FW-17-339 (2)Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit No. FW-2-17-339
Permit Type: Fence/Wall
Pen ' Wofk Classification: Iron/Ornamental
Permit Status: APPROVED
Parcel Number
Issue Date: 2/912017 1 Expiration: 08/08/2017
Applicant
1080 NE 104 Street 1122320290200
MIAMI SHORES, FL 33138-2656 Block: Lot: GREGORY GREER
Owner Information
GREGORY GREER 1080 NE 104 Street
MIAMI SHORES FL 33138-2656
Contractor(s) Phone Cell Phone
CAIBAI CONSTRUCTION LLC (786)229-2770 (786)470-4207
Date Approved:
Date Denied:
Type of Construction: Wire Fence
Classification: Residential
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee - Wire & Wood
$100.00
Scanning Fee
$9.00
Technology Fee
$1.60
Total:
$116.20
Phone
Cell
Valuation: $ 1,800.00
Total Sq Feet: 75 _]
Additional Info: 75' of 5 ' high aluminum railing wi
Scanning: 3
mlay Date Pay Type Amt Paid Amt Due
nvoice # FW-2-17-62892
)2/09/2017 Check #: 5074 $ 66.20 $ 50.00
)2/09/2017 Check #: 5073 $ 50.00 $ 0.00
Available Ins
Inspection Type:
Final
Foundation
Review PIa
Review Bui
F�FD
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, WINDOW DOORS, ROOFING and SWIMMING POOL worK.
OWNERS AFFIDAVIT: I certify t tall the foregoing orm ion accurate and that all work will be done in compliance with all applicable laws regulating
constructions zoping. F1 1 r�utpgtize th ov me contractor to do the work stated.
February 09, 2017
Authorized Signature: wner / licant I / Contractor / Agent Date
Building DepartmeciWOopy
February 09, 2017 1
BUILDING
Miami Shores Village
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
FBC 20 14"
Master Permit No.-F W Z— k `1— 339
PERMIT APPLICATION Sub Permit No.
"ej BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
Folio/Parcel#:,//��
Occupancy Type: 15 Load
OWNER: Name (Fee Simple Titleholder):
Address
Oc-,-20(D Is the Building Historically Designated: Yes
W
Construction Type: Flood Zone: BFE: FFP
Phone#:
City: State: Zip: 3313O
Tenant/Lessee Name: Phone#:
Email: nA4��j �v ��?������� ,) �/ �Q+�-�
CONTRACTOR: Company Name: s=M 11 &2 COX IS / /G CZZ-0A Phone#: %(p � 2 9770
Address: //d976 SGy ;ZiO ' -622R,
City: — 4,v-f ,
Qualifier Name:
r� Zip:
hone#:
State Certification or Registration #: CWA 6--f-0K , /C/err+tificate of Competency #: _
DESIGNER: Arch itecJt/Engineer: / � � ' _ zz' Phone#:
Address: pp�� City: Stat
Value of Work for this Permit: $ zmo" Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration New ElRepair/Replace
' 1::57 '�—( ' 1.4 — I z 9 . I .. - , 1. .- - '77 -4 -4.1 . .
❑ Demolition
Description of Work: A-2 U/ C7 4.1(--1AJG U& ldf7 CAAM
a Y'ft
w
Specify color of color thru tile: ".
Submittal Fee $ > Permit'Fee $ I V00 � CCF $ ( zb CO/CC $
Scanning Fee $ Radon Fee $ Z• DBPR^$ Notary $
Technology Fee $ b 0 Training/Education Fee $ d 4 Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ Z C)
(Revised02/24/2014)
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
a
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�N'OTICE OF COMMENCEMENT."
Notice I
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 commence ent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature lonat-4 —
NER or AGENT
The for nstrumenttwwas
1 acknowledged before me this
Kday of 4r! �! 20 /7 by
7� �whho is personally known to
A.
Pe or who has produced ay66 Ua&k66 as
identification and who did take an oath.
Sign
CONTRACTOR
The foregoing inttrument was acknowledged before me this
day of �}�I`l�/(/ 20J�7J by
ZLS / I ����, who is personally known to
//
me or who has produced �(J Im ��O i 7 as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
W§1LX&,kJ/A6W§2b
Seal: Y Yordanka Wingfield Seal: �
NOTARY PUBLIC Yordanka Wingfield
NOTARY PUBLIC
c —STATE OF FLORIDA STATE OF FLORIDA
01124
Core* GG026296 Comm# GG026296
***************** �s*Core*113AV""
APPROVED BY ` 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
SURVEY AFFIDAVIT
STATE OF (FLORIDA)
COUNTY OF (DADE)
The undersigned Affiant, 646- 6fk- , does hereby attest that
(Property owner)
l
The attached survey, performed by �
(Name of surveyor's company)
For address: %Z
Performed on a;2& (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
F er, Affiant sa naught.
rz�-16&
Propea jyAr Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this day of �p/7
Affiant is personally known to me, _produced XQA?� L! as identification.
�t Yordanka Wingfield
c NOTARY PUBLIC
Q-rA-- OF El ORIDA
9 mnl9mm# GG026290
yes 8/31/2020
Revised (6/25/12)Revised on 5122/2009/ Revised on 6/12/09
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NOTARY PUBLIC
STATE OF FLORIDA
Catwg GG026M
•'`' N�� Expires &31rAM
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
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insuranc7cpverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW Y ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
State of
County of Mia�i
/i-Dade �
The foregoing was acknowledge before me this OZ) day of
By �� who is personally known to me or has produced
t' ( as identification.
Notary:
_ a �>k�
SEAL: Yordanka Wingfield
NOTARY PUBLIC
STATF- OF' FLORIDA
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