RC-16-2898 (3)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 BUILDING PE MIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 8C1 IVFi Wei 4 1 (S+C{Pit City: Miami Shores Folio/Parcel#: (-/ - 2(3 - 01l -0 SS(3 Occupancy Type: Load: County: Construction Type: Master Permit No. Sub Permit No. ❑ REVISION ❑ EXTENSION RECEIVEL APR 24 2018 S FBC 20N �CI131 b 2$6a El RENEWAL [g CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip:33/(0 ) Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Qq ►'llr 1 POLte,I Address: Bci Ne 1 oc+ City: ivy) &U l l State: FL_ Phone#: gS - (132 (o(p6 Tenant/Lessee Name: Phone#: Email: Zip:S3/ b I CONTRACTOR: Company Name: SR- 12 0 1 Copliv�.cf u Co f Phone#: 5- �93& _No Address: gyp, " 1 O SIASQo (* • J City: coci,V1 State: FL Zip: 333 Qualifier Name: l /I 6AR) I 'n - - oni 0 State Certificatioh or. Registration #: G .C. is) Z 15 I Certificate of Competency #: } Phone# DESIGNER: Architect/Engineer: - Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Z i 060 Type of Work: ❑ Addition Alteration w Description of Work: .. t V {2, r 1'OQ' c,evk Square/Linear Footage of Work: ❑ New ❑ Repair/Replace wiotX e ir i . ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's'Name (if applicable) . Bonding Company's/Address i City f I - -- State Zip Mortgage Lender's Name (if'applicable) i Mortgage Lender's Address City „N 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 approved and a reinspection fee will be charged. Signature 2 h OWNER or AGENT The foregoing instrument was acknowledged before me this Z`mil day of f\-pc \, ,20 ,e ,by G 1p JCtc1Y(J+1 Q.,1 , who is personally known to me orwho has produced 'N 1 as identification -and who did take an oath. NOTARY PUBLIC: S Print: Seal: APPROVED BY ARAI K. GONZALEZ '**** MY COMMISSIS •• :*- S: November 2, 2020 'O= Notary Pu • w ... . • •e- edThN "4;a:N.0 Bond Signature CONTRACTOR The fore oing instrument was acknowledged before me this 2. day of 47y-1 , 20 by I/ W r c holis�Ce�rsUona I own to l` I �1.� �1T�1 ��Nll, P � me or who has produced 1 1 1(9,r) as identification and who did take an oath. NOTARY PUBLIC: Sign Print: Seal: Plans Examiner Structural Review 1 1:a :P�'•. MAHARAI K. GONZALEZ �� ,.. MY GVMMISoiON s Gu 044b02 "..°` ,o EXPIRES: November2, 2020 '•r„or ,.' bonded Thru Notary Public Underwriters Zoning Clerk (Revised02/24/2014) Notice to Owner — Workers' Com 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. Signature: 71 1 Ov$ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2LI day of Kr 11 , 20 By I QQ 1 () 1 1 ecou i(QXI-0 who is personally known to me or has produced as identification. Notary SEAL: �:'�e'• MAHARAI K. GONZALEZ • .�, •C = MY COMMISSION # GG 044602 d EXPIRES; November 2, 2020 ,,f, •yes''' Bonded Thru Notary Public Underwriters April 24th, 2018 State of Florida County of Miami Dade S L BUILDING CONTRACTORS CORP. SFL CONTRACTOR .COM CERTIFIED GENERAL CONTRACTOR Before me this day personally appeared Michel Alfonso who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 89 NE 109th Street, Miami Shores, FL 33161 Michel Alfonso-1 to V YQ CIO Certified General Contractor CGC1512151, Mobile 954-636-0101 SFL Building Contractors Corp. 6190 SW 56 Ct. Davie, Florida 33314 PH: 954-600-4066 FAX: 888-908-1043 Email: michel.alfonso@sflcontractor.com Personally know 11 Or produced identification Or Type of identification produced MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters Print, type or stamp name of Notary Owner's Name (Fee Sim le Title Holder): Owner's Address: SLA-p_ t© `t. City: 4,Ac' -Nc 'i\o ce S Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 r1[ CHANGE OF CONTRACTOR / ARCHITECT Permit N. L i%ti `D4g 'SaQru 4; Iket.Neudr PaAcA y pcot.e.k Phone #: 345•a8 t-65SCk State : \O't`4.4� Zip Code: 3 \ 6e Job Address (Of where work is being done): E3CA, N. R. OSS. S* City: Miami Shores State: Florida Zip Code: J 3 6 I l J � Contractor's Company Name: in ilk/Phone #: Address: Inc; D pPGCv 1'-P.1✓ City: I\k i CAM Qualifier's Name : Or. State: F, Architect/ Engineer of Record Name: Address: City: / State: Zip Code: Describe Work: -*,t/ 'iGY�PiUG!/�!t'/CAi (bit/Ore k .Salo, h�n, /34/4rwwMS hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. :cos - i i-q Rqi Zip Code: \ Lic. Number: C - JS01 j.3 t 4- Phone #: Signature Signature The foregoing instrument was aknowledged orbefore me this day of NIA I ,20 y� Y Who is personallylyknow t me or who as produced as indentification. MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Thni Notary Public Underwriters e fore this who i Contractor or Architect ing instrument was aknowledged before me day of 'QP 'S \ , 20 i gby ersonally know "p me or who has produced Notary, Sign: Seal: blic: as indentification. y Dawn Marie Leighton O, NOTARY PUBLIC Si' STATE OF FLORIDA Comm# GG110341 Expires 5/31/2021