PLC-19-795Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
ftfflAn�
Issue Date: 04/12/2€129
Location Address Parcel Number
9801 NE 2ND AVE, Miami Shores, FL 33138 1132060134380
Contacts
Permit NO.: PLC -04'19 -TSS
PeroW Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 10/09/2019
Description: PROPOSED NEW RESTAURANT IN EXISTING Valuation: $ 25,400.00 Ins ection Requests:
SHOPPING CENTER ALL INTERIOR IMPROVEMENTS PLUMBING 3 762-4949
FOR UNIT 9801 & 9805 Total Sq Feet: 2,600.00
AMARANTHINE
Fees
9801 PARK LLC Owner
4141 NE 2 AVE 204 A, MIAMI, FL 33137
A SUNNY PLUMBING COMPANY Contractor
OSIRIS CHAVIANO
6800 SW 17 ST, MIAMI, FL 33155
Business: 3052817317 ASUNNYPLUMBING@YAHOO.COM
$50.00
CCF
$15.60
Description: PROPOSED NEW RESTAURANT IN EXISTING Valuation: $ 25,400.00 Ins ection Requests:
SHOPPING CENTER ALL INTERIOR IMPROVEMENTS PLUMBING 3 762-4949
FOR UNIT 9801 & 9805 Total Sq Feet: 2,600.00
AMARANTHINE
Fees
Amount
Application Fee - Other
$50.00
CCF
$15.60
DBPR Fee
$11.43
DCA Fee
$7.62
Education Surcharge
$5.20
Permit Fee
$712.00
Scanning Fee
$3.00
Technology Fee
$19.05
Tota I :
$823.90
Payments
Date Paid Amt Paid
Total Fees
$823.90
Credit Card
04/11/2019 $50.00
Check # 1017
04/12/2019 $773.90
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 jpquired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNER F ID VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulati co str and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent
Date
2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department APR I 1201°
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 f
INSPECTION LINE PHONE NUMBER: (305) 762-4949 Le
FBC 2019
Master Permit No. CC -10-18-3517
Sub Permit No.PICbU A S
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9801 NE 2nd Ave
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-4380 Is the Building Historically Designated: Yes NO X
Occupancy Type: A-2 Load: 150 Construction Type: III Flood Zone: X BFE: FFE: 10.35'
OWNER: Name (Fee Simple Titleholder): 9801 Park LLC
Address: 4141 NE 2nd Ave. Suite #204A
City: Miami State: FL
Tenant/Lessee Name. Amaranthine Restaurant
Email: Yiannikg@gmail.com
hone#: 305 455 1800
Zip: 33137
Phone#: 954 394 4140
CONTRACTOR: Company Name: 4 S V PL) Phone#: �� D
Address:40ac S.'_0
City: rtkk t ooM� State: FL Zip:
Qualifier Name: 0511 2L-' r—A.4t/1 i4 -W a Phone#:�-
State Certification or Registration #: /4,---7 Z-ZZqZT/Certificate of Competency #:
DESIGNER: Architect/Engineer: YcM Engineering Phone#: 305 484 5596
Address: 14245 SW 21 Terr �7�q- t ,, City: Miami State: FL Zip: 33175
Value of Work for this Permit: $ f rl�u�N, za 41) Square/Linear Footage of Work: 2410 SF
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Proposed new Restaurant in existing Shopping Center, all interior improvements.
Specify color of color thru tile:.
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $
DBPR $
CO/CC $ _
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
Bonding Company's Name (if applicable) N/A
Bonding Company's Address N/A
City
State _
nl/A
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address N/A
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
OWNER orAGENT
The foregoing instrument was acknowledged before me this
C� day of
` k 1 20 , by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: // �
Print: 1�-SO C_ W
Seal:ypsr Notary Pub 'i'.a!e of Florida
URSULA :.• . ,I ACES
My Comm*: D, :G 171127
Expires 01 i, "7'22
APPROVED BY
(Revised02/24/2014)
Signature
CONTR CTOR
The foregoing instrument was acknowledged before me this
0 day of f 'py, � 20 16 by
6"S�Y \S Ui('\Ct,N Q'\0 , who is personally known to
as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: JJ /�
Print: Urs CG- 6-y�e�Q)
Seal:
Notary Public State of Florida
URSULA B LUACES
My Commission GG 171127
Expires 01/21/2022
Plans Examiner Zoning
Structural Review Clerk
A SUNNY PLUMBING, INC.
6800 SW 17ST Miami FL. 33135
305 219 0427
APRIL 10th, 2019
State of Florida, Miami Dade
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
RE: Contractor's Affidavit
Property: 9801 NE 2nd Ave, Miami Shores FL. 33138
Folio# 11-3206-013-4380
Owner: 9801 Park LLC
4141 NE 2nd Ave, #204A, Miami, FL 33137
Permit # CC -11-18-3517
Before me this day personally appeared Osiris Chaviano who, been duly sworn, deposes and says:
That he will be the only person working on the project located at:
9801 NE 2nd Avenue Miami Shores FL. 33138
Osiris Chaviano
A Sunny Plumbing, License # CFC 1427249
Sworn to (or affirmed) a d'subscribed before me this 10th day of April, 2019
Per n own
j RE
State o/ Florida
in
n GG 131884
Public TNtary 2021
CC. Maria Fuentes for 9801 Park LLC
lry
Miami Vil-lage
hores
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to uwner — 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
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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this l0 day of _A, _,20 17.
By Mkifq 5 who is personally known to me or has produced
as identification.
ANAYS LAGO
Notary: :° • �•��` Notary Public . State of Florida
Commission * GG 246553
SEAL: '? or ry My Comm. Expires Oct 26, 2022
Bonded through National Notary Assn.