RC-16-2909 • RECEIVED
�tQ Miami Shores Village CT 26 2016
V VA Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
1n\ Tel:(305)795-2204 Fax:(305)756-8972 TV
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBc 201 y
BUILDING Master Permit No.2cliG-
PERMIT APPLICATION Sub Permit No.
UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
` CONTRACTOR DRAWINGS
JOB ADDRESS: ,� �S Ir,S o'—'o -, 7
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: �� '��'�i to . —®`l,,1`6 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �. �f,c5 ��.�m/p�t.z / Phone&, 0S-P2/(d -6f
Address: WSM 10W kl 0j(l ®2 FL
City:_A o c'A to-4,ki State: �L. Zip: .33 y3�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C 1-c( 1/I Phone#:
Address: D 9 &D Z" V I
r
City: 4 f C-*4 ( / State: �� Zip:
Qualifier Name: 7C)SL, La's& Phone#:
State Certification or Registration#: 0C2 C O �s Certificate of Competency#:
DESIGNER:Architect/Engineer: 6C y�V e- L sus Phone#:
Address: 5, 4D, /lV 0City: A/ct'ws� State:,L Zip: 3/71-
Value of Work for this Permit:$ CP=�-�J - W Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration/ / ❑ New Repair/Replace El Demolition
Description of Work: 1Z s--4l2 @ Q L<r-t 0 i 1 5kg 0!2 4cE , --Z7VcS !A-L A4'Lz W —T.4-eX L 66S
/L -- 2W 60C2,-t /Z �� .� "Z;rM .nc7sr,C+t�
Specify color of color thru tile:
Submittal Fee$ ]• Permit Fee$ I CCF$ • CO/CC$
Scanning Fee$ Radon Fee$ Z • :40 DBPR$ 2• �® Notary$ yj
Technology Fee$ u . Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
m
TOTAL FEE NOW DUE$
(Revised02/24/2014)
♦ t
t
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.
g
Signature u Jq Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
/I day of"� 201 by a. day of r0 C Z 20 by
7J61'/11e-14 who is personally known to who is personally known to
me or who has produced lk"I"(1— �Z";- as me or who has produced .01-"Le— b'- I- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: V4JZA&,
Print: Print.
Seal: �,►�';;°eon TARWA�Y� Seal: 0`;a��°B�o TARSKUIQd WLES
My COMMISSION#FF 059152 * MY COMMISSION#FF 159452
* * S:January 31,-,M 9 P €XFIftES;January 31,2018
mq� �.oe B�dedThtUBudgelNaffirySer;kt� �'Eoxv��P� Bonded TUN BudgetNatazySeNlces
Cut ;
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application-Miami-Dade County Page 1 of 1
P! "T
OFFICE OF 1HE
x«
Summary Report
Generated On:10/23/2015
Property Information
Folio: 11-2136-013-0950
Property Address: 45 NE 103 ST
Owner 45 NE 103RD STREET LLC
1801 S FEDERAL HWY 2FL
Mailing Address i E
BOCA RATON,FL 33432y3 '
Primary Zone 1000 SGL FAMILY-2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL-SINGLE
FAMILY: 1 UNIT
Beds l Baths/Half 2/1/0
Floors 1
, k
uE
h
Living Units 1E.
Actual Area Sq.Ft r >
Living Area Sq.Ft 1,
11
Adjusted Area 1,769 Sq.Ft
Lot Size 9,225 Sq.Ft Taxable Value Information
Year Built 1949
2015 2014 2013
Assessment Information County
Exemption Value $0 $0 $0
Year 2015 2014 2013
Land Value $163,894 $154,253 $87,509 Taxable Value $243,949 $221,772 $201,611
School Board
Building Value $126,950 $123,870 $113,436
Exemption Value $0 $0 $0
XF Value $651 $658 $666
Taxable Value 1 $291,495 $278,781 $201,611
Market Value $291,495 $278,781 $201,611 City
Assessed Value $243,949 $221,772 $201,611 Exemption Value $0 $0 $0
Benefits Information Taxable Value $243,949 $2 21,77 $201 611
2 ,
....................
.......__._.............. ..................
Benefit Type 2015 2014 2013 Regional
Non-Homestead Cap Assessment Reduction 1 $47,546 $57,009 Exemption Value $0 $0 $0
Note:Not all benefits are
...._to all Taxable Values(i.e.County,...... _.-_. - Taxable ValueLLL $243,949 $221,772 $201,611
a 11 pplicabIe
School Board,City,Regional).
Sales Information
Short Legal Description Previous OR Book-
Sale Price PageQualification Description
MIAMI SHORES SEC 5 PB 10-47
LOT 17&E1/2 LOT 16 BLK 123 03/23/2015 $310,000 29552-2887 Not exposed to open-market;atypical
LOT SIZE 75.000 X 123 motivation
OR 19968-1866 10 2001 1 Not exposed to open-market;atypical
COC 22456-3697 06 20041 03/20/2015 $280.000 29552-2883
motivation
06/01/2004 $270,000 22456-3697 2008 and prior year sales;Qual by
exam of deed
10/01/2001 $209,500 19968-1866 2008 and prior year sales;Qual by
exam of deed
The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser
and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
http://www.miamidade.gov/propertysearch/ 10/23/2015
Detail by Entity Name Page 1 of 2
41
� z 92,�, �
Detail by Entity Name
Florida Limited Liability Company
45 NE 103RD STREET LLC
Filing Information
Document Number L15000046707
FEI/EIN Number NONE
Date Filed 03/16/2015
Effective Date 03/14/2015
State FL
Status ACTIVE
Principal Address
1801 S FEDERAL HGWY
2ND FLOOR
BOCA RATON, FL 33432
Mailing Address
1801 S FEDERAL HGWY
2ND FLOOR
BOCA RATON, FL 33432
Registered Agent Name&Address
CASSANO, MATTHEW
1801 S FEDERAL HIGHWAY
2ND FLOOR
BOCA RATON, FL 33432
Authorized Pers onls} Detail
Name &Address
Title MGR
GP 19 MANAGEMENT LLC
1801 S FEDERAL HIGHWAY 2ND FLOOR
BOCA RATON, FL 33432
Annual Reports
No Annual Reports Filed
Document Images
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/23/2015
Detail by Entity Name Page 2 of 2
' e
03/16/2015-- Florida Limited Liability View image in PDF format
Copyright V and Privacy Polities
State of Florida,Department of State
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/23/2015
Detail by Entity Name Page 1 of 2
iW7f �
A
I
�
Detail by Entitya
Florida Limited Liability Company
GP 19 MANAGEMENT LLC
Filing Information
Document Number L13000053350
FEI/EIN Number 46-2509330
Date Filed 04/11/2013
Effective Date 04/11/2013
State FL
Status ACTIVE
Principal Address
1801 S FEDERAL HIGHWAY
2ND FLOOR
BOCA RATON, FL 33431
Mailing Address
1801 S FEDERAL HIGHWAY
2ND FLOOR
BOCA RATON, FL 33431
Registered Agent Name &Address
CASSANO, MATT
1801 S FEDERAL HIGHWAY
2ND FLOOR
BOCA RATON, FL 33431
Authorized Person(s) Detail
Name&Address
Title MGR
DUMERVIL, ELVIS
1717 N BAYSHORE#2641
MIAMI, FL 33132
Annual Reports
Report Year Filed Date
2014 02/05/2014
2015 01/13/2015
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/23/2015
Detail by Entity Name Page 2 of 2
Document Images
01/13/2015--ANNUAL REPORT View image in PDF format
02/05/2014--ANNUAL REPORTF7 View image in PDF format
04/11/2013-- Florida Limited Liability View image in PDF format
C.omricht ,and Privacy Policies
State or Florida,Department of 5tal:e
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/23/2015
Caibi Construction Company
10876 S.W.24th Street
Miami, Florida 33165
10/21/15
State of Florida
County of Miami-Dade
Before me this day personally appeared Jose Losa who, being duty sworn,deposes and says:
That he or she will be the only person working on the project located at:45 NE 103 st
Sworn to (or affirmed)and subscribed before me this 21 day of 10. 2015 b +
Personally know
Or Produced Identification
Type of Identification Produced
n
int,Type or Stamp Name of Notary
TARRHALA KNOWI,ES
* 1 ' 059152 aa;PUB4 TARSHALAKNO
Ea�'i E&.1army31,2018 ,� ••. �' :cn*x$ 059152
oFF► �O edr8u�gettaoY+ry3ewicas * 2x18
P° 9onoetiTntuf3uo{�tiVotaN�'�ices
��OFi�
,SNonsy
Miami shores V
Building Department
R,np, 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
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: lr ec��
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this,ZL day of 0 ,20
By who is personally known to me or has produced
r as identification.
Notary:
TARWALA KNOMM
SEAL: * oe�MYCOMWS1:,.• +:r 959152
EXPIRES:
Janaar�Noovrfl-r %8TInWIPNotary Saratces