PW-18-2319Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
mit
Permit NO. PW-8-18-2319
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 8/30/2018
Expiration: 11/28/2018
Parcel Number
Applicant
1223 NE 102 Street
Miami Shores, FL 33138-
1132050250140
Block: Lot:
LEMAY & ALEJANDRA SANCHE
Owner Information
Address
Phone
Cell
LEMAY & ALEJANDRA SANCHEZ
1223 NE 102 Street
MIAMI SHORES FL 33138-
(786)514-0776
1223 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s)
HABITAT GROUP INC
Phone
(786)299-9903
Cell Phone
Valuation:
Total Sq Feet:
$ 2,150.00
480
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW-8-18-68729
08/30/2018 Credit Card
Amt Paid Amt Due
$ 104.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
In consideration of the iss ance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto an• stric conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Mianii Shores Village. In
accepting this perm I assu e r2 . onsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECT ICAL, ^L < =ING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAV
constructio. and .AIL g. Futhermore
all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
e wove -named contractor to do the work stated.
August 30, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
August 30, 2018 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Inspection Number: PW-000121-2018
Permit Number: PW-8-18-2319
Scheduled Inspection Date: September 25, 2018
Inspector: Miranda, Chris
Owner: LEMAY & ALEJANDRA SANCHEZ
Address: 1223 NE 102 ST
MIAMI SHORES, FL 33138
Project: <NONE>
Contractor: HABITAT GROUP INC
JOHN DUQUE
Permit Type: Public Works
Inspection Type: Public Works Final
Work Classification: Public Works
Phone Number: 7865140776
Parcel Number: 1132050250140
Phone Number: 7862999903
Building Department Comments
APPROACH CONCRETE, REPAIR SIDEWALK
Checklist Item
General Comments
Passed
False
Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments,
/00 -t-
September 24, 2018 For Inspections please call: 305-762-4949
Page 29 of 39
Miami Shores Village
BuildingDepartment p RECEIVED. 318 ,.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138"` 1 °�j)
AUG 3 i •118
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑ ROOFING
LQ
FBC 2011
Master Permit No. iS Cia• - 2W S
Sub Permit No. PIN `e. 2S 19
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING D MECHANICAL QPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: 1223 NE 102 Street
City:
Folio/Parcel#:
Occupancy Type:
Miami Shores County: Miami Dade
Zip:
1I — 37_O S — O2C O 1 e4 0 Is the Building Historically Designated: Yes
Load:
Construction Type: Flood Zone:
BFE:
❑ SHOP
DRAWINGS
NO
FFE:
OWNER: Name (Fee Simple Titleholder): CaCinn Al cAnSNILZ Phone#:
Address:
1223 NE 102 Street
City: Miami Shores State: FL. Zip: 33138
Tenant/Lessee Name: Phone#:786 514-0776
Email•
CONTRACTOR: Company Name: Habitat Group Inc.
Address: 1119 NE 8th St.
Phone#: 954 410-6364
City: Hallandale Beach State: FL Zip: 33009-
Qualifier Name: JOHN DUQUE Phone#: 954 410-6364
State Certification or Registration #: CGC1513855r Certificate of Competency #: •7862999903
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $ 4 2.l SZ'
Type of Work: ❑ Addition ❑ Alteration
Description of Work: N1 i Co
State: Zip:
Square/Linear Footage of Work: 412o 5ttk} .
❑ New ® Repair/Replace ❑ Demolition7C
c:ONc 002— 'Q C si
iL6, y'r f
Specify color of color thru tile:
Y11.•Ilir"1•'::
Submittal Fee $ Permit Fee $ I DO
Scanning Fee $ Radon Fee $
Technology Fee $ - 81 Training/Education Fee $
Structural Reviews $
CCF $ • CO/CC $
DBPR $
.•`? Notary $
0.2.0
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
f
City State Zip
Mortgage Lender'sName (if applicable)
Mortgage Lender's Address
City State'
r
Zip ri.�,..
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'regulatirigr
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
t. t
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. r•
"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 issu d. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature/� _� �"``�/�� `�� Signatu
owsro NT
The foregoing instrumentwas ackn ledged before me this
2-9 -day of � us ,20j0 . ,by
((
62)1'14 ' - Scz%, %�c 'who is personally known to
me or who has produced . as me or who as pro
identification and who did take an oath. identification and w
NOTARY PUBLIC:
e
1,
The foreg
2
CONT CTOR : ' t" :42
x � sf :�mom
i : iristru nt was acknowledged befor Aft
-fir 4 N3oiS
day of , 20 ,A t N Igr
!Val')
W_
NOTARY PUBLIC:
Sign:
111144
Print: yan�GtY'r LYf M.$2
Se's Commission yr># GGt 79635
;,v .,. Expires: January 28, 2022
//��si o� Bonded thru Aaron Natar
Y ,
APPROVED BY
e.
Sign:
Print:
Seal:
uce
11 did take an oath.
• - % 6
!
********************************************************************
LV' (, I
;Plans Examiner
Structural Review
3 _
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 BELDW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
ner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
2'i day of A cliS f , 20 (,5
By LQtrl Xmas►1 C4. �Z who is personallyknown to me . r has produced
as identification.
Notary: i i I:A. ASZ
SEAL:
'i9:1i%i -Yanahyri Chinea
Commission if GG179635
fir 1 s • .�_ •, Expires: January 28, 2022
Bonded thru Aaron Notary
r/11 /2018
fl
IMG 5911.jpg
OOD We
JIMMY PATRONIS STATE OF FLORIDA
CHIEF FINANICAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * TIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CERTIFICATE
CONSTRUCTION INDUSTRY EXEMPTION
This ce
rtifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 12/18/2017
EXPIRATION DATE: 12/18/2019
PERSON: JOHN DUQUE
EMAIL: HABITATGROUP@HOTMAIL.COM
FEIN: 204962611
BUSINESS NAME AND ADDRESS:
HABITAT GROUP, INC.
11900 NE 8TH ST.
HALLANDALE, FL 33009
SCOPE OF BUSINESS OR TRADE:
Door and Window Installation
a All Types ❑ Residential and
Commercial
12 F.S., Certificates of election exempt... apply
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporationurs ant to Chapter 4d0 05(tion 0� this chapter by filing a certificate or election under
IMPOexempt.Pursuant 5tChapter 44e.05(19e. F.S., coon to be election to be
o this section the may not recover theher business
fits or compensaion the e notice
r this chapter. time utter the filing t the 0.05(3) the ., Notices
es of evoke) to , the
onexe within scope of or tradeeelisted t shall be subject to revocation beat any
person aamedroni th en of election cn to be no
uon for
I s of issuance
section.
a
person named on m forlfailce 0 a ofrthe person onamed ontthe certificatelonmeet tthe requirements
for issuance of a certificate. The department
certificate at any t
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13
vv.mmr :-4WD' dxa . ., a;r:•+.,rsRAVY
u_.s:��.
QUESTIONS? (850)413-1609
1
Habitat Group
DATE: 8/29/2018
STATE OF: Florida
COUNTY OF: Miami Dade
Before me this day personally appeared John Duque who, being duly sworn, deposes and says:
That he or she will be the only person working on the project located at:
1223 NE 102 Street, Miami Shores, FL 33138.
ontractor Signature
tiostiUi
� .••\4pTA,9 y.;c(�� -
MY Comm. Expires • "
i December 30, 2018
—
No. FF 188517 / Z.
1111111.10
Sworn to (or affirmed) and subscribed before me this 27 day of August 2018,
By k A ((.c.-Q .
Personally know
Or Produced Identification
Type of Identification Produced
111111111111111111111111111111111111111111111
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
STATE OF F
(HEREBYCE
cttinat Aled i
C FN 2 0 18R,. CI 464432
OR BK 31083 P3 2695 i.1Pasi
RECORDED i t /01/201. 10:5 :1.-,
ARVEY RUIN? CLERK OF f:OURT
rIIANI-DADE COUNTY FLORIDA
ORIDA• COUNTY OF DADE
7 fhFY that thk is a true c pv of the
) this el' on / 91' f
A.D.20 ..
COVENANT OF CONSTRUCTION WITHIN RIGHT OFF r and
Whereas, (owner) n- '� �CZvtC1`t�c Z RR1� CL
hereinafter referred to as the ow er of the following de cs�nb
property (address): 12-2-3 N C., OA 5-1-12X r •
Legal Description: Lot (0 Block / 8'6 Subdivision
Folio# lap •1-o5.--Qz --Ot- O
Requests permission to install (describe work):
Within the public right of way of (address)
I2--L? l'02.Ct—•
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to
make repairs or maintain said items within public right of way including restoration of street by
reason of. the Owner's failure to do so, such expense shall be paid by the Owner or shall
constitute alien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result in the
Village causing the item(s) to be removed and a lien being placed on the property and/or
assessed against the Owner for all costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running
with the land and shall remain in full force and effect and be binding on the undersigned, their
heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in
the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village
(or his fully autho ' ed rep ative).
Signature
Owner or Agent
State of Florida
county of Miami Dade
Me foregoing instrument was acknowledged before me this
1
+OT,
Sig
Print:
• ,,os Pops MAHARAI K. GONZALEZ
•
e+•• MY COMMISSION # GG 044602
±,;; EXPIRES: November 2, 2020
:am
• pF ,Z,�.� Bonded Thru Notary Public Underwriters
\ day of , 2
IMEKSLE.who is personally known to me or who has p duced
as identification.
IC:
•
'\UrO,ECG1 bufl7 ( C.2 •
SEAL:
y