RC-18-3100PERMIT # t
CONTRACTOR: S
SUBMITTAL DATE: ( C 1
ADDRESS•
NAME: V(5&CC)
PROJECT TYPE:
PUBLIC WORKS
ZONINGAlafX
44
STRUCTURAL
ANICAL
ELE AL
IBUILDING
M3
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
909 NE 99TH ST, Miami Shores, FL 33138 1132060340230
Contacts
Permit tva: RC-10-18-3100
Permit Type: Building (Residential)
Work Classification: Alteration
Permit Status: Approved
Expiration: 04/08/2019
VASCO PINTO BAPTISTA LOPES DA SILVA Owner
909 NE 99 ST, MIAMI SHORES, FL 33138
Other: 3056062285
ROTH DESIGN BUILD, LLC Contractor
CAMILO TAMAYO
1240 SW 21 ST, MIAMI, FL 33145
Business: 9548257638
Description: INSTALLATION OF NEW KITCHEN CABINETS, Valuation: $ 14,000.00 Inspection Requests:
INSTALL NEW FLOOR FINISH (PORCELAIN TILE) PATCH AND f05-762-49'49
REPAIR WALLS AND CEILINGS Total Scl Feet: 265.00 77
Fees
Amount
Application Fee - Other
$50.00
CCF
$8.40
DBPR Fee
$6.30
DCA Fee
$4.20
Education Surcharge
$2.80
Permit Fee
$370.00
Residential Application Fee
$200.00
Scanning Fee
$21.00
Technology Fee
$10.50
Total:
$673.20
Payments
Date Paid Amt Paid
Total Fees
$673.20
Check # 1008
10/09/2018 $200.00
Check # 1015
11/06/2018 $473.20
Amount Due:
$0.00
Building Department Copy
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.
OWNAFF!PAVIY I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regu ating-66,0ructyin and zoning. Futhermore, I authorize the above named contractor to do the work stated.
CA 4110 AN'
Signature: Owner / Applicant
Contractor / Agent
Date
November 06, 2018 Page 2 of 2
of
Miami Shores Village RE�EIVED
Building Department OCT 0 9 1018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 Q'4
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 ��
BUILDING Master Permit No. 2 C_ d + 1 O�
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Q . i
JOB ADDRESS: qd� !VYY�� K � 1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ��—:JGlJ6' ' V Is the Building Historically Designated: Yes NO
Occupancy Type: P-S Load: Construction Type: VIS Flood Zone: /� BFE: FIFE:
ia
OWNER: Name (Fee Simple Titleholderr))::�l/"�[��/ 4� ,9�s�� Phone#: �'� MX
Address:
q� dvf cw S/��► r�
City: _/rli IA41 �ln State: Zip: SN7�
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City
Phone#:
ne#: q?fg1S76'V
C90 —1•�
Qualifier Name: Phone#:
State Certification or Registration #: io.A� 16 % Z —Certificate of Competency #: O O• 1O2%
DESIGNE rchite nginl'eer: ��
�I�dU�'"'o'� �-,+0 Phone#:' W l7
Address: SZ2� �rV �����yy � City:'#X/M� v State::'�Zip: IS
Value of Work for this Permit: $ l�4tW CS -/Linear Footage of Work: ,l•��� s �7ir
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ R�epaaiirr/�Repla'c/e� ❑ Demolition
Description of Work: 1Ab_ C";rateyL:w �G�IJ �d^�•�C/ i�MJ�%� ��`• I'��'"
�lAlcl fl �'t��oti T�G,r:- � �%Y c� ��i� Gva►lG.� � �r/G✓.r�6 .
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
W2-o. w
CCF
Radon Fee $ 4* , Z - O DBPR $ rO ' _"-- 4
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
Bond $ "
TOTAL FEE NOW DUE $ • 2-0
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 approved and a reinspection fee will be charged.
Signature VV1- >^ Si natu
g g —��- —
4�
OWNER or AGENT CONTRACTOR
The foregoing instrument was
acknowledged before me this The foregoing instrument was acknowledged -before -me -this
day410 f of �CY / 20 �d by day o1 • 120 1 by
iV4dt!,O 46t , s who is personally known to C�NI�O '�AMA10 who is personally known to
me or who has produced as r„ e or who has produced as
identification and who did take an oat identification and who did take an oath.
NOTARY NOTARY PUBLIC:
Sign: �-� Sign:
Print: Print:'Jc'��
MO IICA UM
MY COMMISSION #FF172421
Seal: JULIASALA Seal: 9,. .s
r° •`"ram =_ Notary Public - State of Florida `•''� d��' EXPIRES OCRober 28, 2018
oz Commission # GG 242596
'? of �� My Comm. Expires Nov 21, 2022 (�z)38e-0t53 FroridallotaryService.com
N i nal NotaryAssn.
APPROVED BY i4a, 1.2 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
10/9/2018 Property Search Application - Miami -Dade County
04
OFFICE OF THE PROPERTY APPRAISER
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..
Summary Report
Property Information
Folio:
11-3206-034-0230
Property Address:
909 NE 99 ST
Miami Shores, FL 33138-2568
Owner
VASCO P B LOPES DA SILVA
MARIA JOSE RUBIO
Mailing Address
909 NE 99 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1100 SG FAMILY - 2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/2/0
Floors
1
Living Units
1
Actual Area
Sq.Ft
Living Area
Sq.Ft
Adjusted Area
2,027 Sq.Ft
Lot Size
12,578.8 Sq.Ft
Year Built
1940
Assessment Information
Year
2018
2017
2016
Land Value
$377,777
$377,777
$326,588
Building Value
$138,950
$138,950
$138,950
XF Value
$3,400
$3,400
$3,400
Market Value
$520,127
$520,127
$468,938
Assessed Value
$141,728
$138,813
$135,958
Benefits Information
Benefit
Type
2018
2017
2016
Save Our Homes
Cap
Assessment
Reduction
$378,399
$381,314
$332,980
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Ex emption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 8 PB 14-33
LOTS 13 & 14 BILK 170
LOT SIZE 106.600 X 118
OR 12950-2748 0786 1
Generated On : 10/9/2018
Taxable Value Information
20181 2017
2016
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$91,728
$88,813
$85,958
School Board
Exemption Value
1 $25,000
$25,000
$25,000
Taxable Value
1 $116,728
$113,813
$110,958
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value 1
$91,728
$88,813
$85,958
Regional
Exemption Value $50,000
Taxable Value $91,728
$50,000
$88,8131
$50,000
$85,958
Sales Information
Previous Sale Price
07/19/2018 $547,000
OR Book -Page
31091-2370
Qualification Description
Qual by exam of deed
07/01/1986 $96,800
12950-2748
Sales which are qualified
02/01/1984 $91,500
12073-1569
Sales which are qualified
06/01/1980 $75,000
10795-1881
Other disqualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version
ROTH DESIGN BUILD,LLC
CGC 1526132
ROTH
Design -Build
954.825.7638 November 4,2018
Camilotamayo@ymaii.com
State of Florida
1240 SW 21 st street Miami Dade County
Miami,Florida
33145 Before me this day personally appeared Camilo Tamayo who, being duly sworn
deposed and says:
That he or she will be the only person working on the project located at
909 NE 99th Street, Miami shores, FL33138
Conifractor-Signatt ir@
Sworn to(or affirmed) and subscribed before me this 50111% day of 0
20/I.
by —
Personally known X
OR Produced identification
Type of Identification produced
fly < <-en
Print types or Stamp Name of Notary
AP 04" Notary Public State of Florida
Monica Karroum
+dc My Commission GG 260571
orw Expires 10/28/2022
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' Comoensation Insurance Exemotion
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: _� r
Ow er
State cf Florida
County of Miami -Dade
The foregoing was acknowledge before me this 5 day of AbV&1ft1L-_ , 20.
By�,C0 (*Ot M A010. who is personally known to me or has produced
�17-7 b as identification.
Notary
?ow Notary Public State of Florida
Monica Karroum
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must,pecify the dscGinp uperations or contractor license number.
...........................................................................................
BUSINESS NAME: .'1,'�+1� i`.`► �"`��A�;—
BUSINESS ADDRESS: CITY A STATy �ZIP��'j
BUSINESS PHONE: ( ) FAX NUMBS
CELL PHONE ( ) QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: