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RC-16-1773r -t6- l�3 -I. _Vw �! �S2 I N3,p ' Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. RC-6-16-1773 Permit Type: Residential Construction e rl I I I Work Classification. -Alteration Permit Status: APPROVED Issue Date: 8/10/2016 1 Expiration: 02/06/2017 Project Address Parcel Number Applicant 424 NE 103 Street 1132060170750 Miami Shores, FL 33138- Block: Lot: DARYL & NARA UNNASCH Owner Information Address Phone Cell DARYL & NARA UNNASCH 424 NE 103 Street (857)526-3203 MIAMI SHORES FL 33138- 424 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone INTERNATIONAL MASTER DESIGNS, (305)232-9610 Valuation: $ 18,000.00 Total Sq Feet: 0 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: NEW KITCHEN CABINETS TO REP Occupancy: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: Bond Return : Classification: Residential Fees Due Amount Bond Type - Owners Bond $500.00 CCF $10.80 CO/CC Fee $50.00 DBPR Fee $8.10 DCA Fee 1 $8.10 Education Surcharge $3.60 Permit Fee' $540.00 Scanning Fee $9.00 Technology Fee $14.40 Work without Permit Fee $0.00 Work without Permit Fee $540.00 Total: $1,684.00 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-6-16-60338 06/24/2016 Credit Card $ 50.00 $ 1,634.00 08/10/2016 Check #: 1004 $ 1,634.00 $ 0.00 Bond #: 3189 Available Inspections: Inspection Type: Fill Cells Columns Final PE Certification Window Door Attachment Framing Insulation Drywall Screw IReview Planning IReview Mechanical IReview Electrical Review Electrical Review Building Review Building 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 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. Futhermore, I g4ithorize the above -named contractor to do the work stated. August 10, 2016 Aorized Signature: Owner "! Applicant / Contractor / Agent Building Department Copy August 10, 2016 1 Miami Shores Village BUILDING PERMIT APPLICATION BUILDING � ELECTRIC ]PLUMBING ❑ MECHANICAL Building Department7BYY, c"f 10050 N.E.2nd Avenue, Miami Shores, Florida 33138INN 2 4 2816 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 0- 4A Master Permit No. V-0-W— A 3 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2 Q' Al. e, / a 3 i -r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholder) Addrpcq- 1(- 2 A Al 2F 1 U 3 City: P 1,6..41 5 po/t-c S Tenant/Lessee Name: Email Construction Type: Flood Zone 962.A vN•j zSH sT. BFE: FFE: Phone#: i- e 7 5r2637a3 State: LL. Zip: Phone#: Le e rs c n/aG 1 �s OrS ,✓S / �G A iv.✓z/l s L CONTRACTOR: Company Name: /1�T��/LN Phone#: ; �6` 3 33 Address: 1 1" 3 1 5"-' 1 1te S r' L 12 c CG City: l"41 Am, zip: 3 3' 9 6 Qualifier Name: 091 fJ1; G 101-4 y — 4 AP Phone#: "3 ° r" .2.12 R 6 ly State Certification or Registration #: Certificate of Competency #: / 3 d o O 3 d � DESIGNER: Architect/Engineer: Phon#7� Address: City: State: Zip: Value of Work for this Permit: $ i B ° a �� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 1� Repair/Replace Demolition Description of Work: N 01,) K 17& N E'rJ 4,4, 1A,0 jS 1'® AjE7ICGd 64% 15)o5-rl V 5' #F &132AA41'C rCUVO.5 �� 'L000 S F),, f' 1V)NS b2'0vS. 2, Specifjr co/o'r of color thru file: . .'1. .:M.. 4 /� Submiital`Fee $ - '� Permit Fee $ �V - (,� CCF $ 10 80 CO/CC $ � Q ' C Scanning Fee $ CQ) Radon Fee $ e, ( 0 DBPR $ 1 V Notary $ Technology Fee $ • 40 Training/Education Fee $ Double Fee $ 5(4 Q Structural Reviews $ Bond $ E 00 TOTAL FEE NOW DUE $ ' 1 ( 34. 1&D (Revised02/24/2014) 1 6 3 k400 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 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 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. Signature s d1t4c4E4 OWNER or AGENT The foregoing instrument was acknowledged before me this -L' day of _ -/ !J a i 20 / (. by Signature ONTRACTOR The foregoing instrument was acknowledged before me this 22 day of Sk)0e- 120 l(0 - by /1f d: l who is personally known to (N\t6LP--1 n lPZ Qea*-k t, who ism ally know o me or who has produced rV, 1 • as me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: * ,* My COMMISSION# FE &U785 Seal: •a: EXPIRES: January 14, 2017 4V Bonded 1 Notary Punic Underwriters , ************************************************************************ APPROVED BY Plans Examiner Ndwy Pudb - Stab of Fbdit GonvabWon 0 FF023893 f1Ay Oomn. Expkes,knr 4.3MY Zoning (Revised02/24/2014) Structural Review Clerk CFN: 20160326905 BOOK 30100 PAGE 4156 DATE:06/0612016 08:35:10 AM DEED DOC 3,840.00 HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY THIS INSTRUMENT PREPARED BY: GREG HERSKOWITZ, ESQUIRE THE HERSKOWITZ LAW FIRM 9100 S. DADELAND BLVD. SUITE 908 MIAMI, FL 33156 Property Appraisers Parcel Identification (Folio) Number.11-3206-017-0750 SPACE ABOVE THIS LINE FOR RECORDING DATA THIS WARRANTY DEED, made this t-2'j'day of June, 2016, by Martin F. EIortegui, a single man, whose address Is 1361 98 St., Bay Harbor island, FL 33154 (hereinafter called the "grantor"), to Daryl Unnasch and Nara Frellas Unnasch, uWa Nara de Freitas Unnasch, husband and wife, whose address is 424 NE 103rd St., Miami Shores, FL 33138 (hereinafter called the "granted'): (117jerever toed herela ilia terns "grantor" and "grantee" include all the parties to this instalment and the heirs, legal representatims and assigns offiufndduals, and ilia surceasors and assigns ofeatporattatts.) W I T N E S S E T H: That the grantor, for and in consideration of the sum of TEN AND 001100'S (S 10.00) Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grouts, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee all that certain land situate in Miami -Dade County, State of Florida, viz.: Lots 9 and 10, Block 92, Amended Plat of Miami Shores Section No. 4, according to the map or plat thereof, as recorded In Plat Book 15, Page 14, of the Public Records of Miami -Dade County, Florida. Subject to casements, restrictions and reservations of record and taxes far the year 2016 and thereafter. TOGETHER, with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever. AND, the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple-, that the grantor has good right and lawful authority to sell and convey said land, and hereby warrants the title to said land and will defend the some against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2015. CFN: 20160326905 BOOK 30100 PAGE 4157 IN WITNESS WHEREOF, the said grantor has signed and settled these presents the day and year first above written. )f (as to all); Samid' lic;n �— Witness 02 Printed Na Me- STATE OF FLORIDA COUNTY OF MIAMI-DAD£ The foregoing instrument was acknowledged before me this y_o 2016, by Martin F. Eloriegui, n single man, who i personally known to me or has produced as identification. SEAL Natluy Public Printed Notary Name My Commission Expires: EM- ANHA ELlE RDawu uypublie - Stalomm. Esplraa Sammfsow 4, EEd 1MOOpb [Vtlbrut CTQB Construction Trades Qualifying Board 1SINESS CERTIFICATE OF COMPETENCY E20900 rERNATIONAL MASTER DESIGNS, INC. B.A.: DIAZ RNA MIGUEL Is certified under the provisions of Chapter 10 of Miami -Dade County QUALIFYING TRADE(S) 0001 GENERAL ENGINEERING Juliana H. Sales P.E. Secretary ofthe Board hsann-Dada cw,ay efs all puperty herein. vxwN.ntartidade.9ovlecpnomy y STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION RGO066810 ISSUED: 10/25/2015 REGISTERED GENERAL CONTRACTOR DIAZ PERNA, MIGUEL INTERNATIONAL MASTER DESIGNS AND P (INDIVIDUAL MUST MEET ALL LOCAL -LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2017 L1510250004017 CTOB Construction Trades Qualifyinq Hoard BUSINESS CERTIFICATE OF COMPETENCY _ -- =` 1 3B000305 .. INTERNATIONAL MASTER DESH 3NS AND PLANNERS LL &;AkD.B.A.., DIAZ PERNA MIGUEL Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL 0913012016' QUALIFYING TRADE(S) 0001 GENERAL (COUNTY) 0044 ROOFING 0055 SWIMMING POOL MIAM Juliana H. Salas P.E. Secretary of the Board kyyrW miamidade.govlecorroiny Wana Wand -Dade Cmty relaim all property Hats herein. ftSTATE OF FLORIDA DEPARTMENT OF BUSINESS AND �..•. ' PROFESSIONAL REGULATION RC0067331 ISSUED: 10/25/2015 REGISTERED ROOFING CONTRACTOR DIAZ PERNA, MIGUEL INTERNATIONAL MASTER DESIGNS AND P (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expiration date : AUG 31. 2017 1-15102S0004015 LE 1111111wim ¢.M Im a i III M ST CwMKE or owl 111111 itA O?F7�^-er'crtesmRv uc'':^as�s°t:+c:amY. w�c.'�li lal take. 000799 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT BILL - DO NOT PAY \ILBT-.-, 1321892 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES INTERNATIONAL MASTER DESIGNS AND PLANNERMNEWAL SEPTEMBER 30, 2016 14631 SW 148 ST CIRCLE 3348000 Must be displayed at place of business MIAMI FL 33196 Pursuant to County Cade Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED INTL MASTER DESIGNS & PLANNERS LLC 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 13b000305 $75.00 08/05/2015 CHECK21-15-112052 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 businm lfolder 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 Ba-276. For more information, visit www miamidade goyhaxcollector From: Maximo Dopazo Fax: (866) 647-9673 To: +13052329610 Fax: +13052329610 Page 3 of 3 06/17/2016 3:47 PM ACORD0 CC) CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 6/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Maximo Dopazo CPIA DOPaTO >k Associates Inc PHONE (305) 470-8500NC. No Exti C No: (866)647-9673 8725 NW 18th Terr Ste 300 'MAIL P ADDRESS: max@do azo.com INSURER(S) AFFORDING COVERAGE NAIC i Miami FL 33172 INSURER Accident Ins Co 11573 INSURED INSURER B International Master Designs and Planners LLC INSURERC: BJSURERD: 14631 SW 148 ST CIRCLE INSURER E : BJSURERF : Miami FL 33196 COVERAGES CERTIFICATE NUMBER:CL1632412935 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE 1NSD WVD POLICY NUMBER POLICY EFF MMID POLICY XP MMIDDIYYYY LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE I X1OCCUR CPPOO1286602 3/20/2016 3/20/2017 EACH OCCURRENCE 1,000 000 $ , PREMISES Eaoccunence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY PRO JECT LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMPIOP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPE TY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA IPER OTH- STATUTE ER E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) General contractor. (305)756-8972 Miami Shores Village 10050 NE 2 Avenue Miami Shores, FL 33138 IIILSJ I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE xander Dopazo/AD z::4-ar_ 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSn95 nnlan11 C -F ATWATER IEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * INDUSTRY EXEMPTION certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. DATE: 11/19/2014 EXPIRATION DATE: 11/18/2016 DIAZ-PERNA MIGUEL 455549832 iS NAME AND ADDRESS: NATIONAL MASTER DESIGNS AND PLANNERS LLC 31 SW 148 STREET FL 33196 OF BUSINESS OR TRADE: ENSED GENERAL CONTRACTOR -PROJECT NTRACTOR MANAGER,CO suant 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 r not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only in 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 mpt 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, 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 OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 INTERNATIONAL MASTER DESIGNS AND PLANNERS MIGUEL DIAZ-PiERNA MASTF-P (* ARCHIT1-:(,77RE AND CITY PLANNING LANDSCAPE ARCHITECT GENERAL ENGINEERING TELEFAX:305-2329610 GENERAL AND ROOFING CONTRACTOR JIINE 22nd,2016 STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DATE APPEARED MIGUEL DIAZ-PERNA (G.C.) WHO BEING DULY SWORN DEPOSES AND SAYS: TO DO GENERAL CONTRACTORS SERVICES TO DO REPAIR WORK AND CONSTRUCTION AT 424 NE 103 ST. CITY OF. MIAMI SHORES VILLAGE. SWORN TO AND SUBSCRIBED BEFORE ME THIS 22nd DAY OF JUNE 2016. MIGUEL DIAZ -PERNA Notary Pubpo - nds of FlorW Corm kWon * FF02M W comm. Egkm Jung 4, 2017 Bonded ftouo melm d Notary Aar 016 ADDRESS:14631 SW 148 ST. CIRCLE; MIAMI,FLA 33196 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: UtMA�A_ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this By ryAaA UONASC+4 1l day of P )Z . , 20 who is personally known to me or has produced �c 2,1 ✓ice \\�`�`���ntiuo! Notary: Z. 5 SEAL: ��N, •O P �,c, 4• -4-n3 ►Z,�.v �(.- 24 f-3 Daryl L. Unnasch 424 NE 103Id St. Miami Shores, FL 60138 December 21, 2018 Ms. Arlenis Silvera Administrative Supervisor Miami Shores Village Office Miami Shores, FL 33138 Dear Ms. Silvera: Thank you for meeting with me on this past Tuesday to discuss the non-existent addition to my home. As we noted considerable paper work had been done more than two years previously in 2016 in anticipation of adding a bedroom and bath to my home. To explain this error, I would like to summarize the unfolding of events from June 2016 to the present time. • My wife, Nara, and I purchased the home at 424 NE 103`d St. on June 3, 2016. • We immediately launched renovation of the home. • We were promptly advised by the Building Department at the Village that we would need authorization from your office prior to initiating the construction. It is puzzling to understand why my contractor allowed the renovation to begin without obtaining this authorization from your office. • The actual renovation commenced in July, 2016 • The initial building plans included an addition to our home — a fourth bedroom and an additional bath. • As renovation proceeded, it became apparent to me that we had underestimated costs which led us to conclude that we could not afford the addition. • A new set of plans was created by my contractor, Miguel Diaz. The new plans were for a smaller addition. • On May 31, 2017, my wife Nara suddenly died of an aneurysm. Because I no longer had her income, it was apparent I would have to quickly revise our plans again. Thoughts of an addition were abandoned. It should also be noted that my age, 81, makes obtaining employment mostly out of the question which is why I have my home for sale. I have been overwhelmed for 20 months with living expenses and costs of trying to complete the renovation. I also have CLL, a form of Lukemia — my days on this earth are limited • Apparently Mr. Diaz failed to communicate this change which is why the Village Office was not aware that the addition to my home had not materialized. It is also indicative of the difficulty I had working with Mr. Diaz and why I am now on my 4tn general contractor. You and I had a very constructive conversation December 18, in which both of us experienced an element of surprise regarding the non-existent addition. We noted that I had paid the village significant monies associated with the various tasks of building the addition. In our December meeting, you advised me that I could request a refund of the money paid the village for the non-existent addition. I appreciate your ability to recognize this fact while I was in your office and to bring to my attention that I could write this letter. Thank you so much! If you have questions or need further clarification from me, I would be happy to assist you. i DUNE 29th 2016 TO: CITY OF MIAMI SHORE VILLAGE LETTER OF AUTHORIZATION. I,NARA UNNASH, OWNER OF THE PROPERTY LOCATED AT 424 NE 103rd ST. AUTHORIZE MR. MIGUEL DIAZ—PERNA TO PROCESS AND OBTAIN A BUILDING PERMIT NECESSARY TO BUILD A PROPOSED ADDITION IN MY PROPERTY. THANK YOU FOR YOUR ATTENTION ON THIS MATTER: ARA UNNASH s�EE ADDRESS:424 NE 103rd- ST.�� lWWTn*2017 *.,Mft TLF: 1-8575263203 NOTE: PROPERTY IS AVAILABLE FOR INSPECTION TO THE CITY,OF MIAMI SHORES VILLAGE WHEN REQUIRED. S INTERNATIONAL MASTER DESIGNS AND PLANNERS MIGUEL DIAZ-PERNA . MASTER OF ARCHITECTURE AND CITY PLANNING LANDSCAPE ARCHITECT GENERAL ENGINEERING TELEFAX:305-2329610 GENERAL AND ROOTING CONTRACTOR TO: CITY OF MIAMI SHORES VILLAGE RE: PROPOSED ADDITION AT 424 NE 103 ST. A PROPOSED ADDITION AT REAR OF THE PROPERTY CONSIST OF: 1.-MASTER BEDROOM ,MASTER BATH,NALK IN CLOSET. 2.-OUTSIDE BARBEQUE AREA" AT INTERIOR REMODELING: 1.-REPLACE AND INSTALL NEW CERAMIC FLOORS. 2.-REPLACE AND INSTALL NEW KITCHEN CABINETS. 3.-ADDITIONAL 11/2 BATHROOMS 4.-UTILITY ROOM REMODELING. MIGUE DIAZ-PERNA (G.C.) ADDRESS: 14631 SW 148th STREET CIRCLE. MIAMI, FLA. 33196 INTERNATIONAL MASTER DESIGNS AND PLANNERS MIGUEL DIAZ-.PERK A . MAS` EPZ OF AR'CHITEC T ? RF AND CITY PLANNING LANDSCAPE ARCHITECT GENERAL ENGINEERING TELEFAX:305-2329610 GENERAL AND ROOFING CONTRACTOR JUKE 22nd,2016 STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DATE APPEARED MIGUEL DIAZ-PERNA (G.C.) WHO BEING DULY SWORN DEPOSES AND SAYS: TO DO GENERAL CONTRACTORS SERVICES TO DO REPAIR WORK AND CONSTRUCTION AT 424 NE 103 ST. CITY OF. MIAMI SHORES VILLAGE. SWORN TO AND SUBSCRIBED BEFORE ME THIS 22nd DAY OF JUNE 2016. MIGUEL DIAZ-PERNA ADDRESS:14631 SW 148 ST. CIRCLE; MIAMI,FLA 33196 M Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: V owm ti/,v(,�tG Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2 U By 1(f 4/1 A lJ Ji/ N,4SJ M2 day of A L, 4 , 20 i & who is personally known to me or has produced as identification. Notary: • " ". NEUSE OW PERM SEAL: *,t►' ,,#� MY COMMISSION t EE W4M JF EXPIRES: January 14, 2017 8m1ed ihruNotary Public Undw*r1 re f u INTERIOR REMODELING ASBESTOS SURVEY CEIVED AN 24 2016 By. Subject Site RESIDENTIAL 424 NE 103 STREET MIAMI SPRINGS, FL 33138 FOE 0.no FLORIDA INTERNATIONAL ENGINEERING & TESTING LAB 'NSK.MT •1�. ,MATl0:.•M1TEGMTl0' 6175 NW 167t* Street, Suite G20, Miami, FL 33015 Ph: 305-378-1991 Fax: 305-378-1997 :` '� iii.x tyr Y �s� a •''srr y „,t ' $.i '.' ' <, t 4.4 �r,� t 4:% �,�., s.:.� F r � -a"✓y . ���i� y4^T �. � *`s�i a"�'u.':L#r;. f ab�3.� ,C,`Fr`:s u ��gq�j s" ✓ asy�y` _ r 1 . 1 7*y F,61,OEO J FLORIDA INTERNATIONAL ENGINEERING & TESTING LAB INSIGHT • INNOVATION • INTEGRATION 6175 NW 167th Street, Suite G20, Miami, FL 33015 Ph: 305-378-1991 Fax: 305-378-1997 June 24, 2016 Residential 424 NE 103 Street Miami Springs, FL 33138 Ref: Interior Remodeling Asbestos Survey at Residential 424 NE 103 Street Miami Springs, FL 33138 To whomever it may concern: Florida International Engineering and Testing Lab LLC was requested to perform an Asbestos Survey at the above referenced location. Please see the lab result that is attached with this report. The report describes the activities associated with our inspection, findings and recommendations. Florida International Engineering and Testing Lab appreciates the opportunity of assisting you in this project. If you have any questions or comments, please do not hesitate to contact the undersigned at (305)-378-1991. Respectfully submitted, Florida International Engineering and Testing Lab VH G V, l,- / 6.24.2016 V.M.B. Venkatesan Project Engineer El '�,~W441 4441• Asbestos Business License # ZA0000218 Mold & Asbestos Surveys & Removal * Phase 1 Environmental Assessment * Air Monitoring & Analysis June 20, 2016 Mr. Vinayagar M. Balakrishnan Florida International Engineering, Inc. 2901 Stirling Road # 203 Fort Lauderdale, FL 33312 RE: INTERIOR ASBESTOS SURVEY REPORT # FL16-05541AS Residential Dwelling 424 NE 103 Street Miami Springs, Florida Dear Mr. Balakrishnan : Pursuant to your request ETS ENVIRONMENT, INC. has performed an Interior Asbestos Survey at the above referenced site. The survey was conducted on June 15, 2016. The scope of the project was to identify & quantify the presence, extent, and condition of any Asbestos Containing Building Materials (ACBM) for the upcoming renovation activities. Therefore our Certified Asbestos Surveyor secured bulk samples for analysis of the building material. Building Description The survey site is a one-story residential dwelling currently under renovation. Structural components consists of a wood framed floor, concrete block with stucco walls, and a sloped deck roof system. The interior consists of wood flooring and plastered drywall panel walls and ceilings. The total area surveyed occupies approximately 1,700 S.F. Project Description At the request of the client, the scope of the project was to identify & quantify the presence, extent, and condition of any Asbestos Containing Building Materials (ACBM) for the upcoming renovation activities. Therefore our Certified Asbestos Surveyor secured bulk samples for analysis of the building material. Bulk sample specimens of materials suspected of containing asbestos were collected and submitted for analysis by Polarized Light Microscopy (PLM) in conjunction with dispersion staining as outlined in 40 CFR, Part 63, Subpart F dated January 1987. Analysis was conducted by ETS Environment, Inc.. Samples were analyzed on a positive stop basis. Using this method, samples from the same homogeneous area are analyzed until one is determined to contain greater than 1 % asbestos. Once this occurs, no additional samples are analyzed from that homogeneous area and the material is classified as an asbestos -containing material (ACM). This method is used to control analytical costs. For additional details on analytical results, please refer to the Analytical Results section of this report. Assessment of Suspect ACM All samples of suspect ACM collected in the coarse of this inspection were determined to contain no detectable quantities of asbestos. Please refer to the Analytical Results section of this report for additional details. 12334 73 COURT NORTH, ROYAL PALM BEACH, FL. 33412 (954)236-0053 (561)333-0624 PAX (561)333-0684 Laboratory Performing Bulk Sample Analysis ETS Environment, Inc. 12334 73 Court North West Palm Beach, Florida 33412 Licensing ETS Environment, Inc. Is licensed to conduct inspections for asbestos -containing materials in buildings under an Asbestos Business License (ZA 0000218) and is qualified by Bruce Marchette, CIH (Asbestos Consultants License # IA 0000041). Disclaimer The scope of the project was to identify & quantify the presence, extent, and condition of any Asbestos Containing Building Materials (ACBM) for upcoming demolition. Therefore our Certified Asbestos Surveyor secured bulk samples for analysis of the building material. However comprehensive this survey report may appear, we do not claim to have identified all materials which may exists within the building. Therefore, if in the coarse of the planned renovation/demolition activities, suspect materials become exposed, all activities should immediately cease and the suspect material brought to our attention for evaluation and recommendations if necessary. CLOSING REMARKS ETS ENVIRONMENT, INC. greatly appreciates the opportunity to provide quality environmental services at a reasonable cost. It has been a pleasure working with you and we look forward to doing so in the future. Should you have any questions or comments, please do not hesitate to call our offices at any time. Respectfully submitted, ETS ENVIRONMENT, Dennis Emerson I.H. AHERA Inspector Certificate No.144519 I hereby certify that the Interior Asbestos Survey conducted on June 15, 2016, at Residential Dwelling, 424 NE 103 Street, Miami Springs, Florida, was preformed by Dennis Emerson an A.H.E.R.A. Certified Inspector utilizing the code of the Federal Regulation Standards, 40 C.F.R., Part 763, Subpart E, Section 763.80-763.99 and the State Asbestos Regulations, Florida Statues 469.003. Reviewed by: /� Bruce Marchette, C.I.H. Date Florida Certified Licensed Asbestos Consultant No. IA0000041 R'"4 k Dwx�q wSte, FL PS4 24( 4 ETS E*oV�IW41411%�,flonoc BULK SAMPLE TRANSMITTAL FORM Client Name: Florida International Engineering, Inc. Project Name: Residential Dwelling 424 NE 103 Street Miami Springs, Florida Report Number: FL16-06541AS Date Collected: 06/15/16 # Location of Sample Description Condition Asbestos —Sample 1 Ceiling Drywall w/ Plaster F.C. NAD 2 Ceiling Drywall w/ Plaster F.C. NAD 3 Ceiling Drywall w/ Plaster F.C. NAD 4 Interior Wall Drywall w/ Plaster F.C. NAD 5 Interior Wall Drywall w/ Plaster F.C. NAD 6 Interior Wall Drywall w/ Plaster F.C. NAD Sampled By: Dennis Emerson NAD = NO ASBESTOS DETECTED SAMPLE CONDITION CODES G.C. Good Condition F.C. Fair Condition P.C. Poor Condition P.D Physical Damage W.D. Water Damage F Friable N.F. Non -Friable H. Con. High Contrast M. Con. Moderate Contrast L. Con. Low Contrast PAS& 3 -q 4 E T S E44� x, f4 04 � F-0 12334 73 Court North West Palm Beach, Florida 33412 (954) 236-0053 ANALYTICAL RESULTS Project: Residential Dwelling Lab Code: 0360 Sample Number Anal. Init. Sample Item Description Asbestos Percentage & Type Identified Percentage & Type Non- Asbestos Fibers Percentage Non -Fiber Mat. 1 DKE Drywall w/ Plaster NAD 1-2 Synthetic 2-3 Fiberglass 7-10 Cellulose 85-90 Matrix 2 DKE Drywall w/ Plaster NAD 1-2 Synthetic 2-3 Fiberglass 7-10 Cellulose 85-90 Matrix 3 DKE Drywall w/ Plaster NAD 1-2 Synthetic 2-3 Fiberglass 7-10 Cellulose 85-90 Matrix 4 DKE Drywall w/ Plaster NAD 2-3 Synthetic 3-5 Fiberglass 10-12 Cellulose 80-85 Matrix 5 DKE Drywall w/ Plaster NAD 2-3 Synthetic 3-5 Fiberglass 10-12 Cellulose 80-85 Matrix 6 DKE Drywall w/ Plaster NAD 2-3 Synthetic 3-5 Fiberglass 10-12 Cellulose 80-85 Matrix DennisSmeriO. Microscopist N.A.D. = No Asbestos Detected PAS6 4.0? 4 Process Number: M2017009928-0 Folio: 1132060170750 Fee Payer: DARYLE L. UNNASCH 424 NE 103 ST Department of Regulatory and Economic Resources Impact Fee Receipt Batch: Site Address: 424 NE 103 ST Collection Date: 05/24/2017 MIAM SHORES, FL 33138 ..... Fee Type Dist Category Cat Category Description Id Code Sufix AREA 11 5002 00 UNIT SIZE (SQ FT) Collection Number: 119871 is Fee Extended IDeferral Deferral Amount Amount lAdmin 325.00 $0.92. $298.35 Total: $298.35 a - Deferred Amount + Deferred Admin: Total Amount Due:? $298.35 Paid Check: $298.35 Paid Cash: $0.00 Paid Credit: $0.00 Paid Convenience Fee: $0.00 Total Paid : $298.35 Report run on: May 24, 2017 03:15 PM Page 1 of 1 MU7.�T� I It Certificate of Completion Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Building Inspection Department Description: NEW KITCHEN CABINETS TO REPLACE EXISTING REPLACE OF CERAMIC FLOORS. LIVING AREAS BEDROOMS AND KITCHEN. Permit Type Building (Residential) Bldg. Permit No. RC-6-16-1773 Owner DARYL UNNASCH Contractor RS CONSTRUCTION DEVELOPMENTAND ENC Subdivision/Project Date Issued 03/05/2019 Construction Type V-B Occupancy R-3 Type Square Footage 2,088.00 Flood Zone X Location If the building is located in a special flood hazard area documentation of the as -built lowest floor 424 NE 103 ST elevation or lowest horizontal structural member has been provided and is retained in the records of Miami Shores, FL 33138 Miami Shores Village. This certificate issued pursuant to the requirements of the Florida Building Code certifying that at the OR time of issuance this structure was in compliance with the various ordinances of the jurisdiction ,S �NG•19J1 I�j� P � regulating building construction or use. 9c.3All�l Building Officials Approval Not Transferable POST IN A CONSPICUOUS PLACE Ismael Naranjo, CBO llvfiavri Shares Vfflage fit ling r, De' L a nt 10050 N� 2Ave TvIiarn! Shores FL 33138 NO. RC;-G- 16-1773 Type: Bidding (Residential) Workclass: Alteration flermit Status: Approved Issue Date: 8/10/2016 Expires: 11/19/2018 INSPECTION REQUEST';: ' 305)?62.4949 or log cn at https://bldg.msv;i.gov/cnprgc)v_prod,srIfservic-i Riecluests must he received by 3:30pm I,VORK IS ALLOWED: MONDAY THROUG! I FRIDAY, 8:00ANi - 7.COPM o,-StJRDAY 8:OOAM - 6-OOPM. NO WORK 16 ALLOWED ON SUNDAY OR HOLIDAYS BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY NO INSPECTION WILL BE MADE UNLESS THE FIERMII CARD ;S DISPLAYED AND HAS BEEN APPROVED PLANS ARE READILY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE I -,AT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES NEITHER THE BUILDING OFFICIAL NOR THE C!TY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO At -LOW INSPECTION . Owner's Name: DARYL & NARA UNNASCH Job Address: 424 NE 103 ST Miami Shores, FL IS 138 POST ON SITE 1132060170750 Owner's Phone: (857)526-3203 Total Square Feet: 0 total Job Valuation: $ 18,000.00 Cortractor(s) Phone Address AA MASTERS CONSTRUCTION DEVELC (305)244-0667 15591 SW 105 TER UNIT 525, MIAMI, FL 33196 Description, NEW KITCHEN CABINETS TO RE[:"-A(.-,E EXsSTING REPLACE OF CERAMIC FLOORS. LIVING AREAS BEDROOMS AND KITCHEN. DOUBLE FEE. WORK STARTED WiTHOUTPER.,VIITS, A 'f flls� �T ON WARNING TO OWNER: YOUR FAIL URCE'TO.PECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED .,f--XD POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LENDER OR AN ,ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. --i ;e,of INSPECTION RECORD INSPECTION DATE INSP Foundation Cta m Xni a 1 I Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Cap Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA compliance Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS WINDOWS :.DOORS INSPECTION D TE INSP Attachment WORKSPUBLIC INSPECTION DATE INSP Excavation ELECTRICAL INSPECTION DATE INSP Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling Ro Rough Telephone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With ELECTRICAL OM ENTS INSPECTION JDATE INSP Final Sprinkler Final Alarm INSPECTION Water Service 2°d Rough Top Out Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank Well Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains HRS Final [ZVUA INSP PLUMBING COMMENTS K INSPECTION I DATE INSP Underground Pipe ROuRh Ventilation Rough Hood Rough Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum MECHANICAL COMMENTS RECEIV�b Miami Shores Village NOV 082018 Building Department CL( 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 S FBC 20iq BUILDING Master Permit No. Q C PERMIT APPLICATION Sub Permit No. 'j�BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CRCHANGE OF ❑ CANCELLATION ❑ SHOP i CONTRACTOR DRAWINGS JOB ADDRESS: 14 a(4 N I 3 5`-t— City: Miami Shores County: Miami Dade zip: "3313. Folio/Parcel#: ( I ` 3 P-QG -CD I V " 67YO Is the Building Historically Designated: Yes NO � Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): �DAfZ—W i-_ C3 Q 0 A b G4} Address: ` a9 iN E i 03 City: HIAM 1 S Nei 2Es State: zip: 3313 Tenant/Lessee Name: Email ne#: CONTRACTOR: Company Name: W 4 t-1 &--;i CQS � VC-9-000-t1ZQ �OQC1` Phone#: VB� S9 7 4188 Address:) O C;;� City: State: Zip: 0,551 S Qualifier Name: Fe &L)err Phone#: n7 �f r! 68' State Certification or Registration #: GE G (S252 It Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: <8 Ad Value of Work for this Permit: $ Type of Work: © Addition ❑ Alteration Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ City: State Square/Linear Footage of Work: _ ❑ New ❑ Repair/Replace Technology Fee $ Training/Education Fee $ Structural Reviews $ _ CCF $_ DBPR $ CO/CC $ Notary $, Double Fee $ Bond $ Zip: Demolition 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 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 qpproved anti a reinspection fee wilJybe charged. Signatu ER or AGENT The foregoing instrument was acknowledged before me this day of Jj QVQ h� �� 20 1 P-, by cas QLV,6z- who is personally known to me or who as produced L ADV— L as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: 10 v ``� NCON Notary Publlc-Strteloi Florida • CommisOn # GG 081989 '• �OFF1. ,' My Comm. Expires Mar 13, 2021 kr&dtlVg*N2mANoWyAM CONTRACTOR The fo)/4oing instrument was acknowledged before me this day of No,&mb1?A- 20, by -TeyVS 4ccy* , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: .I �� r YANIVE LIZETH RINCON Seal: Notay P dic- SmtO of Florda Comsuss.on # GG 08' 989 t7� May Comm. Expires MT 13.2021 oFF`eF' B-&dhVLON"WNmaryA%n. APPROVED BY Plans Examiner Zoning November 3, 2018 Miguel Diaz Penna 14631 SW148 St. Circle Miami, FL 33196 Dear Miguel: I have decided to obtain the services of another General Contractor since you have not closed the four remaining permits. Please respond at your earliest convenience that you have received this letter. Thank you for your assistance. Miami Shores, FL 33138 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756,8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): VAQ L L v�JU-k6C-4 Phone #:((,,� '60a- ya23 Owner's Address: 4 14 R -7,= 103 S-t— City: H 1 Atil Si)o2+r-- S State : T;.-L. Zip Code: -Y-�i2) 8 Job Address (Of where work is being done): 4 0-y sA E_ lo 3 sit - City: Miami Shores State: Florida Zip Code: `213I s Contractor's Company Name: Address: 1 LU, 3 i - o[) I ��� Yb �[fllvdlE�2s Phone #: City: t-Ak /s<W State: 'J; L Zip Code: -J 5 1 �3 % . Qualifier's Name: Hl c oFC. ID1 AG 'W kg -A- Lic. Number: I'3 P-Oc)o 30Y Architect/ Engineer of Record Name: Address: City: Describe Work: State: Phone Zip Code: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. Shores harmless of all Signature �' " Signature hold the Building Official and the legal involvement. Ow —rtrr<genr Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this S day of it 20116,by [�.e jLc Asu-j i Who is personally known to me or who has produced L or? L- as indentification. Notary Puj�Rc:/j_4 Sign: Seal: VANIVE LIZETH RINCJN ',,, Noa �pabIt_5'a;ed;,0'�9 y n&GG08'9S9 • • . = CO^1rtU56.0 y �P` My Co"+rn. ExVes Ma' 12021 �''* o.n°;: Bm+�eCtnM,yrNiru�_h7uyAu". this day of . 20 by who is personally known to me or who has produced Notary Public: Sign:, Seal: indentification. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. X C G "( -7 -7 3 Owner's Name (Fee Simple Title Holder): 0,44Y( 'JNN a5 N Phone #: !0 3 t - o v?- Owner's Address: 42 `F N f l a 3 5 ' City: I tA 1.6 M 1 .5 Nan Ls State : '1= 46. Zip Code: Job Address (Of where work is being done): w e 1 G 3 5 T City: Miami Shores State: —Florida Zip Code: fY.a,vfj25 Contractor's Company Name: 7t A nphone #s i �LG Address: l 6 3� 5 �✓ ! 4 S7-• C l2 c G City: $,4ld r State: TG' Zip Code: 3 y9 6 Qualifier's Name:- uFZ l� 1 L2 - jPF/2 Nd Lic. Number: j,)9- o e � 30 Architect/ Engineer of Record Name: Address: Phone #: City: State: Zip Code: v ro w rL �c W/o P69-v, '7'5 S1/9 �..,.� f?'e-r OS) r / v ,iL 1 cz 9✓ S ✓�,. �' Describe Work: r�12 &,v1 , CGos-,,yy- ,C,y )=' 40& dS rt4,at ivi"0Q >v &A= /,r,5��`GM 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. -C-& Signature Owner or Agent The foregoing instrument was aknowledged before me this _ day of ,20 by Who is personally known to me or who has produced Notary Public: Sign: Seal: Signature Contractor or Architect as indentification. The foregoing instrument was aknowledged before me this day of t�Loj , 206 by WtGCFA- LijlS� who is personally known to me or who has produced T1-`-,,7>PUi�2- UCF N<T- as indentification. Notary P bli Sign: Seal: ,.....;I"'. SINDIA ALVAREZ MY COMMISSION # GG 238273 EXPIRES: September 3, 2022 ••7tE F��l: I3nded Thru NoWy Pubhc Umlem bm =r I cc M C3 0 C3 CO 0 m r— r-I 0 r— Qehn RecePt oardcopy) C3 Realm Recetpt (eW&Mnic) C3C.tifiedMail p,,,tictgd DeIWWY 0 Adult Signature Required Restricted DeAM C3 Adluft�Sign&ture Postage postma* T 2 6 ;V� I Ci/?600 180 age 8nQjT 70 --------------------------------- 1 d - -------------------------- --------------- ------------------ In a hurry? Self-service kiosks offer quick and easy check-out. Any Retail Associate can show you how. Preview your Mail Track your Packages Sign up for FREE www.informeddelivery.com All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Go to: https://postalexperience.com/Pos 840-5330-0223-001-00031-41362-02 or scan this code with your mobile device: Bill #: 840-53300223-1-3141362-2 Clerk: 06 COUNTRY LAKES 13520 SW 152ND ST MIAMI FL 33177-9998 1158680091 10/26/2018 (800)275-8777 1:44 PM Product Sale Final Description Qty Price First -Class 1 $0.50 Mail Letter (Domestic) (HIALEAH, FL 33012) (Weight:0 Lb 0.40 Oz) (Estimated Delivery Date) (Monday 10/29/2018) Certified 1 $3.45 (@@USPS Certified Mail #) (70173040000074842849)4r_-- . Return 1 $2.75 Receipt (®®USPS Return Receipt #) (9590940236237305681884) Total $6.70 Debit Card Remit'd (Card Name:VISA) (Account #:XXXXXXXXXXXX4920) (Approval #: } (Transaction #:932) (Receipt #:026863) (Debit Card Purchase:$6.70) (Cash Back:$0.00) (AID:AO000000980840 Chip) (AL:US DEBIT) (PIN:Verified) Text your tracking number to 28777 (2USPS) to get the latest status. Standard Message and Data rates may apply. You may also visit www.usps.com LISPS Tracking or ca.11r_L-BO.Q�2221811•. - - t13T�:,�NA`I'IONAl. MASTER DESI DNS' AND Pl,ANNF,. S MC(;UEL OF AP,"HITI V IR : ANN"I`I'1' I l-` \ING LANDSCAPE / ARCHITECT RLA 000635 GENERAL ENG)NEERING CONT. E-1700590 TELEFAX:305-23296190 GENERAL AND*}AOOFING CONTRACTOR 13B-000305 E-MAIL:INTERNATIONALMASTERDESIGN@GMAIL.COM ADDRESS: 14631 SW 148 ST, CIRCLE,MIAMI, FLA. 33196 et CT . - /La /p Al lee 5.1 A e-o i 67 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 numue tv uwner — YVorKers- l►oRlpensatlon Insurance tXernDtlorl 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 CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. /7 /' Signatur1.4-- y caner MAHARAI K. GONZALEZ �; MY COMMISSION # GG 044602 '"�,� � EXPIRES• N State of Florida ovember 2, 2020 F. ... Bonded Thru Notary Public Underwriters County of Miami -Dade The foregoing foregoing was acknowledge before me this ��\ day of By T�i1 i �..iynr) 0 kwho !!° is personally known to me or has produced n k � K as identification. J�ol` 2 m 3 o N N Notary: = a o SEAL: A `b' M 15 IN T17R Aa C'IONAl., MASTER DESIGNS' AND f'tAN NER4 M1GH1, I) r'�Z-L'EHNA. MASTER ER O LANDSCAPE / ARCHITECT RLA 000635 GENERAL ENGINEERING CONT. E-1700590 TELEFAX-305-23296190 GENERAL AND ROOFING CONTRACTOR 138-000305 E-MAIL:INTERNATIONALMASTERDESIGNOGMAIL.COM ADDRESS: 14631 SW 148 ST, CIRCLE,MIAMI, FLA. 33196 ar ,Z 3 2U T G1615 G Ld / -b /7 GAS ear rCt f f� t�o2i� J ✓ L 14j"1 Le ...... . . . . . . .... .... • •••••• • •••••• •••••• i�Ui y y r- Ir �- Certified MaII Fee S 3.4 J $ r ees (cheek boz, add tee ) 0 p p ReWm P'@OW O wdeom1 S ❑ Rahn Recdpt (etectmuc) S L • Postmark Q ( ❑ CwUW Mau Rod ted DeRvwy t 26 0 ❑ Aduu SiWIWO— RequMed _ ❑gdu4 S Reatrlcted 11NNery t 0 Postagei�.� C3 rn ota ostage and L6 /f t7�1 G1 A b Sent 7 • - c... AF r 5 ----•...............•-•••...-....------ J'sS1�Z... ��ry'3ie�e; iiP l 4V (Estimated Delivery Date) (Monday 10/29/2018) Certified 1 $3.45 (MUSPS Certified Mail #) (70173040000074842849) e-- { Return 1 $2.75 Receipt (@@USPS Return Receipt #) (9590940236237305681884) Total--'-- $6.70 Debit Card Remit'd $6.70 (Card Name:VISA) (Account #:XXXXXXXXXXXX4920) (Approval #: ) (Transaction #:932) (Receipt #:026863) (Debit Card Purchase:$6.70) (Cash Back:$0.00) (AID:A0000000980840 Chip) (AL:US DEBIT) (PIN:Verified) Text your tracking number to 28777 (2USPS) to get the latest status. Standard Message and Data rates may apply. You may also visit www.usps.com • •• USPS Tracking or call 1-800-222-1811. • . .••.. .... • •..... "go . . •... ••.. ••••a• • •.•• .•• • • • . • • 660019 • ••4 ••. • • ; } Miami Shores Village RECEIVED Building Department DEC ?0 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 C� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC0 KLI BUILDING Master Permit No. kC-4 `- 1-773 PE MIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP 22 CONTRACTOR DRAWINGS JOB ADDRESS: J I City: Miami Shores/ County: Miami Dade Zip: 3©i Folio/Parcel#: // — 3 2 06 -0/% �- 0-7r0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 1C"1 OWNER: Name (Fee Simple Titleholder): �✓2J L U �J N A90-H Phone#: Address: T2,L4- NO 1003 5—r. City: "t A �4 1 S 440tZL7T State: F L Zip: ;�� 13 S Tenant/Lessee Name: Phone#: � 1`�1, Email: dN J Gt,y4. f4,5 M IiN Ca A-r-r . Ne-7" pwue2 CONTRACTOR: Company.Name: "RQ tys sr✓ICg P u.C_, Phone#: �g — ZS,� +zV� Address: 1��70 c-c� T� �( -k-z4 City: S n ri State: 12 Zip: Qualifier Name: kh �iR A L(�3 % Phone#: State Certification or Registration #:�56 Certificate of Competency #:. DESIGNER: Architect/Engineer: Address: Phone#: _ City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition " " , Alteratiioon, ❑ New ,, 1 ElRepair/Replace ❑ Demolition Description of Work: a>ct � r0a M 112 b7(tj ►-paM C RAN Cog - Specify Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) N 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 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." r 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 faith4hat 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 commencemext must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the sen a of such posted notice, the inspection will not be approved and a reir pection fee will be chaeged: p OWN R or AGENT The foregoing instrument was acknowledged before me this !�,�� day of I?— 20 1, by 1/At'r'-v<L ()MiA 64who is personally known to me or who has produced TDDL as identification and who did take an oath. Sign NTRACTOR The foregoing instrument was acknowledged before me this ad day of 1 20 1 1 by 61-,DA- boiv%%� who is personally known to me or who has produced as identificatio6-and who did take an oath. NOTARN'15UBLIC: \ NOTAJfY PUBLIC: Sign: Sign: r ,. .� o...�...... ' t " •` my Co PIF FS .Iz ro. MY COMMISSION #FF189443 Seal: `=_,`• Seal: (407)3980153 Floridallot. EXPIRES January 13, 2019 (407) 39"153 FloridallotarvService.com APPROVED BY n Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. `L-� --9 3 Owner's Name (Fee Simple Title Holder): 0?0K Y L LAJ tJ/t9C '1A Owner's Address: 2 Lf N C 10 3 S T'- Phone #:, , - - 2,�4:29 City: -U 1. /1* 11 S & IL'S State : P L Zip Code: . Job Address (Of where work is being done) NC L023 S7 City: Miami Shores State: —Florida Zip Code: 3.3 13 P-, Contractor's Company Name: Phone #: :3' 6 2 3 2 Address: �3 1 St N 14G Q 2C LL" City: � . t State: ('(_. Zip Code: /`9 Qualifier's Name: f'1 1y — fC--E AJ A Lic. Number: 1346060306 Architect/ Engineer of Record Name: Address: City: State: Phone #: Zip Code: Describe Work: /'� I -}- l -j'f-i S K .. J.f- J H P/�-C-T- iN 1 K1 � 0(A)( t 6 00� C l V LA C.o C %Go�.-1 ^TG► 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete >t We contract. I hold the Building Official and the Signature less of all legal involvement. Signature The foregoing instrument was aknowledged before me this 9-lalay of 12 20n,by 1— uuNa�c� Who is personally known to me or who has produced t-- as indentification. Public: PTCOWN—ISSION #FF189443 EXPIRES January 13, 2019 Contractor or Architect The foregoing instrument was aknowledged before me this day of 20 by who is personally known to me or who has produced as indentification. Notary Public: Sign: Seal: 398-0153 a Miguel Diaz-Penna 14631 SW 148 St., Circle Miami, FL 33196 Dear Mr. Diaz: Daryl L. Unnasch, Ph.D. 424 NE 103`d St. Miami Shores, FL 33138 September 27, 2017 Please be advised you have been relieved of continuing responsibility as General Contractor for the property at 424 NE 103`d St., Miami Shores, FL 33138. You will continue to bear the responsibility of errors and negligence committed in the 16 months that you held the title General Contractor at this address. This change takes effect immediately. Sincerely, Daryl L. Unnasch ( ujy)(--, +ool� Or► c�► fro 1 CA I u-4 Z , g L3 7017 0190 0000 5218 0065 1000 _. �3b2S�lkll4�Z94t�t'3f t _ _ �tIYL, U. . POSTAGE MIAMI PAID FL OCT 03317 AMOUNT $6.59 R2305H129287-03 r k8T"URN TO SENDER UNCLAIMED UNABLE TO FORWARD tsC; 331382457L4 h i�n6-ni35b-a3-44 I# COMPLETECOMPLETE THIS SECTION ON DELIVERY ■ Complete items 1, 2, and 3. A. Signature ❑ Agent ■ Print your name and address on the; reverse so that we can return the card to :-. gip;, X ❑Addressee . ■ Attach this card to the bai;�pf thq. mail , B. Received by (Printed Name) C. Date of Delivery r or on the front if space permits. 1. Artlgie Addressed to: D. Is delivery address different from item 1? ❑ Yes If YES,enter delivery address below: ❑ No rZ- 3. Service Type ❑ priority Mail Express® IIII�I ('II I'I I II I II I I II I I I'I II II I IIII I II III ❑ Adult Signature 13 Restricted Delivery ❑ Registered Mall- RegiMail Restricts ❑stered I 9590 9402 2911 7094 4064 89 El CCeerutlfieignature d ❑ Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Retum Receipt for Merchand se ❑ Collect on Delivery Restricted Delivery 2. Article t` 7 017 0190 0000 5 218 ❑ Signature Confinnation1m ❑ Signature Confirmation 0065 Delivery Restricted Delivery i III I jPS Form 38 jj, July 2U15 PFSN 7530- 12-000-g053 Domestic Return Receipt a .; BUILDING Miami Shores Village Building Department LA 10050 N.E.2nd-Avenue, Miami Shores, Florida 33138 V Tel: (305) 795-2204 Fax: (305) 756-8972 1 (� INSPECTION LINE PHONE NUMBER: (30S) 762-4949 PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC C, APR 18 1018 F C Z0l`-I Master Permit No. Re" G-l6 -/'773 ❑ ROOFING REVISION Sub Permit No. ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z 4 /V F 10 3 mil'%' City: Miami Shores County: Miami Dade zip: Folio/Parcel#: 113 710(a o e -7 0-7 ge) Is the Building Historically Designated: Yes NO Occupancy Type: i F2 Load: Construction Type: 4 BS Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): bAQ!� I% Al AJA5 N' Phone#: 30 - 9oZ--4Z23 Address: 4 2'4 Pe. lv 3 Si' City: d ' n o s State: et Zi 3 3 3 16 P� Tenant/Lessee Name: Phone#: Email: / r 1,6 �� fi�S ✓ G CONTRACTOR: Company Name: I N rL. N>aTlv>y�l, /�AS�rz p�SISwS Phone#: 7BG-3737.79 Address: 1 `L 4 3( S w ("tr Jr. City: MI 4 ""' State: C�' Zip: Qualifier Name: i 9�+ G �� 3 �" �Ja12 ^) j Phone#: -7 Q 3 3 3 7 7 00 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: Square/Linear Footage of Work: State Zip: Type of Work: ❑ Addition [16 Alteration ❑ New ❑JRepair/Replace ❑ Demolition Description of Work: T w O J7✓ 1',012 �/3 13 �'(�fzvp^4 S S / h! i 471 v2 /Z 13 M v Or L u S Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 1i 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..... r 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 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 no77ro�ved and app reinspection fee will be charged. i / 1 I)WNER .r AGECT �ONTRACTOR The foregoing instrument was acknowledged before me this Z ng instrument was acknowledged before m this ( 2 day of M / 46 N 20 f f byday of 1 20 � by r'720 YL 61AIAI JS _____,who is personally known to M11S s is ersonnalllyy known to me or who has produced as me or o has produced �S[/, 11Svas identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: S Print "s No Public - State at Florida ;;�„o MAHARAI K. GONZALEZ Print. = �`�= Seal: My Comm. Expires Jan 14, 2021 Seal: =" o= ExPIRES: November2,2020 ,r'rrrrn�r�`` Bonded through National Notary Assn.-"•'•:FOF ' Boded Thru NotaryPublic Underwriters APPROVED BY 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 CHANGE OF CONTRACTOR / ARCHITECT Permit N. r1 77 3 Vlnhp!!�G� Owner's Name (Fee Simple Title Holder): 02/2 %Z' U �" Phone #: Owner's Address: 4 2 4 V r / 0 3 S' City: X /(lam I 9 140 IL �r State : �� Zip Code: Job Address (Of where work is being done):_ City: Miami Shores State: —Florida Zip Code: Contractor's Company Name: P d 1,0.1 /. 8 04,01 Phone #: Address: / & I ",- Sy'- toAv f4 1Pt -1 4-` City: S a V 2 451 State: (11 Zip Code: 3 7 3 Z 6 Qualifier's Name: /I/tps /• J3rLo- Lic. Number: Architect/ Engineer of Record Name: Address: City: Describe Work: State: Phone #: Zip Code: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the VAgent 'Shores harmless of all Signature Signature 40er legal involvement. Contractor or Architect The foregoing instr ment was aknowledged before me The foregoing instrument was aknowledged before me this day of20 16by )l)a9—k--k this day of , 20 by Who is personally known to me or who has produced who is personally known to me or who has produced f l yr� as indentification. as indentification. Notary Public: Sign: r p.. ' ` ` MY COMMISSION # GG 044602 Seal: 'w ?` .a; EXPIRES: November2, 2020 I„ Bonded Thru Notary Public Underwriters Notary Public: Sign: Seal: r Miami Shores Village Building Department 10050 N.E. 2No Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Change of Contractor/Architect or Engineer . A A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. ll INTERNATIONAL MASTER DES►GNS AND PLANNERS MIGUEL DIAZ-PERNA . MASTER OF ARCHITECTURE AND CITY PLANNING LANDSCAPE / ARCHITECT RLA:000635 GENERAL ENGINEERING CONT. E-1700590 TELEFAX:305-2329610 GENERAL AND ROOFING CONTRACTOR 13B-000305 E-MAIL ADDRESS:INTERNATIONALMASTERDESIGN@GMAIL.COM ADDRESS:14631 SW 148" ST. CIRCLE,MIAMI,FLA. 33196 1 , e` � f i2 %, 4 ST, % NT[72k'ti IZ 4FA-1e0,6Lt) J v NoC) ,CAL C� NS / t52_ O l- �21p�ir IF QvTy-gel? / SO 412 �c��cL �it2- ✓7r � !✓d P Y r T-o ,FJ� Tiles r2vas% o F G/��4*1f Fd� Gri�✓T�eL joy IVELISE DIAZ•PERNA Notary Public - State of Florida Commission N GG 035995 $ My Comm. Expires Jan 14. 2021 Bonded through NalWq Nolary Assn. w�rN��sj W, ru ru Ca C3 0 C3 C3 O C3 m r— rq C3 r— ,+5 xft Services & Few (check box; add fee as ❑ - Receipt (Iwdowy) $ ❑ Return Receipt (electronic) $ ❑ Certifted Mall Restricted Delivery $ V, Adult Signature Required $ $11 ❑ Adult Signature Restricted Delivery $ -ostage $ .70 X Her FATA -st-r- �-- it M-- -w-, AwIt maT, Ui mar gwNo---------------------------------------------------- 1 *117fj� -- 0 ",ea 0,4 ,OPt-• Z 4,4- --------------------------------------------------------- Iii ?✓ '61i, M44 OCC. 3 3 13 Z 0 ��M,Tfimcm Certified Mail service provides the following benefits: ■ A receipt (this portion of the Certified Ma'I labeo. for an electronic return receipt, see a retail ■ A unique identifier for your mailpiece. associate for assistance. To receive a dup1cats ■ Electronic verification of delivery or attempted return receipt for no additional fee, present this del". LISPSO-postmarked Certified MU roccipt to the ■ A record of delivery pnduding the recipient's reta'I aeseciate. signature) that is retained by the Postal Service' Restricted delivery service, which provides for a specified period. delivery to the addressee specified by name. or to the addressee's auftlzod agent. Important Reminders. - Adult signature service, which requires the ■ You may purchase Certified Mail service with sigree to be at Ast 21 years of age (not Rrst-Class Mail°, Rrst-CI;m Package Servkse, available at rats:). or Priority McIIN service. Adult signature restricted de'Nery service, which ■ Certified Mall service is not available for requires the slgnee to be at least 21 years of age Mtornallorrrl mail. and provides delivery to the addressee specified ■ In«_rance coverage Is notavallable for purchase by name, or to the addressee's authorized agent with Certified Mall service. However, the purchase (not available at retaip. of Certified Mail service does not change the ■ To ensure that your Certified Mall receipt is Insurance coverage autorat:c:y Included with accepted as Ia.-al prrof of mai::.g, it should bear a certain Pd^rify Mail Items. LISPS postmark. If you would like a postmark on ■ For an additional fee, and with a proper this Certified Mail receipt, please present your endorsement on the rmu:plece, you may request Certified Mail item at a Post Office' for the foliowing services: postmark Wig. if you don't need a postmark on this - Return receipt service, which provides a record Certified Ma'I receipt, detach the barooded portion of delivery pncluding the recipient's signature). of this label, affix it to the ma::piece, apply You can request a hardcopy reh.-n receipt or an appropriate postage, and deposit the mailplece. electronic version. For a hardcopy return receipt, complete PS Form 3811, Domestic Return Receipt: attach PS Form 3811 to your mailplece; IIdPOffrur Save this receipt for your records. Ps Form 3800, Aprir 2015 (Reverse) PSN 7530-02-000.9047 4/17/2018 USPS.com® - USPS Tracking® Results ALERT: AS OF APRIL 30, USPS.COM WILL NO LONGER SUPPORT OUTDATED BROWSERS. TO... USPS Tracking® FAQs > (http://faq.usps.com/?adicleld=220900) Track Another Package + Tracking Number: 70173040000074842672 Remove X Your item was delivered to an individual at the address at 10:04 am on April 5, 2018 in FORT LAUDERDALE, FL 33326. G Delivered April 5, 2018 at 10:04 am Delivered, Left with Individual FORT LAUDERDALE, FL 33326 Get Updates \/ Text & Email Updates Tracking History Product Information See Less ^ Can't find what you're looking for? Go to our FAQs section to find answers to your tracking questions. u u u hUps://tools.usps.com/go/TrackConfirmAction?qtc—tLabelsl =7017%203040%200000%207484%202672 1 /2 ` `j c7 7 4- 44 i F v, To �',p a✓T o �, YoJ , v, t N �✓ v /L C.S-& 4 S •6''l N°� /FlnJr' �'v�% .aS wN j'"/�dc,rolL oF,l{�G.�,/zG' %/t4VT 7'114- cy�Nt� �,e yL .v,/,6s s ,nJoT 9/ AI, a Y 2�C.c cQ I / % H !' �a o ►�/-� /Z 2 �iC�/L- �Ld�� R C /ems' / /✓/ /V Cr" LUO �6� � t �! � �'C %��.bU/✓1 ��i/'��%�bGl NS X, g3:,',6 , Q/ W! G 1. A,3 / ,tip rP F,z. eo •vT,2es .6 C eG,�j �/G pvu /✓ �%L O.G/1 li C% 1//✓A5 �-1l l */ A. �.sL O! �FvA✓,e 15 i, 3 3-.3 z 6o