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RC-17-42 epw Np. RC-1 17-42 Miami Shores Village Pe nit l ype: VAiii ll"!tia"Oonstfu tion w 10050 N.E.2nd Avenue NW la�f�hbh,Addition/A)xe,rcatiop las � Miami Shores,FL 33138-0000 it Phone: (305)795-2204 PerimtSts:JC4� .,. �coR Expiration: 9/27/2017 I a C2al 01:7 P� Project Address Parcel Number Applicant [,29 NW 94 Street 1131010340140 Miami Shores, FL 33150- Block: Lot: STEPHEN HARPER ODALYS AC Owner Information Address Phone Cell STEPHEN HARPER ODALYS ACOSTA 29 NW 94 Street MIAMI SHORES FL 33150-2237 Contractor(s) Phone Cell Phone NC BUILDERS INC (954)803-1335 Valuation: $ 10,000.00 .. Total Sq Feet: 121 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Drywall Type of Construction:KITCHEN REMODELING Occupancy:Single Family Miscellaneous Stories: Exterior: Window Door Attachment Front Setback: Rear Setback: Tie Beam Left Setback: Right Setback: Final Bedrooms: Bathrooms: I Framing Plans Submitted:Yes Certificate Status: Insulation Certificate Date: Additional Info:KITCHEN REMODELING Truss Insp Bond Return: Classification:Residential ColumnsFoundation Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Window and Door Buck CCF $6.00Fill Cells Columns DBPR Fee $4.50 Invoice# RC-1-17-62549 Wire Lathe DCA Fee $4.50 01/06/2017 Cash $50.00 $290.00 Review Electrical Education Surcharge $2.00 02/28/2017 Check#: 166 $290.00 $0.00 Review Electrical Permit Fee $300.00 Review Building Scanning Fee $15.00 Review Building Technology Fee $8.00 F.Termite Letter Total: $340.00 F.Elevation Certificate Review Planning Review Mechanical Review Plumbing Review Plumbing Declaration of Use Review Structural In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility-,for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAW ANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo T. rize the above-named contractor to do the work stated. February 28, 2017 Autho her / Applicant / Contractor / Agent ate Buildi g D p irtment Copy February 28,2017 1 • Miami Shores Village ti 1Building Department X _FC_F1`111 rI IV � 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JAN 0 6 2017 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949Y: +__1 FBC 20 i4 BUILDING Master Permit No. p_C I �. PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: `�'� A-1dj `�9 7 ty• ST-. City: >Miami Shores County: Miami Dade Zio: / Folio/Parcel#: /3/®/® 3zl® Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 1 � �'e, Phone#: 05 Address: A)UJ 1 ���/, ��r• a City: /f$r7f. Ser,,� State: ;L_/„ Zip: Tenant/Lessee Name: Phone#: 3 05 Vim! &5lv*r Email: CONTRACTOR:Company Name: AIC Phone#: -,5 Address: 6 Z 747 /fit'W /&1!X City: 1A e e L 4 top Stater Zip:_5 307,& Qualifier Name: 66g t1AA1 A,,1J+1//-090 Phone#: '9�5y &75 " State Certification or Registration#: ea e- . 0 o®d"),V5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: Stat//e: Zip: y Value of Work for this Permit:$ ��� ®�® ° Square/Linear Footage of Work: /,2/ � /8e' Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: /� � �� ) l?r r �7✓�� Specify color of color thru tile: ' 2 Submittal Fee$_ SO P f41 1� • Permit Fee$ J00 CCF$ _ CO/CC$ Scanning Fee$ S Radon Fee$ y . 9 C) DBPR$ L.( • S ® Notary$ Technology Fee$ Training/Education Fee$ 2 Double Fee$ Structural Reviews$ e Bond$ TOTAL FEE NOW DUE$ 2 + — (RPViSPdm1?417n141 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. 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law rochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of com ncement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In he absence of such posted notice, the inspection will not be approved a reinspection fee will be charged. Signature Signature "WNER or AGENT 4TRACTOR Thefpretoing instru �ent was a knowledged before' a this The forggoing instrument was acknowledged before me this day 20 l by day of D¢CItL ,20 � by who is personally known to auUL') f4sw awlo who is personally known to me or who has produced ° 7�` as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: u Sign: 1 Print: n Print: ✓�• �� `� M.LALANE Seal: } �`�'• FF 0373 '°SPA.PSB` COMMISSIONs� AJF ;:: Commission# 2017 ® Seal: DIY 024224 octow 5' _XPIR� °= �gd1NuTmyFainhoutenoe800 cS:June 5,2017 ,fJ;, Bonded Thru Notary Public Underwriters .kkk�k>Kgek.k?kik.k�k>t:k$kffi8ck+k(e(eekk[eIIekkkrk .Iek�[eY.#itekIekIe�.kge+kFekYegc(efle.k(eaNakek*;eRk'kIIeIs[eategs(c#8e.k8e.kdck#ktkYeIIc>l:Iekk%>K�#.hkkkkkkk>Kkk(skak.kkIc APPROVED BY o'—i)4/k-3 flans Examiner Zoning Structural Review Clerk ta—i—An,)MA hna Al ♦SNOR C.I �r I.n " Miami shores Village um� .mow ylo�� Building Department RID 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPYOF TATE LI B. CO LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INS D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: /VC OU11-o"'?5; BUSINESS ADDRESS: 0275— 1VW `d CITY ��%�J STATE F7 ZIP -5507,6 BUSINESS PHONE: �� �� �� s FAX NUMBER . CELL PHONE C�) 60 w f�35 QUALIFIER'S NAME: Qec 9,1,4,^1,, A/A(IXaCO, QUALIFIER'S LIC NUMBER:—,r-1;6 060065 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 NAVARRO, GERMAN ANDRES NC BUILDERS INC 6275 NW 104TH WAY PARKLAND FL 33076 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. ` PROFESSIWL REGULATION Every day we work to improve the way we do business in order CBC060085 ISUED 08/09/2016 to serve you better. For information about our services,please � log onto www.myfloridalicense.com. There you can find more CERTIFIED BQ11W �N NTRACTC3R information about our divisions and the regulations that impact NAVARRO G ,, i�FiES you,subscribe to department newsletters and learn more about NC BUILDERS°IM,, the Department's initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.488 FS. and congratulations on your new license! Expiration data:AUG 91,2018 L1608090001645 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CBC060085 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 NAVARRO, GERMAN ANDRES-y zt`*^°'"' NC BUILDERS INC r"*k" 6275 NW 104TH WAY - PARKLAND FI*, 3y64 4 ISSUED: 08/09/2016 DISPLAY AS REQUIRED BY LAW sEQ# L1608090001645 NC Builders, Inc. 6275 NW 104th Way, Parkland FL 33076 License#: CBC060085 December 27,2016: State of Florida County of Broward ���vdl�� GaeGovt`l Before me this day personally appeared who,being duly sworn,deposes and says: That he or shenw_ilcl be the only,,p,-e$rsonh�working on the project located at:� Vo --p Sworn to or affirmed and subs'dized before me this of Q (����vifl�� d�✓� 20 by Personally know l7 *10 OR Produced Identification �l® l1� � 2. K �17v Type of Identification Produced Print,sign, or stamp name of Notary M _* eyeq Co mission# FF 037 a338 P; Expires October 5,2017 P, , Banded Tf.T,Fain I-am I;W n5aIq OR ' Miami shores Village Building Department 10050 N.E.2nd Avenue �lpRpA 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. f1. 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: '4Ow er State of Florida County of Miami-Dade The foregoing was acknowledge before me thisA9_!�Vof ,20A. By Tom' who is personally known to me or has produced as identification. ��� tl ', :�:: ,, M.LALANE _..A_*'] *: Commission#FF 037338 Notary: Expires October 5,2017 ` Bo W Tiw Troy Fein hmrmm 89x385-7048 SEAL: , WE JEFF ATWATER 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 certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 1/10/2015 EXPIRATION DATE: 1/9/2017 PERSON: NAVARRO GERMAN FEIN: 651050244 BUSINESS NAME AND ADDRESS: NC BUILDERS INC 1906 NW 79 AVE MARGATE FL 33063 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 1 to�:t-Iar... _ 1 rrrt - + rwllq /r —.s,.. .rer' 4! �J'7lA r�--'�_ - ��{�71'�� .{.:_: r,""'+..a�.,,,__ mow , BROWARI) COUNTY LOCAL BUSINESS 'TALC RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER I. 2016 THROUGH SEPTEMBER 30, 2017 DSA: Receipt#: 8�4-22'7403 ;.,, i�U3ineSS iV1n18: NC BUILDERS INC .GEN) R 2 CONTRACTOR (BUILD"NG Business Type.CONTRACTOR) b Owner NSMO GERMAN ANDRES NAVARRO Business Opsned:0 9/I 0/2 0 0 9 Business Location: 6275 NW 104 WAY State/County/Cert/Reg:CBC060085 RGAfiE Exemption Code: Business Phone: Rooms Seats Employees Machines Professionals For Vending Business Only Number of Machines: Vending Type: x Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27. 00 3 . 00 0 . 00 0 . 00 0 . 00 0 . 00 30 . 00 1, ' I acro o CERTIFICATE OF LIABILITY INSURANCE 121DATE 2712016/DDIYYYY} 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. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must 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 CONTACT REEL INSURANCE AGENCY PHONE(AM Me 954 956.0006 FAz 954 956.0555 DIBIAI COVER ALL INSURANCE EAnngEss.-MAIL realinsuranc ahoo.com 5800 W.ATLANTIC BLVD. I s t o COVERAGE NAIC 0 MARGATE FL 33063 IN . FEDERATED NATIONAL INSURANCE COMPANY 10790 INSURED INSURER 8: NC BUILDERS,INC. INSURER c 6275 NW 104TH WAY INSURER D PARKLAND FL 33076 NSURER E: 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 TYPE OF INSURANCE DL UB UCY Nqn BER POLICY EFF POLICY EXP LIMITS LTRX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE rX I OCCUR DAMAGE TO RENTED $100,000 GL-0504013473-0.1 618/2016 61812017 MED EXP am $6,000 PERSONAL&ADV INJ RY 1 OWW WW0 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2 000 000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LLABILI Y COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aacklent) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIARCLAIMS-MADE AGGREGATE $ DED R $ STATUTE WORKERS COMPENSATION PEROTH- PR AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE N I A E L EACH ACCIDE $ OFFICERIMEMSFR EXCLUDED? El (Mandatory In NH) E.L.DISEASE-EA EMPLOYE If yes describe under r DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICX UMrf S I f i DESCRIPTION OF OPERATIONS I.LOCATKMIS 1 VEHICLES(ACORD 101,AddlUonal Remarks Schefte,may be attached If more apace Is requtred) REMODELING CBC060085 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VIALLAGE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIM BE CANCELLED BEFORE THE EXPIRA'nCW DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE!kTH&M*0H3Y PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REPRES A ncbuildersipmsn.com 01988-2014 ACORD CORPORA'T'ION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i W (Ire •1 l! I I✓ �.✓0 . . • • • • . . . . . . . ... • •. ••• . . .. . . . ..• . P O ••• ••• ••• ••• •: - os" °�e�' FRANCISCO R PALACIOS L I G I.1 T I N G ;, ��, Notary Public-State of Florida _- Kitchen Remodel -N1 Commission#FF 178347 ••• i a ••• i•• i• !•4'iF ����°�� My Comm.Expires Nov 20,2018 • ••• • • • • •• •• • • • • • ••• • li a � 1�'—�jBLOCK OFENINC V1ITH CBS HLOCK i EXIST. r REF - EX. PORCH 1 -e INDICATE EASTP.0 SPA?E CIRCUIT 1' IN EXIST � f HCJSE PANEL EXACT 'INC-11T#TC FE u`ERIFED BY A I r J FLORIDA LICE,:;EI: ELE.CTNICAL COtTRA;,TOR x d 0 Ln EX. KITCHEf. E'I:'. ;LE. EL T .Jti.EkCA..i ET Ll,-HT-,, H M C J E. -1-T, tl ~ V Ex. _)I%JING ��O "v' z •- EAST ELECT. EX. LglA,DRY Ci. POWEP2 l CJ POWER !" EC#13004765 Alan Wolf Master Electrician EX. GA-%A E T 12/20/2016 / 29 NW 90 Street Mimi Shores 33150