FW-18-3726Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 12/20/2018
Location Address Parcel Number
278 NE 103RD ST, Miami Shores, FL 33138 1132060134860
Contacts
Permit NO.: FW-12-18-3726
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: Approved
Expiration: 06/18/2019
HB GROWTH PROPERTIES LLLP Owner HABITAT GROUP INC Contractor
HB GROWTH PROPERTIES LLLP JOHN DUQUE
17071 W DIXIE HWY, NORHT MIAMI BEACH, FL 33160 1119 NE 8 ST, HALLANDALDE, FL 33309
Business: 7862999903
Inspection Requests:
Description: NEW WOOD FENCE TO REPLACE FW18-1386 Valuation: $ 3,000.00 305-762-4949
Total Scl Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
Planning and Zoning Review Fee
$35.00
Wire and Wood Fence Fee
$70.00
Total:
$155.00
Payments
Date Paid Amt Paid
Total Fees
$155.00
Credit Card
12/20/2018 $105.00
Credit Card
12/20/2018 $50.00
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 d in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In acc ting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are re uired ffinning.
TRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS FIDA�/ that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating c r}attbkct Futhermore, I authorize the above named contractor to do the work stated.
Authorized S�6a#EYOwner / Applicant / Contractor / Agent
December
Date
Page 2 of 2
CCSC)2�
Permit NO. WS-6-18-1675
Et Petmit Type: Windows/Shutters
r■ ■ ■' Work Classification: Door Replacement
Pennit Status: APPROVED
Issue Date: 6/29/2018 1 Expiration: 12/26/2018
mber Applicant
3280550
ALISON SPROUT
Lot:
Phone Cell
S-2103
�8-2103
l $ 11,696.97
Valuation:
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Window Door Attachment
Final
Review Building
Miami Shores Village RECEIVED
DEC 202018
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
FBC 2014t_
BUILDING
Master Permit No. I:v t� �V'"'
PERMIT APPLICATION
Sub Permit No.
OBUILDING ❑ ELECTRIC
❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 278 NE 103 St
City: Miami Shores
County: Miami Dade Zip: 33138
Folio/Parcel#:11-3206-013-4860
Is the Building Historically Designated: Yes NO x
Occupancy Type: Load:
Construction Type: Flood 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
Phone#:
Email: azorapropertymgt@gmail.com
CONTRACTOR: Company Name:
Address: 1
City:
Qualifier Name: J,�
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
'�;L
ne#: 1 D 0 — —4 LS! -51'
YD
_Zip:` 33-So N
�� ) e#: zon -19 n'S
ificate of Competency #:
City:
Phone#:
Zip:
Value of Work for this Permit: $ 3 0O0 Square/Linear Footage of Work: MI-4 0
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: complete work associated with '_FczyQ, as specified under expired permit #
TW - 5- I'a -13Q� C blaw Wood c Tom+,61OA
Specify color of color t ru tile:
Submittal Fee $ wl 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 $
(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
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 abVnce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature - _ Signature
OWNER or AGENT CONTRA TOR
The f egoing
instrument was acknowledged
before a this
The foregoing instrume
t was acknowledged before me this
d of 20 by
day of
20J by
C
,,Q i�
sQnally known to
who is p onally known to
me or who h
produced 1 pc
ll�i
me or who has pr
ced as
identificatio
an ho i a c
identification and
o oath.
NOTARY PU
KATHERINEPi HE
1^ My COMMISSION GG
431
NOTARY PUBLIC:
trxr�
off^ERINE IN HEI R4
OMMI SIO
,2
m S to I
urance
#
�dathrow 0 20 9 31
�
Sign:
Sign:
Is Sta Ins
Print:
Print:
f m
Seal:
Seal:
r0
APPROVED BY / Plans Examiner L Zoning
a Structural Review Clerk
(Revised02/24/2014)
HABITAT GROUP
DATE:12 /18 / 2018
STATE OF: Florida
COUNTY OF: Miami Dade
Before me this day personally appeared John Duque who, being duly sworn, deposes and says:
That he or she will be the only person working on the project located at:
278 NE 103 Street, Miami Shores, FL, 33138.
ractor Signature
Sworn to (or affirmed) and subscribed before me this 18 day of December 2018,
By John Duque.
Per
Or Produced
Type of Identificat�—
i
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.
Signature:
State of Florida
County of Miami- ade
The foregoing wa icknowledge
By
S
Bonded
Notary:
SEAL:
me thi day of , 204,_n X
is personally known to me or has produced