RF-19-1646� _ Rf
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Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 07/22/2029
Parcel Number
280 NE 95TH ST, Miami Shores, FL 33138 1132060133710
Contacts
Permit No.: RF -07 -19 -IMS
Permit Type:
Work Classi affon: Repalr..Roof
Permit Status: Approved
Expiration: 01/20/2020
ARIANNA RIVERO Owner THREE BROTHERS ROOFING CORP Contractor
110 SW 12 ST 1607, MIAMI, FL 33130 LUIS ROCA
570 91 ST, MIAMI, FL 33150
Business: 3053704088
Description: REMOVE AND REPLACE APROX 45 BROKEN TILES Valuation: $ 750.00 Inspection Recuests: ^^f^^
THROUGHOUT THE ROOF. 305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$3.75
DCA Fee
$2.50
Education Surcharge
$0.20
Roofing Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$6.25
Total:
$122.30
Payments
Date Paid Amt Paid
Total Fees
$122.30
Credit Card
07/22/2019 $122.30
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 construction and zoning. Futhermore, I authorize the abc)ve name"ontractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor Agent
Date
July 22, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
BUILDING 7 ELECTRIC
Miami Shores Village
Building Department
JUL
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC20n?-r-01�j�
Master Permit No. ——� l
ROOFING
Sub Permit No.
REVISION F-] EXTENSION [-] RENEWAL
PLUMBING F-] MECHANICAL PUBLIC WORKS F_� CHANGE OF 0 CANCELLATION [:] SHOP
/�j
CONTRACTOR DRAWINGS
p
JOB ADDRESS: Do /V c--.:," /
M
Folio/Parcel#: It " 37-06 - 0 13 - 32 10 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): i r'1Qilf� U�I�►,�i� Phone#: 303 202
Address: ;;_� 3 0 & Qj ` +1 -
city: ("' r j
Tenant/Lessee Name:
State
EL Zip: 3 3 13 a
Phone#:
CONTRACTOR: Company Name: 16re(. SmlLers RaQfin4 Coro Phone#: (3o0370- yDsK
Address: 5 --in N W ql ST
City: MI CUM j State: EL Zip: 33/90
Qualifier Name:
N.
ne#:
State Certification or Registration #: CCG II Certificate of Competency #: _
DESIGNER: Architect/Engineer: I N ZA Phone#: _
Address: N / A City: 'N % A State:
Value of Work for this Permit: $ 7L 5-o . 06 Square/Linear Footage of Work:
N/A
/ Zip: /
Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition
Description of Work: RGrhoof, and re ola re, a L�DroX1 rhh^1 .I,y 4S brO kt4-1
7 � L I �� � � l e. s 1t f-15 4� o(A �.4_ m0 f .
Specify color of color thru tile: P.r_Gc%
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Z L ` �1)
Bonding Company's Name (if applicable) N /A
Bonding Company's Address N JA _
City / State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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 occ 0Sr
ven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved anspection fee will be charged.
Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 / i by
fL j?rLy:s Gtc��yS E who is personally known to
me or who has produced Ari yad W Ogi ✓gra as
X/&6 -000 -7y -84S -//E o9-zs-zoLl
identification and who did �ake an ath.
BLIC: "—" HENRY ALBERTO
State of Flo ' -Notary PuYI
=* •' om i n GG 192842
-,+ m ion Expires
Print:
Seal
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
L day of \T4 /V 20 If , by
A -a-144 �iio�,.+ , who is personally known to
me or who has produced Lars IQ . ,&,0- as
identification and who did take an oath.
NOT
Pri
HENRY ALBERTO
State of Florida -Notary Public
Commission # GG 182842
My Commission Expires
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) M5 0 1 (pl D—
Miami shores Village
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 txemwion
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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 BELO)Y_�OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this / 7 day of Y. ly , 20
By i% r r cE nna Lei yr, -0> who is personally known to me or has produced
as identification.
HFNFiyALBERTO
4,= id
State of Flora -Notary Public
* *c Commission N GG 182842
';teaMy Commission Expires
'p�III0, February 05, 2022
July 15, 2019
State of Florida
Miami -Dade County
THREE BROTHERS ROOFING
CORP.
570 NW 91St STREET
Miami, FL 33150
CCC1330211
Before me this day personally appeared Walter Barrientos who, being duly sworn, deposes and
says:
That he will be the only person working on the project located at:
280 NE 95th ST
Miami Shores, Fk-} 3138
Contractor Signature
Sworn to (or affirmed) and subscribed before me this 17 day of 3N /y 20 /21
by VVirl-ler
Personally knowA
OR Produced Identification
Type of Identificon P duced
HENRY ALBERTO
;State of Florida -Notary Public
=' Commission M GG 1 OTS32
My Commission Expires
February 05, 2022
of Notary
Florida Building Code 6th Edition (2017)
High -Velocity Hurricane Zone Uniform Permit Application Form
Section A (General Information)
I c�
Master Permit Number Process Number
�r+ 9
Contractor's Name Three. Bj-ot4e�5 �ootl ►')4 Cor P
Job Address 2460 N6 CIS'
ST
ROOF CATEGORY
❑ Low Slope ❑ Mechanically Fastened Tile
❑ Asphalt Shingles ❑ Metal Panels/Shingles
Is there an existing Roof Top Solar System? (- Yes (0 No
Are there gas vents on the roof? (' Yes No
ROOF TYPE
ffrmortar/Adhesive Set Tile
❑ Wood Shingles/Shakes
. . 6666
6666..
Will it be reinstalled{ (: Yes..G` No
. •
696.00 .6
6666..
Type? ❑ NatdfdP E LPGX
;0�••;
6666
6666..
6666 .
6666.
❑.New Roof Repair Maintenance Reroofing • • RbtoverincJ. 6690 6 • •
ROOF SYSTEM ROOF INFORMATION •
6666..
. 6666..
Low Slope Roof Area (ft2) ZI Steep Slope Roof Area (f2) Tbtal'(ft2) . •'� •
TTS
Section B (Roof Plan)
Sketch the Roof Plan: Illustrate all levels and sections, roof drain, scuppers, overflow scuppers and overflow drains.
Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and locations of parapets.
123 01-48 4/19 PAGE 2
s^T TO CON"PLI, ;CE VJ', I H
ALL FEDERAL
j111�1T' %N�
SECTION 1524
HIGH VELOCITY HURRICANE ZONES - REQUIRED OWNERS NOTIFICATION FOR ROOFING
CONSIDERATIONS
1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with
the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402
itFn ....
govern the minimum requirements and standards of the industry for roofing system installsfions. Add�tionajly, khe..� •
following items should be addressed as part of the agreement between the owner anti;QBtractor. TM%Owner's • • .;
initial in the designated space indicates that the item has been explained. •
• • • •
2. Renailing wood decks: When replacing roofing, the existing Mod R*f declt Mai 4ave to
be renailed in accordance with the current provisions of Section R4403. (ThErPooleeck is usually'
concealed prior to removing the existing roof system). ;";'; •.
. . . . ......
......
4. Gelling: Exposed, open beam ceilings are where the underside of tL;9* *decking •*—Exposed
can be viewed from below. The owner may wish to maintain the architectural appearance; therefore,
roofing nail penetration of the underside of the decking may not be acceptable. This provides the option of
maintaining the appearance.
6• /V ---Overflow scuppers (wail outlets): It is required that rainwater flows off so that the roof is
not overloa d from a buildup of water. Perimeter/edge wall or other roof extension may block this
discharg if erflow scuppers (wall outlets) are not provided. it may be necessary to install overflow
scu sin accordance with the requirements of Sections R4402, R4403 and R4413.
/1� � (ol,'20
Owner/Agent's Signature to Contracto i nature Date
290 NE -9s- s -r
Property Address Permit Number
Revised on 7/9/2009 LD;07/01/2015;