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BUILDING
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Miami Shores Village �uN 9 019
Building Department Bx:11 .
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No.ac ob- I " I 5
PERMIT APPL CATION
❑ BUILDING ELECTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
t MVI
DRAWINGS
JOB ADDRESS: 01 �& Al E- aA Ve ""'�!' 1 l 1 ` — 01-1 `1LOA
City: Miami Shores County: Miami Dade zip: 3 > 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Gu 40Y' 1 62 3 kl F AAW L CCS Phone#:
Address: �",PfV A;) W % V�, Ste1e.V-f
City: A-4 itt-q 'k lzp— State: rL Zip:.3-36) Al
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _G6 IJXK ,��@t""rc� C0�01c.-6,r" [Le Phone#: Y4'4 SII 3S �14'
Address: / 1 y O-- lj' x) �� a'vXY--
City: 9(AA4Q'Clew
/ _ /State: FC zip: 330 /f
Qualifier Name: (� / L ew el --e- )I f &-h-A Phone#: l u 7 f/ 1 3 RV
State Certification or Registration M 4F (Z i 300 S Lrl Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City:
• O
ne#:
State: Zip:
Value of Work for this Permit: $ V-Jv Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration r El New Q Repair/Replace El Demolition
Description of Work: A -P (d �x i 'I r� �'l C� d1���¢,� WA 1 n s'%,f- YVA a OO %gy p
Specify color. of color thru tile: -
Submittal Fee $'"` Pe"'emit Fee $``L''�0i ea -n- CCF $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ( -4 • 90
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
.i
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 acid zoning.-
"WARNING
oning._
"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 whicoccurs seven (7_Jays after the building permit is issued. In the absence of such posted notice, the
inspection will not I approv� and a rei ection fee will be charged.
Signatu
The foregoing instru
1S +JA day of_
me or who has produced
Elk or AGENT
acknowledged before me this
.)tom 20 n by
who is personally known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
� day of cl 0 20 / 9 by
64%, 6,"� J!�� - / c'V� , who is personally known to
me or who has produced as
identification and who did_Uke an oath.
NOTARY PUBLIC:
Sign: -4 Sign:
Print: �(- QA, C:" e-0 Print:
Seal: Nasty PuSeal:
Public stats a Fbrsds
Les" CWM
�c a Mfr CMANisfon GG 1957
aw�' E>�aa OdH92020
****** * ***********************
� lT
APPROVED BY �/� �� G� Plans Examiner
Structural Review
(Revised02/24/2014)
J
MY COMMISSION # GG 252892
EXPIRES. September 1, 2022
Bonded Thru Notary Public Underwriters
*******************************
Zoning
Clerk
2019 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT
DOCUMENT# L12000146623
Entity Name: GATOR 9723 NE 2ND AVE, LLC
Current Principal Place of Business:
7850 NW 146TH STREET., 4TH FLOOR
MIAMI LAKES. FL 33016
Current Mailing Address:
7850 NW 146TH STREET., 4TH FLOOR
MIAMI LAKES, FL 33016 US
FEI Number: 80-0869819
Name and Address of Current Registered Agent:
GOLDSMITH, JAMES A
7850 NW 146TH STREET., 4TH FLOOR
MIAMI LAKES, FL 33016 US
FILED
Mar 12, 2019
Secretary of State
9577639707CC
Certificate of Status Desired: No
The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent Date
Authorized Person(s) Detail
Title MGR
Name GOLDSMITH, JAMES A
Address 7850 NW 146TH STREET., 4TH FLOOR
City -State -Zip: MIAMI LAKES FL 33016
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and
that my name appears above, or on an attachment with all other like empowered.
SIGNATURE: JAMES A GOLDSMITH MGR 03/12/2019
Electronic Signature of Signing Authorized Person(s) Detail Date
Property Search Application - Miami -Dade County Page 1 of 1
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-3206-013-4210
Property Address:
9723 NE 2 AVE
Miami Shores, FL 33138-2408
Owner
GATOR 9723 NE 2ND AVE LLC
Mailing Address
7850 NW 146 ST. 4TH FLOOR
MIAMI LAKES, FL 33016 USA
PA Primary Zone
6400 COMMERCIAL - CENTRAL
Primary Land Use
1111 STORE: RETAIL OUTLET
Beds / Baths / Half
0/0/0
Floors
1
Living Units
0
Actual Area
Sq. Ft
Living Area
Sq.Ft
Adjusted Area
9,459 Sq.Ft
Lot Size
12,350 Sq.Ft
Year Built
1948
Assessment Information
Year
2019
2018
2017
Land Value
$321,100
$297,018
$321,100
Building Value
$357,252
$355,320
$357,252
XF Value
$26,535
$0
$27,225
Market Value
$704,887
$652,338
$705,577
Assessed Value
$704,887
$652,338
$659,749
Benefits Information
Benefit
Type
2019
2018
2017
Non -Homestead Cap
Assessment Reduction
$0
$0
$45,828
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 10 & 11 BLK 31
LOT SIZE 95.000 X 130
OR 17437-1378 1196 4 (2)
Generated On : 6/19/2019
Taxable Value Information
Previous
2019
2018
2017
County
Exemption Value
$0
$0
$0
Taxable Value
$704,887
$652,338
$659,749
School Board
Exemption Value
$0
$0
$0
Taxable Value
$704,887
$652,338
$705,577
City
Exemption Value
$0
$0
$0
Taxable Value
$704,887
$652,338
$659,749
Regional
Exemption Value
$0
$0
$0
Taxable Value
$704,887
$652,338
$659,749
Sales Information
Previous
OR Book -
Price
Description
Sale
PageQualification
28412-
Transfer where the sale price is verified
12/14/2012
$594,800
2519
to be part of a package or bulk sale.
17437-
Sales which are disqualified as a result of
11/01/1996
$0
1378
examination of the deed
13904-
Sales which are disqualified as a result of
11/01/1988
$0
2796
examination of the deed
13720-
06/01/1988
$340,000
Sales which are qualified
2640
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
https://www8.miamidade.gov/Apps/PA/propertysearch/ 6/19/2019
C
Notice to Owner — Workers' Com
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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. I -
Signature:
Gu-br R1a3 N6 a •Cane } Sww's Jt, �k1s„�:�►t�• iirrustzr'
State of Florida C�JJ
County of Miami -Dade V
The foregoing was acknowledge before me this 9,4*i'day of J V&A- , 20kc�.
By who is.�lly known to me or has produced
as identification.
Notary:
SEAL: AO Nteary Pubk stag a (trio
TIV t.etslye Chirino
BGG 1357,
GOLDEN ELECTRICAL CONTRACTOR, LLC
a 19407 NW 82 CT. MIAMI, FL. 33015
954-512-3848 glaubertregaladojr@gmail.com
AZT
r
#ter
6/25/2019
State of Florida
County of Miami Dade
Before me this day personally appeared Glaubert Regalado Jr. who being duly sworn
depose and says from Golden Electric Contractor, LLC.
That he will be the only person working on the project located at 9723 NE 2 ave, Miami
Shores, Fl.
Contractor Signature
Sworn to (or affirmed and subscribed before me this _25_ day of mune , 2019
Personally know ✓ or Produced Id
Notary Public State 0f Florida
Print, Type or stamp of Notary Lesiye cnirino
My Commission GG 1357
LIf)%Expires 0611 2020