RC-17-1743 (3) v
Miami Shores Village �� ' epi T1�en t±Q
10050 N.E.2nd Avenue NE
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Miami Shores,FL 33138-0000
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h Phone: (305)795-2204
; e 4�1 r Expiration: 01/10/2018
Project Address Parcel Number Applicant
10555 NE 6 Avenue 1122310120040
Miami Shores, FL 33138-2049 Block: Lot: VIVIAN MEDINA
Owner Information Address Phone Cell
VIVIAN MEDINA 10555 NE 6 Avenue
MIAMI SHORES FL 33138-2049
10555 NE 6 Avenue
MIAMI SHORES FL 33138-2049
Contractor(s) Phone Cell Phone Valuation: $ 4,000.00
GATOR ROOFING&CONSTRUCTION (954)253-7332 Total Sq Feet: 0
Approved:In Review Available Inspections:
Comments:
Inspection Type:
Date Approved::In Review Final PE Certification
Date Denied: Window Door Attachment
Type of Construction:STRAPPING OF ROOF. Occupancy:Single Family Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: Drywall Screw
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Planning
Certificate Date: Additional Info: Review Plumbing
Review Mechanical
Bond Retum: Classification:Residential Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building
CCF $2.40 Review Structural
Invoice# RC-7-17-64502
DBPR Fee $2.00 07/14/2017 Credit Card $ 169.40 $50.00
DCA Fee $2.00
Education Surcharge $0.80 07/06/2017 Credit Card $50.00 $0.00
Permit Fee $120.00
Plan Review Fee(Engineer) $80.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $219.40
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 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,ROOFIN d SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and at all rk will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the'above-named contractor to do he work tated.
July 14,2017
Authorized Signature:Owner / Applicant / Co tractor / ant Date
Building Department Copy
July 14,2017 1
SATOR
ROOFING AND CONSTRUCTION, LLC.
Date:July 14 2017
State of:Florida
County of: Miami Dade
Before me this day personally appeared Henry Villarreal who,being duly sworn,deposes and says:
That he or she will be the only person working on the project located at: 10555 NE 6 Avenue, Miami
Shores,FL , 3 31.7 9-
Contractor signature
Personally know
OR Produces Identification
Type of ID produced
`���Illluulru�i
18vloN
Notary Stamp&Sigo--*O* �'
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Miami Shores Village RECEIVED
Building Department JUL 0 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20(4
BUILDING aster Permit No ZC_i-7^ ` _T
PERMIT APPLICATION Sub Permit No.Imo! � �11_'� L
❑BUILDING ❑ ELECTRIC ZfROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: P a A)6 6
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: I t Z,Z-51 D 1 �Zp — Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): l^'l'L`"' Phone#:
Address: lD 1; C klt- ro 4q.ex t_,_
City: � �s �(,QJ State: Zip: t 3
Tenant/Lessee Name: Phone#:
Email: /' _
CONTRACTOR:Company Name: G,, Phone#:
Address: (9'-(`c L4
City: jQ/ State: 1�2 zip:
Qualifier Name: Phone#: s '1 - Z5'3
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State Certification or Registration#: X15 Z� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ D Square/Linear Footage of Work:
Type of Work: ❑ Addition/ ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ I'® CCF$ _ .CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ tbg
(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 suc osted notice, the
inspection will not be approved and a reinspection fee will be charged.
lvti��
Signature V/_V� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was a k wledged before me this
2-5_day of 20 ) by �'7 day of 20 ,by
0-h who is personally known to ho is personally known to
me or who has produced as me or who has produced G�-�.�,�k, • as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: L. J(_'_S Print: W1.�` CNF tc_g7 J ^ED
R,a.
Seal: �*a 4B Luis Enrique Ardila Seal: � � '•6� Luis Enrique Ardila
Notary Public-State of Florida
r
Notary Public-State ofFlorida c Commission#GG 77955
Commission#GG 77955 ;!V s
Expires 2/28/2021
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APPROVED BY / yt Plans Examiner Zoning
),17 Structural Review Clerk
(ReAsed02/24/2014)
goal uUM IR M iami Shores village
Building Department
Cpm 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. § 440.45
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 fled 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
work ers'compe sation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING FLOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
, n
Signature: tAbL ._.
Owner
State of Florida
County of Miami-Dade
The fore ma was acknowlege before me this day of ,20 .
By Tv
whos personally knower-to me or has produced
as identification.
Notary:
c�*pr°`e4 Luis Enrique Ardila
SEAL: o Notary Public-State of Florida
Commission#GG77955
P Expires 2/28/2021