PL-16-2644 Inspection Worksheet
Miami Shores Village `2
10050 N.E.2nd Avenue Miami Shores,FL G J
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-267984 Permit Number. PL-9-16-2644
Scheduled Inspection Date: October 03,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez,Rafael Inspection Type: Final
Owner: ESCOBAR,CARLOS Work Classification: Addition/Alteration
Job Address:362 NE 92 Street
Miami Shores,FL 33138- Phone Number (954)937-1841
Parcel Number 1132060136440
Project <NONE>
Contractor: IMA PROJECTS&INSTALLATION LLC Phone. (786)487-3209
Building Department Comments
PLUMBING FOR 2 BATHROOMS Infractio Passed Comments
INSPECTOR COMMENTS False
TO REPLACE PERMIT#PL12 871
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
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Miami Shores Village T] R94R ni"
10050 N.E.2nd Avenue NEAt
Miami Shores,FL 33138-0000 V
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mom ° Phone: (305)795-2204 F v
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Expiration: 0,V29/2017
Project Address Parcel Number Applicant
362 NE 92 Street 1132060136440
CARLOS ESCOBAR
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
CARLOS ESCOBAR 362 NE 92 Street (954)937-1841
MIAMI SHORES FL 33138-3134
362 NE 92 Street
MIAMI SHORES FL 33138-3134
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
IMA PROJECTS&INSTALLATION LLC (786)487-3209
Total Sq Feet: 0
Type of Work:PLUMBING FOR 2 BATHROOMS Available Inspections:
Type of Piping: Inspection Type:
Additional Info:TO REPLACE PERMIT#PL12-803 Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-9-16-61471
DBPR Fee $2'25 09/30/2016 Credit Card $ 160.70 $0.00
DCA Fee $2.25
Education Surcharge $0.40
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
In consideration of the issuance to me of this permit, I agree to pe the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,state nts or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by ither` yself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS O ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing inf tion is and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above a ed co r ode-the work stated.
September 30, 2016
Authorized Signature:Owner / Applicant Agent Date
Building Department Cop
September 30,2016 1
Miami Shores Villages =-
BuildingDepartment
SEP 2 s 2096
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B
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Tel:(305)795-2204 Fax:(305)756-8972 Tt i
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC rr20 M
BUILDING Master Permit No. b- 2130
PERMIT APPLICATION Sub Permit No. l" .L �- 2G l
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
� P C� CONTRACTOR DRAWINGS
JOB ADDRESS: /V 4 r Z_ �t
City: Miami Shores County: Miami Dade Zip: 7P J ® �
Folio/Parcel#: 11, 32-06. 4913.469fdl® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
�
(�
p iW�1l f Nar�e(Fee Simple Titleholder): C_-6 -_"llX- CP bAn- done#
Address: lylt:- -
City: 1-t 1 Am i Sh OfN State: Zip: 3 3 13®!
Tenant/Lessee Name: Phone#: T5-1 -q 3771 Ry/
Email:
CONTRACTOR:Company an Name: T / s V ® +cvcl* -[Xf yft//A'
f ,/ �"`��Phone#:
T
Address: 2-�g&q W C K /
City: #i4►I.Aen / State: Zip: -39®16
Qualifier Name: 4Jy.1 `// / eel. Phone#:
State Certification or Registration#: 6q /512 iY4046 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address• (( City: State:_ Zip:
fort"P
Value-of Work fort" $9 Square/Linear F t3f WorT J}
Type of Work: ❑ A dition I ❑ Alteration ❑ Ne ❑ Repair/Replace ❑ Demolition
'Dg Cripition of Wo
Specify color of color thru tile: -
Submittal Fee$ Permit Fee$ 03 CCF$_I. 90 CO/CC$
Scanning Fee$_,� Radon Fee$ DBPR$ 2. 2-S7 Notary$
Technology Fee$ Training/Education Fee$ ® Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I GO ' 0
(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.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrumen�tt was acknowledged before me this The foregoing instrument was acknowledged before me this
d6 day of f2e'lkVu� ,20 /J� by day of L4 20 /11 �byy
COS fs w ✓ ,who is personally known to �P/� ,�- ,who is personally knowr�to
me or who has produced fL lir;t,q,' ��CeI as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: / Sign. 1
Print: w C Z_ Print: 7 P
Seal: 1 R� R1yj Vftw Seal: ' LISSETT ROMAN
ot� MY COMMISSION#FF994103
: I�dq f Ublic 00IM:1wW28.2020
State of Florida
*�**��r•�r * M�������*��x�**�**�x*��***�x*�x�*��*****+r*�**�x��a����c*�x*�x�xa�w�x+�+��***��*�x��**�x�x
Commission No, 9737
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Ima
projects & installation, LLC
2488 W 64`h Place,Hialeah,FL 33016
Ph.. 786.487.3209 - Fax.305.647.2160
E-mail:ima@imaoroiects.net
September 22nd, 2016
State of
Country of /q%a oni-D41e
Before me this day personally appeared 4"//Lyr4s, who, being duly
sworn, deposes and says:
That he will be the only person working on the project located at:
Sworn to (or affirmed) and subscribed before me this_,eday ofd ,w4 ,20.&,by
-mel/ L;0",c
Personally known ✓
Or Produce Identification
Type of Identification Produced
rwvwvw�'""` LISSETTR
W
coussro
MW �'M:iu=.
Print, Type or Stamp Name of Notary R19D
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move 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
ME
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 pan-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 caw 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 ZZ— day of
By aZ/C5 F E-5 al'� who is personally known to me or has produced
�L �):),-)(Jov ka)45,0, as identification.
Notary Notary Public
State of Florida
SEAL: My Commission Expkes 8/11/19
Commission No.FF 908737