RC-17-818Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FGORtDA
Permit No. RC--17-818
M Permit Type: Residential Construction
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 817/2017 1 Expiration: 02/0312018
Project Aoaress Parcel Number Applicant
351 NE 105 Street 1122310130290
Miami Shores, FL Block: Lot: JERRY AND SARAH ENGEL
Owner Information
JERRY AND SARAH ENGEL
Address
351 NE 105 Street
MIAMI SHORES FL 33138-
351 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
EDDIE CONTRACTOR CORP (786)986-4676
proved: In Review
mments:
to Approved:: In Review
to Denied:
)e of Construction: NEW KITCHEN CABINETS SAME L
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Fees Due
Amount
Bond Type - Contractors Bond
$500.00
CCF
$35.40
CO/CC Fee
$50.00
DBPR Fee
$26.33
DCA Fee
$26.33
Education Surcharge
$11.80
Permit Fee
$1,755.00
Scanning Fee
$9.00
Technology Fee
$47.20
Total:
$2,461.06
Cell
Valuation: $ 58,500.00
Total Sq Feet: 600
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info: NEW KITCHEN CABINETS SAME LP
Classification: Residential
Pay Date Pay Type Amt Paid Amt Due
Invoice # RC-3-17-63447
08/07/2017 Credit Card $ 2,411.06 $ 60.00
03/24/2017 Credit Card $ 50.00 $ 0.00
Bond #: 3472
Ava iaoie
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss Insp
Foundation
Window and Door Buck
Fill Cells Columns
Wire Lathe
Columns
Review Mechanical
Review Electrical
Review Electrical
Review Electrical
F. Termite Letter
F. Elevation Certificate
Review Planning
Review Building
Review Building
Review Plumbing
Declaration of Use
Review Structural
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 th egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. FuthoRhore_t,
i9affiorize the above -named contractor to do the work stated.
August 07, 2017
Buil g C
August 07, 2017
na re: Owner / Applicant / Contractor / Agent
partment Copy
1
I'1
Eddie Contractor ;,6*
V.
State of Florida, Miami Dade
Miami Shores Village
10050 NE 2"d Avenue
Miami Shores
RE.: Contractor Affidavit
Before me this day personally appeared EDELSO LAVADO who, being duly sworn, deposes and
say:
That he or she will be the only person working on this project located at:
Property: 351 NE 105st — Miami Shores, FL 33138
Contractor Signatu
np
Sworn to (or affirmed) and subscribed before me this day of s/� � . 201
Personally Know Q
OR Produced Identification
Type of Identification Produced
PHY4P
sp+hL
Notary PubMC Ststs of Flo "
Jorge Ortlgosa
My commission FF 952774
EXPires 02/07/2020
T
3470 NW 183`d St. Miami Gardens - 33056 — Florida
Phone: 888.640.7030 / Fax: 888.516.0587
Nob:eto OWnet —
KIam'I''Sho're!§'ViII89P,_,.
Building- Department.
,10050 KE.2nd Avenue
Miami Shores, Florida 33938'
Tel: (305) 796.2204
Faz: (305) 756;8072
on-l'Insurancte ExemI
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. ');la. Si ..`§ 440.05•
allows corporate officers in the construction industry to exemptthemselves from this reguiretnentIfor any construction project prior to.
obtaining a building permit. Pursuantto the Florida Division of Workers' Compensation'Employer Facts'Brochuret
An employer in the construction industry who employs one or more part-time or _full-time
employees, including the owner, ibustobtain•Workers'' compensation coverage. Corpofate officers
or members of a limited liability company, (LLC) in, the construction ;industry may elect to be
exempt if -
I. The officer owns.at lea'st 10.percent:oftht 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 asp an officer of the corporation in the' records •of,the. Florida.:
Department of State, Division of Corporations; and
3. The corporation is registered and lisfed as acffve with the"Florida Department of
State, Division of Corporations.
No more than three corporate -officers Oct corporation or limited liaability company members are
allowed to'`be exempt. Construction' exemptions are valid"for a' period' of two years or until a
voluntary revocation is: flied or the exemption is revoked by"the Division.
Your contractor is requesting a permit underthis workers' compensation exemption and has acknowledge.that he or'she�will -not,use;
day labor, part-time employees or subcontractors f6r your project,:The contractor has provided an affidavit stating that he or she.will
be the only person allowed to Work onsyour project. In these circurtistances, Ivliami Shores.village does not require verification of
workers' aornpeusation,insurance.covera'ge from the contractor's, comparry.'for day- labor, partAime, employees or subcontractors,
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU .HAVE `READ TH1tS NOTICE AND UNDERSTAND ATS`
CONTENTS.
Signature:
O r
State of Florida
County of Miami -Dade
The forego�,wis acknowledgebeforevefhis-day of ' 20,e�t.
to me or has .produced
who
as identfcation.,
Notary: 'C
SEAL:
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