DS-14-2535Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
I Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
J_8NOV014
BY— _
FBC 201(0
Master Permit No. -DS —1 t-/-DLrj:j
Sub Permit No.
'' BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
[—]PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�j' CONTRACTOR DRAWINGS
JOB ADDRESS: `��4 / ,! 57—
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Typee.:) Flood Zone: BFE: �7 FFE:
OWNER: Name (Fee Simple Titleholder): I��GG�✓Y �L%/� �Ct�E:f Phone#:
City
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: v
Address: !� W �� 1�<
71�> rgq Z�<)44)
City: State:: G Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ ����� Square/Linear Footage of Work:
Type of Work: ❑ Add' , ❑ Alteration &New ❑ Repair/Replace ❑ Demolition
Description of Work: t%�/r/�Gt>i/`
Specify color of color thru tile: n
Submittal Fee $ CP ,.Permit Fee $ (DO CCF $ %� ' U� CO/CC $
Scanning Fee $ -C i v Radon Fee $ DB��PRR ��$ q Notary $
Technology Fee $ ('0 Training/Education Fee $ "V Double Fee $ Xf
Structural Reviews $ Bond $ - G;M a
TOTAL FEE NOW DUE $
(Revised02/24/2014) l—� •1 G
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 reinsoection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
/ 1/ day of y0✓Q"�5�� 20 /4-/ by
Ale i Ste/ who is personally known to
me or who has produced 4cL L 3'LD- / 0 °
nd who did take an oath.
NOTARY PU
Signature
ONTRACTOR
The foregoing instrument was acknowledged before me this
l C/ day of d.P.k �-4"r 20 ,-/ by
f�iu�� rjC Cawho is personally known to
me or who has produced �a^Y14(i�/as
identification and who did take an oath.
NOTARY PU
Sign: Sign:
c
Print: Print:
Seal: ���. Seal:
�c 'r P1, Notary Pu die State of Florida
y ? Adrian Noya Ott
blic State of Florida
My :ommission EE077614 Noya
'f• ' `c F, es 03/24/2015 ission EE077814***3i1�a0114r*****APPROVED BY 4 f Plans Examiner ` Zoning
*
Structural Review
(Revised02/24/2014)
Clerk
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
5865044
BUSINESS NAME/LOCATION
SOMI TECH CONCRETE &
PAVING ENGINEERING INC
890 SW 128 AVE
MIAMI, FL 33184
OWNER
SOMI TECH CONCRETE & PAVING
Worker(s)
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2015
6116925 Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
SEC. TYPE OF BUSINESS
196 SPECIALTY
ENGINEERING
E0601099CONTRACT
PAYMENT RECEIVED
BY TAX COLLECTOR
74.60 08/19/2014
0228-14-008252
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 holders qualifications, to do business. Holder 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 68-276.
MIAM For more information, visit www.mismidade govAncollector
Municipal Contractor's Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
CC NO: E0601099
BUSINESS NAME/LOCATION
SOMI TECH CONCRETE & PAVING
ENGINEERING INC
890 SW 128 AVE
MIAMI, FL 33184
MC
RECEIPT NO. EXPIRES
NEW BUSINESS SEPTEMBER 30, 2015
7453489 Must be displayed at place of business
Pursuant to County Code
Sec 10-24
OWNER TYPE OF BUSINESS
SOMI TECH CONCRETE & PAVING SPECIALTY ENGINEERING
CONTRACTOR
Restricted to City of Miami Shores
MIA For more information, visit MMM miamidade gov/taxcollector
PAYMENT RECEIVED
BY TAX COLLECTOR
37.50 10/27/2014
02 24-15-000302
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. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. You may be
personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your
insurance carver since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
Print Name: p
Signature: S
State of Florida )
County of Mia '-Dade )
Sworn to and sikbkribed befo
day of AM v .4�` , ,
'®
of
Notary Public State of Florida
Adfien Noya
My Commission
077614
as 03/24/2015
State of Florida )
,County of Miami -Dade )
►Sworn to and subscribed before me this
day of ✓pals-,r , 20 / y .
of
Notary Public to of Florida
Adrian Noya
My Commission EE077614
Parcel Owner Report
Parcel Number: 1132060171530 526 NE 97 Street
Miami Shores FL 33138-
Tax ID:1132060171530
Owner Information
JAMES SAGE
Phone:
ROBERT & ALLISON LUDICKE
Phone: (305)754-2903
Related Permits
Driveways/Sidewalks/Slabs
Imported Permit
Imported Permit
Imported Permit
Imported Permit
Imported Permit
Imported Permit
Imported Permit
Paint
Plumbing - Residential
Public Works
Re -Occupancy
Residential Construction
Roof
Windows/Shutters
Current Owner: No
Current Owner: Yes
Permit Number
Application Date
Expiration Date
Status
DS-11-14-2535
11/18/2014
06/14/2015
EXPIRED --
R02004-216
10/01/2004
01/01/2999
CLOSED
BP2004-602
05/05/2004
01/01/2999
CLOSED
BP2002-323
02/14/2002
01/01/2999
CLOSED
MC2004-202
11/15/2004
01/01/2999
CLOSED
BP2002-431
02/28/2002
01/01/2999
CLOSED
BP2003-52
01/13/2003
01/01/2999
CLOSED
EL2004-299
10/25/2004
01/01/2999
CLOSED
PT-11-06-2787
11/14/2006
01/01/2999
CLOSED
PL-9-14-2018
09/16/2014
01/01/2999
CLOSED
PW-11-14-2454
11/07/2014
01/01/2999
CLOSED
REOC-9-14-1905
09/02/2014
01/01/2999
CLOSED
RC-10-14-2242
10/14/2014
12/08/2015
APPLIED
RF-12-08-2108
12/05/2008
01/01/2999
CLOSED
WS-12-14-2612
12/01/2014
11/17/2015
APPROVED
Related Code Cases
Case Number Case Status
Case Date
Compliance Date
Ordinance Violation
CASE-9-08-4805 Case Closed
09/10/2008
1/16/2009
Lot Clearing
CASE-9-08-4899 Case Closed
09/26/2008
10/6/2008
Friday, July 24, 2015 Page 1 of 1
'= '-z 'Z�) .
Parcel Owner Report
Parcel Number: 1131010220240 125100 Terrace
Miami Shores FL
Tax ID:1131010220240
Owner Information
ALVARETTA PITTS
Phone:
Related Permits
Decks/Gazebos/Trellises
Fence/Wall
Imported Permit
Imported Permit
Paint
IT' (� �-? r
Current Owner: Yes
Permit Number
Application Date
Expiration Date
Status
DGT-10-11-1833
10/05/2011
01/01/2999
CLOSED
FW-1-08-20
01/07/2008
01/01/2999
CLOSED
EL2005-393
11/09/2005
01/01/2999
CLOSED
BP2002-1496
08/27/2002
01/01/2999
CLOSED
PT-5-08-854
05/09/2008
01/01/2999
CLOSED
<D� �r'1
Friday, July 24, 2015 Page 1 of 1
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PROFESSIONAL SURVEYORS AND MAPPERS
PO.BOX 127GOI HIALEAH, FLORIDA 33012
PHONE: (305) 55G-4002 FAX: (305) 55G-4003
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ABBREVIATIONS AND LEGEND:
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UNDERGROUND PORTIONS OF FOOTING, FOUNDATIONS OR OTHER
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DATE OF FIRM:
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FORTH BY THE STATE OF FLORIDA BOARD OF PROFESSIONAL LAND SURVEYORS IN
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DATE
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