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PL-16-736 Inspection Worksheet Miami Shores Village �° ��_� 2,4 10050 N.E.2nd Avenue Miami Shores, FL l� Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-255230 Permit Number: PL-3-16-736 Scheduled Inspection Date: September 14, 2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: LAMB, PAUL Work Classification: Addition/Alteration Job Address:161 NE 108 Street Miami Shores, FL 33161-7037 Phone Number (786)252-4455 Parcel Number 1121360090220 Project: <NONE> Contractor: EDWARD ROJAS PLUMBING CORP Phone: (305)9446788 Building Department Comments TUB INSTALL SINK AND SHOWER, KITCHEN SINK AND Infractio Passed comments WASHER AND DRYER INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 13,2016 For Inspections please call: (305)762-4949 Page 8 of 44 y�Z1_ f s y Miami Shores Village Pp TY 7jr 3 :3' i 10050 N.E.2nd Avenue NE ' Miami Shores,FL 33138-0000 _ Phone: (305)795-2204 • s� • 10 ORipp• .. . . .n Ex iratton: 11/012016 Iu I� Ilp p Project Address Parcel Number Applicant 161 NE 108 Street 1121360090220 PAUL LAMB Miami Shores, FL 33161-7037 Block: Lot: Owner Information Address Phone Cell PAUL LAMB 374 NE 92 Street (786)2524455 MIAMI SHORES FL 33138- 374 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 EDWARD ROJAS PLUMBING CORP (305)9446788 Total Sq Feet: 0 Type of Work:TUB INSTALL SINK AND SHOWER,KITCHE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:1 Underground Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-3-16-59089 DBPR Fee $3.38 05/05/2016 Credit Card $186.36 $50.00 DCA Fee $3.38 Education Surcharge $0.20 03/21/2016 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $236.36 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 for g infor tion i a c e that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I autho' e the above-na ed nt work stated. May 05,2016 Authorized Signature:Owner / Applicant ! -75dntractor / Agent Date Building Department Copy May 05,2016 1 Miami Shores Village • E 1.-:...�-,��.J�r?. � fir._�_..0 Building Department MAR 21 52016' 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master Permit No. 2c, i(o— 7 3q PERMIT APPLICATION Sub Permit No. ?L trio- 43�a ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP (� CONTRACTOR DRAWINGS JOB ADDRESS: I `y' C () p City: lMiami Shores County: Miami Dade Zip: 331 b Folio/Parcel#: I ' 3 '®®� ®� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: air OWNER:Name(Fe Simple Titleholder): ��\ Phone#: Address: 3-11 * 'Eck":1— City: State: �'= Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Compa y Name: �-��1,���U1 Phone�#a 4 Address: City: �� _�e �C State• �' Zip: Qualifier Name: E t Phone#:3 i "� la� ES State Certification or Registration#: C �-°® "r3 1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New p Repair/Replace ❑ Demolition Description o W r 4 .�--fu G�4 l ,( N �- S C1©CjLj-2f- KIA C�`P 0 Specify color of 01or.tbW',tlli ' .�Z, CCF Submittal Fee$ � �° d Permit Fee$ iv. Scanning Fee$ °� < �1J Radon Fee$ l°� DBPR$ Notary$ Technology Fee$ Training/Education Fee$ o' 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. f` Signature Signature OWNER or AGENT CO TRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 6-1� day of 1*-A ,20 110 by day of ' 4'? Cil 20 f(O by pOdA ,who is personally known to 1._ 1 m� 1 who i er onally known to Me or who has produced as me or who has produced \ as identification and who did take an oath. identification and who did take an oath. NOTARY PU NOTARY P IC: 7 Sign: Sign: Print: �� Print: QAWW RotldB • 0 FF 915134 Seal: o .y J.DR Seal: my Coo. 1"1,2819 _.; M1'COA1MIOd#FF 161360 90ud1091g1/1NMIOIgINftyAs ,r EXPIRES:Jerry 18,2019 Bad 7ftN0"PnbfloU at ************ *** * ** ******************************************************************* APPROVED BY 10a 3-31-1(o. Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) . COMPANY LETTER HEAD � �l 1 I Date: State of 1cna County of ID A Before me this day personally appearedEJ �" W " � l S who,beingduly sworn,deposes and Y PPS' says: That he or she will be the only person working on the project located at: 1 ` Rl a, qv a✓ FL, Sworn to(or affirmed)and subscribed before me this�day of L .20&by Personally know OR Produced Identification Type of Identific io P o c d p••""r'"v"�e., MALVA DAA Notary Public•State d FMfiY • :• Commission#FF 815194 My Comm.Expires Sep 1.201, BandedWougb M""AOK Edwardt,Type or p ame of Notary P'v '`�ja+S �C-CFe;.pg9431 Mbing HI.s Pete Plumb J;:ing gay / I Water k" 24 Hour$ervice Ucene'",Bonded g►nsured One Cali Does It A!( (786)443-1.,,(30S g Email:eddle.rojas ) 788 Weare now @hGttndil.Corn accepting Insurance C/eI� ti 15�oRFs� s Miami shores Village "' "1111" Building Department 9 p 10050 N.E.2nd Avenue LOR1pA 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of I—r " L ,20 C . By 7"C,Li who is personally known to me or has produced as identification. Notary: ss�o1"r a••�•,, MILDRED C SALVADOR SEAL: �`� Notary Public-State of Florida s• • My Comm.Expires Aug 16,2016 Commission#EE 827562 y Assn.1