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RC-17-1571 3 Miami Shores Village Permit yp 1100idenWI Xt CohStIE'iCtIon q�+� 10050 N.E.2nd Avenue NEren Miami Shores,FL 33138-0000 Perrrlt StBttt „ � � Phone: (305)795-2204 OR yyExpiration. 12/23/2017 3 ... - 7”, Project Address Parcel Number Applicant 1100 NE 108 Street 1122320280290 WILLIAM HODGES Miami Shores, FL 33161- Block: Lot: Owner Information Address Phone Cell WILLIAM HODGES 1100 NE 108 Street MIAMI SHORES FL 33161-7300 Contractor(s) Phone Cell Phone Valuation: $ 7,780.00 ARCO CONSTRUCTION 305-892-6507 Total Sq Feet: 65 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Framing Type of Construction:REPLACE ROTTEN WOOD ON CAF Occupancy:Single Family Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Structural Certificate Date: Additional Info: Review Building Review Planning Bond Retum: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Plumbing CCF $4.80 Review Mechanical Invoice# RC-6-17-64304 DBPR Fee $3.50 06/13/2017 Credit Card $50.00 $343.20 DCA Fee $3.50 Education Surcharge $1.60 06/26/2017 Credit Card $343.20 $0.00 Notary Fee $5.00 Permit Fee $233.40 Plan Review Fee(Engineer) $120.00 Scanning Fee $15.00 Technology Fee $6.40 Total: $393.20 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 II foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonn :'Futherm horize the above-named contractor to do the work stated. June 26,2017 Authorized Signature Ow r / Applicant / Contractor / Agent Date Building Dep ent Copy June 26,2017 1 �lG� ���1�� �-�-�4� 7 S ge Miami Shore Villa RECEIVED Building Department JUN 13 1017 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S FBC 20I� BUILDING Master Permit No. C S-7 I PERMIT APPLICATION Sub Permit No. 'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION M SHOP CONTRACTOR DRAWINGS JOB ADDRESS: to- 9 '26r�� City: Miami Shores County: Miami Dade Zip: 531C2 1 Folio/Parcel#: Is the Building Historically Designated:Yes NO Y� Occupancy Type: Load: °Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1 �� / /+ _�'�® , CT Phone#: Address: It 00 NGS 09_e' City: N11314 —&14 State: Zip: Tenant/Lessee Name: 0 / Phone#: Email: CONTRACTOR:Company Name: ARL—La Q_ocliratJ lQ►. Phone#: Address: l Z q6 f�� L(21-tt !�:2 City: \1.,. _ State: (� Zip: 227 Qualifier Name: (,ESi�!� !!�Z 677) C 7 Phone#: / '��� Z�fn,SO 7 State Certification or Registration#4r46 ® 1 32 Certificate of Competency#: DESIGNER:Architect/Engineer: :AWQAJCt D&UAC�VS Phone#: 7,-D��- Address: 7�f;o N %r\l (44® v�H_,GD!city: , . L tate: PL Zip: 0 o Value of Work for this Permit:$-7-2 2 60- Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: 26 P LACE ( �2(DSA) (,L)Qaj7 ON cAa("�©(L t /5 4-aAtfi Ill 2t&): i!11A L _z WOODEN 50 PPOil LS CA) :J 14 GK PAR-Lo Specify color of color thru tile: f, Submittal Fee$ `�'`� Permit Fee$ 5 U CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ 65 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ � ° � Bond$ TOTAL FEE NOW DUE$ � 7-0 (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address OF City State Zip Mortgage Lender's Name(if applicable) �y ��- 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 OWNER o GENT CO ACTR The foregoing instrument was cknowledged before me this The foregoing instrument as,,ack nnwledged before me this day of`` '' 20 1� , by _ day of 1C�--� 20 ,by who is personally known to -Je3tU who is personally known to me or who has produced as me or who has produced S Z S S ZC -,%A identification and who did take an oath. identification and who did take an oath. r ,, (� NOTARY PUBLIC: NOTARY PUBLIC: I I V✓✓/ ►cY�� Sign Si ,l'�* � •., MAHARAI K.GONZALEZ ,f�q , � MY COMMISSION#GG 044602 Print 1'au A, r v Print: :Q` EXPIRES:November 2 2020 ••,Fodng.•' Bonded Thru Notary Public Underwriters Seal: Fotaorm; Seal: PAULA V.GARVER � Notary Public-State of Florida Commission#FF 947330 rk4�lIsS�,l & � 4 �** * * ****N* **. x *xxa.w�r ***e � �*w*xw* *** r**►»*** ***a x APPROVED BY G Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ago i :.� Miami shores Village Building e a ent OR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fant: (305) 756.8972 Notice t® Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. y 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: I. 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. Signa e: - wner State of Florida County of Miami-Dade The foregoing was acknowledge before me this�p _day of J ` -,20n By W A IQ hf 1 flojgs who is personally known to me or has produced JIN IAV as identification. Notary: ,v SEAL: PAULA V.GARVER = y ate o orida Commission#FF 947330 Aly Cantu.Expires Dec 30,2019 Arco Construction Corporation June 7, 2017 State of Florida County of Miami Dade Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and says: oO Y All work to be performed by Lester Jensen at: 107 NW 96 Street, M. Shores, FL 33150 Sworn to (or affirmed)and subscribed before me this 06 day of June , 2017 ,by �r Personally know Or Produced Identification 3 Type of Identification Produced,pa idg V I C�YIS c3 Zn Z m C)Z N ,v O p q N ra Print,Type or Stamp Name of Notary General Contractors/CGCI505163/1665 N.E. 137t" Terrac&N. Miami, FL 33181 305.892-6507 I' 00:000 CP.ct'Po�T�'�IkT� �o 2� X12 ntE jos i� • SAO it'sso � FL 33 ► 61 5582 N.W.7th STREET SUITE 202 SURVEY No. 9-0000753-2 MIAMI,FLORIDA 33126 TELEPHONE:(305)2642660 ova L6 i i 1.7 .;J i • FAX(305)2640229 DRAWN BY: ARY. LAND SURVEYORS SHEET No. 2 OF 2 BOUNDARY SURVEY SCALE =1'=20' ? th ,:AVENUE — 981 r'Ox --I x O 18'ASPHALT 920' 935 R=25.00' PVMPT. L=33.73' b Tan=19.99' d=77'18'14' 0a 15'PWY P.C. CH 31.23' Off. F.I.P 1/2' ,nA' FLP 1/2' NO CAP NOCAP 55.40' 90'17'40•' 9.05' x 9.06' �- 8.97' } 9.86''P.T. F.I.P 1/2° 30.00. 9.61' �= NO CAP 24.90' 30. 0.20'CL 29,19' ,c0•LZ ,& 9.46' a, g R?20 w c 25.24' L=1 t2: . , . . ' W TI'1. 'Og'S Tan=5 .0 £ 9.3_6' CH ilz- ' 9.00' 9.38' x `� Lor-2 BLOCK-3 x p x 9 91 OD LOT-1 0+ 9 BLOC .3 -.1 .49' 24..I 16 } � -% �-A � � 9.29' O Q ¢ O De FWAIW P 1 9.40' 9.70' 1., 5 6'W.F. x'. < - L� 8.58.9T � ; 0�9 yr�g � •s" � 9.70' � o o. 23,14 9.12' G ,L 9.31' I� oso•cc. 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