RC-16-2061Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
issue Oat r;
'PerMif NO. RI
Pe>rnit Type: ;ResidentialConstruction
Wotir Classification: °Alteration
Permit Status;, APPROVED
2/2016
Expiration: 02/08/2017
Parcel Number
Applicant
42 NW 101 Street
Miami Shores, FL 33150-
1131010180250
Block: Lot:
DARYL AND MONICA BRANTON
Owner Information
DARYL AND MONICA BRANTON
Address
Contractor(s) Phone CeII Phone
CONWELL & ASSOCIATES CONSULT (305)962-5673 (305)926-5673
Phone
tion:
Total Sq Feet:
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: KITCHEN REMODEL AND NEW BA
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return :
Fees Due
CCF
CO/CC Fee
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning`Fee
Technology Fee
Total:
Amount
$9.00
$50.00
$6.75
$6.75
$3.00
$5.00
$450.00
$12.00
$12.00
$554.50
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback: L,` j )BatIShoms:
iL.k cate Status:
Additional Info:
Classification:
yet,
Pay Date Pay Type
Invoice # RC-7-16-60704
07/21/2016 Check #: 1308
08/12/2016 Credit Card
it
lagid4nt Due
$ 150.00 $ 404.50
$ 404.50 $ 0.00
tato
Cell
$ 15,000.00
Available Inspections:
ll1 ion Type:
IT bi: E,')✓ertification
Win"dow DooitAttachment
Framing '., 1; ;7*` ,,16.4._
Insulation -4, 1."`',. "
Drywall Screw
Fill Cells Columns
Window and Door Buck
Review Planning
Review Electrical
Review Electrical
Review Building
Review Plumbing
Review Mechanical
Review Structural
In consideration of the issuance t
pertaining thereto and in strict co
accepting .this permit I as
required for ELECTRICAL
i
gnatureT Owner / Applicant / Contractor / Agent
Building Department Copy
of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
ility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
ANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
the above -named contractor to do the work stated.
OWNERSP`AF VIT:
construction and ni
Au iLd
August 12, 2016
Date
August 12, 2016
1
•
Construction Type: Flood Zone: BFE:
4i
City: Miami Shores County: Miami Dade
Folio/Parcel#:.Is the Building Historically Designated: Yr
ott
64214 ':Phone#: ' -76t -C(..J6
Address: ,M�,/ / / s--� - 7
��
City: �4,tui ( �t 7 2 State: ' �� Zip: %j/`�c/,v
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
PERMIT APPLICATION
r`
BUILDING 0 ELECTRIC ❑ ROOFING
❑ REVISION
FBC2019S
Master Permit No. RC-1(1/ "9 I
Sub Permit No.
▪ EXTENSION 0RENEWAL
ID PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS:
ikik-1 to/
❑ CANCELLATION ❑ SHOP
DRAWINGS
Occupancy Type:
Load:
OWNER: Name (Fee Simple Titleholder):
Tenant/Lessee Name: '
Email:
Phone#:
Address: _ ^ ,, ,,
City: / 1 i ,4 tt ( State:
Qualifier Name:
State Certification or Registration #C l S3/0l' Certificate of Competency #:
CONTRACTOR: Company Name: C/OiJi - < C
- ( S0, taL
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ di
Type of Work: ❑ Addition
Description of Work:
(069CANCEL
o
Phone#:
Phone#:
,) c(S—y
7 C • -274'
ft
Phone#:
L E y: State: Zip:
Square inear Footage of Work: %'3 07
Alteration --New ❑'Repair/Replace,
y(ET . 7 c L f o e&�
(OtJJ) ; , -
f.
n Demolition
Specify color of color thrutile: .
Submittal Fee $ 5iV•YPermit Fee,$
Scanning Fee $ ' Radon Fee $
sow
• 9S
Technology Fee $ / 2 ' q Training/Education Fee $
Structural Reviews $
CCF$ `
DBPR $ 6.
3 •w
Co/CC $ 5 0`
Notary $
Double Fee $
Bond $ u�/} (j +
TOTAL FEE NOW DUE $ T V 53
(Revised02/24/2014)
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 attachmen . l .; a ertified copy ofthe-recorded-notice-of commencerneminust'be got"e?t-cTt"the jab-Va.--
for the first inspection which ..c seve (7J says after'the building permit is issued. In the absence of such posted notice, the
inspection will not be approve. ' d a reinspect'. n fee will be , harged.
Signature
0 NER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
al day of CO , 20 It ' ' , by �/, day of /4
Taira-
, ^ho is personally known to W-eh F.6 lt , w
me or who has produced_ ' as r or who has produced as
,20 i w
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
000
��. x't;dfication and who did take an oath.
�s\NOTARY PUBLIC:
Sign: v7
Print:
Seal:
*****************************************************************
APPROVED BY
Plans Examiner
Os.f6S
Zettie Jones
„f COMMISSION S FF209081
- EXPIRES: March 14, 2019
by
Zoning
(Revised02/24/2014)
Structural Review
Clerk
JEFF ATWATER
CHIEF FINANCIAL 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.
EFFECTIVE DATE: 6/8/2016 EXPIRATION DATE: 6/8/2018
PERSON: CONWELL KENNETH F
FEIN: 383763521
BUSINESS NAME AND ADDRESS:
CONWELL & ASSOCIATES CONSUTLING COMPANY
11771 SW 137 PL
MIAMI FL 33186
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED PLUMBING
LICENSED ROOFING HEATING, VENTILATION,
CONTRACTOR CONTRACTOR CONTRACTOR AIR-COND
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
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
CONWELL & ASSOCIATES
11771 SW 137 Place
Miami, FL 33186
Tel: 305-926-5673
Fax: 305-385-7827
May 4, 2016
Miami, Florida
Dade County
Before me this day appeared Kenneth F Conwell who, being duly sworn, deposes and says:
That he will be the only person working on the project located at 42 NW 101st St Miami Shores,
Florida.
Sworn to(or Affirmed) and subscribed before me this 4th day of May 2016, by:
Kenn th Conwell/ Conwell & Associates
/PersonaIIy Known
*esi 10
Notary
Zettie Jones
COMMISSION # FF209081
EXPIRES: March 14, 2019
WWW.AARONNOTARY.COM
Miami Shores Viiiage
Building Department
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 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
workers' compensation ins
BY SIGNING BELOW
CONTENTS.
Signature:
r project. In these circumstances, Miami Shores Village does not require verification of
m the contractor's company for day labor, part-time employees or. subcontractors.
DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 94 day of
ByTVt- A r rttriN
,20it(
who is personally known to me or has produced