WS-17-738 Permit NO. WS-3-1 7-738
`yeortFs y,{ Miami Shores Village Permit Type:Windows/Shutters
10050 N.E.2nd Avenue NE
Miami Shores, re Village
Per I ork Classification:Window/Door Status:
A Rep APPROVED
Phone: (305)795-2204
Permit Status:APPROVED
�ORI�A
Issue Date:3/24/2017 F
Expiration: 09/20/2017
Project Address Parcel Number Applicant
1048 NE 99 Street 1132050180180
Miami Shores, FL 33138-2639 Block: Lot: KRISTIN REESE DANIEL TANNE
Owner Information Address Phone Cell
KRISTIN REESE DANIEL TANNER 1048 NE 99 Street
MIAMI SHORES FL 33138-2639
1020 NE 99 Street
MIAMI SHORES FL 33138-2639
Contractor(s) Phone Cell Phone Valuation: $ 500.00
AC SHUTTERS AND AWNINGS INC 305-799-2068
�,.. _.......� _ _..... m Total Scl Feet: 0
Type of Work:HURRICANE PANEL TO REPLACE PERMIT B Available Inspections:
No of Openings: 15 Inspection Type:
Additional Info:
Window Door Attachment
Classification:Residential Final
Scanning: 1 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Copies Invoice# WS-3-17-63363
$125.00 03/23/2017 Credit Card $392.10 $0.00
DBPR Fee $3.75
DCA Fee $3.75
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $250.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $392.10
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 an on' g. Futhermor , I utho iz thea a-named contractor to do the work stated.
March 23, 2017
Authorized Signat re O ner cant / Contractor / Agent Date
Building Department Copy
March 23, 2017 1
* _ A.
RECEIVED
Miami Shores Village MAR 17
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
F8C 2014 SA
BUILDING Master Permit No.w s 1-1 —1 3
PERMIT APPLICATION Sub Permit No.
&�ISLIILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
C
JOB ADDRESS: "�� w 94 59"
City Miami Shores County Miami Dade
Folio/Parcel#: —_ yls the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: �-y– Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): /� /�/5 T/� / 'A/u�Z._ Phone#:
Address: /6- Aq sl
City: �Q`.r�,r � .z>, 5 State:
Tenant/Lessee Name: Phone#:
Email: �-
CONTRACTOR:Company Name: /"L �Pf'7 * �/t� 4il�,L0p Phone#: 7a
Address: 9190 ,¢yE
City: Le=i State• Zip:33al6
Qualifier Name: 4Ir/4r/�a � 1'` Phone#: Q — 7J� 2cg;d'
State Certification or Registration#: :J GG o//flf6/7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: Gty: State: Zip:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
�O Q�^���G� ❑ Repair/Replace ❑ Demolition
Description of Work: ��,Z 13p V S --(Z4 I
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ OBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
taewsedoz/za/zaial
r
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. 1 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 constructian 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.
t
SignatureSignature Axle /J�
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
fo
!_1daay of MAa-L*-A 20 1-7 by /� 1 S' day of �a f'�-� 20 1 '7 by
L�J "�,4�'-w-ho is personally known to h & m do Com'L CI ,whos personally k on wi'to
me or who has produced as me or who has produced as
identification and who did take a111tilrtlir/i identification and who did take an oath.
NOTARY PUBLIC: SS�`lvF�q//i NOTARY PUBLIC:
A� i
Sign: _Z S •. N *_ Sign: �Z///
Print: ,O: #FF 954760 ,oma, Print tai �d �����5.•''�••EXp''• ///i
�9qf'• 'aYc+::�o s
Seal: Seal: . ai
"� a:k
i►ii«►i««►«►.«ilii«««It►i►►«««i« i .. ►►►« •«►ti►►i«i«►►►►►««iii►i►i««►►«ilii«►;iii►«�tRRgy►t`��e ���
Pubfir
APPROVED BY Plans Examiner
Structural Review Clerk
(ReviseM2/24/2014)
gY OREs
Miami Shores Village
Building Department
OR 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
iallows 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 IO 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
i
' Signature:
Owner
i
I State of Florida
County of Miami-Dade
l ^n^ �
The foregoing was acknowledge before me this day of
By V— `A 5T1 N (AN tv��� who is personally known tome or has produced
*e�,ti,1;N11 /
aside c n `��LVERq ��4i
,•'SOON Qp'•. i
Notary J�` r6,2020/9C�`s;
G Z
SEAL:
S:
0
ro
�A�''�ititPiiu ii, \\`\
Mar 231703:16p WILVERALMARALES 305-382-6777 p.1
CERTIFICATE 4F LIABILITY INSURANCE �►1131232017Y)
03/23/2017
THIS CERTIFICATE IS 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. i
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policylies)must be endorsed. If SUBROGATION IS AIVED,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 endorsemenl(s).
PRODUCER CONTACT WILVERALMARALi—ES
NAME:
Wam Insurance Corp PHONEr (305)274-4353 FAX 305 2749994
10637 SW 88th St.Ste 7-1 EMAIL
-ADRliFSs: -_--
Miami, FL 33176 LN RE. AFFORDIN covIk NIUc r
Phone (305)274-4353 Fax (305)2749994 INSURERA. SCOTTSDALE INSURANCE CO
INSURED _ _...--. -- _......_._._
INSURER B:
A C SHUTTERS,AND AWNINGS, INC rNSURER C:
8190 W 26 Ave INSURER D: T
INSURER E:
Hialeah FL 33016- - — - ----- ------.._._.
_...._ .. ..-__- - INSURER F.
COVERAGES CERTIFICATE NUMBER: _ R ISION 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 CONTRACTOR OTHER DOCUMEN WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 'ADDLSUBR ._....-....__POLICY EFF POLICY EXP
-----
7R.. ,-_----_- TYPE OF INSURANCE
LINTS
COMMERCIAL GENERALUA80.I1Y EA HOCCURRENCE $ 1,000,000.00
__7..
J CLAIMS-MADE Lyme OCCUR DAMAGE TOI2ENTED-.-___ I. 100,000.00
_PRMISES-LEa oocurtancel $ _._-.._._.
— -
LI CPS2508483 0812612016,08/26/2017 EXP(Any ane person) t$ 5,000.00
A
PE SONALBAOVINJURY $ 1,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER _GE ERAL AGGREGATE_ $ 2,000,000.00
POLICY F] jECj LOC PR DUCTS-CONP/0P AGG S 1,000,000.00
L I OTHER $
AUTOMOBILE LIABILITY CO BINED SINGLE LIMIT
ANYAUTO BO 3ILY INJURY(Per person) $
❑ ALL OWNED I 1 SCHEDULED — -
AUTOS _J AUTOS BO ALY INJURY(Per accident) $ —
1j HIRED AUTOS _71 AUTOS
NON-OWNED --P. .-.ERTY AMAGE
L_.J ..._I AUTOS a 'dant $
UMBRELLA use I occuR I
EA 1H OCCURRENCE $
EXCESS LAB
' IU CLAIMS-MADE
--
— --- _ AG REGATE $
OED '—J RETENTION$WORKERS
I '
AND EMPLOYERS COMPENSATIOY .._.. Y/N r--I PER
ANY PROPRIETOR/PARTNER/EXECUTIVE-- I E. EACH ACCIDENT I $
OFFICERIMEMBEREXCLUDED? NIA _-
(Mandstory in NH)
If yes.describe under E. DISEASE-EA LOYE $ _
..._
DESCRIPTION OF OPERATIONS belay E. .DISE EMPDISEASE-POLICY LIMIT $ _
I .
i
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD'101,AdditionalRamn space Is nqulmd)arkeSehedule,irma —�
j CONTRACTOR LIC*SCC131149617
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE JDESISED POLICIES BE CANCELLED BEFORE
MIAMI SHORES VILLAGE THE EXPIRATION DATE THERTICE WILL BE DELNERED IN
BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 AVE AUTHORIZED REPRESENTATIVE — —`
MIAMI SHORES VILLAGE,FL 33138
305.756-8972 WILVER ALMARALES j
®1988-2014 AC RD CORPORATION. All rights reserved.
ACORD 25(2014101)QF The ACORD name nd logo are registered marks of ACORD
R
wA
JEFF ATWATtR
CHIEF FINANCIAL 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 certifiers that the individual listed below has elected W be exempt irgm Florida Workers Compensation lane.
EFFECTIVE DATE: 12130!2016 EXPIRATION DATE: 12!3012018
PERSON: COLON ARMANDO
FEIN: 061657932
BUSINESS NAME AND ADDRESS:
AC SHUTTER AND AWNINGS INC
8180 W 26 AVE
HIALEAH Fl. 33016
SCOPES OF BUSINESS OR TRADE:
DOOR AND VONDOW
INSTALLATION
Ftartima to Chopw 44.05(141,F.S..an ORrow Of a cerporoS:on who ekds exerrvtm true:•tis duni tw by film 6 crrlifr39M/of e"iw unMv this Seam
may not iecovtA b4tWts or=npcnss6on"or the crteptw-Pwwarvi to CAaitter 440.05117).F 5-,c rtrrmes d efecum to be exenpt-.apply v*
WWAI•»Kupe of the tumess or bade Isteo on em ntl4ca of olection t0 Da exanpt tisrsaard to ChWsr 440.05(111),F.S..Naticrt d ate 60a to be
suempl arta ce-ftbcaks d ekdion to be exerrgA shell be wblyd to reaocatmn S.m my lrne otter the 9j-V of the nice tr r*ise sm*d was drift—de•
am perun narnet4 on the nates 9r CMCiirhic rte tenger meats M requvem its Ot this aettiorr for WiiigtrM ef■errytli-el4,yhr tlrFatmre Out rewte a
DF&f2-13M-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 UUEsrIONS?(950}413.1609
Local Business Tax Receipt
;tiliami-DaaCounty.slat'_�of Florida
LB
54R00a1
WIA1TNU, EXPIRES
RtNEWAL SEPTEMBEFC30r 2017
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RICK;iCQT .GO+YERWR KEN,.AIYSLI4,—CRFTARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTMO INDUSTRY LICENSING BOARD
Tnr.SPECIALTY STRUCTURE M14TRACTUR
N,mT,e3 b-13w IS CERI:FIEC e'
Urxiar the provAimS Of CT2pk/L89 FS
EKclratundax: AUCs 31 7019
COLON,ARAIANIX)R
AC SHUTTERS AND AWNMIGS INC
14995 NVIBTCT =_
MAI FAH FL33013
Is'sum. 07mee-v16 DISPLAYAS REQUIRED BYLAW SE0e L1007W=1212
Accordion Shutters■Storm Shutters■Bahama Shutters■Roll-ups
Aluminum Awnings■Canvas Awnings■Retractable Awnings■Aluminum Roofs
Screen Patios and Repairs
3/19/2017
State of Florida
County of Dade
Before me this day personally appeared Armando Colon who, being duly sworn, deposes and says:
That he or she will be the only person working on the project located at: 1048 NE 99 ST Miami Shores, FL,
33016
Sworn to (or affirmed)and subscribed before me this 9P day of 20/2, by
ersonally know
Or Produced Identification
Type of Identification Produced
WDO JR
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8190 W 26-Ave. WIMeah Gardensq FL 33016 OFFICFa 305-828-1444 FAX#305-828-708Z
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SEPPATWATER
CHIEF FlNANCIAL.OFFICER STATE OF KORIDA
DEPARTM51SI5? OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CERTIFICATE. OF ELECTION TORE EXEMPT FROM FLOVAi WOkKEI S` OMPERSATION.LAW
TNN oortifies 4W the individual Jlstn+d belm Inas e1 ed to be exempt orrt Flanda Wcck a &npan-snllaon law.
EFFECTIVE DATE,: 121-3012016 0,12IR I,TION DATE,. 12??3=018
FE11M1 M1657932
932
BUSINESS NAME AND ADDRESS-.
AC SH,UTTER AND AWNINGS INC
1 00 W 28 AVE
HIALEAH FL 3-sI}pa
SCOPES OF BUSINESS OR, TRADE
DOOR AND WINDO
W T LLATION
to crtrt to Chopw drl .4't5(1 't,F. titt�tti sur A ccr m v. c 3ccfi exam ren his ;a a+'c�by rJFj)4,1'oeyb r,.or tt t,'�;i Un►i this baa
ftwy nota ger t-je-ft er€ 'n eis nt3rs "w tt t didptt^. RUM–c"to NEI[O r a41D #1,21). F ".. Cafiffkatft cel'd6wim as a overt _tip �.
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DFST.27 D'i -2 -2 CER'TIF'ICATE OF ELECTION TO IBE EXENWIf FCEVI$F I„) 0 -13 OUES iI NS? (&50)413-1009
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, FI 33138
Tel: (305)795-2204 • Fax; (305)756-8972
12/10/2015
To: Current Owner
1048 NE 99 Street
Miami Shores, FL 33138
Permit: BP2005-1241
Address: 1048 NE 99 Street Miami Shores FL 33138
Date Expired:2/18/2006
Dear Sir or Madam,
Our records indicate that the above referenced permit has expired without obtaining the
proper final inspection. In order to serve you better, we need to keep our files up to date.
As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid
(expired) unless the work authorized by such permit is commenced within six months after its
issuance, or if the work authorized by such permit is suspended or abandoned for a period of
six months after the work is commenced, or completed without obtaining the final inspection
of the work performed.."
Please be advised that open permits will hinder your ability to refinance or sell this property
Please contact the Building Department, within 15 days of receipt of this letter in order to take
care of this matter.
Sincerely,
Ismael Naranjo (CBO)
Building Director