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DS-15-554Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. DS -3-15-554 Permit Type: Driveways/Sidewalks/Slabs e' I m' Work Classification: Addition/Alteration Permit Status: APPROVED ue Date: 3/3012015 Expiration: 09/26/2015 Parcel Number Applicant 5 NW 106 Street Miami Shores, FL 33150- 1121360060240 Block: Lot: ESTEBAN MATIAS STAVILE Owner Information Address Phone Cell ESTEBAN MATIAS STAVILE 2723 NE 6 Lane WILTON MANORS FL 33334- Contractor(s) LELACK CONSTRUCTION Phone (954)263-7120 Cell Phone Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Work: PAVER DRIVEWAY Bond Return : Scanning: 3 Additional Info: Classification: Residential Fees Due Bond Type - Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $3.00 $2.25 $2.25 $1.00 $150.00 $9.00 $4.00 $671.50 Pay Date Pay Type Invoice # DS -3-15-54786 03/30/2015 Check #: 1623 03/13/2015 Credit Card Bond #: 2650 Amt Paid Amt Due $ 621.50 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Foundation Review Planning Review Building Review Building 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. Futhermore, I authorize the above-named coy ractthe work stated. March 30, 2015 Authorized Signature: Owner / Applicant , ' actor / Agent Building Department Copy Date March 30, 2015 1 I 10 40 1 inch = 20 ft. EF1MIT#:Q5JS 5sy l M ami Shcres Village w / SUBJECT YO COMPLIANCE WITH ALL FEDERAL STATE ANL) CCUN"i f RULES AND REGULATIONS I.% APPROVED a w 0 0 _Z Z 0 N IBLDG DEPT I LEGEND (C) = Calculated CL = Clear = Center Line CONC. = Concrete = Delta ENC. = Encroachment F.F.EL = Finish Floor Elevation F.I.P. = Found Iron Pipe F.I.R. = Found Iron Rod F.D.H. = Found Drill Hole F.N. = Found Nail F.N&D. = Found Nail & Disc I.D. = Identification L = Length (M) = Measured 0/L=OnLine (P) = Plat P.C. = Point of Curvature P.B. = Plat Book PG. = Page R = Radius (R) = Record U.E. = Utility Easement 0 \4c-.4qGF\14-235;-5 II+ IC6 iv .4, 3/:Si^GI1 4. Yi. S: PM Ji F.I.P. 1/2* No I.D. SKET,H•, ••QF BQUfDARY SURVEY : • • •: •: • ••••• •• •SCALE: 1" = 20' • • • • • . • • . . .•• . . . . .•• • ••• • • • • •• • • • • • • • • • • • • • • • • ••• ••• • ••• • •• • • • • •• • • • • • • • • • ••• • 1 C] •• ........... .•,. ,. .,..,...,•' '��...�,. ..'.i. ... .. .. .... :'.••N••QRTI4ho EAE AVENUE• • ....... • •• • ................................................. . ........:..... ........... •FULLY.'PAVED R. -L-25.00'1.. ..:.:.:.:: ..1.-=-39.401 011)(R) f90724:: PEDESiR1AN 11) 23' PARKWAY F.N. 0— P.C. °i2288' (M .(R .D.H. 0 BLOC( CORNER Y.' \moo- 25.25' 15' ALLEY 8944'501C) 9017'2410) F.I.P. 3/4' No I.D. 122.81' (M)(R) LOT 15, BLOCK 206 F.I.P. 3/4 No I.D. 37.50' RECF-WED MAR 1 3 2015 BY•_ — 16.39. SYMBOLS AIR CONDITIONER POOL PUMP 4 ca, WATER HEATER CABLE TV CATCH BASIN WATER METER CONCRETE POLE WOOD POLE 3 J J S 4 fr r 1 x— - off - EXISTING ELEVATION UTILITY P011 MANHOLE ELECTRIC BOX COVERED AREA CHAIN UNK FENCE (C.L.F.) METAL FENCE (M.F.) OVERHEAD UNES 0 PLASTIC FEND (P.F.) — 1/ — WOOD FENCE (W.F.) —r < WIRE FENCE (WR.F.) a37 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 BUILDING PER IT APPLICATION UILDING ❑ ELECTRIC ❑ ROOFING ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: 01,4-1 10(.44" sr City: Miami Shores County: Folio/Parcel#: Occupancy Type: Load: RECET\TED MAR 13 2015 FBC20) Master Permit No. J ),S la - 559 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR iM S IN(J,r t t �L RENEWAL ❑ SHOP DRAWINGS 33(' O OWNER: Name (Fee Simple Titleholder): Miami Dade Zip: Is the Building Historically Designated: Yes Construction Type: Flood Zone: BFE: Address: .h' (VA.) 10(0 VkAi awe NO FFE: Sligo 1 Phone#: Ft_ 33 co City: 11M w 'tt Sttriva State: L- Zip: 33/0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: C CIC_ Coln LA CA‘ tu,. Phone#: C(54"6 UO- 79 ' 7 Address: 58 8 ALA) City: PO- r -ct.f,,; lA.6' Zip: .33 06/ Qualifier Name: IAMV Phone#: State Certification or Registration #: C(ni,/1'ISH ee.(,I 3a-a1OtCertificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ti 57)0OO t Square/Linear Footage of Work: r /OW SPL - State: i 2C . f, LP. -tack Type of Work: ❑ Addition ❑ Alteration [New ❑ Repair/Replace Description of Work: 1201}(le ie Oak Cu ay El Demolition Specify color of color thru tile: Submittal Fee $ . SQ CO Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ O d • G (3` TOTAL FEE NOW DUE$ 1 - Cc -0 d-tcq 621.sC� (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve- nd a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this me or who has produced ,20 l,S ,by - , who is personally known to P�n1 tfsoiJ (`( (400,r2 as identification and who did take an oath. NOTARY PUBLIC: Sign: Prin Seal: elik. KYLE C HAMBRICK ****************** **expiMQE+9'llsmegYSi" !mt********************* 1407) 39 I MY COMMISSION # EE867056 Signature CONTRACTOR The foregoing instrument was acknowledged before me this Cifil day of /KCc! Crl , 20 /cr- , by Yn , who is personally known to me or who has produced Pevsoc'u (/Y 46,4 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: I:. KYLE C HAMBRICK ii MY COMMISSION # EE867056 XPIRES Janua 22. 2017 . ?) k�oaN aryServloe oom f (C Cc APPROVED BY (Revised02/24/2014) ' MfdaPk ySegv$ a oom 3/10 fi Plans Examiner Structural Review ************** **** ************** / S Zoning Clerk JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/18/2014 EXPIRATION DATE: 12/17/2016 PERSON: LELACK MICHAEL J FEIN: 010858773 BUSINESS NAME AND ADDRESS: LELACK CORPORATION LELACK CONSTRUCTION 5888 NW 66TH WAY PARKLAND FL 33067 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ROOFING CONTRACTOR CONTRACTOR Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 4.40.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Miami Shores Village 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 Y• ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this I *1.) day of NO rch , 201S . By CS)ebyYlc_No Owner ;'"*:';'' KYLE C HAMBRICK i' '`T: � MY COMMISSION # EE867056 , '• aP EXPIRES January 22, 2017 1407) 3984153 PkndINotoryservbe cam who is personally known to me or has produced as identification. March 11, 2015 Re: Esteban Matias Stavile Residence 5 NW 106th Street Miami Shores, FI 33150 The letter is to make aware the owner and the Village of Miami Shores that LeLack Construction is exempt from workers compensation and Michael LeLack will be performing some of the work and any work not be completed by Michael LeLack will be subcontracted out to a contractor with workers comp. Subcontractors have not been hired yet, but will notify the Village of Miami Shores as soon as they are contracted. Sincerely; *+"444; KYLE C HAMBRICK I MY COMMISSION # EE867056 t.�. EXPIRES January 22, 2017 1407) 398.0153 F cridaNataryServioe cam LeLack Construction 1705 Banks Road Margate, FL 33063 P. 954.688.4577 F. 877.281.8639 info@lelack.com CGC1514048 CCC1329108 STATE OF (FLORIDA) COUNTY OF (DADE) Miami Shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, 2 5 kt,Loh." , does hereby attest that (Property owner) The attached survey, performed by g01 -65e_(_ C�t 6 C.v` — (Name of surveyor's company) For address: 5 f w ((D ( �,� St-v't e, t- A ►co., ► 51104-e s , �L Performed on 3/44 ZOi `( (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Aff . /ay eth Prope Owner Signature -7014 Property Owner Print Name SWORN TO AND SUBSCRIBED before me this )04' day of A 4c c r )GtS Affiant is personally known to me, produced Revised on 5/22/2009/ Revised on 6/12/09 as identification. a; + ;F KYLE C HAMBRICK -ti ' ••: MY COMMISSION z# EE86705$ ` EXPIRES January 22. 2017 Ia07) 399.0183 FiandalloloryServbe win Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) sE-c bav� N1r� *CL S he,w i (� hereinafter referred to as the owner of the following described property (address): 5 "'1-- Fawn , 11' V2rsr bu t� Legal Description Lot Block Subdivision Folio # Requests permission to install (describe work): P evg— Orr Cue, 4„j 0,'t Within the public right of way of (address) Nita— Ont)-Q.w 0:1 IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 1 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this " lay of cArc h , 2015 SIE NED, EALED, AND DELIVERED in the presence of: lam, 40:/.7.Z4114, PARIS A NPANCIC C!14•;';;S:ONUEE153873 .2015 PARIS A. ZUP '�� MY CONIAISS10N a EE IWO i . v * EXPIRES: December 15, 2015 Rat '' g ildes Onto 2 /7 (Owner's Signature ) Lelack Construction 6574 N State Rd. 7 #160 Info@lelack.com GCG1514048 Coconut Creek, FL Licensed and Insured 954-263-7120 Permit Extension Request ivED SEP 2 3 2015 We are requesting an extension on permit #B515-554 for the permit located at address as followed, G rn Q ni-h Ex+en s t'an Job Address: 5 NW 106th Street Miami Shores, FL Job Description: Driveway Construction If you have any questions or concerns please give us a call at 954- 288-6131. Thank you. -Lelack Construction 16