#: // - 3 2 D Co Y - ®0 f0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Q-0 h )1 IJ /tl r l< Phone#: YO< 93/� 350 I
Address: o�/ 9�
City: l l oM 1 �!� yState: ISL Zip:
Tenant/Lessee Name: -& PhonO#:
Email: 70A Gla r I 1 10-7 / (4 ni mal L' COW^-
CONTRACTOR:Company Name: 944 /D PhonO#: 7 0&d 39 1? ,0
Address:13 500 SW �2 S O s7-
City:
7City: t0lo ej 1-ee-0' Stat �� Zip: / o�
Qualifier Name: Y:K 9.4 G"
State Certification or Registration#: eF& A/9 8, 6 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ goo - &D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: g a-mo ye, a in k ke b lace, E X 6 5�i nj b l qm b 1 n j
,nal / —�
ucLI N llJ ® W 4r a . °
Specify color of color thru tile:
Submittal Fee$ �- ®o Permit Fee$'
��� CCF$ CO/CC$
Scanning Fee$ r Radon Fee$ - �DIBPR$ e` �� Notary$
Technology Fee$ 7 Training/Education Fee$ ` ' " Double Fee$ 61
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 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.
Signatur Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of QX,4►a ,20 0 , by 0b/ day of /A alr o k 20 by
D (.A& who�perso�nallyown1.SftG G 6 i4 CC IP I c who is personally known to
me or who has produced as me or who has produced �Jp L as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:(Z;sW1 -- 6.1 �— Sign:
Print Hca Print: 2 w a S
P n.0
Seal: r MY COMMISSION#FF909539 Seal: ' NSSi FF4Y0M
'F�Ro�P E3�)12ES:August 19,2019 yry R OUST 17,2017
PWO Uml s
APPROVED BY ,- I� Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
S�OREs y
s� ��► Miami shores Y
Ellis umM
Building Department
10050 N.E.2nd Avenue
�LORIDp' 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 ]0 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 aldavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village d es not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time a ployees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. 7
Signature:
Owner
State o Florida
County of Miami-Dade l�
The fore g was acknowledge before me this ®�day of A V G1 J 5 /' ,20 ! .
By `t 4/ who is personally known to me or has produced
�— as identification.
Notary:
Wu;
CESAR RAMOS
SEAL: ' SSIONEFF41001
AUGUST17.8017
PuOoufwwwfts
GMP CONTRACTOR'S
13500 SW 250 ST HOMESTEAD FL 33092
PHONE: 786-399-0821
GMP CONTRACTOR'S
LIC #CFC 1428225
E-mail, lazplumbing@gmail.com
Date:
State of
County of
Before me this day personally appeared to being duly sworn,deposes
and says:
That he or she will be the only person working on the project located N ��
Sworn to(or aff ed) and sgbscribed before me this day of A U U�01 1.20-h(a,by
tlr�
Personally know��
OR Produced Identification
Type of Identification Produced
0 CESAR RAMOS
a, COMMIS ION#FF 4100)
s QUS1 17,2017
n � ubflc Undue
Print, Tyl6vor Stamp Name of Notary