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CC-18-865Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. C C-4-18-86 5 Permit Type: Commercial Construction Work Classification: Alteration Permit Status: APPROVED Issue Date:S/23/2018 Expiration: 11/19/2018 Parcel Number Applicant 689 NE 92 Street Number: 9-G Miami Shores, FL 1132060430210 Block: Lot: JOYCE D LANGE Owner Information Address Phone Cell JOYCE D LANGE 689 NE 92 Street MIAMI SHORES FL 33138- (305)632-0200 689 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) DILBERT ENTERPRISES, INC Phone Cell Phone 786/256-6434 (305)945-0727 Valuation: Total Sq Feet: $ 7,000.00 107 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: REMODEL ONE BATHROOM CHAN Stories: Front Setback: Left Setback: Plans Submitted: Certification Date: Bond Return : Scanning: 3 Occupancy Load: Exterior: Rear Setback: Right Setback: Certification Status: Additional Info: Classification: Commercial Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary' Fee Permit Fee Scanning Fee Technology Fee Total: Amount $4.20 $3.15 $2.10 $1.40 $5.00 $210.00 $9.00 $5.60 $240.45 Pay Date Pay Type Invoice # CC-4-18-67028 05/23/2018 Check #: 1129 $ 190.45 $ 50.00 04/04/2018 Credit Card $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Tie Beam Slab Termite Letter Framing Store Front Attachment Insulation Drywall Screw Fill Cells Columns Window and Door Buck Ceiling Grid Review Planning Review Electrical Review Building Review Building Review Plumbing Review Structural Review Mechanical 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. Futhermore authorize the above -named contractor to do the work stated. thorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 23, 2018 Date May 23, 2018 1 Address: c <34e ) City: leiJes Qualifier Name: ...fi'/!/ State Certification or Registration 1#: j DESIGNER: Architect/Engineer: BUILDING PERMIT APPLICATION (UILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: 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 FBC 20 �Z�(5 Master Permit No. (`� (i _y Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS OWNER: Name (Fee Simple Titleholder): Address: City: 144 is '& t4E 2 4fo T? V j A 4- 9i t1 h M j 514042.E S State: f L NO FFE: Phone#(3t6) 6??fo?Ao zip: ?ail a Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �e� �j� /�ij� e I/jG phone#: " .6 �',3G/ State: //.me.//4 SDo 1 r Certificate of Competency #: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ FrJG47 Type of Work: Square/Linear Footage of Work: / 272 SW7 ❑ Addition ❑ New Alteration ❑ Reair Re lace `/ P / P ❑Demolition Des iption of Work: !�� et/se�.� �.�%2.�nc ®cam .1: 5Ape-e/e / //g,57/7 /%ice i% Specify color of color thru tile: Submittal Fee $ 50 v 00 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ •Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Zip: .7,..?a,-;- Phone#: �� a 5 6 t,/3y Double Fee $ Bond $ S TOTAL FEE NOW DUE$ 'C3t0 • "�' 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 "' be -" Signat ENT The foregoing instrument was acknowledged before me this day of tv10 y C l Jor who has produced fl OWNER or c Qs blow, ,10 identification and who did take an oath. NOTARY PUB C: S Print: Seal: by ally known to as Signature's"' CONTRACTOR The foregoing iristrum t was acknowledged before me this day Of 7_0)4 , 20 id) , by 42.41c, A 1 J) mho is personally know to me or who has produced L//, IA (ppUjas identification and. who did take an oath. NOTARY PUBL Sign: Print: ******R R*************+rat►******************* 1.77* / i APPROVED BY f3 N014 ALUM ." ., VYV1f Y 'sr `r V V''I Notary Public State of Florida Sindia Alvarez +Yer#My Commission FF 156750 s s sRltn QIPQ4Qj4 Plans Examiner .;1, *******ERR*********** Zoning Structural Review Clerk (Revised02/24/2014) 3/23/2018 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-3206-043-0210 Property Address: 689 NE 92 ST UNIT: 9G Miami Shores, FL 33138-2956 Owner JOYCE D LANGE Mailing Address 689 NE 92 ST #9G MIAMI SHORES, FL 33138-2962 PA Primary Zone 3000 MULTI -FAMILY - GENERAL Primary Land Use 0407 RESIDENTIAL - TOTAL VALUE : CONDOMINIUM - RESIDENTIAL Beds / Baths / Half 0/0/0 Floors 0 Living Units 0 Actual Area Sq.Ft Living Area 861 Sq.Ft Adjusted Area 861 Sq.Ft Lot Size 0 Sq.Ft Year Built 1949 Assessment Information Year 2017 2016 2015 Land Value $0 $0 $0 Building Value $0 $0 $0 XF Value $0 $0 $0 Market Value $130,878 $130,878 $99,150 Assessed Value $52,472 $51,393 $51,036 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $78,406 $79,485 $48,114 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $2,472 $1,393 $0 Senior Homestead Exemption $25,000 $25,000 $26,036 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description SHORES PLAZA WEST CONDO UNIT 9-G-1ST FLOOR BLDG 2 UNDIV .03617% INT IN COMMON ELEMENTS CLERKS FILE 73R-213196 Generated On : 3/23/2018 Taxable Value Information 2017 2016 2015 County Exemption Value $52,472I $51,393 $51,036 Taxable Value $0 $0 $0 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $27,472 $26,393 $26,036 City Exemption Value $27,472 $26,393 $26,036 Taxable Value $25,000 $25,000 $25,000 Regional Exemption Value $27,472 $26,393 $26,036 Taxable Value $25,000 $25,000 $25,000 Sales Information Previous Sale Price OR Book -Page Qualification Description 01/01/2003 $57,000 20960-1414 Sales which are qualified 07/01/1993 $34,000 16007-2865 Sales which are qualified 09/01/1981 $46,500 11204-1002 Sales which are qualified 10/01/1973 $23,500 00000-00000 Sales which are qualified 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: Shores Plaza West Condo P.O. Box 530428 Miami Shores, Fla. 33153-0428 (305) 692-9054 March 27, 2018 Mrs. Joyce Lange 689 N.E. 92nd Street, Apartment 9G Miami Shores, Florida 33138 Dear Mrs. Lange, This letter serves as permission from the Shores Plaza West Condominium, Inc. Board of Directors for you to renovate your unit's bathroom, along with its plumbing and wood supports. As you know, our condominium Rules and Regulations require such approval. I believe that Miami Shores Village also requires the approval of the condominium, so this letter can be shared with the Village as to their requirements. The Board and the Village does require that the bathroom and its supporting joist work be done by licensed contractors and that all necessary building permits will be obtained from from the Village as a prelude to the work itself. Albert Mora, President Shores Plaza West Condominium Association., Inc. Joyce O lange Property Address: 689 NE 92nd St City. Miami Shores State: 11 Zip. 33138 31' RECEIVED ` PR 04 2018 BY H u W E BEDROOM S BATH BEDROOM r KITCHEN DINING LIVING ROOM ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. • 29' BATHROOM RECEPTACLE ECAMP CKT ANDTTE� 16' 13' C) C) 0 C Notice to Owner — Workers' Corn p Miami Shores Village' Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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. 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. Signat Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of °Q( _l CQ Lt 20 `e BY Lk �� 1G n�, lQ is personally known to me or has produced V 1 iC l� as iden ' (cation. MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 202o Bonded Thru Notary Public Underwriters Dilbert Enterprise Inc 2088 SW 57 Ave West Park, Fl 33023 License Number: 05BS00635 Date: Ka.A. `D IS State Of O ri Ct 0\ County Of 1' iCrtili b0►d`{ Before me this day personally appeared rY) id4 • ALL itberA-who, being duly sworn, deposes and says: That he or she will be the only.person/working on the project located at: ?7 M ontractor Signature Sworn to (or affirmed) and subscribed before me this 15 day of by k rvvcY, . A :N\hkA 0(6 Personally know OR Produced Identification Type of den cation o. - d _] ri v Qr t�Cs r S •e Print, Type or Stamp Name of Notary ,-or ^Y''•, YANADY PRIETO MY COMMISSION # FF 214031 EXPIRES: March 25, 2010 " 8tRA Bonded Fh:nIJ Putit tiode,0104 JIMMY PATRONIS STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 03/28/2018 EXPIRATION DATE: 03/27/2020 PERSON: DILBERT ARNICK A FEIN: , 320509721 BUSINESS NAME AND ADDRESS: DILBERT ENTERPRISES INC 12990 W DIXIE HWY APT 2 MIAMI FL 33161 03-28-2018 SCOPES OF BUSINESS OR TRADE: 1- Wallboard,Sheetrock,Drywall, P 2- Carpentry Installation Of Ca * i IMPORTANT: Pursuant to Chapter 440 . 051141 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 440.05113), 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. C-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850) 413-1609