RC-19-449Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
N-�
Issue Datet'03/26/2019
Parcel Number
124 NW 95TH ST, Miami Shores, FL 33150 1131010330610
Contacts
Permit NO.: RC-02 -194 49
Perm, it Type: Building (Residential)
Work classification., Alteration
Permit Status: Approved
Expiration: 08/27/2019
Anissa Andrews Owner
124 NW 95 ST
ECOBUILD PROFESSIONAL LLC Contractor
DOUGLAS WILSON
655 7 AVE N, TIERRA VERDE, FL 33715
Business: 9543266195 dougwilson915@outlook.com
Inspection Requests:
Description: REMOVE AND REPLLINTHE
ALL CEILING IN Valuation: $ 450.00
BEDROOM #3 AND CLOSET INCLRM #3 IS LOCATED 3t15-742-4913
ON THE WEST END OF THE HOMNEWER ADDITION ,TotalSq Feet: 2,487.00
PAINT CEILING WALLS AND TRI
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$50.00
Scanning Fee
$9.00
Structural Review ($90)
$90.00
Technology Fee
$2.50
Total:
$211.30
Payments
Date Paid Amt Paid
Total Fees
$211.30
Credit Card
02/28/2019 $50.00
Credit Card
03/26/2019 $161.30
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.
AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
•onstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Signature: Owner
/ Applicant / Contractor / Agent
Date
March 26, 2019 Page 2 of 2
Miami Shores Village c I E
7
Building Department FEB 7 19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: WY'
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 200
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 124 NW 95th St.
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: 1131010330610 Is the Building Historically Designated: Yes NO X
Occupancy Type: Res. Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):Anissa D. Andrews Phone#:352-246-8171
Address:7867 Hampton Village Pass
City: Annandale State: VA Zip: 22003
Tenant/Lessee Name: N/A Phone#:
Email: Anissa77@aol.com
CONTRACTOR: Company Name: EcoBuild Professional Phone#: 954-326-6195
Address: 655 7th Ave N.
City: Tierra Verde State: FL Zip: 33715
Qualifier Name: Douglas W. Wilson Phone#: 954-326-6195
State Certification or Registration #: CGC1525892 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $2487.00 Square/Linear Footage of Work: 450 sq ft
Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition
Description of Work: Remove and replace drywall ceiling in bedroom #3 and closet included
Bdrm #3 is located on the west end of the home in the newer addition
Paint ceiling, walls and trim
Specify color of color `hru tile: j
Submittal Fee $ G� d Permit Fee $ CCF $ V • CO/CC $
Scanning Fee $ ) Radon Fee $ 2—DBPR $ �� Notary $
Technology Fee $ 2 'S� Training/Education Fee $ 0 . zo Double Fee $
Structural Reviews $ V Bond $
TOTAL FEE NOW DUE $ I t71 V
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
E.
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 Signature
OW or AGENT CONTRACTOR
The foregoing instrume as acknowledged before me this The foregoing instrument was acknowledged before me this
7 day of 1OfUCA 20 by �Th day of _116j(Umr 20 by
v4 ,�q 4 is ersonally known to 0 QS VV i�s6h ho is personally known to
me or who has produced V� (kd!f1A as me or w o has produced �rV�e✓ l i C`P11SJ as
identification who did toNOTARY PUBtn
C:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
identification R•rT�ho did
NOTARY PUDLIC:
Sign:
�
AV�Q
.� Print:
A" L'
Y PRIET
MY COMMISSION # FF 214031
Seal:
` 'y
AIL �.
yWW-- PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
EXPIRES: March 25, 2019
underwrWers
Thro rotary Pubbt 11 dersrr
t Plans Examiner
Zoning
,
"i
Structural Review
Clerk
► Pg1;f 011;nNAi
ECOBUILD PROFESSIONAL, LLC
655 7th Ave N
Tierra Verde, FL 33715
DATE:
STATEof
County of �c d-e--
Before me this day personally appeared D40u1 1 S � 141 L SeILI who,.
being duly sworn deposed and says:
F
That he or she will be the only person working on the project located at:
13 710
i
fF
t
Co or Signature
may,
Sworn to (or affirmed) and subscribed before me this 13 day of 20
by
Personally know
OR Produced IdentificationL1JL-
Type,gfAIdentification Produced
CYNTHIA GAYOT
Notary Public - Sfate of Florida
My Comm. Expires Aug 4, 2020
3
s
Notice to Owner = Workers' Com
WaMi :Shores Village -
Building iD.eparime' ,
10050 N.Elrnd Avenue
. Miami Shores, Florida 33138
- - Tel:,(305);795:2204 ,
'Fax:'( 758.8972'
ansatilon'Insurance:Exem• lion r
. • ..'Pt' . .
Florida Law requires Workers' 'Compensation insurance coverage under Chapter,440f of the.Florida Statutes.' Fla, 5tat`¢ 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:
k Z
An employer, `in the : construction industry who employs one or, more P pan dme -or full-time
employees, including the owner, must obtain workers"compensation coverage: Corporate off -jeers Y
or members of a limited liability comPany,(LLC)-iri thnstiuction industry',may,elect to be y
exempt -
1. The off cer owns at least 10 percent of the stock, of the corporation;`or n the case'of
an LLC,, a statement attesting to the minimum 10 percent ownership;
2..; The officer,is listed as an officer -of the:&rporation in the records of the Florida
Department of State, Division of Corporations; and r
3; ` The cofporation.is registered and listed_as'acai a _with 6e Florida' Departrnert•of, `
' State, Division`ofcorporations.
1 No more than'three Eorporate'officers per torporation-or limited liability,conipany members are
allowed•to tie exempt. 'Construction, exemptions' are °valid'for�a period of two years or until a e
�a voluntary revocation is filed or the exemption`is revoked by "the Division.-,`
Your contractor is requesting 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 projegt The contractor 1i" -- ' ded-an affidavit stating that he or she-wdl
be the only personallowed to work ' on your project. In these cir cumstances, Miami Shores Village does" not require veriSiation of
workers' compensation insurance coverage'from the contractor scompany for day'.labor; pait-time employees or snbwn iactors:
BY S1dNl G -.BEL6W YOU ACKNOWL'ED!l�, THAT, YOU' I AVE.f READ' THIS NOTICE :AND, UNDERSTAND., ITS
'CONTENTS. ai fi > -.♦ w f:i� - a.
Signature.
:. '� Y r •.tile
State ofFlorida4
County of Miami -Dade-
..
.,
-The for'�egoing was acknowledge before me this . 2Q � day of ' �T-1-4v rUn , 20
By. '-Ssa 1+-r1 c'►tiQ W S .who is personally known ^d me or has pioduced
as' identification.
Notary: YANADY PRIETO
' MY COMMISSION # FF 914031
SEAL: LQ b EXPIRES: March 25, 2019
' aonded Thru Notary Pubk Undewhfff ,
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ADD SMOKE/CARBON MONOXIDE DEACTNS.
ANY AND ALL,CLOTH AND RUBBER
INSULATED CONDOCTORS TO BE REPLACED
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