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DEMO-16-2137 2 illlt t `yt►�"mss°,i Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 A � M Phone: (305)795-2204 .� , Expiration: 02/0602017 Project Address Parcel Number Applicant L255NE 99 Street 1132050090100 iami Shores, FL 33138-2642 Block: Lot: JOSH WOLLOWICK Owner Information Address Phone Celt JOSH WOLLOWICK 1255 NE 99 Street (305)531-0970 FL 33142- 1255 NE 99 Street FL 33142- Contractor(s) Phone Cell Phone Valuation: $ 36,500.00 STRONG DEVELOPMENT S CONSTRt (305)321-1586 _. .._. :.,.. _ .. ...._ .. Total Sq Feet: 1321 Type of Demo:Building Available Inspections: Additional Info:COMPLETE INTERIOR DEMOLITION OF EXI Inspection Type: Classification:Residential Final Scanning:3 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $22.20 Change of Contractor Fee Invoice# DEMO-7-16-60798 $75.00 08/10/2016 Check#:1477 $ 1,226.06 $50.00 CO/CC Fee $0.00 DBPR Fee $16.43 07/29/2016 Credit Card $50.00 $0.00 DCA Fee $16.43 Education Surcharge $7.40 Notary Fee $5.00 Permit Fee $1,095.00 Scanning Fee $9.00 Technology Fee $29.60 Total: $1,276.06 In consideration of the issuance to me of thisfmit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the lans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility f all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MEC,;MICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that hd foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fu4he ore,I authorize the above-named contractor to do the work stated. August 10,2016 Authorized Si na e:Ownef / Applicant / Contractor / Agent Date Building epartment Copy August 10,2016 1 (2 Miami Shores Village �l Building Department JUL 2J 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 r-�Q FBC 20 �— BUILDING Master Permit No.T" 01( I�� PERMIT APPLICATION sub Permit No. ,BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12- r r 61) Q E / 9 5 -1 City: Miami Shores County: Miami Dade Zip: 33/-?,y Folio/Parcel#: ?_ ti10 g U % Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ® w o flo w 1GL Phone#: Address: '7 J i IIC ��v R� Vtt 7 City: / State: EL Zip: '7-7 /3-v Tenant/Lessee Name: / / / Phone#: Email: ITP ,f46'1 Wb l /OiVICk , 66 CONTRACTOR:Company Name: s c:cC.n c De y pe�-V'A-� Phone#: Address: �Pp b®�C E-6-.5-9c'35" City: H / Oq "" / State: Zip: 33 Z 3" Qualifier Name: F /?i R F-c•d e e4-CS' Phone#: State Certification or Registration#: 6G /57/ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ f Square/Linear Footage of Work: 13 21 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace X Demolition Description of Work: OQtAI?UCT1- I N e— `�(�4U1 11 130 CJ-t CA I ST(N 6 Specify color of color thru tile: Submittal Fee$ ESCPermit Fee$ 0 ° CCF$ ® CO/CC$ W Scanning Fee$ 9 . CK-) Radon Fee$ ( �0• �43 DB``P��R$ 1� ° Notary$_ � r ` Technology Fee$ q ° ® Training/Education Fee$ - `-C® Double Fee$ Structural Reviews$ Bond$ CNCTOTAL FEE NOW DUE$ 1 �� (Revised02/24/2014) 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 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 Signature g g ttO 'N'ER or AGENT CNTRACTOR The foregoing instrumas Acknowledged before me this The foregoing instrument was acknowledged before me this day of ( 20 /,K by S day of 20 by _ who is personally known to F1L q Nc1J t-1 F-°-1--4Y j who is personally known to me or who has produced opL/9L-W Al Y2 0 ` ZS-76as me or who has produced F6 3 z J Z,>-"-" ''7`�—�?" as identification and who did take an oath. ZY(o identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: _5�Qi 37 Print: rr2 �� � Print: <7:Zi n��_ 'lam Seal: ......4! ��9 'e79 � Seal: n oPAY POe. Notary Public State of Florida t ie'FF1291,V • " Sindia Alvarez . o`�' My Commission FF 156750 � II - APPROVED BY y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SNORES 1� Miami shores Village uu nm� J L 29 2016 Building Department rE �L0R 0 BY., - 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.X,�Cm®(h- 2P3 ) Owner's Name(Fee Simple Title Holder): JOS kU11 WOWiC� Phone#: 3 Owner's Address: 7 4 rl AIE &LV.f h®K C our t -H- 70Z- City: H- 70Z- City: M ( a Vh[ IState: PL Zip Code: 3 Job Address (Of where work is being done): I Z53" NC- CIOP e z City: Miami Shores State:—Florida Zip Code: 7313 Y Contractor's Company Name: liC:koe21 r (plots W ji flP1 Phone#: Ift- L/12 - 131 Address: Z 2`11 14 W I 1 /g-0t 9 t t City: M If4 M I State: Wil- Zip Code: -3 14 Z Qualifier's Name: / Lic. Number. Architect/ Engineer of Record Name: P-C-(v m Q' 4d'' h Gf iii Phone#- SjI - ZJa � - 17 Address:9641 SIS 22-1,q CbLj City: 0 a VI L State: Zip Code: 3 5 3 Describe Work: VC ph 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. 1 hold the Building Official and the Miami Shores harmless of all legal involvement. Signature Signature Own or Agent Contra c or o Architect The foregoing instrum nt was aknowledged before me The foregoing instrume wa aknowledged before me this�day of J,20 ,by �yS� VY I` rON(CiC, this , day of ,20,�by u ink ��/�j�av� )2 Who is personally known to me or who has produced who is personally known to me or who has produced F--L— r?L t i qaa ''9&S -7lv -�i)�,()as indentification. as indentification. Notary Pub i �� Notary_ Public: Sign: 6�Yy/t�tivG ,� Site . P CARMEN DE BERNARDI } ,o. CARMEN DE BERNARDI Seal: °°= Notary Public-State of Florida SSIr °a°_ Notary Public-State of Florida °QE My Comm.Expires Mar 1,2018 My Comm.Expires Mar 1,2018 Commission#FF 87976 '%e4 �o � Commission # FF 87976 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ,M 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FUERTES, FRANCISCO JOSE STRONG DEVELOPMENT&CONSTRUCTION COMPANY 4807 NW 98 PLACE DORAL FL 33178 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 restaurants, DEPARTMECVT.OF BUSINESS AND and they keep Florida's economy strong. PROFESSi ULATION Every day we work to improve the way we do business in order to CGC 1514111 z � 08/27/2014 serve you better. For information about our services,please log onto �� www.myfloridalicense.com. There you can find more information ` Y Y i CERTIFIED"G about our divisions and the regulations that impact you,subscribe � � . to department newsletters and learn more about the Departments FUERTES F- STRONG-DE UCTION 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, i IS CERTIFIED adder-the proYisio.ns of Ch.489 FS. and congratulations on your new license! ! Expiration,date AUG 31,2016 L1408270003482 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESSAND PROFESSIONAL REGULATION CONSTRUCTION,.INDUSTRY LICENSING BOARD. ! ' The GE IICERAL,CONTRACTORw > Named below IS CERTIFIED Under..-the-provisions of Chapter 489 FS. - Expi_ra4on,date--AUG 31;.2016 - r Fl1EftTES, FRANCISCO JOSS STRONG DEVELOP LIGTION GOMPANY A 4807 NW 96-PLACE DORAL e ' er ISSUED: 08/27/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408270003482 .ociai Business Tax Receipt Miami-Dade County, State of Florida THIS OTA BILL - 00 NOT PAY 7052111 3USINESS NAME/LOCATION RECEIPT NO. PIRES PRONG DEVELOPMENT&CONSwC110N COMP $ OBER 30, 2016 3785 SW 61 AVE 7 Must 10 dlWWW at place of business )INECREST FL 33143 Pursuant to County Coda Chapter 8A-ArL 9&10 WMER SEC. OF BusnuESS TRONGDEVELOPMENT& i CTRICALCONTRACTOR PA �nlEO .ONSfRUCI[ON 3 $4 TAX 5-� 09/1 015 Vorker(s) 1 CREDITCARD-1 5 �gmentaftbe Lecal flusbW83MULTha ftcofpk awe fi , p tea eftbe s todoba Haidermustcomptyw0saq ba Wga%wyas rvldabapplytaffiab Tke 810 aba>mattm dls�ayadaA ap c&I - Cede S�1N-236 For arra a bdormatfarr,visit 5 -oval Business Tax Receipt vfiami=Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 1162580 �'L- .BT IUSUVESS NA1ME1LOCATtON RECEIPT NO. EXPIRES TRONG DEVELOPMENT AND CONSTRUCTION CO WIEIMAL SEPTEMBER 30, 2016 785 SW 61 AVE 64266M Mustbe dspWvvd at place of business 1NECREST FL 33143 Pursuant to County Code Chapter 9A-Art 9&10 0JUN]ER SEC.TYPE OF BUSINESS rRONG DEVELOPMENT AND 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED CGC1514111 BY TAX COLLECM /orlcer(s) 1 $45.00 09/14/2015 CREWCARD-15-046095 • This Local BasimmTaxltaceiptaaty payamntultmLocal BnslmsTaxThIasaacts vero�t - penakara ohe s to do b»s Hald"Must agm1'wb6ap* bssWa=oraalr�eleterylawsffi MO BECWTNil ub—mmtbe on80 valdclas- ->lada CadaSec 8a- & Formas ialomradcs,vidt ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 16. 1 7/19/2016 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 °NAMEcT Alexander Dopazo Dopazo & Associates Inc PHONE (305)470-8500 FAX N�:(866)647-9673 8725 NW 18th Terr Ste 300 ��ESS,alex@dopazo.com INSURERS AFFORDING COVERAGE NAIC d Miami FL 33172 INSURERAAccident Ins Co 11573 INSURED INSURER 6: Strong Development And Construction Company INSURER C: PO Box 565808 INSURER D: INSURER E: Miami FL 33256 INSURER F: COVERAGES CERTIFICATE NUMBER.CL162512478 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 ADDL SUBR POLICY EFF POLICY EXP R TYPE OF INSURANCE POLICY NUMBER M D D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ CPP0017940-01 2/6/2016 2/6/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY D PRO ❑LOC 1 JECT PRODUCTS-COMP/OPAGG $ ,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (Per accident AUTOS AUTOS ( )BODILY INJURY P $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UABB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'UABIUTY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) General Contractor. License #CGC1514111 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3057952204 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Alexander Dopazo/AD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025/Pm4nn 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: 12/21/2015 EXPIRATION DATE: 12/20/2017 PERSON: FUERTES FRANCISCO FEIN: 208809308 BUSINESS NAME AND ADDRESS: STRONG DEVELOPMENT&CONSTRUCTION COMPANY 4807 NW 98 PLACE DORAL FL 33178 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL CONTRACTOR CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a ceritficate of election under this section may not recover benefits or compensation under this chapter.Pursuant m Chapter 440.05(1 2),F.S.,Certifies 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 shag be subject to revocation 1,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 carrtificate.The department shall revoke a DFS-F2-DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 STRONG Mi Box 565808 Miami,FL 33256 D E�► � Phone:(305)321-1586 Fax:(305)596-4975 July 19th,2016 State of Florida County of Dade Before me this day personally appeared Francisco Fuertes who being duly sworn,deposes and says: That he or she will be the only person for Strong Development&Construction Co. working on the project located at 1255 NE 99 ST in Miami Shores,FL,under the worker's compensation exemption. That if any and all employees for Strong Development& Construction Co.working at the project,will do so under a leasing company which provides worker's compensation insurance. That all subcontractors hired to perform work at such property will be required to provide proof of insurance prior to commencing work. Sworn to(or affirmed) and subscribed before me this 19th day of July,2016,by Francisco Fuertes who produced a Florida Driver's License F632-250-74-180-0. Am MA U0 COMMISSION 0 MINS Q, EXPIRES' JUN mil Ana M. Canto 5guRES s� Miami shores Village Building Department artment "rEs 04 10050 N.E.2nd Avenue halOR o., 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20 16'. By 6,5°� a �''—'icwho is personally known to me or has produced f-- 19L-4 W4 ZO_V2--r-76^7t'O `{(D—Oas identification. Notary: SEAL: `otRx'' v' Ann ado C t® _ i Bit