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PLC-15-2422 CC `S`- 2q Zi Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax:(306)756.8972 Inspection Number: INSP-244066 Permit Number. PLC-9-15-2422 Scheduled Inspection Date: March 14,2016 Permit Type: Plumbing-Commercial Inspector HwundIM Rafael Inspection Type: Final Owner. ,SHORES SQUARE INVESTMENTS Work Classification: Addition/Afteration Job Address:9017 Biscayne Boulevard Miami Shoves,FL 33138-0000 Phone Number Parcel Number 113206011007047 Project <NONE> Contractor: EF DESIGN 8 CONSTRUCTION Phone:(305)409.4581 Building Department Comments ALL PLUMBING FOR INTERIOR RENOVATION. me nts INSPECTOR COMMENTS False Inspector Comments Passed CA Palled � pper/ Correction Needed Re-Inspection Fee No Additional Urepedions can be sdieduied until ns-Inspection The is paid March 14,2016 For Inspections please calk(30762-4849 Page 10 of 40 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)785-2204 Fax:(305)756.8872 Inspection Number: INSP-254763 Permit Number: PLC-8-15-2422 Scheduled Inspection Date: March 16,2016 Permit Type: Plumbing -Commercial Inspector: Hernandez,Rafael Inspection Type: Final Owner. ,SHORES SQUARE INVESTMENTS Work Classification: Addition/Alteradon Job Address:8017 Biscayne Boulevard Miami Shores,FL 33138-0000 Phone Number Parcel Number 1132060110070-17 Project <NONE> I Contractor: EF DESIGN&CONSTRUCTION Phone:(3056)40941581 Building Department Comments ALL PLUMBING FOR INTERIOR RENOVATION. Infractiol Pa-sed merKs INSPECTOR COMMEN717S False Inspector Comments CREATED AS REINSPECT ON FOR INSP 244066. Pending revision and Passed coffin Failed Correction Needed Re-inspection Fee No Additional inspections can be scheduled untll redrwdbn fee Is paid Meeh 15,2016 For Inspections please calk(305)762-4848 Pam 29 of 31 Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL 33138.0000 Phone: 0788-2204 . .. Expiration:0710912016 ProjectAddress Parcel NUMI) r' App 9017 Biscayne Boulevard 113206011007047 SHORES SQUARE INVESTMENT Miami Shores, FL 331384000 Block: Lot: omw inionnsawr Address Phone coo SHORES SQUARE INVESTMENTS 3850 BIRD Road MIAMI FL 33146. s phone Cell Phone $4,000.00 Valuation: EF DESIGN a CONSTRUCTION (305)409.4.Wl Total Sq Feet: 0 Type of Work:ALL PLUMBING FOR INTERIOR RENOVATIO Avai#abie Inspections: TOO of Piping. Inspection Type: Additional Into: Top.Out Commercial Re Pipe Scanning:1 Main Drain Heater WawSeryke Final Water Main Lavatory Review Plumbing Urround Fees Due Amount Pay Dats Pay Type Amt Paid Amt Due CCF $2.40 Invoice 0 PLC41-18.67186 DBPR Fee $4.60 01/11/2016 Check e:1581 $568.40 $60.00 DCA Fee $4.50 Education Surcharge $0.80 09/23/2015 Credit Card $50.00 $0.00 Permit Fee $300.00 Sc ww9ng Fee $3.00 TecduroloW Fee $3.20 Work wrdW Permit Fee $300.00 Tatak $818.40 In consideration of the Issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Vile. in accepting this permit I assume responsbIlfy for all work done by either'myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,MORS,ROOFING and SWIMMING POOL worts. OWNERS AFFIDAVIT: I certify that as the foregoing information Is accurate and that all work will be done in compliance with all apps"laws regulating construction and zoning. Futhermore,I authorize the above-nerrwd contractor to do the work stated. January 11,2016 Au6xwbwcTftrftw94Oww / AW kept / Contractor / Agent Dft Building Department Copy January 11,2010 1 Miami Shores Village 7SEP 2 241 Building Department By. 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax-.(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20114 BUILDING Master Permit No. C0_is- .-i 42,) PERMIT APPLICATION Sub Permit No. ?Loj f- 2 qa7---- [:]BUILDING rj ELECTRIC M ROOFING E] REVISION [] EXTENSION [:]RENEWAL 21(LUMBING []MECHANICAL [-]PUBLIC WOR.KS M CHANGE OF []CANCELLATION M SHOP CONTRACTOR DRAWINGS JOBADDRESS: fto -11 &$!fftnt. X/Vol. City: - Miami Shores County: Miami Dade Zip: Folio/ParceIN: Is the Building Historically Designated:Yes_NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 9—he" r hone#: mlwu ftgr Address: (@" Atif 4,26! 21— city: W. Kadzi., State: MW Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: W—ft d:k-%A_ do%6 A-&Qp±fR!2 Phone#:J?0S'-24 f- PZ4 7 Address: a19*7 W*4 . olve- city: "Vag, _State: Qualifier Name: Eot!jAet Fowl-eedo hone#: W %a State Certification or Registration M -..--jCertfficate of Competency#: DESIGNER:Architect/Engineer: 14 2 8 Z I Phone#: Address: City: "S1i;ie:*'—' - , zip: Value of Work for this Permit-$._YA Square/Linear Footage of Work: Type of Work: D Addition B'Alteration ❑ New ❑ Repair/Replace 0 Demolition DescriptionofWork: gZi &4oni;* 4 *.r 41LO f oe bf I? Specify color of color thm die.- >. Submittal Fee$ Permit Fee$ XlogIM,�CCFS$ CO/Cc$ Scanning Fee$ Radon Fee$ _ DBm$ Notary Technology Fee Training/Education Fee$ Double Fee$ Structural Reviews$--a— Bond$ 6 TOTAL FEE NOW DUE$' (Revlwd02/24/2014) f Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(If applicable) Mortgage Lender's Address i City State Zip i 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..... I 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$25W, 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 nd a ins n fee will be charged. Signature Signature O AGENT CONTRACTOR The foregoing instrume acknowledged before me this The foregoing Instrument was acknowledged before me this day of_i� Qj� .20_r[--V by �day of cR 7 A ,20 /J: _ by 1 _fZ ,who is pew naily mown to iAi A44 F 14 r d b who is ersona,y�riow?�jto me or who has produced as me or who has produced as Identification and who did take an oath. identification and who did take an oath. NOTARY PU NOTARY PUBLIC: Sign: Sign: k&" Print: Print: Seal: OEM IM Seal: ftft N> Ift AV men 11f StBI� APPROVED BY 'a ' !A Pians Examiner Zoning i Structural Review Clerk (RevMM2/24/2014) i AR FATA Gwwral Contractor ��+a Coll 305 409 A4581 EF DESIGN CONSTRUCTION, IM �(.e�'ltr�Ctor.00111 ', 297 NW 152 Ave WW , F( January 8,2016 This letter is to certify that I am an independent contractor with no employees. I do not sub contract work out nor hire any employees. AdrrM.:F:a�j<ardo Lic#CFC148221 General Contractor 297 NW 152nd Ave Hollywood FL 33028 Miami Shores Village Building Department CpR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner-- Workers' Compensation Insurance Exem tion Florida Law requires Workers' Compensation insurance coverage under Chaffer 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 Dent 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 vohmtary 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 time 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,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Sr• :.Ze... -..� gnature: r- owner State of Florida County of Miami-Dade �,, The foregoing was acknowledge before me this. _day ofgg"j _,204. By dn,t e.1 er n QN[�� who i4��ersonal�..._'ly kno me or has produced 3.. as identification. No tarq Public.State of F SEAL- Co�ia810 B FF spa My COMM Ekores Sit 7. emow trsaygn tam