FW-17-13204
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. FW -5-17-1320
Permit Type: FencelWall
Work Classification: Wood Fence
Permit Status: APPROVED
Issue Date: 5/22/2017
Expiration: 11/18/2017
Parcel Number
Applicant
118 NE 102 Street
Miami Shores, FL
1132060131890
Block: Lot:
KARON COLEMAN
Owner Information
Address
Phone
Cell
KARON COLEMAN
118 NE 102 Street
MIAMI SHORES FL 33138-
(305)987-8422
118 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s)
WILCON CO
Phone
(786)399-8855
CeII Phone
Valuation:
Total Sq Feet:
$ 9,000.00
265
Approved:
Comments:
Date Approved: :
Date Denied:
Type of Construction: Wood Fence
Classification: Residential
Additional Info: 6 FT HIGH HORIZONTAL WOOD FEP
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$3.98
$3.98
$1.80
$5.00
$265.00
$9.00
$7.20
$301.36
Pay Date Pay Type
Invoice # FW -5-17-64009
05/11/2017 Credit Card
05/22/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 251.36
$ 251.36 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Building
Review Planning
vir
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.
OWNER
construct
AFF, 'AVIT.i I
ze
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
rmore, I authorize the above-named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
May 22, 2017
Date
May 22, 2017
1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
RECEIVED
MAV 111
Ot\(.4--1
Permit No. `P w 1
Master Permit No.
Permit Type: BUILDING ��(( I
OWNER: Name (Fee Simple Titleholder):11GACIA Cd r. kle/► n Tse
Address:
City: \\N, u rn' ShOReS
NIA
Tenant/Lessee Name:
Phone#: 3 OS - q $7" VW
State: "FL
Email: ni`fl C co_c.:\ C pD. ( w
JOB ADDRESS: C. 1 0
Zip:2a
Phone#: N )A
City: Miami Shores County:
Folio/Parcel#: \ i— 3a o (o C 3— 9 0
Is the Building Historically Designated: Yes NO
CONTRACTOR: Company Name: J I 1(0(3 &--O '
Address: el4/No 44 TM %\V2 eD ,
IAA'S:
A S
Qualifier Name: W f/// fl- ?7 C at/Z
State Certification or Registration #:
Contact Phone#: .7 c 9 3 qc-/ Address:
DESIGNER: Architect/Engineer:
Miami Dade
Zip: 3313
Flood Zone: tS )( 11
Phone#:
P
State: ( Zip: 3 3/ 38— '
Phone#: 7'0 3q` 48 J
Certificate of Competency #>/C �j / 57 Zc Z
��Email �./C2V Z Z3 /?a'/ / e-(04-,
Phone#:
Value of Work for this Permit: O a Square/Linear Footage of Work: 7 Co S
Type of Work: ❑Address ❑Alteration 1 1Z-61..)WONew DRepair/Replace ❑Demolitio
Description of Work: (, ' r4 • 1 citv (-tii o Uhl T iV ... ?KJ 'F-" 1 roi"
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
***************************************Fees********************************************
Submittal Fee $
Scanning Fee $ c:9-•
Notary $ 5. 00
Double Fee $
Yy
Permit Fee $ - GS - w CCF $ S '4
CO/CC $ �I
Radon Fee $ DBPR $ 8 Bond $ _so
Technology Fee $ '
Training/Education Fee $ \ • e0
Structural Review $
TOTAL FEE NOW DUE $ 25 l310
Bonding Company's Name (if applicable)
Bonding Company's Address f 4
City State Zip
NIS
Mortgage Lender's Name (if applicable) W2;1I S 'fag -30
Mortgage Lender's Address p, C) , (��( (p ( (� ,31%
City ost 0.S State T%C
zip -726C,
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 attach •n . Also, a certified copy of the recorded notice of commencement t be posted at the job site
for the first inspection which occ, . seven (7) days after the building permit is issued. In the abs of such posted notice, the
inspection will not be approv- • < • • reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of M, 20 i, by Kc y oks Col Q tel_
)(who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY,PUBLIC:
Sign: 1 Pi
Print: -.'i IVE77E-
My Commission Expires:
/di"
********************
APPROVED BY
*
GA TTE MEICINORRE
Nobnr ►Mlle - Stab of Florida
C0000110011 r FF 9115285
111 4111
17
(Revised 07/10/07)(Revised 06/1 0/2009)(Revised 3/1 5/09)(rev6/4/1 0)
Signature
ontractor
The foregoing instrument was acknowledged before me this yr
day of /47 , 20 1.4 by 4//f- ewe,. ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Si
3
Print:
G • ?av2
My Commission Expires:
***************************,
Plans Examiner
Structural Review
;;ti L, EN 'a ' a
f ova : Notary Public =
Miami Shores Viiiage
Building Department
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:
wner
State of Florida
County of Miami -Dade
The foregoing/60-6
was acknowledge before me this // day of /1/ , 20/.
By / (Z, i i&'
Notary:
SEAL:
who is personallyknown to me or has produced
as identification.
Vs, Notary Public—XS ate ,.
'�
.:77 Commission *'FF 20443
%Fob .,p, My Comm. Expires Apr 7, 2019
'''' '"" Bonded through National Notary A
Date:
WILCON CO.
GENERAL CONTRACTOR
CONSTRUCTION
LICENSED & INSURED
IGC# 1512642
WILLIAM CRUZ
9636 NE STH AVE Ro.
MIAMI SHORES FL, 331313
WCRUZZ3gNOTMAiL.GOM
DESIGN -BUILD
CELL 756-399-0055
Orr,cE 305-456-9902
State of
County of Dade
Before me this day personally appeared 6jin C /� tz who, being duly swom, deposes and says:
That he or she will be the only person wotKing on the project at 11'8' NE 10 Z LS+ .
Sworn to ( or affirmed and subscribed before m
4
Personally Know
Or produced identification
Type of identification produced
Print, type or stamp of Nota
Co -bloc -0
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
ru Notary Public Underwriters
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SUBJECT TO CGMIPUPNCE WITH ALL FEDERAL
STATE ANO CCUNiY RULES LID REGULATIONS
PW I; -1320