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PL-16-2928Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe mi1 Permit NO. PL-10-16-2928 Permit Type: Plumbing -Residential Work Ctassifrcation: Addition/Alteration Permit Status: APPROVED Issue Date. 4/14 7 Expiration: 07/31/2018 Parcel Number Applicant 440 GRAND CONCOURSE Miami Shores, FL 33138- 1132060170030 Block: Lot: EDUARDO & XIMENA CALLE Owner Information Address Phone CeII EDUARDO & XIMENA CALLE 440 GRAND Concourse MIAMI SHORES FL 33138 (305)751-2707 440 GRAND Concourse MIAMI SHORES FL 33138 Contractor(s) Phone DESIGN -PLUMBING SOLUTION LLC (786)287-7835 CeII Phone Valuation: Total Sq Feet: $ 3,500.00 0 Type of Work: ROUGH PLUMBING FOR NEW ADDITION , I Type of Piping: Additional Info: ROUGH PLUMBING FOR NEW ADDITION , I Bond Return : Classification: Residential Scanning: 1 Fees Due CCF Change of Contractor Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $110.00 $3.38 $3.38 $0.80 $225.00 $3.00 $3.20 $351.16 Pay Date Pay Type Invoice # PL-10-16-61807 04/14/2017 Credit Card 10/27/2016 Credit Card Amt Paid Amt Due $ 191.16 $ 50.00 $ 50.00 $ 0.00 Invoice # PL-2-18-66367 02/07/2018 Credit Card $ 110.00 $ 0.00 Available Inspections: Inspection Type: Final Rough Top Out Underground Review Plumbing Review Plumbing 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin• •tr rmo uthorize the above -named contractor to do the work stated. February 07, 2018 Authori : Si ature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 07, 2018 1 -C7 t __-'5 1. ,.. Address: JOB ADDRESS: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 • Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FEB I_ 2018 FBC 20 BUILDING Master Permit No. IRC—6 —2-8c., 7 PERMIT APPLICATION Sub Permit No. po b -Z'i Z ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS WCHANGE OF ❑ CANCELLATION ❑ SHOP 1 CONTRACTOR cLh cl O CI rCoon u t. 5 City: Miami Shores County: Miami Dade DRAWINGS zip: 33) 38, Folio/Parcel#: )1-32©4.617 00 30 Is the Building Historically Designated: Yes NO 7'L Occupancy Type: Load: ConstructioniType: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): EAOC-c?ctO/ jY (l. V Cj CO ` Phone#: 3 Z9 J -751 — 270 7 LH-0 G K-Q V) 4 Cp fl cot/ ` 5 City: 1,C3 2 S Y1a C € State: - G e (itiQ Zip: 3 (J l Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: * P IL) it n ✓ (Vl l - �� Phone#: ,7 8(3."' 2 8 7— 7 8 3 J- Address: i014.-2.) SCl.7 (57 (0f_: City: -4 1 a <en k State: Qualifier Name: , 9 ✓t-'41 e_5 Q% S State Certification or Registration #: R F) (0 75 3 5 Certificate of Competency #: 11 P a 4 0 3 72 e Zip: 3 3 ) G Phone#: 7 B ro -- 2137 --78 -5 a — 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 ❑ Repair/Replace ❑ Demolition Description of Work:' S k4c)CQ CV\al ec Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ •Technology Fee $ Training/Education Fee $ Structural Reviews $ uZ e�(-4-1c 5<) V0 21 Ai I _.� F (d‘n 4'1 co</4-4.1) — s Ld� CCF $ DBPR $ Notary $ Double Fee $ Bond $ (hh //�� TOTAL FEE NOW DUE$ (1�)' W (Revised02/24/2014) r %, r. Bonding Company's,Nairrie (if applicable) Bonding Company's Address City State , Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address • City- State Zip r .f 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." 1 r 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. J Signature &ttd1, cEue OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this -The foregoing instrument was acknowledged before me this 3 k St-- day of GV \)ta-Y J , 20 l ? , by 1st day of ce b(u et ivj , 20 l e , by ���1.'�-vC�O Tr�1S!-,w\�tv who is personally known to ( SC 2 • �( \TS I" aS , who is personally known to me or who hasdu 'produced as me or who has proced , f I VQ e V 1 1 C`06t as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: \�C�. —C`\ z t,iCk0 Seal: ********** HILDA M ELIZONDO At MY COMMISSION 0 FF080312 EXPIRES April 13, 2020 7) 39&0153 APPROVED BY .00m * identification and who di ake a -rit ya h. NOTARY P, Sign: Print: Seal: YANA Y RIETO MY COMMIS # FF214031 EXPIRES: March 25, 2019 oc ....... d Bonded T hru Notary Pub!ic Undeiwdters r 1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) DESIGN PLUMBING SOLUTION LLC Date: 02/07/2018 State of: Florida County of: Miami Dade Before me this day personally appeared Jose R Iglesias who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: 440 Grand Concourse. Miami Shores. Florida, 33138. Contractor Signature Sworn to (or affirmed) and subscribed before me this day of 20 le) by s e� i2 7r. esci S ,i7 P MAHARAI K. GONZALEZ - MY COMMISSION # GG 044602 *i + <? EXPIRES: November 2, 2020 Bonded 'Nu Notary Public Underwriters •% ,,,, . ,+:•• Personally know: OR Produced Identification: Type of Ide ification Produced: 4 I 1 Ci2JMV2-' Print, ype or Stamp Name of Notary 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' 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 ' t day of 1--''`n`M'l 20 who is personally known to me or has produced as identification. Notary: SEAL: HILDA M EUZONDO MY COMMISSION aR FF960312, EXPIRES Apn113. MO 4107)3611163 i11515m14a1oryS.Mes.com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. 1 10 t 7'—� ctD-2 Owner's Name (Fee Simple Title olde Owner's Address: fhi . rC -& 1 City: M (c*",4 Job Address (Of where work is being done): City: Miami Shores Contractor's Company Name: Address: � )/,;)?35 City: • J'�lt(MA ll Qualifier's Name : Oro S(y if (, `0'/ (/)'l CDC State :L /(a GAD State: Florida State: hone ) 7si -gZ07 Zip Code: , .> /J2 (;1 C©(.t -/LQ Zip Code: 33/5g Phone #:? 13 5s1 - Zip Code: .518 Lic.Number: C2565./ Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Worlc I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature Signature Owner or Agent The foregoing instrument was aknowledged before me this ) -day of Tandary',20I 3,by (Lady Min elz' (le Who is personally known to me or who has produced Pe(6urkaa f 1\9 tenie as indentification. Notary Pub ' • . Sign: 11 r[itili'"/e Seal: 4ta 2 Notary Public State of Florida �. Maria P Miller • My Commission GG 172426 dc" Expires 01/03/2022 Contractor or Architect The foregoing instrument was aknowledged before me this .3 day of YIJi/ft, 201$ by ec oot V Ej who is ersonally known to me or who has produced as indentification. No Sign: Seal: » .liYAr .•. iY DAYSI L GUTIERREZ Notary Public - State o1 Florida Commission # FF 973227 My Comm. Expires Apr 3. 2020 STATE OF FLORIDA DEPARTMENT BUSIES PROFESSIONAL REGULATION AND RF11067535 ISSUED: 09/27/2017 REGISTERED PLUMBING CONTRACTOR IGLESIAS, JOSE R DESIGN - PLUMBING SOLUTION LLC (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expiration date : AUG 31. 2019 L1709270002234 Construction des (1uaiifying Board BUSINESSCERTiFiCATE OF COMPETENCY 11P000372 1 P000372 DESIGN -PLUMBING SOLUTION LLC D.B.A.: IGLESIAS JOSE R Is certified under the provisions of Chapter 10 of Miami -Dade County QUALIFYING TRADE(S) 0001 PLUMBING Jaime D. Gascon, P.E. Secretary of the Board Miami -Dade County retains all property rights herein. Mt®� www. miamidade.gov/economy J Local Busi ness Tax Fecei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7189424 BUSINESS NAM EILOCATION 'DESIGN PLUMBING SOLUTION LLC- 10421 SW 157 PLACE #105 .MIAMI,'FL . 33196 OWNER DESIGN - PLUMBINGSOLUTION CIO JOSE IGLESIAS Worker(s) 1 RECEIPT NO. RENEWAL 7470739 SEC. TYPE OF BUSINESS LLC 196 PLUMBING CONTRACTOR 11P000372 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place or business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYM ENT RECEIVED BY TAX COLLECTOR 82.50 10/12/2017 0223-18-000092 This Local Business Tax Receipt only con-rms payment d the local Business Tax. The Receipt is not a license, permit. or certi"cationdthe holder'squali"caticrs, to do tininess. Helder mat complywith any governmental ornongovernmental regtiataylawsandregtirementswhichapplytothebusiness. TheRErBPTNQabovemust bedapleyed onall commercial vehicles - Miami -Dade tbde Sec 8a-27 . Poi' more intomrefion; visit www.rnianidadegov/teccollector JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/29/2017 PERSON: IGLESIAS FEIN: 452950835 BUSINESS NAME AND ADDRESS: DESIGN - PLUMBING SOLUTION LLC 10421 SW 157 PLACES. #105 , MIAMI FL SCOPE OF BUSINESS OR TRADE: Licensed Plumbing Contractor 33196 EXPIRATION DATE: 11/29/2019 JOSE R SR IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 ACOR®® �, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/31/2018 THIS CERTIFICATE'S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate'does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Preferred Insurance Network 14380 SW 139 Ct. Miami FL 33186 CONTACT NAME: Antonia Fernandez INC No. ExU: (305) 971-9776 (A/C, No): (305) 971-7997 E-MAIL ADDRESS: antoniaf@piniauto.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : USLI 25895 INSURED Design Plumbing Solution LLC 10421 SW 157th PI Apt 105 Miami FL 33196 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CL1698935 A 04/28/2017 04/28/2018 EACH OCCURRENCE $ 500,000 1 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT J LOC OTHER: GENERAL AGGREGATE $ 500,000 PRODUCTS -COMP/OP AGG $ 500,000 $ AUTOMOBILE. LIABILITY ANY AUTO OWNED _ SCHEDULED P.UTOS NON -OWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident $ UMBRELLA LIAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A " PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF CPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Miami Shores Village Bldg. Dept. has been added as certificate holder. License # RF11067535 Type : Plumbing contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2 Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 440 GRAND CONCOURSE Miami Shores, FL 33138- Owner Information EDUARDO & XIMENA CALLE Address Pe �m it Permit NO. PL-1 O-16-2928 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/14/2017 Expiration: 10/11/2017 Parcel Number 1132060170030 Block: Lot: Phone 440 GRAND Concourse MIAMI SHORES FL 33138 Applicant EDUARDO & XIMENA CALLE CeII (305)751-2707 440 GRAND Concourse MIAMI SHORES FL 33138 Contractor(s) Phone DYNASTY PLUMBING SERVICES COF (305)461-0720 CeII Phone Valuation: Total Sq Feet: Type of Work: ROUGH PLUMBING FOR NEW ADDITION , I Type of Piping: Additional Info: ROUGH PLUMBING FOR NEW ADDITION , I Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $3.38 $3.38 $0.80 $225.00 $3.00 $3.20 $241.16 Pay Date Pay Type Invoice # PL-10-16-61807 04/14/2017 Credit Card 10/27/2016 Credit Card Amt Paid Amt Due $ 191.16 $ 50.00 $ 50.00 $ 0.00 $ 3,500.00 0 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground In considerate pertaining • ereto and in strict conformi with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting his permit I assume respon jbility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are require' .r ELECTRICAL, PLUMBING, ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations OWNR. AFFIDAVIT: I certify that al the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating const ucti, n and zoning. Futhermor'l uthorize the above -named contractor to do the work stated. April 14, 2017 A thorized Signature: Owner \t \' Applicant / Contractor / Agent Date Building Departme Copy April 14, 2017 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue. Miami Shorts, Rorida 33138 Tet (30S) 795-2204 Roc (30S) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 e-1-4‘ FBC 20) 4 BUILDING Master Permit No. 9 G ( -1S r 2861 PERMIT APPLICATION Sub Permit No. Q (.. k 0 " I b - Zci za RECEIVED OCT 27 2016 �BUILDING ❑ ELECTRIC p ROOFING p REVISION 0 EXTENSION []RENEWAL 2twM81NG ❑ MECHANICAL 0PUBLIC WORKS 0 CHANGE OF 0 CANC.EUATION ❑ SHOP i CONTRACTOR DRAWINGS JOB ADDRESS: l" i L4 Q 2-00(( Co cv.) `P se 138 Foiko/Pats: Is the Bonding Historically Desitmotetk Yes NO OccuoantyType: toad: Construction Type Flood Zone: art: FEE: / OWNER: Name (Fee Simple Titleholder): 1jkL A lk.ke5 C ak1 Phones: Address: 7L4 kJ 17 1084" Gty: Mkomm 'SV1O'e.ei state: FL Tenant/Lessee Name: Phonett: Email: : 33138 CONTRACTOR: Company Name: ON, A0S* ? 1 V A'O \ \ See`Acec Monett: 76to' Se 1- guio i Address: IV-3S %V.) \ **' -k- 0ty: NV�NeNt State; . FL ZIP: 5318(e Qualifier Name: )%(.LU O Z. `� �/iy /."9 Phoned: State Certification or Registration t3: ‘I".../.125 ..- . / Certificate of Competency It �.�e 0ESICNEIt�yArrchitect/Engineer: t \9`i ma1 a b....)4-t�\erl1 -tile Photo: 70S' 4 (o I - 07Z 0 Address: 3 it Coea\ VJa1/4i, Ctty: WllarINA State: FL LP: 1141 S value of Work for this Permit $ SS Type of Wore E Additi4rr ❑ A1teradon Swam/Linear Footage of Wort ❑Nw 0 ReparriRcplaaa �afWorlc ► a. t �� kV\ v.,. �(C VWITRAMIrdillIZERFAIMECNICEINI Specify color of color tile: Subm?tsal Fee $ U 4 t 4 Permit Fees ttF s 2 • co/t s - " Scannbtg Fees _ Radon Fee $ 3 TeMnotogy Fee S 5 - T►a n ng/Educotlon Fee $ DBPR s 3 .3 ! Notary $ —e - - 0 Dc hieFee s -i�- Structural Rt±vtews $ sond $ TOTAL FEE NOW DUE $ i q / • Bonding Company's Name {if applicable) Bonding Company's Address City State Tap Mortgage Lender's Name (if applicable} Mortgage Lender's Address City State Z►p Application is hereby made to obtain a permit to do the work and instaitations as indicated. I certify that no work or instillation has commented prior to the i suarete of a permit and that MI work will be performed to meet the standards of an taws 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 AFROAV1T: 1 certify that MI the foregoing information is accurate and that all worts will be done in compliance with sit app4c.ibte 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 Appfxant: As o condition to the issuance of a building permit with an estimated voiur exreedrbg $2500, the. applicant musr promise in good Phis that a copy of the notice of con merrcement and construction lien low 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 of the job site for the first inspection which occurs seven (7) days after the burld&tg permit is issued: In the obsenrx of such pasted notice the inspection wilt not be approved and o reinspection fee w,71 be charged. Si/nature &4a1nS(6111Q___. ignature OWNER or AGENT iK7'Rl1 The foregoing inst., _ before me this The foregoing instrument was acknowledged before me this jrO Jc—YL (0I -, who ISI:Naligknown to M)DU () vikee A , who is personalty known to day of , 20 1(0 , by 1 t1 day of OCTPgge . 20 ((o ,by me or who has produced as identification and who did take an oath. NOTARY PUBLIC: SPrt: Print: Seal: ♦O**doe Nam! M APPROVED BY ifte n a dp2/24Z011) Amy Osborne COMMISSION,FF906700 meorwho has produced as ide • te:. n and • did to oath. NOT BUCt Sign: Print: Seal: OT' . .0011 sassssssssssmtssssassassaass Plans Examiner StrudunH Review GUTIEAREZ Notary Public - State of fiotvida _ rQ FF 973227 ut-A, My Comm. Expires Apr 3, 2020 Zoning Clerk uc IMI.n ncr[c RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - CONSTRUCTION INDUSTRY LICENSING BOARD I:ICENSE`NUMBERI ''.CEC1425651 =. 11/0 The;PL'UMBING,:CONTRACTOR .Na"rned•belowIS CERTIFIED -Underthe.provisionsof Chapter 489FS. Expwation',date:- AUG 31, 2018 - _ VARELA, RODOLFO-ALBE 2Ib ` ' 4 r DYNASTY PLUMBING SER CES CORP. -. 19686 SW 1.3OTH AVENI 2MIAMI ISSUED: 07/24/2016 005086 DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6962741 BUSINESS NAME/LOCATION DYNASTY PLUMBING SERVICES CORP 12255 SW 128 5T #411 MIAMI FL 33186 RECEIPT NO. RENEWAL 7238306 OWNER SEC. TYPE OF BUSINESS DYNASTY PLUMBING SERVICES CORP _196 PLUMBING CONTRACTOR RODOLFO VARELA PRES CFC1425651 Worker(s) 1 i SEQ # L1607240001864 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 08/02/2016 CREDITCARD-16-045149 E i 4 This Local Business Tex Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental'` or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. • 0