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DS-19-395Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: DS-02-19-395 Permit Type: Driveways/Sidewalks/Slabs Work Classification: Addition/Alteration Permit Status: Approved Issue Date:05/02/2019 I Expiration: 10/29/2019 Location Address Parcel Number 102 NE 107TH ST, Miami Shores, FL 33161 1121360070240 Contacts JAMES MILLS Owner LELACK CONSTRUCTION Contractor MICHAEL LELACK 11515 ne 6th ave, Biscayne park, FL 33161 Business: 9542637120 Inspection Description: CONCRETE DRIVEWAY WITH SQUARE DESIGN Valuation: $ 600.00 Inspection Requests: 4949 Total Sq Feet: 1,100.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 Concrete/asphalt/pavers, slabs, dways, $100.00 swalks DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.20 Planning and Zoning Review Fee $35.00 Scanning Fee $9.00 Technology Fee $3.75 Total: $202.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $202.80 Check # 5235 05/02/2019 $202.80 Amount Due: $0.00 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. Ina cepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits ar req ired for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNE AFFID VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulati g construc'on and zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date May 02, 2019 Page 2 of 2 Miami Shores Village v0\ i\101V\ BUILDING 1i PERMIT APPLICATION 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 0 BUILDING ❑ ELECTRIC ❑ ROOFING \FEB 2 0 019 B FBC 20 A Master Permit No. — Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 102 NE 107 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2136-0070240 Is the Building Historically Designated: Yes NO Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: 102 NE 107 STREET City: MIAMI SHORES Tenant/Lessee Name: N/A Email: MJLELACK@LELACK.COM JAMES T. MILLS Phone#: (954) 263-7120 State: FL CONTRACTOR: Company Name: LELACK CONSTRUCTION Address: 6574 NORTH STATE ROAD 7 #220 city: COCONUT CREEK Qualifier Name: MICHAEL LELACK Phone#: (954) 263-7120 State Certification or Registration #: CGC1514048 Certificate of Competency #: N/A DESIGNER: Architect/Engineer: N/A Phone#: N/A Address: N/A City: State: Zip: Value of Work for this Permit: $ 6000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: CONCRETE DRIVEWAY WITH SQUARE DESIGN hone#: N/A 33161 State: Specify color o�lor hru tile: Submittal Fee Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) FLORIDA one#: (954) 263-7120 Zio: 33073 CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ S00 TOTAL FEE NOW DUE $ !�-� ' -Bnndir*'ompany's Name (if applicable) . 'ironding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 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. o, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be apkrovan a reinspection fee will be charged. Signatu ER or AGENT The foregoing instrument was acknowledged before me this S day oft h `' ` !L `� 20 t by IO-e5 ) M r 11 S who is personally known to me or who has produced �:_lc%; 7 cl `t T )7 as identification and who did take an oath. Signatu The foregoing ins ent was acknowledged before me this 1,341 day of 20 / `I by n Lchazc Le t Q do who is personally known to me or who has produced PC .D `c"' S f;..(CQn 3-*L identification and who did take an oath. as NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 'l S f "�, G(,P Seal: Seal: -—. �,r r^� Notary Public Stale of Ronda ,?o!S"•r °P' KYLE C HAMBRICK Louis Gabriel Machado " MY COMMISSION # GG066511 M Commission GG 279150 a EXPIRES January 26, 2021 an Expires 11/26I202 �?gvri,•` ry ######### APPROVED BY �YI Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Lelack Construction 6574 N State Rd. 7 #160 icifollelacl..c01 it CGC1514048 rnrnnt & r'rPPk Fi License and Insured 954-263-7120 November 20', 2018 Project: James T Mills Alphonso F Martin 102 NE 1071' Street Miami Shores, FL 33161 Proposal #07181306 We are pleased to present this proposal to provide our contracting services for the below referenced project. Our services and fees will be as follows: scope of work (Concrete driveway with sayare design) • Demo and remove existing concrete, asphalt, grass and debris. • Excavate and grade to the right elevation. • Lelack Construction to supply and install two 1 '/21' pvc pipe under the driveway as sleeves for future electrical and sprinklers line. • Concrete to be 3000 psi with fiber -mesh 6" thick and 6" in the swale area. o Form, pour and finished new concrete. o Expansion cuts and Pressure washes with 48 hours. © Remove debris and tape off effective areas. • Gravel or turf are not included. except permit fee, survey and pest control. • All labor, materials, equipment's and coupons--- The total cost for the work described above is based on a site visit. The total estimate is $6,000.00. After permit approval, our estimated construction time is approximately 10 working days. Please note that permit will be paid by owner. payment agreement: 3No deposit to be upon signed agreement, 40% after excavation and form, 30% upon completion. A`c r idyl ed, bV DATE PATE Page -o 1 "TNE ?RESSURE'S ON US..." Miami shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant,JOY1'IC'S I M A S , does hereby attest that (Property owner) The attached survey, performed by I F1C)+'rCi ) �� I 1 / ► C- (Name of surveyor's company) For address; 10Z 0' , l(p I Performed on I L, q -S (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Furthp4AW6f say eth naught. P;Oerk% nbr Signature 1Toarr\es Mils Property Owner Print Name SWOR40 AND SUBSCRIBED before me this day of Affiant is personally known to me, _produced Ch ITD as identification. �.►=1,,,;/E7p Public State of Florida 1 ,Gabriel Machado mmission GG 279150 Notarys 11/28l2022 Revised on 5122/2009/ Revised on 6/12ro9 LA Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 rmouce to VWner — VVorKerS" �ompensavon 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: l . 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 subcon actors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on our project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance erage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BEL W O ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. i � Signature: 1 ner State of Florida \1 County of Miami -Dade The foregoing was acknowledge before me this day of t-f ►D, % 20 I-_ By .J/. ;f1 e who is personally known to me or has produced as identification. Notary "- Notary Public State of Florida SEAL: Louis Gabriel Machado c. • My Commission GG 279150 a� Expires 11/26/2022 LELACK CONSTRUCTION 6574 N STATE RD 7 #220 infonlelack.com CGC1514048 Coconut Creek, FL 33073 License and Insured 954-263-7120 Village of Miami Shores Building Department 10050 NE 2Id Avenue Miami Shores, FL 33138 Date: 05/01/19 State of: Florida County of: Miami- Dade Before me this day personally appeared MICHAEL LELACK who, being duly sworn, deposes and says: That he will be the only person working on this project located at: James Mill's Residence 102 NE 1071h Street Miami Shores, FL 33161 me this r day of 4b t32019 Personally known: OR Produced Identification: Type of Identification Produced: L U PuDYt State o► Fkuis Gab►iel Machado corrWAM9ior rJG 2T�1pires 11,26"OP2 fI . _ LOCATION SKETCH SCALE: 1" Id0 ' r'r + ,ASMI OZ t4W+ 107to 1, NAO �� -- U ic H H N Cy O M VL - I �7j r l� O Io FLOOD ZONE. .� —THIS IS A FLOOD 14AZAR 1� N COMMUNITY W1NE Wes-- K. PANEL No. l BASE FLOOD ELEV. NOTE: UNDERGROUg6), ENCROACHMiN I herttly certify that this sketch of survey belief as surveyed and platted under n%y 1 the 3ocla ofeaslonal Land Survi (e1(e no ea aS11 ; • srAepf nd Sh.9wn. 40rofessianal Land. Surveyor * 4 State of Florida (Not Wild Unless Imprinted With An A301e 5 70 0 0 0 V :...: TONE THIS IS NOT A FLOOD HAZAR13 ZONE SUFFIX; DATE OF FIRM: LOWEST FLOOR ELEV. ' HIG Aid. GRADE ,IF ANY, NOT LOCATED. C-�t&,e. �tlr11t� i / ) the above dewxibad property is true and oorreat� the best of my knowledge and Iction. I farther osrtify that -this survey, most the minimum requirements adopted by rs and the Florida Land Title Assoclatlon and also CH 21 HH4 EA. code. Thera j Notes: I. If sholrn, bearings are to an assumed meridian (by plot) Vora 2. If ahown,elevetions are referred N.G.Y. Datum 1929 3. This is a land survey. 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