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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.