MC-15-1896Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
aVED _.
Expiration: 09/12/2016
Applicant
1208 NE 95 Street
Miami Shores, FL
1132060144100
Block: Lot:
PEDRO DE MELLO
Owner Information
Address
Phone
CeII
PEDRO DE MELLO
1208 NE 95 Street
MIAMI SHORES FL 33138-
(305)753-5504
1208 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone CeII Phone
AA MASTERS MECHANICAL AIR MOV (305)559-7004
Valuation:
Total Sq Feet:
$ 1,200.00
00
Tons:
Additional Info:
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 3
Date Approved: : In Review
Type of Work: GARAGE CONVERSION
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning F,ee
Technology Fee
Amount
$1.20
$2.25
$2.25
$0.40
$150.00
$3.00
$1.60
Total: $160.70
Pay Date Pay Type
Invoice # MC -7-15-56502
03/16/2016 Cash
07/28/2015 Check #: 404
Amt Paid Amt Due
$ 110.70 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
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 all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futh- • - . •• he above-named contractor to do the work stated.
March 16, 2016
ner / Applicant / Contractor / Agent
Building Department Copy
Date
March 16, 2016 1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECEIVED
JUL 28 2015
13Y;
FBC209961
Master Permit No )5 4 F95
)"%L / o
Sub Permit No. r aiitii�/!/�►
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 41O$ NC -/QS*Vf•
City: Miami Shores County: Miami Dade Zip: .33/.3g
Folio/Parcel#: / I'® Cl? — 0 /i " Y/ 00 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): P19 We/I m` -e r 4 f�-it Phone#: °S 75 3 sSSY
Address: /40 7 ?/ -/ olQ/'-u
City: 1/14)6k (4.44. lead' State: Zip: 33/3?
Tenant/Lessee Name: Phone#:
Email:
gye j:
CONTRACTOR: Company Name:4 /7 M /j S`f Its M C c -h if -/e 4 C Phone#: 7P 4' 76'Y 3 0
Address: /550 / . 1 &) (0 4 -tie rte} C"Er P M (A /4 / i
City: /1 r fi M 6' State: Q.,_ Zip: 2 /°2--,6Qualifier Name:j6_,..) VS'�
' /`. CC/ e euPhone#: 7J' %4j' 0
State Certification or Registration #: c AC 0.e�J7 22_ ,C Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
i.
Value of Work for this Permit: $ r k0 0 24 70----0-quare/Linear Footage of Work:
Type of Work: ❑ Addition fcAlteration
6a4rat2 6&.v
Description of Work:
❑ New
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile: �j)�,
Submittal Fee $ 4, C. Permit Fee $ {C
G'lJ CCF $ 20 CO/CC $
Scanning Fee $ 03 Radon Fee $ DBPR $ • $ Notary $
Technology Fee $ t 00 Training/Education Fee $ D. Double Fee $ 0
Structural Reviews $ e Bond $
TOTAL FEE NOW DUE $ / i U --910
(Revised02/24/2014)
$
Bonding Company's Name (if applicable)
Bonding Company's Address p
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'$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature _ -----�
OWNER orAGEttT
The foregoing instrument was acknowledged before me this
C rl da of e LI 4 v , 20 by
, who is personally known to
me or who has produced D') o f g 7q 2 f b
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
JO
'.$ OP COM
EXPI
,40/) ;s384-.0 C
Signa
CONTRACTOR
The fo ':_oing instrument was acknowledgedtbefore rr�e this
'l day of d4 A C --it/ , 20 ! , by
C C! �fA , who is personally known
me or who has produced as
identification and who did take an oa�
NOTARY PUBLIC: %� �." =''�' fi 0SSEAU
0 I/7I/7
(Q1 a5d31S3
Sign:
Print:
Seal:
fl4
MtssicN z1
47.
s Fs> May 4 :201
********************************************s***s***********************************ss**s*********s*********
APPROVED BY Ylw \\o r Plans Examiner
. � LLL
(Revised02/24/2014)
Structural Review
�oning
Clerk
Date: V3. /0 JS
State of /oi21DR
A A 1M /14 m'/' tet. 'H0v;
"6 / -1672//4/6 S'ys7 S Coe?
S5-51 S) ioS ,eie c 4 <4 s 2S
M. 33J9.
County of Dad. Q
Before me this day personally appeared "3-iS as F- GxRe-A who, being duly sworn, deposes and
says:
r o e � n� on -e> f‘e/L4-ew
TA) 0 yy,t h r G�
"4441%cii-t-
1 rNegs
1ut,i` di. Gt- 33138
Sworn to (or affirmed) and subscribed bef ren* this 1 day of t ottrck . 20 I , by
Sous
°F. 6u egek
JORGE ROSSEAU
MY COMMISSION 4FF119015
E'PI1:Es may 4 2018
FUn:Pit.MerySeme crm
Personally know
OR.Produced Identification
Type of Identification Produced
CO
Print, Type or Stamp Name of Notary •
Miami Shores Village
Building Departmen
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
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this \ 0 day of , 20 % S .
BycleASY0 irk QY /giVe C0 R 4 de ckleil(
Esq OWDe1R21 O
Notary:
SEAL:
who is personally known to me or has produced
as i . - ntification.
1.651.
,,. JORGE ROSS>.
MVCOMMtssloN s
..f fi EXPIRES Mal...;
(40r) woraanwan,,amen. _...