Loading...
EL-19-1394Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 278 NE 103RD ST, Miami Shores, FL 33138 rnntartc Permit NO.: EL-06-19-1394 �Permit Type: Bectrical - Residential ,. L' work Classification: Addition/Alteration Permit Status: Approved Issue Date: 07/12/2019 1 Expiration: 01/08/2020 Parcel Number 1132060134860 HB Growth Properties LLLP Owner 278 103 KLEAN POWER ELECTRIC INC Contractor GUILLERMO ALONSO 6601 SW 80 ST, MIAMI, FL 33143 Description: GARAGE CONVERSION INTO LIVING AREA. Valuation: $ 8,200.00 Inspection Requests: KITCHEN & BATHROOMS REMODELING 305-762-4949 TotalSq Feet: 600.00 Fees Payments Date Paid Amt Paid jAmount 50% Renewal Fee Total Fees $143.50 Credit Card 07/12/2019 $143.50 Total: Amount Due: $0.00 Building Del:(a ment Copy In consideration of the is ante 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 ermit 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 above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date July 12, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village KECL -0 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 �1 FBC 201'1 Master Permit No. l Sub Permit No. L—CLO —q " 139A BUILDING ❑E ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL F—IPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHA WE OF CANCELLATION ❑ SHOP CONI'R1kCTOR DRAWINGS JOB ADDRESS: 278 NE 103 St City: Miami Shores County: Mie 1m-Dade Zip: 33138 Folio/Parcel#:11-3206-013-4860 Is the Buildh ?WistoricallyDesignated: Yes NO x Occupancy Type: Load: Construction Type: F)od Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): HB Growth Properties LLLP Phone#: 954-774-4616 Address: 17071 W Dixie Hwy City. N Miami Beach State: FL Zip: 33160 Tenant/Lessee Name: na Email: azorapropertymgt@gmail.com CONTRACTOR: Company Name: Address: 45 101 5u City Phone#: Phone#: 9& `,COL 07,6 L Zip: 121t; Il f Qualifier Name: PrI[QUh7 (9l)(110'V1ti'47 *V (oW Phone#: _ State Certification or Registration #: r-G( 5a?wb6 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: _ Address: City: State: Value of Work for this Permit: $e 2-Cq2 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: @v@N1WeA@Wk 6kmj, , ter, oc t- ►,, L)4ly v kA N Specify color of color thru tile: Zip: ❑ Demolition Submittal Fee $ Permit Fee $ — - CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ _ TOTAL FEE NOW DUE $ % ► 3 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) na Mortgage Lender's Address City State 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. 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. Signature ��iii • • 1 The foregoing instrument t),,as acknowledged before me this NOTARY PUBL' Sign: " Print: Signature ,Z CONTRACTOR The foregoing instrument was acknowledged before me this day of � MU O1 v 20 , by ,, («'A4J I who is peVsonally known to me or who has pr uce it as K identification and a%0 E INE PIN EIRA_ ON # 079431 NOTARY PUBLIC: a s 21 In urance Sign: Print: Seal: Seal: *******r*****�****s***********s**********r*************•*rtt*******�***s*rs********s************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. -00, State of Florida County of Miami -Dade The foreg g was acknowle ge before this day of , 20. By w o is personally kn wn to me or has produced Notary SEAL ORK2N1 n tst Bute mum" on. 04/02/2019 State of Miami Dade Miami Shores Building Department Before me this day appeared, Alonso Guillermo who being duly sworn, deposes and say: That he will be the only person working on the project locates at 278 Ne 103 St. /eanPower Electric Inc Guillermo Alonso