FW-19-2066Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: FW -0-19-2066
Permit Type: Ferrce/Wall
Work Classification. Wood Fence
Permit Status: Approved
Issue Date: 09/17/2419 Expiration: 03/16/2020
Parcel Number
10816 NW 2ND AVE, Miami Shores, FL 33168 1121360020160
Contacts
FLOYD MARTINEZ Owner SOUTH FLORIDA FABRICATION AND Contractor
10816 2 AVE, MIAMI SHORES, FL 33168 FENCING INC
Other: 2023094959 ANTONIO IGLESIAS
Business: 3052335333
Description: WOOD FENCE Valuation: $ 7,200.00Ins ection Requests:
T
305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.80
DBPR Fee
$4.13
DCA Fee
$2.75
Education Surcharge
$1.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$6.88
Wire and Wood Fence Fee
$225.00
Total:
$339.16
Payments
Date Paid Amt Paid
Total Fees
$339.16
Check # 3570
09/05/2019 $50.00
Check # 3571
09/17/2019 $289.16
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 AFFI AVIT: I cert' hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating c uction and g. Fut rmore, I authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent Date
September.17, 2019 Page 2 of 2
a
Miami Shores Village RECEIVED
Building Department SEP 0 5 1019
/ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tei: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20tr1 �
BUILDING Master Permit No. FVq
PERMIT APPLICATION sub Permit No.
BUILDING (� ELECTRK ❑ROOFING ❑ REVISION ❑EXTENSION [—]RENEWAL
]PLUMBING ❑ MECHANICAL QPUBLIC WORKS ❑ CHANGE OF [] CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10816 NW 2 AVE.
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#; 11-2136-002-0160 Is the Building Historically Designated: Yes NO.
Occupancy Type: load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): FLOYD A MARTINEZ Phone#;
Address: 10816 NW 2 AVE
City MIAMI SHORES State: FL
Tenant/Lessee Name: Phoned:
Email:
33138
CONTRACTOR: Company Name: SOUTH FLORIDA FABRICATION AND FENCING phone#: 305-233-5333
Address: 6989 SW 125 ST.
City: PINCREST State: FL Zip: 33156
Qualifier Name: ANTONIO I IGLESIAS phone#: 305-710-4512
State Certification or Registration #: Certificate of Competency #: 13BS00086
DESIGNER: Architect/Engineer: phone#:
Address: _ _. .. ~� City _ ,.. �_... _...... 47::
zip:
Value of Work for this Perm' : $ 1 2� cZ uare%linear Footage of�7
Type of Work: ❑ Additi ❑ Alteration iNew ❑ Repair/Replace
Description of Work: WOOD
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF 5 CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 2-�n .(
(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
Zi
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.
Signatureil�
OWNER or AGENT
The foregoing instrument wa3 cknowledged before me this
— day of u 20 by
rl dtl Aak who is personally known to
me or who has produced as
identification and who�did take an opthl--\
NOTARY PUBLI
Signature ----~ -
CONTRACTOR
The foregoing instrument was acknowledged before
me this
day of SF� 20) 1 by
/CIfT XYNII IS 4� who is personally known to
me or who has produced r - Z Ivd-� as
identification and who did take an oath.
NOTARY PUBLIC:
•MY
.IGLESIAS,, v %nom �, U'
Sign: •. Sign: . cn?
N 0,
Print: o` EXP.NES:May30,2020 Print:
OF Fvo waa F• Se �a"a
Seal:
"•.'%a� S
APPROVED BY / Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
"till 171 H NAIN
if�b[H
08/29/2019
State of: State of Florida
County of: Miami Dade
Before me this day personally appeared 4;x7inko .1a I c.L ho, being sworn, deposes and says:
That he or she will be the only person working on the project locate at: t ®t 1(, A2 -(IJ 2 �.
Sworn to (affirmed) and subscribed before me thislCLday of U d1 , 20 S ,by
Personally know
Or Produced Identification
Type of Identification Produced
f&"%0-, -f Le+-�e —
Print, type or Stamp Name of Notary
MA(BI PEREZ
*; MY COMMISSION # GG 232887
;•a. :a�: EXPIRES: June 27, 2022
''FdF w„?."•' eonM Thal NotM Pubric UMerwrkm
6989 SW 125 St PINECREST, FL. 33155 M PH 305-233-5333 FAX., 9-305-359-5997
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
s _ - Y
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 �' ` day ofy 20 1.
'
By__ O _& � _�who is personally known to me or has produced
') as identification.
Notary. ecy-b�
SEAL: M#131 PEREZ
ap` ° MY COMMISSION # GG 232887
EXPIRES. Jima 27,2022
•��rt0►��l.• �Qb 1tIN N(N�Y