Loading...
EL17-1739 r i Miami Shores Village RECEIVED Building Department OCT 191017 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 ! S FBC 201` BUILDING Master Permit No. 'sFe 'l- 3 PERMIT APPLICATION Sub Permit No.CU 7��1 BUILDING CTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � `I CONTRACTOR DRAWINGS JOB ADDRESS: `/tel STI City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 3'ZO(0— (50) OOS-D Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): '►1d0v— r Phone#: SSI ko Addres City: State: Zip: 3.5136. Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: /o "V 1LtL'CTkC— �OQ� Phone#: 79G—Zbj Address: City: State: Zip: —52)�� S Qualifier Name: U--.c v--D Phone#: S915-7-135 State Certification or Registration#: Certificate of Competency#: r DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ AdditionA❑ Alteration ly�-vew r ❑-Repair/Replace. ❑,Demolition ;Description of Work: �•a , as, .a, i' H S. Ctr..i'2 ec C.' S«'3 l a }r f}' `y r.WX ut`n 'Yvf O ti P," ' " Specify color of color thru tile: Submittal Fee$ Permit Fee$ d0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ � . GC7 DBPR$ Notary$ i Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 21 I F• 7:10 1(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 y 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.! 3i..W 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 Signature OWNER or AGENT NTRACTOR The foregoing instrument was cknowledged before me this The foregoing instrument was knowledged before me this 0day f 20 by r day of 20 by t4 Ck) C who is rsonally kn to 6eCli�� who i rsonally know o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: SOF Notary Pubhc State of Florida ;off° Notary Public State of Florida Sign: Re Ino Betancourt Sign: Region get-nGg-m • My Commission GG 023377 My Commission GG 023377 Print: orn Expires 08/22/2020 Print: ofw Expires 081 Seal: Seal: 4 ############################################################################################################ APPROVED B _l9l�G�l Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) _.YORK ELECTRIC CORP. November 3, 2017 State of Florida County of Dade Before me this day personally appeared Roberto Moreno who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 9341 NE 91h ave, Miami Shores, FL. r Contractr Signature Sworn to and subscribed before me this 31d day of November, 2017 by Roberto Moreno, who is Personally known out, , 116UNTO SANWZ N ary Public•State of flotlda •= Commission #FF 245271 '=.. Comm.Expires Jun 29,2018 Bonded through National Notary Asan. 2517 SW 13 st.Miami,FL.33145 PH 786-287-7380 FAX 305-815-2735 R� Miami shores Village Building Department ACORZUp► 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 f: 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 fled 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: Vwn G State of Florida County of Miami-Dade J The foregoing was acknowledge before me this day of20�. who is personally known to me or has produced N�`{{{{SII illlll//z as idem-LON. Notary: x71. 2 .4" d C)i S� SEAL: S :% o°� I E:m -- Miami Shores Village REc-:IV 1 Building Department JL 06 017 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY--- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20% g-s}h BUILDING Master Permit No. PERMIT A=ON Sub Permit No. EL I1"1 3 1 F_JBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP _ CONTRACTOR DRAWINGS JOB ADDRESS: _ City: Miami Shores County: Miami Dade Zi03 I Z Y Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �A 1/7(� Lee /��r�'�•t�� Phone#: Address: ''��// City: /w/*'0i State: Zip: Tenant/Lessee Name: Phone#: Email: ,�� �! ! CONTRACTOR:Company Name: /�eA� �� y A� L rc s Phone#: Address: 1500 /fir 04V Aks, Wei City: eZ?/ State: Zip: 33) 1 Qualifier Name: l.II o�e Z ©�9�rG I-ZPhone#: State Certification or Registration M. �C I3 a 0.� Z 6 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: r Address: I City: State:. Zip: . Value of Work for this Permit:$ U Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alter�ation— ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 6G� C�L�- cGryC Specify color of color thru tile: Submittal Fee$ "J� r Permit Fee$ 70e-041 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 3 '(�D DBPR$ Z4 , Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 0 (Revised02/24/2014) r ' 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$250, 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 b approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was.acknowledged before me this 219 day of �1.1.W�/ 120 1:7 ,by a7 day of \T-v1il 20 '17 by AkAJC&,r� Y who is personally known to ff€RAlMAJ#Cr, OI 6R- Q,' ,who is personally known to me or who has produced as me or who has produced Vl--' as identification and did take an oath. identification and who did take an oath. 8 S NOTARY PU NOTARY PUBLIC: y i W_N 4 � N 2 Sign: Sign: '' w Print: Print: r Seal: ;r",, ALFREO Ck Seal: * .;tKf 00 , Commission FF 065936 "4 �<: _y 'I w" %'quo 11,Rol? Expires JanAry 23,2018 'FoFn :.'?t..n�k,is►N6Saryg9ryi6t?9 ' A,(„;•' Bonded lhru Troy'aln Insurance 800385.7019 APPROVED BY //l Z” �'7i�y [ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)