FW-17-897Miami Shores Village
10050 N.E. 2nd Avenue NE
s... fig " '" Miami Shores, FL 33138-0000
Phone: (305)795-2204
�20 RIDp'
Project Address
750 NE 97 Street
Miami Shores, FL 33138-
WESTINGHOUSE LLC
Permit
Issue Date: 4/13/2017
Parcel Number
1132060142220
Block: Lot:
Address
2061 NW 112 Avenue
MIAMI FL 33172-
2061 NW 112 Avenue
MIAMI FL 33172-
Contractors) Phone Cell Phone
ADANAC DEVELOPMENT AND CONS'
Comments:
Date Approved:
Date Denied:
Tvoe of Construction: Wood Fence
lassification: Residential
Fees Due
Amount
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee - Wire & Wood
$130.00
Scanning Fee
$9.00
Technology Fee
$3.20
Total:
$149.40
Permit No. FW-4-17-897
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: APPROVED
Expiration: 10/10/2017
Applicant
WESTINGHOUSE LLC
Phone Cell
Valuation: $ 3,500.00
Total Sq Feet: 130
Additional Info: INSTALL NEW S HIGH WOOD FENC
Scanning: 3
Pay Date Pay Type Amt Paid Amt Due
Invoice # FW-4-17-63536
04/03/2017 Credit Card $ 50.00 $ 99.40
04/13/2017 Credit Card $ 99.40 $ 0.00
Available Ins
Inspection Type:
Final
Foundation
Review Building
Review Building
Review Planning
Review Planning
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 agzoning. F re, I authorize the above -named contractor to do the work stated.
� April 13, 2017
Authorized Signature: Owner / Applicant / Contrac / Agent Date
Building Department Copy
April 13, 2017
%t
\� Miami Shores Village
6\<
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
-BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 'ds-'3 1� (z C-� -) !1
FBC 201 y �- `
Master Permit No- i
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
.�w
y
Folio/Parcel#: O Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type:`
Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
�-'`��� ti ho:��os
(^ L
Phone#:
Address:_ -k3
City: ` ` `�
State: (✓
,1
Zip: ) 7 �-
Tenant/Lessee Name:
^
Phone#:
Email:
CONTRACTOR: Company Name: }-"411"J-:�•- 'k js
Address: ) U Ni��
J
City: r" +rr i State VLr
Qualifier Name: P- 't� c .4 ✓ Phone#:
State Certification or Registration #: C C- - Certificate of Competency #: _
DESIGNER: Architect/Engineer: dN / Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ , 7 v Square/Linear Footage of Work: ) 3 C)
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace rr ❑ Demolition
Description of Work: c h ��� �� via �.. '� �� L w cI d R'L ►-\ CQ_
Specify color of colorrtthru tile:
Submittal Fee $ � Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
G
TOTAL FEE NOW DUE $
(Revised02/24/2014)
R
Bonding Company's Name (if applicable) JV/
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) jai 4-
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 approved and reinspection fee will be charged.
Signature Signature
OWNER or AG T CONTRACTOR
The foregoing instrument was acknowledged before me this
day of FZ!,!>v , 20 ) by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
1&A4641
Q/ s'
tiL
ro+* "Y*. , -vbfc State of Florida
Brenda Belie
MY Colnr.� Ss-o rF 987682
Exo—
APPROVED BY
The foregoing instrument was acknowledged before me this
v� day of 20 by
�Pk\1 who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
gL
Notary Public StataofFlorida
Seal:Brenda BelloMyCommission FF 987682
Expires osn7l2ozo
as
************************************************ **********
r�
Plans Examiner ** ** * Z///3/�9Zoning
(Revised02/24/2014)
Structural Review
Clerk
ADANAC
Development &
Construction Services Inc.
November 15, 2016
State of Florida
County of Miami Dade
Before me this day personally appeared David Harder who, being duly sworn, deposes and says:
That he or she will be the only person working on the project located at: 750 NE 97 Street, Miami
Shores, FL.
David Harder
President
0-
Sworn to (or affirmed and subscribed before me this day of �' , 20 I C , by
Otis; ��cN �V
Personally Know: t"/
OR Produced Identification: r\/ /-��
Type of Identification Produced:
Z&4& AAQtv
� ° Notary Public State of FbWa
Brenda Bello
/27/2020
I:frint, Type or Stamp Name of Notary M� g �SMon FF 987e82
100 NE 84 St, Suite 200, Miami, FL, 33138
43050 759-8912 Fax: 4866) 381-2107
www.adannedevelopment.com
Licensed and Insured CGC 1506482
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:
Owner
State of Florida
County of Miami -Dade
L
The foregoing was acknowledge before me this day of J v n� �V 20 1 O
By h'S h C-- who is personally known to me or has produced
r: V a V 5 (; C e t-. C-o- as identification.
Notary:
SEAL: �t Notary Public State of Florida
Brenda Bello
My Commission FF 987682
%opo Expires 06127/2020 _ _