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WS-17-1627 (4)�sti!O1S o? Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 �� RIDA Permit NO. WS--17-1627 Permit Type: Windows/Shutters erill'it rkClassification Window/Door Replacem Permit Status: APPROVED Issue Date: 7/2812017 ( Expiration: 01/24/2018 Project Address Parcel Number Applicant 7 NE 91 Street 1132060130080 Miami Shores, FL 33138- Block: Lot: ANCAR GLOBAL COMPANY Owner Information Address Phone Cell ANCAR GLOBAL COMPANY 7 NE 91 Street (786)484-9143 MIAMI SHORES FL 33138- 7 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone GLOGOZ CONSTRUCTION COMPANY (786)447-8129 Type of Work: 11 WINDOWS AND 3 DOORS REPLACEMENT No of Openings: 14 Additional Info: 11 WINDOWS AND 3 DOORS REPLACEMENT Classification: Residential Scanning: 3 Fees Due Amount CCF $4.80 DBPR Fee $3.60 DCA Fee $3.60 Education Surcharge $1.60 Permit Fee $240.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $269.00 Valuation: $ 8,000.00 Total Sq Feet: 0 Pay Date Pay Type Annt Paid Amt Due Invoice # WS-6-17-64367 07/28/2017 Check #: 1402 $ 169.00 $ 100.00 06/21/2017 Check #: 1393 $ 100.00 $ 0.00 Available Inspections: Inspection Type: Window Door Attachment Final Review Building 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, PI.4IMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I c4lify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ;f n" g. F ermore. I aiithori7e the above -named contractor to do the work stated. July 28, 2017 Authorized SigrWture: Owner / Applicant / Contractor / Agent Building Department Copy July 28, 2017 1 BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department JUN212017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 4f---t Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 200 Master Permit No. Sub Permit No. VIIS t --4 - I (o2-q BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [--]PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: rl y )k- C1 I �3 13 Folio/Parcel#: 11— Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -Rn c%qr G-la M n� Phone#: Address: I G/) �'+. City: M ;n Mt -S In,,, State: Zip: Tenant/Lessee Name: Phone#: Email: /�/ _ 1 CONTRACTOR: Company Name: & t la C`/' -C32— r�(LS�rLAi�1 ICl f1 Phone#: Address: V LI.K- S Lt 0 R <--� City: Qualifier Name: C-''c�CI'A P-6, M, (le-Z Phone#: State Certification or Registration #: 1 5 T 3ZZ<:) Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ X G Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New oe Rep/air/Replace Description of Work: u-i 4 )[�s 6(o r R'-0- D (�� Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) p: ►� lj1" State: Zip: ❑ Demolition Permit Fee $ d VV CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ _ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ W 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 X Signature A04g��& Laloela an!en f WNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �2- day of 20 17' , by day of 20 �'� by Fled�l who is persona y known to who is pers ally known to me or who has produced as me or who has produced Q(''rea- Vcrgcm1 l�'.Tas identification and who did take an oath. identification and who did take an NOT Sign Prin- taal NOTARY PUBLIC: Sign:_ Print: Seal: A1FF119045 APPROVED BY I 1 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 IYVULeW LV VWIICI — YYVf KCfb %.oU11I VFI5aTlvn insurance r_xempiion 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: l . 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: C__ Owder State of Florida c County of Miami -Dade The foregoing was acknowledge before me this QJZ day of , 20 By_A�Ak a 1) ( 11y wh is personally known t me or has produced as identi "N" GLORIA RAMIREZ Notary: MY COMMISSION p r 27. 20 84 EXPIRES December 27, 2020 SEAL:' Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Inspection requirements for: Windows, Doors, Skylights or Fixed Glass (cladding) Permits Upon issuance of permits for the scope of work involving the removal, changing and/or replacement of any type of windows, doors, sidelites, skylights or fixed glass (cladding) the permit holder or qualifier bearing his signature on the permit application shall abide by the requirements of this department and comply with the following statement: Upon obtaining window and/or door permits for the installation of same, it is the responsibility of the permit holder to request window/door framing in -progress inspection, prior to concealment of any horizontal or vertical clip mullion, bucks, shims, etc. Inspector will also verify anchor type, edge distance, embedment and spacing. The purpose for this inspection, is for the verification of conformance with Product Approval (NOA). Acknowledgement: 6-A.2'a� �1� �/7 &9&'9 9dalifier/Own—er Si ture Date Print Name Date: ( Z% 1 1 "1 State of f) Y County of Before me this day personally appeared (�Ie-,r,'i who, being duly sworn,deposes and says; That he or she will be the only,person working on the project located at: °7 r'J E q 1 s4 m)( Contractbr Sianature �S Sworn to (or affirmed) and subscribed before me this day of 2017 T Personally Knovw x Produced Identification Type of Id. Produced 0#-\� �c I dbA 2:-) I'--� .....••... ANGELA DEL VALLE Publa��pv �4 Print, Type, or Stamp Name of Notary ?• Notaryss SState of Florida • , Commission State Ff 947283 i My Comm. Expws Dec 30, 2019 �'' ������ BMW twouO NOMM Way Assn.