DS-19-2338N
Us 101PI-'
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Anh I 1 (1)
Permit NO.: DS-1 0-19-2338
Permit Type: Driveways/Sidewalks/Slabs
Work Classiflcation: Addition/Alteration
Permit status: Approved
issue Date:03/10/202o Expiration: 09/08/2020
Location Address Parcel Number
1311 NE 105TH ST, Miami Shores, FL 33138 1122320270050
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DAVID CARLISLE Owner
700 NE 90 ST, Miami Shores, FL 331382138
Business: 3052182999 david@davidinmiami.com
VICO CONTRACTORS INC Contractor
ANTONIO LYON
1825 PONCE DE LEON BLVD 561, CORAL GABLES, FL 33134
Business:3056998582 antonio.lyon@vicocontractors.com
Description: REMOVAL OF EXITING ASPHALT IN 9 PARKING Valuation: $ 7,432.15 inspection Requests:
SPACESINFRONT OF BUILDING. REPLACEMENT WITH 3000 PSI
CONCRETE AT 4" DEEP. REMOVAL AND REPLACEMENT OF 6 Total Sq Feet: 1,900.00
SIDEWALKS
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.80
Concrete/asphalt/pavers, slabs, dways,
$125.00
swalks
DBPR Fee
$2.63
DCA Fee
$2.00
Education Surcharge
$1.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$4.38
Total:
$234.41
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$234.41
Credit Card
10/03/2019 $50.00
Check # 1306
03/10/2020 $184.41
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. 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 9jthat all the fore ofuginf r ation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I aujhorie jhf above named contractor to do the work stated.
Authorized Signature: Owner / Applicant /
/ Agent
Date
March 10, 2020 Page 2 of 2
I�ul �� 10 °ilZo'1�1
<<
BUILDING
PERMIT APPLICATION
Miami Shores Village �CTJO3 zb1s
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
F BC 20
Master Permit No. !TSB' (b— (L( -'
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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JOB ADDRESS: !
v
City: Miami Shores
County: Miami Dade
7,
Zip: �'1 J
'—1
Folio/Parcel#: 1' — 223 Z — d Z 1
00 SD Is the Building Historically Designated: Yes NO _ Q
Occupancy Type: (k!L�7 Load:
Construction
Type: Flood Zone:
BFE: FFE:
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3 Gs 2 `K.� Zq Ci
OWNER: Name (Fee Simple Titleholder):
Phone#:
Address: J�� N�
(,0�*N
51
City: l `110ft1, Sh0le5
State: �l�
Zi : 3
Tenant/Lessee Name:
Phone#: zG%CV(
Email:
CONTRACTOR: Company.
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' 1 1�( t/�' l��
Phone#: EA) �1 Z
Name:
Address: A 2 J
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5
City: �i� S
State: 33V3
z�: � R
Qualifier Name: ffiV�CgN�o UV 1 Phone#: j
State Certification or Registration #: �C Z b Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State
Zip:
Value of Work for this Permit: $ l �Ll-1� Square/Linear Foot ge of work: 1906
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: ( a Of e dy 1 s 4 bA))A5
\U` `� 3060 V1k
Il
acmo CC gof_U U
Specify color of color thru tile:
Submittal Fee $ 1 Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $.
Double Fee $
Bond $ 1 G� . Cp
KJ TOTAL FEE NOW DUE $ 1 • 9/
684-'41
f
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
Zi
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 ature
NE rAGE CONTRACTOR
The foregoing instrument wa�s� acknowledged before me this
- day of ®c,j� f 20 by
I�YW A Cn►Ai4,\e who is personally known_ to
me or who has produced �C�u��P as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
7— day of 6`:i OVA 20 � J by
who is personally known to
me or who has produced 1ua /r as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print: h ,�'QZ. Print: \�Gr�c�J� MUir"Q-Z
NOTARY.PUBLIC Ramon Martinez
Seal: Seal: NOTARY.PUBLIC
a ESTATE OF FLORIDA -STATE OF FLORIDA
? Comm# FF950260 0 —
C 19�� Expires 111312020 wS Comm# FF950260
APPROVED BY /2-J/-Plans Examiner 1� Zoning
Structural Review Clerk
(Revised02/24/2014)
2355 Salzedo Street Coral Gables, FI 33134 Suite 204 A
(786)234-2739 info@vicocontractors.com
Date:
State of�(I�Gt
County of bad'
Before me this day personally appeared �W4L>v,,c, l-�l who, being duly
sworn, deposes and says:
The he or she will
jjb''ethe only jperson (working on the project( located at:
��ndY1C,V�fl-1�.�
Contractor signature
Sworn to (or affirmed) and subscribed before me this Zday of bZN,-Q r , of 2019
by�ti� L�Io r
Personally Know ✓�
Or produced ID
Type of ID Produced
L sys-n10-Sg-ve-o
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:
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.
State of
County of Miami -Dade
�d
The foregoing was acknowledge before me this- day of '�U�r 20_A_.
By�y kcl mar_ \ S�L who is personally-Iffiewn to me or has produced
'1 �5 as identification. Ramon Martinez
t r
NOTARY.PUBLIC
Notary: —STATE OF FLORIDA
y = Comm# FF950260
SEAL: ONCEr Expires 1/13/2020
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This property described as:
The West- 80 feet of Lot
Lot 4-A,� is577'
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71NC0 SUBDIVISION, ,;0
91
according to the Platy
thereof, as recorded ].I'1 yz�
Plat Book 53, Page 54
of the Public Records of 3. 57" X4�
Dade County, Florida. -- z �/ T- C
Note: Underground encroachments and z
utilities if any, not located. (= _ . o
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Carlisle, David L.,
PROPERTY OF: 131.1. ]? 1 5
Not valid unless embossed Miami Sr r _s j l� i
A BOUNDARY SURVEY L A N ' _ and,' G rA 1- 1 A, 1 N C.
with Surveyor's Seal. I hereby certify that the survey repre-
sented hereon meets the minimum ENGINEERS - LAND SURVEYORS - LAND PLANNERS
technical standards set forth by the
Board of Land Surveyors; pursuant to Office address: 359 Alcazar Avenue, Coral Gables, Florida 33134
Section 472.627, Fla. Sta{{�� tes. There are
noenyY achments,ovQflaps,easements
appp tl on the; rfat, other than as Mailing address: P.O. Box 561131, Miami, Florida 33156
sho' n. hqr to.
Fla. Reg. Lfnd jurveyor No. J? ' DATE SCALE 17RAWN BY DRW(;. NO
' � •'7/�ir/F Sly/!/f - ---- — --- _--- --121fi1
9-28-99 "Recertified", Name, Certified To and flood nforiat' n 108687
r4 revised, V-9oIr.-xz:,-, '112- v,>Pt0o • 71),1(6. ••,,....,_---..
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APPROVED_P,�_-_DATE altAT r'o CGhIPLIPTiCE WI FH ALL. FEDERAL
STATE ANv C(t UN i'e r3;.,L_cS A^,D REGULATIONS