PL-19-2585Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
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Issue Date: 01/13/2020
Location Address Parcel Number
9290 N BAYSHORE DR, Miami Shores, FL 33138 1132050270240
Contacts
Permit No.: PL-10-19-2596
Permit Tyre: Plumbing - Residential
Work Classification: Gas
Permit Status: Applied
Expiration: 07/13/2020
RICKI LEE LONDON Owner
9290 N BAYSHORE DR, MIAMI SHORES, FL 331382949
ADVANTAGE GAS SERVICES INC Contractor
DANIEL SANTANA
16891 SW 139 PL, MIAMI, FL 33177
Business: 3059798281 info@advantagegas.com
Description: NEW GAS LINE FOR GENERATOR Valuation: $ 1,500.00 Requests:
Inspection 305-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
01/13/2020 $61.10
Credit Card
10/29/2019 $50.00
Amount Due:
$0.00
Building Department Copy
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 constructio d zoning.Futhermore, I authorize the above named contractor to do the work stated.
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Authorized Signature: Owner / Applicant / Contractor / Agent Date
January 13, 2020 Page 2 of 2
- gECEIVED
Miami Shores Village o� 2 g 2019
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 V/
BUILDING
PERMIT APPLICATION
❑BUILDING
PLUMBING
Folio/Parcel#:_
Occupancy Type:
❑ ELECTRIC ❑ ROOFING
FBC 20 1�4 2-
Master Permit No��L(b- ✓ 2�
Sub Permit NO?L IV" ( r -
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Load
I v Is the Building Historically Designated: Yes
Construction Type: Flood Zone: BFE: _
NO
FFE:
OWNER: Name (Fee Simple Titleholder): �` ��nJ� l��IJ� Phone#: 1 —6� —
Address:
City: )K01 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:
nCoom(2any Name:
Address: k VG u``''
City: cf�\O " 't
Qualifier Name:
State Certification or Registration #: U `-
V \ J Phone#: ; 05 MQ
—4-�_ Zip:
C( Phone#:
rtificate of Competency #:
DESIGNER: Architect/Engineer: ,Phone#: _
Address: City: State
Value of Work for this Permit: $ W Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $!,A-) • Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
Zip:
❑ Derpolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I O
(Revised02/24/2014)
r-
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
Zi
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 Q" Lk 1a & Signature a-_=�
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
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dayof®i�� Q�h2 20 by TZ—d y of� 20 , by
�oWu�ti� w is personally known to is persona own to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print
Seal
identification and who did
NOTARY PUBLIC:
Print:
Seal: � .,,r.�•
y� or IV
**********************************************************************
APPROVED BY _, I (/y Plans Examiner
Structural Review
Notary ublic State of Florida
Carl Cavall0
My mmission GG 323605
Expires 06130/2023
* * * * ***************
Zoning
Clerk
(Revised02/24/2014)
Advantage Gas Services
16891 SW 139" PL
Miami, FL 33177
Phone 305-979-8281
L142062
Date: 11/22/2019
State of Florida
County of Dade
Before me this day appeared Daniel Santana who, being duly sworn, deposes and says:
That he will be the only person working on the project located at: 9290 N Bayshore Dr. Miami Shores FL
33138.
Contractor Signature
Sworn and subscribed before me this 22 day of October 2019. BY Daniel Santana
Personally know
Carlo Cavallo
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: �—� c '
Owner
State of Florida
County of Miami -Dade l n
The foregoing was acknowledge before me this V✓ day of A 20
By_ 6 ` who is personally known to me or has produced
✓C�
a i entification.
ovpr a Notary Public State of Florida
Notary: ? `f; Carlo Cavallo
c� My Commission GG 323605
SEAL: a'fp�po'F Expires06/3012023