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FW-13-2332 (2)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: BUILDING City: Miami Shores Folio/Parcel#: County: Permit No. IlOCT12(I3 ii FBC `20' _ M_`-"----- -Master Permit No. `'et,--3 i 3 ROOFING I TA tr Miami Dade Zip: Is`the Building Historically Designated: Yes . Nc( Flood Zone: NC/ OWNER: Name (Fee Simple Titleholder): Address: d25 ! Ale 9 City: / , !,� wt I 511 or CS State: 51-e Tenant/Lessee Name: J' Email: FL Phone#: 305- 5,7g -9952 Zip:4 3Y W8 Phone#: ,.. CONTRACTOR: Company Name: Address: City: Qualifier Name: If. Phone#: . - Zip: } State Certification or Registration #:1 Certificate of Competency #: Phone#: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: ' Phone#: u Value of Work for this Permit: $ `a)- t Squa inear Fo age of Work: 11 Type of Work: ❑Addition Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: L-.3 rE_ i } 'Color thru tile: ***************************************Fees******************************************** i Submittal Fee $ Permit Fee $ CCF $ CO/CC $ ' -. ` Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ 'Structural Review $ TOTAL FEE NOW DUE $ / ' U (/ Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this I k The foregoing instrument was acknowledged before me this day of O' , 20 12, by S'z 'f2'fi / , day of s , 20 , by who is personally known to me or who has produced i '7 who is personally known to me or who has produced as"identification and who did take an oath. Bonding Company's Name (if applicable) Bonding Company's Address 'City State Zip ,q • s .Mortgage L"ender'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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 approved and a rejspection fee will be charged.. Signature As identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ��,,, ,,,,, a� /0 Sign: — _ ,��;:'� Sign: Print: —1 ,,, ..`-07 �A`04, 010, : 0 _ Print: cc` % ``/? f4. �l/►.... My Commission Expires: N. My Commission Expires: APPROVED BY tt Plans Examiner Structural Review 5/15 Zoning Clerk (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Miami Shores' Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: J CVc°h gg V' JI / DATE: f O/l i ADDRESS: 5) , ")l rh 5 yv, r ha rc5 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial ev f° 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name insiead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or lice .. f , rs on s , permits and contracts. //��' �.0j,‘V Initial 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may, also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built a ubstanti. ly improved it for sale or lease, which violates the exemption. t ,//A ° - Initial :i ./ %� 5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. , I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initia 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.mvforidalicense.com/dbor/pro/cilbrnde .html Initial 11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understand at I am the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the inform have provided on this disclosure. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working`on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property gwner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 1 I day of , 20 9 By6-11-LvC• i3464y who was personally known to me or who has Produced there License or a��id�n�i ica tr&, �i: o Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. - Owner's Name (Fee Simple Title Holder): Owner's Address: c' �� 46 9 8 41$ City: fl' A 1; S f State : Job Address (Of where work is being done): City: Miami Shores 751 3Av; Phone #: (64 .0 4 3133 'Fl.it 194- Zip Code: 37 "I 8 State: Florida Contractor's Company Name: -IL- NZr Address: 21 Z1 S'» 4t GOO City: State: p( Qualifier's Name : in._ ; a Fcar.__Cy) JO 2„ Zip Code: 33(`8 Phone #:)?6- — L2L -- r g ?. Zip Code: .2 r2 1' Lic. Number: C'G< I j-( / O' r Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold t ► - ding Official and the Miami Shores harmless of all legal i t. Signature Odfner or Agent The foregoing instrument was aknowledged before me this �' day of -Alotn ,20Ig,by lc/ xre S Who is personally known to me or who has produced as ' . • entification. Signature Notary Public: Sign: Seal: iE MY COMMISSION # FF964004 EXPIRES February 23.2020 tier) 388411b3 r•bndallouryS*Mae.00n' Cont'ri' or Architect The foregoing instrument was aknowledged before me this , day of J1d41 ch , 201iby ( who is personally known to me or who has produced 4.1 'Z.r Notary Public: Sign: Seal: as indentification. MARTIN G TORRISI MY COMMISSION # FF964004 EXPIRES February 23.2020 140n 338-0»3 HondallororySeMce.00m ,4coREY CERTIFICATE OF LIABILITY INSURANCE �"'� DATE(MM/DD/YYYY) 11 /22/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to 1 the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Occidental Risks Services, Inc 11890 SW 8st Suite 500 Miami, FL 33184 Phone (305) 433-4068 Fax (888) 678-2045 CONTACT Vicky Fernandez (PpNIcC N Exn: (305) 433.4068 l No): (888) 678-2045 ADD IIESS: V1Cky©ocddentalrisks.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : International Insurance Company of Hannover INSURED The Narsha Group LLC 212 SW 3rd Avenue #600 Miami, FL 33129 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POUCY NUMBER POUCY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMITS A V COMMERCIAL GENERAL LIABILITY CLAIMS -MADE V OCCUR ❑ N IG06A005511-02 08/08/2016 08/08/2017 EACH OCCURRENCE $ 1,000,000.00 DAMAG❑ ENTED PREMISESO(Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 ❑ PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLES PER: P❑ POLICY ❑ JECT ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE UABIUTY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS NON -OWNED HIRED AUTOS ❑ ❑ AUTOS ❑ ❑ COMBINED arnSINGLE LIMIT(E) $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident) ) $ PROPERTY DAMAGE (Per accident) $ $ , ❑ UMBRELLA UAB ❑ OCCUR ❑ EXCESS LWB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / NER ANY PROPRIETOR/PARTNER/EXECUTIV N /A go PER ❑ 0T E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) General Contractor • CERTIFICATE HOLDER CANCELLATION 1 Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �_,---' L i . . T 1 ACORD 25 (2014/01) QF © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P. 4I 1- a .. 'a'TU FIAI.J 1 1" f-".fir iT. + ' 3 N. r !1-i \ 1( 1t1,: 3'1AJi:a Tr39,:3 -14T 1 • 1 1' rr.1A J3"3 Sqt rtr'r '+1 1 T •.1 8A ( 1 s4 1';iif17:1 �� AE V. 3'i. TI:. 1 3 •��.. �! li :]1.. 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Irs` [ TO: FROM: DATE: Department of Regulatory:and Economic Resources Board Administration Section 11805 SW 26i° Street (Coral Way) • Room 230 Miami, Florida 33175-2474 Telephone 786-315-2573 Fax 786-315-2570 www.miamid.ade goy/development MEMO II B ,'I t 'ne i t s in iami Dade County ecreta o the Board Board of ' isles and Appeals December 1"t, 2016 SUBJECT: Certificate of Reinstatement The Narsha Group LLC Luis Felipe Naranjo, Qualifying Agent 1444 Biscayne Boulevard, Suite 115-9 Miami, Florida 33132 State License #CGC1511070 As a result of the Board of Rules and Appeals meeting held on September 22, 2016, it was previously advised that the above Contractor's permitting privileges were administratively suspended in Miami -Dade County. This is to inform your Department that the above Contractor's permitting privileges have now been ADMINISTRATIVELY REINSTATED in Miami -Dade County. If you have any questions concerning this matter, please do not hesitate to contact Daniel Vuelta, Contractor Enforcement Supervisor at 786-315-2562 or via 'email at DV045nmiamidade.gov. Scanned by CamScanner Arlenis Silvera From: berkeys@bellsouth.net Sent: Thursday, May 01, 2014 4:42 PM To: Arlenis Silvera Subject: possible extension on Permit NO FW-10-13-2332 Importance: High Dear Arlenes, or (Building Dept) Permit NO FW=10-13-2332 As a safe measure I am requesting a very small extension because our Permit ends this Sunday and I would have needed the inspection done Monday morning after our new Gates are hung. The work would have been done by Permit deadline but the inspection would end up falling on Monday 12 hours after deadline of permit. I ask ever so kindly that I not have to pay $75 for a 12 hour extension, or even 5 days as Arlenes suggested to avoid any changes after inspection. It's just Anthony Florres put a deadline on us to paint our entire perimeter wall a couple weeks ago, delaying work on the gate. I still will have it done on time, but the permit ends on Sunday. As a 11 year resident of Miami Shores that has no choice to do my own upgrades and House work because of economic reasons, I ask ever so kindly that is taken in consideration. Steven Berkey 251 NE 98th Str Miami Shores, FL 33138 cell 305-333-9932 I� - o 4l_ ' I tt . d fiapc,Ev~t er):; i