EL-19-1951Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 09/09/2019
Location Address Parcel Number
113 NE 101ST ST, Miami Shores, FL 33138 1132060131910
Contacts
Permit NO.: Et -08-19-1951
Permit Type: Electrical - Residential
Work Classification. Solar
Permit Status: Approved
Expiration: 03/09/2020
DANIEL YEH Owner TOWER ELECTRIC OF PALM BEACH INC Contractor
JOEL CHAPEL
Business: 5617181816
Description: SOLAR PV ROOF MOUNTED Valuation: $ 25,854.00 Inspection Requests:
305 71-4 M7 I
Total Sq Feet: 0.00
Fees
Amount
CCF
$15.60
DBPR Fee
$13.57
DCA Fee
$9.05
Total:
$38.22
Payments
Date Paid Amt Paid
Total Fees
$38.22
Credit Card
09/09/2019 $38.22
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 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 conduction and zoning. FutDw dre,� authorlthe above named contractor to do the work stated.
Authorized Signature: Owner /' Applicant / Contractor / Agent Date
September 09, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
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
❑BUILDING M ELECTRIC ❑ ROOFING
REQEIVEID
A G 28A1,� 9
FBC 20 li::�_
Master Permit No. E - O" ! el -'9 !;1
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11.3 /1/0 .16 1 Sl_
Folio/Parcel#: 1 b / 3 - / y/O Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: N 61/ Flood Zone: BFE: FFE: _
OWNER: Name (Fee Simple Titleholder): �d ht 16 ]L4` I-1 Phone#:
Address: / 1-9 A5 IC S7-
City: M I A t4/ ,5140d a -S State: ri_ Zip: _ 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:�0� A L*4re%ce/ c QEr-8AW C4- Phone#:Siem~'7/�(^
Address: jayn3 so4SE7- pol a'r C C
1RLiF
City: (Al EL- LIt4Gn 6/State: (-L Zip:
Qualifier Name: c3`oELL�fI.Phone#: SZ/�-
State Certification or Registration #: e l nAD 3'Sdc, a Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:(( City: State: Zip:
Value of Work for this Permit: $ c1� � � i — Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: ,Rot) ff 1''f pl. NLrll Ip
Specify color of color thru tile:
Submittal Fee $ 0 Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ � 8 ' "72--
Radon
2
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
M
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.
Signature2
OWNER or AG NT
The foregoing instrument was acknowledged before me this
la day of 4Q(9 LLQ J 20 _ 1 by
—,D,4lJ1a, who is personally known to
me or who has produced —ML- as
Signature L4 -d--,
ONTRACTOR
The foregoing inst ment was acknowledged before me this
lA day of .4L4 GU ST 20 by
EL C,AA±—�WJL , who is OEREa y Hawn o
me or who has produced WL— as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
yer,,-r�-
,
Sign:�,/1
Sign:
Print:
Print:
ublic State of Florida
er PavlinekAlexander
Seal: =12/19/2020
SeaI:
o�onr PSB`
Notary Public State of Florida
Pavlinek
My Commission GG 035271
mission GG 035271
:,
��or
Expires 12/19!2020
2/19/2020
fvo°
3�
APPROVED Y
/ 'Plans Examiner
Zoning
A
OLA?
1 Structural Review
Clerk
(Revised02/24/2014) I (�
CFN: 20190447826 BOOK 31530 PAGE 1054
DATE:07/18/2019 01:14:27 PM
DEED DOC 6,810.00
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Prepared by:
Carlos A Gil, Esq.
Carlos A. Gil, P.A.
3910 W. Flagler Street Suite 100
Miami, FL 33134
305-443-2525
Return to:
Nadia Gavarrete
Settlement Department
80 SW 8`h Street, Suite 2000
Miami, FL 33130
[Space Above This Line For Recording Data]
135-000:: Warranty Deed
This Warranty Deed made this 28 day of June, 2019 between Gil J. Green, a single man and Deanna Marie
Elizabeth Hinckson f/k/a Deanna Green, a single woman, whose post office address is 10 10 1 East Bay Harbor Drive, Unit
604, Bay Harbor Islands, FL 33154, grantor, and Brooke A. Hensley and Daniel Dante Yeh, wife and husband, whose
post office address is 113 NE 101 Street, Miami, FL 33138, grantee:
(Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of
individuals, and the successors and assigns of corporations, trusts and trustees)
Witnesseth, that said grantor, for and in consideration of the sutra of TEN AND NO/ 100 DOLLARS ($10.00) and other
good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged,
has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, Grantors entire fee simple
interest in the following described land, situate, lying and being in Miami -Dade County, Florida to -wit:
Lots 15, 16, and 17, Block 14, of AMENDED PLAT OF MIAMI SHORES SECTION NO. 1,
according to the Plat thereof as recorded in Plat Book 10, Page 70, of the Public Records of Miami -
Dade County, Florida.
Parcel Identification Number: 11-3206-013-1910
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the
grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said
land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all
encumbrances, except taxes accruing subsequent to December 31, 2018.
In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written
State of Florida
County of Miami -Dade
r
CFN: 20190447826 BOOK 31530 PAGE 1055
(Seal)
.Gil . Gr n
f
(Seal)
Deanna Marie Eliz eth Hinckson f/k/a Deanna Green
The foregoing instrument was acknowledged before me this 28 day of
known or [X] has produced a driver's license as identification.
[Notary Seal]
RMIFNTO
COMb11SSi0N
# FF..P6823
EXPI,R_S; A,, ;127, 2020
�cnded Thru NOiary
Pub!ic Undery filers
State of Florida
County of Miami -Dade
Notary
Printed Name:
[j is personally
My Commission Expires: C) Z4 - Z-7 _ ZC)
The foregoing instrument was acknowledged before me this 28 day of June, 2019 by
Deanna Green, who L] is personally known or [X] has produced a driver's fi ense a
[Notary Seal] Notary Pub]
Printed Name:
gam; My Commission Expires
�— 7, b`� JENNIFER SARMIEN70
MY OOMMISSiON #1 FF 95682s
:* *- E-VIRES:A e,127,2020
0' Bonded 7hru Notary Pubic Undemmers
ina Marie li'zabeth Winckson f/k/a
ification.
04-Z7- 7,ZD
TOWER ELECTRIC OF PALM NEACH
12203 SUNSET POINT CIRCLE
WELLINGTON, FL 33414
(561) 718-1816
September 9, 2019
State of Florida
County of Broward
Before me this day personally appeared t1' e-41 Cko-o who, being duly
sworn, deposes and says:
That he will be the only person working on the project located at:
afee�
Confad Signature
Sworn to (or affirmed) and subscribed before me this day of f
, 20 1 � by_ —Ib,4 C C4_4. A e-�
R
Notary Public State of Florida
kfl
Alexander PavlinekMy commission b0 025211
Expires 12/19/2000
Personally know v
Or produced Identification
Type of Identification Produced
IP l J
Notary Public
Miami shores \
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
IVotICe to VWfler -- YYDf Kers- klompensayon insurance txemption
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 I.J.-C, a statement attesting to the minimum 1.0 percent ownership;
2. The officer is listed as an officer of the corporation irr 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.
13Y SIGNING BI -LOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND TTS
CONTENTS.
Signature:
Owner
State. of Florida
County of Miami -Dade
The foregoing was acknowledge before me this _J_____ day of Se 4 201q .
who is personally known to me or has produced
as identification.
Notary: AP10.1.4ooar Pyo4 Notary Public state of Florida
? ` ^ Alexander Pavlinek
y c' My Commission GG 035271
SEAL: +�OF o� Expires 12/19/2020