DEMO-18-2165Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
errnit
Permit ivo. DEMO-8-18-2165
Permit Type: Demolition,
Work Classification: Building
Permit Status: APPROVED
Issue Date: 9/5/2018
Expiration: 03/04/2019
Parcel Number
Applicant
909 NE 99 Street
Miami Shores, FL 33138-
1132060340230
Block: Lot:
VASCO PINTO BAPTISTA LOPE:
Owner Information
Address
Phone
CeII
VASCO PINTO BAPTISTA LOPES DA 909 NE 99 Street
- - - MIAMI SHORES FL 33138-
(305)606-2285
909 NE 99 Street
MIAMI SHORES FL 33138-
Contractor(s)
ROTH DESIGN BUILD, LLC
Phone
(954)825-7638
CeII Phone
Valuation:
Total Sq Feet:
$ 2,500.00
465
Type of Demo: Building
Additional Info: DEMOLITION OF EXISTING KITCHEN CABI
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.00
$2.00
$0.60
$100.00
$9.00
$2.40
$117.80
Pay Date Pay Type Amt Paid Amt Due
Invoice # DEMO-8-18-68547
09/05/2018 Credit Card $ 67.80 $ 50.00
08/14/2018 Check #: 1495 $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Electrical
Review Electrical
Review Building
Review Plumbing
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 ELECTRIC , -LUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A [DAVIT: ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construct - ,and zo. ?. - uthermore, I authorize the above -named contractor to do the work stated.
September 05, 2018
zed Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 05, 2018
1
k: Y. 1iGO Vf V %oW vortuW» G�,IUbU - �.W4
BUILDING
PERMIT APPLICATION
UILDING ❑ ELECTRIC
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
❑ ROOFING
PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: CM )%5 114
City: Miami Shores
Folio/Parcel#: 11' 32ot 'O ' 0230 Is the Building Historically Designated: Yes
Occupancy Type: R.,J Load: Construction Type: 4 e Flood Zone: 1/is. BFE:
Master Permit
RECEIVED
AUG 14 2018
FBC 20Pc
No. `C,m0e-24S
Sub Permit No.
❑ REVISION ❑ EXTENSION
❑RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County: Miami Dade
OWNER: Name (Fee NSimple`Titleholder): i wed � so
Address: t�' 1 V 11 er
City: Mimi L yopti State:
Zip: 651aS
NO X
FFE:
Phone#: SCS 400( ''1216S
Zip: 3 3 1 3 t
Tenant/Le se'e Name: _ Phone#:
Email \ ..-y-aistor Ise 611.44ivcov1
CONTRACTOinp R:.Coanq Na-Me: 1 %6k UU4i t2'C/ Phone#:
Addres:: No stL)" ;1st s11 Gr
City:` `.'' IV `iAti i ' State: kl/
Qualifier 'Name:
C.4 'G1&4' 'O
State Certification or Registration #: C 1SZCI 3 Z
Zip/�f� i t {�-
Phone#: ' \' i/4si
Certificate of Competency #: ZCA' $O,IOZT1
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work this Permit: 412.ttO
Square/Linear Footage of Work:
's .OF.
Typ cf.Work:.. {}•.Addition ❑ Alteration n New ❑ Repair/Replace rSr Demolition
Dcscriptioh of War
511304etitt t.af cGa4mTItote.,uv1
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ (G C CCF $ CO/CC $
Scanning Fee $ Radon Fee $ Z - %A DBPR $ Z. . Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 69-• at)
(Revised02/24/2014)
Bonding Company's Narne (if applicable)
Bonding Commpany'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.`,
+ \
ti +
"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."
t
' r4,t1 (
I
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in goodfaiththat 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 thcjob site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such. posted,'nctice, the
inspection "will not be approved and a reinspection fee will be charged.
•'J
Signattire_�_
€— l...,.1
{ • E•`,"Fc,%.1 , NERorAGENT
. _ r 4The foregolttg instrument was acknowledged before me this
k'd r.,.. "' day of,id''C'"� ¥— , 20 k.8 , by
ti , 2 th,W CIO) .9Piiiivho is personally known to
me or who has produced
identification and who did take an oath.
r :''tip`
NOTARYYPUBLIC:.
If
7i
Sign: '' )", .v
Pri-
•• MONI
'Seal: MY GOMMISSION #FF172421
e P
Of ° .EXPIRES October 28, 2018
(407)39e-0153'�- FloridaNut:'ryService.com
*********************************
t•"��
t , I y
....Signatu
CONTRACTOR 1!2-
The foregot g instrument was cknowledged'before me this
%‘..) day of ��^J^"Y � � �< , 20 ..:,� t r , by
, who is personally known to
as me or who has produced as
identification and who did take an oath.
r -
NOTARY PUBLIC:
Sign: t ... - ,.
Print:', l.t...l, „---c 'r,r-.="( —' o.:.i' l
Seal:
*********************
� MONICA{KARRQUM"
MY COMMISSION
EXPIRES October,28,'201'8'
' r
(407) 398-0153 FloridallotaryService:cort(
`
************************************
APPROVED BY Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
Prepared by and Return to:
Richard A. Golden, Esq.
Kramer, Golden & Brook P.A.
1175 NE 125 STREET Suite 512
North Miami FL .313161
KGBPA File #117-18R
Parcel ID Number: 11-3206-034-0230
Warranty Deed
This Indenture, Made this I t M. day of
JOHN E. DOLL and CARME DOLL,
of the County of Miami -Dade
VASCO PINTO BAPTISTA LOPES
wife
whose address is: 909 NE 99 STREET,
CFN: 20180477896 BOOK 31091 PAGE 2370
DATE:08/07/2018 02:44:11 PM
DEED DOC 3,282.00
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
July , 2018 A.D. ,
husband and wife
DA SILVA and
MIAMI SHORES,
of the County of Miami -Dade ,
Witnesseth that the GRANTORS, for and in consideration of the sum of
TEN DOLLARS ($10) DOLLARS,
and other good and valuable consideration to GRANTORS in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, have
granted, bargained and sold to the said GRANTEES and GRANTEES' heirs, successors and assigns forever, the following described land, situate,
lying and being in the County of Miami -Dade State of Florida to wit:
Lots 13 and 14, Block 170, SECTION NO. 8 OF MIAMI SHORES, according
'to the plat thereof as recorded in Plat Book 14, Page 33, Public
Records of Miami -Dade County, Florida.
Between
State of Florida , grantors, and
MARIA JOSE RUBIO, husband and
FL 33138
State of Florida , grantees.
and the grantors do hereby fully warrant the title to said land, and will defend the same against lawful claims of all persons whomsoever.
Laser Generated by 0 Display Systems. Inc 2018 (863) 765-5555 Form FLWD-2
CFN: 20180477896 BOOK 31091 PAGE 2371
Warranty Deed - Page 2
Parcel ID Number: 11-3206-034-0230
In Witness Whereof, the grantors have hereunto set their hands and seals the day and year first above written.
S ed, sealed and livered our presence:
rinted Nam
Witness
JOHN E. DOL
P.O ddr s: 358J ,lARC 7UE', I�QOVER, AL 35226
CARMEN M. DOLL
P.O. Address: 3584 MARC AVENUE, HOOVER, AL 35226
STATE OF Florida
COUNTY OF Miami -Dade
The foregoing instrument was acknowledged before me this / 9 day of July
JOHN E. DOLL and CARMEN M. DOLL, husband and wife
who are personally known to me or who have produced their Florida dx er' s licen •enttfication,
gill 4
ant Nam=
Notar Publi
My Commission Expires:
1 �MIV KERRYDIAZ
,!, ) MY COMMISSION#GG111255
-A.,,,,4; EXPIRES: June 17, 2021
_ 8 ,I,t bonded Thru Nobly Public Underwriters
117 —18R Laser Generated by 0 Display Systems. Inc.. 2018 (863) 763-5555 Form FLWD-2
i
(Seal)
(Seal)
, 2018 by
Prepared by and Return to:
Richard A. Golden, Esq.
Kramer, Golden & Brook, P.A.
1175 NE 125 STREET, Suite 512
North Miami FL 33161
KGBPA File #117-18R
Parcel ID Number: 11-3206-034-0230
Warranty Deed
E-RECORDED
ID- zwi o4/7-7 �c!%
County:WU 0i'Yu- -
Date: 717/1 Time• / Pm
This Indenture, Made this t t M. day of July
JOHN E. DOLL and CARME DOLL, husband and wife
of the County of Miami -Dade
VASCO PINTO BAPTISTA LOPES
wife
whose address is 909 NE 99 STREET,
DA SILVA and
MIAMI SHORES
of the County of Miami -Dade e
Witnesseth that the GRANTORS, for and in consideration of the sum of
TEN DOLLARS ($10) DOLLARS,
and other good and valuable consideration to GRANTORS in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, have
granted, bargained and sold to the said GRANTEES and GRANTEES' heirs, successors and assigns forever, the following described land, situate,
lying and being in the County of Miami -Dade
State of Florida to wit:
Lots 13 and 14, Block 170, SECTION NO. 8 OF MIAMI SHORES, according
to the plat thereof as recorded in Plat Book 14, Page 33, Public
Records of Miami -Dade County, Florida.
, 2018 A . ,
sitnpli(ilc'
Between
state of Florida , grantors, and
MARIA JOSE RUBIO, husband and
, FL 33138
State of Florida , grantees.
and the grantors do hereby fully warrant the title to said land. and will defend the same against lawful claims of all persons whomsoever.
Laser Generated by •Ci Display Systems. Inc.. 2018 (863I 763-5555 Form FLWD-2
Warranty Deed - Page 2
Parcel ID Number: 11-3206-034-0230
In Witness Whereof, the grantors have hereunto set their hands and seals the day and year first above written.
Sf ed, sealed and
rinted N
Witness
our presence:
JJ�J (Seal)
JOHN E. DOL
P.O. ddr s: 3584 MARC VUE, HOOVER, AL 35226
(Seal)
CARMEN M. DOLL
P.O. Address: 3584 MARC AVENUE, HOOVER, AL 35226
STATE OF Florida
COUNTY OF Miami -Dade
The foregoing instrument was acknowledged before me this / day of July
JOHN E. DOLL and CARMEN M. DOLL, husband and wife
who are personally known to me or who have produced their Florida dr ers licen .enttfication.
al Ink .1
ant• Nam=
Notar Publi
My Commission Expires:
1:1YpY4'' KERRYDIAZ
1 � ••. MY COMMISSION # GG 111255
IT:. nn - EXPIRES: June 17, 2021
''FO ;Fs;.... Banded Thru Notary Public Underwriters
2018 by
117-18R
Laser Generated by C Display Systems, Inc., 2018 18631763-5555 Form FLWD-2
Miami Shores Village
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 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 f BELOVVV YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS ._
_Owner
State of Florida•L, • • `•
County' of Miami -Dade
The foregoing was acknowledge before me this kOM- day of , 20 IA .
By V co (Fell 1-, -C/// /
Notary: Mop—.��,�}
SEAL:
who is personally known to me or has produced
as ,identificatioriz
\ MONICA KARROUM
ft ``I MY COMGHSSION #FF172421
?'+ A`.•. F PIRES October 28, 2018
ow) 398-0153 F otidallotaryService.com
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. / COPY OF QUALIFIER'S STATE LICENCES
B. / COPY OF LOCAL BUSINESS TAX RECEIPT
C. ✓ COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
—*Workers Compensation EXEMPTION must have NOTICE TO OWNER form' and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW`.'
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: foil+ P4N E41147, l.l.G
• "S
ti
STATE fLi ZIP .3i314+
BUSINESS PHONE: (154") v25 713(!
r
BUSINESS ADDRESS: I2.410 E*J lila SIIte:CI,TY.� Ni1�M•
CELL PHONE ("19) $251638 QUALIFIER'S NAME: LIit A10'`' u '
QUALIFIER'S LIC NUMBER: 646 te2.4
ROTH
Design -Build
ROTH DESIGN BUILD,LLC
CGC 1526132
954.825.7638 August 13, 2018
Camilotamayo@ymail.com
1240 SW 21 st street
Miami,Florida
33145
State of Florida
Miami Dade County
Before me this day personally appeared Camilo Tamayo who, being duly sworn
deposed and says:
That he or she will be the only person working on the project located at
909 NE 99th Street, Miami shores, FL33138
'' Sworn to(or affirmed) and subscribed before me this day of
2006
by
Personally known
OR Produced identification
Type of Identification produced -
Print type or Starnp Name of -Notary
° MONICA,i1CARROUM
MY COMMISSION #FF172421
EXPIRES October 28, 2018
(407) 398-Or5,7 Floridallota Service.com
Inspection Worksheet
Miami Shores .Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Inspection Number. INSP-001799-2018
Permit Number. DEMO-8-18-2165
Scheduled Inspection Date: November 21, 2018
Inspector. Naranjo, Ismael
Owner. VASCO PINTO BAPTISTA LOPES DA SILVA
Address:
Project:
909 NE 99 ST
Miami Shores, FL 33138
Contractor. ROTH DESIGN BUILD, LLC
CAMILO TAMAYO
Permit Type: Demolition
Inspection Type: Building Final
Work Classification: Commercial
Phone Number 3056062285
Parcel Number. 1132060340230
Phone Number. 9548257638
Building Department Comments
DEMOLITION OF EXISTING KITCHEN CABINETS AND WALL SIDING REMOVAL OF CERAMIC TILE AT LIVING ROOM
Checklist Item
General Comments
Passed
False
Comments
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -Inspection fee is paid.
November 20, 2018 For Inspections please call: 305-762-4949
Page 8 of 28