Loading...
PL-19-762Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date. --0/17/2019 Parcel Number 750 NE 97TH ST, Miami Shores, FL 33138 1132060142220 Contacts Permit NO.: PL4W19-762 Permit Type: Plumbing - Residential Work Classification: Aiferaon Permit Status: Approved Expiration: 10/14/2019 Description: PATCH INTERIOR WALLS REMOVE PANELING AND INSTALL DRYWALL REPLACE BATHROOM FIXTURES INSTALL NEW KITCHEN CABINETS INSTALL NEW FLOORING PAINT INTERIOR INSTALL NEW LIGHT FIXTURES INSTALL NEW GFCI AND SMOKE DETECTORS REPAIR SCREEN ENCLOSURES TO Fees INVESTINGHOUSE LLC Owner DARWIN TORREMIC 2061 NW 112 AVE 131, MIAMI, FL 33172 SLAZAR CONSTRUCTION INC Contractor ERIC SALAZAR Business: 3654126355 $50.00 CCF $1.80 DBPR Fee Description: PATCH INTERIOR WALLS REMOVE PANELING AND INSTALL DRYWALL REPLACE BATHROOM FIXTURES INSTALL NEW KITCHEN CABINETS INSTALL NEW FLOORING PAINT INTERIOR INSTALL NEW LIGHT FIXTURES INSTALL NEW GFCI AND SMOKE DETECTORS REPAIR SCREEN ENCLOSURES TO Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $55.00 Scanning Fee $15.00 Technology Fee $2.63 Total: $129.03 Building Department Copy Valuation: $ 3,000.00 Ins ection Requests: 305-762-4949 Total Sq Feet: 2,468.00 Payments Date Paid Amt Paid Total Fees $129.03 Check # 1225 04/17/2019 $129.03 Amount Due: $0.00 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. OWNERS 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. Futhermore, I authorize the above nani�d centm_ctor to�ohhft)work stated. i Authorized Signature: Owner / Applicant / Contractor / Date April 17, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION F-IBUILDING ❑ ELECTRIC Miami Shores Village DECEIVE® Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 APR 0 8 019 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20r7a �j Master Permit No. -R C= n1 -1 1 " -2 11 T Sub Permit No. Pcog _1 1"—IVz ROOFING REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL r-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: _Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder):�P,hone#:--"J1e6 5Z 22� Address: iso vl 1 J T j City: I MI SState: Zip: Tenant/Lessee Name: Email CONTRACTOR: Company Name: Q, Wt Address: �i V 0 City: 0 1 �c State: Qualifier Name: S KIZ kv— State Certification or Registration #: CF DESIGNER: Architect/Engineer: 4) Phone#: Dy 41""� 5�) hone#: Certificate of Competency #: wo Address: City: State: Zip: Value of Work for this Permit: $�Square/Linear Footage of Work: 2s;� C Type of Work: ❑ Addition ❑ Alteration ❑ New ❑Repair/Replace ❑ Demolition Description of Work:_ Specify color of color thru tile: r Submittal Fee $ �_. Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2.014) Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ - Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ I - gOev Cuc2405. 3I usg- (n25 2 MOQyZ(k Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State q90 tie q9 �Ve 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 bsence of such posted notice, the inspection will notjapprd and a reinspection fee will be charged. Signature _� _ Signature _ .OWNE or AGENT-------0RACTOR The foregoing instrument was acknowledged before me this _�_ day of`\ �,.�• l 20� . by �Y1M\ DCA-', who is personally known to me or who has produced The foregoing instrument was anowledged before me this day of �`��� , 20_, by who is personally known to as me or who has produced as identification and who did take an oath. identification and who did take an oat . NOTARY PUBLIC: NOTARY BLIC: Sign: Sign:_ Print: Print: Seal: MARIA RODRIGUEZ Seal: Fill - MY COMMISSION # GG 068353 MY COMMISSION # GG 068353 EXPIRES: February 4, 2021 %r �r rY EXPIRES: February 4, 2021 Banded Tbru Notary Public Underwriters of f �Bonded Thru Notary Public Undervaiters ************************************************************************************************************ APPROVED BY -------- t'r t7 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2.014) ow Tt1E s r r •' . + ' k-RICKSCOTT; GOVERNOR • �. y . + }- JONATHAN ZACHEM,SECRETARY,• i Cpl N•8 .��.��'r _.+ - . • r t'� # t . . . -.STATE FLORIDA 4 •�•DEPARTMENTIOFBUSINE **��jj �. FESSIONALREGULATION- ' .+ y tr CONSTRUCj ti G *BOARD" THE PLUMBI_ '. ., y4`CT4�H� S C .UNDER THE'' ' +, ' •�' , PROVI T.ERa8 T UTES+ > ' r r . a, �a . EXPIRATI ,31, 2020 -,_ ;, . . . a = Always verifVlicenses online"at MyFloridaLicense.com ' _ r - - . _= Do not alter'this'document'in any form, �'4 This is,your license.It is unlawf_ul'for anyone other than th'e,ficensee,to use; this document. "4 002617 Local Business Tax.-Becei-pt Miami -Dade County, Statwof Florida -THIS ISNOT A BILL -DO NOT PAY 6092548 BUSINESS NAME&OCATION RECEIPT NO. SLAZAR CONSTRUCTION INC RENEWAL 10381 SIN 138TH Cr 6355168 MIAMI FL 33186 LBT i EXPIRES SEPTEMBER 30, 2019 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. -9 & 10 OWNER, SEC TYPE OF BUSINESS PAYMENT RECEIVED SLAW CONSMIJOCIN INC 196 P UMBING CONTRACTOR BY TAX COLLECTOR CFC1427198 $75;09 08/14/2018 Worker(s) 1 CREDITCARD-18-061242 This Local Business Tax Receipt only confimn payolent of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder I*ust`fi'bm)ly with any governmental or nongovemmentel regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed an all commercial vehicles - Miamt-Dade Code Sec 8e-=. For more information, visit Www mimeidade'gov/taxcollecter CERTIFICATE OF LIABILITY INSURANCE DAT 04103//9 Y) _ _ 04!03119 TMS CERTPFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such andorsement(s). PRODUCERCONTACT .._......-----... ....._._..... .. ....__. .... .....— _.._.._--_'.__. NAME: All Insurance Services _ All Insurance Services PHONE -Malo. ExO: (305) 822-4472 — _ jam• Not: (305) 556-4354 1548 W. 37 St. l Jfernandez@aisrv.com Hialeah, FL 33012 INSURERIS) AFFORDING COVERAGE I NAIC 0 Phone (305) 822-4472 Fax (305) 556-4354 _INSURER A:,., UNITED SPECIALTY INSURANCE COMPANY INSURED INSURER B: Slazar Construction Inc. INSURER C : 10381 SW 138 Ct INSURER D: Miami, FL 33186- (305) 412-6355 INSURER E: —_. - -I INSURERF, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEW ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AODL�UBRI--__--- ---POLICY EFF NSR POLICY EXP L TYPE OF INSURANCE NS POLICY NUMBER (MMIoomm M LIMITS GENERAL LWBIUTY EACH OCCURRENCE I $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000.00 PREMISES Ea occurrence) $ ❑ ❑ CLAIMS -MADE ❑d OCCURMED EXP A Y Y CG000005454-02 10!26/2018 10126!2019 (Aryone person) El PERSONAL BADV INJURY $ 1,000,000.00 ❑ _ LGENERAL AGGREGATE $ 2,000,000.00 ❑ UMBRELLA LIAR [I OCCUR EACH OCCURRENCE $ F]EXCESS LU1B ❑ CLAIMS -MADE N N AGGREGATE S ❑ DED ❑ RETENTION$ _ _ $ WORKERS COMPENSATION 11 WC STATU- ❑ OTH- AND EMPLOYERS' LIABILITY YIN UTORY LIMITS ANY PROPRIETOR/PARTNERlEXECUTNE OFFICERIMEMBER EXCLUDED? r_1 N 1 A _ER.EACH ACCIDENT S (Mandatory In NN) �l E.L DISEASE - EA EMPLOYE $ under IDESCRIPTIIONOfOPERATIONS below __..__..__...... .._ __.,_.... EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace Is required) SLAZAR CONSTRUCTION, INC License k CFC1427198 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT I 100 50 NE 2 AVE MIAMI SHORES VILLAGE 33138 ACORD 25 (2010106) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �yq ! ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GEN'L AGGREGATE LIMIT APPLIES PER ❑ POUCY © jE ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO u ALL OSNE ❑ SCHEDULED AUTOS NON-OWNED HIREDAUTOS AOS F] n COMBINED SINGLE LIMIT Me accident BODILY INJURY (Per person) $ $ $ BODILY INJURY (Per accident (P°accDAMAGE eb $ ❑ UMBRELLA LIAR [I OCCUR EACH OCCURRENCE $ F]EXCESS LU1B ❑ CLAIMS -MADE N N AGGREGATE S ❑ DED ❑ RETENTION$ _ _ $ WORKERS COMPENSATION 11 WC STATU- ❑ OTH- AND EMPLOYERS' LIABILITY YIN UTORY LIMITS ANY PROPRIETOR/PARTNERlEXECUTNE OFFICERIMEMBER EXCLUDED? r_1 N 1 A _ER.EACH ACCIDENT S (Mandatory In NN) �l E.L DISEASE - EA EMPLOYE $ under IDESCRIPTIIONOfOPERATIONS below __..__..__...... .._ __.,_.... EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace Is required) SLAZAR CONSTRUCTION, INC License k CFC1427198 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT I 100 50 NE 2 AVE MIAMI SHORES VILLAGE 33138 ACORD 25 (2010106) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �yq ! ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Wz JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/21/2018 PERSON: ERIC F SALAZAR FEIN: 201387305 BUSINESS NAME AND ADDRESS: SLAZAR CONSTRUCTION INC 10381 SW 138 COURT MIAMI, FL 33186 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 12/20/2020 EMAIL: SLAZARCO@GMAIL.COM Licensed General Contractor Licensed Plumbing Contractor Licensed Roofing Contractor IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 SLAZAR CONSTRUCTION INC 10381 SW 138 Ct Miami, FL 331.86 Phone: 305.41.2.6355 Tuesday, April 16, 2019 State of Florida County of Miami Dade Before me this day personally appeared Erick Salazar who, being duly sworn, deposes and says: That h ill be the o i erson working on the project located at: 750 VE 97 St Miami Sho s, FL 33138 Contractbx Si Sworn to (or affirmed) and subscribed before me this day of rl 20A5A-, by �Z—:)�ACV= LLW Personally know OR Produced Identification Type of Identifi MARIA RODRIGUEZ MY COMMISSION # GG 068353 EXPIRES: February 4, 2021 '° Bonded Thru Notary Public Underwriters Print, Type or Stamp Name of Notary 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: I. 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: State of Florida County ofMiami-Dade (' The foregoing was acknowledge before me this day of i—I 1 20_CA By �L�\��c'1 who is personally known to me or has produced as identification. MARIARODRIGUEZ Notary: MY COMMISSION # GG 068353 4 4: EXPIRES: February 4, 2021 SEAL: QRhk; p�' Bonded Thfu Notary Pub#c Undensaiters