PL-16-2406 7 3 g
Miami Shores Village � Plu
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10050 N.E.2nd Avenue NE _ . �� sf �i�Op
Miami Shores,FL 33138-0000 ,
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�tg s Phone: (305)795-2204 '' '
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Expiration: 03(1 2017
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Project Address Parcel Number Applicant
1070 NE 96 Street 1132060143510
MARTY MCGRAW
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MARTY MCGRAW 1070 NE 96 Street
Miami Shores FL 33138-
1070 NE 96 Street
Miami Shores FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 250.00
ELITE INSTALL SOLUTIONS INC (954)461-1340
Total Sq Feet: 0
Type of Work:GAS WATER HEATER REPLACEMENT. Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Final
Bond Return: Press Test
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-8-16-61140
DBPR Fee $2'25 08/29/2016 Credit Card $50.00 $115.10
DCA Fee $2.25
Education Surcharge $0.20 09/15/2016 Check#:6287 $115.10 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 res onsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUM G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I rt' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni erm e,I authorize the above-named or to do the work stated.
September 15,2016
Authprfied S nature:Owner / Applicant Contractor / Agent Date
Building epartment Copy
September 15,2016 1
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Miami Shores Village a G2. 2a�6
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Building Department LBY -
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 J
FBC 20 A �'�
BUILDING Master Permit No. l� : 0
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1070 NE 96 ST
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-014-3510 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):MARTY CHRISTOPHER MCGRAW Phone#:7732941462
Address: 1070 NE 96 ST
City: Miami Shores State: fl Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email: N/A
CONTRACTOR:Company Name: ELITE INSTALL SOLUTIONS Phone#: 9546101340
Address: 14150 SW 129 ST
City: MIAMI State: FL Zip: 33186
Qualifier Name: JAMES MCCALL Phone#: 9546101340
State Certification or Registration#. CFC1429014 Certificate of Competency#: CFC1429014
DESIGNER:Architect/Engineer: N/A Phone#:
Address:N/A City: State: Zip:
Value of Work for this Permit:$ • Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New X Repair/Replace ❑ Demolition
Description of Work: GAS WATER HEATER REPLACEMENT
Specify color of color thru tile: f 1
5 ° Permit Fee s CCF lJ CO CC$
Submittal Fee$ $ $ CO/
CC
Fee$ Radon Fee$ DBPR$ 05 Notary$
Technology Fee$ >y Training/Education Fee$ ® Double Fee$ Q,
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I �!
(Revised02/24/2014)
y
Bonding Company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) N/A
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. 1 a
i
Signature Signature
WNER or ENT CO RACTOR
The fore oing instrume acknowledged before me this The forego g instrumq t was acknowledged before me this
t i'S 20- �b da of 20 �� ,b
day of y y y
who is personally known to o is personally known to
me or who has produced �G 71>6 as me or who has produced as
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identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: J
a
Sign: Sign:
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Print: off Print:
'STEPHANIA MONTOYA -HNIA MON T OYA
Seal: r 'M'y
COMMISSION#FF220189 Seal
s r i�N1�q!SSION#FF220189
D„'P!RES:APR 14,2019 r;RES:APR 14,2019
r t.d?hrough 1st State Insurance r out 1st State Insurance
APPROVED BY PWfNPlans Examiner Zoning
,-T
Structural Review Clerk
(Revised02/24/2014)
.4
Service Order#573-1053-7215-10 . Customer Copy
SERVICE LOCATION SERVICE ORDER DESCRIPTION
Residential Service Category:General Plumbing&Bathrooms
MCGRAW,MARTY Title:General Plumbing,Gas-42333-MI WH GAS
1070 NE 96TH ST,,
MIAMI SHORES,FL 33138 Task 1:42333-MI WH GAS
PRIMARY:773-294-1462
[3 Pickup product at designated Sears Holdings Location Travel to installation site Unpack and prepare
SERVICE EVENT DATE merchandise for installation Inspect product for any damage or defects Inspect Installation site and provide quote
Jul.13,2016-Jul.13,2016 for any additional work required Disconnect old product and piece in accessible location per customer's request
2:30 PM-4:30 PM Connect new unit to existing,code approved utilities per manufacturers instructions Level and secure product and
install any manufacturer supplied safety hardware Test product for proper performance Instruct Customer on
Arrival Time: AM/PM product operation Clean up any job related debris Dispose of packaging and other installation material.
Departure Time AM/PM
NOTICE TO CUSTOMER:A city permit may be required for the installation of a water heater or other installed
SERVICE PROVIDER appliance within your city limits.If a permit is required,you will be billed separately for the cost of the permit.The Sears
GERMAN HERRERA(TECH ID#83891) Authorized contractor who performs the installation will requestthe permit from your city.Please contact your
FIRM ID#32860 municipality following installation for inspection requirements.
BUYER CUSTOM REFERENCE Task 2:42469-AI WH HAUL
SALES CHECK NUM 1:016550226533 ❑Remove old product from customer??????s home Return product to designated Sears facility as required by Sears
SALES CHECK DATE 1:2016-06-30 policy or dispose of old product according to all local codes and regulations.
SALES CHECK TIME 1:13:02:50
SELLING ASSOC:0 Task 3:99888-BLDG PERMITS PERMIT PRICE PRE-PAID BY CUSTOMER$169.99
ORDER NUMBER:04202464 ❑Complete Permit Application(s) Obtain Permit(s)from all applicable municipalities Complete/attend inspection as
SERVICE REQUESTED:INSTALLATION required by the municipality.
ORDER
PRODUCT INFORMATION Task 4:Deliver Merchandise
DIVISION:042 ❑Pick up merchandise at designated facility(reference the parts section of the service order for pick up location and
ITEM NUMBER:57650 description of the merchandise).
DESCRIPTION:KENMORE Deliver merchandise to customer.
ADDITIONAL WORK PERFORMED/SERVICE PROVIDER NOTES:
Service Order#573-1053-7215-10 Page 1 of 10
EOR prJIt
s� �► Miami shores Village
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Building Department
10050 N.E.2nd Avenue
FNres�N�o
�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:
L 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-rime 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 f eg ' g wa acknowledge before me this day of ,20 �O
B ( who is personally known to me or has produced
Y P Y
as identificatio .
Notary:
SEAL: 'g�w STEPHANIA MONTOYA
'a°' °�✓COMMISSION#FF220189
EXPIRES:APR 14,2019
ihrou'h 1st State Insurance
f �
ELITE SOLUTIONS INC
954-494-0853
DATE:09-08-2016
State of Florida
County of Miami Dade
Before me this day personally appeared Marty McGraw who, being duly sworn, deposes and says:
• GERMAN HERRERA
That he or she will be the only person working on the project located at: 1070 NE 96th Street Miami Shores, FL 33138
Sworn to(or affirmed)and subscribed before me this 8th day of September. 2016, by MARTY MCGRAW
Produced identification FL DRIVERS LICE
Stephania Montoya
)WW A MONTOYA
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