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PL-16-2661Miami Shores Village 10050 N.E. 2nd Avenue N - ... Miami Shores, FL 33138-0000 Phone: (305)795-2204 CORI" N Permit NO. PL-9-16-2661 Permit Type: Plumbing - Residential en m Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 3/28/2017 1 Expiration: 09/24/2017 Project Address Parcel Number Applicant 9400 N BAYSHORE Drive 1132050100110 Miami Shores, FL 33138- Block: Lot: AMINE DOUKKALI MARIELA B F Owner Information Address Phone Cell AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776 --- MIAMI BEACH FL 33139- 801 N VENETIAN Drive MIAMI BEACH FL 33139- Contractors) Phone Cell Phone ORIGINAL PLUMBING INC (954)274-3041 Type of Work: REPIPE SANITARY DRAIN AND WASTE PIP Type of Piping: Additional Info: REPIPE SANITARY DRAIN AND WASTE PIP Bond Return Classification: Residential Scanning: 1 Fees Due Amount CCF $25.80 DBPR Fee $22.58 DCA Fee $22.58 Education Surcharge $8.60 Permit Fee $1,505.00 Scanning Fee $3.00 Technology Fee $34.40 Total: $1,621.96 Valuation: $ 43,000.00 Total Sq Feet: 4000 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-9-16-61499 09/28/2016 Credit Card $ 50.00 $ 1,571.96 03/28/2017 Credit Card $ 1,571.96 $ 0.00 mvanaoie inspections: Inspection Type: Top Out Final Review Plumbing Underground 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 zor raj . Futherry►CM--authorize the above -named contractor to do the work stated. March 28, 2017 Authorized SigAajure: 6vMer / /fpplicanY / Contractor / Agent Building Department Copy 1 Notice to Owner —Workers' Conn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel; (305) 795.2204 Fax: (305) 756.8972 nsation 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 i. 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 VA14- The foregoing was acknowledge before me this dayof , 20 By Notary: SEAL: who is personally known to me or has produced .,: MAYRA M. MCAU AO MY COMMISSION # GG 083308 EXPIRES: March 20, 2021 �' :.`.°• • Banded Thru Notary PutrNc Underwrites ORIGINAL PLUMBING INC CFC057806 18001 N.W. 2N' PLACE Miami, FL 33169 TEL,954-274-3041 Date : mazk2a J (.YJ 19- State County of 1 me this day personally appeared �[Dc""who, being duly swan, deposes and BeforeY P Y says : That he or she will be the only person working on the project located Sworn to (or affirmed) and subscribed before me this day of 20 r ,, by Personally know OR Produced Identification Type of Identification Produced ae'�1'1 c Print, type or stamp Name of Notary CHI L. WSON MY COMMISSION # FF 076361 * * EXPIRES: March 10, 2018 Nr��'O"'ee BoMeEThruBudgetNotary Services Miami Shores Village RECEIVED BUILDING PERMIT APPLICATION ❑ BUILDING Zr`,MBING ❑ ELECTRIC Building Department SEP 28 2016 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 201q Master Permit No.?... C Ka - Sub Permit No. Q I 11 (Q —n tU ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑ MECHANICAL PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: pq _ D c L E:)e'r "/ City: Miami Shores F County: Miami Dade Zip: J Folio/Parcel#: I 1 — 3 2 D S — DID- D a 2 Is the Building Historically Designated: Yes NO Occupancy Type: iS E4A'd.oad: Construction Type: L 6 L - Flood Zone: X/ BFE: FFE: OWNER: Name (Fee Simple Titleholder): / 44(-Le- V D cJ% C- w Phone#: Yd S� 66 Address: a v o o 4v S %(r t Zip: 5'31 3 c� City: 11f ee'1147 e` G/'�_ J State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: J Address:© City: I rx, State: Qualifier Name: State Certification or Registration ;�_e �hiecCertificate of Competency #: �J %•9 t� tone#:DESIGNER:Arrchitect/Engineer: � Address: L sL/V i p��_City: . State: �' Zip: 1 Value of Work for this Permit: $ , Square/Linear Footage of Work: 4 D c) Type of Work: ❑ Addition Alteration [flew ° Repair/Repl ce ❑ Demolition .. _ _ a , _ i -./-- Description of Work: Specify color of color thru tile: 0 0 .FA V Submittal Fee $�pc1 D' Permit Fee $ CCF $ .Z 5_ CO/CC $ Scanning Fee $ Radon Fee $ 2 ' S 0 QDBPR $ `� Notary $ �— Technology Fee $'04 '`4y Training/Education Fee $ C- ' COC) Double Fee $ Structural Reviews $ <_ Bond $ `` ^ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 on 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. tt Signature OWNER or AGENT The foregoing instrument was acknowledged before me this lay of 20 l� by who is personally known to me or who has produced �.1.i as identification and who did take an oath. NOTARY PUBLIC: Sign: ' Print: 3g—�k 7 Seal: . Notary Public State or Florida C Rodriguez �� My Commission EE 861704 APPROVED BY Signature 4CONCTOR The foregoing inst�7;z was acknowledged before me this 0 day of�7*E-r( , 20/'Z by i/lu•N who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: � Notary Public - Stab of Florida Seal: : • = COMMIssion M FF 986667 ' My Comm. Expires May 8. 2020 '•:�" of c.Qa`� Banded through National Notary Assn. i ***************************************************************** Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)