WS-18-110 Permit No.. S-1-11$=110
`yµuRes Miami Shores VillagePermit Type:Windows/Shutters
10050 N.E.2nd Avenue NE � � i'
Miami Shores,FL 33138-0000 C%55irG8ttOrl" IndCtifY/QOOf F � CfI1
••" �` Phone: (305)795-2204 Permit Status:APPROVED
fi�ORIDA
issue Date:-1/18/2018 Expiration: 07/17/2018
Project Address Parcel Number Applicant
113 NE 105 Street 1121360050100
ANNIKAASHTON ERIC HERNA�
Miami Shores, FL 33138-2032 Block: Lot:
1
Owner Information Address Phone Cell
ANNIKA ASHTON ERIC HERNANDEZ 113 NE 105 Street (854)554-0418
MIAMI SHORES FL 33138-2032
Contractor(s) Phone Cell Phone
$ 3,400.00
WILCON CO (786)399-8855 Valuation:
Total Sq Feet: 0
Type of Work:INSTALLATION OF 6 WINDOWS HURRICANE Available Inspections:
No of Openings:6 Inspection Type:
Additional Info: INSTALLATION OF 6 WINDOWS HURRICANE Window Door Attachment
Classification:Residential Final
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
Invoice# WS-1-18-66129
DBPR Fee $2.40 01/18/2018 Credit Card $ 129.80 $50.00
DCA Fee $2.00
Education Surcharge $0.80 01/16/2018 Cash $50.00 $0.00
Notary Fee $0.00
Permit Fee $160.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $179.80
i
In con sideratio noY t e issuance to this permi I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the pla s s, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for ap.ork done either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOW DORS,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 contractor to do the work stated.
January 18, 2018
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 18,2018 1
1
Miami hores Village `
RFS
Building Department sell
10050 N.E.2nd Avenue
Miami Shores, Florida 33138 zT-- gee
Tel: (305) 795.2204 LORIDp`
Fax: (305) 756.8972
Inspection requirements for:
Windows, Doors, Skylights or Fixed Glass (cladding) Permits
Upon issuance of permits for the scope of work involving the removal,changing and/or
replacement of any type of windows,doors,sidelites,skylights or fixed glass(cladding)
the permit holder or qualifier bearing his signature on the permit application shall abide
by the requirements of this department and comply with the following statement:
Upon obtaining window and/or door permits for the installation of same, it is the
responsibility of the permit holder to request window/door framing in-progress
inspection,prior to concealment of any horizontal or vertical clip mullion,bucks,shims,
etc.Inspector will also verify anchor type,edge distance,embedment and spacing.The
purpose for this inspection, is for the verification of conformance with Product
Approval (NOA).
Ac 'owl dgeme/n :
17
iier/Ow Sig e D to Print Name
F
Miami Shores Village RECEIVED
Building Department JAN 108 2017
�\ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 --�/
Tel:(305)795-2204 Fax:(305)756-8972 111
INSPECTION LINE PHONE NUMBER:(305)762-4949 S 4
FBC 201H
BUILDING Master Permit No. V,(--
PERMIT
`(
PERMIT APPLICATION Sub Permit No. VJS )
®'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION El SHOP
CONTRACTOR DRAWINGS '
JOB ADDRESS: 113 N� I OSS
City: Miami Shores / County: Miami Dade zip:
Folio/Parcel#: 11 _ 2 6 ^ 0 0<—0/00—is the Building Historically Designated:Yes—N O
Occupancy Type: e55. Load: Construction Type: Flood Zone: BFE: FFE:
S'%Aq I C_C04-i IT- �J
OWNER: Name(Fee Simple Titleholder):_ feACG I�Q/JDF7_. Phone#: � \ l-2-� ?`�
'Address: t I k)FI c7 '
City: tA t*t W6 2E'S State: Zip: 2> 9 Q
Tenant/Lessee Name: Phone#:
Email: 22
CONTRACTOR:Company Name: �� �'��i1 ln'- Phone#:_'7 7V H 0c�
6 �
Address:��(n rc%L: snl- t '
City: State: Zip:
Qualifier Name:-All 1 1I �✓►'� �%/u/2 _ Phone#: '2 %-6 3"[//��
g-MSr
State Certification or Registration#: CV (,S l Z 44- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: _ City: _ State: Zip:
Value of Work for this Permit Square/Linear Footage of Work:'
Type of Work: ❑ Addition ❑ :Alteration Q New �S•1? 2Repair/Replace ❑ Demolition f
Description of Work: t'Y1 C c1�Y 4 f r- 1 �'. (Q%1 r` Do l
C
Specify color of color thru tile:
-Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
14
BondingrGornpany's Name(if applicable) '
Bonding Company's Address r
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 nce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature G Signature
OWNER or AGENT CONTRACTO
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3 day of � ) . 20 by day of 20 6 by
1�`—rtn-n a (Vo(27 ,who is personally known to L1 I Uvkya who is personally known to
me or who has produced - as me or who has produced as
identification and who did t e' ication and who d
ra Ms DE �
ti, + .i Nota►y Public`a' 's�0 s� >. DE r° c
. �Uz
NOTARY PUBLIC: to of o RY PUBLIC: * «C" Notar
amisslon#FF0454 »l Y Public State of^Florida
J %.;�;o P. � )�nComm.Expires ' �' , r°, Qmmission#.FF 204,14
• th gAr�sl ? 9 ` ., o P,, My L�omm Ex Ire t
Sign: �` s : '�ftO Nor2ryAs� '� "" Bon*throuch p;i s Apr l"2019
Print: Z Print:
Seal: Seal:
1.0
�a
***********r•rss*s*ss**r*r***s* ***s*****s********s***r********s*rs*s*s*sr�**ar•ss****s*********s*sss*s**r*
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ANC.I
Miami shores Village
"N " Building Department
1%-77Qrw
C�RID�* 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 i£
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. x.
oe
Signature: ;<rqP Pe DENA CRUZ }
+°. * Notary Public'-State of,Florida
caner �t
* = Commission#FF 204.513
State of Florida FF��:�' My Comm.Expires Apr 7,201,9
Bonded through National Notary As
County of Miami-Dade
T was acknowledge before me this��day of 20 .
By who is personally known to me or has produced
�t_Zas identification. to
DENU2 s
Notary: !/ *o NotaFy Publlc `ate o}Flo'flda `
° M � � CGtnmission#A�FZ �3
'•',�oFF o?� MC mm.Expire3' = _
SEAL: � ndetlthrough N ucmal '
3
WILCON CO.
GENERAL CONTRACTOR
CONBTRUCTION MANAGEMENT
LICENSED & INSURED ,
r-sC# 1512642
-
WILLIAM CRUZ
DESIGN-BUILD
9636 NE 5TH AvE RO. CELL 786-399-8855
MIAMI SHopeS FL, 33136 OF-FtcE 305-4669982
Date. t k-1 1
WCRUZ23C�HOTMAf L.COM
State of .V4b► A o A-
County of Dade
Befrore me this day personalty appeared jjj_L�[,Ljj � who, being duly sworn, deposes and says:
Than he or she will be the only person woiKin9 on the project at 1 I /QiF
Sworn t ( or affirmed) and subscribed before me this day of ,20 by
Personally Know
Or produced Identification
T YM of lde6tificafion produced
DEE
% uz �".
?�»r oe•,
° Notary f ubllc-State of Florida
•� sion#,FF 204543
R
k
1 FF,�' iN r6mm.Expires Apr 7',.2q` g '
° �r"""•: So Athrough National k, �
Print, type or stamp of Notary,
r
t