WS-19-1006Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: WS-06-19-1006
Permit Type: Windows/Shutters
Classification: Window/Door Replacement
Permit Status: Approved
Issue Date.06/19/2019 1 Expiration: 12/16/2019
Location Address Parcel Number
1700 NE 105TH ST 514, Miami Shores, FL 33138 1122300500900
Contacts
CHRISTOPHER SWARTZ Owner
1700 N. E. 105 ST. #513
HABITAT GROUP INC Contractor
JOHN DUQUE
1119 NE 8 ST, HALLANDALDE, FL 33309
Business: 7862999903
Description: REPLACE 1 SUIDING GLASS DOOR AND 2 valuation: $ 5,993.07 Inspection Requests:
4949
WINDOWS
Total Sq Feet: 400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.20
Scanning Fee
$3.00
Technology Fee
$3.25
Windows/Shutters Fee
$80.00
Total:
$145.05
Payments
Date Paid Amt Paid
Total Fees
$145.05
Credit Card
05/07/2019 $50.00
Credit Card
06/19/2019 $95.05
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 a2g-7z-or y*ermore, I authorize the above named contractor to do the work stated.
/ Applicant / Contractor / Agent
Date
June 19, 2019 Page 2 of 2
Miami Shores Village
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
'EI
JUN 19 2019
}
FBC 20-1'1
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.jS-Os--n _tdC o
BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS (CHANGE OF ❑ CANCELLATION SHOP
!� CONTRACTOR DRAWINGS
JOB ADDRESS:
1100 a19 106 yr. . jl reC1 •
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1, � 1.. •bO" �J /' O - 04010 0 Is the Building Historically Designated: Yes NO ^
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 0MA"?64O + *.A)iA"2 Phone#: o - 300-11000
Address: 1100 P1E (0S W • �+
City: KI�% 5K*f4ep State: Zip: 33 %'oCb
Tenant/Lessee Name:
Email:
one#:
CONTRACTOR: Company Name: 06riorr &W? 1 #1G• Phone#:
Address:: l k� �t %^^ ��`e is 'fir' 2
City: NiAU-" State: � Zip:
Qualifier Name: V0*04 D00%.9 Phone#:
State Certification or Registration #: � �'.: J 13 Certificate of Competency#;,
• a 9. k
DESIGNER: Architect/Engineer: Phone#:
Address:
City:
Value of Work for this Permit: $ �L�� • D>� Square/Linear Footage of Work:
Zip:
Type of Work: ❑ ' Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of,Work: Z. W W'A&Vis , " 9>60-0-
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I S + OS
Bonding Company's Name (if applicable)
Bonding Company's Address
1 City
1.
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. • t
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT' IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERT�f'." I 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 on esi tnoted 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 lat'the job site
for the first inspection which occurs seven (7) days after the building permit istissued. In the bsence of such posted notice, the
inspection will not be approved.onad einspecti.00nn Jee will be charged. r
Signature
OWNER or AGE
The foregoing instrument was acknowledged before me this
day of x w 20, by
C*f%&W4fK h'' I&VAf , who is personally known to
me or who has produced 1"'— 1 as
identification and who did take an oath.
Y Pus" LAZARO ALVAREZ
NOTARY PUBLIC: ��;.••• c* MyCOMMISSION#FF946819
* PIRES: January 17.2020
OF f40 gpn 2 ded ThN Budgal Not2ry �'�
TF
Sign: M
Print:
Seal:
Signatu
CONT CTOR
M " .• � } i
The fQorregoin ' trume1nt'w`as acknowledged before me this
1y day of c1� j�►� T 20 , by
s
who is personally known to
me or who has produced fl, I D as
identification.and Who,did take an oath.
NOTARY PUBLIC: okYPLg,'F` LAZAROALVAREZ
* MY COMMISSION # FF 946879
* EXPIRES: January 17.2020
Sign:
9roFF� ,qC0 a goaded TIN 8ud9et Ndaq sor i
�A,,� /�-
Print: L 1" v A.,0i A4z—
Seal
::*�r**s**ss****r*aa****s****r�►*rs*s*•s*s*s***rs**ss***s•**r**r*s********�**r*r***r*r****r****r***r
APPROVED BY L Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
Habitat Group Inc
1118 NE 8 st
Hallandale, fl 33309
786-299-9903
6/18/2019
State of Florida
County of Dade
Before me this day personally appeared :10t*W bJN who, being duly sworn,
The a or she will be t e only person working on the project located at
170P i e 105 Vt #514 mi shores, FI 33138
Signature
Sworn to (or affirmed) and subccdbed before me this `� day ofy� Y .2019
By
Personally known
Or produced ID_
J�
Type of ID produced
ottY?�a��c LAZAROALVAREZ
* * MY COMMISSION 0 FF 90179
N� EXPIRES: January 17, 2020
9lFOF F���CJ Bonded TINU Budo "ry SWAM
PRINT, type or stamp name of notary
0
04
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 Yam) ACKN�OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. ,/
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
By t*M`?(0Mz%- 6 vikK7.,
1tday of
A414 , 20 1q
who is personally known to me or has produced
as identification.
Notary:
SEAL: �01Pup, (gZAROpLVAREZ
MY COMMISSION f« FF 946870,
dk a EXPIRES: January 17,2020
C IV E;L
- % Miami Shores Village MAY 0 7 2 19
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
FBC 2017 Ltr,l
BUILDING Master Permit No. uJ —oz-o- 441
PERMIT APPLICATION Sub Permit No. 3 -" OS- 11, - 6
<uILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
^ CONTRACTOR DRAWINGS
JOB ADDRESS: 11 0 0 a Vol- 1 05 4
City: Miami Shores County: Miami Dade Zip: 33139
Folio/Parcel#• 11" Zt30" 050 — Vq 0 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): CMH'K0 [ ACft► '30WZ Phone#:10,5- 300-,000
Address: I'10 a lJsGC I ID V7 -ST • *- 51 4-
City: KN Prm I ✓"CIA S State: r i— Zip: 33 t31&
Tenant/Lessee Name:
Email:
n e#:
CONTRACTOR: Company Name: Ga c5'L'o'ti-- Con34ucLa ii W Phone#: 1(B(o
Address: $�q'� %! w �_0%I S 30S- 3CO '-7000
City: ✓A t A-" State: FS— Zip:
Qualifier Name: C..-L-* Phone#:
State Certification or Registration #: GAG t5 t 9 LZO Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City:
n e#:
C-yq
Value of Work for this Permit: $ Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition
❑/Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 4. �jV t� �f•Xi �s �.'f DO� Z- 011�J O (>AJ 5
Specify color of color t ru tile:
Submittal Fee $ 1 .0 Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ q'S • 6-r-,
(Revised02/24/2014)
Of -
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
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 beposte'd a``t 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.
Signatu4
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2J'W day of � ,20 IlCt
GA "400Pft-44- ��"Rrho' ersonally know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
S n: • • ��
Print: y
Signature
r
CONTRACTO
The foregoing instrument was acknowledged before me this
Z« day onf '�� 20 1' 7 by
who i ersonally known t
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: o1►RrP4e LAZNROALVAREZ Seal: MY COMMISSION
? ; ••.•�k+ * * MY COMMISSION S FF M79
MY COMMISSION # FF 046879
. # --'It
„ EXPIRES: January 11, 2020
�„ oe EXPIRES: Jam ary 17, 2020 �r�o so dw ThN �t �y s-tes
9,F ,l Bor" Thru Budget Services f
„
OFFS
APPROVED BY (J� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
GoGloz Construction Co.
5545 sw 8 st.
Miami, FI 33134
786-447-8129
4/1/2019
State of Florida
County of Dade
Before me this day personally appeared &L-OtuR 'l*-Hl PV.Z who, being duly sworn,
The he or she will be the only person working on the project located at
1700 ne 105 st #514 Miami shores, FI 33138
Coritractor Signature
Sworn to (or affirmed) and subscribed before me this 1'517- day of P^L .2019
By GVe'ut A. 'P.A-ft J A4 -U-
Personally known
Or produced ID
Type of ID produced
PRINT, type or Mary
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 co rage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BEEN YOU/ KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. // _
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
day of N
,20 V-)
By 0-4411141PT0'%1A1 wGz - 15&-16+472— who is rsonally known t e or has produced
identification.
Notary:
SEAL: * ' o* Commission # FF 946879
Expires January 17, 2020
��OFFLOP�C Bond�dibtu9Ydp«M�f'�