WS-17-1918Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. WS -7-17-1918
Permit Type: Windows/Shutters
er m'tm Classification: Window/Door Replacem
Permit Status: APPROVED
Parcel Number
Issue Date: 7/27/2017
Expiration: 01/2312018
Applicant
1279 NE 97 Street
Miami Shores, FL 33138-2559
1132050090440
Block: Lot:
JORGE & MAGALYS TOLEDO
Owner Information
Address
Phone
Cell
JORGE & MAGALYS TOLEDO
1279 NE 97 Street
MIAMI SHORES FL 33138-2559
Contractor(s)
LONGA CONSTRUCTION INC
Phone
(954)254-0491
CeII Phone
Valuation:
Total Sq Feet:
$ 8,500.00
0
Type of Work: REPLACE EXISTING (12) WINDOWS WITH
No of Openings: 12
Additional Info:
Classification: Residential
Scanning: 4
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$3.30
$3.30
$1.80
$5.00
$220.00
$12.00
$7.20
$258.00
Pay Date Pay Type
Invoice # WS -7-17-64698
07/27/2017 Check #: 1609
07/27/2017 Check #: 1607
07/27/2017 Credit Card
Amt Paid Amt Due
$ 158.00 $ 100.00
$ 50.00 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Window Door Attachment
Final
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 . ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELE - CAL, -. UMBINECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS
constructio
FFIDAVIT: I cert fy t
and zoning. Fut ' er
the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
authorize the above-named contractor to do the work stated.
Author
natur
Owner Applicant / Contractor / Agent
Building Department Copy
July 27, 2017
Date
July 27, 2017 1
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
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
UL 2 7 2017
FBC201'--\
Master Permit Now S 1 —ICI IS
Sub Permit No.
❑ EXTENSION RENEWAL
❑ ROOFING ❑ REVISION
❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
7NTRACTOR
JOB ADDRESS: / 2 7 1 A/ l-"
❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: `-3 3 / 3 d
Folio/Parcel#: Is the Building Historically Designated: Yes NO c -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
Cr•e- --c l U i rt' Phone#:
'���✓% / 2 7 S /c/ 61,-- `j 7 S-4
City: ' YLY-€ State: --4 ( , Zip: (3 / 3 V
Tenant/Lessee Name: Phone#:
OWNER: Name (Fee Simple Titleholder): j
Address:
Email:
CONTRACTOR: Company Name: d�rY/' OK S' VJPhone#:
Address:
City:
Qualifier Name:
/O7 5- 1/ /
State: r
SC 4 ILa <kr6e
Zip:
Phone#:
3313�'i'
State Certification or Registration #: C O T ? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $ O v Square/Linear Footage of Work:
State: Zip:
Type of Work: ❑ Addition ❑ Alteration
'to r�ePko.c� exp;t- cl
Specify color of color thru tile:
Description of Work:
❑ Neyv
C.C./ eltid'c CrJ S 7 2' 019-4z"`-tvt
per W' 15 -
'`i4Q
❑ Repoli/Replace ❑ Demolition
4.42-56
6_7er
Submittal Fee $ Permit Fee $ CCF $ , ' CO/CCS$ ".''
.' v-..r--,.r'ti/"C►",Cp`�ar �.., -`- .
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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 approved and a reinspection fee will be charged.
Signatur Signature
OWNER or AGENT
The foregstrument was acknowledged before me this
day of 51`/ , 20 17 , by
71)( 1 • TO )r -do, who is personally known to
fl -
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: -'
Seal:
SIA
CONT
ACTOR
The foregoing instrument was acknowle•ged before me this
2 -3 -t -h day of
0
, 20 11 , by
t�_�
VsCar 61- , who is personally known to
as me or who has produced D r9 V•i L 11 t"tens e as
identification and who did t
NOTARY PUBL
PAULA V. GARVER
Notary Public • State of Florida
•
vi Commission # FF 947330
�vot..s My Comm. Exp' es Dec 30. 2019
*******mw**weirm ti************* A***********
Sign:
Print:
Seal:
wO
*****************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
.."t
= MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
Banded Thru Notary Public Underwriters
Zoning
Clerk
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
i, '>.'�:4...,'+ �i7•- ro•Jy •:i3t „� r.: �f �?�. n• ,
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
Depai Gnent 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.
County of Miami -Dade
The foregoing was acknowledge before me this ab day of J. -LA' i , 20 i n.
By 1ORge Lu 1 S who is personally known to me or has produced
U Paste ori as identification. L—tO3sid c7`�S
entification.
Notary:
SEAL:
QQcL
LESLIE RACKL
MY COMMISSION # GG 056758
:zq EXPIRES: March 13, 2021
V,ReP Bonded Ther Notary Public Underwriters
LONGA Construction
July 26, 2017
State of Florida
County of Miami Dade
Before me this day personally appeared Oscar Longa who, being duly sworn deposes and says:
That he will be the only person working on the project located at:
1279 NE 97 street Miami Shores
Contractor signature
Sworn to (or affirmed) abd subscribed before me this 2q -day of
By OS CQY 1 on.(3 Jz
1 .2017,
Personally known
Or Produced Identification
>c
Type of Identification Produced -P 11 CQ_ _
Print, Type or Stamp Name of Notary