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PW-18-1627 (2)�sKO1S y� Miami Shores Village 10050 N.E. 2nd Avenue NE r «�, — Miami Shores, FL 33138-0000 yF�I `Phone: (305)795-2204 LORIDp Project Address 9801-9845 NE 2 Avenue Miami Shores, FL 33138 - Permit NO. PW -6-1$-1' 627 ■ Permit Type: Public Works ' Work Classification: Public Works Permit Status: APPROVED Issue nate: 7/6/2018 I Expiration: 10/04/2018 Parcel Number Applicant 1132060134380 PARK LLC Block: Lot: PARK LLC 4141 NE 2 Avenue MIAMI FL 33137- 4141 NE 2 Avenue MIAMI FL 33137- Contractor(s) Phone Cell Phone J.C. & ASSOCIATES GROUP, INC (305)253-8225 (305)742-3199 ning: 3 Fees Due Amount CCF $0.60 DBPR Fee $4.50 DCA Fee $3.00 Education Surcharge $0.20 Miscellaneous Fee $50.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $368.10 Phone Valuation: $ 750.00 Total Sq Feet: 300 Pay Date Pay Type Amt Paid Amt Due Invoice # PW -6-18-67922 07/06/2018 Check #: 20218 $ 318.10 $ 50.00 06/18/2018 Cash $ 50.00 $ 0.00 Avauaoie ins Inspection Type: Excavation Review Planning Review Public Works Final Public Works 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, ROOFIIIP and SPIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate qn� {fjat�glYwork will be done in compliance with all applicable laws regulating construction and zoning.Futhermore, I authorize the above-named contracto t �jf�%dtiork stated. Authorized Signature: Owner / Applicant / Building Department Copy July 06, 2018 nt July 06, 2018 1 _ RECEIVED .,.' Miami Shores Village JUN 13 2018 Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property j Property Permit#:ev'� - `� Name of Applicant (if utility see below): /9 0 P.�►- .1C, (� �� - Owner off the following described property: Legal Description: Lot /3 4 14, Block1:04- Subdivision �Pi77onJ I BoGlr-lo�7a Folio #; ! /• 32©lr • 013 •�P3Q>O Address: 61 01 - 139,¢5' IJE 2.dO.die.. MIA,") V14BZZ-E5 rl. 3313'1 UTILITY NAME: NA, Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration #: Certificate of Competency # 1 CONTRACTOR NAME: ✓G4 A-s*oL ld'7;icrJ 60rovP• LAIC, Qualifier/Authorized Agent: �Jt wlj C. lA60 Address: 7)4 1 ` /Z2 -j&- - City: M IAwym State: ZIP: 33 ) 93 Telephone: (_50s )74231'" Email: State Certification or Registration #: Certificate o Competency M Requests permission to install (describe work, attach separate page if necess ry) in the adjoining right of way: 12LDt)GE V?<1e'TaN r' PGD�JiSR-s oN R• D. W . 30 2ff-0xVC-_ . T.�Ro M.-TZ4f IW& F*W- Aopwo P Zonl/NYo PLE_ PZ • 4.260.18 •'?-S Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ 'Irrigation ❑ Landscape ❑ Antenna �q Other: P-,i51>VGE ij0e# E'1Z ! NM-4HINL P'3AVrias DESIGNER: Architect/Engineer: PV>L t?W15 - ,&� rrEg— •AlclA•- Address: ev vo • *-vim ?w I City: State: V(� ' ZIP: 33 f5t, Telephone: �� ?�fliEmail: �t.P.�i tit • Gdv� Registration #:..)S,2•C0107351 Value of Work for this Permit: $ Square/Lineal Footage of Work: Sob SF ***** Fees ***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ in - e Bonding Company's Name (if applicable): AJ ZA=. Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature A�Olicant or Authorized Agent The foregoing instrument acknowledg d before me thins �L—day of was 20'Z by p1,1 who is personally known to me or who has produced as identification. Signature _ C pany/ ility Agent The foreoing'instr e t was acknowlec 4 me this I 12- da of 2 is personally known to me or who has pr identification. Sign: Print: Print: SEAL: ,;>y; -- CAROLINA R. HERNANDEZ SEAL: °*. MY COMMISSION # FF 928131 o: EXPIRES: October 15, 2019 ; ;; °• Bonoad Th Notary Public Underwrtters before, 5, by as MY COMMISSION # FF 928131 EXPIRES: October 15: 2019 Bondd Thru Notary Public Underwriters -- ***** ************************************** APPROVED BY: Public Works Director, or Designee 2017-04-15 6/13/2018 Property Search Application - Miami -Dade County . , OFFICE Summary Report Property Information Benefit Folio: 11-3206-013-4380 Property Address: 9801 NE 2 AVE Miami Shores, FL 33138-2407 Owner 9801 PARK LLC Mailing Address 4141 NE 2 AVE # 204 A MIAMI, FL 33137 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 10,803 Sq.Ft Lot Size 13,000 Sq.Ft Year Built 1953 Assessment Information Benefit Type 2017 2016 2015 Non -Homestead Cap Year 2017 2016 2015 Land Value $338,000 $338,000 $286,000 Building Value $1,162,000 $463,449 $417,104 XF Value $0 $11,054 $11,090 Market Value $1,500,000 $812,503 $714,194 Assessed Value $1,500,000 $785,613 $714,194 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $26,890 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). IShort Legal Description I 11 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 13 & LOT 14 BILK 32 LOT SIZE 100.000 X 130 OR 15605-3244 0692 4 Generated On : 6/13/2018 Taxable Value Information 2017 2016 2015 County Price Book- Exemption Value Sale $0 $0 $0 Taxable Value $1,500,000 $785,613 $714,194 School Board 3022Qual by exam of deed Exemption Value 4364 $0 $0 $0 Taxable Value Sales which are disqualified as a result of $1 500,0001 $812,503 $714,194 City ... $1 09873- Exemption Value $0 $0 $0 Taxable Value $1,500,000 $785,613 $714,194 Regional Exemption Value $0 $0 $0 Taxable Value $1,500,000 :$:7=8561L3:$714,194 Sales Information Prev ious O R Price Book- Qualification Description Sale Page 08/17/2016 $1,750,000 3022Qual by exam of deed 4364 06/01/1992 $0 15605- Sales which are disqualified as a result of 3244 examination of the deed 11/01/1977 $1 09873- Sales which are disqualified as a result of 0684 1 examination of the deed 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 6/13/2018 Detail by Entity Name DTY;""tCri Department of State / Divisinn of Ca oratians / Search_Records / Detail By Dr.,r..urnent Number / Detail by Entity Name Florida Limited Liability Company 9801 PARK, LLC Filing Information Document Number L16000130646 FEI/EIN Number 81-3267935 Date Filed 07/11/2016 State FL Status ACTIVE Last Event LC DISSOCIATION MEM Event Date Filed 12/04/2017 Event Effective Date NONE Principal Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Mailing Address 4141 NE 2ND AVENUE 204-A MIAMI, FL 33137 Registered Agent Name & Address HOWARD B. NADEL, P.A. 301 W. HALLANDALE BEACH BLVD. HALLANDALE BEACH, FL 33009 Authorized Person(s) Detail Name & Address Title MGR CHEMTOV, SHAWN 4141 NE 2ND AVENUE, SUITE 204-A MIAMI, FL 33137 Title MGR Fuentes, Maria 10820 SW 200th Drive Miami, FL 33157 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetai I?i nqui rytype= EntityN am e&directionType= Initial&searchNam eOrder=9801 PARK%2OLl6.. 1/2 JC & ASSOCIATES GROUP INC. 7741 SW 122 AVE MIAMI FL 33183/ PHONE 305 742 3199 / jclago@pagroup.cc June 11th, 2018 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores FL. 33138 Property Owner: 9801 Park LLC Location: 9801-9845 NE 2nd Ave & 211-217 NE 98 St, Miami Shores FL. 33183 Folio: 113206 013 4380 SCOPE OF WORK: Permit for Planter reduction with pavers. PLANTER MODIFICATION: Reduce Planters on NE 2"d Ave at the above mentioned property as per plans submitted and approved in Zoning File # PZ4-26-18-28 Hearing date April 26th, 2018. Provide Pavers over compacted fill to match existing adjacent pavers. Protect the existing ground -cover planting and the Trees. Provide temporary barricade protection as required to keep work area safe at all times. Clean and restore area for completion. JC and Associates Group Inc. Certified General Contractor CGCO57500 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 on 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: 7M Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this le- day of 120 M By �i�1/1� C -C'�J %k --A who is personally known to me or has produced as identification. L:"'; >l •, CAROLINA R. HERNANDEZ MY COMMISSION # FF 928131 a r{ EXPIRES: October 15, 2019 JC & ASSOCIATES GROUP, INC. 7741 SW 122 Ave Miami FL. 33183 June 11 th, 2018 State of Florida, Miami Dade Miami Shores Village 10050 NE 2"d Avenue Miami Shores, FL 33138 RE: Contractor's Affidavit Property: 9801-9845 NE 2nd Ave, Miami Shores FL. 33138 Folio# 11-3206-013-4380 Owner: 9801 Park LLC 4141 NE 2"d Ave, #204A, Miami, FL 33137 Before me this day personally appeared Juan Carlos Lago who, been duly sworn, deposes and says: That he will be the only person working on the project located at: 9801-9 4 N 2nd Avenue Miami Shores FL. 33137 Juan Car Lago Contractor Signature JC& Associates Group. LLC License # CGC057500 Sworn to (or affirmed) and subscribed before me this 11th day of June, 2018 Persoll known RC1 bl is of ?� p!::°�a,. CAROLINA R. HERNANDEZ MY COMMISSION # FF 928131 EXPIRES: October 15, 2019 ..;;„;° Bonded Thru Notay Public Urdervrciters CC. Maria Fuentes Shawn Chemtov for 9801 Park LLC 10820 SW 200`h Drive Suite: Office Miami, FL 33157 305-253-8225 9 305-252-18 fax • 305-742-3199 eel 10050 N.E SECOND AVENUE MIAMI SHORES, FLORIDA 33138-2382 TELEPHONE. (305) 795-2207 TRAVIS HENDALL FAX F-051756-8972 Planning & Zoning Director DEVELOPMENT ORDER File Number: PZ -4-26-18-28 Property Address: 9801 NE 2"d Avenue Property Owner/Applicant: 9801 Park LLC Address: 9801 NE 2"d Avenue. Miami Shores. FL 33138 Agent: Julio and Juan Lago Address: 7741 SW 122"d Avenue, Miami, FL 33183 Whereas. the applicant 9801 Park LLC (Owner). has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Pursuant to Articles IV. V and VI of Appendix A Zoning. Sec. 400 Schedule of Regulations and Sec. 600. Site plan review and approval required. Whereas. a public hearing was held on April 26, 2018 and the Board. after having considered the application and after hearing testimony and reviewing the evidence entered. finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan. drawings. and the conditions agreed upon at the hearing: 1) Planning and Zoning Board zoning approval is granted as shown on the plans submitted and made a part of this approval for a site plan review of the outside planters. 2) Applicant to apply for and obtain all required building permits from the Building Department before beginning work. Pagel of2 VISIT US www.miamishoresvillage.com 3) Applicant to apply for and obtain all necessary permits and approvals from outside agencies before beginning work. 4) Applicant to obtain FDOH/MDEHS. MDDRER/EPRD and Fire approval as required. 5) Applicant to meet all applicable code provisions at the time of permitting. 6) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair. or if the work authorized by it is suspended or abandoned for a period of at least one (I ) year. 7) All signage shall be under a separate permit. 8) The applicant must obtain and provide a copy of the contract for valet senJces. 9) The applicant prior to placing any tables or chairs in the county right of way provide documentation showing the county approves of such use. 10) At all times continue to provide the minimum clearance of the sidewalk to comply with ADA standards. I I ) Move the table which is adjacent to the valet area. The application with conditions was passed and adopted this 26'h day of April, 2018 by the Planning and Zoning Board as follows: Motion to approve subject to Staffs recommendations with the addition to include that the material shall be permeable to ensure adequate drainage and irrigation for landscape feature subject to Public Works review by Mr. Snow. seconded by Mr. Brady and the vote was unanimous in favor of the Motion. Mr. Snow Yes Mr. Bergman Yes Ms. Hegedus Yes Mr. Brady Yes Chairman Busta Yes Date John Busta Chainnan. Planning Board Page 2 of 2