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INSPECTION RECORD POST ON SITE
Permit NO. RC-11-17-2768
SgOREs
Miami Shores Village '140 Permit Type:Residential Construction
10050 N.E.2nd Avenue MW
xxxx y "`x" Miami Shores,FL 33138-0000 _ WOrk_CIBSS/fcati3n:Alteration
Phone: (305)795-2204 Fax: (305)756=8972
�toRiDA Issue Date: 2/5/2018 Expires: 09/03/2018
INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.miamishoresvillage.comlcap
REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY.
Requests must be received by`3 pm for following day inspections.
Residential Construction Parcel #:1132060133300
Owner's Name:SAM SZABLA ;.„ + � Owner's Phone:
Job Address: 'k. •�. ? . Total Square Feet: 1735
Miamm Shore
Bond Number: 3635 Total Job Valuation: $ 18,000,.00
WORK IS ALLOWED:
MONDAY THROUGH FRIDAY,8:OOAM-7:OOPM.
Contractors a `e „� imarytCgn_tra orSATURDAY 8aOOAM-6:OOPM.
QUINTERO GENERAL CONSTRUCI
INV
73 es NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS.
BUILDING AND ROOFING INSPECTIONS ARE DONE
MONDAY THROUGH FRIDAY.
NO INSPECTION WILL BE MADE UNLESS THE-PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE�READLY AVAILABLE. IT IS
THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE'AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
REQUIRED TO ALLOW INSPECTION.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
INSPECTION RECORD
STRUCTURAL
.. ...• �:
INSPECTION DATE INSP INSPECTION DATE INSP., INSPECTION' DATE INSP
Foundation Attachment
Stemwall Rough '
Slab ' Water Service
Columns(1st Lift) 2"d Rough
Columns(2nd Lift) •- Top Out L
Tie Beam _ INSPECTION ` DATE =INSP ' Fire Sprinklers
Truss/Rafters Excavation Septic Tank j
Roof Sheathing Sewer Hook-up
Bucks =,r� ; Roof Drains '
t InteriorFraming " Gas
'Insulation ; INSPECTION'" DATE INSP LIP Tank
Ceiling Grid Temporary Pole Well
Drywall 3 30 Day Temporary Lawn Sprinklers '
Firewall 'Pool Bonding Main Drain
Wire Lath Pool Deck Bonding Pool Piping
Pool Steel Pool Wet Niche Backflow Preventor
Pool Deck Underground Interceptor
Final Pool Footer'Ground Catch Basins
Final Fence Slab Condensate Drains
Screen Enclosure Wall-Rough HRS Final
Driveway Ceiling Rou
Driveway Base Roug PLUMBING CO M NTS
Tin.Cap Telephone Rough
Roof in Progress Telephone Final
Mop in Progress TV Rough
Final Roof TV Final
Shutters Attachment Cable•Rou h '
g _.._
Final Shutters Cable Final
Rails and Guardrails Intercom'Rough
ADA compliance 'Intercom Final
Alarm Rough INSPECTION =DATE INSP
Alarm Final Underground Pipe
DOCUME TS Fire Alarm Rough
Soil Bearing Cert a Fire Alarm Final ough
Soil Treatment'Cert Service Work With
Floor Elevation•Survey, , ►• .�AA _ 'Ventilation Rough
Reinf Unit Mas Cert ELECTRICAL COMMENTS iHOOd Rough
Insulation Certificate Pressure Test
Spot Survey Final Hood
Final Survey Final Ventilation -
Truss Certification t ; Final Pool Heater_
STRUCTURAL COMMENTS Final Vacuum
`:,MECHANICAL COMMENTS
INSPECTION DATE INSP
Final Sprinkler
Final Alarm
r �"-' '{.' , Y - _� �; r� - .t-.�..,.� �tn�rv....�. 5.,_- L--..--,•��—...�....ra.u...�.v...�..o:�w9ss.�..•,p,r ,e...�..., ,a .-..
PECTIOI R -# , �.
�CO � POSE ON SITE
IN
Permit NO ..RC=11-1 1-2:768
Perm�t4Type:Resid�alhtial'�onstructlon
10050 N E 2nd Avenue v
es - t., '• °` iNQrx CleSStf7.Caftpn:AiteratiOnl
Miami Shoes FL 33138 0�•000 •;.
Phone, (305)795-2204 Fail"•(305)756-8972
�toRtpA' ' y •Issue Date 2/5/2018
i
} Expires: 9/03/2018
"bin
� ,,...
INSPECTION REQUEsrs: (305)762-4949,0-Log'"on at.htFFtp_s/%bldg mianlshoresviilage.comlcap' r ;,
REQUESTS ARE,ACCEPTED'DURING 8:30AM :;3:30PM;FOR.TH FOLLOWING BUSINESS DAY: ,
;. Re nests musf;be received b 3
y" pm for following day.inspections.
-Residential ,a6nstr'c rw L f. Parcel #•1:132060�133300
_
' Owrier's'Name SAM SZABLA , Owner's'Phone:
tom` - 3 -
Job'Address` - s ;y
s .. Squ
{
Total a Feet: 173
5,.
' Bond Numtier.,3635 ;, ; Total Job'Valuation. r.$ 18,000:00
wr
4 COIttC :a z fi •• y WORK 11i'ALLOWED: `
MONDAY THROUGH FRIDAY;8:00AM--7:00PM,
im,actor s
QUINTERO GENERAL CWSTRUC ori SATURDAY 8 OOAM:'-6 OOPM.=
i + ( eS r� a NO,WORK IS ALLOWED+ON SUNDAY OR HOLIDAYS. ,' r
BUILDING'AND'R60FING INSPECTIONS ARE DONE; 1
�• +' MONDAY THROUGH'FRIDAYr ^ '�
, -
'I F
• r
•:ea �
L e - F"• -t ~ -w ' rte, a' � '�i - L _ .
As
} NO INSPECTION`WILLIBE.MADE'UNLESS THE RERMIT=CARD'IS DISPLAYED AND HAS'BEEN APPROVED." PLANS"ARE READLY AVAILABLE..IT IS
THE PERMIT APPLICANT'S RESPONSIBILITY TO,ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE RED TO'ALLOW INSPECTION.
THE
ON.ITY SHALL BE LIABLE FOR EXPENSE ENTAIL'EDJN'THE REMOVAL OR REPLACEMENT OF ANY MATERIALREQI
a +
S
WARNING' TO•-t :OWNER:- YOUR." FAILURE,- TO •�'IRECORD A ., NOTICE. , O�F�.
COMMENCEMENT,' MAY-RESULT JN-r YOUR'P`AYING TWICE FOR' IMPROVEMENTS.
TO•:YOUR PROP'ERTY.. A NOTICE- OF. COMMENCEMENT � MUST• BE RECrORDED
" °AND, POSTED ON- THE JOB` SITE BEFORE. THE' FIRST fzINSPECTION. IF YOU
i _.
t INTEND; TO. OBTAIN „FLNANCING, CONSULT WITH YOUR, LENDER' OR" AN'
ATTORNEY, 8EFORE` COMMENCING WORK ,OR''`RECORDIN-G 'YOW--NOTICE OF,
i COMMENCEMENT: 4 = ••
f, q
INSPECTION RECORD
WINDOWSSTRUCTURAL
: DOOR ii PLUMBING ■
INSPECTION DATE. INSP NSPECTION DATE I INSP INSPECTION DATE INSP
Foundation Attachment
Stemwall Rough
Slab Water Service
Columns(1st Lift) 2nd Rough
Columns(2nd Lift) PUBLIC WORKSTop Out
Tie Beam INSPECTION DATE INSP Flre Sprinklers
Truss/Rafters Excavatiat Septic Tank
Roof Sheathing Sewer Hook-up '
Bucks Roof Drains
Interior Framing, ,Gas
Insulation INSPECTION D,y7E INSP LP Tank
Ceiling Grid._ Temporary Pole Well
Drywall. 30 Day Temporary Lawn Sprinklers
Fir",all ftoMonding .Main Drain
Wire Lath Pool Deck Bonding Pool Piping
Pool Steel Pool Wet Niche_ Backflow Preventor
Pool Deck Underground Interceptor
Final Pool Footer Ground_ Catch Basins
final-Fence Slab Condensate.Drains
Screen Enclosure Wall Rough HRS Ficial
Driveway Ceiling lou
Driveway Base_ " Roug �8 PLUMBING CO M NTS
Tin Cap f _ Telephone Rough_
Roof in Progress Telephone Final
Mop in Progress. TV Rough
Final Roof TV Final
Shutters.Attachment , Cable Rough.
,Final Shutters Cable Final
Rails and Guardrails Intercom Rough_
ADA compliance Intercom Final MECHANICAL
Alarm Rough INSPECTION DATE INSP
Alarm Final 'Underground Pipe
DOCUMENTS 'v Fire Alarm Rough "
w
Soil Bearing Cert Fire Alarm Final --Rough
Soil Treatment Cert Service Work With
Floor Elevation Survey Ventilation R�ugh
Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough
,insulation Certificate Pressure Test
Spot Survey Final Hood
final Survey Final Ventilation
Truss Certification ' Final Pool Heater
STRUCTURAL COMMENTS Final Vacuum
MECHANICAL COMMENTS
INSPECTION DATE__. ;INSP
`Final Sprinkler
Final Alarm
Yanady Prieto
From:_ Yanady Prieto
Sent: Tuesday, December 12, 2017 9:19 AM
To: 'Sam Szabla'
Subject: RE: 107 NE 91st Street (Permit Update)
Good morning Mr. Szabala
As per our conversation yesterday, the Building Official is requesting a meeting at the job site . Please let us know what
day is best for you to meet with the Building Official at the house 107 NE 91 Street.
Best Regards!
Yani Prieto
Permit Clerk
Miami Shores Village Building Department
10050 NE 2 Ave
Miami Shores Village FL 33138
Office: 305-795-2204 Ext:4860
Fax: 305-756-8972 www.miamishoresvillage.com
-----Original Message-----
From: Sam Szabla (mailto:sam@samszabla.com]
Sent: Monday, December 11, 2017 3:42 PM
To:Yanady Prieto<PrietoY@msvfl.gov>
Cc: sam@samszabla.com
Subject: 107 NE 91st Street(Permit Update)
Hi Yanady,
I just left a message and thought I would follow up with an email in case that's easier.
I stopped in today about the permits for 107 NE 91st.
I
As I mentioned, I'm in a desperate situation, my furniture is being delivered and I need my engineered flooring down
ASAP, I have 2 holiday events at my home and I'm running out of time.
Please let me know the status, I'm been on the GC.. and he said he's turned in everything.
Thankyou
Sam Szabla
305-781-5895
Sent from my iPhone
Permitwo, ,RC-1 1-17-2768
Miami Shores Village t Pennit Type:Residential Construction
10050 N.E.2nd Avenue NE Work Classification.Alteration
Miami Shores,FL 33138-0000 Penu Permit Status:APPROVED
Phone: (305)795-2204
issue Date:215/2018 [ Expiration: 08/04/2018
Project Address Parcel Number Applicant
107 NE 91 Street 1132060133300
Mimi Shores, FL 33138- Block: Lot: SAM SZABLA
Owner Information Address Phone Cell
SAM SZABLA 107 NE 91 Street (306)781-5895
MIAMI SHORES FL 33018-
107 NE 91 Street
MIAMI SHORES FL 33018-
-Contractor(s) Phone Cell Phone Valuation: $ 18,000.00
QUINTERO GENERAL CONSTRUCTIO (786)487-5738
Total Sq Feet: 1735
Approved: In Review Available Inspections:
Comments: Inspection Type:
Date Approved: : In Review Final PE Certification
Date Denied: Window Door Attachment
Type of Construction:INSTALLATION OF NEW WOOD FL Occupancy: Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: Drywall Screw
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Electrical
Certificate Date: Additional Info: INSTALLATION OF NEW WOOD FL( Review Electrical
Review Electrical
.Bond Return Classification:Residential Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building
Bond Type-Owners Bond $500.00 — Review Building
CCF $10.80 Invoice# RC-11-17-65718 Review Building
CO/CC Fee $50.00 02/05/2018 Credit Card $441.30 $700.00 Review Planning
't Due
0.00
DBPR Fee $8.10 11/21/2017 Credit Card $200.00 $500.00] Review Plumbing
DCA Fee $5.40 02/05/2018 Credit Card $500.00 $0.00 Review Plumbing
Education Surcharge $3.60 Bond 3635 Review Structural
Permit Fee $540.00 Review Mechanical
Scanning Fee $9.00
Technology Fee $14.40
Total: $1,141.30
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. F hermore,I authorize the above-named contractor to do the work stated.
February 05, 2018
Authodzed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 05, 2018 1
<� Q
•c,�\`� Miami Shores Village Nov 12017
r��C� Building Department -
1��� G�,r� \� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
JOS \�Q\ Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
20 r'TBUILDING Master Permit No. �BC
G
PERMIT APPLICATION Sub Permit No.
'KgUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
-yL CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Ji¢M ���¢6l/� Phone#: 30:07'-/— S-m7
Address: "� �Q jer `f Sr
City: /Ki`�...t,>' s 4"s State: iac zip: 3 O
Tenant/Lessee Name: // Phone#:
Email: 5^,.t ® `JAS SzA-44# •co^
CONTRACTOR:Company Name: Q�J/iJ�p,�, PaL�F' c.p.J�/litQti Phone#:
Address: A AJ it a Tefu.
City: State: Zip:
Qualifier Name: eR,•i1~v i z;z Phone#:
State Certification or Registration#: (f 4.,5—C /S'/ Sx'�� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: ��� City: State: Zip:
Value of Work for this Permit: On n - 6$' juare Linear Footage of Work: /-7405
Type of Work: ❑ Addition ❑ Alteration F-1New �RRepair/Replace1:1Demolition / l
Description ofWork: .1n/S /)44-d /:�005F• FX/OX
00D OIL e0_. •SZ4,% WooD o2 2u1b.aSQ6aAr
A.ucQ i`a ,P,,•o,er�.4 ,�
CAA-,j9e ev Qe,t se" c¢s 90 /F _gAX1.s-✓i?,d To f JC d .•vC.4 -40W _UV
reett-co•-1 .� •'.✓A Fi°.�ce, l des��iovse :sa l �aco� To eewco�e�'�y � �: T s�4
Specify color of color thru tile:
Submittal Fee$ G0 1 Permit Fee$ CCF$ lb'a-) CO/CC$ �.
Scanning Fee$ / ' C�D Radon Fee$ DBPR$ Notary$ JZ
Technology Fee$ Training/Education Fee$ J'(OBJ Double Fee$ U
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
9V1• 30
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 Ap#licant: 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 a chment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wilFnot be 0 e and a rein ection fee will be charged.
Signature Signature
10
Vuht
R or AGENT CONTRACTOR
The foregoi ' s acknowledged before me this The foregoing instrument was acknowledged before me this
2-0 day_/of/ A)O&±:t 4A— 20 /-4 by 2-0day of I'D LJev11� 20 I- by
�
5 5Z461A ,who isEE
known o Q,)erhardD Qy Igkt iD who is personally known to
me or who has produced as me or who has produced bL``' A(tvCr l.tCeASe as
identification and who did take gn oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: P
Print: Print: ublic-State of Florida
�.c ommission#GG 119484
Seal: ,.�������� MARIJAIR RAVELO Seal: „P`' My Comm. Expires Jun 27.2021
+ o' Notary Public-State of Florida
_'4 .•= Commission#FF 206163
MI Comm y�r lwapla
l�ed�hr0lig�tuation Notary Assn. ********************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
n
Property Search Application - Miami-Dade County t Page 1 of 1
'�'3
CEAU'ff THE, PROPERR APPRAISER
.11P V11-1,11
Summary Report
I Generated On: 11/21/2017
Property Information
Folio: 11-3206-013-3300 -- °
Property Address:
107 NE 91 ST
Miami Shores,FL 33138-2809
Owner MACNED LLC
Mailing Address
5161 COLLINS AVE#616
MIAMI BEACH,FL 33140 USA ,
PA Primary Zone 1000 SGL FAMILY-2101-2300 SQ
0101 RESIDENTIAL-SINGLE
Primary Land Use FAMILY: 1 UNIT
„'"",�.#, �. .nom �!'y�. _ ,d"`• �, . jrr
Beds/Baths/Half 4/3/1
r s
Floors 1 y w
Living Units 1
Actual Area Sq.Ft
Living Area S Ft 0 �
q•
Adjusted Area 2,389 Sq.Ft
Taxable Value Information
Lot Size 13,880.1 Sq.Ft
2017 2016 2015
Year Built 1948
County
Assessment Information Exemption Value $50,000 $50,500 $50,500
Year 2017 2016 2015 Taxable Value $390,964 $127,771 $126,532
Land Value $346,844 $346,844 $263,645 School Board
Building Value $93,314 $166,274 $166,274 Exemption Value $25,000 $25,500 $25,500
XF Value $806 $806 $706 Taxable Value $415,964 $152,771 $151,532
Market Value $440,964 $513,924 $430,625 city
Assessed Value $440,964 $178,271 $177,032 Exemption Value $50,000 $50,500
Taxable Value $390,964 ]$E127,771 $126,532
Benefits Information Regional
Benefit Type 2017 2016 2015 Exemption Value $50,000 $50,500 $50,500
Save Our Homes Assessment Taxable Value $390,964 $127,771 $126,532
Cap Reduction $335,653 $253,593
Homestead Exemption $25,000 $25,000 $25,000 Sales Information
Second Previous OR Book-
Homestead Exemption $25,000 $25,000 $25,000 Sale PricePageQualification Description
Widow Exemption $500 $500 10/10/2017 $100 30728- Corrective,tax or QCD;min
Note:Not all benefits are applicable to all Taxable Values(i.e.County,
0902 consideration
School Board,City, Regional). 12/19/2016 $485,000 30352- Qual by exam of deed.
1221
Short Legal Description 04/01/2005 $0 _ 23391- Sales which are disqualified as a result
MIAMI SHORES SEC 1 AMD PB 10 70 0398 of examination of the deed
LOTS 15&16 BLK 24 00000
01/01/1973 $52,000 Sales which are qualified
LOT SIZE IRREGULAR 00000
CF 73R21941
COC 23391-0398 042005 5
The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser
and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
http://www.miamidade.gov/propertysearch/ 1 11/21/2017
CFN: 20170651232 BOOK 30761 PAGE 2301
DATE:11/20/2017 10:31:58 AM
THIS INSTRUMENT PREPARED BY AND RETURN'fU. DEED DOC 3,345.00
Stephanie Howsrd HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY
ALL ABOUT CLOSING,INC.
101 NE 3rd A:venut,Suite 1500
1+T.LAUDERDALE,FL 33301
Prop"Appraisers Parcel Identification(Folio)Nuff6a 113206-013-3300
Florida Documentary Stumps in the amount of 53,34!L00 have been paid hereon.
SPACE AROVE-11113 LINE FOR RECORDNG DATA
WARRANTYDEE
THIS WARRANTY DEED,rttsdo the 15th day of November.2017 by Matned,LIC,s Florida'llarlted figAt1'
company,whose Post of ke address is 107 NE.91st Street,Miami Shores,FL 33138 herein called the Granum.to Sam
Szabla,a sia*moo whose past office address is 1107 NE 91st Street,Miami Smrres,FI433LU.berrirratler atled the
Grantee,
(1YAerevvardMnibrOwMems'Cowmr'taadYirdrarK*)WIN*oft rWAatkfsWIN~ird1kAdm ItOngrrrarnlarA+"WW
au"ofbKftvii4 v> aml out axet.uamoadmagnrO-g—thrnxj
W 1 T N 9 S S 9 T H.'110 the Grantor.for and in consideration of the sum of TEN AND ODAWS($lt}OO)Dollars and who
valuable considerations,rectipt whereof is hereby admowledged,hereby grants,barpirm sells,aliens,xmises,releases.
aanveyt and confifnns oruo the G"Atee all that terMin land situate in M1iAMli-RADE County,;state of Florida,viz.
Lot:15 sad IC Block 24,of Miami Shores Section No.1 Amended,acewding to plat thereof as recorded In Past
Book 30,Page M of the Public Records sfi1 ismi-Dade Catrety,gids.
Sbbject to eats,test.k and risiservsdoas of record and to for the year 2013 and thereafter:
TOGET1119R,with all the worn ents,hreroditarr>catts and apptc umnces therm belongingor in anywise upperuriam&
TO HAVE AND TO HOLD,the:same in fee simple famm.
AN%the Grantor hereby covenants with said Grantee that the Grantor Is lawfully seized of said lend in fee sirnple;that die
aortor hag good right and lawful authority to sell and convey said land,and hereby warrants the title to said land and will defend
thtc seers agatttst t!o lawful daitra ofall persons whorttttoever;artrl that said laud is fide of all ease t taxes accruft
sutmtgoerit to December 31.2014.
W WffN6SS W11Et2ROV,the said Grantor has signed and soated these prewts the day and year first above written,
deliIn of
V4'ftiic tel ignature macnedt a. M lNlhy
company
WW�Printed NWV
Mare Moi
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Witness;rig Printed Name
$TATE OF FLORIDA
t t71LtWrY OF IlfUMI-DAD1
The foregoing imstrumait was ac nowledIged before me this 15th day of November,2017,by
Atart MschkroM Massg" Member of Maceed, uC, a Fhb rlda limited Habillty company who is
known to tete or has produ"d as identification arts!Q
dd not take an oats.
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WINI.J}I,.I Notaryl b yw.J�Ar�iw� +/ !•....i.. ..
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Local Business Tax Receipt
Miami-Dade County, State of Florida
—THIS IS NOT A BILL-DO NOT PAY
6234546 'LBTr
BUSINESS NAMIE/LOCATION RECEIPT NO. EXPIRES
QUINTERO GENERAL CONTRACTOR CORP RENEWAL SEPTEMBER 30, 2018
8801 AW 1:12 TERR 6499123 Must be displayed at place of business
l HIALfAH'CARDENS FL 33018 Pursuant to County Code "
Chapter 8A—Art.9&10 t
OWNER SEC.TYPE OF BUSINESS
6 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED
QUINTERO GENERAL CONTRACTOR CORD C1515292 BY TAX COLLECTOR
Worker(s) 1 - $45.00 07/11/2017
CREDITCARD-17-046657
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental
or nongovernmental.regulatory laws andlequirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276.
' For more information,visit www.miaMidade.noy/taxcallector-
STATE OF FLORIDA
1 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION srq
CONSTRUCTION INDUSTRY LICENSING BOARD
CGC1515292
The GENERAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS
Expiration date:.AUG 31, 2018' ':
QUINTERO,' BERNARDO, `
'QUINTERO GENERAL CONTRACTOR CORP �y '�� `" g ; ■ 'y
8801 NW 112TH;TERRACE
" HIALEAH-GARDENS`�FL_33018
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ISSUED: 07/11/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607110000797
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QUINTERO GENERAL CONTRACTOR CORP f
r Bernardo Quintero 8801 nw 112 terrace
Hialeah Gardens fl 33018
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Date: 11/20/2017
'State of florida
County of dade
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Before me this day personally appeared Bernardo Quintero who, being duly sworn, deposes and says:
That helor she will be the only person working on the project locate at 107 ne 91 st Miami shores
I Sworn to (or affirmed )and subscribed before me this 20 day of nov.2017, by.Bernardo Quintero'
B nardo Quintero Personally know 1/
Or produced identification
Type of identification produced
I i
t
PLa, MR IJAIR RAVELO
oy�pblic-State of Florida
Print,type or st .tt of ff��}}
's « »•p ssion#FF 206163
My Comm.Expires May 5,2019
Bonded through National Notary Assn.
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goal ,,... Miami shores, Village,
`z �d Building Department
F s�
OR1Dp' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
1
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers yin 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 I
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 YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
i
Signature: ♦z
Owner
State of FI
ori
County of Miami-Dade
The foregoing was acknowledge before me this �� day of_ ':)AAJVA ,20_.
BY ��"� Sg/� wh is personally known t me or has produced
as identification.
Notary:
SE
y PVe, MARIJAIR RAVELO
Notary Public-State of Florida-
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BATHROOM RECEPTACLE ON 20 AMP CKT
t AND G.F.I PROTECTED
ELECTRICAL REVIEW
APPROVE _DATE
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b-��" ADD MOKE/CARBON MONOXIDE DETECTORS. �a GoesT bo �°
_ "01; ANY AND ALL CLOTH AND RUBBER f j�9 M�PO
Jnt INS TED CONDUCTORS TO.BE REPLACED.
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1BATHR00M RECEPTACLE ON 20 AMP CKT
AND G.F.I PROTECTED
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fv9�ami Shires Village
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APPROVEDBY DATE
7.10, ZONING DEPT
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LIO 1 LOT 16 STATE ANu C(-IN i'f rfl le��Arit)HE(tiLATIC)NS
BLOCK 24 &OCK� 24' 1
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