RC-17-618 (2)Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
a
Permit NO. RC -3-17-61$
a Permit Type: Residential Construction
Pe r m Work Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue crate: 7/1712017
Expiration: 01/13/2018
Applicant
157 NW 103 Street
Miami Shores, FL 33150-
1121360131540
Block: Lot:
CASSA GROUP LLC
Owner Information
Address
Phone
Cell
CASSA GROUP LLC
18181 NE 31 Court
AVENTURA FL 33160-
(305)610-1905
Contractor(s)
904 INVESTMENTS
Phone
(754)245-1623
CeII Phone
Valuation:
Total Sq Feet:
$ 60,000.00
1000
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Construction: INTERIOR
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return :
RENOVATION NEW KIT(
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
Bond Type - Owners Bond
CCF
CO/CC Fee
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Plan Review Fee (Engineer)
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$36.00
$50.00
$2.00
$2.00
$12.00
$1,800.00
$80.00
$27.00
$48.00
$2,557.00
Pay Date Pay Type
Invoice # RC -3-17-63229
03/08/2017 Credit Card
06/02/2017 Credit Card
Bond #: 3455
Invoice # RC -6-17-64292
07/17/2017 Credit Card
Bond #: 3455
Amt Paid Amt Due
$ 200.00 $ 1,807.00
$ 1,807.00 $ 0.00
$ 550.00 $ 0.00
,■
Building Department Copy
Available Inspections:
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss lnsp
Fill Cells Columns
Wire Lathe
Columns
Foundation I
Window and Door Buck -
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Building
Review Structural
Declaration of Use
Review Electrical
Review Electrical
Review Electrical
Review Mechanical
Review Mechanical
Review Plumbing
Review Structural
July,17, 2017
2
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Perm
Issue Dai
Permit NO. RC -3-17-618
Permit Type: Residential Construction
Work Classification: Addition/Alteration
Permit Status: APPROVED
7117/2017
Expiration: 01/13/2018
Parcel Number
Applicant
157 NW 103 Street
Miami Shores, FL 33150-
1121360131540
Block: Lot:
CASSA GROUP LLC
Owner Information
Address
Phone
Cell
CASSA GROUP LLC
18181 NE 31 Court
AVENTURA FL 33160-
(305)610-1905
Contractor(s)
904 INVESTMENTS
Phone
(754)245-1623
Cell Phone
Valuation:
Total Sq Feet:
$ 60,000.00
1000
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type' of Construction: INTERIOR RENOVATION NEW KIT(
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return :
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
Bond Type - Owners Bond
CCF
CO/CC Fee
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Plan, Review Fee (Engineer)
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$36.00
$50.00
$2.00
$2.00
$12.00
$1,800.00
$80.00
$27.00
$48.00
$2,557.00
Pay Date Pay Type
Invoice # RC -3-17-63229
03/08/2017 Credit Card
06/02/2017 Credit Card
Bond #: 3455
Invoice # RC -6-17-64292
07/17/2017 Credit Card
Bond #: 3455
Amt Paid Amt Due
$ 200.00 $ 1,807.00
$ 1,807.00 $ 0.00
$ 550.00 $ 0.00
Available Inspections:
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss Insp
Fill Cells Columns
Wire Lathe
Columns
Foundation
Window and Door Buck
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Building
Review Structural
Declaration of Use
Review Electrical
Review Electrical
Review Electrical
Review Mechanical
Review Mechanical
Review Plumbing
Review Structural
In consideration of the
pertaining thereto and
accepting this per
required for ELE
OWNERS AFFI
construction and
issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
ify 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.
Authorized Si
ner / Applicant / Contractor / Agent
July 17, 2017
Date
1
\\N;)
4
BUILDING
PE IT APPLICATION
BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: / 57
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
❑ ROOFING
❑PUBLIC WORKS
Master Permit No.
Sub Permit No. G �� — (7 1 9
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
City: Miami Shores
County:
Folio/Parcel#:
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Miami Dade Zip:
Is the Building Historically Designated: Yes NO
Construction Type: eAti 0 Flood Zone: BFE: 'FFE:
c ASST 1929C1 p t t Phone#:
Address: OP �G' `3( cT 5-0?
City: ,P V IV/ State: (, Zip: .33460
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 02/ V44, -'4O Ph oiie#:
Address: 1L / r 1&k') tit(' l c5-1-
City: A) IP-- i Si.> State: FL
{
Qualifier Name: 4(2.AA()1,1N n1-1LCAIOA)7_
State Certification or Registration #: C-l� e /3-1 4,7e Certificate of Competency #:
DESIGNER: Architect/Engineer: —F. -Cc -4_1,04W (No b44114arik.
7s zz/a--/6oZ 3
Zip: 333.2 `L
Phone#: 7 zg.r/63
Address: I -(99 r %/) f(/ S'1
Value of Work for this Permit: $ COO - 00
Type of Work: ❑ Addition
Description of Work: r-5-1,)
��. Phone#: %�l zir> Z a
•
City: sodifelie, State: n— Zip: 337,23
Square/Linear Footage'of Work: 1 SQ
Alteration ❑ New ❑ Repair/Replace ❑ Demolition
PIA -)0 V +6-1-7a47
� �t_ u1 r'GdZccr% ,
Specify color of color thru tile: �J[� -.
Permit Fee $ !/ - a CCF $ 36 W CO/CC 133.,G0
Radon Fee $ ? �� DBPR $ 2 � • Notary $
Training/Education Fee $ IZ ` Ct)Double Fee $ yer
Submittal Fee $
Scanning Fee $
Technology Fee $ ` 8 ' JD
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 2/05 ` 00
Bonding Company's`Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City - -'• '`. t 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issueIn the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before rme this
Gv rr day of �//6 ,20 / 7 ,by
Alic9 ft n1 �" � 2_9-4.!Y) ,, who is personally known to
me or who has produced fes(, 2 L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
`,����pYPp •,, EliesDelgado
s• 'cOMMISSION#EE884546
q�' ���' a' EXPIRES: MAR. 17, 2017
`4i� .. WWW.AARONNOTAR1:COM
Signature y' JLAI
CO 17 RACTOR
The foregoing instr ment as acknowledged before me this
�G day of / 6 , 20 l 7 , by
-{44-l&AO.AJV5 , r/Z-�tho is personally known to
me or who has produced i/�4/ . C.as
identification and who did ' take$hEliesber Delgado
'r°•:.:. ' cCOMMISSION#EE884546
EXPIRES: MAR. 17, 2017
#a°„ o% WWW.AARONNOTAR1:coni
NOTARY PUBLIC:
Si
Print:
Seal:
eCtestte,2y'
•
......................... .......... .......................................................................
i
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Zoning
Structural Review Clerk
Property Search Application - Miami -Dade County
OFFICE OF THE PROPETY :kP : JISE
Summary Report
Property Information
Folio:
11-2136-013-1540
Property Address:
157 NW 103 ST
Miami Shores, FL 33150-1235
Owner
CASS A GROUP LLC.J
Mailing Address
18181 NE 31 CT 509
AVENTURA, FL 33160 USA
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds/Baths/Half
2/1/0
Floors
1
Living Units
1
Actual Area
1,620 Sq.Ft
Living Area
1,372 Sq.Ft
Adjusted Area
1,491 Sq.Ft
Lot Size
9,150 Sq.Ft
Year Built
1940
Assessment Information
Year
2017
2016
2015
Land Value
$196,886
$164,440
$164,440
Building Value
$48,264
$103,774
$103,774
XF Value
$1,184
$1,188
$954
Market Value
$246,334
$269,402
$269,168
Assessed Value
$246,334
$269,402
$96,373
Benefits Information
Benefit
Type
2017
2016
2015
Save Our Homes Cap
Assessment Reduction
$0
$50,500
$172,795
Homestead
Exemption
$45,873
School Board
$25,000
Second Homestead
Exemption
$25,500
Taxable Value
$25,000
Widow
Exemption
City
Exemption Value
$500
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 5 PB 10-47
LOT 17 & W1/2 LOT 18 BLK 127
LOT SIZE 75.000 X 122
OR 14581-516 0690 5
Page 1 of 1
Generated On : 6/12/2017
Taxable Value Information
Previous
2017
1 2016
2015
County
Exemption Value
$0
$0
$50,500
Taxable Value
$246,334
$269,402
$45,873
School Board
Exemption Value
$0
$0
$25,500
Taxable Value
$246,334
$269,402
$70,873
City
Exemption Value
$0
$0
$50,500
Taxable Value
$246,334
$269,402
$45,873
Regional
Exemption Value
$0
$0
$50,500
Taxable Value
$246,334
$269,402
$45,873
Sales Information
Previous
Price
OR Book-
Qualification Description
Sale
Page
30118-
t
06/13/2016
$277,000
1220
Qual by exam of deed
05/12/2011
$100
27692-
Corrective, tax or QCD; min
1209
consideration
06/01/1990
$0
00000-
Sales which are disqualified as a result
00000
of examination of the 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/
6/12/2017
Detail by Entity Name
Page 1 of 2
/ iorida Department of State
DIVISION OF Corzvotz:;rotas
Dr/CM
org,., :,i/:,;3
.41 44 0,4 Stimel rd.h
Department of State / Division of Corporations / Search Records / Detail By Document Number /
Detail by Entity Name
Florida Limited Liability Company
A S5 GROUP LLCI
Filing Information
Document Number L14000152474
FEI/EIN Number 47-1962290
Date Filed 09/30/2014
State FL
Status ACTIVE
Principal Address
18181 NE 31 CT
509
AVENTURA, FL 33160
Mailing Address
18181 NE 31 CT
509
AVENTURA, FL 33160
Registered Agent Name & Address
SILVANA, CARPINTERO
18181 NE 31 CT
APT 509
AVENTURA, FL 33160
Address Changed: 01/23/2017
Authorized Person(s) Detail
Name & Address
Title MGR
1lll RAJI, CAROLINA
18181 NE 31ST CT APT#509
AVENTURA, FL 33160
Title MGR
CARPINTERO, SILVANA
18181 NE 31 CT
APT 509
AVENTURA, FL 33160
}
http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/12/2017
}
Detail by Entity Name Page 2 of 2
Annual Reports
Report Year Filed Date
2015 01/20/2015
2016 04/27/2016
2017 01/23/2017
Document Images
01123/2017 .. ANNUAL REPORT
04/27.2016 -- ANNUAL REPORT
01/2012015 -.. ANNUAL REPORT
09/30/2014 -- Florida Limited Liability
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
Florida r....:.an -iedt
rwsior! o; Corpora ions
http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/12/2017
M iami 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 fall -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.
County of Miami -Dade
The fore. I ing wasacknowle• ge before me this
By 1114/ l/ d
Notary
SEAL:
n day ofJOAO ,201
who is personally known to me or has produced
identification.
a RAYMOND A. DEOUARTO
Gc. Notary Public, State of Florida
0 Commission# FF 123597
{ My comm. expires June 2. 2018
DO
� Construction
GREEN BUILDING
GENERAL CONTRACTOR CGC 1510878
904
Village of Miami Shores
Building Department
Miami Shores
RE: 157 NW 103 ST. Miami Shores, FL
12095 NW 44th St
Sunrise, FI, 33323
Ph 754-245-1623
I —
June 7, 2017
To Whom It May Concem:
This letter is to inform you that I am the General Contractor for the above referenced property, and I will be the only person
working = rac ors w
STATE OF FLORIDA COUNTY OF M tGYY)
The foregoing instrument was acknowledged before me this I!� day of 2017,
by (name of person acknowledging.) -F€% fC(P u ! ( N'1c /'q oe- •
(Seal)
Personally known:
OR Produced Identification:
Type'of Identification Produced: 4-A Dr \CY-s
L0eca-tC b 6Cr ;0357—
‘41-01*,
•03z7' -.tir., ,3IJO2zj
of Nota Public
Print, Type/Stamp Name of Notary
00%.,MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
EXPIRES: November2, 2020
,,...„,,,f,.9,,,,,,,,,?, ... Bonded Thru Notary Public Underwriters j
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
MARQUEZ, FERNANDO ELIAS
904 INVESTMENTS, L.L.C.
12095 NW 44TH STREET
SUNRISE FL 33323
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridaticense.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about.
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Honda,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
CGC1510878
(850) 487-1395
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL -REGULATION
CGC1510878`• '%, 4tiSSUED ` 09/1312016
CERTIFIED GENERAL;CONTRACTOR
MARQUEZ, FERNANDO ELAS
904 INVESTh1ENTS,:L L G;;
IS CERTIFIED under the provisions of Ch.489 FS.
Expiration date AUG 31, 2018 _ !,1600130033564
DETACH HERE
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
The GENERAL CONTRACTOR
Named below, IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
MARQUEZ. FERNANDO ELIAS,--
904
LIAS 904 INVESTMENTS L L.C: s'`
12095 NW:44TH°STREETn ="`0` `!'-:,'=»
SUNRISE_ os--'EL-1••333'23,
ISSUED: 09/13)2016
DISPLAY AS REQUIRED BY LAW
SEQ # L1609130003564
u.. m,..em,,,.r'nn...a �,eNA�' e®Lt*vex�"`•5 j,.� �`��',x:v +ur3' y,;.yv:.a�
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017
DBA:
Business Name: ' `' 4
INVESTMENT LI,C
Owner Name: FERNrN0a M SQ E:
Business Location: 12090 NW 44 Ti -1 S
SUNRISE
Business Phone:
Rooms Seats Employees
2
27.00
Receipt #:182674 0-- 1 OJTEz~K'1.'vF
Business Type:
Business Opened:02/24/2015
State/County/Cert/Reg:C GC 15 : 0 8 7 8
Exemption Code:
Machines
Professionals'
Number of Machines:
Transfer Fee NSF Fee
0.00
0.00
For Vending Business Only
Penalty
2.70
Vending Type:
Prior Years I Collection Cost
0.00 0.00E
Total, Paid
29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal dr that
it is in compliance with State or local laws and regulations.
Mailing Address:
904 INVESTMENT La.
12093 NW 44TH ST
SUNRISE, FL 33323
Receipt #01A-16-00000060
Paid 10/04/2016 29.70
2016 - 2017
°# BROVVARDk 0UNFT ,<LOCAL BUSINESs,TAIGPF.rxta .,.:.,
JEFF ATWATER
CHIEF FINANICAL 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: 3/3/2017 EXPIRATION DATE: 3/3/2019
PERSON: MARQUEZ FERNANDO E
FEIN: 202614619
BUSINESS NAME AND ADDRESS:
904 INVESTMENTS LLC
904 CONSTRUCTION
12095 NW 44TH ST
FORT FL
LAUDERDALE
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor
33323
IMPORTANT: 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 440.05(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
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13
QUESTIONS? (850)413-1609
STATE OF FLORIDA PERMIT NO.
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION •R:
[ ] New Syst-m [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT:
AGENT: Tet, -10
MAILING ADDRESS:
Holding Tank [ ] Innovative
Temporary [
TO BE COMPLETED BY APP 'CANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED P UANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILI Y TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQI1 STING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT:
BLOCK: S DIVISION:
PROPERTY ID #:
PLATTED:
ZONING: I/M OR EQUIVALENT: [ Y/N ]
PROPERTY SIZE: ACRES WATER S,PPLY: [ ] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS [ Y/N ]
PROPERTY ADDRESS: .
DISTANCE TO SEWER: FT
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
] Floor/Equipment Drains
[ ] RESIDENTIAL ] COMMERCIAL
No. of Building Comme•cial/Institutional System Design
Bedrooms Area Sqft Table Chapter 64E-6, FAC
] Other (Specify)
SIGNATURE: DATE:
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
Page 1 of 4
2017 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED
DOCUMENT# L14000152474 Jan 23, 2017
Entity Name: CASSA GROUP LLC Secretary of State
CC6082507662
Current Principal Place of Business:
18181NE31CT
509
AVENTURA, FL 33160
Current Mailing Address:
18181 NE 31 CT
509
AVENTURA, FL 33160
FEI Number: 47-1962290
Name and Address of Current Registered Agent:
SILVANA, CARPINTERO
18181 NE 31 CT
APT 509
AVENTURA, FL 33160 US
Certificate of Status Desired: No
The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent
Authorized Person(s) Detail :
Title MGR Title MGR
Name MIZRAJI, CAROLINA Name CARPINTERO, SILVANA
Address 18181 NE 31ST CT APT#509 Address 18181 NE 31 CT
City -State -Zip: AVENTURA FL 33160
APT 509
City -State -Zip: AVENTURA FL 33160
Date
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and
that my name appears above, or on an attachment with all other like empowered.
SIGNATURE: SILVANA CARPINTERO MANAGER 01/23/2017
Electronic Signature of Signing Authorized Person(s) Detail Date
May 3, 2017
Mr. Ismael Naranjo
Chief Building Officer
Miami Shores Village
Building and Zoning Department
Miami Shores, FL
Imo Construction
GREEN BUILDING
12095 NW 44TH ST, SUNRISE FL 33323
PH (754) 2451623
STATE OF FLORIDA LICENSE CGC 1510878
904
REF: Process Number RC 3-17-618.
Address: 157 NW 103 ST.
Dear Mr. Naranjo
We are contractors in the address referenced above and respectfully request your authorization to start the
remodeling project according with section 105,12 of the Florida Building Code as follows:
"105.12 Work starting before permit issuance.
Upon approval of the building official, the scope of work delineated in the building permit application and plan may be
started prior to the final approval and issuance of the permit, provided any work completed is entirely at risk of the
permit applicant and the work does not proceed past the first required inspection."
Thank you in advance to take your time for reviewing this process.
Should there be any questions or need additional information, please do not hesitate to contact us.
Sincerely,
Fernando E. Marquez,
General Contractor
dti 44"(f
...6/7/2017
Design Indoor Cooling Temp.: 75 °F
Design Outdoor Cooling 'femp.: 90 ° F'
Temp. Difference Cooling :I5°F
Indoor Humidity: 50 • Grains difference: 58
Load -Calc
Cassa Group LLC
157 NW 103 ST, Miami Shores FL
Area: Miami Airport, FL
Front Door Orientation South
Whole House Load Calculator
Design Indoor Heating Temp. :70 ° F
Design Outdoor Heating "I'emp.: 50 ° F
Temp. Difference Heating :20° F
fS 11 - types TD:Cool: I �°F Heat 20°F Sq. ft. - types 1 and Z shadingI q. 1 and _' shading g I Sg. ft.- types I and "_'
Outside Wall: North 11:495 2: I Windows x 11:43 2:
Glass Doors x
1:42 2: i Doors
17
Outride Wall: South
1:495 2:
Windows L •
1:60 2:
Glass Doors L •
I. 2: 1 Doors
20
Outside Wall: E & W
L 802 2:
Windows L •
1:59 2:
1: 2.
Glass Doors 1. •
G lass Doors x
1: 2:
I : 2
Doors
Doors
266
Outside Wall: N F. & NW 11: 2: f Windows x
Outside Wall: SE & SW
1: 2:
Windows L • L 2: Glass Doors L • I: 2:
Doors
111
Sky Lights
N: S:
FAN. i NE -NW: SE -SW:
Floor - (linear fl. if slab)
1:1466 2:
Basement
Walls -above grade: below grade: sq. ft
Ceiling I: 1466 2:
Basement 1Floor -- lwidth 23ftor 1 • fat below grade: 1 2 ft. • 1
Number of: Appliances 4 F ireplaces 1 •
k t Number of People 14 Fresh air recommended: 39cfm —. 39 CFM �P
Conditioned - Sq. ft: 1266 I Cubic. Ft.: 10761 1 Construction: average • 1 Duct system: attic • R-8 • good •
Total Btu's Cooling
Sensible Load
254952709
Latent Load • Teta Heating
•• •• • •• •
• • •t4 1 1
basement walls
Calculate Load
282
0
Btu breakdown
htlp://www.loadcalc.netfloaciphp#
.
• .
....
.
....
Structure types • • • • .
•• .• •• •
Outside Walls 1: Brick -no insulation w/R3.. board •
ii•.
Outside Walls 2: Brick -no insulation Adlt3 board. •
Windows 1: single pane - blinds, •
Windows 2: single pane no intertIletad:
Glass Doors 1: single pane slider - blinds
Glass Doors 2:
Floors 1: closed or vented crawl tile no insulation
Floor 2: closed or vented crawl tile no insulation
Ceiling I: Ceiling under attic space R-30
Ceiling 2: Ceiling under attic space R-30
Doors: Metal with storm
Skylights:
Basement Walls:
Basement Floor:
Win ht.: 5' 0" Overhang: 1.5' Top to overhang: 2'
... •
..
.
•
• •
•�•
•
•
•
RECEIVED
JUNE 2017
1'1
Sensible
Latent
Heating
walls
4912
5090
windows
5467
4115
ceilings
2533
938
doors
280
266
floors
2643
3507
appliances
4800
people
920
800
glass doors
882
1067
skylights
0
0
basement walls
0
0
basement floor
0
0
infiltration
681
1627
2216
fresh air
0
0
0
duct load
2377
282
932
Totals
25495
2709
18131
htlp://www.loadcalc.netfloaciphp#
.
• .
....
.
....
Structure types • • • • .
•• .• •• •
Outside Walls 1: Brick -no insulation w/R3.. board •
ii•.
Outside Walls 2: Brick -no insulation Adlt3 board. •
Windows 1: single pane - blinds, •
Windows 2: single pane no intertIletad:
Glass Doors 1: single pane slider - blinds
Glass Doors 2:
Floors 1: closed or vented crawl tile no insulation
Floor 2: closed or vented crawl tile no insulation
Ceiling I: Ceiling under attic space R-30
Ceiling 2: Ceiling under attic space R-30
Doors: Metal with storm
Skylights:
Basement Walls:
Basement Floor:
Win ht.: 5' 0" Overhang: 1.5' Top to overhang: 2'
... •
..
.
•
• •
•�•
•
•
•
RECEIVED
JUNE 2017
1'1
•
Project
REScheck Software Version 4.6.2
Compliance Certificate
Residential -Alteration
Energy Code:
Location:
Construction Type:
Project Type:
Climate Zone:
Permit Date:
Permit Number:
2014 Florida Building Code, Energy
Miami Shores, Florida
Single-family
Alteration
1 (273 HDD)
Construction Site:
157 NW 103 ST
Miami Shores, FL 33150
Owner/Agent:
Cassa Group LLC
157 NW 103 ST
Miami Shores, FL 33150
Designer/Contractor:
Fernando Marquez
12095 NW 44 ST
Surise, FL 33323
Compliance: Passes
Compliance: L7% Better Than Code Maximum UA: 59 Your UA: 58
The % Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home.
Envelope Assemblies
• •
• . .
.. •
•
••••
• •
••••
• •
•• ••
•
••••
••••
.•••
• • •
•• •
•
••••
•• • •
•• •
• • •
• • •
•
•
�•
•
•
•
•
• •
.•
Assembly
Gross Area Cavity Cant. ,
or R -Value R -Value Factor 114
Perimeter
Ceiling 1: Flat Ceiling or Scissor Truss
Exemption: Framing cavity filled with insulation
Wall 1: Solid Concrete or Masonry:Interior Insulation
Exemption: Framing cavity filled with insulation
Window 1: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 2: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 3: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 4: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 5: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 6: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 7: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 8: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
•
•
Project Title: Residential -Alteration Report date: 06/07/17
Data filename: C:\Users\Fernando\Documents\Office\904 Construction\Engineering\Mechanical report Page 1 of 2
forms\REScheck\157 NW 103 ST.rck
Assembly
Gross Area Cavity Cont.
or R -Value R -Value U -Factor U A
Perimeter
Window 9: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 10: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 11: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Door 1: Solid
Door 2: Solid
Door 3: Glass
SHGC: 0.25
Floor 1: All -Wood Joist/Truss:Over Outside Air
Exemption: Framing cavity not exposed.
Crawl 1: Solid Concrete or Masonry
Wall height: 3.0'
Depth below grade: 1.0'
Insulation depth: 0.0'
Exemption: Framing cavity not exposed.
Mechanical Equipment
Electric Central Air
Description
Compliance Statement: The proposed building design described
cations submitted with the permit application. The proposed
rgy Conservation requirements in REScheck Version 4.6.2 an
4A�`t
ection Checklist.
�o n n
�
e - Title rl411_
20
17
41
• •
• . .
.• •
•
Fuel type Efficiency
Electric
0.900
0.900
0.600
• •
• • • •
• • •
•• •
16 SEER •• •
•
• • •
her s consistent with the building :tans, specificationG; end other
ding ha- been esigned to meet•the•2tL14 Florida Building cm. o:
complyh t ma atory requii'I'tnerfs listetl•ift the RESclueck •
•
•..
• •
• •
•• •
•
18
15
25
•
•
•
• •
•
••
••
Dat;
Project Title: Residential -Alteration Report date: 06/07/17
Data filename: C:\Users\Fernando\Documents\Office\904 Construction\Engineering\Mechanical report Page 2 of 2
forms\REScheck\157 NW 103 ST.rck
6/7/2017
Design Indoor Cooling Temp.: 75 °F
Design Outdoor Cooling "tentp.: 90 ° H'
Temp. Difference Cooling :15°F
Indoor Humidity: 50 • Grains difference: 58
Load -Calc
Cassa Group LLC
157 NW 103 ST, Miami Shores FL
.area: Miami Airport, FL
Front Door Orientation South
Whole House Load Calculator
Design Indoor Heating Temp. :70 ° F
Design Outdoor Heating temp.: 50
Temp. Difference Heating :20° F
iTD:Coola 5'F Hrat40°F
Sq, ti. - types I and 2
sltaduig) Sq. t.: types 1 and 2
shading l Sq. ft- types i and 2 � I Sq. ll.
walls
Outside Wall: North
1:495
2:
Windows x 11:43 2:
Glass Doors x
I I:42 2: Doors 117
111 2: 1 Doors 20
4115
ceilings
Outside Wall: South 11:495
2:
. Windows L • I1:60 2: Glass Doors l •
doors
Outside Wall: E & W 1:802
2:
Windows l • 1:59
2: Glass Doors l • I1: 2: DoorsI
2643
Outside Wall: NE & NW
I:
2:
Windows s II- _s Glass Door, s
I
1: 2- Doors
'people
920
Outside Wall: SE & SW
1:
2:
f Windows L • I I: 2: _".'VGlass Doors l •
1: 2: L Doors I ..-
1067
skylights
Sky Lights
N:
S:
E -W: NE -NW: SE -SW:
0
Floor - (linear ft if slab) 1:1466
2:
Basement 'wails
-above grade: I below grade: I sq. ft
-- 'width 23ft. or ''. • ! feet below grade: 2 ft.
recommended: 39cfm --, 39 CFM • • • • •
•
0
Ceiling 1:1466
2'
! Basement!Floor
2216
Number of: Appliances 4
Fireplaces 1
•
0
Number of People 4
2377
Fresh air
932
Conditioned - Sq. ft: 1266
I
Cubic. Ft.: 10761 Construction: average • Duct systdt} atilt • R.8• • • good
••
L
Total Btu's Cooling
28204
Sensible Load
25495
Latent Load
2709 ••••
Tota Btu s Heating
• ^ ' • •
Btu breakdown
http://www.loadcalc.net/load.php#
••••
• •
•• .•
• • •
Structure types •
•.••
•• •
• •
•.•
•
•
• •
•'•
•
•
Outside Walls 1: Brick -no insulation a%R3 board • •
Outside Walls 2: Brick -no insulation w/11.3 board • • • : • •
••
Windows 1: single pane - blinds
Windows 2: single pane no internal shade
Glass Doors 1: single pane slider - blinds
Glass Doors 2:
Floors 1: closed or vented crawl tile no insulatio
Floor 2: closed or vented crawl tile no insulation E C E1 �/E
Ceiling 1: Ceiling under attic space R-30
Ceiling 2: Ceiling under attic space R-30 nJUN
Doors: Metal with storm 20p,
Skylights: atk
Basement Walls:
Basement Floor:
Win ht.: 5' 0" Overhang: 1.5' Top to overhang: 2'
Sensible
Latent
Heating
walls
4912
5090
windows
5467
4115
ceilings
2533
938
doors
280
266
floors
2643
3507
appliances
4800
'people
920
800
glass doors
882
1067
skylights
0
0
basement walls
0
0
basement floor
0
0
infiltration
681
1627
2216
fresh air
0
0
0
duct load
2377
282
932
Totals
25495
2709
18131
http://www.loadcalc.net/load.php#
••••
• •
•• .•
• • •
Structure types •
•.••
•• •
• •
•.•
•
•
• •
•'•
•
•
Outside Walls 1: Brick -no insulation a%R3 board • •
Outside Walls 2: Brick -no insulation w/11.3 board • • • : • •
••
Windows 1: single pane - blinds
Windows 2: single pane no internal shade
Glass Doors 1: single pane slider - blinds
Glass Doors 2:
Floors 1: closed or vented crawl tile no insulatio
Floor 2: closed or vented crawl tile no insulation E C E1 �/E
Ceiling 1: Ceiling under attic space R-30
Ceiling 2: Ceiling under attic space R-30 nJUN
Doors: Metal with storm 20p,
Skylights: atk
Basement Walls:
Basement Floor:
Win ht.: 5' 0" Overhang: 1.5' Top to overhang: 2'
41.
REScheck Software Version 4.6.2
Compliance Certificate
Project Residential -Alteration
Energy Code:
Location:
Construction Type:
Project Type:
Climate Zone:
Permit Date:
Permit Number:
2014 Florida Building Code, Energy
Miami Shores, Florida
Single-family
Alteration
1 (273 HDD)
Construction Site:
157 NW 103 ST
Miami Shores, FL 33150
Compliance: Passes
Owner/Agent:
Cassa Group LLC
157 NW 103 ST
Miami Shores, FL 33150
Designer/Contractor:
Fernando Marque •
12095 NW 44 SY
Surise, FL 33325•: • •
Compliance: L7% Better Than Code Maximum UA: 59 Your UA: 58
The % Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home.
Envelope Assemblies
••••
• •
••••
• •
•• ••
• • •
• •
• •
• • •
•• •
••••
• •
•••.
••••
• • •
•. •
•
••••
• •
••••
•• •
• • •
• • •
•
• •
•
••• •
••
••
�•
•
• •
••
•
•
•
Assembly
Gross Area
or Cavity Cont. U -Factor UA
Perimeter R -Value R -Value
Ceiling 1: Flat Ceiling or Scissor Truss
Exemption: Framing cavity filled with insulation
Wall 1: Solid Concrete or Masonry:Interior Insulation
Exemption: Framing cavity filled with insulation
Window 1: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 2: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 3: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 4: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 5: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 6: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 7: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 8: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Project Title: Residential -Alteration Report date: 06/117/ 7
Data filename: C:\Users\Fernando\Documents\Office\904 Construction\Engineering\Mechanical report Page 1 of 2
forms\REScheck\157 NW 103 ST.rck
Assembly
Gross Area
or Cavity Cont. U -Factor UA
Perimeter R -Value R -Value
Window 9: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 10: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Window 11: Metal Frame:Single Pane
SHGC: 0.00
Exemption: Storm window alteration.
Door 1: Solid
Door 2: Solid
Door 3: Glass
SHGC: 0.25
Floor 1: All -Wood Joist/Truss:Over Outside Air
Exemption: Framing cavity not exposed.
Crawl 1: Solid Concrete or Masonry
Wall height: 3.0'
Depth below grade: 1.0'
Insulation depth: 0.0'
Exemption: Framing cavity not exposed.
Mechanical Equipment
20 0.900 18
17 0.900 15
41 0.600 25
• •
• • ••••
• • •
--•• • --- ••••
•
• • •
•• •
•
• •
•••• •••• • •
• • • •
•••• ••••
• •
•• ••
•• •
• •.
•••
•
Description
Fuel type Efficiency
Electric Central Air
Complia a Statement: The proposed building design described
cal tions submitted with the permit application. The propos
ergy Conservation requirernents in RESchegj Version 4.6.
c"fion C cks /1J
yo
NaFne - Title
Electric
16 SEER • • •
• • •
•• •
• •
• ••
•
•
• •
••• • •
is consistent with the building plans, specifications and other
(ding h. be= designed to meet the 2014 Florida Building Code,
co -1 wit the mandatory requirements liste• in he REScheck
4116il Ad AAI
n,.
Project Title: Residential -Alteration Report date: 06/07/17
Data filename: C:\Users\Fernando\Documents\Office\904 Construction\Engineering\Mechanical report Page 2 of 2
forms\REScheck\157 NW 103 ST.rck
•
BUILDING
PERMIT APPLICATION
'BUILDING
❑PLUMBING
JOB ADDRESS:
City:
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
❑ ELECTRIC ❑ ROOFING
❑ MECHANICAL ❑PUBLIC WORKS
1S7 Ntil /o3 gD
Miami Shores
County:
Master Permit No.
Sub Permit No.
FBC 20
12Cii-271a
FE 6 2017
a't.4
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF al CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
Folio/Parcel#:
Occupancy Type: Load:
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO,
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Rs 4j- Group u -C Phone#:
Address: 1 4 4 4 8 17 3 S-+
1
City: M i A-bv1 1
Tenant/Lessee Name: ra► . Phone#:
Email:
State: -f tbr: (510k
�75'1
-Fe ✓A cL
Zip:33) 77
CONTRACTOR: Company Name: , I U 1` ' Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: - City:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
❑Demolition
Description of Work: Q (a14 e -e R C 1 - 27 4 Z
V.7Or %i yl -t d ON t
State: Zip:
❑ New ❑ Repair/Replace
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $
DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE$
Bonding Company's Name (if applic• • -
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 instal a ion 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. W 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.
i �11� p � ;' iiiri., • ,�,
F 44
' ' , � Q,f
�' P
" ''' Signatur
Omeir
ER or AGENT
The foregoing innt was acknowl: dged before me this
/ day of 4.4 , 20 ( { , by
Jeo\ i 4 ✓r Wk‘'IM-1-4-y.\ , who is personally known to
'0 p(
Signature
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing in . ument was acknowledged before me this
day of 20 , by
who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �/ _ -, Sign:
Print: �:eul
'% 56e Print:
f'p 0
as
Seal:9�: '; a'COMMISSION#EEI3i34546 Seal:
EXPIRES: MAR.
17, 2017
WWN'.AARONNOTARY.Cpm
************************************************************************************************************
APPROVED BY Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
February 15, 2017
Village of Miami Shores
Building and Zoning Department
10050 N.E. 2nd Ave
Miami Shores, FL 33138
RE: 157 NW 103rd ST, Miami Shores FL 33138
Dear Sirs,
This is in reference to the permit #RC16-2742 that I would like to close since the scope of work has been
reduced considerably. No work has been done on the property and I will submit a new set of drawings
with the new scope of work.
Should there be any questions or need additional information, please do not hesitate to contact me.
Sincerely,
305-610-1905
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