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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 � xg .. 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: