RC-17-2158Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. RC-$-17-2 58
Permit Type: Residential Construction
WorkClassification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 10/24/2017
Expiration: 04/22/2018
Parcel Number
Applicant
5 NW 105 Street
Miami Shores, FL
1121360050320
Block: Lot:
DEBORAH LEONE
Owner Information
Address
Phone
Cell
DEBORAH LEONE
5 NW 105 ST
MIAMI FL 33150-1241
Contractor(s)
HIBISCUS CONSTRUCTION CO.
Phone
(305)815-6870
CeII Phone
Valuation:
Total Sq Feet:
$ 16,500.00
0
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: REPAIR STRUCTURAL DAMAGE T
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return :
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Plan Review Fee (Engineer)
Scanning Fee
Technology Fee
Amount
$10.20
$7.43
$4.95
$3.40
$495.00
$60.00
$9.00
$13.60
Total: $623.58
Pay Date Pay Type
Invoice # RC-8-17-6'4994
08/25/2017 Check #: 1384 $ 50.00 $ 573.58
10/24/2017 Check #: 1504 $ 573.58 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Foundation
Window and Door Buck
Fill Cells Columns
Wire Lathe
Truss lnsp
Columns
Review Mechanical
Declaration of Use
Review Electrical
Review Electrical
Review Building
Review Structural
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Plumbing
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 A : I certify that all the foregoing ' •rmation is accurate and that all work will be done in compliance with all applicable laws regulating
constr on and zoning. Futhermore, I authorize the above- ed contractor to do the work stated.
October 24, 2017
Authori • nature: Owner /
ant / Contractor / Agent Date
Building Department Copy
October 24, 2017
1
r4;0c4
3��^ cif 6
n
\O` BUILDING
PERMIT APPLICATION
•BUILDING ❑ ELECTRIC
❑PLUMBING- ❑ MECHANICAL
JOB ADDRESS: 5 NW 105 st
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
Master Permit N
Sub Permit No.
5144
C20/Y
❑ ROOFING ❑ REVISION ❑ EXTENSION
❑ PUBLIC WORKS CHANGE OF ❑ CANCELLATION
CONTRACTOR
❑RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores
Folio/Parcel#:11-2136-005-0320
Occupancy Type:
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
Load: Construction Type: CMU Flood Zone:
OWNER: Name (Fee Simple Titleholder): Deborah Leone
Address: 5 NW 105 st
BFE:
NO
FFE:
Phone#:
City: Miami Shores
Tenant/Lessee Name: N/A
Email:
State: FL Zip:
Phone#:
CONTRACTOR: Company Name: Hibiscus Construction Co
Address: 166815 NW 18 Ave
Phone#: 305-815-6870
City: Miami
Qualifier Name: Phaion Hicks
State: FL Zip: 33056
Phone#:
305-815-6870
State Certification or Registration #: CGC 1517816 Certificate of Competency #:
DESIGNER: Architect/Engineer: SMK Consultants
Address: 2540 NW 155 Terr
Value of Work for this Permit: $ 16,500
Type of Work: ❑ Addition ❑ Alteration
Phone#: 305-815-6870
City: iviiami
Square/Linear Footage of Work:
State: FL Zip: 33056
❑ New El Repair/Replace n Demolition
Description of Work: Repair structural damage to CMU exterior wall North East corner of house
Specify color of color thru tile:
Submittal Fee $ 5 ` Permit Fee $ 414% , CO
Scanning Fee $ Radon Fee $ '-1
Technology Fee $
Structural Reviews $ vV •
CCF $ - CO/CC $
DBPR $ R' LL3 Notary $
�.r
Co a
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ E 3 ` 6.8
(Revised02/24/2014).
Bbnding Company's Name (if applicable) N/A
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: 1 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.
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this , I The f egoing instrument s acknowledged before me this
day of flu1.-•,•20 1 -7 ; by" day of , 20 1 _by
Lee,yle , who is personally known to `- r , who ' personally known to
me or who has produced 14.... L_ j. as r6br who has produced
LSDU,)CoSVLo
identification and who did take an oath.
NOTARY PUBLI :
Sign:
Print: (eorLQ Q )ve; l
— —___.-.-4.10-4.— „,
Seal: r trw-
GE01NE O'NEILI
Notary Public - Mots of Reeds
Commission # FF 988412 L-V2 (,/2 a
identification and who • take an oath
NOTARY PUBLIC:
as
APPROVED BY
Sign:
Print:
Seal:
Plans Examiner
Structural Review
ssi:•5" W e �
`
,1 otary Public - Slate of Florida
• Commission # FF 962521
V- My Comm. Expires Jun 5,
°'�o m sts's Bonded through National Notary Assn.
********
Zoning
Clerk
(Revised02/24/2014)
Property Search Application - Miami -Dade County
TY
Summary Report
Property Information
Folio:
11-2136-005-0320
Property Address:
5 NW 105 ST
Miami Shores, FL 33150-1241
Owner
DEBORAH LEONE
Mailing Address
5 NW 105 ST
MIAMI, FL 33150-1241
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds / Baths / Half
2 / 2 / 0
Floors
1
Living Units
1
Actual Area
1,379 Sq.Ft
Living Area
1,324 Sq.Ft
Adjusted Area
1,242 Sq.Ft •
Lot Size
9,225 Sq.Ft
Year Built
1941
Assessment Information
Year
2017
2016
2015
Land Value
$198,007
$166,118
$166,118
Building Value
$89,157
$89,227
$82,267
XF Value
$20,403
$20,403
$13,083
Market Value
$307,567
$275,748
$261,468
Assessed Value
$103,199
$101,077
$90,734
Benefits Information
Benefit
Type
2017
2016
2015
Save Our Homes
Cap
Assessment
Reduction
$204,368
$174,671
$170,734
Homestead
Exemption
$25,000
$25,000
$25,000
Second
Homestead
Exemption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
DUNNINGS MIAMI SHORES EXT NO 1
PB 41-51
LOT 16 BLK 203
LOT SIZE 75.000 X 123
OR 12244-2479 0884 1
Page 1 of 1
Generated On : 8/25/2017
Taxable Value Information
2017
2016
2015
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$53,199
$51,077
$40,734
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$78,199
$76,077
$65,734
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$53,199
$51,077
$40,734
Regional
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$53,199
$51,077
$40,734
Sales Information
Previous Sale
Price
OR Book -Page Qualification Description
08/01/1984
$65,000
12244-2479 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:
http://www.miamidade.gov/propertysearch/
8/25/2017
01"E _ STATE OF FLORIC
DEPARTMENT OF biJSINESS AND PROFESSIONAL Rt 3ULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
HICKS, PHAION P
HIBISCUS CONSTRUCTION CO.
16815 NW 18TH AVENUE
MIAMI FL 33056
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridalicense.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
LICENSE NUMBER
CGC1517816
•
(850) 487-1395
STATE OF FLORIDA ,
DEPARTMENT.OFrBUSINESS AND
PROFESSIjIAL'REGULATION
CGC1517816, .0,SSA,:"; 6/20/2017
CERTIFIED GENERAL:CONTBACTOR
HICKS, PHAION.R k yK
• HIBISCUS CONSTRUCT101�t`� ,:41
IS CERTIFIED under^the provisions' of.Ch.489_FS--
'Expiration date : AUG 31; 2018 L1706200000633
DETACH HERE
MATILDE MILLER, INTERIM SECRETARY
STATE OF, FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION`
CONSTRUCTION. INDUSTRY LICENSING -BOARD'
The GENERAL CONTRACTOR
Named.below IS CERTIFIED
Under the provisions of Chapter489 FS.
Expiration'date:y"AUG 31;'2018
HICKS PHAION'P,.
HIBISCUS CONSTRUCTION CO.-
16815 NW1.8TH AVENUES `^^
MIAMI .F.L"33056=•
DISPLAY AS REQUIRED BY LAW SEQ # L1706200000633
ISSUED: 06/20/2017
•
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
6715172
BUSINESS NAME/LOCATION
HIBISCUS ROOFING AND
CONSTRUCTION INC
16815 NW 18 AVE
MIAMI GARDENS, FL 33056
RECEIPT NO.
RENEWAL
6988498
OWNER SEC. TYPE OF BUSINESS
HIBISCUS ROOFING & CONSTRCTN 196 GENERAL BUILDING BY TAX COLLECTOR
INC CONTRACTOR
EXPIRES
SEPTEMBER 30, 2017
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
Worker(s)
MIAM
1 CGC1517816
PAYMENT RECEIVED
45.00 07/25/2016
CREDITCARD-16-043582
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 and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276.
For more information, visit www.miamidade.gov/taxcollector
•
JIMMY PATRONIS
CHIEF FINANICAL OFFICER
STATE OF FLORIDA
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.
0.
EFFECTIVE DATE: 8/3/2017 EXPIRATION DATE: 8/3/2019
PERSON: HICKS PHAION
FEIN: 205482142
BUSINESS NAME AND ADDRESS:
HIBISCUS CONSTRUCTION CO.
166815 NW 18 AVE'
MIAMI GARDENS FL 33056
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor Licensed Plumbing Contractor
IMPORTANT: Pursuant to Chapter 440.05(14), 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 440.05(13), 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.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
16815 NW 18 Ave.
Miami, FL 33056
(305) 815-6870
(954) 324-ROOF
CGC 1517816
10/17/2017
State of Florida
County of Miami -Dade
Before me this day personally appeared Phaion Hicks who, being duty sworn, deposes and says:
That he will be the only person working on the project located at:
5 NW 105 St
Miami Shores
Sworn to and subscribed before me this 17th day of October 2017 by kaiou-
personally known
Notary stamp
RICKELLE D WILLIAMS
fate of Florida • Notary Public
Commission 0 FF 140650
My Comm. Expires 07.11•2018
Bonded through
Ams$afeteu
fl so
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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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this Z �!
By biffstr,4, halt.
day of 0 CIO bet—,20a .
who is personally known to me or has produced
FL as identification.
Notary:
SEAL:
RICKELLE D WILLIAMS
��" State of Fio'ida - Notary Public
?�iq ; Commission M FF 140550
s My Comm. Expires 07-11-2015
h,,ro,11 `ts Branded Through
American safety Council
■
ID: r3
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-288566 Permit Number: RC-8-17-2158
Scheduled Inspection Date: August 14, 2018 Permit Type: Residential Construction
Inspection Type: Final
Owner: LEONE, DEBORAH Work Classification: Addition/Alteration
Inspector: Naranjo, Ismael
Job Address: 5 NW 105 Street
Miami Shores, FL
Project: <NONE>
Contractor: HIBISCUS CONSTRUCTION CO.
Phone Number
Parcel Number 1121360050320
Phone: (305)815-6870
Building Department Comments
REPAIR STRUCTURAL DAMAGE TO CMU EXTERIOR
WALL NORTH EAT CORNER HOUSE.
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
'Yct?
August 13, 2018
For Inspections please call: (305)762-4949
Page 3 of 39