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FW-17-339Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit No. FW-2-17-339 Permit Type: Fence/Wall Pen ' Wofk Classification: Iron/Ornamental Permit Status: APPROVED Parcel Number Issue Date: 2/912017 1 Expiration: 08/08/2017 Applicant 1080 NE 104 Street 1122320290200 MIAMI SHORES, FL 33138-2656 Block: Lot: GREGORY GREER Owner Information GREGORY GREER 1080 NE 104 Street MIAMI SHORES FL 33138-2656 Contractor(s) Phone Cell Phone CAIBAI CONSTRUCTION LLC (786)229-2770 (786)470-4207 Date Approved: Date Denied: Type of Construction: Wire Fence Classification: Residential Fees Due Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee - Wire & Wood $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 Phone Cell Valuation: $ 1,800.00 Total Sq Feet: 75 _] Additional Info: 75' of 5 ' high aluminum railing wi Scanning: 3 mlay Date Pay Type Amt Paid Amt Due nvoice # FW-2-17-62892 )2/09/2017 Check #: 5074 $ 66.20 $ 50.00 )2/09/2017 Check #: 5073 $ 50.00 $ 0.00 Available Ins Inspection Type: Final Foundation Review PIa Review Bui F�FD 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, WINDOW DOORS, ROOFING and SWIMMING POOL worK. OWNERS AFFIDAVIT: I certify t tall the foregoing orm ion accurate and that all work will be done in compliance with all applicable laws regulating constructions zoping. F1 1 r�utpgtize th ov me contractor to do the work stated. February 09, 2017 Authorized Signature: wner / licant I / Contractor / Agent Date Building DepartmeciWOopy February 09, 2017 1 BUILDING 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 FBC 20 14" Master Permit No.-F W Z— k `1— 339 PERMIT APPLICATION Sub Permit No. "ej BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Folio/Parcel#:,//�� Occupancy Type: 15 Load OWNER: Name (Fee Simple Titleholder): Address Oc-,-20(D Is the Building Historically Designated: Yes W Construction Type: Flood Zone: BFE: FFP Phone#: City: State: Zip: 3313O Tenant/Lessee Name: Phone#: Email: nA4��j �v ��?������� ,) �/ �Q+�-� CONTRACTOR: Company Name: s=M 11 &2 COX IS / /G CZZ-0A Phone#: %(p � 2 9770 Address: //d976 SGy ;ZiO ' -622R, City: — 4,v-f , Qualifier Name: r� Zip: hone#: State Certification or Registration #: CWA 6--f-0K , /C/err+tificate of Competency #: _ DESIGNER: Arch itecJt/Engineer: / � � ' _ zz' Phone#: Address: pp�� City: Stat Value of Work for this Permit: $ zmo" Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration New ElRepair/Replace ' 1::57 '�—( ' 1.4 — I z 9 . I .. - , 1. .- - '77 -4 -4.1 . . ❑ Demolition Description of Work: A-2 U/ C7 4.1(--1AJG U& ldf7 CAAM a Y'ft w Specify color of color thru tile: ". Submittal Fee $ > Permit'Fee $ I V00 � CCF $ ( zb CO/CC $ Scanning Fee $ Radon Fee $ Z• DBPR^$ Notary $ Technology Fee $ b 0 Training/Education Fee $ d 4 Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Z C) (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 a 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�N'OTICE OF COMMENCEMENT." Notice I 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 commence ent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In th sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature lonat-4 — NER or AGENT The for nstrumenttwwas 1 acknowledged before me this Kday of 4r! �! 20 /7 by 7� �whho is personally known to A. Pe or who has produced ay66 Ua&k66 as identification and who did take an oath. Sign CONTRACTOR The foregoing inttrument was acknowledged before me this day of �}�I`l�/(/ 20J�7J by ZLS / I ����, who is personally known to // me or who has produced �(J Im ��O i 7 as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: W§1LX&,kJ/A6W§2b Seal: Y Yordanka Wingfield Seal: � NOTARY PUBLIC Yordanka Wingfield NOTARY PUBLIC c —STATE OF FLORIDA STATE OF FLORIDA 01124 Core* GG026296 Comm# GG026296 ***************** �s*Core*113AV"" APPROVED BY ` 1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, 646- 6fk- , does hereby attest that (Property owner) l The attached survey, performed by � (Name of surveyor's company) For address: %Z Performed on a;2& (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. F er, Affiant sa naught. rz�-16& Propea jyAr Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of �p/7 Affiant is personally known to me, _produced XQA?� L! as identification. �t Yordanka Wingfield c NOTARY PUBLIC Q-rA-- OF El ORIDA 9 mnl9mm# GG026290 yes 8/31/2020 Revised (6/25/12)Revised on 5122/2009/ Revised on 6/12/09 0 CONTRACT caaBA1 CONSTRUCTION U PROPOSAL 10876 SW 24 terrace U RMOICE . Miami, F13316S calbaiconstaxtionagmail.com Name• 67 c Sim» of noefai CW1)-tr'10F )?14P67 Tfis %� 'SvrtJ ylt�W JW6 �vs� w�, .�� j %W X 04 s,-e Cola 96 ' 7� o ty PM6V 0-) oMw& oA) A� Nu-tG'T WA7e-D /r /l0 ti67 lW 7w-5� sWo�vv�o (ogsudsc)uAD . rhE 27&,5 -27-, 0WoF- poftvy9uY,t'mofr/ \-J"farda ka Wingfield NOTARY PUBLIC STATE OF FLORIDA Catwg GG026M •'`' N�� Expires &31rAM 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 be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insuranc7cpverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW Y ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. State of County of Mia�i /i-Dade � The foregoing was acknowledge before me this OZ) day of By �� who is personally known to me or has produced t' ( as identification. Notary: _ a �>k� SEAL: Yordanka Wingfield NOTARY PUBLIC STATF- OF' FLORIDA F.ft M6 w3liiu3o